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HomeMy WebLinkAbout11-13-09ti 1 y 1505607121 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number Po Box 2sosol INHERITANCE TAX RETURN 2 1 0 9 0 6 8 1 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 6 7 2 6 7 3 9 0 0 5 2 0 2 0 0 9 1 0 2 5 1 9 3 2 Decedent's Last Name Suffix Decedent's First Name MI H Y A T T J O A N K (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI H Y A T T G LE N N A 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 Retum 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 ~ 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 1 AX INFUKMA I IUN Jt1UULU tit UIKtI. ~ tU ~ u: Name Daytime Telephone Number R O G E R B I R W I N E S Q U I R E 7 1 7 2 4 9~ 3 5~x~ Firm Name (If Applicable) ~!~ t ~" REG ~~ F WILLS9$E ONf~. -~ ~ t~ ~::: ~. I R W I N & M c K N I G H T P C ~`° c-~ -~ ~.'Y-k ~- First line of address ~-~,, ~ ~ "~"~ :r ~ ~ -, ~; 6 0 W E S T P O M F R E T S T R E E T ~~~C~ "~' - --~, ~c. _ Second line of address -~ W .°;~ -.r _,,,.I c.r 1 %.~ City or Post Office C A R L I S L E Correspondent's a-mail address: Y~ ~ _; ,, State ZIP Code DATE FILED ~ P A 1 7 0 1 3 Under penalties of perjury, I 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. Declaration of preparer other than the personal representative is based on all information of s any knowledge. SIGN~IR F PERSON R~PONSIBL'F„` F~~ ILIN RETURN ` ~ ATE2_ ~ q ~~F "` ~ 1 1 1465 MAPLEWOOD DRIVE NEW CUMBERLAND PA 1?070 SIGNATURE O P EPARER O ER TH REPRESENTATIVE DAT 60 WEST P,f~MF^iET STREET 1505607121 CARLISLE PLEASE USE ORIGINAL FORM ONLY Side 1 PA 17013 15056U7121 J r 'C22L0950S'[ 422L095052 Z aP!S 1N3WAVd213A0 Ntl ~O aNf1~321 d JNI1S3f1b321 32lH f10A ~I lt/AO 3H1 NI lll~ 'OZ 0 0 ° 0 '6L ................................................ anQ X1'66 0 0. 0 .8 ~ 0 0 0 9 6' X a;e~ ~e~a;epoo ;e a~gexe; ti6 auil ~o;unowy •86 0 0' 0 ~~ 0 0. 0 Z6' X a;e~ 6ul~gis;e a~gexe; ~, ~ aui~ ~o;unowy •~ ~ 0 0. 0 •g6 0 0 0 0• X a}e~ ~eaui~;e a~gexe; ~~ aui~ ~o;unowy '96 0 0° 0 'S ~ 9 Q° h O h Q Q o• x (Z• 6)(e) g ~ 66 •oaS ~apun saa~sue~; ~o 'a;e~ xe; ~esnods ay;;e a~gexe; {,~ auil ~o;unowy •g6 S311V213181/Ollddt/ 210 SNOI1~f1211SN133S - NOI1V1f1dW00 Xdl 9 ~ ~ h 0 h ~ Q 'b6 .................. (£6 auil snuiw Z6 auil) ~1 of;oafgng anleA ~aN 't~6 • •g ~ • • • ' ' ' ' • ' ' • ' ' ' • • ' • (p a~npayoS) spew uaaq ;ou set' xe; o; uoi;oa~a ue yoiynn ~o~ s~sn~l £ 6 66 oaS~s;sanbag ~e;uawu~ano0 pue a~qe;uey0 •g ~ 9 Q• h O h Q Q •Z6 ....... .................. (~ 6 aui~ snuiw g aui~) a;e;s3;o anleA 3aN 'Z6 0 0. 6 9 6 ' 6 6 ....... .................... (0 6 '8 6 sauil leio3) suol;onpaa le;ol ' 6 6 • '06 ....... ..... (I alnPayoS) suai~'8 `sad;i~igei~ a6e6~ow `;uapaoaa ~o s;qaa •06 0 0 • 6 9 6 .6 ~ ~ • • • • • • • • • • • • ' • (H a~npayoS) s;so0 ani;e~;siuiwpy'8 sasuadx3 ~e~aun~ •g 9 Q • E L E 6 ~ .8 ........................... - (~-~ saui~ le~oi) s;asst' ssa0 le~ol '8 9 ~ • E Z E 6 Q 'L ' ' ' ' ' ' ' pa;sanba~ 6ui~~i8 a;e~edaS ~ (O a~npayoS) ~(~adad a;egad-u N snoaue~~aosiW ~ s~a~sue~l sonin-aalul 'L •g ' ' • • • • • pa;sanba~ 6ui~~i8 a;e~edaS ~ (~ alnPayoS) ~adad paunnp ~(~;uio~ •g • 'S ' ' ' • ' • ' (3 alnPayoS) ~adad ~euos~ad snoaue~~aosiw ~ s;isodaa ~uee 'yse0 •g • .~ ........................ (d alnPayoS) algeniaoaH sa;oN'8 sa6e6~ow •~ •£ • • • • • (O a~npayoS) diys~o;ai~dad-a~oS ~o diys~au}~ed `uo~e~od~o0 p~aH ~(~asol0 'E • .Z .................................. (e alnPayoS) spuog pue shoo;S 'Z • ~ ........................................ (d alnPayoS) a;e;sa ~eaH • ~ NOll~d-If111dV0321 0 6 E ~. 9 2 Z 9 'C .1..L d Jl H • ~I N d 0 (' :aweN s,~uapa~aa ~agwnN i(}unoaS ~eiooS s,;uapaoaa X3 005 6-n321 2222095052 1 REV-1500 ~x Page 3 File Number npcedpwt's Complete Address: 21 09 0681 DECEDENT'S NAME JOAN K. HYATT STREET ADDRESS 1465 MAPLEWOOD DRIVE CITY CARLISLE STATE PA ZIP 17013 Tax Payments and Credits: 1 • Tax Due (Page 2 Line 19) (1) 0.00 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 0.00 3. InterestlPenalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 0.00 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. (4} 0.00 5. if Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 0.00 Make Check Payable to: REG/STER 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 sha{I 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 "intrust 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 exemat 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}J. 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-1510 FiJC + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER JOAN K. HYATT 21 09 0681 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 OECEDENTAND THE DATE OF TRANSFER. ATTACHACOPYOFTHEDEEDFDRREALESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IFAPPLICABLE) TAXABLE VALUE 1. AMERICAN GENERAL LIFE INSURANCE COMPANY 28,275.63 100. 28,275.63 ANNUITY #A36014321 F 2. AMERICAN GENEARL LIFE INSURANCE COMPANY 61,098.23 100. 61,098.23 ANNUITY #A36014322 F BENEFICIARIES: ALL DISCLAIMED TO ESTATE CLAIRE E. RINGLE THOMAS M. HYATT MICHAEL G. HYATT TOTAL (Also enter on line 7 Recapitulation) ~ $ 89,373.86 (If more space is needed, insert additional sheets of the same size) REV-1511 FrX + (10-06) a COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER JOAN K. HYATT 21 09 0681 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Street Address City State Zip Year(s) Commission Paid: 2, Attorney Fees IRWIN & MCKNIGHT, P.C. 900.00 3, Family Exemption: (If decedents address is not the same as claimants, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees REGISTER OF WILLS 54.00 5 Accountants Fees 6. Tax Return Preparers Fees 7. REGISTER OF WILLS -FILING FEE 15.00 TOTAL (Also enter on line 9, Recapitulation) I $ 969.00 (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (g-00) z 1 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER JOAN K HYATT .,~ .,., ,,.,.,. ~. ~~ ~~~~ RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright sppousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. GLENN A. HYATT Spousal 88,404.86 1465 MAPLEWOOD DRIVE REMAINDER NEW CUMBERLAND PA 17070 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ fir more space is neeoea, insert aaalnonal sneers or the same size) t ~ ~` 1 a l~ O ,~ ,~ __~r -LeST HILL 61~D TESTAMENT ~ ~'7 f' _} l_i --! C F r~~ • dGAN K. IiTATT I, JOA11 K. HYATT, Gg CDt'aOpvli9, Pennsylvania, be=og oP full age, sound mind and memory and under no restraint, do make , publis~tt and .~#eclare th.a inatrUment to be my Last i~ili and Teetaoenb and- Hereby revoke ell Halls and C.bdicils ever - be fore made by .me . IT~ I direct my Sxeeutar to pay all of the Expenae$ aP my Last illness, oi' my t'uneral and b.u' ial Sac o f t he edmin ie- irration oP ~qyR e~at~ate . ITBW.II ~~- I d3reot t4Y E.t~eautor t4 pay all inberitaace, tranai'er_, estate and aimiiar t axes (including interest and ~nF.3~.ties ) assessed or payable by. reason of my death on any ~ropertiy or interest ire propacty Nhiob is..ineluded in aY. estate for the purpose of ooapucing taxes, 2~y Exeoutor shall not require I ang beneficiary under chls Gill to reimburs® my estate fbr taxes paid on property pas9ing under the terms vl thfs Will. II l o ~ 8 ~ tea: ~ • 1, ' ~._-~ r°~..i i~ .~ -~~ ~" --i c' '~ -~ O -' _ ^- ,;- .J : - ~ , ~~ ~.'~. ~~ ~. _~ r 1 .. ITEM ITI I Kereby authvriza ^y~ Executor to utilize the services of en attorney, aoes~untant and any ocher prot'essional a9 way , be necessary in the ade!inistratioo of this, mg bast Nfil and Testament . T.na expens®s lneut`red by the B~oeoutor using such Frote9sioual services shall be an expense to aY estate and shall ue paid b~- mg estate. ' I'_"EM IV Hy tae egtor named herein aha13. be enti:.led to reaeon- ~ble oom.Fensatfou cyom~nensuraC a uiicn the service8 aatuallp perPorm~ed and to .reimburseaeni ~br ExFenaee oroperiy .incurred. ITE~9 1 give, devise and bequeet~i ay entire estate, ~ahetber ~ real, pers~oaal or mixed , of every kind, nature ana deaorip- tion. whatsoever, end Wherever situated, wgiah I me-y riow o~-n ar hereafter aognire , or have the r igbt , td dispose o f ®t the tine aP my death, try the power oP appointteot or otherWiee, tQ my: spouse, GLiNB A. BILATT, sasolutely and in Pee 9imp~l,e. IT6~1 YI . 3hou? d, horever , :oy spouse , GLENN 1!. Hl' A'~T, predaeease me or fai3 to sur4ire• me by thirty (3d) days, then the $it`ta , devlsea and bequests to my spouse shall Pail end be o f roc; e.F!'e ct , are e { n that event , I gi0e , devise a~-d bequest h the Ersti~e residue oP ~- estate , whFther rea.~ , peraonEl or ~~ 20'8 ~i t ' - ioixed , of every kind, naturF and deserip4 ion Mhstsoever , arc whereve^ situated, MhfcYt I ma,~ now oMn or hereai'ter 3equ3.re, or have vhe .right to dispose •of at the. time CF oqy death, by the powe. • o e appoints®nt or othe~rKfse, to my• children, lIICBABL G.' HYAT?, RHOMAS M. ~IYATT and Q.AIRE 6. RIIiQ-LB, •ab®oiutely. $nd in ~+ee simple, share and share alike. Shou3d ens such ehi.ld predecease coe, Shea his or her share shall pass per stirpes, GhaC is ~ a~ i'f that child lass living isa~e, the porEion oP my estate a~herwise reserved for CbaE child shall t~e distributed among said living issue oy • right . o P. t~epresentat ion; cr tb~ it' that child has ao . living issue, she portion of r~-. estate aClasrKL9e reserved ~r that Qhild sha~.l be distributed mnong those or •mv ehi]dren Mho did Survive nle and, by right ci" representation, among .the .living lesue oP those oP a~ ohi]dren Mho did predeoease me. ITH ~~~ . ? nomicate and appoint •my spouse, GLENN A. H1fATT as Executor o e ibis, ~y .Last (ifll and Testame:~t, • and -require Ebat .@ai~3 'Bx~outor serve w3thouC bond. In the event thaE the above-naaed BxeQUtor s6a11, Pot any reason, sail to gvali [~ , or 68~rivg . ~uali tied, te~il to vos.plete the admi_nistraGlon of ~q~ estate, 1 r~oainate anc apfioinG. ny .son, MICIiANL G. !1Yl1T'P instead ar-d gi~re to said E~oecu%or ail rilahEs, pcwera sad imaunities set Porth in th,ia ..Will, ir~o]udir~ tba reouirem+snt that said . Exeeutoe~ sec~ve withcot bond. of 8 i ~ ~' _ - LTBM. ~IIi ,-ti{• {~ IT soy gift, bequest or LegaQy made to this, my Lsa~ . WS11 and 'iest~gt, Wauld, but far Ehis I6ea, be made Eo ar~y .person Mho•, at thaE tine , is Tess Chan tveaty-Five (251 years o? d, then in that ev®nt the g3tt, bequest or .legacy • shall -be .made Eo my son, I~ICEiABb G. i~YILT'T, ; R triueE, for the benefit o P said person. In the event. that PIYGQA$L 0. I~YATT ret'uaes or tHils tis serve, I hereby grant the sate rights, power8 and .privileges and impose the sane dtttiFS upon, ax;d .cake sa:~.d _giPC, bequest or Ieg®oy to, my daughter , p,A?gE $. .1INGL6 instead. In the event thaE GLAIR3 $. RIEIGL$.relliseS or Fa„tis t© aerv~e, i hereby grant the same r.3ghts, .parrers sad .privileges and imo~Cae the Sete duties upor~, end make said gf FE, bequea C or legacy to, my. son,. ?A0~1l~.S M . iiYpTT inste~e. 1'he purpose oP said ?rust 19 Eo e:~sure an adequate la~re~. o!' .ioeone ~ augpQrt, mainvenanee and edueal~io:~ Por said bene8`ieisary. •It i.s ay expreea intenCion and direction that the -ineoae cr principal oP said ?rat shall not Supplant or replace the legal ob.3.aation eor support, mainCenanoe or edueatio~r t~6ieh say other person .~oight have wibh reapeot to said bene~oiary, but. rather s4~a11 only 9uppletent other, . existioa s~eurces o P laooe!e. To meet thi a purpose , I eopnirEr the TrLSEee to distribute, or noE to distr ibuEe, ~1 or part of the ineoae end to inva4e ali or wart of the. prircipai as the Troatee in its sale discretion sleeidas, Ttfe Trv9~ee sball have tree power to manage, inveeG ana rein~re9t the assets of fr-e TrLSt esEate ~ tC e411ect the 4 of E ~' ~~ /~ , i .oGOae theref7ran ®nc1 to apply so• auoh oe a~.i of the net 3.neooe anc~ pr~3neiupal thereof as set tarth above. Any net i~neome not -eo applies shall be added to the corpus of the "rusC aod.heid, admio3st~ered wind diepoaed of ea a perm thereo!'. The oocpus op Ch$ Sruac shall be paid aver to gueh beneficiary whop tie or she. reaohes tihe ags [scat ret~srred to in this -Item, or, f e suck benEf'ieierp sha11 die belorie reaching :.hat. age, upon Y.is or her death Cho eorpu~a cf the TcusL shall be paid over •to the residuary beneCieiary of this, ny Last Will and Teatamer~t, or, if.none are then surviving, to my Chen living heirs at law, ny rfght of representation. ITBM Iii Regardless of anytbir~g in tHis inatrumenC to the wntrary, no Trust shall eantisue a0are than twenty-ooe (2 t~ years aPte- the death of Lhe survivor oP mysei 1', my. Spouse and each lineal dasCendant ae mibe livi:~g at the Circe of mY death. 3c~meeiahely prior to tt~e expiration of atieh Feriod, each Trust rhea in ex3.steneo shall torm~.zate, and tihe then exisbiog Frinafpal of eaQh soak TcusG, including any undis~- tribated cr aecrued-ineorne Chereo?, shall vest in ana be dis~ributed to its then current income be~sri~iary. ITBH k In add=lion to the FCwers oenferred 1lpDR exiBCUitors and trustees Dy- laK, •my Sxe eutor and Trustee, i f tiny , er any 5 of 8 ~S' i duly appointed sueaeseor shall have authority without ea~adiQation;..order or d3rectior~ oP the court : - ~ a) To se? 1, pursuant to oj~t.3DTs or other.M3.9e , et • public or private sale and upon euca6 terms 28 the BxeQUtor shall deem best , any real ar person~.l properti;~ belonging to G:Y estate, wit6vut regard to the necessity of such sale I'or the purpose of paying debts, taxes or legacies; (b ~ To . retafn any oc all oP such Property nv t so required Kfthout liabilitQ for any-depreciation there- o F; (c; To assign or tran9fe r certf Pf oatea o f stook, bonds . or other s+eeurities; (d) '!'c adjust , compromise and settle any sad ~1 claims .in t'avor ar or aigainst QY .estate; ie) To aonduet and c~aNry .cn all btisireas now eondue~ed by me ar_d t4 do a31 *hings necessary or .proper in •tlie usual course or business nn1:i3 such time as the busi- ness -car be gold or distributed as a .going -concern or other.Fefae ~ • and G he Csxecutcr ar:~11 be amnerated fteom any loss which may. result thereby; nand (rl To do any. and all things neeesesry or proper tc aompiel~e the admfnistr2t:~on e° ny estate, all 2s Pylly as I could do it living. E~ of 5 f .-.. - /.. • t~XI . As used •hereip, the singular i~rm of a word inelndea both the 9inguaar a!td plural, ahd reference tc xords bt a pertain gander iholudes reference co all genders. 3TE...~ If 3 and any beneficiary and®r this, uy~Last Nail and 'Peatamert , 9t-okld dfe in a eo®on eeeident or disaster or under such oirati~a9t ance that iic is diPfieul t or la-praeG seal to deternfne Kho survived the other , or iS aov bens Pieiery, tiboagh aurv3viog me, shoulQ die Nitbin Eh~ty (30~ days from and after tre dace o.~ r-y dea4h, then svCn benetioiar~r shall be deuced to hags pre4eceaa®d me. I?~ -aflTil&SS 1iHfsTiHOF, I ha~-e hereunto signed qy name and aoknoxledged and published this =os4rument, eonsis:.i~r~g of ~,_ typewritten pages, .identified by my signature, as ny i.est Aill and TesbamEnt, in the enae of the urderafgned witresaea, o:~ this i~;sa- ° P , 19~k . 1 ~~ r,` JO E. HYATT ile eertii'~p that dt)AK K. FIFA ,the Teetatrls named above, eubsoribesl ~t®r nano hereto, on this daf and in vur ~resea~ee, and to us declared the same bo be her Last dill and Testameat; that ae subscribed our name8 hereby as vitneesea, in the presence as-d at the .request of said ?estatrix and in the prosenoe oP each other; aaa tray at the time or the e~aeoat ion oP said inaLrurment arts of our 'ab- seribi,ng the same as witnesses, said 'la9tatr ix xas c f sound end disposing mind and 93gned it as her Free and ~ro?untsry act . kTTN ~~ our ban t ~~~ , ~e~-ns~rlvania, Ibis J..3 aY c P , 9 ~..- Resides at ~~.x!'~ nee ~ gtnesa ~ ct 6 i t 4 ~: c c c c .~ -~ • 1 ,. f Cbmmon~realth cf Penns; Lvaoia tkuoty of s1le~het~y ACKNaWLEDGN~NT I, JOAN X.• HY%ZTt, testatrix, whose name is signed to the toregaing instrueent , having been. duly qualified ac- cording to lax, da hereby aeknoxiedge tbat I signed sad e~oeeuteti the in9truotent as my Oast 1~itl and Teetamerrt; that T sigae d .it wi~li.iogly ; aT~d t]nat I aS;gned it as mry tree and voludtary .sot lbr the ourpasas thereir•. expressed. ' ~ ~J .Na H~rorn •Qr aF!'±rsed to and aokn wledged be for me by JOAN h. iiYA'i'T, the testatrix, this day 4l _, i989. Kota :.Pn 1 Jl~ ~~~1W~RTKi~m L`o:ocnerrsealt 6 v e Qeno9ylvania ) ~ ~~~~e~~~m6 Ocunt3r c ~'• Aliegt!ec~y Ne , I ~~~ and ~ ,Jan s» h L. ~a~!^~ , the witneea e e w ~a se moss • ar a signed o t he Po r ego iog instrument , being •3uly qual iSied seaording tc lent, do depcse aT~d.9ay that we ~rere present and east testatriz sfgn and z~aeeute the instirwoent as iaer t,aet Will avd ?eetanent; t:~et s31e aigneci iC willingly and that s1~e executed .t as bar free and .voluntary sot f~ot• tho pu~•poaes therein expressed; bhat s®eh of is in C he hearing and eight of ttre testatrix 9i goad the Will as witnesses; and thaC to th, beat of our knvwl- etlge, the testatris was at Chet time eighteen t 1a} or Wore gears oS age, of sound si.od and uneer no eonsfiraint or undue ioPluenoe. ss Cocas i rn o ~ Ffzrmed to sad s ba ribe bo tsJ'orv. me by End ~. , ~i n sea , t is 1 aY o! , 1g rl! J q y PuD e • uusl~FS. o~r~. ~am~~ ~aeuc !~QG111ll~~IP.l+1~~E~f C~II1T ~~ G~'!ylS~ilil }XI'l~'rs ~ ~ ~Ic~+te Hs fl~:5ec. 4~i~+~'~ ~'°~ 8of8 ~P t~ e c e h ~~-~~~ ` j - 'd ~ 1' . ~/ /: Am~r~B ~ ate I~I'8a17B Com~nr 11tD.1~AYYKAR~ CA®t'[MZ, 09092009 Od6107~ ~C~LAI~l1TION AMOiJI~T 40BAG362 5601 W/H STATE TAXES OF 366.43 ~i/I 1 • ~ ` ~-~ a7.~ ~ d~ ~~ A36014321F28,642.06 ~ A360I4321F X28,275.53 PLEASE Dg1'ACH A KSBp l~'OS YOUR IUiCOIR[~~ ~:"~~ ~'% ,~~ ~ ~. /~- ;' Amapa G Lane Ia9uareance Company .y ~, 111D. DIAY'Y~AR CHIC NO. 09092009 00510x16853 E~~LAi~ATI0~1T AMOUNT 40BAG363 . 5607 W/H STATE TAXPS OF -- ~ ~ ~~~ l o ~ G -~ .. ~~ - r„t,d.~ d~,- d ~~ ~ ~a ~~~ ,~ 7 ~ ~ `~~ !~ •~. ~~ ~ ~~ '~•~- A360243Z2F62,889.28 A36014322F $61,098 23 ru~.~se ngr~ca ~ ~ ~ Yoga ~coQns RELEASE OF ALL CLAIMS I, Claire Ringlet with intent to bind myself, my heirs, executors, administrators, and assigns, do hereby expressly release and discharge AMERICAN GENERAL ANNUITY INSURANCE COMPANY, and its employees, agents, affiliates, parent, subsidiaries, successors and assigns (hereafter "AGAIC"), from all claims, demands and actions that I ever had, or now have, or may have, against AGAIC, arising from, and in consideration of, AGAIC's acceptance of delivery of my letter of 7/24/2009, executed by me with respect to my beneficial interest(s) in AGAIC contract #A36014321 F & A36014322F which acceptance results in the payment by AGAIC of the proceeds of said account(s) other than to me. I acknowledge that AIGA has not provided any advice, tax, legal or otherwise, in connection with the transaction giving rise to this Release of All Claims. I have read this Release of All Claims, understand its terms and execute it voluntarily and with full knowledge of its significance. To ensure compliance with requirements imposed by U. S. Treasury Regulations, AGAIC informs you that any tax advice contained in this communication was not intended or written to be used, and cannot be used, for the purpose of (i) avoiding penalties under the Internal Revenue Code, or (ii) promoting, marketing, or recommending to another party any transaction or matter addressed herein. Dated this /~ •' day of f~,,,,,~ ,200,x. Signature: Printed Name: Claire E Ring_le, STATE OF 1~~~,Ivu•-~=. COUNTY OF (~,..~~a~.G-...~ On this ~~ day of ~w•~• , 200 ,before me, a Notary Public, on this day personally appeared C1~~~e r . /~~.~.~%E ,known to me to be the person whose name is subscribed to the foregoing instrument and acknowledged to me that he (she) executed the same for the purpose and consideration herein expressed. Given under my hand and seal of office this 1'f ` day of ~~,~,,~- , 200 Y . ~j ~~- Notary Publ c 'nand for the Sta TM Off' PENNSYLVANIA Notarial Seal Roger t3. Irvuin, Notary Public Carlisle Boro, Cumberland County My Commission Oct. 3, 2012 Member, Pennsyivanla on of Notaries American General Life Companies Member of Asaerican International Gm"rr~, Inc. P:O. Box 871 • Amarillo, TX 79105-0871 • (800)247-6584 RELEASE OF ALL CLAIMS I, Thomas M Hyatt, with intent to bind myself, my heirs, executors, administrators, and assigns, do hereby expressly release and discharge AMERICAN GENERAL ANNUITY INSURANCE COMPANY, and its employees, agents, affiliates, parent, subsidiaries, successors and assigns (hereafter "AGAIC"), from all claims, demands and actions that I ever had, or now have, or may have, against AGAIC, arising from, and in consideration of, AGAIC's acceptance of delivery of my letter of 7/24/2009, executed by me with respect to my beneficial interest(s) in AGAIC contract #A36014321 F & A36014322F ~ which acceptance results in the payment by AGAIC of the proceeds of said account(s) other than to me. I acknowledge that RIGA has not provided any advice, tax, legal or otherwise, in connection with the transaction giving rise to this Release of All Claims. I have read this Release of All Claims, understand its terms and execute it voluntarily and with full knowledge of its significance. To ensure compliance with requirements imposed by U.S. Treasury Regulations, AGAIC informs you that any tax advice contained in this communication was not intended or written to be used, and cannot be used, for the purpose of (i) avoiding penalties under the Internal Revenue Code, or (ii) promoting, marketing, or recommending to another party any transaction or matter addressed herein. Dated this ! Y ~ day of ,200. Signature: f' Printed Name: Thomas M Hyatt STATE OF ~~~~ COUNTY OF ~~ ~~~ On this ~~~ day of ~/~~,~,..+•~ , 200, before me, a Notary Public, on this day personally appeared ~,~~~,y,. !~~-f~- ,known to me to be the person whose name is subscribed to the foregoing instrument and acknowledged to me that he (she) executed the same for the purpose and consideration herein expressed. A Given under my hand and seal of office this ~ ~ day of y,~.~,,,,,~ , 200 `~ . 3 c~- Notary Publ' in d for the Stg>j W LTH F PENNSYLVANIA rial Seal Roger B. Irwln, Notary Public Carlisle Boro, Cumberland County My Commission Expires Oct. 3, 2012 American General Life Companies Me»~6er ofAmerican International Group, Inc. P.O. Box 871 • Amarillo, TX 79105-0871 • (800)247-6584 RELEASE OF ALL CLAIMS I, Michael G Hyatt, with intent to bind myself, my heirs, executors, administrators, and assigns, do hereby expressly release and discharge AMERICAN GENERAL ANNUITY INSURANCE COMPANY, and its employees, agents, affiliates, parent, subsidiaries, successors and assigns (hereafter "AGAIC"), from all claims, demands and actions that I ever had, or now have, or may have, against AGAIC, arising from, and in consideration of, AGAIC's acceptance of delivery of my letter of 7/24/2009, executed by me with respect to my beneficial interest(s) in AGAIC contract #A36014321 F & A36014322F which acceptance results in the payment by AGAIC of the proceeds of said account(s) other than to me. I acknowledge that AIGA has not provided any advice, tax, legal or otherwise, in connection with the transaction giving rise to this Release of All Claims. I have read this Release of All Claims, understand its terms and execute it voluntarily and with full knowledge of its significance. To ensure compliance with requirements imposed by U.S. Treasury Regulations, AGAIC informs you that any tax advice contained in this communication was not intended or written to be used, and cannot be used, for the purpose of (i) avoiding penalties under the Internal Revenue Code, or (ii) promoting, marketing, or recommending to another party any transaction or matter addressed herein. Dated this r ~ ` day of ~~-- ,200 ~ . Signature: Printed Name: ichael Hvatt STATE OF /'~uM.*,I. -~ COUNTY OF C.~..~+~-~ On this t ~ ~ day of ~ ~~i~,~.~~--~ - , 200 ,before me, a Notary Public, on this day personally appeared aL1, ~ ~ ~ ~ . ~ o~ ~` ,known to me to be the person whose name is subscribed to the foregoing instrument and acknowledged to me that he (she) executed the same for the purpose and consideration herein .expressed. Given under my hand and seal of office this ~ ~ day of , 200 9 . .~~ Notary Publi , i and for the Stat~~~~~TH OF PENNSYLVANIA Notarial Seal Roger B. Irwin, Notary Public Carlisle Boro, Cumberland County American General Life Compa ~ My Commission Expires pct. 3, 2012 Member ofAmerican International Group, Inc. Member, Pennsylvania Association of Notaries P.O. Box 871 ~ Amarillo, TX 79105-0871 ~ (800)247-6584