HomeMy WebLinkAbout03-0459 Estate of
also known as
Social Security No.
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older and the executrices
in the last will of the above decedent, dated April 11, 1996
and codicil(s) dated N/A
PETITION FOR PROBATE and GRANT OF LETTERS
Hazel R. Lehman aka Hazel Myers Lehman No 21-03- ~c~
To: Register of Wills for the
County of Cumberland in the
210-26-7692 Commonwealth of Pennsylvania
named
(state relevenat circumstances, e.g. renunciation, death of executor, etc.)
Decedent was domiciled at death in Cumberland
with her last family or principal residence at
86 Mohawk Road, Lower Mifflin Township, Cumberland County
(list street, number and municipality)
County, Pennsylvania,
Decedent, then 84 years of age, died May 26,2003
at Borough of Carlisle, Cumberland County
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent: No Exceptions
Decedent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows:
$
$
$
$
unestimated
Total: unestimated
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters testamentary
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
therg,on.
Joy~ R~ Shugha'rt
199 Horseshoe Rd
Carlisle PA 17013
/~I ,, ',,. Sanderson - /J
//$3 F Street
Carlisle PA 17013
(~ATH OF PERSlJlNAL REPRSEINTATIVE
COMMONWEATLH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
Sworn to or affirmed and subscribed
before me this, ~.q~c~ day of
June, 2003
The petitioner(s) above-named swear(s) or affirm(s) that the statement in the foregoing peition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
/I-2 -
(l u
Register
Estate of
Hazel R. Lehman
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW ~ ,~ 20 tgL3 , in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated~ April 11, 1996
described therein be admitted to probate and filed of record as the last will of Hazel R. Lehman aka Hazel Myers Lehman
and Letters Testamentary
are hereby granted to Joyce R. Shughart and Joan L. Sanderson
FEES
Probate, Letters, Etc. $
Short Certificates(1 ) $ ~,~. oo
~,,~i~.-t,~p~ $ '~, .oo
~ $ IO.oc3
Total__ $ ~ '-lq. O~
Filed~i~...r..~.. :..0..~ .....................
~ ~ ~-~-o3
x,. Register of Wi~s~ v ~
~,0. O0 Robert M. Frey #06274
ATTORNEY (Sup. Ct. I.D. No.)
5 South Hanover Street
Carlisle, Pennsylvania 17013
ADDRESS
(717) 243-5838
PHONE
REGISTER OF WILLS OF al~MR~.a.,.aSn COUNTY
OATH OF SUBSCRIBING WITNESS
Robert M. Frey
(each) a subscribing witness to the will presented herewith,.. (each) being duly qualified according to
law, depose(s) and say(s) that he was
Hazel R. Lehman aka Hazel Myers Lehman present and saw
the testat.zix._~, sign the same and that he signed as a witness at the
request of testat rix ._ in l-~r _ presence and (in the presence of each other) (in the presence of the
other subscribing witness(es)). .'
Sworn to or affirmed and subscribed before
me this
day of
June 2003
Robert M. Frey (Name)
~5 South Ha novae~Street: Cmqisle PA 1701
(Address)
(Name)
(Address)
REGISTER OF WILLS OF ·CUMBERLAND COUNTY
OATH OF NON-SUBSCRIBING WITNESS
RI- aa- qsq
Mary C. Wert
(each) a subscriber hereto, (each) being duly. qualified according-to law, depose(s) and say(s) that
_ she is familiar with the sig.,..nature of _Kristta King
~XX
testat rix of (one of the subscribing witnesses to) the will presented herewith and
that she
believes the signature on the will is in the handwriting of
Krista Kin
Sworn to or affirmed and subscribed before .
me this ._______1.[-~ day of
_ June 2003 xl~ (Name)
· ~ ~k~d~ Register (Address)
(Name)
(Address)
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and
Testament written on two ( 2 ) pages, this 1 lth day of April, 1996.
Hazel ~. Lehman, -
also sometimes known as
(SEAL)
Hazel 1VFyers Lehm[n
Signed, sealed, published and declared by HAZEL R. LEHMAN, who is sometimes known
as HAZEL MYERS LEHMAN, the Testatrix above named, as and for her Last Will and
Testament, in our presence, who, in her presence, at her request, and in the presence of each other,
have hereunto subscribed our names as attesting witnesses.
Page 2 of 2 Pages
LAST WILL AND TESTAI~[ENT
OF
HAZEL R. LEHMAN
FREY & TILEY
ATTORNEYS-AT-LAW
5 SOUTH HANOVER STREET
CARLISLE, PA 17013
TELEPHONE (717) 243-5838
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Hazel R. Lehman AKA Hazel Myers Lehman
Date of Death: May 26, 2003
Will No. Admin.No. 21-03-0459
To the Register:
I certify that notice of (beneficial Interest) estate administration required
by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the
following beneficiaries of the above-captioned estate on: June 18, 2003
Name Address
A.Arlene Dyarman
B.Marie Dyarman
Merle H. Myers
Joyce R. Shughart
Carol J. Reed
Judy K. McNew
JoAnn L. Sanderson
111 Limekiln Rd.,Carlisle PA 17013
16 Bear Rd., Carlisle PA 17013
718 Gobin Street, Carlisle PA 17013
199 Horseshoe Rd., Carlisle PA 17013
802 Cedarwood Village,Morehead City NC 28557
91 Walmar Manor, Dillsburg PA 17019
53 "F" Street, Carlisle PA 17013
Notice has now been given to all persons entitled thereto under Rule 5.6)a)
except NO EXCEPTIONS
Date: June 18, 2003
Name:
Address:
Capacity:__
Signature
Robert M. Frey
5 South Hanover Street
Carlisle, Pennsylvania 17013
Personal Representative
X Counsel for Personal Representative
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 002942
FREY ROBERT M
5 S HANOVER STREET
CARLISLE, PA 17013
........ fold
ESTATE INFORMATION: SSN: 210-26-7692
FILE NUMBER: 2103-0459
DECEDENT NAME: LEHMAN HAZEL R
DATE OF PAYMENT: 08/26/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 05/26/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $3,283.00
TOTAL AMOUNT PAID:
$3,283.00
REMARKS: JOANN L SANDERS & JOYCE R
SHUGHART-C/O ROBERT M FREY ESQ
SEAL
CHECK# 101
INITIALS: VZ
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
· COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
" DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
I-.-
z
I,U
(J
UJ
O
_l
10.
12.
13.
I--.
Q.
O
20. ~l
REV-1500 t ,.,,-,-,,,,.,,. ON,¥
INHERITANCE TAX RETURN .,LE...BE. 21-03- 459
RESIDENT DECEDENT
Lehman, Hazel R. aka Lehman, Hazel Lehman
DATE OF DEATH ¢¢IM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR)
I
5/26/2003 I 7/23/1918
IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
210-26-7692
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
~'~1. Original Return
U2. Supplemental Return
E~3, Remainder Return (date of death prior to 12-13-82)
~---~ 4. Limited Estate E~4a'FuturelnterestC°mpr°mise(date°fdeathaffer12'12'82)[---'~ 5. Federal Estate Tax Return Required
~-]6. Decedent Died Testate (Attach copy of Will) E~] 7. Decedent Maintained a Living Trust (Attach copy of Trust) 8. Total Number of Safe Deposit Boxes
E~ 9. Litigation Proceeds Received [] 10. spo.., Po~ Credit <de,. of deam ~eh,~n 12-3%91 and 1-1-95) ~--~11. Election to tax under Sec. 9113(A) (Attach Sch O)
THiS SECTION MUST BE COMPL,- ~ ~:D, ALL' CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOlil n BE DIRECTED TO;
NAME ~-- ,,1AILING ADDRESS
Robert M. Frey
FIRM NAME (If Applicable)
Fre¥ and Tile¥
TELEPHONE NUMBER
(717)243-5838
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedu
3, Closely Held Corporation. P
4. Mortgages & Notes Receiva[
5. Cash, Bank Deposits & Misc~
(Schedule E)
6. Jointly Owned Property (Schec
[~ Separate Billing Requested
7, Inter-Vivos Transfer & Miscellan
(Schedule G or L)
tnover Street
TOTAL GROSS ASSETS (lotal L
Funeral Expenses & Administrative Costs (Schedule H) (9)
Debts o! Decedent, Mortgage Liabilities, & Liens (Schedule I) 10)
TOTAL DEDUCTIONS (lotal Lines 9 & 10)
NET VALUE OF ESTATE (Line 8 minus Line 11)
Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not
been made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
,nnsylvania 17013
32,482
19,406
27,267
14,964
(8)
OFFICIAL USE ONLY
- y
94,119
17,973
349
(11)
(i2)
18,322
75,797
(13)
(14)
75,797
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal lax
rate ,or transfers under Sec.9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate~
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
75,797
x .0__ (15) 0
x .0 45 (~6) 3,411
x .12 (17) 0
x .15 (18) 0
¢9) 3,411
> >BE SURETO ANSW~I~ ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH'< <' : ':
ll.t:~:llllCllli Fld/~| r'[. ~ll~,i:l l_~llllli::lll: I'-HdZ[ICI l~rlrr1~rl .'
Dec'edent'~ Complete Address:
86~aSTREET ADDRESS
wk Road
I Newvi~le
STATE
PA
ZIP
17241
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3,283
172
(1)
Total Credits ( A + B + C ) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E ) (3)
4, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
(4)
5. If line I + line 3 is greater than line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B)
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 lo designate who shall use the properly transferred or its income; ........... ~ l~
c. retain a reversionary interest; or .............................. [] I~
d. receive the promise for Fife of either payments, benefits or care? ................. ['--'l ~-~
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? .... r--'] []
4. Did decedent own an Individual Retirement Account, annuity or other non-probate properly which
contains a beneficiary designation? ............................... E~ []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true,
3,411
3,455
0
44
0
0
and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowled,qe.
99 Horseshoe Rd,Carlisle PA 17013 (2) 53"F" Street, Carlisle PA 17013
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
DATE
AODRESS ! !
5 South Hanover Street~ Carlisle, Pennsylvania 17013
' : i '
For dates of death on or after July 1, 1994 and- pefore January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. Section 9116 (a)(1.1)(i)].
For dates of death on or after Janua~, 1, 1995, the tax..~rate irnlx~ed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. Section 9116 (a)(1.1)(ii)].
The statute does not exampt a transfer to a su~ving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surciving spouse is the only peneficJary.
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 stepperent of the child is 0%[72 P.S Section 9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. Section 9116(1.2) [72 P.S Section 9116(a)(1
The tax rate imposed on the net value of transfers to or for the use of the decedenrs siblings is 12% [72 P.S. SeCion 9116(a)(1.3)] .A s bng s defined, under Section 9102, as an
indNidual who has at ~east one parent in common with the decedent, whether by bto~l or adoption
217
REV-1503 EX+ (6-~)
COMMONVVEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT OECEDENT
ESTATE OF
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
Hazel R. Lehman, Hazel Myers Lehman
21-03-0459
IIEM
NUMBER
1.
All property jointly.owned with right of survivorship must be di_~c__!n_ __~_ on Sch_,~_,_,!e F.
DESCRIPTION
Series EE Bonds
D45028038EE (500) 3/95
D45028039EE (500) 3/95
M67440438EE (1,000) 7/96
M67490437EE (1,000) 7~96
M67440436EE (1,000) 7/96
V5068160EE (5,000) 7/94
V5068161EE (5,000) 7/94
V5068162EE (5,000) 7/94
V5068163EE (5,000) 7~94
X5094704EE (10,000) 10~95
X5004703EE (10,000) 10/95
Sedes E Bond
#Q5204223290E (25) 12/74
Prudential (20 shares ¢~28.44)
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
VALUE AT DATE
OF DEATH
369
369
663
663
663
3,780
3,780
3,780
3,780
6,972
6,972
122
569
32,482
:~-"~',:'. :..'",".":~ '.~a~~~_~ '
?'"':..~ ':"F : ' .'' .'~ ' ..' '~ ' . ~ .' ; ¥ ' .::' :: '= ·.. ',~ . ' .... . " ' ''' , FROM ISSUZ
~'.'~ ~. 'y?? ... :: ... ., . ~ ~ .............
'.,~?~f'~ ~ o' ~ ~ '" '
· .':".',~.: ~ Z ' - i '.~...1~' ~ · . ; 07: ,,
. ":- '; ~- ,~ ~ "i~'~k~?E~A;~E'ii~ ........ :' .': m'.~ '.:,., ' '. .....
. .-..'::~j
~J~-~"HAZEC MYERS' LEHMAN:...~' - .---:-.
~':'..:?¢.""-:' '-:: ': · '-..' ?q,-z~.~_¢ ~ .. F'RB PITT
.. , i .- ,.. . 7 22-94
' MUH.AEK HU '~ ~. ~.:~'~I: ~-. ' - '.:. '
. . .,. .. · . .: . . ~y.~ ~;q~..~,.. .....
· ?"'. :' ....~. "~'~ i'" r' ~: ' ' ,~'.;.,:~:" .' '
'.o-o_o9:p ;~r6~s~st ...... '~:'-:~:' 0o'o"
,.,. ~.~ :~; ~E ~:..:~ f;<'~-: ....... ;~:"~' ;Q''? ~:" -';' ..
.... ~ :"' .~:~ ~.: i~V S'O b 8 i
· "'::0:~'0 o ~o °o ,,:oa ::aooo'so ~a~ ~ ~ ~,,, ',
!
ISSUE DATE' '
Decembe
,,'Nat'! Bank.' h,
Prudential Financial
&OYCE ~ SHUGHART
JOANN L SANDERSON
EST HAZEL R LEHMAN
CIO ROBERT M FREY
5 SOUTH HANOVER ST
CARLISLE PA 17013-3307
Retain for Your Tax Records
Date Reference Number
09112103 30028-7353
6055-04
is
;3
Dear Policyholder,
We're pleased to inform you that Prudential has completed its conversion from a mutual company to a stock company.
As part of our conversion, we are issuing cash payments to eligible owners of the company. This includes anyone who
owned an eligible policy or annuity contract as of December 15, 2000. Your check is below.
This does not affect your insurance policy or annuity in any way.
Your payment is a benefit of holding an eligible policy or contract. It does not replace your policy or contract, or change
your benefits, cash values, eligibility for policy dividends or guarantees. You do not have to give anything up to receive
your payment.
How your payment was determined.
Company actuaries and external advisors developed a plan for dividing the value of Prudential among its owners. Factors
such as the type of life, annuity or health policy or contract you owned, the face value, and how long you owned it
determined your compensation. Your payment was first calculated as a number of stock shares. These shares were then
converted to an equivalent value in cash. Compensation for all policies eligible for cash payment is included in this
check.
SEE BACK FOR MORE DETAILS.
c
rs
~RU-001 New 1/02
010051441
Prudential Financial
Company Name
PRUDENTIAL {KBA)
PAY TO THE
ORDER OF:
Please Cash Within 180 Days
09112103.
Company Number Reference Number
2302 10 30028-7353
JOYCE R SHUGHART &
JOANN L SANDERSON
EST RAZEL R LEH~tAN
CIO BOBERT N FREY
5 SOUTH HANOVER ST
CARLISLE PA 17013-3307
To Fleet Bank, Hartford, CT
Check Number
010051441
100516&1
51-44
119
Authorized Official
EquiServe, Inc.
ml'Oi, OO5 [hl,~llm m-'Oi,~qOOhhSm: &JAOi~?,,
REV-150~ EX + (1-97'.~'(I)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONVVEALTH Of PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hazel R. Lehman aka Hazel Myers Lehman 21-03-0459
Include the proceeds of §tigatior~ am:l the date the proceeds were received by the estate. ALL PROPERTY JOINTLY-OVa/NED WITH THE RIGHT OF SURVIVORSHIP MUST BE DISCLOSED ON SCHEDULE F.
ITEM
NUMBER
3.
4.
5.
6.
VALUE AT DATE
DESCRIPTION
M&T Bank, C/D#31003911173787
Accrued interest to date of death
M&T, Checking Account #736252
Automobile, 1994 Dodge
Refund, United American Insurance Company
American Express Travelers Cheque
Cash on Hand
TOTAL (Also enter on line 5, Recapitulation)i
OF DEATH
3,000
1
3,851
1,900
37
120
10,497
19,406
(If more space is needed, insert additional sheets of the same size)
M&T
499 Mitchell Road, Millsboro, DE 19966 Mail Code 501-120
Frey & Tiley
Attorneys At Law
5 South Hanover Street
Carlisle, PA 17013
Phone (302) 934-2909
F ax (302) 934-2955
September 12, 2003
Re: Estate of Hazel R. Lehman
Social Security: 210-26- 7692
Date of Death: May 26, 2003
Dear Sir or Madam:
Per your inquiry dated June 25, 2003, please be advised that at the time of death, the above-named decedent had on deposit
with this bank the following:
Type of Account
Account Number
Ownership (Names olO
Opening Date
Balance on Date of Death
Accrued Interest
Total
Type of Account
Account Number
Ownership (Names 099
Opening Date
Balance on Date of Death
Accrued Interest
Total
Certificate of Deposit
31003911173787
Hazel Myers Lehman
11/20/95
$3,000.00
$ .71
--~7603771 ................................
Checking Account
736252
Hazel Myers Lehman
09/01/67
$3,850.81
$ 0.00
--~X~3~Ygi ............................
Type of Account
Account Number
Ownership (Names
Opening Date
Balance on Date of Death
Accrued Interest
Total
Checking Account
1191764
Hazel Myers Lehman
Clair W Lehman
12/03/93
$466.43
$ 0.00
-~-43-6-. ¢~ ..............................
Type of Account
Box Number
Ownership (Names
Opening Date
Safe Deposit Box
2058
Hazel Myers Lehman
O2/O7/92
Sue Kimble ji
Records Management
(302) 934-2909
KRISTEN M SANDERSON 2 2 @
53 F ST
CARLISLE PA 17013-140960.8224/2313
P,O. BOX 40
Mecharltcsburg. PA 17055 ~ ~ '
': E q': ='R i? EL ~,~:0 i? i?q
~ M~.~ ~~~. [--]SAVINGS
Manufacturers and Traders Trusl Compan~ ~CHECKING
NAME
ADDRESS
PREFIX ACCOUNT NUMBER
Prefi]For[tate!enl!,?!~s'~is 1530!(~)'tl 91~ Iq ~ ~'~l 71
Prefix For Passbook Savings is 2100
UUU-Ug4 (~U1
DATE~// ~.~ X~.4~ J DEPOSIT TICKEI
DOLLARS CENTS
CASH
CHECKS~,D -('~',C~r:~(/ / ~ ~)~
TOTAL
TOTAL FROM OTHER SIDE
TOTAL DEPOSIT /~F~ ~)~'~
CHECKS AND OTHER ITEMS ARE RECEIVED FOR DEPOSIT TO THIS ACCOUNT
SUBJECT TO THE RULES AND REGULATIONS OF THIS BANK
UNITED AMERICAN INSURANCE COMPANY
Post Office Box 8080
McKinney, Texas 75070-8080
Policy 9:574508659
Pay To The Order ··~·
Estate of Hazel M Lehman
86 Mohawk Dr
Newville PA 17241
DATE: 05/27/2003
CHECK NO: 590-019
8
JPMorgan Chase Ban~
San J~.qelo, Texas
Authorized Signature
Void If Not Presented Within
12 Months Of The Date Shown Above
"' 5qO0 i, qO 788,' ': i, & ;, 500880~: ""0 f= ~000 5 i,&8 8,'
217
REV-1509 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
Hazel R. Lehman aka Hazel Myers Lehman
FILE NUMBER
21-03-0459
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A. SEE ATTACHED
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
ITEM FOR JOINT MADE ~NCLUDE N~NIE OF FIN,~NCIAL JNSTI31JTJON.4ND BANK ACCOUNT N~MBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NIJMBER. ^3'FACH DEED FOR JOINTLY-HELD RE~L ESTATE.
VALUE OF ASSET INTEREST DECEDENT'S INTERES3
1. A. 3.1.94 A. ArleneDyarman 7,724 50.00% 3,862
2. B. 3.1.94 B.Marie Dyarman 7,724 50.00% 3,862
3. C. 3.1.94 Merle H. Myers 7,724 50.00% 3,862
4. D. 3.1.94 JoyceR. Shughart 7,724 50.00% 3,862
5. E. 3.1.94 Carol J. Reed 7,724 50.00% 3,862
6. F. 3.1.94 Judy K. McNew 7,724 50.00% 3,862
7. G. 3.1.94 JoAnn L. Sanderson 7,724 50.00% 3,862
8. H. 12.3.93 Cia/r Lehman 466 50.00% 233
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
~ 0
0
0
0
0
0
TOTAL (Also enter on line 6, Recapitulation) $ 27,267
(If more space is needed, insert additional sheets of the same size)
SCHEDULE "F"
(A)
A. Arlene Dyarman
111 Limekiln Road
Carlisle PA 17013
Daughter
(B)
B. Marie Dyarman
16 Bear Road
Carlisle PA 17013
Daughter
(c)
Merle H. Myers
718 Gobin Street
Carlisle PA 17013
Son
(D)
Joyce R. Shughart
199 Horseshoe Road
Carlisle PA 17013
Daughter
(E)
Carol J. Reed
802 Cedarwood Village
Morehead City NC 28557
Daughter
(F)
Judy K. McNew
91 Walmar Manor
Dillsburg PA 17019
Daughter
(G)
JoAnn L. Sanderson
53 "F" Street
Carlisle PA 17013
Daughter
(H)
Clair W. Lehman
86 Mohawk Road
Newville PA 17241
Spouse
-:~'~- ~ .~ ':~ ... ...... . ~ ........ :. ...... ~ ........... :':-.::~:' .~'7~":?~ ::~"~
. :::::::::::::::::::::::::::::: ::?: "::: ::~ ':'..: ,: · 4,. '~. ~ .... : ::~'~"~ ...., : "B "'~ :: : ·: - . · : :~
:" ".. :::, :'.:=·. :.21 26 7692: ~',~ '~ '" ....... · ' ' '0~: l'q~n .:'
..,. .... ...::~ ... ~ ~, ~ .... · i~. ~.. ., :.~ . · : -' _:-. ,- ::'. . .-.: · . ~ . ~ ---~ .
., · '~ ".'~','.-.' ,' , ' no~7~E~i~fEd6'7 ...... ,'..-~- : ; ' '..' :. '.. '...."-..' '. : · .......... ........ =--~ ·
::~,:-::::.~'.:.~.~~, ~:: ~--:~ :.::.:~cu:,.s <:"' ::':' ':'" '' :::':"?'::'::~':::":'"":"::::":' ": :':' '"''
:~-~ ~" <-'~: ..~. TAMER: "SERVIC~:::-.:::'::~'. :':?' :::~:: : -~:~: ,:'~ ': '04~07-9~'
:: ~" ':'~'~ ' WJES';: HIGH..ST : =":~ h ~' .',-'".;: · ",' ' ' ' "'~'~i' .... "
'::'.?. ::~'::'.:"'.:: :" :,,::~":.: '::<::::':'.~:=-: ".- ~'-'-"~2.:~:': ....... .:..X:~ 5 q51 B'qE-E.
~'d'~:':'~ :~?S:~:i': :..'.:~:'::'.':'~F: - .' '.,-.. ~<:.;: ::. ~:.: ':,-. , . ' . · ' ~~r~ ~':.., · % :'.': :~ .~: -~' :.-'>'-. t ' : : .' .
~ ...... :::::::::::::::::::::::: :: ................... -:-:-:-:-' :,'~::::~ '~.;~.:' .... ' ..... ':'-:' "=' ...... :.:. ' :::::::.:._:::~', ....... '" - ,,, .- '-'
7~
'7, 7Qq
Type of ~tccount
~tccount Number
Ownership (Names oj)
Opening Date
Balance on Date of Death
Accrued Interest
Checking Account
1191764
Hazel Myers Lehman
Clair ~Y Lehman
12/03/93
$466.43
$ 0.00
Type of Account
Box Number
Ownership (Names oJ)
Opening Date
Safe Deposit Box
2058
Hazel Myers Lehman
02/07/92
Sue Kimble o)~
Records Management
(302) 934-2909
M&T
499 Mitchell Road, Millsboro, DE 19966 Mail Code 501-120
Frey & Tiley
.Attorneys At Law
5 South Hanover Street
Carlisle, PA 17013
Phone (302) 934-2909
F ax (302) 934-2955
September 12, 2003
Re:
Estate of Hazel R. Lehman
Social Securi~: 2] 0-26- 7692
Date of Death: May 26, 2003
Dear Sir or Madam:
Per your inquiry dated June 25, 2003, please be advised that at the time of death, the above-named decedent had on deposit
with this bank the following:
Type of Account
Account Number
Ownership (Names oJ)
Opening Date
Balance on Date of Death
Accrued Interest
Total
Type of Account
Account Number
Ownership (Names
Opening Date
Balance on Date of Death
Accrued Interest
Total
Certificate of Deposit
31003911173787
Hazel Myers Lehman
11/20/95
$3,000.00
$ .71
Checking Account
736252
Hazel Myers Lehman
09/01/67
$3,850.81
$ 0.00
--~-~;~3~?gi .............................
217
REV-1510 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
Hazel R. Lehman aka Hazel Myers Lehman
FILE NUMBER
21-03-0459
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.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THE TR,N~SFEREE, ~'IEIR RELATIONSHIP TO DECEDENT AND THE D^TE OF DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER TRANSFER. ATTACH A COPY OF 'n-lE DEED FOR RE~L ESTATE. VALUE OF ASSET INTEREST ~,F~,c~) VALUE
1. ,Jackson National Life Insurance Co., Annuity ¢K)059018300 14,964 100.00% 14,964
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
' 0
0
0
0
0
0
TOTAL (Also enter on line 7 Recapitulation) $ 14,964
(If more space is needed, insert additional sheets of the same size)
Jackson National Life Insurance Company
Insuring your financial future.*
May 23, 2003
Hazel M Lehman
86 MOHAWK RD
NEWVILLE PA 17241-9434
Policy Valuation
Policy Owner: Hazel M Lehman
Policy Number: 0059018300
Dear Hazel M Lehman:
Thank you for using 3NL's automated telephone system to obtain intbrmation on this policy.
The values fbr this policy, as of May 23, 2003, were:
Accumulation Value $14,963.55
Cash Surrend. er Value'~. ?,: ,. $14,739.10
*Please see Contract for definitions' :..'
For questions regarding this statement, please contact your Jackson National Life Representative or
contact JNL directly at '(890)777-7779, 8:00 a.m. to 8:00 p.m. (ET), Monday through Friday.
Jackson National Life Insurance Company
Lansing MI 48909-7886
www.jnl.com
217
REV-1511 EX + (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
Hazel R. Lehman aka Hazel Myers Lehman
21-03-0459
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
1.
2.
3.
5.
6,
7.
8.
9.
DESCRIPTION
FUNERAL EXPENSES:
Ronan Funeral Home
Westminister Cemetery, Grave Opening
Westminister Cemetery, Headstone
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) Joyce R. Shughart and JoAnn L. Sanderson
Social Security Number(s) / EIN Number of Personal Representative(s)
Street Address SEE ATTACHED
City State Zip.
Year(s) Commission Paid: 2003
Altomey Fees
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant NONE
Street Address
City
Relationship of Claimant to Decedent
Probate Fees
Accountanrs Fees
Tax Return Preparer's Fees
:iling Fee, Pennsylvania Inheritance Tax Return
Filing Fee, Final Account
Cumberland Law Journal, Advertising
The Sentinel, Advertising
State __ Zip.
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
AMOUNT
7,602
945
745
4,153
4,153
79
15
107
75
99
$ 17,973
CHEDULE "H"
JoAnn L. Sanderson
53 "F" Street
Carlisle PA 17013
Joyce R. Shugart
199 Horseshoe Road
Carlisle PA 17013
S.S.#
REV-1512 EX+ (6-98) AT
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Hazel R. Lehman aka Hazel Myers Lehman
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
21-03-0459
Include unreimbursed medical expenses,
ITEM
NUMBER DESCRIPTION
2.
3.
4.
Lehman's Storage Rental
Thompson Eye Associates
Merle Myers, Miscellaneous
JoAnn Sanderson, Cleaning Supplies
TOTAL (Aisc enter on line 10, Reca
VALUE AT DATE
OF DEATH
88
107
42
112
349
(If more space is needed, insert additional sheets of the same size)
217
REV-1513 EX + (9-00)
COMMONVVEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
Hazel R. Lehman aka Hazel Myers Lehman
FILE NUMBER
21-03-0459
NUMBER
I.
II.
1.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and
transfers under Sec. 9116 (al (1.2)]
A. Arlene Dyarman
111 Limekiln Road
Carlisle, Pennsylvania 17013
B.Marie Dyarman
16 Bear Road
Carlisle, Pennsylvania 17013
Merle H. Myers
718 Gobin Street
Carlisle, Pennsylvania 17013
Joyce R. Shughart
100 Horseshoe Road
Carlisle, Pennsylvania 1713
Carol J. Reed
802 Cedarwood Village
Morehead City NC 28557
Judy K. McNew
91 Walmar Manor
Dillsburg, Pennsylvania 17019
JoAnn L. Sanderson
53 "F" Street
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Daughter
Daughter
Son
Daughter
Daughter
Daughter
AMOUNT OR SHARE
OF ESTATE
1/7% residue of estate
117% residue of estate
1/7% residue of estate
1/7% residue of estate
1/7% residue of estate
117% residue of estate
Carlisle, Pennsylvania 17013 Daughter !/7% residue of estate
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE~ ON REV-1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
Clair W. Lehman
500.00
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART Il - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
(If more space is needed, insert additional sheets of the same size)
ATTACHMENT TO SCHEDULE "J"
CLAIR W. LEHMAN
86 MOHAWK ROAD
NEWVILLE PA 17241
SPOUSE
BEQUEST OF $500.00
LAST WILL AND TESTAMENT
OF
HAZEL R. LEHMAN,
ALSO KNOWN AS HAZEL MYERS LEHMAN
I, HAZEL R. LEHMAN, also known as HAZEL MYERS LEHMAN, of Lower
Mifflin Township (mailing address: 86 Mohawk Road, Newville, Pennsylvania 17241)
Curabe. rland 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 and making void any and all Wills by me at any time heretofore made.
1. I direct my hereinafter named Executrices to pay all of my just debts and funeral
expenses as soon after my death as may be found convenient to do so. I direct that all transfer,
inheritance and estate and succession taxes which may be payable upon account of my death shall
be paid from the residue of my estate regardless of whether the asses upon which said taxes are
based are includedin my probate estate.
I direct that my body be interred beside that of my first husband, Merle K. Myers, on
my burial lot located in Westminster Cemetery located in North Middleton Township near the
Borough of Carlisle, Pennsylvania.
2. I give and bequeath the sum o $$00 to my husband, Clair W. Lehman, provided he
shall survive me by a period of ninety (90) days. This b~quest is not larger because I am
confident he has more than sufficient resources to adequately provide for him. '
3. All of the rest, residue and remainder of my estate, real, personal and mixed, and
wheresoever the same may be situate, I give, devise and bequeath in seven (7) equal shares as
follows: .
a) One (1) share to my daughter, A. Arlene Dya~nan, her heirs and assigns, provided
she shall survive me by a period of ninety (90) days, but should she fail to so survive me then the
same shall lapse and be added to the remaining shares;
b) One (1)share to my daughter, B. Marie Dyarman, her heirs and assigns, provided
she shall survive me by a period of ninety (90) days, but should she fail to so survive me' then the
same shall lapse and be added to th'e remaining shares;
e) One (1) sha~e to my son, Merle H. Myers, his heirs and assigns, provided he shall
survive me by a period of ninety (90) days, but should he fail to so survive me then the same shall
lapse and be added to the remaining shares;
d) One (1) share to my daughter, Joyce R. Shughart, her heirs and assigns, provided
she shall survive me by a period of ninety (90) days, but should she fall to so survive me then the
same shall lapse and be added to the remaining shares;
e) One (1) share to my daughter, Carol J. Reed, her heirs and assigns, provided she
shall survive me by a period of ninety (90) days, but should she fail to so survive me then the
same shall lapse and be added to the remaining shares;
f) One (1) share to my daughter, Judy K. MeNew, her heirs and assigns, provided
she shall survive me by a period of ninety (90) days, but should she fail to so survive me then the
same shall lapse and be added to the remaining shares;
g) One (1) share to my daughter, $oann L. Sanderson, her heirs and assigns, provided
she shall survive me by a period of ninety (90) days, but should she fail to so survive me then the
same shall lapse and be added to the remaining shares;
4. I hereby nominate, constitute and appoint my daughters, ./oyce R. Shughart and $oan L.
Sanderson, or the survivor of them, as co-Executrices of this my Last Will and Testament, and I
further direct that neither of them shall be required to post any bond to secure the faithful
performance of her duties in the Commonwealth of Pennsylvania or in any other jurisdiction.
Page 1 of 2 Pages
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and
Testament written on two ( 2 ) pages, this llth day of April, 1996.
Hazcl'R. Lehman,
also sometimes known as ·
(SEAL)
azel IVf'~ers Lehn~ '
Signed, sealed, published and declared by HAZEL R. LEHMAN, who is sometimes known
as HAZEL MYERS LEHMAN, the Testatrix above named, as and for her Last Will and
Testament, in our presence, who, in her presence, at her request, and in the presence of each other,
have hereunto subscribed our. names as attesting witnesses.
Page 2 of 2 Page~
BUREAU OF ZNDZVZDUAL TAXES
TNHERZTANCE TAX DZVZSTOH
DEPT. Z80601
HARRZSBURG, PA 171Z8-0601
ROBERT H FREY
5 S HANOVER ST
CARLZSLE
PA 11~013
COMMONNEALTH OF PENNSYLVANZA
DEPARTMENT OF REVENUE
NOTZCE OF ZNHERZTANCE TAX
APPRAZSEMENT, ALLO#ANCE OR DZSALLO#ANCE
OF DEDUCT/ONS AND ASSESSMENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FZLE NUMBER
COUNTY
ACN
1Z-01-2003
LEHHAN
05-Z6-Z005
21 03-0q59
CUMBERLAND
101
Amoun~ Ram'i ~'l:Dd
HAZEL R
HAKE CHECK PAYABLE AND REMZT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLTSLE, PA 17013
CUT ALONG THZS LZNE ~ RETAZN LONER PORTZON FOR YOUR RECORDS ~
REV-1547 EX AFP (01-03) NOTZCE OF ZNHERTTANCE TAX APPRA]:SEMENT, ALLONANCE OR
DTSALLONANCE OF DEDUCT]:ONS AND ASSESSMENT OF TAX
ESTATE OF LEHMAN HAZEL R F]:LE NO. 21 03-0q59 ACN 101 DATE 12-01-2003
TAX RETURN NAS: (X) ACCEPTED AS FILED ( } CHANGED
RESERVATZON CONCERNTNG FUTURE ZNTEREST - SEE REVERSE
APPRAZSED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Es~a~e (SchDdula A) (1)
2. S~ocks and Bonds (Schedule B) (2)
3. ClosDly HDld S~ock/Per~narship Znteres* (Schedule C) (3)
q. Mor~geges/No~as RDcD~vable (Schedule D)
5. Cash/Bank Deposits~Misc. Personal Proper~y (Schedule E) (5)
6. Jointly Owned Proper~y (Schedule F) (6}
7. Transfers (Schedule G) (7)
8. To,al Assa~s
APPROVED DEDUCTZONS AND EXEMPTZONS:
9. Funeral Expanses/AdD. Costs/Misc. Expanses (Schedule H) (9)
10. Debts/Mortgage Liabili~/as/L/ans (Schedule I) (10)
11. To,al Deduc~/ons
12. Ne~ Value of Tax Ra~urn
.00
32~q8Z. O0
.00
.00
191q06.00
271267.00
lq~96q.00
17,973. O0
3q9.00
NOTE: To /nsure proper
credi~ ~o your account,
submi~ ~he upper portion
of ~h/s ford w/~h your
~ax payment.
9q,119.00
13.
NOTE:
(11) 18.322.fl0
(12) 75,797.00
Char/~Dble/governDDn~al BDques~s; Non-Dlec~ed 911:5 Trusts (Schedule J) (1:5)
Ne~ ValuD of Es~a~:D Sub,~ec~: ~o Tax (lq)
:Zf an assesseent ,as $ssued previously, lanes 14, 15 and/or 16, 17,
reflect flgures that include the total of ALL returns assessed to date.
.00
75,797.00
ASSESSMENT OF TAX:
1.6. Amoun~ of Line lq a'l: Spousal ra~a
16. Amoun~ of L/ne lq ~axabla e~ L/neel/CIDss A re~D
17. ADoun~ of L/nD lq e~ S/b~L/ng ra~cD
18. Amoun~ of L/ne lq ~exabla a~ Colla~eral/CIDss B rD~e
19. Pr/ncipel Tax Due
TAX CREDZTS:
PAYMENT RECEIPT DISCOUNT
DATE NUMBER INTEREST/PEN PAZD (-
08-26-2003 CDOOZ9qZ 170.55
11-2q-2003 REFUND . O0
IF PAZD AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
18 and 19 will
3,q11.00
.00
.00
.00
( ZF TOTAL DUE IS LESS THAN $1, NO PAYMENT ZS REQUIRED.
IF TOTAL DUE 1S REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SZDE OF THIS FORM FOR INSTRUCTZONS.)
TOTAL TAX CREDZT
BALANCE OF TAX DUE
ZNTEREST AND PEN.
TOTAL DUE
3,Z83.00
q2.55-
AMOUNT PAZD
(L.6) .00 x O0 = .00
(~6) 75,797.00 x OqS= 3,qll. O0
(17) . O0 x 12 = . O0
(~a) .00 x 15 = .00
(~9)= 3,q11.00
RESERVATION:
PURPOSE OF
NOTICE:
PAYMENT:
REFUND (CR):
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December 12, 1982 -- [f any future interest in the estate is transferred
in possession or enjoyment to Class B (collataral) beneficiaries of tho decedent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rata on any such future interest.
To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (72 P.S.
Section 9140).
Detach the tap portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side.
--Hake check or money order payabie to: REGISTER OF NILES, AGENT
A refund of a tax credit, which was not requested an the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office
of the Register of Wills, any of the Z5 Revenue District Offices, or by calling the special Z4-hour
answering service for forms ordering: 1-800-$62-2050; services for taxpayers with special hearing and / or
speaking needs: 1-800-447-3020 (TT only)o
Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. Z810Z1, Harrisburg, PA 17128-1021,
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
OR
1982 ZOZ
1985 16Z
1984 llZ
1985 lSZ
1986 102
--Interest is calculated as folloas:
INTEREST = BALANCE OF TAX UNPAID
Factual errors discovered an this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Past Assessment Review Unit, Dept. 280601, Harrisburg, PA 171Z8-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions far Inhar[tance Tax Return for a Resident
Decedent" (REV-1501) for an expIanation of administratively correctable errors.
If any tax due is paid within three (5) calendar months after the decedant's death, a five percent (5Z) discount of
the tax paid [s aZ[owed.
The 15Z tax amnesty non-participation penalty is computed on the total af the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and [n the the same time period as you would appeal the tax and interest
that has boon assessed as indicated on this not[ce.
Interest is charged beginning with first day of delinquency, or nine (9) months and one (l) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six (62) percent per annum calculated at a dally rate of .000164. All taxes which became delinquent on and after
January 1, 1982 w[11 bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2003 are:
Interest Daily Interest Daily Interest Daily
Rate Factor Year Rate Factor Year Rate Factor
.000548 1987 9Z .000247 1999 7Z .00019Z
.000458 1988-1991 112 .000501 2000 82 .000Z19
.000301 1992 92 .000247 2001 92 .000247
· 000356 1993-1994 72 .000192 2002 62 .000164
.000274 1995-1998 9Z .000247 Z003 52 .000137
X NUNBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
BUREAU OF TNDZVZDUAL TAXES
INHERITANCE TAX DIVISION
DEPT.
HARRTSBURG, PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANZA
DEPARTMENT OF REVENUE
ZNHERZTANCE TAX
STATEMENT OF ACCOUNT
REV-1G07 EX AFP
ROBERT M FREY
5 S HANOVER ST
CARLISLE
PA 17015
DATE 12-08-2005
ESTATE OF LEHMAN HAZEL
DATE OF DEA~
21 05-0q59
CUMBERLAND
101
FZLE NUMBER
COUNTY
ACM
Amount Remit'l:ed
MAKE CHECK PAYABLE AND REMZT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
NOTE: To insure proper credit to your account, subm/t the upper portLon of this form w/th your tax payment.
CUT ALONG THZS LINE ~1~ RETAIN LOWER PORTZON FOR YOUR RECORDS ~
REV-1607 EX AFP (01-03)
x~ ZNHERZTANCE TAX STATEMENT OF ACCOUNT
ESTATE OF LEHMAN HAZEL R FILE NO. 21 05-0q59 ACN 101 DATE 12-08-2005
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN TN THE NAMED ESTATE. SHO#N BELOW
IS A SUMMARY OF THE PRTNCTpAL TAX DUE, APPLTCATTON OF ALL PAYMENTS, THE CURRENT BALANCE,, AND,, 'rF APPLZCABLE,,
A PROJECTED TNTEREST F'rGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 12-01-2005
PRINCIPAL TAX DUE: ....................................................................................................................................................................................................
PAYMENTS CTAX CREDITS):
5,q11.00
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID
170.55
08-26-2005
11-Zq-ZO05
CO0029q2
REFUND
.00
3,285.00
q2.55-
ZF PAZD AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( ZF TOTAL DUE 1S LESS THAN $1,
NO PAYMENT .rS REQU.rRED.
.rF TOTAL DUE .rS REFLECTED AS A 'CREDZT' (CA),
TOTAL TAX CREDZT $,qll.00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
YOU MAY BE DUE A REFUND. SEE REVERSE SZDE OF TH'rS FORM FOR .rNSTRUCTZONS. )
IN RE: ESTATE OF HAZEL R. LEHMAN
AKA HAZEL MYERS LEHMAN,
LATE OF LOWER MIFFLIN TOWNSHIP
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY,
PENNSYLVANIA
ORPHANS COURT DIVISION
21-2003-0459
ORDER
AND NOW, this __1 ~day of January, 2004, the within account is confirmed and
distribution directed in accordance with the schedule.
BY THECOURT,
FIRST AND FINAL ACCOUNT OF JOANN L. SANDERSON AND JOYCE R.
SHUGHART, EXECUTORS OF THE LAST WILL AND TESTAMENT OF HAZEL R.
LEHMAN AKA HAZEL MYERS LEHMAN, LATE OF LOWER MIFFLIN TOWNSHIP,
CUMBERLAND COUNTY, PENNSYLVANIA, DECEASED.
DATE OF DEATH:
MAY 26, 2003
LETTERS TESTAMENTARY
ADVERTISED:
The Sentinel: June 26th, July 3rd & 10th, 2003
CLJ: July 4th, 11th and 18th, 2003
ESTATE FILE NO.:
21-03-0459
PRINCIPAL RECEIVED
ACCOUNTANT IS CHARGED WITH THE AMOUNTS OF PRINCIPAL AND INTEREST RECEIVED
AND CLAIMS CREDIT FOR THE DISBURSEMENTS MADE AS STATED BELOW:
2003
May 26 Series EE Bonds $31,792.40
#D45028038EE ($500) $369.40
#D45028039EE ($500) $369.40
#M67440438EE ($1,000) $663.20
#M67440437EE ($1,000) $663.20
#M67440436EE ($1,000) $663.20
#V5068160EE ($5,000) $3,780.00
#V5068161EE ($5,000) $3,780.00
#V5068162EE ($5,000) $3,780.00
#V5068163EE ($5,000) $3,780.00
#X5004704EE ($10,000) $6,972.00
#X5004703EE ($10,000) $6,972.00
May26 Series E Bond $121.57
#Q5204223290E ($25.00) $121.57
May 26 Prudential Stock (20 shares @28.44) $568.80
May26 M&T Bank, C/D #31003911173787 $3,000.00
Accrued interest to May 26, 2003 $.71
May 26 M&T Bank, Checking Acct #736252 $3,850.81
May26 Cash on'Hand $10,996.50
May 26 American Express Travel Cheques $120.00
#DB356 456 660 ($20.00)
Page I of 5
June 13
Aug. 13
#DB356 456 664 ($20.00)
#DB422 094 321 ($20.00)
#DD559 397 258 ($20.00)
#DD559 397 260 ($20.00)
#DB219 003 785 ($20.00)
Refund, United American Insurance Co.
Automobile, 1994 Dodge
TOTAL PRINCIPAL RECEIVED
INCOME RECEIVED
$37.07
$1,900.00
$52,387.86
2OO3
May 26
2003
May 29
June 5
June 6
June 26
June 27
July 3
July 3
July 18
July 18
Interest, M&T Bank, C/D#31003911173787
TOTAL INCOME RECEIVED
DISBURSEMENTS
Clair Lehman, Bequest
Register of Wills, Probate Will
Lehman's Storage & Rentals, Miscellaneous
Thompson Eye Associates, Medical
Register of Wills, (1) Short Certificate
Ronan Funeral Home
Merle Myers, Repairs to Automobile
The Sentinel, Advertising
Cumberland Law Journal, AdvertiSing
$18.50
$18.50
$500.00
$79.00
$87.50
$107.00
$3.00
$7,601.50
$42.00
$98.69
$75.00
Page 2 of 5
Aug. 3
Aug. 11
Aug. 26
Sept. 5
Oct. 14
Oct. 27
Oct. 24
Dec. 1
Dec. 1
Dec. 1
Dec. 1
West Minister Cemetery, Headstone
Register of Wills, (1) Short Certificate
Register of Wills, Agent
Estimated PA Inheritance Tax
Register of Wills, (1) Short Certificate
Register of WillS, Filing Fee
PA Inheritance Tax Return
Register of Wills, Additional Probate Fee
Register of Wills, Filing Fee for Final Account
Joyce R. Shughart, Executor's Fee
JoAnn L. Sanderson, Executor's Fee
Robert M. Frey, Prepare & File 2003 Taxes
Robert M. Frey, Attorney Fee
TOTAL DISBURSEMENTS
RECA PITULA TION
TOTAL PRINCIPAL
TOTAL INCOME RECEIVED
TOTAL RECEIPTS
LESS TOTAL DISBURSEMENTS
BALANCE FOR DISTRIBUTIONS
$745.00
$3.oo
$3,283.OO
$3.00
$15.00
$140.00
$107.00
$2,O76.5O
$2,076.50
$25.oo
$4,153.00
$21,220.69
$52,387.86
$ 1e.5o
$52,406.36
$21,220.69
$31,185.67
Page 3 of 5
PROPOSED SCHEDULE OF DISTRIBUTION
BALANCE FOR DISTRIBUTION
TO:
A. Arlene Dyarman
111 Limekiln Road
Carlisle PA 17013
1/7 of residue of estate:
TO:
B. Marie Dyarman
16 Bear Road
Carlisle PA 17013
1/7 of residue of estate:
TO:
Merle H. Myers
718 Gobin Street
Carlisle PA 17013
1/7 of residue of estate:
TO:
Judy K. McNew
91 Walmar Manor
Dillsburg PA 17019
1/7 of residue of estate:
TO:
Carol J. Reed
802 Cedarwood Village
Morehead City NC 28857
1/7 of residue of estate:
TO:
Joyce R. Shughart
199 Horseshoe Road
Carlisle PA 17013
1/7 of residue of estate:
TO:
JoAnn L. Sanderson
53 "F" Street
Carlisle PA 17013
1/7 of residue of estate:
$31,185.67
$4,455.10
$4,455.10
$4,455.10
$4,455.10
$4,455.09
$4,455.09
$4,455.09
TOTAL DISTRIBUTION
$31,185.67
Page 4 of 5
COMMONWEALTH OF PENNSYLVANIA )
):SS.:
COUNTY OF CUMBERLAND )
Before me, the undersigned officer, personally appeared Joyce R. Shughart
and JoAnn L. Sanderson, Executors of the Last Will and Testament of Hazel R.
Lehman aka Hazel Myers Lehman, deceased, who, being duly sworn according to
law, deposes and says that the foregoing First and Final Account is true and
correct to the best of their knowledge, information and belief.
6~c e~ Shugh~trt
j~Ann'L. Sanderson
Sworn to and subscribed be,fore
me this <~,.q ~' day of O 0.9/~ ~- 2003.
MY .......... "';. ~':~-AND CO. PA
Page 5 of 5
First and Final Account of JoAnn
L. Sanderson and Joyce R.
Sh,~ghart, Executrices of the Last
Vg]II and Testament of Hazel R.
Lehman AKA Hazel Myers
Lehman, Late of Lower Mifflin
Township, of Cumberland
County, Pennsylvania, Deceased
Proposed Schedule of Distribution
FREY & TILEY
ATTOFIN EY$-AT-LAW
5 South Hanover Street
Oarli$1e, PA 17013
Telephone (717) 243-5838
· ~ =~ereby cert~/that writt~ n.: ~,,~ fili~j of this
Stateme~ o~ Pmpmled Dtstr~ ,,. :~nd of the cl~e.
time and ~ ~ the ~em~, ..... ?~e preee~tt~ to
the Court for ~ anc'J of ~ la~t c~ to 1~
~ hm bern glW,n to; ,~very L.13ad claimant
and to evee/elher ~ Imov,~ to tt"~e accountant to
be~'teflctary, heir or negt of kit.
...-~by certify that writ'~e.r., nat~ce of the filing
.: ~is ~ccount, and of th~ ~;~, :~ urne and piece
,c: corff~matlon ~ of the iast day to file writte
,,.;F~ctions to aald .do:)ount, has been given to
,:vary unpaid (~almant and to evory other pets(
,~nown to the aoommtan~ ~o nave or claim an
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG:, PA 171Z&-0601
ROBERT M FREY
5 S HANOVER ST
CARLISLE
PA 17013
COMMONWEALTH OF PENNSYLVAN'rA
DEPARTMENT OF REVENUE
ZNHERZTANGE TAX
STATEMENT OF ACCOUNT
DATE 1Z-08-2005
ESTATE OF LEHMAN
DATE OF DEATH 05-26-2005
FILE NUMBER 21 03-0q59
COUNTY CUMBERLAND
ACN 101
Amount RemLt~ed
REV-I~07 EX AFP CDi-OS)
HAZEL R
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV-1607 EX AFP (01-03) ~# 'rNHERZTANCE TAX STATEMENT OF ACCOUNT
ESTATE OF LEHMAN HAZEL R FILE NO. 21 03-0q59 ACH 101 DATE 12-08-2003
TH'rS STATEMENT TS PROVIDED TO ADVTSE OF THE CURRENT STATUS OF THE STATED ACM TN THE NAMED ESTATE. SHONN BELON
TS A SUMMARY OF THE PRTNCTpAL TAX DUE, APPLZCATTON OF ALL PAYMENTS, THE CURRENT BALANCE, AND, ZF APPL/CABLE.,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 12-01-2003
PRINCIPAL TAX DUE: ...........................................................................................................................................................................................................................
3,q11.00
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID ¢-)
08-26-2003
11-2q-2003
CDOOZ9q2
REFUND
170.55
.00
ZF PAID AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( ZF TOTAL DUE ZS LESS THAN $1,
NO PAYMENT ZS REQUIRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR),
AMOUNT PAID
3,283. O0
q2.55-
TOTAL TAX CREDIT 3,q11.00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Hazel R. Lehman
Date of Death: May 26, 2003
Will No.
Admin. No. 21-03-0459
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the
following with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes (X) No ( )
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
3. If the answer to No.1 is Yes, state the following:
(a) Did the personal representative file a final account with the Court?
Yes (X) No ( ). January 14, 2004 date Confirmed
(b) The separate Orphans' Court no. (if any) for the personal
representative's account is:
(c) Did the personal representative state an account informally to the
parties in interest? Yes (X) No ( )
(d) Copies of receipts, releases, joinders and approvals of formal or
informal accounts may be filed with the Clerk of the Orphans' Court
and may be attached to this report.
Date: April 19, 2005
,~---),_ 7,,~
Signature /
Robert M. Frey
Name (Please type or print)
5 South Hanover Street
Carlisle. Pa 17013
Address
(717) 243-5838
Telephone No.
Capacity: ( ) Personal Representative
( X ) Counsel for personal representative
J
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 4/15/2005
FREY ROBERT M
5 S HANOVER STREET
CARLISLE, PA 17013
RE: Estate of LEHMAN HAZEL R
File Number: 2003-00459
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after
July I, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by:
5/26/2005
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
~~~
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Personal Representative(s)
Judge
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