HomeMy WebLinkAbout06-26-06
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REV. 1500 EX (6-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
!z Wa ner Lee Ann
~ DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
~ 8/16/2005 4/1/1926
W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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OFFICIAL USE ONLY
FILE NUMBER
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COUNTY CODE
.-9~ 0859 _ _ _
YEAR NUMBER
SOCIAL SECURITY NUMBER
209-12-0765
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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o 2. Supplemental Return D 3. Remainder Retum (date of death prior to 12.13.82)
D 4a. Future Interest Compromise (date of death after 12-12-82) D 5. Federal Estate Tax Return Required
D 7. Decedent Maintained a Living Trust (Attach copy ofTrust} _ B. Total Number of Safe Deposit Boxes
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D 10. Spousal Poverty Credit (d.te of de.th between 12.3'.91 .nd '.'.95) D 11. Election totex under Sec. 91 '13(A)I Att"hSch c:t;~
Original Return
limited Estate
Decedent Died Testate (Attach copy of Will)
Litigation Proceeds Received
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Elaine C. Britt, Es ire
FIRM NAME (If Applicable)
Fox Rothschild LLP
TELEPHONE NUMBER
P.O. Box 5231
1. Real Estate (Schedule A)
(1)
Princeton, NJ 08543-5231
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'C(FFjCIAL USE ONL'r'~
609-896-3600
2. Stocks and Bonds (Schedule B)
(2)
3 Closely Held Corporation. Partnership or Sole-Proprietorship (3)
4, Mortgages & Notes Receivable (Schedule D) (4)
5 Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E) (5)
Z 6, Jointly Owned Property (Schedule F) (6)
0 o Separate Billing Requested
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:5 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
:::l (Schedule G or L)
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a.. B. Tolal Gross Assets (total Lines 1-7)
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W 9 Funeral Expenses & Administrative Costs (Schedule H) (9)
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10. Debts of Decedent, Mortgage Liabilities, & Liens (ScI\edule I) (10)
11. Total Deductions (total Lines 9 & 10)
12, Net Value of Estate (Line 8 minus Line 11)
13 Charitable and Governmental BequestslSec 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
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15. Amount of Line 14 taxable at the spousal tax
rate. or transfers under Sec. 9116 (a)(1.2)
0 x .0 ~(15)
0 x .0 45 (16)
70,862 x .12 (17)
0 x .15 (18)
(19)
16, Amount of Line 14 taxable at lineal rate
17. Amount of Une 14 taxable at sibling rate
18, Amount of Line 14 taxable at collateral rate
19 Tax Due
20,0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
3W4645 1,000
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65,447
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28,885
(8)
22,903
567
(11 )
(12)
(13)
(14)
94,332
23,470
70,862
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70,862
8,503
8,503
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Decedent's Complete Address:
SffiEET ADDRESS
CITY I STATE I ZIP
Carlisle PA 17013-
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
8,503
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7,600
400
Total Credits (A + B + C) (2)
8,000
3 Interest/Penalty if applicable
D. Interest
E. Penalty
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Total Interest/Penalty (0 + E) (3)
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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)
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5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
503
A. Enter the interest on the tax due. (SA)
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B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
503
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:. . . . . . . . . . . . . . . D [1g
b. retain the right to designate who shall use the property transferred or its income: . D []I
c. retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . . D [1g
d. receive the promise for life of either payments, benefits or care? . . . . . . . . . D []I
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . .. D []I
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? D [Jg
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. lXJ D
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN,
Under penalties of perjury, I declare that I have examined this retum, induding 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 informat'lon of which preparer has any knowledge
DATE
ADDRESS
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P.O. Box 5231, Princeton, NJ 08543
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
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ADDRESS
DATE
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P,O. Box 5231, Princeton, NJ 08543
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 thp ".0 _HL
[72PS.S9916(a)(1.1)(i)]. ~
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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
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets an<
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
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 Of for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in '.
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. S 9116(a)(1.3)]. A sibl
individual who has at least one parent in common with the decedent, whether by blood or adoption.
3W4646 1000
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REV-1502 EX + (6-98) SCHEDULE A
COMMONWEALTH OF PENNSYLVANIA REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Lee Ann B. Wagner 21 05 0859
All real property owned solely or as a tenant In common must be reported at fair market value. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property which Is jolntly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1 . None
DESCRIPTION
VALUE AT DATE
OF DEATH
3W4695 1 000
TOTAL (Also enter on line 1, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
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R EV-1503 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
Lee Ann B, Wagner
21 05 0859
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1. None
DESCRIPTION
VALUE AT DATE
OF DEATH
3W4696 1.000
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
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REV-1504 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
_IDE. ENT
ESTATE OF
SCHEDULE C
CLOSELY-HELD CORPORATION,
PARTNERSHIP OR SOLE-PROPRIETORSHIP
FILE NUMBER
Lee Ann B. Waqner 21050859
Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a
sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships.
ITEM
NUMBER
1 . None
DESCRIPTION
VALUE AT
DATE OF DEATH
3W4e971.000
TOTAL (Also enter on line 3. Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$
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REV-1507 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Lee Ann B. Waqner
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
FILE NUMBER
21 05 0859
All property jolntly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTlON
VALUE AT DATE
OF DEATH
None
TOTAL (Also enter on line 4, Recapitulation) $
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3W46AC 1.000
(If more space is needed, insert additional sheets of same size)
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REV-1S08 EX + (6-98)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
21 05 0859
ESTATE OF
Lee Ann B. Waqner
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
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1
2000 Ford Taurus station wagonr
estimated value
5,000
2
Carlisle Insurance Services,
refund on cancellation of auto
insurance policy
53
3
Carlisle Insurance Services,
refund on cancellation of
homeowners insurance policy
82
4
Comcast Cable, refund on
cancellation
15
5
Decedent was the lifetime
beneficiary of a Trust Under the
Will of her father, G. William
Wagner. Decedent's interest in
the trust ceased with her death.
All accrued and accumulated income
through the date of her death had
been paid to the decedent during
her lifetime.
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6
Decedent's personal property, sold
by Rowe's Auction Servcie. Value
is net sales price.
2,669
7
Harrisburg Symphony Orchestra,
refund of unused subcription
205
8
M&T Bank, Classic Checking Account
No. 884073
49,306
9
M&T Bank, Credit Card Account No.
4264 2973 1700 4328, credit
balance
3,778
10
M&T Bank, Savings Account No.
15004212114438
1,113
11
Sprint Nextel, refund on
cancellation
7
Total from continuation schedules
3,219
3W46AD 1.000
65,447
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
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Estate of: Lee Ann B. Wagner
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Schedule E (Page 2)
Item
No.
Description
12
Thornwald Nursing Home{ refund of
overpaid room and board
13
Time, Inc., refund on subsription
cancellation
14 United States Treasury, refund due
on decedent's 2005 income tax
return
15 Walnut Bottom Radiology{ refund
Total (Carry forward to main schedule)
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209-12-0765
Value at Date
of Death
2,938
21
139
121
3,219
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R EV-1509 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Lee Ann B. Wagner
SCHEDULE F
JOINTLY-OWNED PROPERTY
FILE NUMBER
21 05 0859
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINTTENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A.
B.
c.
JOINTL Y-OWNED PROPERTY:
lEfTER DATE a:SCRIPTlON OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AfIO BAN<. ACCQl..NT DATE OF DEATH DECO'S VALUE OF
N..MBER OR SIMILAR IDENTIFYING !'UMBER ATTACH DEED FOR
NUMBER TENANT JOINT ..k:)INTlY-ttiD REAL ESTAre VALUE OF ASSET INTEREST DECEDENTS INTEREST
1. A.
NonE
TOTAL (Also enter on line 6. Recapitulation) $ 0
(If more space is needed, insert additional sheets of the same size)
3W46AE 1.000
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REV-151O EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Lee Ann B. Waqner
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
21 05 0859
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 IN:l'...l:E Tl-E NAME OF nE TRANSFEREE. THEIR RELATIONSHIP TO DEceDENT ANj DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE
NUMBEF Tl-E DATE OFTRAf\GFER_ ATTACl-i A CQP'Y OF THE DEED FOR REAl ESTATE. VALUE OF ASSET INTEREST (IF .APPLICABLE) VALUE
1. TIAA Annuity Contract No.
IC82598-2 dated 8/1/88.
Contract provides for monthly
payments for life, with
guaranteed payments for 20
years. Beneficiary is Val R.
Wagner. 22,445 100.0000 0 22,445
2 TIAA Annuity Contract No.
IC83659-1 dated 9/1/88.
Contract provides for monthly
payments for life with
guaranteed payments for 20
years. Beneficiary is Val R.
Wagner. 6,440 100.0000 0 6,440
TOTAL (Also enter on line 7, Recapitulation) $ 28,885
(If more space is needed, insert additional sheets of the same size)
3W46AF 1 000
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REV.1511 EX + (12.99) SCHEDULE H
COMMON'NEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Lee Ann B. Wagner 21 05 0859
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
DESCRIPTION
A
FUNERAL EXPENSES:
1.
Hoffman-Roth Funeral Home, Inc.
funeral services
Total from continuation schedules
B.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
1.
Name of Personal Representative(s)
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
City
State
Zip
Year{s) Commission Paid:
2.
Attorney Fees
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
5 Accountant's Fees
6.
Tax Return Preparer's Fees
7.
1
Bank of America
check order fee
2 Estimated remaining administration
expenses
Total from continuation schedules
3W46AG 1.000
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$
AMOUNT
11,812
1,724
8,100
550
12
500
205
22,903
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Estate of: Lee Ann B. Wagner
209-12-0765
Schedule H Part 1 (Page 2)
Item
No.
Description
Amount
2
Valley Forge Memorial Gardens
monument
1,724
Total (Carry forward to main schedule)
1,724
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Estate of: Lee Ann B. Wagner
209-12-0765
Schedule H Part 7 (Page 2)
2
Register of Wills, Cumberland
County
probate fees
205
Total (Carry forward to main schedule)
205
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REV-1512 EX+ (12-03)
COMMONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Lee Ann B. Wagner
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FilE NUMBER
21 05 0859
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
Pennsylvania Department of Revenue
balance due on decedent's 2005
state income tax return
434
2
Pharmerica
balance due
18
3
PPL Electric Utilities
balance due
106
4
Sprint
balance due
9
3W46AH 2.000
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
567
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REV-1513 EX+ (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Lee Ann B. Wanner
FILE NUMBER
21 05 0859
1
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers
under Sec. 9116 (a) (1.2)]
Val R. Wagner
1010 East Avenue
P.O. Box E
Mantoloking, NJ 08738
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
AMOUNT OR SHARE
OF ESTATE
NUMBER
I
100% of Residue to Val R. Wagner
1010 East Avenue
P.O. Box E
Mantoloking, NJ08738: 70,862
Brother
70,862
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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
3W46AI 1.000
TOTAL OF PART" - 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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REGISTER OF WILLS
CUMBERLAND County, Pennsylvania
CERTIFICATE OF GRANT OF LETTERS
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No. 2005-00859 FA No. 21-05-0859
Es ta te Of: LEE ANN B WA GNER
(First. Middle. Last)
Late Of:
CARLISLE BOROUGH
CUMBERLAND COUNTY
i~,
Deceased
Social Securi ty No: 209-12-0765
WHEREAS, on the 27th day of September 2005 an instrument dated
February 23rd 1988 was admitted to probate as the last will of
LEE ANN B WAGNER
(Firsl. Middle. Lastl
la te of CARLISLE BOROUGH, CUMBERLAND County,
who died on the 16th day of August 2005 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 tha t I have this day granted Letters TESTAMENTARY to:
VAL R WAGNER
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 COURT HOUSE,
CARLISLE, PENNSYL VANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my offi ce on the 27th day of September 2005.
\BtulCU ~\.n W' l ~p~) 1~
eglster 0 II/S
9QA C6- _O~
eputy
* * NOTE * * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST)
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I, LEE ANN B. WAGNER, of Cumberland County,
Pennsylvania, make this will and revoke all prior wills and
codicils.
FIRST: Payment of Certain Expenses. The expenses of
my last illness, funeral, burial and gravemarker shall be paid
out of my estate.
SECOND: Tanqible Personal Property.
(A) I give my automobiles and all other tangible
personal property (and any insurance policies relating thereto)
to my brother, VAL R. WAGNER, if he survives me; or if he does
not, to his children who survive me, to be divided as they
shall agree, or in the absence of agreement, as my executor
shall deem appropriate. Any property not distributed by my
executor shall be sold and the proceeds added to the residue.
(B) The cost of delivering the property to the
residences of the beneficiaries shall be paid from my estate as
an expense of administration.
THIRD: Residue. I give the residue of my estate to
my brother, VAL R. WAGNER, if he survives me by thirty days;
or, if he does not so survive me, to his issue who so survive
me, per stirpes.
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FOURTH: Minor and Disabled Beneficiaries.
(A) Any property payable hereunder to a beneficiary
who is a minor, or who, in the opinion of my trustee, is
disabled because of illness, advanced age or other reason, may
be paid to or applied for the benefit of such beneficiary, to
the extent determined by my trustee, and the balance shall be
held by my trustee as a separate trust, with power to invest
and reinvest. said property and any income earned thereon
shall, to the extent deemed appropriate by my trustee, be paid
to such beneficiary or applied for his or her health,
education, support, maintenance, comfort or welfare. Any
income not so paid or applied shall be accumulated and added to
principal. Any funds to be applied hereunder either shall be
applied directly by my trustee or shall be paid to a parent of
such beneficiary or to any person or organization caring for
such beneficiary, and my trustee shall have no further respon-
sibility for any funds so applied or paid.
(B) If the administration of a separate trust is or
shall become impractical, the trust referred to in Paragraph
(A) may be distributed to the beneficiary or the person or
organization caring for the beneficiary or, in the case of a
minor, may be converted to cash and deposited in a savings
account, savings certificate, money market fund or similar
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interest bearing investment, payable to the beneficiary upon
attaining majority.
(C) The balance of principal and income in the
separate trust shall be paid to the beneficiary upon attaining
majority or in the case of a disabled beneficiary when, in the
opinion of my trustee, he or she is free of disability; in the
event of the death of the beneficiary the same shall be paid to
the beneficiary's personal representative.
FIFTH: Administrative Provisions.
(A) Death Taxes. All federal, state and other death
taxes payable because of my death on property included in my
gross estate for tax purposes, together with any interest and
penalties on such taxes, shall be paid out of the residue of my
estate at the times that my executor shall consider advisable.
(B) Protective Provision. No interest in income or
principal shall be assignable by, or available to anyone having
a claim against, a beneficiary before actual payment to the
beneficiary.
(C) Minority. For the purposes of my will a minor
shall be anyone under twenty-one years of age.
SIXTH: Discretionary Powers. My executor and
trustee, in addition to any authority conferred by law or
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before me
~-nd sworn
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4 ~-p( ~~ ~~L_
Lee Ann B. Wagner /
JbC.~
witL~/~
Subscribed, sworn to or affirmed and acknowledged
by LEE ANN B. WAGNER, the testatrix, and subscrfbed
to Rr affirmed before me by \j~"t-~ ~ ~d).~nd
S .0Q.JY\IU.A'-.9\ ' witnesses, this '7..---:7 day of
, 1988.
/~
ELOISE.oI.. KLlNGeS
Notary Public, Philo., Philo. eel
My Commission Expires Feh. 21. 1f8f
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I, G. WILLIAM WAGNER, of Delaware County, Pennsylvania,
make this will and revoke all prior wills and codicils.
FIRST: P<lyment of C'~l:tain Expenses. The expenses
of my last illness, funeral, burial and gravemarker shall be
paid out of my estate.
SECOND: Tangible Personal Proper!y.
(A) I give my automobiles and all other tangible
personal property (including any insurance policies relating
thereto) to my wife, MARJORIE C. WAGNER, if she survives me
by thirty days.
(B) If she does not so survive me, I give the
same to my children who so survive me, to be divided as they
shall agree. Any property not distributed to either child
shall be sold and the proceeds added to the residue.
(C) The cost of delivering the property to the
residences of the legatees shall be paid from my estate as
an expense of administ:ration.
THIRD: Marital Deduction Trust. If my wife,
MARJORIE C. WAGNER, survives me, which shall be presumed if
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the order of our deaths cannot be established by proof, I
give a sum e~lal to the lesser of (a) the maximum marital
deduction allowable for federal estate tax purposes and !b)
the minimum amount whic~l, ~fter taking into account all
credits and deductiors available to my estate for federal
estate tax purposes, will result in no tax, to my trustees
IN TRUST to keep it invested and thereafter:
(A) During my wife's lifetime, she shall be paid
the income at least quarter-annually together with so much
of the principal as my disinterested trustee may deem desirable
for her health, maintenance, support, comfort and welfare,
and so much of the principal as she shall from time to time
request in writing delivered to my trustees.
(B) On her death the principal shall be paid to
such person or persons (including her estate) in such manner
and for such estates as she may appoint by last will or
codicil thereto specifically referring to the power hereby
conferred.
(C) Should my wife fail in whole or in part
effectively to exercise the above power, there shall be paid
out of the principal not effectively appointed an amount
equal to any increase in taxes and administration expenses
payable by her estate because of the inclusion in her gross
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estate of the principal of this trust, such payments to be
made upon the certification of her personal representatives
of the sums due. The remaining balance of principal shall
<-hen he added to the principal of the residuary trust.
If any property not passing under this Article
qualifies for the marital deduction or any similar benefit
,
available under the federal estate tax law in force when I
die, the value of that property shall be taken into con-
sideration in determining the size of this .trust; provided
that no generation-skipping transfer of which I am the
deemed transferor shall be considered in det~rmining the
size of this trust. No property ineligible for the marital
deduction or any similar benefit shall be allocated to this
trust; no death taxes on my estate shall be paid from this
trust; any property distributed in kind to it shall be
distributed at the lower of (i) its value at the time of
distribution or (ii) either its value as finally determined
for federal estate tax purposes or, if it is acquired after
my death, its adjusted income tax basis; and, subject to the
foregoing, my disinterested executor shall have absolute
discretion in selecting the property to be allocated to this
trust, without any duty to make a ratable apportionment of
values. If any property which is part of this trust shall
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be or become unproductive of income consistent with its
value, my wife may require my trustees to make it productive
or convert it within a reasonable time to property which is
clearly productive of income consistent with its value.
FOURTH: Residuary Trust. I give the residue
of my estate to my trustees IN TRUST, who shall invest and
reinvest the principal, and hold the same as a separate
residuary trust and thereafter:
(A) If my wife, MARJORIE C. WAGNER, survives me,
during her lifetime my trustees shall:
(1) Pay to her the' net income at least
quarter-annually;
(2) Pay to or expend for her or my issue,
after taking into account funds available from other sources,
so much of the principal as my disinterested trustee may
from time to time deem appropriate for the health, maintenance,
support or education of my wife or any of my issue;
(3) Pay to her such amounts of principal as
she may request in writing, to the extent that at the time
of such written request the amount requested, together with
all amounts previously reques'ted by her under this paragraph
during that calendar year, does not exceed five thousand
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dollars ($5,000.) or five per cent (5%) of the value of the
principal as of the date of the receipt of such written
request, whichever is greater, such withdrawal right not to
accumulate from year to year.
(B) Upon the death of the survivor of my wife and
me, my trustees shall divide the then-remaining principal
into as many equal shares as there shall be children of mine
then living and children of mine then dead with issue then
living.
(1) From the share of each living child my
trustees shall:
(a) Pay to him or her the entire net
income at least quarter-annually;
(b) Pay to or expend for him or her or
his or her spouse or issue so much of the principal of his
or her share as my disinterested trustee, after taking into
account funds available from other sources, from time to
time may deem appropriate for the health, education, main-
tenance or support of said life tenant, spouse or issue;
(c) Pay to him or her such amounts of
principal as he or she may request ill writing, to the extent
that at the time of such written request the amount requested,
together with all amounts previously requested by him or her
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under this sub-paragraph during that calendar year, does not
exceed five thousand dollars ($5,000), such withdrawal right
not to accumulate from year to year;
(d) Upon each child's death (or at the
time of division into sepai'ate shares with respect to the
share of a child then deceased with issue then living) the
then-remaining principal of such child's share shall be paid
to his or her then-living issue, per stirpes; or in default
of such issue to my then-living issue, per stirpes, provided
that any principal payable to a grandchild of mine shall be
held by my trustees in further trust for such grandchild and
thereafter:
(i) From the share of each grandchild
of mine, my trustees shall pay to him or her the entire net
income and pay to or expend for him or her so much of the
principal of his or her share as my disinterested trustee,
after taking into account funds available from other sources,
from time to time may deem appropriate for his or her health,
education, maintenance or support. Each grandchild may be
written request to my trustees withdraw from the principal
of the share of the trust held for his or her benefit the
following: Up to one-half at any time after reaching twenty-
five (25) years of age and the entire balance thereof at any
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time after reaching thirty (30) years of age. The maximum
amount which a grandchild may withdraw before reaching
thirty (3D) years of age is to be based on the market value
of his or her trust at the time of his or her fjr~t ~equ~st
after re,lching twenty-five (25) yea:t.s of age.
(ii) Upon each grandchild's death, the
then-remaining principal of such grandchild's share shall be
paid to the then-living issue of such grandchild, per stirpes;
or if none, to that grandchild's parent's (who is a child of
mine) then-living issue, per stirpes; or if none, to my
then-living issue, per stirpes;
(2) If none of the beneficiaries identified
above in this Article are living at the time fixed for
distribution thereunder, the balance of principal shall be
paid one-half to those natural persons who would be my
heirs, and one-half to those natural persons who would be my
wife's heirs, under the Pennsylvania intestate laws, if I
and she had died residents therein at such time, unmarried,
without living parents and intestate.
(3) If any principal becomes payable under
subparagraphs (d) or (ii) above to a child or grandchild of
mine who has property held in trust under this Article, then
such principal shall be added to said trust.
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FIFTH: Minor and Disabled Beneficiaries.
(A) Any income or principal payable hereunder to
a beneficiary who is a minor, or payable under Article
FOURTH to a beneficiary who in the opinion of !,l} d: sir.tere~ted
truste~ is disabled because of. illness, advan~ed age or
other reason, may be paid to, or applied for the benefit of,
such beneficiary, to the extent determined by my disinterested
trustee and the balance shall be held by my trustees as a
separate trust, with power to invest and reinvest. Said
income and principal and any income earned thereon shall, to
the extent deemed appropriate by my disinterested trustee,
be paid to such beneficiary or applied for his or her health,
education, support, maintenance, comfort and welfare. Any
income not so paid or applied shall be accumulated and added
to principal. Any funds to be applied hereunder either
shall be applied directly by my trustees or shall be paid to
a parent of such beneficiary or to any person or organization
caring for such beneficiary and my trustees shall have 'no
further responsibility for any funds so paid.
(B) If the administration of a separate trust is
or shall become impractical, the trust referred to in para-
graph (A) may be distributed to the beneficiary or the
person or organization caring for the beneficiary or in the
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case of a minor the same may be converted to cash and deposited
in a savings account payable to the minor upon reaching
majority.
(C) The balance of pri'ilcip:~l 2Dll Llcome in the
separate trust shall De paid to :he minor upon reaching
majority or in the case of a disabled beneficiary when, in
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the opinion of my disinterested trustee, he or she is free
of disability; in the event of the death of the beneficiary
the same shall be paid to the beneficiary's personal represen-
tative.
SIXTH:
Administrative Provisions.
(A) Death Taxes.
All federal, state and other
death taxes payable because of my death on property included
in my gross estate for tax purposes, together with any
interest and penalties on such taxes, shall be paid out of
the principal of my residuary trust at the times that my
executors or trustees shall consider advisable.
{B} Protective Provision.
No interest in
income or principal shall be assignable by, or available to
anyone having a claim against, a beneficiary before actual
payment to the beneficiary.
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(C) Undistributed Income.
All income undistri-
buted at a beneficiary's death shall be treated as if it had
accrued thereafter.
(e) Minority. For the purposes of my will, a
minor shall be anyone under twenty-one years of age.
(E) Education. As used herein the term "education"
.,
shall be broadly construed and shall include, but not be
limited to, private preparatory school, college, vocational
school, graduate school and professional school.
(F) Adoption. As used herein, the words "child",
"children" or "issuell shall not include adopted individuals
or their issue.
(G) Rule Against Perpetuities Qualification
Clause. The principal of any trust hereunder shall vest
absolutely in interest not later than twenty-one (21) years
after the death of the survivor of myself, my wife, and such
of my issue and the spouses of my issue as are living at my
death, and immediately prior to the expiration of twenty-one
(21) years after the death of the survivor of the above
group the principal of each trust which has not previously
vested in interest shall vest absolutely in and become
payable to the person or persons then entitled to the income
therefrom.
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(H) Reimbursement of Beneficiary's Estate.
Except as provided in paragraph (C) of Article THIRD, any
increase in taxes or administration expenses payable by the
estate of a beneficiary hereunder because of the inclusion
in his or her gross estate of principal or income which he
or she was entitled to withdraw prior to his or her death
(which right terminated upon his or her death) shall be paid
out of such principal or income upon the certification of
his or her personal representatives of the sums due.
SEVENTH: Discretionary Powers. My executors
and trustees, in addition to any authority conferred by law
or elsewhere herein and without leave of court, shall have
the following discretionary powers with respect to all
property, until actual distribution thereof:
(A) To retain any' or all property, real or per-
sonal;
(B) To invest in all types of real or personal
property without restriction to so-called legal investments
and, sUbject to the provisions of paragraph (C) of Article
THIRD, to keep a reasonable amount of cash uninvested;
(C) To exercise any right or option arising from
ownership of any securities held hereunder and to register
the same in the name of a nominee;
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(D) To compromise any claims and to abandon any
property considered by my executors or trustees to be of
little or no value;
(E) To repair, alter, improve, partiti0n, div.:.de
or lease for any period of time, any real or personal property;
(F) To borrow money from any source without
personal liability therefor and to secure the repaying
thereof by note or bond and mortgage or pledge of real or
personal property;
(G) To sell any real or personal property at
public or private sale for such prices and upon such terms,
including the granting of options, as may be considered
proper;
(H) To apply directly for the benefit of my wife
all sums to which she is entitled from the marital deduction
trust if she is, in my disinterested trustee's opinion,
disabled by adv,anced age, illness or other cause;
(I) To distribute in kind and, except as provided
in paragraph (C) of Article THIRD, to allocate specific
assets among the beneficiaries (including any trust hereunder)
in such proportions as my executors or trustees may think
best, without regard to the income tax basis of any such
asset, so long as the total market value of any beneficiary's
share is not affected by such allocation;
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(J) To allocate any property received or charge
incurred to principal or income or partly to each, without
regard to any law defining principal and income; provided
that this authority. s~all not extend to the marital deduction
trust and that a~l decisions under this paragraph shall be
made by my di~interested executor or trustee alone;
(K) To use administrative or other expenses as
income tax or estate tax deductions and to value my estate
for tax purposes by any method permitted by the law in force
when I die, without regard to whether the size of the marital
deduction trust will be affected thereby and without requiring
adjustments between income and principal for any resulting
effect on income or estate taxes; provided that all decisions
under this paragraph shall be made by my disinterested
executor alone; and
(L) To employ such agents, custodians, attorneys,
accountants or investment counsel, and to rely on advice
given by such attorneys, accountants or investment counsel
as may be reasonably necessary or desirable in managing,
protecting and investing any property or trust funds, and to
pay them reasonable compensation therefor in addition to the
fees otherwise payable to my executors or trustees.
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EIGHTH:
Executors and Trustees. I appoint my
wife, MARJORIE C. WAGNER, and my son, VAL R. WAGNER, executors
of and trustees under this will, and I direct that:
(A) If my wife or my son for any reason fails to
qualify or ceases to act as an executor or trustee, fiLst my
daughter, LEE ANN B. WAGNER, and then my grandson, VAL X.H~
,
WAGNER, shall become an executor or trustee in that order;
(B) Any individual executor or trustee may resign
at any time without court approval;
(C) As used herein the words "disinterested
executor" and "disinterested trustee" shall refer to my
executor and trustee other than my wife and in the case of a
particular trustee my trustee who is not an income beneficiary
of such trust.
(D) No executor or trustee shall be required to
give bond.
Signed this
11th day of June , 1980.
/s/ G. William Wagner
G. William Wagner
SIGNED, PUBLISHED and DECLARED in our presence as his will
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by G. WILLIAM WAGNER, and we at his request, in his presence
and in the presence of each other, sign as witnesses.
/s/ Frank S. Deming Phila. , PA
witness Address
/s/ Harry C. Schaub philadelphia, PA
witness Address
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COMMONWEALTH OF PENNSYLVANIA
SSe
COUNTY OF PHILADELPHIA
I, G. WILLIAM WAGNER, the testator whose name is
signed to the attached or foregoing instrument, havin1 been
july qualified according to law, do hereby acknowledg~ that
I signed and exeL:uted the instrument as my last will; that I
signed it willingly; and that I signed it as my free and
voluntary act for the purposes therein expressed.
/s/ G. William Wagner
G. William Wagner
Sworn or affirmed to and acknowledged before me,
by G. WILLIAM WAGNER, the testator, this 11th
day of June , 1980.
/s/ Marianna C. Moore
Notary Public
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COMMONWEALTH OF PENNSYLVANIA
5S.
COUNTY OF
PHILADELPHIA
We, Frank S. Deming and
Harry C. Schaub ,the wj,tnl~Eser: who~~e names are signed
to the attached or foregoinc i115-crument, being duly qualified
according to law, do depose a.ld say that we were present and
saw testator sign and execute the instrument as his last
will; that he 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 ~s witnesses; and that to the best of our
knowledge the testator was at that time 18 or more years of
age, of sound mind and under no constraint or undue influence.
/s/ Frank S. Deming
witness
/s/ Harry C. Schaub
Witness
Sworn or affirmed to and subscribed to before me
by Frank S. Deming and Harry C. Schaub
wi tnesses, this 11th day of June , 1980.
/s/ Marianna C. Moore
Notary Public
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"I
to},
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TlAA Contract No: IC82598-2
CREF Certificate No: IC83659-1
LEE ANN B WAGNER, deceased
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"I 1'1- 1:1 Ii! =
A fixed income (contractual payment), plus dividends as declared, payable monthly
beginning as of 09/01/2005 and continuing through 07/2008.
$665.25
+
$770.24
Total Initial Payment
t
$1435.49 )( JJ":: S"tJ 'lI{~"
Contractual Payment
Current Dividend
=
The commuted value of the annuity installments was $22445.330n 08/0112005. The total
value actually payable in a single sum will be larger than this amount since interest will be
credited on this commuted value until payment is made. ;iI. ':a., y l.{ s' ~ '1
Your CREF Stock Income is a variable income payable monthly beginning as of 09/0112005
and continuing through 08/2008.
185.78
Current Value of
One Annuity Unit
$231.21
Total Initial Payment
Number of Annuity Units Per
Payment
x
=
$416.99 ><3'- -:: ~ If oll.,t
The commuted value of the annuity installments was $6439.730n 08/01/2005. The total value
actually payable in a single sum may be more or less than this amount, depending upon
CREF's interim investment experience. '~'!J." .,
$ :t *'- -f'~ .f. 0"
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TEACHERS INSURANCE AND ANNUITY ASSOCIATION
DATE OF MINIMUM
CONTRACT FIRST FREQUENCY GUARANTEED DATE OF
NUMBER PAYMENT OF PAYMENT PERIOD BIRTH
IC82598-2 08/01/88 Monthly 20 Years MO DA YR
ANNUITANT Lee Ann B Wagner 04/01/26
$665.25
ANNUITY
PAYMENT
DATE OF ISSUE
MO DA YR
08/01/88
'PROVISIONS
1. CONSIDERATION
THIS CONTRACT IS ISSUED IN EXCHANGE FOR THE SURRENDER TO TlAA OF CONTRACT
NUMBER(S):
A087597-9
PROCEEDS IN THE AMOUNT OF $164,961.31 ARE APPLIED TO THIS CONTRACT. THESE ACTS
FULFILL ALL THE OBLIGATIONS OF THE CONTRACT THAT HAS BEEN SURRENDERED.
THE CONSIDERATION FOR THIS CONTRACT HAS BEEN DELIVERED AT TlAA'S HOME OFFICE IN
NEW YORK, NEW YORK.
2. COMMUTED VALUE
THE COMMUTED (DISCOUNTED) VALUE IS A ONE-SUM AMOUNT PAID IN LIEU OF A SERIES OF
. PAYMENTS. IT IS LESS THAN THE TOTAL OF THOSE PAYMENTS, BECAUSE FUTURE INTEREST,
INCLUDED IN COMPUTING THE SERIES OF PAYMENTS, WILL NOT BE EARNED IF PAYMENT IS TO
BE MADE IN ONE SUM. THE COMMUTED VALUE OF FUTURE PAYMENTS IS THEREFORE THE SUM OF
THOSE PAYMENTS LESS THE INTEREST FROM THE DATE OF COMMUTATION TO THE DATE EACH
PAYMENT WOULD HAVE BEEN MADE. THE COMMUTED VALUE OF THE ANNUITY PAYMENT WILL BE
COMPUTED AT THE EFFECTIVE ANNUAL RATE OR RATES OF INTEREST SHOWN BELOW:
$637.94
$27.31
EFFECTIVE RATE
OF INTEREST
2.50%
2. 25 %
PART OF ANNUITY PAYMENT
902.9
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BENEFICIARY DESIGNATION (SEE PROVISION 2)
CLASS I BENEFICIARY(IES)
NAME
Val R. Wagner
RELATIONSHIP TO ANNUITANT
Brother
CLASS II BENEFICIARY(IES)
· NAME
Bonne M. Wagner
Val H. Wagner
RELATIONSHIP TO ANNUITANT
Niece
Nephew
00 RIGHT TO RECEIVE PRESENT VALUE OF ANNUITY PAYMENTS IN ONE SUM. AT THE
ANNUITANT'S DEATH, EACH BENEFICIARY SHALL HAVE THE RIGHT TO ELECT TO RECEIVE IN
ONE SUM THE THEN PRESENT VALUE OF THE SHARE OF ANY REMAINING UNPAID ANNUITY PAY-
MENTS APPORTIONED TO SUCH BENEFICIARY.
(THIS PROVISION IS APPLICABLE ONLY IF THE PRECEDING SPACE (_) IS MARKED WITH AN (X).)
( ) AUTOMATIC ONE-SUM PAYMENT OF PRESENT VALUE OF ANNUITY PAYMENTS. AT THE
ANNUITANT'S DEATH, THE PRESENT VALUE OF THE SHARE OF ANY REMAINING UNPAID ANNUITY
PAYMENTS APPORTIONED TO A BENEFICIARY SHALL BE PAID IN ONE SUM.
(THIS PROVISION IS APPLICABLE ONLY IF THE PRECEDING SPACE (_) IS MARKED WITH AN (X).)
902.9-1011.8
Page 5
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ADDITIONAL PROVISIONS
IT IS UNDERSTOOD AND AGREED THAT IF A TESTAMENTARY TRUSTEE OR AN INTER VIVOS TRUSTEE
IS DESIGNATED AS BENEFICIARY:
(A) TlAA SHALL NOT BE OBLIGED TO INQUIRE INTO THE TERMS OF ANY WILL OR
OF ANY TRUST AFFECTING THIS CONTRACT OR ITS DEATH BENEFITS AND SHALL NOT BE
CHARGED WITH KNOWLEDGE OF TERMS THEREOF.
(B) IF BENEFITS BECOME PAYABLE TO A TESTAMENTARY TRUSTEE AND (I) THE WILL IS
NOT PRESENTED FOR PROBATE WITHIN 90 DAYS FOLLOWING THE DATE OF THE ANNUITANT'S
DEATH; OR (II) THE WILL HAS BEEN PRESENTED FOR PROBATE WITHIN THE AFORESAID 90
DAYS AND NO QUALIFIED TRUSTEE MAKES CLAIM FOR THE BENEFITS WITHIN NINE MONTHS
AFTER THE ANNUITANT'S DEATH; OR (III) IF EVIDENCE SATISFACTORY TO TlAA IS FUR-
NISHED TIAA WITHIN SUCH NINE-MONTH PERIOD THAT NO TRUSTEE CAN QUALIFY TO RECEIVE
THE BENEFITS, PAYMENT SHALL BE MADE TO THE SUCCESSOR BENEFICIARY(IES) AS DESIG-
NATED ON THE REVERSE SIDE, IF ANY SUCH BENEFICIARY(IES) ARE DESIGNATED AND SUR-
VIVE THE ANNUITANT; OTHERWISE TO THE EXECUTORS OR ADMINISTRATORS OF THE ANNUITANT.
(C) IF BENEFITS BECOME PAYABLE TO AN INTER VIVOS TRUSTEE AND (I) THE TRUST
AGREEMENT IS NOT IN EFFECT; OR (II) NO TRUSTEE CAN QUALIFY TO RECEIVE THE BENE-
FITS; OR (III) THE QUALIFIED TRUSTEE IS NOT WILLING TO ACCEPT THE BENEFITS, PAY-
MENT SHALL BE MADE TO THE SUCCESSOR BENEFICIARY(IES) AS DESIGNATED ON THE REVERSE
SIDE, IF ANY SUCH BENEFICIARY(IES) ARE DESIGNATED AND SURVIVE THE ANNUITANT;
OTHERWISE TO THE EXECUTORS OR ADMINISTRATORS OF THE ANNUITANT.
(D) PAYMENT TO AND RECEIPT BY SAID TRUSTEE, SAID SUCCESSOR BENEFICIARY(IES)
OR SAID EXECUTORS OR ADMINISTRATORS OF THE ANNUITANT, AS PROVIDED FOR IN (B) OR
(C) ABOVE, SHALL FULLY DISCHARGE TIAA FROM ALL LIABILITY TO THE EXTENT OF SUCH
PAYMENT. TlAA SHALL HAVE NO OBLIGATIONS AS TO THE APPLICATION OF FUNDS SO PAID
AND SHALL, IN ALL DEALINGS WITH SAID TRUSTEE OR WITH SAID EXECUTORS OR ADMINIS-
TRATORS, INCLUDING BUT NOT LIMITED TO ANY CONSENT, RELEASE OR WAIVER OF INTEREST,
BE FULLY PROTECTED AGAINST THE CLAIMS OR DEMANDS OF ANY OTHER PERSON OR PERSONS.
902.9-1011.8
Page 6
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3. Annuity Payments. Your income begins as of the Date of First Payment if you are then alive. Payments
will continue to you for the rest of your life. If you die within the Minimum Guaranteed Period following the Date
of Issue, payments will be continued to the beneficiary for the remainder of that period. In lieu of payments due the
beneficiary, the Commuted Value of such payments may be paid to the beneficiary in one sum, unless otherwise
specified on Page 5. The Date of First Payment,' Minimum Guaranteed Period, Frequency of Payment and the
amount of each payment are shown on Page 3. Payments in addition to the amount shown on Page 3 may be made
by TIAA. TIAA does not guarantee that there will be such Additional Amounts.
If you outlive all beneficiaries but die within the Minimum Guaranteed Period, we will pay to your estate the
Commuted Value of any payments remaining due. If a beneficiary dies while entitled to receive payments, the
Commuted Value of any payments remaining due to him or her will be paid to the surviving person or persons
named to receive it. If no one so named is then living, the Commuted Value will be paid to the estate of such
beneficiary.
Payments are subject to the provisions of any method of payment agreement or any beneficiary designation in
effect under this contract.
4. Change of Frequency of Annuity Payments. You, or a beneficiary receiving payments, may request a
change to equivalent payments made annually, semi-annually, quarterly or monthly. However, TIAA may decline
to make a change from one frequency to another of fewer payments per year. TIAA will also have the right to
decline any change that would result in payments of less than $10 each.
5. Termination of Annuity Payments. The final payment to be made under this contract will be the last
payment due on or before the date of your death, unless you die within the Minimum Guaranteed Period. In that
case, the final payment will be the last payment due within that period.
6. Beneficiary. Beneficiaries are persons named, in form satisfactory to TIAA, to receive any payments
remaining due at your death. Different classes of beneficiaries, such as primary (first) and contingent (secondary),
may be oesignated. These classes set the order of payment. If a class contains more than one person, any payments
remaining due at your death will be paid to the then living persons in a class in equal shares, unless provided
otherwise. For example, if you die during the Minimum Guaranteed Period with your spouse having been named
as primary beneficiary and ':my children" as equal contingent beneficiaries, your spouse would receive any
payments remaining due upon surviving you. But if your spouse did not survive you, then your surviving children
would receive equal shares of any payments remaining due.
The term~ "children" or "my children" may be used to name a class of beneficiaries, either primary or
contingent. Unless otherwise specified, these terms will mean all children born of your marriage or marriages and
any children legally adopted by you. The term "children" also has the same inclusive meaning when used to name
as beneficiaries the children of your spouse, your child, your brother or your sister.
The beneficiary designation may be changed as exolained below, unless otherwise specified on Page 5.
7. Benefits Based on Incorrect Data. It payments are determined by data as to your age or sex that are
incorrect, the amount of payments will be recalculated based on the correct data. Any amounts underpaid by TIAA
on the basis of incorreet age or sex will be paid when the correction is made. Any amounts overpaid by TIAA on
the basis of incorrect age or sex will be charged against payments due after the correction is made. Any amounts
so paid or charged will include compound interest at the effective rate of 6% per year.
8. Proof of Survival. TIAA reserves the right to require satisfactory prool mat anyone named to receive
benefits under the terms of your contract is alive on the date any payment is due. If this proof is not received by us
after requested in writing, TIAA will have the right to withhold payments entirely until such proof is received.
9. Procedure for Elections and Changes. You or a beneficiary, having the right to do so, may elect or
change, in accordance with the terms of your contract, any of the following by written notice satisfactory to TIAA
sent to its home office in New York, NY:
A) the method of payment to the beneficiary;
B) the beneficiary;
C} the frequency of payments; or
D) the surrender of this contract for its Commuted Value.
902.9
Ed. 1-82
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TEACHERS INSURANCE AND ANNUITY ASSOCIATION
DATE OF MINIMUM
CONTRACT FIRST FREQUENCY GUARANTEED DATE OF
NUMBER PAYMENT OF PAYMENT PERIOD BIRTH
IC83659-1 09/01/88 Monthly 20 Years MO DA YR
ANNUITANT Lee Ann B Wagner 04/01/26
$185.78
ANNUITY
PAYMENT
DATE OF ISSUE
MO DA YR
09/01/88
PROVISIONS
1. CONSIDERATION
THIS CONTRACT IS ISSUED IN EXCHANGE FOR THE SURRENDER TO TIAA OF CONTRACT
NUMBER(S):
B439609-5
PROCEEDS IN THE AMOUNT OF $47,933.02 ARE APPLIED TO THIS CONTRACT. THESE ACTS
FULFILL ALL THE OBLIGATIONS OF THE CONTRACT THAT HAS BEEN SURRENDERED.
THE CONSIDERATION FOR THIS CONTRACT HAS BEEN DELIVERED AT TlAA'S HOME OFFICE IN
NEW YORK, NEW YORK.
2. COMMUTED VALUE
THE COMMUTED (DISCOUNTED) VALUE IS A ONE-SUM AMOUNT PAID IN LIEU OF A SERIES OF
PAYMENTS. IT IS LESS THAN THE TOTAL OF THOSE PAYMENTS. BECAUSE FUTURE INTEREST,
INCLUDED IN COMPUTING THE SERIES OF PAYMENTS, WILL NOT BE EARNED IF PAYMENT IS TO
BE MADE IN ONE SUM. THE COMMUTED VALUE OF FUTURE PAYMENTS IS THEREFORE THE SUM OF
THOSE PAYMENTS LESS THE INTEREST FROM THE DATE OF COMMUTATION TO THE DATE EACH
PAYMENT WOULD HAVE BEEN MADE. THE COMMUTED VALUE OF THE ANNUITY PAYMENT WILL BE
COMPUTED AT THE EFFECTIVE ANNUAL RATE OR RATES OF INTEREST SHOWN BELOW:
$185.78
EFFECTIVE RATE
OF INTEREST
2.50%
PART OF ANNUITY PAYMENT
902.9
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BENEFICIARY DESIGNATION (SEE PROVISION 2)
CLASS I BENEFICIARY(IES)
NAME
Val R. Wagner
RELATIONSHIP TO ANNUITANT
Brother
CLASS II BENEFICIARY(IES)
NAME
Bonne M. Wagner
Val H. Wagner
RELATIONSHIP TO ANNUITANT
Niece
Nephew
~ RIGHT TO RECEIVE PRESENT VALUE OF ANNUITY PAYMENTS IN ONE SUM. AT THE
ANNUITANT'S DEATH, EACH BENEFICIARY SHALL HAVE THE RIGHT TO ELECT TO RECEIVE IN
ONE SUM THE THEN PRESENT VALUE OF THE SHARE OF ANY REMAINING UNPAID ANNUITY PAY-
MENTS APPORTIONED TO SUCH BENEFICIARY.
(THIS PROVISION IS APPLICABLE ONLY IF THE PRECEDING SPACE (_) IS MARKED WITH AN (X).)
( ) AUTOMATIC ONE-SUM PAYMENT OF PRESENT VALUE OF ANNUITY PAYMENTS. AT THE
ANNUITANT'S DEATH, THE PRESENT VALUE OF THE SHARE OF ANY REMAINING UNPAID ANNUITY
PAYMENTS APPORTIONED TO A BENEFICIARY SHALL BE PAID IN ONE SUM.
(THIS PROVISION IS APPLICABLE ONLY IF THE PRECEDING SPACE (_) IS MARKED WITH AN (X).)
102 . 9-1011. 8
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ADDITIONAL PROVISIONS
IT IS UNDERSTOOD AND AGREED THAT IF A TESTAMENTARY TRUSTEE OR AN INTER VIVOS TRUSTEE
IS DESIGNATED AS BENEFICIARY:
(A) TlAA SHALL NOT BE OBLIGED TO INQUIRE INTO THE TERMS OF ANY WILL OR
OF ANY TRUST AFFECTING THIS CONTRACT OR ITS DEATH BENEFITS AND SHALL NOT BE
CHARGED WITH KNOWLEDGE OF TERMS THEREOF.
(B) IF BENEFITS BECOME PAYABLE TO A TESTAMENTARY TRUSTEE AND (I) THE WILL IS
NOT PRESENTED FOR PROBATE WITHIN 90 DAYS FOLLOWING THE DATE OF THE ANNUITANT'S
DEATH; OR (II) THE WILL HAS BEEN PRESENTED FOR PROBATE WITHIN THE AFORESAID 90
DAYS AND NO QUALIFIED TRUSTEE MAKES CLAIM FOR THE BENEFITS WITHIN NINE MONTHS
AFTER THE ANNUITANT'S DEATH; OR (III) IF EVIDENCE SATISFACTORY TO TlAA IS FUR-
NISHED TlAA WITHIN SUCH NINE-MONTH PERIOD THAT NO TRUSTEE CAN QUALIFY TO RECEIVE
THE BENEFITS, PAYMENT SHALL BE MADE TO THE SUCCESSOR BENEFICIARY(IES) AS DESIG-
NATED ON THE REVERSE SIDE, IF ANY SUCH BENEFICIARY(IES) ARE DESIGNATED AND SUR-
VIVE THE ANNUITANT; OTHERWISE TO THE EXECUTORS OR ADMINISTRATORS OF THE ANNUITANT.
(C) IF BENEFITS BECOME PAYABLE TO AN INTER VIVOS TRUSTEE AND (I) THE TRUST
AGREEMENT IS NOT IN EFFECT; OR (II) NO TRUSTEE CAN QUALIFY TO RECEIVE THE BENE-
FITS; OR (III) THE QUALIFIED TRUSTEE IS NOT WILLING TO ACCEPT THE BENEFITS, PAY-
MENT SHALL BE MADE TO THE SUCCESSOR BENEFICIARY(IES) AS DESIGNATED ON THE REVERSE
SIDE, IF ANY SUCH BENEFICIARY(IES) ARE DESIGNATED AND SURVIVE THE ANNUITANT;
OTHERWISE TO THE EXECUTORS OR ADMINISTRATORS OF THE ANNUITANT.
(D) PAYMENT TO AND RECEIPT BY SAID TRUSTEE, SAID SUCCESSOR BENEFICIARY(IES)
OR SAID EXECUTORS OR ADMINISTRATORS OF THE ANNUITANT, AS PROVIDED FOR IN (B) OR
(C) ABOVE, SHALL FULLY DISCHARGE TlAA FROM ALL LIABILITY TO THE EXTENT OF SUCH
PAYMENT. TlAA SHALL HAVE NO OBLIGATIONS AS TO THE APPLICATION OF FUNDS SO PAID
AND SHALL, IN ALL DEALINGS WITH SAID TRUSTEE OR WITH SAID EXECUTORS OR ADMINIS-
TRATORS, INCLUDING BUT NOT LIMITED TO ANY CONSENT, RELEASE OR WAIVER OF INTEREST,
BE FULLY PROTECTED AGAINST THE CLAIMS OR DEMANDS OF ANY OTHER PERSON OR PERSONS.
902 . 9-10 11.8
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: 3. Amluity Payments. Your income begins as of the Date of First Payment if you are then alive. Payments
will continue to you for the rest of your life. If you die within the Minimum Guaranteed Period following the Date
of Issue, payments will be continued to the beneficiary for the remainder of that period. In lieu of payments due the
beneficiary, the Commuted Value of such payments may be paid to the beneficiary in one sum, unless otherwise
specified on Page 5. The Date of First Payment,. Minimum Guaranteed Period, Frequency of Payment and the
amount of each payment are shown on Page 3. Payments in addition to the amount shown on Page 3 may be made
by TIAA. TIAA does not guarantee that there will be such Additional Amounts.
If you outlive all beneficiaries but die within the Minimum Guaranteed Period, we will pay to your estate the
Commuted Value of any payments remaining due. If a beneficiary dies while entitled to receive payments, the
Commuted Value of any payments remaining due to him or her will be paid to the surviving person or persons
named to receive it. If no one so named is then living, the Commuted Value will be paid to the estate of such
beneficiary.
Payments are subject to the provisions of any method of payment agreement or any beneficiary designation in
effect under this contract. .
4. Change of Frequency of Annuity Payments. You, or a beneficiary receiving payments, may request a
change to equivalent payments made annually, semi-annually, quarterly or monthly. However, TIAA may decline
to make a change from one frequency to another of fewer payments per year. TIAA will also have the right to
decline any change that would result in payments of less than $10 each.
5. Termination of Annuity Payments. The final payment to be made under this contract will be the last
payment due on or before the date of your death, unless you die within the Minimum Guaranteed Period. In that
case, the final payment will be the last payment due within that period.
6. Beneficiary. Beneficiaries are persons named, in form satisfactory to TIAA, to receive any payments
remaining due at your death. Different classes of beneficiaries, such as primary (first) and contingent (secondary),
may be designated. These classes set the order of payment. If a class contains more than one person, any payments
remaining due at your death will be paid to the then living persons in a class in equal shares, unless provided
. otherwise. For example, if you die during the Minimum Guaranteed Period with your spouse having been named
as primary beneficiary and "my children" as equal contingent beneficiaries, your spouse would receive any
payments remaining due upon surviving you. But if your spouse did not survive you, then your surviving children
would receive equal shares of any payments remaining due.
The terms "children" or "my children" may be used to name a class of beneficiaries, either primary or
contingent. Unless otherwise specified, these terms will mean all children born of your marriage or marriages and
any children legally adopted by you. The term "children" also has the same inclusive meaning when used to name
as beneficiaries the children of your spouse, your child, your brother or your sister.
The beneficiary designation may be changed as exolained below, unless otherwise specified on Page 5.
7. Benefits Based on Incorrect Data. It payments are determined by data as to your age or sex that are
incorrect, the amount of payments will be recalculated based on the correct data. Any amounts underpaid by TIAA
on the basis of incorrect age or sex will be paid when the correction is made. Any amounts overpaid by TIAA on
the basis of incorrect age or sex will be charged against payments due after the correction is made. Any amounts
so paid or charged will include compound interest at the effective rate of 6% per year.
8. Proof of Survival. TIAA reserves the right to require satisfactory proot that anyone named to receive
benefits under the terms of your contract is alive on the date any payment is due. If this proof is not received by us
after requested in writing, TIAA will have the right to withhold payments entirely until such proof is received.
9. Procedure for Elections and Changes. You or a beneficiary, having the right to do so, may elect or
change, in accordance with the terms of your contract, any of the following by written notice satisfactory to TIAA
sent to its home office in New York, NY:
A) the method of payment to the beneficiary;
B) the beneficiary;
C) the frequency of payments; or
D) the surrender of this contract for its Commuted Value.
902.9
Ed. 1-32
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