HomeMy WebLinkAbout11-02-06
. -
_._u'lWIl'
*
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
COMMONWEALTH OF PENNSnVANIA
DEPAflTMENT OF REVENUE
DEPT. 210101
HARRIS8UR~. PA ~~!.~_1__._ _
~
I~~
O~~
~II
OFFICIAL use ONLY
FILE NUMBER
21 06
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
182-22-9906
I
~
~~~~~~~~~~S~ FIRST. AND MIOOLe_INI~~)____ _____.____. "0- ,.. _P"
DATE OF DEATH (MM-OO-YEAR) ; DATE OF BIRTH (MM'D~ --..--
07/31/2006 ________j_!..9/01/192~___....______
<IF APPUCABLE) SURVIVING SPOUSE'S NAME ( LAST. FIRST AND MIDDLE INITIAL)
0711
NUMBER
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAl SECURITY NUMBER
. -. .D---2....--S~pplem~~tal Ret;;~---- --
4a. Futurelntere8t Compromise (date 01 death alter
12-12-82)
7. Decedent Maintained a Uving Trust (Attach
copy 01 Trust)
10. Spousal Poverty Credit (date 01 death between
- 1. 1 1. .
o 3. Remalnder Retum (date 01 dea1h prior to 12-1~)
o 5. Federal Estate Tax Retum Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
1. Original Retum
o 4. Umited Estate
n
~ 6. Decedent Died Testate (Attach copy
) 01 Will)
o 9. Litigation Proceeds Received
LEPHONE NUMBER
717/697-1800
5521 Carlisle Pike
--.-.-.---.-.---..- .---...-------..-.--..----..---- Mechanicsburg, PA 17050
I
1.:Real Estate (Schedule A)
2..Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4,Mortgages & Notes Receivable (Schedule 0)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. JolnUy 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)
-" ~-.--..'_._'...,.~...__..._-._"-
(1 ) 152,1..38.70 ~}
-.-.-.-.- c:o
-~-:
(2) None
~_.._---~----
(3) None
(4) None
(5) 382,928.96
.------.-..-
(6) 1,639.20
(7) 69,367.09
(8)
(9) 43,694.80
(10) 116.25
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Sublect to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(11)
(12)
(13)
(14)
OFFICIA~E oN~I'; b
.~ \~1 ~
rV <;7\
--n
. "'os
~.:..n
C)
-11
'J"'"
_:<ri'
~.".
--
C;?
N
CO
606,073.95
43,811.05
562,262.90
4,100.00
558,162.90
15.Amount of Line 14 taxable at the spousal tax rate, x .00 (15)
or transfers under Sec. 9116{a)(1.2) ..__*_._0__4"_'_' _._.__., __.__._______.
~ 16.Amount of Line 14 taxable at lineal rate x .045 (16)
-..----..---.-----
i 17. Amount of Line 14 taxable at sibling rate .12 (17)
~ x
-.--.--"'-.-----
g 18. Amount of Line 14 taxable at collateral rate 558,162.90 x .15 (18) 83,724.44
. "..._'_.._R__..~.....______ _0________
19. Tax Due (19) 83,724.44
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Copyright 2000 fonn software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6..(0)
Oecedent's Complete Address:
STREET ADDRESS
1051 Country Club Road
CITY
ISTATE PA
lZIP 17011
Camp Hill
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1) 83,724.44
4,186.22
Total Credits (A + B + C)
(2)
4,186.22
3. InterestlPenalty if applicable
D. Interest
E. Penalty
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3) 0.00
(4)
(5) 79,538.22
(5A)
(58) 79,538.22
TotallnterestlPenalty (0 + E)
4. If Une 21s greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
5. If Une 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
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;.................................................................................. ~ I
b. retain the right to designate who shall use the property transferred or its income;....................................
c. retain a reversionary interest: or.. ............................... .................. ...... .......................... ............. ..................
d. receive the promise for life of either payments, benefits or care? ..............................................................
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?............ ................. ... ................... ...... ....................... ........................... ........... 0 ~
3. Old decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... 0 ~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?. ..... ............... ......................... ................................ ....................................... ~ 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.
------~_.. _.__._~,-_.-_._..__."._---------
UnclIr perlIIIIes of P'IPY. I decIan!llhat I have examined this return. including ac:companying schedules and statements. and to the best of my knowledge and belief, It Is Irue. correc:t and cornpIeta. Dec:laratlon of
ptepnrolherthan the ~~~!l_~.~s~ClIl~dlnf~~l!o.!:'~.~~~~~rer ha~~ny ~_~~~__.__
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS DATE
R~" 0... A _ _ __ ____~_~.~O~J'tfr~'llt ~ -" ::z (, ,;J" <1 (.
SIGNA R PER ESP N I F~ ADDRESS · I DATE
L!;~t Oft PA'= OlliER 1>tAH R..:...Ni'AnVE------AOORESS ---- ---- /cJ / '3 oJ (,
Thomas J. Ahrens
5521 Carlisle Pike I/) /..'J .../ /_
.... _...__.' Mechanicsburg, PA 17050 '/.)'1 Pcp
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. ~9116 (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. i9116 (a) (1.1) (ii)). The statute does not exemDt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure
of assets and filing a tax retum 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. ~9116 (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. f9116
1.2) [72 P.S. i9116 (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 .5. f9116 (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.
*
SCHEDULE A
REAL ESTATE
CCUotONWEALTH OF PENNSYLVANIA
INHERITANCE TAX REtURN
RESIDENT DECEDENT
..L..__=:;_.: _..~:::::'__"'7.=,:::::-,. -----=,::=.:::=:::::':=:"-==::::"':::':':::::::_n._._.___
I FILE NUMBER
21 - 06 - 0711
ESTATE OF Shaub, Matilda E
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 jointly-owned with right Of survivorship must be disclosed on
schedule F.
ITEM
NUMBER
1
DESCRIPTION
VALUE AT DATE OF
DEATH
152,138.70
50% ownership in 1051 Country Club Road, Camp Hill, PA
County assessed value- $266,910, Common level ratio of 1.14
TOTAL (Also enter on Line 1, Recapitulation)
152,138.70
*'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONALPROPERTV
~TH OFPENNSYlVAHIA
INHERITHlC! TAX RETVRN
RESIDENT DECEDENT
I
----- _.-._-....-... -_.-. ~-_. .'" ".-....-......--..---.---. -.-------.--...-.---. --..,..-.
-.....'"0. __" fi., ___...__. __. ~. ..._.____ ,____. _4_0__",_,"_..__., ______..__._._ . ._... _.~
I FILE NUMBER
21 - 06 - 0711
ESTATE OF Shaub, Matilda E
Include the proceeds of litigation and the date the proceeds were received by the estate. All property Jolntly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM
NUMBER
1
DESCRIPTION
VALUE AT DATE OF
DEATH
18.735.89
M & T Bank checking account # 77205820
2
M & T Bank CD # 31003915824302
5,266.18
3
M & T Bank CD # 31003915124372
20,666.16
4
Refund of Dr. bill
266.00
5
Ameriprise Financial Services Money Market account # 011341462593002
10,589.04
6
Ameriprise Brokerage Account # 000142711423021
53,699.71
7
Ameriprise Financial Services account # 47174131 021
270.205.98
8
Personal Items in house
3.500.00
TOTAL (Also enter on Line 5, Recapitulation)
382,928.96
.
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDEN!__ ________. . _.__ .1.__ _
0"_-- ._
--.---.--------------.
I FILE NUMBER
21 - 06 - 0711
ESTATE OF
Shaub, Matilda E
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
~_. . -----"..-"-"
Hailey Vorkapich
ADDRESS
RELATIONSHIP TO DECEDENT
Grand Niece
A
------. ---------.----....---.-
102 Wheatland Road
Lewisberry I P A 17339
Kaitlyn Vorkapich
- ..--- ....,.....,-.,-------.---
102 Wheatland Road
Lewisberry I P A 17339
Grand Niece
B
JOINTLY OWNED PROPERTY:
ITEM LETIER l---.D'A TE--.----II~~I-ud~~~me J1r.~fn~t1Jh~~J?fof~J?f~nccount number DATE OF DEATH %OF DATE OF DEATH
DECO'S VALUE OF
NUMBER F~~~ ! ~6i~~ lor similar Identifying number. Attach deed for Jointly-held real VALUE OF ASSET INTEREST DECEDENT'S INTEREST
, lestate.
____+_________....__.______.. __, - __ ..__h _.. ___________ _____.._.___..____...._..._________________ 1,639.201 50% 819.60
1 A : OS/22/2003 : 3 $1,000 Series EE US Savings Bonds
: I
i
2 B i OS/22/2003 3 $1,000 Series EE US Savings Bonds 1,639.201 50% 819.60
I i
J
J i
j i I
1 i
\ i I
I
! I
I
j I
I
, I
I
; I
!
!
j I
i
! I
!
i
I
i
!
, I
i I
i
, I
I I
I
I
I i
j I
i I
I i !
, I
I
I
i ._____, ._____.___~..~._._ ...__. ... .__,._ _..~_.____._~.__~_~_n____. _,_~_____~_~.
TOTAL (Also enter on line 6. Recapitulation) 1,639.20
*'
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
i
i
i
_~ _~__l_____~_
ESTATEOF
ShaU~:~~~I~a E_uu_-- _____ I FILE N~~~: - 0711
This schedule must be completed and flied If the answer to any of questions 1 through 4 on page 2 Is yes.
I -~~SCRIPTIO~O~-~~~;;R~--------~'---':-:ATE OF DEATH I % OF EXCLUSION
Include the name of the transferee, their relationship 10 decedenl i VALUE OF ASSET I DECO'S (IF APPLICABLE) TAXABLE VALUE
8l1d the dale of transfer. Atlach a copy of lhe deed for rell 8s1118. I INTEREST
ITEM
NUMBER
1
-----..--.~ --"---.. -+-. ._--+-'.._..~ ...---..-..--.--.-----------..----.----.- '..--i
IDS Life Insurance annuity # 93007685424 7
61,767.59 100%
2
I
I
I
liDS Life Insurance annuity # 931075060547
I
I
I
I
I
I
7,599,50, 100%
!
. _____.._.__ ..!.__.._.___-L...
TOTAL (Also enter on line 7. Recapitulation)
61,767.59
7,599.50
69,367.09
*'
SCI-EDllE H
RN3W.. EXPENSES &
AIlVINISlRATlVE COS1S
CClMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DEOEDENT
--.j -".._--- -.--..----,-----.--------..-------
FILE NUMBER
21 - 06 - 0711
ESTATE OF Shaub, Matilda E
Debts of decedent must be reported on Schedule I.
ITEM I ______.____u_______.. -
NUMBER I FUNERAL EXPENSES: DESCRIPTION
A. 1 ~me-';~n- A~e~-F~neral Ho~-~, .In~~' -- ..--- _u_________.___.
AMOUNT
7,501.80
2 Funeral luncheon
180.00
3 Flowers
226.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Ruth Jane Dunn 12,000.00
Social Security Number(s) I ErN Number of Personal Representative(s):
Street Address
City Harrisburg State PA Zip 17109
Year(s) Commission paid 2006
2. Attomey's Fees Ahrens Law Firm, P .C. 22,750.00
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 522.00
5. Accountant's Fees
6.
Tax Return Preparer's Fees Estimated estate tax prep fee
250.00
7. Other Administrative Costs
1
Inheritance tax filing fee
15.00
250.00
43,694.80
Total of Continuation Schedule(s)
TOTAL (Also enter on line 9, Recapitulation)
*
SchedLE H
FlI1eraI ExpelS! S &
AamistndiveCostsccnlinued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DEC_~l:)~~_.
.~. L.. "d'_
ESTATE OF Shaub, Matilda E
2 ~timat~d-20-06i~c~'~~tax prep fee
i
I
I
I
I
i
i
I
I
I
I
i
I
I
i
I
I
i
I
i
i
FILE NUMBER
21 - 06 - 0711
250.00
Page 2 of Schedule H
*'
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
OOMMOHWEH.TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
REIlIOENT DECEDENT
~:.~-::;=:"-;;"=";::=::=:==::':":'::::'~-===:'-::;:':'M" _
I FILE NUMBER
21 - 06 - 0711
ESTATE OF Shaub, Matilda E
Include unrelmbursed medical expenses.
-----_. - 4_'_''', . ,_,. __.._. _____... ....n. ..___.__'_._._n_....__....__._____.
ITEM DESCRIPTION AMOUNT
NUMBER
.__..... .. ---.---.-...-... - .-.------- --- ----- -.--.-.-...-.---.-.-... --_._._-_._-------
1 United Water 18.96
2 pp & L 67.27
3 Verizon 30.02
--~.__.------ ... ...........-.-- - p'- ........--.. .-..__.....-. '. __. '___.m._...__.__~___
TOTAL (Also enter on Line 10, Recapitulation) 116~25
REV.1S13EX+ (t-GO)
*'
SCHEDULE J
BENEFICIARIES
_J
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Shaub, Matilda E
I FilE NUMBER
21 - 06 - 0711
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
RELATIONSHIP TO
DECEDENT
Do Not UIt Tru......)
AMOUNT OR SHARE
OF ESTATE
I. TAXABLE DISTRIBUTIONS (Include outright spousal distributions)
i
j
jRuth Jane Dunn
~OOO Woodvale Road, Harrisburg, PA
I
Nikki Vorkapich
102 Wheatland Road, Lewisberry, PA
I
Jan Ellen Robinson
324 Sherringham Drive, Hockessin, DE
1
Cousin 25%
2
Daughter of Cousin 25%
3
Daughter of Cousin 12.5%
4
Mark Vorkapich
18235 Fall Creek Drive, Lutz, FL
Grandson of Cousin 12.5%
I
i
! See Continuation Schedule(s) attached
Enter dollar amounts for distributions shown above on lines 15 through 18, as approprla e, on Rev 1500 cover sheet
ll. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTAIBUTIONS
1 Landisburg Cemetery 100.00
2 Trinity UCC Church of Landisburg 2,000.00
3 Rockville United Methodist Church of Harrisburg 1,000.00
4 Humane Society of Harrisburg 1,000.00
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
4,100.00
, ..
*'
SCHEDULE J
BENEFICIARIES continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
---=-=~---'--~--'-"-- -. . -.-.. -._.
ATE OF Shaub, Matilda E
~~'I~--' --.--.--..-..
JMBER i NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
Uu_U_u t_~__._..._..______. .. __ '..' .......,..__..,._._____.__.._____...._______________
-- uu_ . ~AxABLE DISTRIBUTIONS (include outright SjUSal distributions, and transfers under
. i Sec. 9116(a)(1.2) ,
i
INicholas Andrew Vorkapich
102 Bramblewood Road, Lewisberry, PA
I
!
5
6
Matthew Robinson
121 Seaman Avenue, Apt 2F, NYC, NY
!
I
!
--1_,_____
I FILE NUMBER
21 - 06 - 0711
RELATIONSHIP TO AMOUNT OR SHARE
DECEDENT OF ESTATE
Do Not Uat Tru.....}
Grandson of Cousin 12.5%
Grandson of Cousin 12.5%
Page 2 of Schedule J
..
m M&rBank
2600 Linglestown Road, Harrisburg, PA 17110
7176520885 FAX717 652 6512
COpy
August 11, 2006
RuthJ.Dmnn,Execunix
4000 W oodvale Rd.
Harrisburg, P A 17109-1319
Dear Mrs. Dunn:
I am writing to notify you of the account balances for the accounts of Matilda E. Shaub
upon the date of her death, July 31,2006.
Checking Account # 77205820........................ $18,735.89
Certificate of Deposit # 31003915824302.... ........ $5,266.18
Certificate of Deposit # 31003915124372............ $20,666.16
The remaining funds in each of these accounts have been moved into the newly
established estate account, titled as follows.
Account # 9843036659
ESTATE OF MATILDA E SHAUB
RUTH J DUNN, EXEC
Please contact me should you need any further assistance with the aforementioned
accounts.
yan P. S1. Jo
Assistant Branch Manager
M&TBank
(717) 652-0885
rstiohn@mandtbank.com
1::
o ~
D.o
CD-
o::~
~~
.s ~
c .-
CDO
><C
c
.I oil oil oil oil oil ...
0 It) It) It) It) It) It)
Z Q. Q. Q. Q. Q. Q.
€ (W) (W) (W) (W) (W) ~
S ::s
1W,S ~ (W) ~ ~ ~ ~
as 0 0 0 0 0 0
sew N ~ t:! ~ ~ ~
.~ _0 i:t5 It) It) It)
- 0 0 0 0 0 0
.5
0 ....
C
..
(I) I ~ ~ S 8 co ~
.a,S 0
0 0 0 0 0 0
c_ ~ t:! t:! t:! t::! ~
-0
1< co co co co
0 0 0 0 0 0
CD
Z
'a ?f!. ?f!. ?f!. ?f!. ?f!. '#.
N N N N N N
Q; co co co co co co
>= N N N N N N
"#. ~ ~ ?f!. ?f!. ~
.I 0 0 0
~ ~ ~ ~ ~ ~
~ ~ ~ ~ ~ ~ ~
~ ~ ~ ~ ~ ~
0 0 0 0 0 0
'l:t 'l:t 'l:t 'l:t oq- 'l:t
CD cO cO cO ~ cO ~
::s ~ ~ ~ ~
~ ~
0 0 0 0 0 0
.. ~ ~ ~ ~ ~ ~
I ! co ~ co ~ ~
oq- 'l:t
.a
.5
0 0 0 0 0 0
0 0 0 0 0 0
CD d d d d d ci
u 0 0 0 0 0 f6
.C It) It) It) It) It)
0- M-
~ ~ (W) (W) ~ (W)
!s 0 0 0 0 0 0
0 0 0 0 0 0
.- t:! ~ t:! ~ C:! ~
_0 It) It) It)
0 0 0 0 0 0
..
CD
.Q W W W W W w
E w w w w w W
::I 0) co ~ 0 ~ ~
z ~ 'l:t It) It) It)
N N N N ("II
c; N N ("II N ("II ("II
0) Q) 0) 0) 0) 0)
1: ,.... ,.... ,.... ,.... ,.... ,....
CD co fe co co co co
th ,.... ,.... ,.... ,.... ,....
:E :E ::! :E :E :E
e 0 0 0 0 0 0
0 0 0 0 0 0
0 q o. o. o. o. q
c ~ ~ ~ ~ ~ ~
Q) ~
0
I w w w w w W
1:
CD W W W W W W
th
en
t: 0 ~ N ~ oo;t It) co
0 z
m
coco
00
00
~~
cor--
~O
co
o
so
as
o
-
c.
.t: Cl.
Cl.
i.L
'"C
0 ~
oo;t '0
cO
,.... ~
N Q)
CD ~- C)
::s~ co
~ Q.
~:2
::so
fI)
.!!~CQ)
c(\Io-
0 Q)Q);l(\l
"'lIt Q) >>fJ '0
cO .o1t)::s'O
- fI)" Q)
..,.... Q)._ Q) C)
I~ >0 '0 C
-c~(\I
00(\1.1:
.e Z.o,,~
.5 fl)Q)CQ)
~:58a
-g:s~'O
OC,.!.Q)
.o::Sfl).I:
0 -g I ~8.B
0 .8-(\1...
ci z:6.e~
0 :r:.Q.~o
CD o. :r: -fI)-
U~ c:'C lB::s a
.C ~
a. (\I Q) ... ~ '1::
a E~aQ.
..... >0.- E Q)
i [~~~
~.s0Q)('IS
~~~~g
~.- (\I Q) '0
.21 fI).o Q)
fI) jjj Q) ~.g
;Q')-geQ.
'0 >013" ~
C '0.5 i'G)
oz" .0
.0 fI) c: ~ fI)
I .- (\I .-
)("C.....~:;
W ~ m ~.o
. m .
'\"""(\1'0
'>>::SC
cW(\ICO
-Z:E1!l.o
,o.......J:
Q) Q)Q)J:
.I: ~=1::
fI) a:l(\la:l
~-<s......
fI) 00
fI)~CC-
a:l Q)'-'-"
~'C'O'o Q)
'0'- Q) Q) C)
sg'~~i
.0 'E .- .- 'fi
~ml~~
o ~...
.'Ouiuio
CWWI::
'0 -
c......'o
(\IOOQ)
'0-;;;-;;;.1:
Q)Q)Q)fI)
5 'C 'C ~
~Q)Q)
cncnfl)
a:l(\l;
.~ .~ .~ '0
'O'O'oC
CCcO
.800.0
.0.0
I I 0
< It).. .
en :eQ..
m . .
15
I-
~
oU) i
-"0
ceco ~
(1)0
f:a3 c
::l
..
~ Daniel V Lowe
....,.. 08lO9I2006 02:52 PM
To: John A BenkovlchIFieldIWH/AEFA@AMEX
cc:
Subject: **** DATE OF DEATH VALUES **** Re: 143871424001 - MATILDA E
SHAUB - ESTATE SETTLEMENT REQUIREMENTS - *#'9~1~ OF
DEATH VALUES TO FOLLOW'" - PLEASE DO NOT DELETE
AuguSt 9, 2006
JOHN A BENKOVICH JR
AMERIPRISE FINANCIAL SERVICES
4661 TRINDLE RD
CAMP HILL, P A 17011-5603
Dear JOHN A BENKOVICH JR:
IDS Life Insurance Company
RlverSource Funds
Amerlprlse Certificate Company
Amerlprlse Brokerage
70100 Amerlprlse Financial Center
Minneapolis. MN 55474
Thank you for your recent inquiry regarding MATILDA E SHAUB's accounts. These are the values of the
accounts as of 07/3112006.
Mutual Funds
Account Number
011341462593002
.
Total Value
$10589.04
Annuities - Post 1985
Account Number
93007685424 7 004
931075060547 004 PIa
Total Value
· '~~~.. 6.~$2. '
...~ ~.5
Life Insurance
Account Number
90904205141 9004
'Total Value
$275000.00
LTC Premium Return
Account Number
910026239053004
Total Value
$0.00
Ameriprise Brokerage Account
Account Number
000142711423021
Total Value
$53699~71.
l
~
# of shares
10589:040
Asset Value Per Share
1.00
SPS Advantage ONE Features
COpy
Account Number
000471741314021
Total Value
$270205.98
Client Name:
Date of Death:
MATILDA E SHAUB
07/31/2006
Account:
Valuation Date:
14271142021
07/31/2006
Estimated Values
Client Name:
Date of Death:
MATILDA E SHAUB
07/31/2006
Account:
Valuation Date:
47174131 021
07/31/2006
Estimated Values
The date of death values provided are for estate tax purposes and are not a value to be paid. Accounts may be
subject to market fluctuation as governed by each product. Please note that the values indicated for any Life
Insurance product(s) reflect the gross death benefit at date of death, not the cash value. Values for any
proprietary mutual funds include accrued dividends as applicable. Values provided for brokerage products are
manually calculated, and should be used as estimates only. The prices used to provide values are estimates
obtained from outside sources believed to be reliable. Ameriprise Financial does not guarantee the values.