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Home My WebLink About06-21-10 (3)1 J 1505607121 8urearr of bodbidud TaNet totsglr Code`Yeer ~'ie Number Pf> 80X Yl900t 1N1'1E ~~~~N~`~ I ~ $ 8 b Pet 2 ~, 0 9 sea,rl+h~in, n°" ltE1.t7~VII Date of Death Date of Bkth 03 2 6 9 1 8 4 9 9 6 0 9 2 0 2 0 0 9 1 11 9 1 8 DscsderrPs last Name Suffix Decedent's First Hams MI H A Z E N G E R A L D T N E I'~~pv~•bia~ EaM.r M spanea last Name tlatwvi~ • ~ ~OM1 SuMbc Spouse's First Name MI Spouss~ Soda) Seaafty Number THIS RETURN MtlST BE ~ qr DUPt.lCATE tIMITii 1'i1E Au. ~ ~ fy1/A($ sdow REGISTER OF W1l.LS ® ~• °"~ .ban ^ 2. Supplemerrt~ Rebxn 3. RerrrakWar Rebxn ({date of death ^ 4. Lbnked Estate ^ 4a. Futures Interest Corn j~ble {date of d th per io 1 ~-13-Qx) ', ^ g. F~ ~ ~a ~~ ® 8• D~eo_adent Died Testsls SPX ~ ^ ea aRer 12-12-82 7. Deoederrt sd a llNrrp Trust (Attach CgiY of Twit) 8. Total Nrrmbsr of Sale bsposit Booms 9. ^ ~"°r' f'^~e ^ 10. Spousal Poverty Credit {date of death between 12-31-91 and 1-1.9d) 11. aeclbn to arx ^ ~. 9113(A) - TiNfi slECTtON fiU6T I!E CO~LETt~ eu Nttach Sch. O) ~O~E>:POIiDttICEAND Name t~tIF~ tTN1.TA><NFOMMTiON ORECTEDTO : D A V I D H R A D C L I F F T~~ Fkm Name ~ffApptlcable) , E S Q '9 3 1 8 R A D C L I F F L A W O F F I C E, P C as ~ per First Nne of address ~ _ _,_, ri b 0 1 1 M O M M A R O A D Second Nrle d address ~ ~ r ti =; SUSTE 201 a~~ c^ Gty or Poe olpce ~ . ' "' t State 21P Code DA -... -, s, -~ r` L EM O Y NE PA 170 43 .. ~. ~~~ L 1505607121 Bids 1 1sos6o7121 J J 1515607221 REV-1500 EX Decedents Social Security Number ooosa.rM':-~: GERALDINE M. HAZEN 2 6 9 1 8 4 9 9 6 RECAPITULATION 1. Real estate (Schedule A) ........................................ 1. 2. Stocks and Bonds (Schedule B) .................................. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages 8 Notes ReceNable (Schedule D) ................. ....... 4. 5. Cash, Bank Deposits S Miscellaneous Personal Property (Schedule E) ....... 5. 8 4 2 . 3 6 6. Jointly Owned property (Sched~e ~ ~ Separate Billing Requested ....... 6. 9 9 2. 9 6 7. Inter-Viw~s Transfers 8 Miscellaneous Pnmbate Property (sa,edule G) ~ separate lining Requested ....... 7. 2 1 8 7 2 9. 1 4 8. Togl Groos Ascots (total ones 1-7) .................... ....... 8. 2 2 0 5 6 4. 4 6 9. Funeral Expenses & Administrative Costs (Schedule H) ......... ....... 9. 1 4 ' 4 6 0. 1 8 10. Debts of DecederH, Mortgage Liabilities, ~ Liens (schedule I) ..... ....... 10. 3 2 6 9. 9 8 11. Total Doducdons (total Lines 9 8 10) .................... ....... 11. 1 7 7 3 0. 1 6 12. Not Valw of Estabs (Line 8 minus Line 11) .................. ....... 12. 2 0 2 8 3 4 . 3 D 13. Charitable and GovemmeMal Bequests/sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............ ...... 13. • 14. Not Valw 8ubjact to Tax (Line 12 minus Line 13) ............ ...... 14. 2 0 2 8 3 4 • 3 0 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 1B. Amount of Line 14 taxable at lineal rate X .045 2 0 2 8 3 4. 3 0 1s. 9 1 2 7. 5 4 17. Amount of Line 14 taxable at sibling rate X .12 D. 0 D 17. 0. 0 0 18. Amount of Line 14 taxable at collateral rate X .15 O. D 0 18. D. 0 0 19. Tax Dw ................................................ 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 1505607221 9 ~ 2 7. 5 4 1505607221 J REV-1500 EX Pape 3 Decedents Complete Address: STREET ADDRESS 1905 EAST. TF File Numixr 21 09 0888 clTr MECHANICSBURG STATE zIP PA 17050 Tax Payments and Credits: 1 • Tax Due (Page 2 Line 19) 2. CrediLs/Payments (1) 9,127.54 A. Spousal Poverty Credft B. Pray Payments 5,000.00 C. Discount 263 15 3. Interest/Pena rf a Total Credits (A + B + C) (2) 5.263.15 hY ' pplicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, eater the difference. This is the OVERPAYMENT. -~ FIII In oval on Pape 2, Line ZO to roquest a refund. (4) ' 0 00 5. H Line 1 + Une 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 3.864.39 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. Thy is the BALANCE DUE (56) 3,864.39 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPRCyPi~IIATE BLOCKS 1. Did decedent make a transfer and: Yes ' ~ a. retain the use or income of the property trensfemed : ..................... ................................................. b. retain the right th 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. ff death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration7 ...................................................................................... n 3. Did decedent own an 'in trust for" or payable upon death bank account or security at his or her death? ......... Ibxl ^ 4. Did decedent own an Individual Retirement Account, annuity, orother nai-probate propeRy 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 ~I~RT 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 thb surviving spouse is three (3) peroent [72 P.S. §9118 (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 [/2 P.S. §9116 (a) (1.1) (ii)]. The statute does rwt ex~not a transfer to a surviving spouse from tax, and the statutory requirements for disdosurle ~ 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 irrrposed an the net value of transfers from a deceased child twentyone years of age or younger at death to or for the use of a nad~ral parent, an adoptive parent, or a stepparent of the child is zero (0) percent p2 P.S. §9116(a)(1.2)j. The tax refs 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, exca~t as noted in 72 P.S. §9116(1.2) p2 P.S. §9116(a)(1)j. The tax rate imposed on the net value of transfers to or for the use of the decedents siblings is twelve (12) percent (72 P.S. §9116(a)(1.3)j. A sibliing 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-1508 EX + (6-eg) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSIT`S, ~ MISC. IN RESIDENT DE E~ " PERSONAL PROPERTY ~.__ -- GERALDINE M. HAZEN ~~~~ nVIfiOCR 21 09 08$8 Include the proceeds of litigation and the date fhe proceeds were received by the eslale. wttll ht of suniv must be disclosed on &hsduN F. ITEM NUMBER DESCRIPTION VALUE AT DATE 1 • COUNTRY MEADOWS -REFUND OF DEATH 747.08 2• INORTHRUP GRUMMAN -RETURN INSURANCE PREMIUM 95.28 TOTAL (Also enter on line 5 Recapitulation) I ~!~; (If more space ~a needed, maert addilronai sheets of the same size) REV-1509 EX + (8-gg) scH~au~~ F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NIJ~ER GERALDINE M. HAZEN 21 09 0888 If an asset ~ mach joint urilhin ona yar of 1M dacadant's dab of loath, it moat ba roPortad on Schaduh Q. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. DAVID B HAZEN 1899 (11 lelrr`o i wu~ SALEM, OH 44460 s GARY F HAZEN 4022 EFLAND-CEDAR GROVE ' HILLSBOROUGH, NC 27278 i JOINT LY-0YYNED PROPERT Y: LETTER DATE DESCRIPTION CF P ITEM NUMBER FOR JOINT TENANT MADE JOWT ROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION MID BANK ACCOUNT NUMBER OR SaMLAR bENTiFYING NUMBER. ATTACH DEEDFOR JOMITLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET ', DECD'S. '~ MITEREST DATE OF DEATH DECEDENTS INTERES T 1. A., B M&T ACCOUNT #9846285915 1,510.35 ' ' 33.33 503.40 2. A., B M&T ACCOUNT #41856856 978.12 33.33 326.01 3. A M&T ACCOUNT #9846285006 327.09 50. 163.55 TOTAL (Also enter on line 6, Recapitulation) (ti more space is needed, insert additlonal sheets of the same size) REV-1510 EX + (6.ge) scHeou~E INTER-VNOS TRANSFERS ~ COM INHMONwEAL~ OF~ RETURN aN~ MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER GERALDINE M. HAZEN 21 09 0888 This schedule must be completed and filed 'rf the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVgR SHEET is yes. DESCRIPTION OF PROPERTY ITEM iNauoe tF+e r~ of try mua, nam aruno~w ro neee~rrt MHO DATE OF DEATH 96 OF DECD'S EXCLUSION TAXABLE NUMBER TM~DA~OFTM~' "~T'~""~'°FT"Erx~nro~RE:uuE~~*E. VALUE OF ASSET INTEREST ' nnawuc~x0 VALUE 1. MERRILL LYNCH CASH ACCT #872-27016 13,828.58 100. ~ 0.00 13,828.58 2. WELLS FARGO ADVISORS CASH ACCT #1135-1962 204,869.07 100. 0.00 204,869.07 3. SCHWAB ONE ACCT #2304-9142 31.49 100. 31.49 _ TOTAL (Also en(Br on line 7 (H more space is needed, insert additional sheet of the same size) REV-1511 EX + (10.06) COMMONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN SCHEDULE H FUNERAL EXPENSES 8 ADMINISTRATNE COSTS -- •--• - -• FILE NUMBER GERALDINE M. HAZEN 21 09 0888 Debts of decedent moat be repoRed on scheduN L ITEM NUMBER DESCRIPTION AMOUNT A• FUNERAL EXPENSES: 1. MENTOR CEMETERY 650.00 2. MYERS-HARNER FUNERAL HOME 5,045.00 3. FUNERAL MEAL 531.18 B• ADMINISTRATIVE COSTS: 1 • Personal Representative's Commissions Name of Personal Representative (s) Street Address C~' Sfale 7~p Year(s) Commission Paid: 2, AtbmeyFees RADCLIFF LAW OFFICE,PC 3. Famtiy Exemption: (K decedents address is not the earns as claimants, attach explanation) Claimant Street Addre~ Cdy State Zip Relationship of Claimant to Decedent 4• Probate-Fees 5. AcoourdanYs Fees 6. Tax Retum Preparer's Fees SCHROEDEL SCULLIN & BESTIC, LLC (2009 TAX PREP) 7. FILING FEE - PA INHERITANCE RETURN & INVENTORY 8. EXECUTORS EXPENSES 9. OVERNIGHT DELIVERY CHARGE -RETURN & INVENTORY 10. CERTIFIED MAIL 6,000.00 298.00 980.00 30.00 903.46 17.00 5.54 TOTAL (Also enter on line 9 Recapitulation) I : (If more space is needed, insert additional sheets of the same siae) - i REV-1512 EX + (12-03) COMMONWEALTH of PEWNSYLVANUI ~" ~s ~cE~ " SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8~ LIENS E8TATE OF GERALDINE M. HAZEN FILE NUMBER 21 09 08 8 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, Irtcludinp unreitmb~raled medical tucpertees. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. HOLY SPIRIT HOSPITAL 188.58 2. PATRIOT NEWS 18.35 3• .HOME INSTEAD 165.00 4. JFS WEALTH ADVISORS 469.72 5• WEST SHORE EMS 878.33 6• COUNTRY MEADOWS 1,500.00 7. SHARON EASTER 50.00 TOTAL (Also enter on line 10, Rec~itulation) I Qf mope space ~s needed, u~serl additional sheets of the same size) REV-1513 EX + (9.00) COMMONWEALTH of PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER GERALDINE M. HAZEN 21 09 0888 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not Lfst Trusbs(s) AMOUNT OR SHARE OF ES I. TAXABLE DISTRIBUTIONS [r~lude o ht sappoousal distributions, and transfers under Sec. 91166 (~a (1.2)~ TATE 1. DAVID B. HAZEN Lineal 101 417 15 1622 QUAKER LANE , . SALEM, OH 44460 2. GARY F. HAZEN Lineal 101 417 15 4022 EFLAND-CEDAR GROVE , . HILLSBOROUGH, NC 27278 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE 0 II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. I B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ', s' (tf more space is needed, insert additbnal sheets of the same s¢el SHEET LAST WILL AND TESTAMENT KNOW ALL MEN BY THESE PRESENTS, that I, GERALDINE M. HAZEN, currently residing at Camp Hill, Cumberland County, Commonwealth of Pennsyl~a~ia, being in good health and of sound and disposing memory do hereby make, declaze and pub111sh this as my Last Will and Testament, hereby revoking all former Wills and Codicils heretofor¢ made by me. FIRST: I direct that all of my debts not barred by the statute of li~itations, expenses of my last illness, funeral expenses, costs of administration and claims )allowed in the administration of my estate shall be paid b~ my Executor hereinafter named, from', my estate as soon after my decease as shall be found convenient. SECOND: I bequeath my automobiles, household and personal effect's land other tangible personal property of like nature (not including cash or securities), togetHer with any existing insurance thereon, to my sons, DAVID B. HAZEN and GARY F. HAZI~P~T, per stirpes, to be divided between them as they may agree, in as nearly equal shares as possibl~,~ provided that if they are unable to agree then they shall make selections in turn with the oldest go~xg first until the dollar value of the items selected is as nearly equal as possible. It is my intention that if either son should predecease me, his shaze shall pass to his descendants. THIRD: I give, devise and bequeath the rest, residue and remainder) of my estate, whether real, personal or mixed, and of any nature whatsoever and wherever situate, to my sons, DAVID B. HAZEN and GARY F. HAZEN, in equal shazes, per stirpes. It is my arltention that if either son should predecease rrie, his share shall pass to his descendants. FOURTH: Provided that he agrees to serve without commission or compensation, I hereby nominate, constitute, and appoint DAVID B. HAZEN, as Executor of thin Iny Last Will and Testament without necessity for posting security regazdless of state of resider~cle. In the event that DAVID B. HAZEN shall predecease me, or be unwilling or unable to a~cX as my Executor, as aforesaid, then I nominate, constitute and appoint GARY F. HAZEN a's Executor of this my Last Will and Testament, without necessity for posting security regazdles~ bf state of __ - __ ~__ residence, under the same condition that he agrees to serve without commissioru or compensation. FIFTH: My Executor shall have, in addition to the powers and authority conferred upon my Executor by law, the following additional powers and authority: 1. To sell at public or private sale, exchange, transfer, partition, give options upon, repair, lease, mortgage, pledge or otherwise dispose of any property, real or personal, at any time constituting a portion of my estate, and upon such terms and conditions as the Executor shall deem wise. 2. To invest and reinvest any money at any time in such bonds, stocks, notes, real estate, mortgages, life insurance, annuities or other securities, or such property, real or personal, as the Executor shall deem wise, without being limited by any statutes or rule of 112~w regarding investments by the Executor. 3. To retain, without incurring any liability, as investments, any pro~rty owned by me at the time of my death, as long as my Executor may deem it wise, and even though such property is not the kind of property an Executor would purchase as an investment; and even though to retain such property might violate sound diversification principles. 4. To cause any security or other property which may constitute a potion of my estate to be issued, held or registered in the Executor's own name, or in the names of a nominee, or in such form that title will pass by delivery. 5. To consent to the reorganization, consolidation, readjustment of thje financial structure, or sale of the assets of any corporation or other organization, the securities of which constitute a portion of my estate, and to take any action with reference to such securities which, in the opinion of the Executor is necessary to obtain the benefit of any such reorganization, consolidation, readjustment or sale; to exercise any conversion privilege or subsdxiption right given to my Executor as owner of any securities constituting a portion of my estate resulting from any reorganization, consolidation, readjustment, sale, conversion or subscripltion. 6. To pay all costs, taxes, chazges and expenses in connection with the administration of my estate, including such compensation to the Executor which sell be in accordance with established fees throughout the period of administration of my esttate. r- __ _ __ _. __ ___ _. _ __ ._. _ _ . ___ .. 7. To determine what is "income" and what is "principal" hereunder, and my Executor's decision thereon shall be final; and to purchase securities at a premiuun or discount, and to apply or charge said premium or discount against income or principal as the Executor may determine. 8. The Executor may make payments to or on behalf of any person v~+ho is the beneficiary hereunder but in no event, however, shall payments be made to any ctreditor or other such person because of anticipation of payment by the beneficiazy, and any such claim made by way of anticipation by the beneficiary shall be of no validity or legal effect. 9. To borrow money from any person, firm or corporation, including any corporation acting as an Executor hereunder, for the purpose of protecting and prle~erving or improving my estate hereunder; to execute promissory notes or other obligations fbr amounts so borrowed. 10. To employ legal counsel, accountants, brokers, investment advisors, custodians, managers and other agents and employees and to pay reasonable compensation out of my estate or any funds held hereunder to which said compensation is attributable, provided (that my son shall not be compensated for his services as Executor. 11. To carry on any business owned or controlled by me at my death fpt whatever period of time my Executor shall think proper, and my Executor shall have the power to do any and all things my Executor deems necessary or appropriate, including the power to close out, liquidate or sell the business at such time and upon such terms as my Executor shall deem best. 12. To make distributions in cash or in kind. 13. To compromise controversies. 14. To do all other acts in my Executor's judgment necessary or desirable for the proper and advantageous management, investment and distribution of my estate. SIXTH: I direct that all transfer and inheritance taxes, state or federall, assessed because of my death, whether the funds, property or insurance proceeds to which suich taxes are attributable pass under this Will or not, shall be paid out of my residuary estate; th~ti my Executor pay, or provide for payment of all such taxes at such time, or times, and in such mariner as my Executor deems best. 3 IN WITNESS WHEREOF, I, GERALDINE M. HAZEN, the Testator td this, my Last Will and Testament, typewritten on four sheets of paper which I have identified lat the bottom of each page by my initials, hereunto set my hand and seal the / >'QT day of ~- 2006. G RALDINE M. H N The preceding instrument consisting of this and three other typewritten pages, each identified by the initials of the Testator, GERALDINE M. HAZEN, this day and date thereof s~gjned, published and declared by GERALDINE M. HAZEN, the Testator therein named ss and for her Last Will, in the presence of us who, at her request, in her presence, and in the prds~nce of each other have subscribed our names as witnesses. ./~ - ~.~~P~/ 4 I, GERALDINE M. HAZEN, Testator, whose name is signed to the attached o~ foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I'~,signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it als'my free and voluntary act for the purposes therein expressed. GERALDINE M. HAZEN Sworn or affirmed to and acknowledged before me by GERALDINE M. HAZ1~N, Testator, the s~ day of _ J~OJG~'lff3 , 2006. ~~~- ~/ (SEAL ~ ~C ) Notary Public NOTARIAL SEAL „/' ', DAVID H RADCUFF Notary Pubis LEMOYNE BOROUGH, CUMBERLAND COUNTY My Commission Expires Jun 29, 2008 COMMONWEALTH OF PENNSYLVANIA : COUNTY OF : SS We ~AYi~LEE/(/~ ~IUSPL and ~~IVIC ~ ~i.;.,,al' ,the witnesses whose names are signed to the attached or foregoing instrument, being duly qu ified according to law, do depose and say that we were present and saw Testator sign and execute the instkr~lment as her Last Will; that she signed willingly and that she executed it as her free and volun therein expressed; that each of us in the hearing and sight of the Testator signed thee W~i'll ~s witnesses sand that to the best of our knowledge the Testator was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. /l~ ~ ' t Sworn or affirmed to /an//d subscribed to before me by ~ T L E~~ /Q /v Us~ 'and - ~~'~~~~ ~, t~.~~/~/J1Dit/ witnesses, this /s~ day of Jd,~~_ 2006. ~~ , (SEAL) ~y~~/~/r~ ~,~ al ~ -~ NoTARiAL sEAL Notary Public DAVID H RADCUFF / ' Notary Public ' LEMOYNE BOROUGH, CUMBERLAND COUNTY My Commission Expires Jun 29, 2008 5