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HomeMy WebLinkAbout05-14-0915056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number Poaox2sosol INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 08 1198 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 11/16/2008 12/24/1952 Decedent's Last Name Suffix Decedent's First Name MI NAZAY TERESA_ _ S (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW °'~° 1. Original Return 2. Supplemental Return ._,. 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~,~„ 4a. Future Interest Compromise (date of ?„ 5. Federal Estate Tax Return Required death after 12-12-82) ~~ 6. Decedent Died Testate :;= 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received .,.. 10. Spousal Poverty Credit (date of death c~ a 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number THOMAS E. FLOWER (717) 737-3405 Firm Name (If Applicable) _ __ ', REGISTER OF, WALLS USE ONL`T. ~ SAIDIS, FLOWER, LINDSAY _ . l ~ , First line of address _. 2109 MARKET ST _ Second line of address -~-' t ~~ City or Post Office _ .. . __ ...State ZIP Code _ _ DATE-Fd~ED ,.,~ __ ~ CAMP HILL `, PA 17011 :s . _ ; _ ; ~, Correspondent's a-mail address: tflOWer@Sfl-IaW.COn1 untler penalties of perjury, I tleclare 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. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE QF~ERSON RE~SPONSIBILE FOR FILING RETURN DATE ADDRESS ~ + l/'+ It/11(w ~Cr _ ~, RUTH NAZAY, 24 COLD SP IN S RD., CARLISLE, PA 17015 7 SIG E OF PREPARER O HAN REPRESENTATIVE DATE 'c.~'u~-c $~~sZ O q HVURCJJ SAIDIS, FLOWER & LINDSAY, 2109 MARKET ST., CAMP HILL, PA 17011 PLEASE USE ORIGINAL FORM ONLY 15056051058 Side 1 15056051058 15056052059 REV-1500 EX Decedent's Social Security Number Decedent's Name: TERESA S NAZAY . RE CAPITULATION 1. Real estate (Schedule A) . ........................................... . L 166,000.00 2. Stocks and Bonds (Schedule B) ...................................... . 2. 1,035.69 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .... . 3. 4. Mortgages & Notes Receivable (Schedule D) ............................ . 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... . 5. 16,568.94 j 6. Jointly Owned Property (Schedule F) ~;= Separate Billing Requested ...... . 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property __ (Schedule G) 4"°""` Separate Billing Requested....... . 7. 8. Total Gross Assets (total Lines 1-7) .................................... 8. 183,604.63 9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9. 33,442.97 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................ 10. 71,283.46 11. Total Deductions (total Lines 9 & 10) ................................... 11. 104,726.43 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 78,878.20 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. 78878,20 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0 _ 15. i 16. __ Amount of Line 14 taxable °° °° °' at lineal rate X .0 45 72,540.20 16. 3,264.31 17. Amount of Line 14 taxable at sibling rate X .12 6,338.00: 17 760.56 18. Amount of Line 14 taxable at collateral rate X .15 1 g 19. TAX DUE ......................................................... 19. 4,024.87 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN O +uw,;;; 15056052059 Side 2 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: File Number _.. 21 ~ 08 ':1198 _. DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER TERESA S NAZAY 179-44-8536 STREET ADDRESS 703 HALDEMAN BLVD CITY STATE Zlp NEW CUMBERLAND PA 17070 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. InterestlPenalty if applicable D. Interest E. Penalty 4,024.87 Total Credits (A + B + C) (2) Total InterestlPenalty (D + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 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. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) (4) (5) (5A) (56) 0.00 0.00 4,024.87 4,024.87 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 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 three (3) percent [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 zero (0) percent [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 zero (0) percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, 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 twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER T. SANDRA NAZAY 21-08-1198 au 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. (ir more space Is neetletl, insert additional sheets of the same size) B-H l+o~r`App•a!sal services Flle No 030D109 f Address: 703 Haldeman Blvd. City: New Cumberland County: Cumberland Legal DeSCflption: See Attached Deed Copy from DB 238 PG 197 Borrower: N/A Lender/Client: Estate of T. Sandra Nazay Address: 703 Haldeman Blvd. New Cumberland. Pa. 17070 Prepared By: G_ Arthur Calaman, Pa. Cert.# RL-139418 Company: B-H Agency Appraisal Services Address: 163 N. Hanover Street Carlisle, Pa. 17013 Phone: (717) 243-1000 ext. 216 Fax: (7 Prepared As Of: March 3, 2009 _____ _ _ Cover Page with Photo and Contents Cover Letter Uniform Residential Appraisal Report Certification and Limiting Conditions Text Addendum Subject Photos Building Sketch Comparable Photos Location Map Deed/Legal Description Unit Na.: N/A State: Pa__ Zip Code: 17070 17) 243-1718 Email: bhap_praisal@_c_o_m_c_a_st.net _ ___ Estimated Market Value: $ X166,000.00 _ _ __ ____ _ REV-1503 EX+ (6-98) ~ SCHEDULE 6 COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER T SANDRA NAZAY 21-08-1198 All property jointly-owned with right of survivorship must be disclosed on Schedule F_ (li more space Is needed, Insert additional sheets of the same size) REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER T. SANDRA NAZAY 21-08-1198 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 1996 HONDA PASSPORT, 86,500 MILES, SALE PROCEEDS 2,000.00 2 MEMBERS FIRST FCU ACCT #72569 -CHECKING 137.28 3 MEMBERS FIRST FCU ACCT #72569 -SAVINGS 596.63 4 MEMBERS FIRST FCU ACCT #72569 -MONEY MGT SAVINGS 8,370.03 5 HOUSEHOLD FURNISHINGS & PERSONAL EFFECTS 2,500.00 6 US Treasury CSF Lumpsum payment 969 98 7 FEDERAL INCOME TAX REFUND 1,995.02 TOTAL (Also enter on line 5, Recapitulation) $ I 16,568.94 (If more space is needed, insert additional sheets of the same size) St 0 MEMBERS 1St FEDERAL CREDIT UNION Send Inquires to: 5000 Louise Drive PO Box 40 Mechanicsburg, PA 17055 www.membersi st.org Main Switchboard: (717) 697-1161 or (800) 283-2328 EZ Call: (717) 697-4372 or (800) 283-4372 TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 TeleBranch: (717)795-6049 or (800)237-7288 T SANDRA NAZAY 703 HALDEMAN BLVD NEW CUMBERLAND PA 17070-1433 Statement of Accounts Oct 25, 2008 thru Nov 24, 2008 Account Number: 72569 Balances at a Glance: Checking: 347.28 Savings: 830.18 Certificates: 15, 243.27 Loans: o.oo Money Management: 8,370.03 Swipe 5 YTD Reward: s.25 Page: 1 of 3 Your current Member Loyalty Rewards level is Gold. Your aggregate balance as of November 1st is $2s,s38.40. An aggregate balance of $35,000 and having 3 products will move you to the Platinum level. Need a gift for someone special? Our VISA Prepaid Gift Cards make the pertect gift for everyone on your list. Ask an associate for details. CHECKING ACCOUNTS 11 -CHECKING Date Transaction Description Additions Subtractions Balance Oct 25 Balance Forward 87 s8 Oct 27 Withdrawal Debit Card 44.03- 43.65 TRANSACTION DATE - 10/26/2008 10/25 4445001456145 TURKEY HILL #0091 069 LEMOYN Oct 31 Deposit Swipe 5 Rebate 0.90 44.55 Nov 04 Deposit Members 1st Online Transfer From Share 00 1,700.00 1,744.55 Nov 05 Withdrawal Bill Payment LEFFLER ENER 812.00- 932.55 Nov 05 Withdrawal Bill Payment PHH 795.27- 137.28 Nov 22 Deposit by Check 210.00 347.28 Nov 24 Ending Balance 347.28 Courtesy Pay and NSF Fee Summary Courtesy Pay Fees Year- to- Date 90.00 WITHDRAWALS AND OTHER CHARGES Date Amount Description Date Amount Description Oct 27 44.03 Withdrawal Debit Card Nov 05 795.27 Withdrawal Bill Payment Nov 05 812.00 Withdrawal Bill Payment 3 Withdrawals and Other Charges for 1, 651.30 DEPOSITS AND OTHER CREDITS Date Amount Description Date Amount Description Oct 31 0.90 Deposit Nov 22 210.00 Deposit by Check Nov 04 1,700.00 Deposit Members 1st Online Transfer 3 Deposits and Other Credits for 1, 910. 90 --- Continued on following page --- 4t Send Inquires to: Main Switchboard: 717 697-1161 or 800 283-2328 5000 Louise Drtve ( ) ( ) OCt 25, 2008 thru Nov 24, 2008 EZ Call: 717 697-4372 or 800 283.4372 PO Box 40 ( ) ( ) Mechanicsbur , PA 17055 TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 s Account Number: 72569 MEMHER51^~ TeleBranch: (717)795-6049 or (800)237-7288 ..o ,o~ www.memberslst.org Page: 2 Of 3 SAVINGS ACCOUNTS 00 - REGULAR SAVINGS Date Transaction Description Additions Subtractions Balance Oct 25 Balance Forward 154.87 Oct 28 Withdrawal at ATM #927965 102. 00- 52.87 ATM RGNL/MAC 99 OLD YORK ROAD NEW CUMBERLAN PA Oct 31 Deposit Dividend 1.000% 0.77 53.64 Annual Percentage Yield Earned 1.010% from 10/01/2008 through 10/31/2008 Nov 03 Deposit ACH CIVIL SERV 2,167.86 2,221.50 ID: 3121736156 CO: CIVIL SERV Nov 04 Withdrawal Members 1st Online Transfer To Share 11 1,700. 00- 521 .50 Nov 10 Deposit VISA Credit Card 75.13 596.63 Cash Reward Nov 24 Ending Balance 596.63 02 - HOLIDAY CLUB Date Transaction Description Additions Subtractions Balance Oct 25 Balance Forward 0.00 Nov 24 Ending Balance 0.00 05 - MONEY MANAGEMENT Date Transaction Description Additions Subtractions Balance Oct 25 Balance Forward 8,361.93 Oct 31 Deposit Dividend Tiered Rate 8.10 8,370.03 Annual Percentage Yield Earned 1. 150% from 10/01/2008 through 10/31/2008 Nov 24 Ending Balance 8,370.03 1Z- ROTH IRA SAVINGS Date Transaction Description Additions Subtractions Balance Oct 25 Balance Forward 233.35 Oct 31 Deposit Dividend Tiered Rate 0.20 233.55 Annual Percentage Yield Earned 1.010% from 10/01/2008 through 10/31/2008 Nov 24 Ending Balance 233.55 CERTIFICATE ACCOUNTS 21 - 12 MONTH ROTH IRA CERT Maturity Date - Jan 24, 2009 Date Transaction Description Additions Subtractions Balance Oct 25 Balance Forward 7,440.12 Oct 31 Deposit Dividend 3.980% 25.15 7,465.27 Annual Percentage Yield Earned 4. 050% from 10/01/2008 through 10/31/2008 Nov 24 Ending Balance 7,465.27 zz - 1z MONTH BOTH IRA CERT Maturity'Date -Jan 15, 2009 Date Transaction Description Additions Subtractions Balance Oct 25 Balance Forward 4,014.97 Oct 31 Deposit Dividend 3.980% 13.57 4,028.54 Annual Percentage Yield Earned 4. 050% from 10/01/2008 through 10/31/2008 Nov 24 Ending Balance 4,028.54 --- Continued on reverse side --- St Send Inquires to: Main Switchboard: (717) 697-1161 or (800) 283-2328 ~~° 5000 Louise Drive E2 Call: (717) 697-4372 or (800) 283.4372 PO Box 40 TDD: Mechanicsburg, PA 17055 (717) 697-5312 or (800) 283-2328 ext. 5312 MEMBERS I° TeleBranch: (717)795-6049 or (800)237-7288 .,o...,~m ,. www.membersist.org Oct 25, 2008 thru Nov 24, 2008 Account Number: 72569 Page: 3 of 3 23 - 12 MONTH ROTH IRA CERT Maturity Date - Jan 30, 2009 Date Transaction Description Additions Subtractions Balance Oct 25 Balance Forward 3,737.59 Oct 31 Deposit Dividend 3.740% 11.87 3,749.46 Annual Percentage Yield Earned 3. 800% from 10/01/2008 through 10/31/2008 Nov 24 Ending Balance 3,749.46 YTD SUMMARIES TOTAL DIVIDENDS PAID 00 REGULAR SAVINGS 7.61 02 HOLIDAY CLUB 1.81 05 MONEY MANAGEMENT 230.24 11 CHECKING 0.00 12 ROTH IRA SAVINGS 1.95 21 12 MONTH ROTH IRA CERT 243.81 22 12 MONTH ROTH IRA CERT 131.56 23 12 MONTH ROTH IRA CERT 115.91 Total Current Year Roth IRA Contributions Total Year To Date Dividends Paid NOTE: Total includes closed shares Total Year To Date Nontaxable Dividends Total Year To Date Interest Paid NOTE: Total includes closed loans Add Your Photo For Security 0.00 239.66 493.23 0.00 Your personal safety and financial security are top priorities at Members 1st. As a result of increased scams and fraudulent activity throughout the entire country, we are strongly encouraging members to have their photos added to their account records. When visiting our branch offices, you may be asked by one of our Associates to allow us to take your photo. This member identification program will assist in our fraud deterrence initiatives and will take our identity theft prevention program to the next level. We are experiencing an increasing number of attempted fraudulent activities and as a result, we need to be able to verify your identity immediately upon retrieving your account information. In addition to having your photo in our files, you may be required to show additional forms of identification based on the type of transaction you are seeking. This is for your protection and security and we appreciate your ongoing cooperation and understanding. REV-1510 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER T SANDRA NAZAY 21-08-1198 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. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH ACOPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE ~ • MEMBERS FIRST FCU ACCT #72569 - ROTH IRAs, PAYABLE TO KRISTOFER T. NAZAY, SON -NONTAXABLE: DECEDENT WAS 56 YRS. p 0.00 2. FEDERAL EMPLOYEE TAX-DEFERRED THRIFT SAVINGS ACCT - PAYABLE TO SON -NONTAXABLE: DECEDENT WAS 56 YRS. OLD p 0.00 TOTAL (Also enter on line 7 Recapitulation) $ I 0.00 (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 T. SANDRA NAZAY 21-08-1198 Debts of decedent must be reported on Schedule I, ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t' PARTHEMORE FUNERAL HOME, CREMATION WITH MEMORIAL SERVICE 3,890.00 2. STATIONERY 135.00 s URN 203.00 a OBITUARY 280.62 e DEATH CERTIFICATES 72.00 s CLERGY, ORGANIST SOLOIST, ALTAR SERVERS HONORARIA; MEMORIAL DINNER 540.00 7 CORONER'S AUTHORIZATION FEE 25.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 2,500.00 Name of Personal Representative(s) RUTH NAZAY Social Security Number(s)/EIN Number of Personal Representative(s) Street Address 24 COLD SPRINGS RD City CARLISLE State PA Zip 17015 Year(s) Commission Paid: 2. Attorney Fees 15,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3,500.00 Claimant KRISTOFER T NAZAY Street Address 703 HALDEMAN BLVD City NEW CUMBERLAND State PA Zip 17070 Relationship of Claimant to Decedent SON 4. Probate Fees 340.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. PUBLISH ESTATE NOTICES, 75 + 162.03 237.03 s. SHORT CERTIFICATES 16.00 s. LEGGETT'S, PLUMBING AND ELECTRICAL REPAIRS 3,070.00 to. SHAMBAUGH MASONRY, CHIMNEY REPAIRS 700.00 i ~ COUNTY/LOCAL REAL ESTATE TAXES 763.14 t2. CONTINUATION SHEET TOTAL 2,171.18 TOTAL (Also enter on line 9, Recapitulation) $ 33,442.97 (If more space is needed, insert additional sheets of the same size) T. SANDRA NAZAY ESTATE SCHEDULE H CONTINUATION SHEET 21-08-1198 Al LEFFLER ENERGY, HEATING FUEL, 3 MONTHS 1,218.00 A2 REAL ESTATE APPRAISAL 325.00 A3 PPL ELECTRIC, 3 MONTHS 201.89 A4 PA AMERICAN WATER, 3 MONTHS 128.14 A5 NEW CUMBERLAND BORO. SEWER/TRASH BILL 298.15 CONTINUATION SHEET TOTAL: 2,171.18 REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER T. SANDRA NAZAY 21-08-1198 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~ PHH MORTGAGE LOAN 66,148.61 2. COMCAST CABLE, PAST DUE AMOUNT 485.97 3. ATT MOBILE, PAST DUE AMOUNT 96.56 4. MEMBERS 1 ST VISA 2,353.92 5. WEST SHOREEMS,AMBULANCE 1,102.53 6. HOLY SPIRIT HOSPITAL 150.00 7. NEW CUMBERLAND BORO., SEWER/TRASH, PAST DUE AMOUNT 298.15 8. PINNACLE HEALTH HOME CARE 154.46 9. J.C. PENNEY 47 98 10. PPL ELECTRIC, PAST DUE AMOUNT 96 78 11. PA AMERICAN WATER, PAST DUE AMOUNT 259.30 12. VERIZON, PAST DUE AMOUNT 89 20 TOTAL (Also enter on line 10, Recapitulation) $ I 71,283.46 (If more space is needed, insert additional sheets of the same size) Payment Statement Page 1 of 1 Log Out ~ Glossary ~ FAQ ~ Contact Us MortgageQuestions.com Stillc^~h~a~vequestiostn~s? , r Your Accounts ~ Statement ~ Payments T Resource Center ~ Message t'Cro~~~n'~~~ntt~l-67 ~`"~""'<'"j '~! Overview Activity Escrow Information Year End Information PMI Information Overview Customer Information Loan Number: 0011720992 Borrower: ESTATE OF TERESA NAZAY Co-Borrower: Home Phone: 717-774-5561 Other Phone: 999-999-9999 Payment Information Having trouble making mortgage payments? Click here for help! Billing Mode: Coupon Book First Payment Date: 03/01/2001 Last Payment Date: 01/12/2009 Next Payment Due: 02/01/2009 Payment Due: $790.13 Your payment is comprised of the following amounts: Principal and Interest $518.88 City Tax: $62.20 Hazard Escrow: $74.42 Other Taxes: $122.26 OveragelShortage: $12.37 Miscellaneous Prin Loan Information Mailing Address Loan Type: Original Loan Amount: Principal Balance: interest Rate: Loan Mature Date: 703 HALDEMAN BLVD NEW CUMBERLAND, PA 1; Conventional without PMI $80,000.00 $66,148.61 6.750% 02/01 /2031 Yea r to Date Tota Is Principal: Interest: Insurance: Taxes: Miscellaneous: $145.97 $372.91 $0.00 $0.00 $0.00 All information viewed on this site is sent through a secure connection. Any information you exchange with this site can nat I viewed by anyone else on the Web. Account information is updated daily at 8:00 am Tuesday -Sunday. Account activity firom Saturday to Monday will be available by 8:00 am Tuesday. © 2009, MortgageQuestions.com. All rights reserved. https://www.mortgagequestions.com/home/ 15882/landscape?jpid=MQPaymentStatementI... 1 /20/2009 REV-1513 EX+ (g-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER T. SANDRA NAZAY 21-08-1198 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE 1 TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 KRISTOFER T. NAZAY, 703 HALDEMAN BLVD, NEW CUMBERLAND SON 100% OF RESIDUE 2 RICHARD J. NAZAY, JR, 24 COLD SPRINGS RD, CARLISLE 17015 BROTHER 3,169 3 VICTORIA WHEELER, 109 LEE ANN CT., ENOLA, PA 17025 SISTER 3,169 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROU GH 18, AS APPROPRIATE, ON RE V-1500 COVER SHEET 11 NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I S (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT OF T. SANDRA NAZAY I, T. Sandra Nazay, of 703 Haldeman Avenue, New Cumberland, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking all other Will and Codicils heretofore made by me. FIRST I direct the payment of my just debts and expenses of my last illness and funeral from my estate as soon after my death as conveniently may be done. I direct that my body be cremated, the remaining ashes buried beside my parents in Holy Cross Cemetery, and a suitable marker erected at my grave. It is my wish that the funeral 2 ceremony be conducted in St. Theresa's chapel, and be followed by a small reception at modest expense. I direct my personal representative to make known to those attending this reception my wish that they celebrate, not mourn. I authorize my r ~-- personal representative to expend funds from my estate, in such amounts as they shall deem necessary and desirable, for the preceding purposes. SECOND I give Three thousand one hundred sixty-nine ($3,169.00) dollars, each., to Victoria Wheeler and to Richard J. Nazay, Jr., to be paid to them out of the proceeds of sale, after the house I own at 703 Haldeman Avenue, New Cumberland has been sold or liquidation of assets. THIRD I give, devise and bequeath all the rest, residue and remainder of my estate to my son, Kristofer Tyler Nazay, absolutely and in fee simple, if at the time of my death he has attained the age of twenty-five (25) years. FOURTH In the event that my son, Kristofer Tyler Nazay, has not attained the age of twenty-five (25) years, then I give, devise and bequeath my estate together with any other property which may be added, to Sharon and Paul Sherban, of 614 Northlawn Ct. Lancaster, Pennsylvania, IN TRUST nevertheless, upon the following terms and conditions: (A) To hold, manage, invest and reinvest the principal so received, and accumulation of income thereon, and to use, pay and apply the income and ~ principal or so much thereof as in Trustee's sole discretion may be necessary for the maintenance, support, medical expenses and education of my son. If upon my death, Kristofer is under 18, I wish Kristofer to continue the education at Carson Long i~iiitary institute, in Mew Bioonuieid. (B) The payments authorized by this trust may be made by my trustee directly to said child, should he be, in the sole opinion of trustee, of such age and ability to handle properly the funds so paid, or may be made directly to the person having custody and care of said child, or may be made directly to any institution entitled to such payment by reason of services rendered or to be rendered to said child. 2 (C) The amount to be paid for the benefit of my son shall be determined from time to time by his need, and the amounts and times of said payment shall be determined by such need, provide that payment be made at least quarterly. (D) All payments of principal and income hereby given shall be free from anticipation, assignment, pledge or obligations of the beneficiary, and shall not be subject to any execution or attachment. (E) All principal and accumulated income, not so applied, shall be distributed to my son, as follows: (i) After my son shall have attained the age of twenty-one (21) years, my Trustee shall thereafter pay to my son the net income derived from the Trust in installments not less frequently than quarterly and such amounts of the principal, as in the sole discretion of my Trustee, may be necessary for my son's maintenance, support, medical and nursing care and education, including college and graduate education, taking into consideration any other means readily available for such purposes. (ii) After my son shall have attained the age of Twenty-five (25) years, my Trustee shall distribute to my son outright the then remaining balance of the Trust. (F) In the event that Sharon and Paul Sherban is unable or unwilling to serve as Trustee's of the trust herein established for the benefit of my son, I appoint Ruth Nazay as Successor Trustee. 3 FIFTH In addition to the powers conferred by law, I authorize any personal representative, trustee or guardian acting under this instrument, in his/her absolute discretion: (a) To retain in the form received, or to sell either at public or private sale any real or personal property: (b) To exercise any options to subscribe fc-r stocks, bonds, or other investments. (c) To join in any plan of lease, mortgage, consolidation, exchange, reorganization or foreclosure of any corporation. in which my estate or any trust may hold stocks, bonds or other securities; (d) To sell, transfer, convey, mortgage, pledge, lease or exchange any property, real or personal, which at any time may form part of my estate, for the payment of debts or taxes, or for any purpose of administration or distribution, for such prices and upon such terms as they, in their- sole discretion, may deem wise, and to execute and deliver deeds of conveyance or transfer thereof; (e) T o make settlements and compromises on such terms as they, in their sole discretion may deem wise without the: necessity of obtaining any court approval thereof; (f) To make distribution hereunder either in cash or kind, as they, in their discretion may deem wise. 4 SIXTH In the event that legal custody of my son, Kristofer, is not assumed by his natural Father, I appoint Sharon and Paul Sherban guardian of the person of my son, during his Minority. In the event Sharon and Paul Sherban is unable or unwilling to act as Guardian. I appoint, as Alternate Guardian, Ruth Nazay SEVENTH I appoint Sharon and Paul Sherban Guardian of the property of my son, during his minority. EIGHTH d ~ I do hereby nominate, constitute and appoint Sharon and Paul Sherban to act as Executor of this my Last Will and Testament. Provided, however, that if he is unwilling o~ ~ unable to act as Executor, I direct the duties of Alternate Executor be performed by I-- Ruth Nazay. NINTH I direct that no personal representative, guardian, trustee or other fiduciary appointed nc'.er this instrument shall be required to give bond for the faithful performance of their duties in any jurisdiction. 5 IN WITNESS WHEREOF, I, T. Sandra Nazay, have hereunto set my hand and seal to this my Last Will and Testament, consisting of six (6) typewritten pages, the first five (5) of which bear my signature in the margin for identification, this _18 day of August , 2005. c, ~=~~ ~_ C~ T. Sandra Nazay, Test ix Signed, sealed, published and declared by the above-named Testatrix, T. Sandra Nazay, as and for her Last Will and Testament in the presence of us, who have Hereunto subscribed our names at her request as witnesses thereto, in the presence of said Te tatrix and o e ~ - ~'`~ ADDRESS ~~3 ~,t, .Sri~lXJ~LS ~ -~~. ~~ ~i~~ si3v~~ pq ~7Ci. ~ ~ ~~~-~~ ADDRESS ~~ C~/~~y~'rti1 ~~ ~~~f~~~~'+~~°,1~ ~'r.~ro 6 JOHN E. SLIKE ROBERT C. SAIDIS JAMES D. FLOWER, JR CAROL J. LINDSAY JOHN B. LAMPI DANIEL L. SULLIVAN DEAN E. REYNOSA THOMAS E. FLOWER MARYLOU MATAS JASON E. KELSO LAW OFFICES SAIDIS, FLOWER & LINDSAY A PROFESSIONAL CORPORATION 2109 MARKET STREET CAMP HILL, PENNSYLVANIA 17011 TELEPHONE: (717) 737-3405 -FACSIMILE: (717) 737-3407 EMAIL: tflowerQsfl-law.com www.sfl-law.com May 12, 2009 Office of the Register of Wills Cumberland County Courthouse Room 102 One Courthouse Square Carlisle, PA 17013 CARLISLE OFFICE: 26 WEST HIGH STREET CARLISLE, PA 17013 TELEPHONE: (717)243-6222 FACSIMILE: (717)243-6486 REPLY TO CAMP HILL ~-~ r.a _ :._> Re: Estate of Teresa S. Nazay ==~ ~ ~ File No. 21-08-1198 `--~° ~~: ~ ~. - ~ -< Dear Sir or Madam: ~ ~" ,+ ~ .~, _ Enclosed are the original and two copies of the Inheritance Tax Retu~l-~pr the move- referenced decedent along with a check in the amount of $15.00 in payment of the fili»g fee. Please return atime-stamped copy in the enclosed self-addressed stamped envelope. ", Please contact our office if you have any questions regarding this matter. Very truly yours, SAIDIS, FLOWER & LINDSAY Karen Riccardo, Assistant to Thomas E. Flower, F,sq. TEF/kar Enclosures .. _. _ _ _.. _._... _. r ~~C. ~~~C~ ,711 ~. ~S o i--.. iI? ~ ~ ~ti c q~ LL \'' tc~, ~ VI i ?~3~ ,'dH ~~ ..ti ~~ '~ '~~; tt~.~ "ti. ~ A ~ ~ a vo ~ ~ ~¢ ~~ ~ r' O o .a L y z ~~ ~~ 3 ~ ~~ o, a O O ~ O w` °~ ~ U o ~~ ~ r~r +~-~ ~ N 'C ~ A d p ~ ~ p ~ m~ EU ~ U E O N ~~ ~ 7 O ~ (0 OU~OU O H ~~-i 4 Q ~'" ~ -~ , . -C , :;~r~ -, t~„ .'_ ~-- -~-: ,~}-, ~ -;~, ,~.. .~ ,)'~ . _c- .~,