HomeMy WebLinkAbout03-0967Estate of
also known as
Register of Wills of Dauphin County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Lee_
, Deceased
Social Security No. Ic~"O-~'~'J-33
Petitionel(s). who is/ar® 18 years Of ege or oldel, apply(les) for:
(COMPLETE "A" OR "B" BELOW:)
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut(~
Decedent, dated ' '~1111~ and codicil(s) dated
named in the Last Will of the
State fe~event r2rcurrmteoce~, e.g., mnun~ation, death of executor, etc.
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered
for probate; was not the victim of a killing and was never adjudicated incompetent:
B. Grant of Letters of Administration
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse
(if any) and heirs:
Name Relationship Residence
/
(COMPLETE IN ALL CASES:) Attach additional
~hoets if necessary.
Decedent was domiciled at death
residence at ~.1o0 ~e.,~ OreeEbi~jRnx
County, Pennsylvania, with his/her last family or principal
, 20 0__~, at
Decedent, then ~ years of age, died
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property .............................. $
(If not domiciled in PA) Personal property in Pennsylvania ......................
(If not domiciled in PA) Personal property in County .......................... $
Value of real estate in Pennsylvania ............................................... $
Total ..............................................................
Real Estate situated as follows: I i ~ :5 K, ,,,.~ I,~ P4k. 0_,, ,v.¢,
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the
,I
I~e ~ ~e.,~ ,r,~ bur1
appropriate form to the undersigned:
I
Typed or printed name and residence
R~I-7
Oath of Personal Representative
Commonwealth of Pennsylvania
County of~l~lll~ ~--~/~ I~n~J
The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and
correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent,
Petitioner(s) will well and truly administer the es~ ~ ~~/ ~
Sworn to and affirmed and subscribed
before me this ~ ~ day of
DECREE OF REGISTER
also known as /
Deceased No.
Social Security No: /~_~-2. ~.~_~-~ Date of Death: !
AND NOW, ~?~_~. ~) , 204~:~, in consideration of the Petition
on the reverse side hereon, sati~actory proof having been presented before me,
IT IS DECREED that Letters I~Testamentary [] of Administration
are hereby granted to ~
in the above estate and that the instrument(s), if any, dated
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters ...........................
Short Certificate(s) ..........
Renunciation ..................
Affidavit ( ) .................
Extra Pages ( ) ............
Codicil ..........................
JCP Fee ........................
Inventory & Tax Forms...
Other ............................
Attorney:
I.D. No:
Address:
TOTAL ................
Telephone:
FILED:'"'7-~. ~ /~L..~
DATE
Rl~-7a
L~ST ~LL i~D TEST~ENT
OF
LEE L. H~YDEN~ JRo
I, LEE L. HAYDEN, JR., of Fairview Township, York County,
Pennsylvania, being of sound mind, memory and understanding, do
make and publish this, my Last Will and Testament, hereby revok-
ing all former Wills by me at any time heretofore made.
ITEM I. I direct that all inheritance and estate taxes
becoming due by reason of my death, whether such taxes may be
payable by my estate or by any recipient of any property shall be
paid by my Executor out of the property passing under ITEM II of
this Will, as an expense and cost of administration of my estate.
My Executor shall have no duty or obligation to obtain reimburse-
ment of any such tax so paid, even though on proceeds of insurance
or other property not passing under this Will. In the absolute
discretion of my Executor, such taxes may be paid immediately, or
the Executor may postpone the payment of taxes on future or
remainder interests until the time possession thereof accrues to
the beneficiaries.
Page 1 of 3 pages
~ ~N(~
IT~ II. I give, devise and bequeath one .~_ h
of the rest, residue and remainder of my estate to my daughter,
Diana Caine-Helwig, provided that she survives me by thirty (30)
days. In the event my daughter should predecease me or not survive
me by thirty (30) days, then her share shall be distributed in
accordance with ITEM III hereof.~
I
IT~ III. All the rest, residue and remainder of my
estate, of whatsoever nature and wheresoever situate at the time
of my death, I give, devise and bequeath to my son, Lee L. Hayden,
III, of Glenville, Georgia, my daughter, Patricia LeFaivre, of
Taneytown, Maryland, and my daughter, Judith Welch, of Woodbridge,
Virginia, or the survivors of them, in equal shares.
I~F~ IV. I nominate, constitute and appoint my son, Lee
L. Hayden, III, as Executor of this, my Last Will and Testament.
In the event he is unable to act, I appoint my daughter, Judith
Welch, to so serve. It is my desire that my Executor serve without
bond. My executor shall have the power without court order to
execute, acknowledge and deliver deeds, bills of sale or other
instruments in writing which may be necessary for the proper
conveyance or transfer of any of the assets of my estate.
/
Le~' L. Hayden//~r. {_
Page 2 of 3 pages
2
IN WITNESS WHEREOF, I have set my hand and seal to this, my
Last Will and Testament, typewritten on two (2) other pages, this
16th day of July, 1996.
COIOfON~TH OF PENNSYLVANIA :
: SS
COUNTY OF DAUPH'rN :
I, LEE L. HAYDEN, JR., testator whose name is signed to the
attached or foregoing instrument, having been duly qualified
according to law, do hereby acknowledge that I signed and executed
the instrument as my Last Will and Testament; that I signed it
willingly; and that I signed it as my free and voluntary act for
the purposes therein contained.
COIOfON~EALTH OF PENNSYLVANIA
COUNTY OF DAUPHIN
Sworn or affirmed to and acknowledged before me, by LEE L.
HAYDEN, JR., testator,this 16th day of July, 1896.
Le~ L. Hay~en, J.~
!
: ,~rrisb'~o, ~uphin ~u~y
We, James H. Turner and Shelly J. Kunkel, the Witnesses,
respectively, whose names are signed to the attached or foregoing
instrument, being duly qualified according to law, do depose and
say that we were present and saw the testator sign and execute the
instrument as his Last Will and Testament; that LEE L. HAYDEN, JR.
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 was at that time eighteen or more
years of age, of sound mind and under no constraint or undue
influence.
Sworn or affirmed to and subscribed to before me by
James H. Turner and Shelly J. Kunkel, the witnesses, this 16th day
of July, 1996.
~ary Public /,"'/-
REAGER & ADLER, PC
ATTORNEYS AND COUNSELORS AT LAW
THEODORE A. ADLER +
DAVID W. REAGER
CHARLES E. ZALESKI
LINUS E. FENICLE
DEBRA DENISON CANTOR
2331 MARKET STREET
CAMP HILL, PENNSYLVANIA 17011-4642
717-763-1383
TELEFAX 717-730-7366
WEBSlTE: ReagerAdlerPC.com
February 5, 2004
THOMAS O. WILLIAMS
SUSAN H. CONFAIR
JOANNE HARRISON CLOUGH
SUSAN J. SMITH
+ Certified Civil Trial Specialist
Cumberland County
Register of Wills
Estate of Lee L. Hayden, Jr.
Estate No. 21-03-967
Dear Sir or Madam:
Enclosed please find our check number 4159 in the amount of $3,420.00. Pleas. e apply this amount
to the above referenced estate as a prepayment in discount for the inheritance tax. Please provide a receipt
for the payment.
Should you have any questions, please feel free to contact me.
Legal Assistant
Enclosure
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVE~ FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11~96)
CD 003530
REAGER & REAGER
2331 MARKET STREET
CAMP HILL, PA 17011
........ fold
ESTATE INFORMATION: SSN: 192-05-5233
FILE NUMBER: 21 03-0967
DECEDENT NAME: HAYDEN LEE L JR
DATE OF PAYMENT: 02/05/2004
POSTMARK DATE: 00/00/0000
COUNTY: CUM BERLAN D
DATE OF DEATH: 11 / 17/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $3,420.00
TOTAL AMOUNT PAID:
$3,420.00
'~REMARKS: REAGER&ADLERPC
CHECK# 4159
· SEAL
INITIALS: SK
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
CERTIFICATION OF NOTICE UNDER RULE
Name of Decedent: L~f_ L, )clfi~ ~fo
Date of Death: [~1}~10~
~11 No. ~0O~ :- 00'~ ~'~ Admin. No. ~l-
To ~e Register:
I ce~ ~at notice of ~nefi~M in~t) ~m~ ad~trafion requ~ed by Rule 5.6(a)~f the ~h~s' Cou~ Rules was
se~ed on or mailed to the following beneficiaries of the above-captioned estate on ~EC~ ~ B~< ~ t ~ ~ 00 3 ·
Name Address
LE~ L. 'd~Y'.(~,~.,~ ~ -. %38
p,~'.( LEFAIvP-,.E .- .~"]~0 E~,~'~ ,~o'"i'l KEV f)cO'f , l--ng£t~-To~,,d ~rnO ;t~'Tt3')'t°10G
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
l t: [d tg ~W 170.
Signature
ame
Address
Telephone(71'/) 533-9(~13
Capacity: __
Personal Representative
__Counsel for personal representative
REV-1500 EX (6-00)
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COMMONWEALTH OF J REV' I 500
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601 INHERITANCE TAX RETURN
HARRISBURG, PA 17128-0601 RESIDENT DECEDENT
n
DECEDENTS NAME (LAST, FIRST, AN~ ~IlD~DI_E INITIAL)
LEE
L.
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH ~M~-DD-YEAR)
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
OFFICIAL USE ONLY
FILE NUMBER
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
[~1. Original Return
~]4. Limited Estate
[~]6. Decedent Died Testate (Attach copy of Will)
~)9. Litigation Proceeds Received
NAME ~C~'~T ~L~ J~) 6LW
FIRM NAME (IfApEl~b_..~J~~
~lIO~n~q P(f L~uJ
TELEPHONE NUMBEB
[~2. Supplemental Return
[-"-~ 4a. Future Interest Compromise (date of death alter 1242-82)
--"]7. Decedent Maintained a Living Trust (Attach copy of Trust)
[~10. Spousal Poverty Credit (date of death between 12-3141 and 1-1-95)
COMPLETE MAILING ADDRESS
[~3. Remainder Return (dale of death prior to 12-13-82)
FI5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
~---~ 11. Election to tax under Sec. 9113(A) (Attach Sch O)
14.
1. Real Estate (Schedule A) (1) ~(~)~, (~ , ~0
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 (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
---]Separate Billin§ Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7) (8)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10) (11)
12. Net Value of Estate (Line 8 minus Line 11) (12)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13)
made (Schedule J)
Net Value Subject to Tax (Line 12 minus Line 13) (14)
OFFICIAL USE ONLY
!
o58. o-7
15.
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2) x .0 __ (15)
16. Amount of Line 14 taxable at lineal rate ~ '|1 (~' O'] x .0 ~r'~ (16)
17. Amount of Line 14 taxable at sibling rate x .12 (17)
18. Amount of Line 14 taxable at collateral rate x .15 (18)
19, Tax Due (19)
Decedent's Complete Address:
STREETADDRESS
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3.4,tO, co
Total Credits ( A + B + C ) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E )
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
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
(3)
(4)
(5)
(5A)
(5B)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; .......................................................................................... [] []
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? .............................................................................................................. [] []
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. [] []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ []
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
Declaration of preparer other than the personal representative is based on all information of whi~?~ preparer has any knowledge.
SIGNATURE_[.~E~PERSON RES_PONSIB~.E j~OR FILIkJ,(j~?ETU~
SIGNATURE OF PREPARER OTHER ~AN REPRESENTATIVE
declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete.
DATE
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. §9116 (a) (1.1) (ii)].
The statute does not exempt 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. §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. §9116(1.2) [72 P.S. §9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
SCOTT ALAN BLY ESQUIRE
SCOTT ALAN BLY ESQ
P 0 BOX 341
HERSHEY PA 17033
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
DIVISION OF THIRD PARTY LIABILITY
ESTATE RECOVERY PROGRAM
PO BOX 8486
HARRISBURG, PA 17105-8486
April 13, 2004
Re: LEE HAYDEN JR.
SSN: 192-05-5233
Dear Attorney Bly:
Pursuant to your letter dated April 05, 2004, the Department of Public
Welfare (DPW), Estate Recovery Program, has reviewed the information you
provided regarding the above-referenced individual.
It has been determined that this individual did not receive any type of
assistance during the questioned period.
Therefore, according to the information you provided, the Department's
Estate Recovery Program will not seek any recovery from this estate.
If you have any questions, please feel free to contact me.
Sincerely,
Ronald D. Hill, Manager
TPL Casualty Unit
(717)772-6604
(717)772-6553 FAX
REV-1502 EX+ (6-98)~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF FILE NUMBER
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 VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
C. mP
TOTAL (Also enter on line 1, Recapitulation) $ ~' I O~ i O(30, O O
(If more space is needed, insed additional sheets of the same size)
R~-1508 EX + (1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
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
s ,Ss. %~
TOTAL (Also enter on line 5, Recapitulation) $ ...~, 6(0 (o. (o 8
(If more space is needed, insert additional sheets of the same size)
,l ~ toO0, oo
,8o
REV-1509 EX + (1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATEOF ~..~ )... ~R,,tbC~O .,~,, FILENUMBER
·
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
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTERES
TOTAL (Also enter on line 6, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
EV-1511 EX+ (12-99) ,-
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
fl,
FUNERAL EXPENSES:
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s) L~ ,
social Security Number(s)/EIN Number of Personal Representative(s)~)I0'. %5- ~"'~ ~F
Street Address
City
Year(s) Commission Paid:
Attorney Fees ~CO.-[-(- ~L~
State __ Zip
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant ~lj3[
Street Address
City State__Zip
Relationship of Claimant to Decedent
Probate Fees ~ .~-~ ~ ~'
Accountant's Fees
Tax Return Preparer's Fees
CoFQ-~%~ ~ TOTAL (Also enter on line 9, Recapitulation) I
(If more space is needed, insert additional sheets of the same size)
'qS.oo
Continuation of Schedule H for the Estate of Lee L. Hayden Jr.
File No' 21-03-0967
REV-1512 EX * (1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE I
DEBTS OF DECEDENT,
MOETGAGE LIABILITIES, & LIENS
FILE NUMBER
Include unreimbursed medical expenses.
iTEM
NUMBER
DESCRIPTION
TOTAL (Also enter on line 10, Recapitulatior
(If more space is needed, insert additional sheets of the same size)
AMOUNT
to,goo ,oo
°l S .oo
$ q, 35o. %
0% ,o¢
REV-1513 EX+ (9-00~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUMBER
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I
1.
II
1.
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
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)
FIDELITY
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Web Address: Http://www.fidelitybank-pa.com · E-MAIL Address: admin@fidelitybank-pa.com
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Bloomfield
4719 Liberty Avenue
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15224-2025
412/682-0311
Brighton Road
3300 Brighton Road
Pittsburgh, PA
15212-2396
412/734-2675
Carnegie
17 West Main Street
Carnegie, PA
15106-1651
412/276-1266
Cranberry
1339 Freedom Road
Cranberry Twp., PA
16066-5003
724/742-0100
Mt. Lebanon
312 Beverly Road
Pittsburgh, PA
15216-1588
412/571-1333
Mt. Lebanon
728 Washington Road
Pittsburgh, PA
15228-2021
412/561-2470
Northway
6000 Babcock Blvd.
Pittsburgh, PA
15237-2500
412/367-9010
Perrysville
1009 Perry Highway
Pittsburgh, PA
15237-2105
412/364-3200
Strip District
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Pittsburgh, PA
15222-4418
412/402-1000
Troy Hill
1729 Lowrie Street
Pittsburgh, PA
15212-4398
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Zelienople
251 South Main Street
Zelienople, PA
16063-1188
724/452-6655
March 31, 2004
Scott Alan Bly, Esquire
PO Box 384
Hershey, Pa. 17033
REF: Lee L. Hayden Jr.
Dear Attorney Bly:
This letter is in reply to your letter dated the 30th day of March 2004 in reference
to the late Lee L. Hayden Jr., who passed away on the 17th day of November 2003.
At the time of his death he held only the one account here. This was the checking
account that you made reference to in your letter. The checking account number
as you stated is 22040521 and the account was opened on the 17th day of February
1982. On the 21st day of October, 1996 there was an ownership change to Lee L.
Hayden Jr. or Lee L. Hayden III. The date of death balance as of the 17th day of
November 2003 was $ 3,338.44.
Should you require any further information or have any questions, please feel free
to contact me at your convenience at 724-452-6655.
Diane K. Grunnagle
Savings Counselor
OMB NO. 2502-0265 lr
B. TYPE Of LOAN:
A. 1.J~-iFHA 2.j--'jFmHA 3. r-JCONV. UNJNS. 4. j-'tvA ~.j'-JCONV. iNS.
U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT6. FILE NUMBER: J 7. LOAN NUMBER:
ROSS,CRAIGJ 47640975
SETTLEMENT STATEMENT 8. MORTGAGE INS CASE NUMBER: OLD MORTGAGE INS CASE NUMBER:
6.125%\F\651 JSG
C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by Ihe settlement agent are shown,
Items marked "[POC]" were paid outside the closing; they are shown here for informational purposes and are not included in the totals.
~0 3/98 ( ROSS,CRAIG.P F D/ROSS,C RAIG/17 )
D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER:
CRAIG K. ROSS and ESTATE OF LEE L. HAYDEN, JR. COUNTRYWIDE HOME LOANS, INC.
TAMMIE K. ROSS
1183 KINGSLEY ROAD
CAMP HILL, PA 17011
G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 73-1649955 I. SETTLEMENT DATE:
, 1183 KINGSLEY ROAD Community Land Transfer
CAMP HILL, PA 17011 December 10, 2003
CUMBERLAND County, Pennsylvania pLACE OF SETTLEMENT
2331 Market Street
Camp Hill, PA 17011
J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION
100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER:
101. Contract Sales Price 108~000.00 401. Contract Sales Price 108,000.00
102. Personal Property : 402. Personal Properly
103. Settlement Charges to Borrower (Line 1400)5,879.33 403.
104. 404.
105. 405.
Adjustments For Items Paid By Seller in advance Adjustments For Items Paid By Seller in advance
106. City/Town Taxes to 406. Cit},/Town Taxes to
107. County Taxes 17./10/03 to 01/01/04 20.53 407. County Taxes 12/10/03 to 01/01/04 20.53
108. Schoo[Taxes t2/10/03 to 07/01/04497.76 408. SchoolTaxes 12/10/03 to 07/01/04 497.761
109. Sewer & Refuse Proration 12/10/03 to 01/01/04 16.82 409. Sewer & Refuse Proration 12/10/03 to 01101/04 16.82:
110. 410.
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 114,414.44 420. GROSS AMOUNT DUE TO SELLER 108,535.11
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER:
201. Deposit or earnest money 1,000.00 501. Excess Deposit (See Instructions)
202. Principal Amount of New Loan(s) 107,153.00 502. Settlement Charges to Seller (Line 1400) 15,258.04
203. Ex stin,a loan(s} taken subject to 503. Existing loan(s) taken subiect to
204. 504. Payoff of first Mortgage
205. 505. Pa}'off of second Mortgage
206. '! 506.
207. 507. (Deposit disb. as proceeds)
208. 508.
209. Seller Contribution 4,000.00 509. Seller Contribution 4,000.00
Adjustments For Items Unpaid By Seller Adjustments For Items Unpaid By Seller
210. City/Town Taxes to 510. City/Town Taxes to
211. County Taxes to 511. Count}, Taxes to
212. School Taxes to 512. School Taxes to
213. 513.
214. ; 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. TOTAL PAID B¥11:OR BORROWER 112,153.001 520. TOTAL REDUCTION AMOUNT DUE SELLER 19,258.04
300. CASH AT SETTLEMENT FROM/TO BORROWER: 600. CASH AT SETTLEMENT TO/FROM SELLER:
301. Gross Amount Due From Borrower (Line 120) 114~414.44 601. Gross Amount Due To Seller (Line 420) 108,535.11
302. Less Amount Paid B~dFor Borrower (Line 220) ( 112,153.00) 602. Less Reductions Due Seller (Line 520) 19,258.04]
303. CASH ( X FROM ) ( TO)BORROWER 2,261.44 603, CASH ( X TO)( FROM)SELLER 89,277.07
The undersigned hereby acknowledge receipt of a completed copy of pages 1&2 of this statement & any attachments referred to herein.
ESTATE OF LEE L HAYDEN, JR.
TAMI~E K. ROSS ~
L. SETTLEMENT CHARGES
$ 104,000100 ~ 7.0000 % 7,280.00
[NC. FUNDS AT
SE3'TLEMENT
:ONNECTION WiTH LOAN
% to
ri Fee
Loan Discount
Credit Report
% to
to ROLAND JOHNSON APPRAISALS
to COUNTRYWIDE HOME LOANS, INC.
35.00
to LANDSAFE FLOOD ~
Commitment Fee to COUNTRYWIDE HOME LOANS, INC. 100.00
n Fee to
809,
810.
811.
900. ITEMS REQUIRED BY LENDER TO BE PAID iN ADVANCE
%)
Interest From 12/10/03 to 01/01/04 ._~.~$ 17.9800001day ( 22days
i Premiumfor months toCOUNTRYWIDE HOME LOANS, INC.
903. Hazard Insurance Premium for 1.0 years to
904.
905.
RESERVES DEPOSITED WITH LENDER
1001. Hazard Insurance 71.76
3,000 monlhs_..~_~ $ 23.92 per month
~lnsurance months ~ $ ~h
months ~ $ per month
~ Taxes 12.000 months ~ $ 27.85 per month
School Taxes 8,000 months_.~__~ $ 74.42 per month
months..~_.~ $ per month
~__ er month
Jstment m~~per month
1100. TITLE CHARGES
-278.85
;ettlement or Closing Fee to
Abstract or Title Search to
1103. Title Examination to
1104, Title Insurance Binder to
1105, Document Pr_r_e.,oarstion to
to Communi~ Land Transfer
35.00
1107. Attorney's Fees to
above item numbers:
to COMMUNITY LAND TRANSFER
923.75
[~cludes aboveitemnumber~102,1103 & 1104
$ 107,153.00
Coverage $ 108,000.00
,300, 8.1 to Community Land Tranbfer
' Fee to Cash
, Fee to Cash
Inspection to Biechler & Titlery, Inc.
Escrow for Inhertiance Tax to Reager & Adler, PC
1116. Deed Preparation to Reager & Adler, PC
117.
1118.
12g0. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording Fees: Deed $ 38.50; Mortgage $ 50.50; Re[eases $
:Deed 1,080.00'Mort a e
1203. State Tax/Stamps: Revenue Stamps 1,080.00; Mo~gage
Power of Attomey to RECORDER OF DEED~S
ADDITIONAL SETTLEMENTCHARGES
to [
to Bowers Pest Control 35.00
1303, 2003 School Taxes to BONNIE K. MILLER, TREASURER ,[ 982.34
1304. Transaction Fee to The Homestead Grou , In.p_~ 3t 100.00
1305. TermiteTrealment to Bowers Pest Control 683,70
1400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103, Section J and 502, Section K) 5,879.3 15,258.04
i~y ~lgning page 1 of th~$ stalement, the signatories acknowledge receipl of a comp~ete~ copy of page 2 of mis two page slatemenL
Certified to be a true copy.
Communit
Settlement Agent
( ROSS,CRAIG I ROSS,CRAIG 117 )
DEPOSITTICKET
~. PN CBANK
FOR CREDITTOTHE ACCOUNT NAMED HEREON
DATE i-- ~/-° Y'
NAME
REGIONAL ID
THIS DEPOSIT IS ACCEPTED SUBJECTTO VERIFICATION ANDTOTHE RULE $ AND REGULATIONS OF THIS BANK.
l
DEPOSITS MAY NOT lIE AVAil. ABLE FOR IMMEDIATE WITHDRAWAL
[] CHECKING [] SAVINGS NET DEPOSIT $
CASH
TRANSIT NUMBER
CHECKS
PLEASE LIST
SEPARATELY
SHOWING
BANK'S
TRANSIT
NUMBER
TOTAL
LESS CASH RECEIVED
DOLLARS CENTS
I I l IF~AO"as~
ct.- Io I~ IcHEcKs
~ i./., i~.
....
...... _~ ~.~RE
'-" F= [,0 q,,' q q ~.01:
~NTRAL MEDICAL EQUIPMENT cO., HARRISBURG, PA 17109
The Estate Of Lee Hayden
235748
2/9/2004
1,000.00
Cash
2/9/2004
235748
1,000.00
3/21/04
BILL OF SALE
Received a check from Rodney and Beatrice Redding for $4,100.00 for the sale of the 1996 Ford
Aerostar Van for the Estate of Lee L. Hayden, Jr.
KATHRYN D. REED
NOTARY PUBLIC STATE OF MARYLAND
My Commission Expires January Ol~ I~
PN CBANK
040
UNIVERSITY (002)
909 WEST GOVERNOR ROAD
HERSHEY PA 17033
Cashbox l0
, Deposit Check
15:53P JAN 12 2004
Account Number 5004210083
Tran Amount $55.88
~/S ID ~WSHO026 Sequence Number 00015
Batch 401
PN CBANK
040
UNIVERSITY (002)
909 WEST GOVERNOR ROAD
HERSHEY PA 17033
Cashbox 13
* Deposit Check
13:03 MAR 25 2004
Account Number 5004210083
Tran Amount $4,100.00
W/S ID WWSHO022 Sequence Number 00062
Batch 401
This deposit or payment is accepted subject to
verification and to the rules end regulations of
this bank. Deposits may not be available for
immediate withdrawal. Receipt should be held
until verified with your statement.
This deposit or payment is accepted subject to
verification and to the rules and regulations of
this bank. Deposits may not be available for
immediate withdrawal. Receipt should be held
until verified with your statement.
State Farm Mutual Automobile Insurance Company
One State Farm Dr
Conoordville PA 19339
3540 5 57P
HAYDEN~ LEE L JR , ESTATE OF
C/O DIANA CAINE-HELWIG
256 WILLIS RD
ETTERS PA 17519-9596
I,,,111,,,1.,11,,,,111,1,,I,1,,,,11,1,1,,,11,,,I,1,,11,,,,,111
AGENT
DIANA CAINE-HELWIG
1099 W GOVERNOR ROAD
P O BOX 384
HERSHEY, PA 17033-0384
(717)533-8613
99336-5-P
MAR 31, 2004
RE: Policy Number:
Refund Amount:
692 9689-F 15-38E
**** 100~80
The attached refund is a result of the termination of your policy.
If you have any questions, please contact your State Farm agent.
Policyholder Service
134-6775.1 Rev. 07-01-2002 (olb0101b)
6A3F501
Register of Wills of CUMBERLAND County, Pennsylvania
Certificate of Grant of Letters
No. 2003-00967 PA No. 21-03-0967
ESTATE OF HAYDEN LEE L JR
Late of MECHANICSBURG BOROUGH
UU~~ UOU~'I'~, '
Deceased
Social Security No. 192-05-5233
WHEREAS, on the 20th day of November
dated July 16th 1996
was admitted to probate as the last will of HAYDEN LEE L JR
late of MECHANICSBURG BOROUGH , CUMBERLAND County, who died on the
17th day of November 2003 and,
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, DONNA M. OTTO , Register of Wills in and for
~he County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify
nhat I have this day granted Letters TESTAMENTARY
-o HAYDEN LEE L III
2003 an instrument
who has duly qualified as Executor'(rix)
~nd has agreed to administer the estate according to law, all of which fully
~ppears of record in my Office at CUMBERLAND COUNTY COURT HOUSE,
CARLISLE, PENNSYLVANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
Df my Office the ~0th day of November 2003.
.megls5er or Wl~'AS /
**NOTE** ALL NAMES ABOVE~_PPEAR (LAST, FIRST, MIDDLE)
LAST WZLL M~D TEBTAHBNT
OF
LEE L. HAYDBN; uR.
I, LEE L. HAYDEN, JR., of Fairview Township, York County,
Pennsylvania, being of sound mind, memory and understanding, do
make and publish this, my. Last Will and Testament, hereby revok-
ing alt former Wills by me at any time heretofore made.
ITEM I. I direct that all inheritance and estate taxes
becoming due by reason .of my death, whether such taxes may be
payable by my estate or by any recipient of any property shall be
paid by my ExecUtor out of the property passing under ITEM II of
this Will, as an expense and cost of administration of my estate.
My Executor shall have no duty or obligation to obtain reimburse-
ment of any such tax so paid,..eventhough on proceeds of insurance
or other property not passing under this Will. In the absolute
discretion of my ~xecutor, such taxes may be paid immediately, or
the Executor may postpone the payment of taxes on future or
remainder interests until the time possession thereof accrues to
the beneficiaries.
Page I of 3 pages
T give, devise and bequeath one~~(~
of the rest, residue and remainder of my estate to my daughter,
Diana Caine-Helwig, provided that she survives me by thirty (30)
days. In the event my daughter should predecease me or not survive
me by thirty (30) days,, then her share shall be distributed in
ITeM II~. Ail the rest, residue and remainder of my
estate, of whatsoever nature and wheresoever Situate at' the time.
of my death, I give, devise and bequeath to my son, Lee L. Hayden,
III, of Glenville, Georgia, my daughter, Patricia LeFaivre, of
Taneytown, Maryland, and my daughter, Judith Welch, of Woodbridge,
Virginia, or the survivors of'them, in equal shares.
ITEM IT, I nominate, constitute and appoint my son, Lee
L. Hayden, III, as Executor of this, my Last Will and Testament.
In the event he is unable to 'act, I appoint my daughter, Judith
Welch, to so serve. It is my desire that my Executor serve without
bond. My executor shall have the power without court order to
execute, acknowledge and deliver deeds, bills of sale or' other
instruments in .writing which may be necessary for the proper
conveyance or transfer of any of the assets of my estate.
Page 2 of 3 pages
2
IN NITNESB NH~EOP, I have set my hand and seal to this, my
Last Will and Testament, typewritten on two (2) other pages, this
16th day of July, 1996.
C0)O[O:HW]r,A,T,'I'~ OF I:'wI~TBYLV'&_WZ~ ;
~ BB
C'0U'14'1~ OF DATT~HZN ~
I, LEE L. HAYDEN, JR., testator whose name is signed to the
attached or foregoing instrument, having been duly qualified
according to law, do hereby acknowledge that I signed and executed
the instrument as. my Last Will and Testament; that I signed it
willingly; and that I signed it as my free and voluntary act for
the purposes therein, contained.
Sworn or affirmed to and acknowledged before me, by LEE L.
HAYDEN, JR., testator,this 16th day of July, 1~96.
L-e~/L.. aay~en, 'J~ ~/ · *
.'.
CO~O~~ OF P~BYLV~I~ . ~rrt~g.~~
We, James H. Turner and Shelly 'J. Kunkel, the Witnesses,
respectively, whose names are signed to the attached or foregoing
instrument, being duly qualified according to law, do depose and
say that we were present and saw the testator sign and execute the
instrument as'his Last Will and Testament; that LEE L. HAYDEN, JR.
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 was at that time eighteen or more
years of age, of sound mind and under no constraint or undue
influence.
Sworn or affirmed to and subscribed to before me by
James H. Turner and Shelly J. Kunkel, the witnesses, this 16th day
of July, 1996.
/ .....
jsg~realestate~ross.escrow
December 10, 2003
ESCROW AGREEMENT
AGREEMENT made the 10th day of December, 2003, by and between Diana/Caine-
Helwig, agent for Lee L. Hayden, III, Executor of the Estate of Lee L. Hayden; Jr.. hereinafter
called "Seller", and REAGER & ADLER, PC, hereinafter called "Escrow Agent".
WITNESSETH:
WHEREAS, Seller is selling a residence located at 1183 Kingsley Road, Camp Hill,
Cumberland County, Pmmsylvania; and
WHEREAS, settlement for the purchase of the above residence was conducted on December
10, 2003, at which time Five Thousand and 00/100 Dollars ($5,000.00) the Sellers proceeds was
escrowed by Escrow Agent for payment of inheritance tax. The conditions are hereinafter set forth
under Paragu'aph 3.
WHEREAS, the pat'ties are desirous of clarifying the terms and conditions for the escrowed
funds and, for this reason, have agreed to reduce to writing the conditions of the escrow.
NOW, THEREFORE, in consideration of the mutual covenants contained herein and with
the intention of being legally bound hereby, the parties do hereby agree as follows:
The parties hereby acknowledge the fact that $5,000.00 has been placed in escrow and is
currently being held in a non interest beating account maintained by Escrow Agent until
such time as the terms and conditions of the Escrow Agreement, as they are hereinafter set
forth, are satisfied.
For purposes of this Agreement, notice shall be sent to the following addresses:
,;
SELLER'S ADDRESS
The items set forth below constitute the subject matter of the Escrow with respective
amounts listed for their correction and/or completion:
Imheritance Tax filing for the Estate of Lee L. Hayden, Jr. Upon filing of the Inheritance tax
return by Attorney Scott Alan Bly and request by Attorney Bly, a check will be issued to the
Register of Wills for the Inheritance tax. If the funds required are less than $5,000.00 the
jsg\realestate\ross.escrow
December 10, 2003
o
o
remaining funds will be held in escrow until notification that the Inheritance Tax Return was
accepted by the Pennsylvania Department of Revenue.
Liability of Escrow Agem: Escrow Agent shall not be liable for; and Seller and Buyer
expressly release Escrow Agent from liability arising out of, any act, omission or other
matter or thing arising hereunder, except for Escrow Agent's willful misconduct or gross
negligence. Seller and Buyer, jointly and severally, agree to indemnify and hold Escrow
Agent harmless from and against any and all costs, claims or damages, howsoever
occasioned, that may be incurred by or asserted agains, t it arising out of or in connection with
the Escrow Agreement or Escrow Agent's action or failure to act hereunder, including
without limitation, costs and expenses (including attorney's fees) or depositing the Escrow
Fund in court or defending itself hereunder, except for Escrow Agent's willful misconduct
or gross negligence.
Duties of Escrow Agent: Escrow Agent undertakes to perfonu only such duties as are
expressly set forth herein, being purely ministerial in nature. Escrow Agent shall have no
responsibility for detenuining the due authorization, execution and delivery of any notice or
other document delivered to Escrow Agent or the genuineness of the signature thereon.
Escrow Agent may rely and shall be protected in acting upon any written notice, instructions
or request furnished to it hereunder and believed by it to be genuine and to have been sibmed
by proper parties. Escrow Agent may rely on instructions in writing sent to Escrow Agent
by facsimile transaction.
Governing Law: This Escrow Agreement shall be governed and construed in accordance
with the laws of the Commonwealth of Pennsylvania.
This Agreement shall be binding upon the heirs, successors or assigns of the parties hereto.
jsg~realestate~ross.escrow
December 10, 2003
IN WITNESS WHEREOF, the undersigned have hereunto set their hands and seals the day
and year first above written.
WITNESS: ~~ '
DIANA CAINE-HELWIG, AGEI'qT FOR
LEE L. HAYDEN, III, executor for the
ESTATE OF LEE L. HAYDEN, JR.
,05.905MS ~V.,O /03)
This is to certify that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Records in accordance
with Act 66, P.L. 304, approved by the General Assembly, June 29, 1953.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Charles Hardester
State Registrar
0417281 DEC 17200
No. Date
H105.143 Rev. 2/87
TYPFJPR~JT
PERMANENT
BLACK INK
COMMONWEALTH OF PENNSYLVANIA ° DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
SEX .I SOCIAL SECURITY NUMBER .I DATE OF DEATH(MD.Ih,. Day, Year)A~
~. Lee. L. Hogde. n, Jr. z Uo~c la. 192 -05 -5255 I~. Nove. moer 17, 2uu5
AGE Last Birthday UNDER 1 YEAR I UNDER 1 DAY I DATE OF SI.R.TH ~B!R~THP_LACI~ (Cijy a?J PLACE OF DEATH ICheck mir one - se~ instructions on other side}
88 ,..I I I I I, 10-26-19151, P4.t.t.~Swtgh, PAli~"""l-I .... ,.,.,UI DoAU %"2[i~ .... []
~OUNTYO~DEAT.~ ~ C,3. SO.O,~.OFDEA.. ~AC,},~.~,ME0,.~in.~,~e.~t..0.~.~.. WAS__Z~=D~TOF.IS.~.,=OR,O,.? Ip=~-¢ .......
I I I No L-~' Yes Il ff Y~, s~ Cuban, I ..... " . .
DECEDENTS
2100 Be~ Creek Bo~cv~d RESIn"CE
Yee~n~csb~g, PA 17055 I ~"> ~. c~,~ C~b~d ~p* ~,d.D~"°'~'~,~ Mec~icsb~ ~o.
FA~ER'S N~E (Fimt.~, ~st) MOTHER'S~E ([~t, M~d~ Ma~.Sum~)
~,. Lee HaFden, ~. ,.An~e Ee~za ~o~
INFORMA.N'PS NAME (Ty~e/Pfint~, ~ .
METHOD OF DISPOSmON DATE OF DISPOSITION
LICENSE NUMBER
Ill
. Ent~ UNDERt. YING
DATE PRONOUNCED DEAD (MonIh, Day, Year}
DUE TO (OR AS A CONSEQUENCE OF]:
D*JE TO (OR ~S A CONSEGUENCE OF):
INFORMANT'S M~II,J N.G.ADD~ESS (S. tr~o~n, S~te,.~J~ Code.)
=Ob. 256 Wr~S Koml, ~:~.;:v./ts, FA l/5J¥
pLACE OF DISPOSITION- Narqe of Cemetery, J3mmatoty .ILOCATiON - C~rTO~n, State, ZiP Code
or O~m Place Caemo. t~on Soc,tet_.g 06 _
PA Cre~ator~ l=~d' fl~risour~, PA 17109
re *on So ~¢ty P
4,00
(r Al Adopt Ih~ ,S ~G~Ny .EyDea r )
WAS CASE t~BPI=NRED TO A MEDICAL EXAMINER ~ORONER?
Co~ld not ~ det~ I ~, TION (~, Ci~, S~}
122 Sou~ Fllb~t St. Mechanicsb~g,PA
B REAGER & ADLER, PC
THEODORE A. ADLER +
DAVID W. REAGER
CHARLES E. ZALESKI
LINUS E. FENICLE
DEBRA DENISON CANTOR
ATTORNEYS AND COUNSELORS AT LAW
2331 MARKET STREET
CAMP HILL, PENNSYLVANIA 17011-4642
717-763-1383
TELEFAX 717-730-7366
WEBSlTE: ReagerAdlerPC.com
May 12, 2004
THOMAS O. WILLIAMS
SUSAN H. CONFAIR
JOANNE HARRISON CLOUGH
SUSAN J. SMITH
+ Certified Civil Trial Specialist
Cumberland County
Register of Wills
Estate of Lee L. Hayden, Jr.
Estate No. 21-03-967
Dear Sir or Madam:
Enclosed please find our check number 16361 in the amount of $497.61. Per Diana C aine-Helwig,
the copy of the attached return has already been filed. Please apply this amount to the above referenced
estate. Please provide a receipt for the payment.
Should you have any questions, please feel free to contact me.
.__~Very truly yours,
Legal ~ssistant
Enclosures
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 003933
BLY SCOTT ALAN
P.O. BOX 341
HERSHEY, PA 17033
........ fold
ESTATE INFORMATION: SSN: 192-05-5233
FILE NUMBER: 2103-0967
DECEDENT NAME: HAYDEN LEE L JR
DATE OF PAYMENT: 05/13/2004
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 11 / 17/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $497.61
REMARKS:
TOTAL AMOUNT PAID:
$497.61
SEAL
CHECK# 16361
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
3~fl/¥Ngl~ (J3ZIIJOHJ.I'I¥
· .E ~ 55 E h'l 005
:,'B'E ,J, ~ ! E 'I E 0:,
.ii il 51E ':3 'I 0.,
19'/-6~'~
J-NFIOI, N¥
~0
~J30~JO
3HI Ol
AVd
T9£9T
El £/£Z~:I-09
>N¥SDNd ~
llOZI VINVAIASNN3d'lllH d~VO
133~±S 13H~V~
INflOOOVlV83N30
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMNONNEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLONANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
SCOTT ALAN BLY ATTY
PO BOX $84
HERSHEY PA
17033
DATE 06-21-2004
ESTATE OF HAYDEN JR
DATE OF DEATH 11-17-2005
FILE NUMBER 21 05-0967
COUNTY CUMBERLAND
ACM 101
Amount Remitted
LEE L
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF MILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~
DISALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF HAYDEN JR LEE L FILE NO. 21 03-0967 ACN 101 DATE 06-21-2004
TAX RETURN WAS: C X) ACCEPTED AS FILED C } CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate CSchedule A)
2. Stocks and Bonds CSchedule B) C2)
5. Closely Held Stock/Partnership Interest CSchedule
q. Mortgages/Notes Receivable CSchedule D)
5. Cash/Bank Deposits/Misc. Personal Property CSchedule E) C5)
6. Jointly Owned Property (Schedule F)
7. Transfers CSchedule G) C7)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/M/sc. Expenses CSchedule H) C9)
10. Debts/Mortgage Liabilities/Liens (Schedule I) ¢10)
11. Total Deductions
12. Net Value of Tax Return
108t000.00
.00
.0O
.00
669.22
.00
C8)
16,947.38
7t330.45
Cll)
(12)
15.
14. Net Value of Estate Sub3ect to Tax
NOTE: If an assessment was issued previously,
reflect figures that include the total
ASSESSMENT OF TAX:
15. Amount of Line lq at Spousal rate
16. Amount of Line 14 taxable at Lineal/Class A rate
17. Amount of Line 14 at Sibling rate
18. Amount of L/ne 14 taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS:
Char/table/Governmental Bequests; Non-elected 9115 Trusts (Schedule J)
(15)
lines 14, 15 and/or 16, 17,
of ALL returns assessed to date.
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
115,335.90
24.277.8~
91,058.07
.00
91 , 058.07
18 and 19 will
¢1s) ~.*00 x 00. _ .00
c1~) 91, 058-:107 x 0~ = 4,097.61
c~7) .00 x 12c2_. = .00
cie) .00 x 1~i = .00
(~)= 4,097.61
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID
02-05-2004
05-13-2004
CD003530
CD003933
180.00
.00
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
AMOUNT PAID I
497.61
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
4,097.61
.00
.00
.00
c IF TOTAL DUE IS LESS THAN ~1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU NAY BE DUE~
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
RESERVATION=
PURPOSE OF
NOTICE=
PAYMENT:
REFUND
OBJECTIONS=
ADHIN-
ISTRATIVE
CORRECTIONS=
DISCOUNT=
PENALTY=
INTEREST=
Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred
in possession or enjoyment to Class 8 (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class 8 (collateral) rate on any such future interest.
To fulfill the requirements of Section 21~0 of the Inheritance and Estate Tax Act, Act 25 of 2000. (72 P.S.
Section 91~0).
Detach the top portion of this Notice and submit with your payment to the Register of Rills printed on the reverse side.
--Hake check or money order payable to: BEGXSTEE OF NXLLS) AGENT
A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an °~pplication
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications are available at the Office
of the Register of Rills, any of the 25 Revenue D/strict Offices, or by calling the special 24-hour
answering service for forms ordering: 1-800-562-2050; services for taxpayers with special hearing and / or
speaking needs= 1-800-4~7-$020 (TT only).
Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interestl as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Beard of Appeals, Dept. 281021, Harrisburg, PA 17128-1021,
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
OR
Factual errors discovered on this assessment should be addressed in writing to= PA Department of Revenue,
Bureau of Individual Taxes, ATTN= Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
If any tax due is paid within three (3) calendar months after the decedent°s death, a five percent (5~) discount of
the tax paid is allo~ed.
The 15X tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six (6~) percent per annum calculated at a daily rate of .O0016q. All taxes which became delinquent on and after
January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2004 are=
Interest Daily Interest Daily Interest Daily
Rate Factor Year Rate Factor Year Rate Factor
20~ .000548 ~'8-1991 11~ .000501 ~ 9~ .0002~7
16~ .000~$8 1992 9~ .000247 2002 6~ .000164
11~ .000501 1995-1994 7~ .000192 2003 5~ .000157
1995-1998 9% .000247 200~ c~. .O00llO
1999 7% .000192
2000 7% .000192
1983
1984
1985
1986 10~
1987 10~
--Interest is calculated
XNTEREST = BALANCE OF
o0005S6
.000274
.000274
as follo~s=
TAX UNPAXD
X NUNBBR OF DAYS DELTNgIUBNT X DALLY I'NTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
1N THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
ESTATE OF LEE L. HAYDEN JR.,
DECEASED
ORPHAN'S COURT DIVISION
NO: 2003-00967
PA NO: 21-03-0967
FAMILY SETTLEMENT AGREEMENT
Filed on behalf of:
Lee L. Hayden III, Executor of the
Estate of Lee L. Hayden Jr.
Counsel of Record:
Scott Alan Bly, Esquire
PA. I.D. No.: 71887
P.O. Box 384
Hershey, PA 17033
(717) 533-8613
(717) 533-8632-fax
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
ORPHAN' S COURT DIVISION
1N RE:
ESTATE OF LEE L. HAYDEN JR.,
DECEASED
) NO: 2003-00967
) PA NO: 21-03-0967
)
FAMILY SETTLEMENT AGREEMENT
: THIS AGREEMENT is made and entered into this ~,/~' day of
~ "t: ,2004 by and among Lee L. Hayden III, as
Executor o~the,~state of Lee L. Hayden Jr., Deceased (hereinafter referred to as "the
Executor"); and LEE L. HAYDEN I[I, JUDY WELCH, PATTY LEFAIVRE, and
DIANA CAINE-HELWlG (hereinafter referred to as "the Beneficiaries").
WlTNESSETH THAT:
WHEREAS, Lee L. Hayden Jr. of Mechanicsburg, Cumberland County,
Pennsylvania, died on November 17, 2003 leaving his Last Will and Testament dated
Julyl6, 1996, with codicils dated October 12, 1996 and February 4, 1998,which was
admitted to probate by the Register of Wills of Cumberland county, Pennsylvania No.
2003-00967 (a true and correct copy of his Last Will and Testament is attached hereto as
Exhibit "A"); and
WHEREAS, Lee L. Hayden III., the Executor named in the said Will, duly
qualified and is now serving as Executor of the Estate of Lee L. Hayden Jr., Deceased
(the "Estate");
WHEREAS, Lee L. Hayden III is also the son of the decedent; and,
WHEREAS, Judy Welch is the daughter of the decedent; and,
WHEREAS, Patty LeFaivre is the daughter of the decedent, and;
WHEREAS, Diana Caine-Helwig is the daughter of the decedent, and;
WHEREAS, the parties hereto constitute all of the beneficiaries under the
Will of Lee L. Hayden Jr. and
WHEREAS, each of the parties to this Agreement does acknowledge to
have received from the Executor an advance cash distribution as evidenced by Receipts
for Distribution which are attached hereto and marked as Exhibit "B"; and
WHEREAS, each of the parties to this Agreement has been furnished with
a complete listing of the estate assets, receipts, disbursements, and distributions which are
all set forth on the Accounting attached hereto and marked Exhibit "C"; and
WHEREAS, the duties and responsibilities of the Executor incident to the
administration of the Estate have been substantially completed; and
WHEREAS, the Beneficiaries desire to have the balance of the Estate
distributed without a formal accounting by the Executor to the Orphan's Court Division
of the Court of Common Pleas of Cumberland County, Pennsylvania (the Court having
jurisdiction over the matter), in order that expense, delay, and publicity may be avoided.
NOW, THEREFORE, the parties hereto, for good and valuable
consideration receipt of which is hereby acknowledged, and intending to be legally bound
hereby, agree with one another as follows:
1)
The foregoing provisions of this Agreement are incorporated
herein by reference.
2)
Each party hereto acknowledges and agrees that the Executor will
not file an Account or Petition for Distribution or secure a Decree
of Distribution from any Court having jurisdiction in the matter
of the Estate of Lee L. Hayden Jr., Deceased and they further
acknowledge their right to compel an accounting an accounting
which right they and each of them hereby waive.
3)
Each Beneficiary acknowledges and agrees that the Schedule of
Distribution attached hereto as Exhibit "D" is satisfactory and
proper and they and each of them accept disthbution in accordance
with its provisions and by executing this Agreement each
acknowledges receipt from the Executor of the property allocated
to him or her on Exhibit "D' in full and complete satisfaction of
his or here legacies under the Will of Lee L. Hayden Jr., Deceased.
4)
The Beneficiaries and each of them hereby forever release and
Discharge the Executor from any and all claims and liabilities of
any kind or nature whatsoever, arising from or related to her
services or status as Executor of the Estate.
s)
It is the expressed intention of the parties hereto that the legal
effect intended by the Agreement he the same in each and every
respect as would be obtained had a Decree of Distribution in this
Estate been entered by the Orphan's Court Division of the Court of
Common Pleas of Cumberland County, Pennsylvania, which
Decree had become final and unappealable.
6)
This Agreement shall be interpreted pursuant to and governed by
the laws of the Commonwealth of Pennsylvania, and shall inure to
the benefit of and be binding upon the parties hereto, their personal
representatives and heirs at law, as the case may be
1N WITNESS WHEREOF, we hereunto set out hands and seals the day and year
first above written.
WITNESS:
Lee L. Hayden III, Executor and Beneficiary
of the Estate of Lee L/Hayden Jr.
Judy Welch. Beneficiary of the Estate of Lee
L. Hayden Jr.
Patty LeFaivre, Beneficiary of the Estate of Lee
L. Hayden Jr.
Diana Caine-Helwig, Beneficiary i~fthe Estate
of Lee L. Hayden Jr
Name of Decedent:
Date of Death:
Will No.:
STATUS REPORT UNDER RULE 6.12
Admin. No.:
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the
following with respect to completion of the administration of the above-captioned estate:
State whether administration of the estate is complete:
Yes ~ No ['--1
o
If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes _ No ~1 -- ~ ~t_%~ ~ ~:~,{ ~tn~a~¢,~-[
b. The separate Orphans' Court No. (if any) for the personal representative's
account is: ~
c. Did the personal r_eipresentative state an account informally to the parties
in interest? Yes 1~ No [-']
Date:
Copies of receipts, releases, joinders and approval of formal or
informal accounts may be filed with the Clerk of the. Orphans' Court
and may be attached to this report.
Signature
Name
Address
Telephone No.
Capacity: ~ Personal Representative
~ Co~sel for personal representative