HomeMy WebLinkAbout02-02-10t ~
15056041158
REV-1500 Ex cos-o5> OFFICIAL USE ONLY
' PA Department d Revenue County Code Year File Number
Bureau of Individual Taxes 21 09 00875
Po eox z9osol INHERITANCE TAX RETURN
Harrisburg, PA 17129-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
083-12-2477 02152009 07301923
Decedent's Last Name
HAYMAKER
Suffix Decedent's First Name
DOUGLAS
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name
Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
- - REGISTER OF WILLS
FILL IN APPROPRIATE BOXES BELOW
1. Original Retum
^ 4. Limited Estate
0 6. Decedent Died Testate
(Attach Copy of Will)
^ 2. Supplemental Retum
^ 4a. Future Interest Compromise (date of
death after 12-12-82)
^ 7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
MI
B
MI
^ 3. Remainder Return (date of death
prior to 12-13-82)
^ 5. Federal Estate Tax Retum Required
_ 8. Total Number of Safe Deposit Boxes
^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credft (date of death ^ 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST t3E COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD t~E DIRECTED TO:
Name Daytime Telephone Number
CRAIG HAYMAKER 717-691-8600
Firm Name (If Applicable)
First line of address
823 HIGHLAND COURT
~_
Second line of address °
i~r1 ~
Qi C! ~'3
City or Post Office State ZIP Code ~ ,~
_-:
MECHANICSBURG PA 17050 ~ ~ ~, ~ ~~.,
"r"7
i ..
Correspondent's e-mail address: ~ ~, ~'~'
t
Under penakies of perjury, I declare that 1 have examined this return, including accompanying schedules and statements, and to the best of my knowl~ end 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.
Side 1
1 5056041 1 58 BM46473.000 15056041158 J
REGISTER OF WILLS USE ONLY
~n,1
P O. BOX 8300 CAMP HILL, PA 17001.-830_0
PLEASE USE ORIGINAL FORM ONLY
'EstatB of DOUGLAS B. HAYMAKER
Executors (Page 1)
Name CRAIG HAYMAKER
Address 823 HIGHLAND COURT
083-12-2477
MECHANICSBURG, PA 17050-
Tax ID - -
r ~
15056042159
REV-1500 EX
Decedent's Social Security Number
083-12-2477
u
DecedenPa Name1-IATMAKER DOU GLA S B
RECAPITULATION
1. Real estate (Schedule A) 1. O.OO
2. Stocks and Bonds (Schedule B) . 2. O.OO
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . 3. O.OO
4. Mortgages & Notes Receivable (Schedule D). . 4. O.OO
5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ... 5. 60131.00
6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ... . 6. O
OO
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property .
(schedule G) ~ Separate Billing Requested 7.
119264.00
8. Total Gross Assets (total Lines 1-7). a. 179395.00
9. Funeral Expenses 8 Administrative Costs (Schedule H) . 9. 15595.00
10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I). 10. 422.00
11. Total Deductions (total Lines 9 & 10) . .. 11. 16017.00
12. Net Value of Estate (Line 8 minus Line 11) 12. 163378.00
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) . .. .. 13. O.OO
14. Net Value Sub)ect to Tax (Line 12 minus Line 13) .. .. 1 a. 163378.00
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers urtder Sec. 9116
(a>(1.z) x .o- 0.00 15. 0.00
16. Amount of Line 14~axable
li
l
X
~
nea
at
rate
.
163378.00 16. 7352.00
17. Amount of Line 14 taxable
at sibling rate X .12 O.OO 17• O.OO
18. Amount of Line 14 taxable
at collateral rate X .15 O.OO 18• O.OO
19. TAX DUE 1 s. 7352.00
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
15056042159 snnesasz.ooo 15056042159
<~EV-1500 ESC Page 3 Fib Number
Decedent's Complete Addresa~ 77 f1t] nna7~
DECEDENTS NAME
HAYMAKER DOUGLAS B
sTREET ADDRESS
801 N HAN V R T ET
CUMBERLAND
COY STATE ZIP
CARLISLE
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit O.OO
B. Prior Payments 0,00
C. Discount 0.00
(1) 7352.00
3. InteresUPenalty if applicable
D. Interest 72.00
E. Penalty 0.00
Taal credi<a (a + s + c) (z> 0.00
Taal InteresUPenalty (D + E> (3) 72.00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
FIII in box on Page 2, Line 20 to request a refund. (4) O OO
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the Tax DUE. (5) 7424.00
A. Enter the interest on the tax due. (5A) 0,00
B. Enter the total of Line 5 + 5A This is the BALANCE DUE. (58) 7424.00
Make Check Payable to: 1~GISTER OFW11.it..S, 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)].
Far dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or Tor the use of the surviving spouse is zero (0) percent
[72 P.S. §9116 (a) (1.1) (ii)J. 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 beneTiciary.
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 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. Jj9116(a)(1.3)J. 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.
6M4671 1.000
REV-1508 EX+t&!ie)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA I CASH, BANK DEPOSITS, 8t MISC.
INF~RITANCE TAX RETURN
RESIOENr ~ECEOENT PERSONAL PROPERTY
ESTATE OF FILE NUMBER
DOUGLAS B. HAYMAKER __ 21 09 00875
Include the proceeds of litigation and the date the proceeds were received by the estate
3W46AD 1.000 (If more space is needed, insert additional sheets of the same size)
Rt_V-1510 EX i (8-99)
COAM~AONVVEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS 8
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
DOUGLAS B. HATMAI~R 21 09 00875
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
NUMBE DESCRIPTION OF PROPERTY
R~C1117ET1£1YNEOFTf£TWWBFEREE.TF£IRREIATION&1PTOOECEDBirMD
R TFE64TEOFTRN$$t.ATiPp1ACOPYOFThEOEmFORRFALESTATE
DATE OF DEATH
VALUE OF ASSET
°~OF DECdS
INTEREST
EXCLUSION
~FAPPUCAe~E
TAXABLE
VALUE
~• HARTFORD LIFE ANNUITY 92,264 100.0000 0 92,264
2 TRANSFERS WITH ONE YEAR OF
DEATH 27,000 100.0000 0 27,000
TOTAL (Also enter on line 7, Recapitulation) I S 119 264
(It more apace is needed, insert additional sheets of the same size)
3W48AF 1.000
REV-151, EX: 1,0-05, SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES St
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
DOUGLAS B. HATMAI~R 21 09 00875
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. PENNSULA MEMORIAL PARK 4,502
2 OMNI NEWPORT NEWS HOTEL 335
Total from continuation schedules ?,858
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
Cib State Zip _
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedent's address is not the same as Gaimant's, attach explanation)
Claimant
Street Address
4.
5.
6.
7.
City State Zip
Relationship of Claimant to Decedent
Probate Fees
Accountant's Fees
Tax Retum Preparer's Fees
None
400
2,500
TOTAL (Also enter on line 8 Recapitulation) ~ S 15
7W48AG ,.000 (If more space is needed, insert additional sheets of the same size)
Estate of: DOUGLAS B. HAYMAKER 21 09 00875
Schedule H Part 1 (Page 2)
Item
No. Description Amount
3 WEYMOUTH FUNERAL HOMES 7,656
4 REV STEPHEN NICHOLLS 200
Total (Carry forward to main schedule) 7,858
REV-1512 EX * (12-OB)
Pennsylvania SCHEDULE I
oEPARTbENrOF REVENUE DEBTS OF DECEDENT,
9V~ERITANCE TAX RETURN MORTGAGE LIABILITIES ~ LIENS
RESOEHr aECEOErrr
ESTATE OF FILE NUIIIBER
DOUGLAS B. HAYMAKER 21 09 00875
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimburaed medical expenses.
8W46AH 2.000 If more space is needed, insert additional sheets of the same size.
f;EV-1513 EI(+ (11-08)
Pennsylvania
OEPARTNENf OF REVENUE
INHERITANCE TAX RETURN
RESIOENTDECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUMBER
~~~ ~ L1 V 7 VVO/7
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 2116 (a) (1.2).]
1. DOUGLAS HAYMAKER, JR
3410 AVENIDA DEL PRESIDENTE
APT 20
SAN CLEMENTE, CA 93672
One Third of Residue: 54,459 Son 54,459
2 CRAIG HAYMAKER
823 HIGHLAND COURT
MECHANICSBURG, PA 17050
One Third of Residue: 54,459 Son 54,459
3 JOHN HAYMAKER
3070 LEEDS GARDEN LANE
ALPHARETTA, GA 30022
One Third of Residue: 54,459 Son 54,459
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1 8 OF REV-1500 COVER SHEET, AS APP ROPRIATE.
[) NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBtJIIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
1.
B. CHARRABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON UNE 13 OF REV-1500 COVER SHEET. S 0
8W46AI 2.000 " "'~'~ ayaw ~a ~ieeueu, n~seir narnuvna~ sneers or me same size.
LOCAL REGtSTF~~-~'S CERTtt=tCATt4ht Qt= CE/~TFt
WARNING: It is Illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $.6.OD' This is .to certify that the information here giv.,en a
correctly copied`from an original Certificate of Deat
duly filed with me as ::Local ,i~iegistrar: The origin
certificate wiYl he forwarded ` to' the >atate Vit<
Records Office for permanent. ding.
~~_ ~ , _
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38162.001/33685
11/11/94 mak
LAST WILL AND TESTAMENT
OF
DOUGLAS BLAXLAND HAYMAKER
JoNBS, BLEC1~(AN,
WOLTZ & BELLY, P.C.
boo Thimble Shods Blvd.
Pos[ Of6a Bar 12888
Newport News, VA
23612,2888
(804) 873.8000
I, DOUGLAS BLAXLAND HAYMAKER, a resident, of Newport News,
,_
,,-.
Virginia, do make, publish and declare this to bye .my Last Will and
Testament, hereby revoking all wills and codicils heretofore made by me.
ARTICLE I
FAMILY MEMBERS
My wife, Barbara Berry Hatmaker, is living at the time of the
execution of this will. We have three (3) children by our marriage,
namely: Douglas B. Hatmaker, Jr., John D. Hatmaker and Craig W.
Hatmaker. The word "issue" whenever used herein shall mean lawful
descendants, whether natural or legally adopted.
ARTICLE II
ADMINISTRATIVE AND FUNERAL EXPENSES
I direct my Executor to pay or provide for payment of my
administrative and funeral expenses, including the cost of a suitable
memorial, as soon as practicable after my death.
ARTICLE III
DEATH TAXES
I direct that all estate, inheritance, succession, transfer or
other taxes imposed by reason of my death upon property passing under or
outside this will and made payable under the laws of the United States;
this State or any other state or country be paid out of the general funds
of my estate as an administrative expense, without apportionment.
38162.001/33685
11/11/94 mak
ARTICLE IV
TANGIBLE PERSONAL PROPERTY
I bequeath to my wife, Barbara Berry Hatmaker, if she survives
me, all tangible personal property, including personal effects and
household furnishings, and any automobiles owned by me at my death, and
all policies of insurance relating to such property. If my wife does not
survive me, I bequeath all of the aforesaid property in equal shares to
my children, per stirnes. The property passing under this Article does
not include assets held by me primarily for business or investment
purposes. In the sole discretion of my Executor, I authorize my Executor
to distribute said property to them in kind, even though one or more of
them may be under twenty-one (21) years of age, hold all or any part of
a beneficiary's share for his or her benefit until he or she reaches age
twenty-one (21) years, deliver all or any part to a friend, relative,
guardian, or person with whom he or she may be residing, without further
responsibility, or sell all or any part and add the net proceeds
therefrom to my residuary estate to be disposed of as hereinafter
ded.
JoNfs, BLSCf~II~SAN,
Q/OLTZ 8c KFLLY, P.C.
~ 600 Thimble Shout Blvd.
i Pott Office Bo: 12888
Newport Neat, VA
23611,2888
(804) 8738000
I request that my family honor any written memorandum that I
may leave regarding the disposition of any particular items of my
tangible personal property. This request is precatory and not mandatory..
ARTICLE V
RESIbUARY ESTATE
All the rest, residue and remainder of my property, real and
personal, tangible and intangible, wheresoever situate and howsoever
held, I give, devise and bequeath to my wife, Barbara Berry Hatmaker, if
she survives me. If my wife predeceases me, or if we should die in a
-2-
38162.001/33685
11/11/94 mak
~ JoNPS, liL7:QDdAld,
~ WOLTZ & 1CELd.Y, P.C.
j 600 Thimble Shwlt 73hd.
Post 06a 1Soz 72888
Newport Newt, VA
2367b2888
(804) 873.8000
common disaster, then I give, devise and bequeath my residuary estate in
equal shares to each child of mine who is living at my death and to the
then living lawful issue, collectively, of each child of mine who
predeceases me, such issue to take ,per stirnes the share which their
ancestor, the deceased child of mine, would have taken if alive, subject
only to the provisions hereinafter made with respect to the share of an
individual under the age of twenty-one (21) years.
ARTICLE VI
INDIVIDUAL UNDER TWENTY-ONE {21) YEARS
If under the foregoing provisions an individual under the age
of twenty-one (21) years shall become entitled to any share of my estate,
then notwithstanding anything herein to the contrary I give, devise and
bequeath such individual's share to my Executor as Trustee, with all the
powers and authority hereinafter conferred upon my Executor, to pay to
or expend for the benefit of such individual, with or without the '
intervention of a guardian, so much of the net income and principal of
his or her share as in the sole discretion of the Trustee is deemed
necessary for his or her health, education and support, adding to the
principal of his or her share any income not so paid or expended, until
ae or she attains twenty-one (21) years of age, at which time he or she
shall be entitled to receive his or her share free of any trusts. This
provision shall not be construed to postpone the vesting of any share of
my estate in such individual, but shall have only the effect of
postponing his or her uncontrolled enjoyment thereof before reaching age
twenty-one (21) years. No surety shall be required on the bond of the
Trustee.
-3-
38162.001/33685
11/11/94 mak
ARTICLE VII
APPOINTMENT OF EXECUTOR
A. I nominate and appoint my wife, Barbara Berry Hatmaker,
as Executor of this my Last Will and Testament. If my wife is for any
reason unable or unwilling to serve, then I nominate and appoint my son,
Craig W. Hatmaker, as successor Executor. Should he be for any reason
unable or unwilling to serve, then I appoint my son, Douglas B. Hatmaker,
Jr., as successor Executor.
B. My Executor shall serve without fee, but shall be
reimbursed for reasonable expenses incurred in the administration of my
estate.
C. I request that no surety be required on the bond of my
Executor, and I direct that an appraisement of my estate be waived.
ARTICLE VIII
FIDUCIARY POWERS
To the extent not in contravention with any other provisions
of this will, my Executor shall have, in addition to all of the powers
granted by law, all the powers set forth in Section 64.1-57 of the Code
of Virginia, as amended, which powers are incorporated in whole in this
my Last Will and Testament.
ARTICLE IX
WAIVING OF ACCOUNTINGS
I hereby direct that my Trustee shall not be required to file
annual accountings with a court as otherwise provided by Virginia law.
~~y~
~,
JONES, BLECHMAN,
WOLTZ & KELLY, P.C.
600 Thimble Shod: Blvd. _ 4 _
Pott Office Boz 12888
Newport Neva, VA
23612-2888
(804) 873-8000
38162.001/33685
11/11/94 mak
ARTICLE X
CONSTRUCTION OF TERMS
Where appropriate to the context, pronouns or other terms
expressed in one number and gender shall be deemed to include any other
number and gender. Tax-related terms shall be construed in the context
of the federal revenue laws in effect at my death.
IN WITNESS WHEREOF, I sign, seal, publish and declare this
instrument to be my Last Will and Testament, this 14th day of
November 1994, at Newport News, Virginia.
F L)
DOUG BLAXLAND HAYMAKER
We, the undersigned, do hereby certify that the testator has
signed, sealed, acknowledged and declared the foregoing as and for his
last will, in the presence of us, three competent witnesses, all present
together at the same time, who, in his presence and at his request, and
in the presence of each other, have hereunto subscribed our names as
attesting witnesses on the day and year above written.
~~ ~ . ~~j residing at _r~~ ~a>L~ _ \~ A
..--~
E,L ~ ?Ullel~["~c1 residing at ~GcYX`n~ i(.7~2~ f ~.~ ,
' / .(~ZQ/ residing at
C
JONFS, ByLECHMAN,
WOLTZ ac gEI3.Y, P.C.
600 Thimble SbosL Blvd.
Putt Office Banc 12888
Newport News, VA
23612-2888
(804) 873.8000
-5-
38162.001/33685
11/11/94 mak
~-
JoNFS, sLECfm1AN,
WOLTZ & B.ELi.Y, P.C.
600 Thimble Shoal Blvd.
Post Off~ee Box 12888
Newport News, VA
23612-2888
(804) 873.8000
(COMMONWEALTH OF VIRGINIA
CITY OF NEWPORT NEWS, to wit:
Before me, the undersigned authority, on this day personally
appeared DOUGLAS BLAXLAND HAYMAKER, ~ Elizabeth D. Gordon ,
Vicki L.Hudson and Madelyne M. Miller known to
me to be the testator and the witnesses, respectively, whose names are
signed to the attached or foregoing instrument and, all of these persons
being by me first duly sworn, DOUGLAS BLAXLAND HAYMAKER, the testator,
declared to me and to the witnesses in my presence that said instrument
is his Last Will and Testament and that he had willingly signed or
directed another to sign the same for him and executed it in the presence
of said witnesses as his free and voluntary act far the purposes therein
expressed, that said witnesses stated before me that the foregoing will
was executed and acknowledged by the testator as his Last Will and
Testament in the presence of said witnesses who in his presence and at
his request and in the presence of each other, did subscribe their names
thereto as attesting witnesses on the day of the date of said will and
that the testator, at the time of the execution of said will, was over
the age of eighteen (18) years and of sound and disposing mind and
Sworn and acknowledged before me by DOUGLAS BLAXLAND HAYMAKER,
the testator, and Elizabeth D. Gordon Vicki L. Hudson and
Madelyne M. Miller witnesses, this 14th day of November ,
1994.
(SEAL)
commission expires : 4/30/98
Notary Pub is
-6-
s't'AT+~E~ ~HtI~A.... ' ..:.:...' .;PAGE :,..'.....:.
JAN.30-FEB.28,2009 1 OF 5
00 0 0630TH NM I17
zl is12~93A~ANtE
ua8o z~~o~o9 Bh~ANc[
DOUGLAS B HAYMAKER C H E ck i z ti S
BARBARA B HAYMAKER C~~ c k- 1 1 N H
823 HIGHLAND CT
MECHANICSBURG PA 17050 CHeck 12.33
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I
ACCOUNT
ACCOUNT
INTEREST EARNED MATURITY
ENDING
TYPE NUMBER YEAR-TO-DATE DATE BALANCE
I
~ MiT SELECT MITH INTEREST
000009839129658
4.14
55,086.13
MiT MARKET ADVANTAGE 015004210578405 56.42 0.00
TOTAL DEPOSITS 55,086.13
M&T SELECT WITH INTEREST
ACCOUNT N0. 9839129658
II
E
07
O1
02
02
02
02
02
02
D2
02
02
02
02
02
02
Lp
FIA R
:~::.'~~.L~:: BARBARA B NATMAKER
CARROIL STREET OFFICE
DOUGLAS B HAYMAKER
BARBARA B HAYMAKER
:.
STATENEM'. P~RIaD ,' ~~~
JAN.30-FEB.28,2009 2 OF 5
11Y
FSx'F
02-27-09 EDWARD JONES 9044 CCD 1,000.00
02-27-09 INTEREST PAYMENT 2.36
ENDING BALANCE
55,086.13
555,086.13
1233 02-24-09 100.00 1244 02-23-09 12,000.00 1245 02-17-09 12,000.00
1246 02-10-09 12,000.00 1247 02-25-09 4,502.40 1249 02-19-09 334.14
ANNUAL PERCENTAGE YIELD EARNED = D.04
MdT PARTICIPATES IN THE FDIC'S TRANSACTION ACCOUNT GUARANTEE PROGRAM (TAG),
UNDER WHICH ALL BALANCES IN NON-INTEREST-BEARING TRANSACTION ACCOUNTS ARE FULLY
GUARANTEED BY THE FDIC THROUGH 12/31/09. TA6 COVERAGE IS IN ADDITION TO AND
SEPERATE FROM THE COVERAGE AVAILABLE UNDER THE GENERAL FDIC DEPOSYT INSURANCE
RULES. MdT WILL ALSO HAKE ALL CONSUMER NOW ACCOUNTS (OTHER THAN POWER CHECKING)
ELIGIBLE FOR COVERAGE UNDER TAC BUT TO DO SO, THE FDIC REWIRES MiT TO COMMIT TO
PAY NO MORE TWIN .50% INTEREST THROUGH 12/31/09. THUS, MGT WILL PAY NO MORE THAN
.50% INTEREST ON SUCH ACCOUNTS (OTHER THAN POWER CHECKING) THROUGH 12/31/09.
°'' DOUGLAS B HATMAK
M&T MARKET ADVANTAG '~i:~f'~G'~Si2z BARBARA 8 HAYMAKER
ACCOUNT N0. 15004230578405 CARROLL STREET OFFICE
Af`f`f111WT CIIMIIADV
~: >::~::~::~ ..a;..~ ::: ::::>::C y:....,. ., ...: ...
~.
NO. AMOUNT N0. AMOUNT
55,057.31 0 0.00 , 0 11..99 0.00
Loden f~~l
,.
I' S'fA1'~MENT OF PAYMENT cne~k No. 114739645
FOR: BENEFIT PROCEEDS FROM ACCOUNT N0. 711194500
C/O CRAIG HAYMAKER
To change your withholding on future distributions, please contact
Hartford Life. Withholding too little may result in tax penalties.
000350
ESTATE OF DOUGLAS HATMAK
823 HIGHLAND COURT
MECHANICSBURG PA 17050
09/28/2009
GROSS AMOUNT 92,264.45
NET AMOUNT 92,264.45
Federal Taxable Amount 32,264.45
The Hartford Life Insurance Companies
Attn: Individual Annuity Operations
P.O. Box 5085
Hartford, CT 06104-5085
800-862-6668