HomeMy WebLinkAbout09-30-11 (2) 15
05610140
REV-1500 ~` ~°~-~°~
PA Department of Revenue
Bureau of Individual Taxes OFFICIAL USE ONLY
Po BOx 280601
Harrisbur PA 17128-0601 INHERITANCE TAX RETURN County Code Year File Number
ENTER DECEDENT INFORMATION BELOW RESIDENT DECEDENT 2 1 1 0 0 6 7 9
Social Security Number
Date of Death MMDDYYYY Date of Birth
2 0 2 2 0 7 1 6 7 0 MMDDYYYY
6 3 0 2 0 1 0 0
Decedent's Last Name 5 3 0 1 9 2 4
M A $ $ E
Y Suffix Decedent's First Name
MI
H A Z E L M
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name
Suffix Spouse's First Name
MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
FILL IN APPROPRIATE OVALS BEL REGISTER OF WILLS
OW
1. Original Return ^ 2. Supplemental Return
^
4. Limited Estate ^ ~ 3. Remainder Return (date of death
Prior to 12-13-82)
4a. Future Interest Com
r
i
^X 6. Decedent Died Testate ^ p
om
se date of
death after 12-12-82) ( ^ 5. Federal Estate Tax Return Required
7
D
(Attach Copy of Will)
^ 9. Litigation Proceeds R
i .
ecedent Maintained a Living Trust _
(Attach Copy of Trust) 8. Total Number of Safe Deposit Boxes
ece
ved ^ 10. Spousal Poverty Credit (date of death
^ 11. Election to tax under Sec
between 12-31-91 and 1
9113
1
.
-
(A)
-95)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL
Name
TAX NFORMATION SHOULD BE DIRECTED T0:
R O G E R B I R W Daytime TelePpone Number4
I
N E S Q U I R E 7 1 7 2 ~4 9, 2, 3 ~~
~ ~'
REGISTER QF VyILLS USA ONLY '
First line of address -~ ~
6 0 W E S T
P O M F
Second line of address , ~ -
R E T S T R E E T
t ~•J
Clty Of POSt CfftICL~
C A R L I S L E
State ZIP Code ~ DATE FILED
P A 1 7 0 1 3
Correspondent's a-mail address:
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATU PERS N RESPON I FOR FILING RETURN
D TE
ADD ESS
83 REGENfY WOODS NORTH 3v ~~
SIGNATURE Ofi ~REPARER OTH~R THA~1~?tEPRESENTATIVE CARLISLE P A 17 015
,. ,
WEST Pdl~FRET STREET
CARLISLE
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610140
TE
f Ss/~,
A 17013
1505610140
J
1505610240
REV-1500 EX
Decedent's Name: HAZEL M• M A S S E Y
RECAPITULATION Decedent's Social Security Number
2 0 2 2 0 7 1 6 7
1.
2.
3. Real Estate (Schedule A) ................................ • , •
Stocks and Bonds (Schedule B) .................................
Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) 1 • 2 0 Q ~
..... 2. 1 7 7
..... 3. 0 ~ ~ ~
0 ~ 7 8
4. Mortgages and Notes Receivable (Schedule D) ..................... .....
4.
5.
6.
7. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..
Jointly Owned Property (Schedule F
Inter-Vivos Transfers & Miscellaneous NaProbate Pr Plerty Requested ..
(Schedule G) ~ Separate Billing Requested .. ..... 5. 1 1 6 9
..... g.
..... 7.
3. 5 5
8.
9.
10.
11. Total Gross Assets (total Lines 1 through 7) ..............
•••.•....
Funeral Expenses and Administrative Costs (Schedule H) ..... .
~~••••~~
Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .........
Total Deductions (total Lines 9 and 10)
..•. 8. 3 3 4 6
~•~• 9. 1 9 0 3
.... 10. 9 2 2
4. 3 3
7. 2 5
1 . 6 9
12.
13. .......... .
................
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) ..................
....11. 2 8 2 5
12 5 2 0
... . 13.
8. 9 4
5 . 3 9
14. Net Value Subject to Tax (Line 12 minus Line 13)
.
TAX CALCULATION -SEE INSTRUCTIONS FOR .................
APPLICABLE RATES ....14. 5 2 0 5. 3 9
15. Amount of Line 14 taxable
at the spousal tax rate
or
,
transfers under Sec. 9118
(a)(1.2) X .0 _ 0 . 0 0 15
16. Amount of Line 14 taxable .
0 •
0
0
at lineal rate X .045 5 2 0 5. 3 9
17. Amount of Line 14 taxable 1s
2 3 4 .
2
4
at sibling rate X .12 ~ ~ 0 0
17
18. Amount of Line 14 taxable • 0 . 0 0
at collateral rate X .15 0 0 0
18
o.
0
0
19. TAX DUE ......................................................19.
2 3 4. 2 4
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
L 1505610240 1505610240
REV-1500 EX Page 3 File Number
G~cedent's Complete Address: 21 10 0679
DECEDENT'S NAME
HAZEL M. MASSEY
STREET ADDRESS
141 N. BEDFORD STREET
ciTv
CARLISLE STATE Zip
PA 17013
Tax Payments and Credits:
1• Tax Due (Page 2, Line 19) (1) 234 24
2. Credits/Payments
A. Prior Payments
B. Discount
3. Interest
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund.
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
Total Credits (A + B) (2) ~,~,~
(3)
(4) 0.00
c5) ~3 ~~Y 2.,2,2,5-~.
Make check payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred : .................................
b. retain the right to designate who shall use the property transferred or its income; ............................... ^ 0
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? .................................................................................... ^ 0
3. Did decedent own an "intrust for" or payable-upon-death bank account or security at his or her death? ......... ^ Q
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 Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
3 percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after Jan.1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an
adoptive parent or a stepparent of the child is 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 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 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, undE
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1502 EX+ (01-10)
pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
ESIAtE OF:
FILE NUMBER:
HAZEL M. MASSEY 21 10 0679
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property
would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property that is jointlyowned with right of survivorship must be disclosed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1. 141 NORTH BEDFORD STREET, CARLISLE, PENNSYLVANIA 20,000.00
APPRAISAL ATTACHED
TOTAL (Also enter on Line 1, Recapitulation.) I $
If more space is needed, use additional sheets of paper of the same size.
REV-1503 EX + (6-98)
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
HAZEL M. MASSEY 21 10 0679
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
1. 33 SHARES OF PRUDENTIAL FINANCIAL, INC. STOCK OF DEATH
53.66 X 33 = $1,770.78 1,770.78
TOTAL (Also enter on line 2, Recapitulation) I $ 1, 770.
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX + (6-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
IN R SI DENT DECEDENTRN PERSONAL PROPERTY
ESTATE OF FILE NUMBER
HAZEL M. MASSEY 21 10 0679
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointty-owned with right of survivorship must be disclosed on Schedule F.
ITEM
VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. SOVEREIGN BANK -CHECKING ACCOUNT #0981103154 28 95
2. SOVEREIGN BANK -STATEMENT SAVINGS #1674301872 ~ 245.82
3. M&T BANK -SAVINGS ACCOUNT #15004208226793 868.24
4. CORNERSTONE FEDERAL CREDIT UNION -SAVINGS ACCOUNT 49 78
5. CORNERSTONE FEDERAL CREDIT UNION -MONEY MARKET ACCOUNT 7,861.76
6. PERSONAL PROPERTY -APPRAISAL ATTACHED 164.00
7. 12003 CHEVROLET MALIBU LS I 2,475.00
TOTAL (Also enter on line 5, Recapitulation) I $ 11 693 55
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (10-09)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
~~ ~.,i ~ yr FILE NUMBER
HAZEL M. MASSEY 21 10 0679
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. HOFFMAN-ROTH FUNERAL HOME 3,441.60
OPENING/CLOSING GRAVE 1,599.00
B. I ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s) of Personal Representative(s) MARLO STOFKO
Street Address 83 REGENCY WOODS NORTH
City CARLISLE State PA zIP 17013
Year(s) Commission Paid:
2, AttomeyFees: IRWIN & McKNIGHT, P.C.
3. Family Exemption: (If decedents address is not the same as claimants, attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4• Probate Fees: REGISTER OF WILLS
5. I Accountant Fees:
6. ~ Tax Retum Preparer Fees: PATRICIA A. ROSENDALE, CPA
2,500.00
7. REGISTER OF WILLS -FILING FEE 30.00
8. SOVEREIGN BANK -DATE OF DEATH VALUATION 20.00
9. MARLO STOFKO - REIMBURSEMENT OF CLEANING SUPPLIES/PETS/HELP 3,750.00
10. CUMBERLAND LAW JOURNAL -ESTATE NOTICE 75.00
11. THE SENTINEL -ESTATE NOTICE 187.54
12. TERMINEX -PEST CONTROL 125.00
13. S.W. BARRETT REAL ESTATE -APPRAISAL ON REAL ESTATE 350.00
14. ROY D. GOTTSHALL -APPRAISAL ON PERSONAL PROPERTY 25.00
15. RICHARD CASSEL -TRASH REMOVAL 1,085.00
16. REGISTER OF WILLS -SHORT CERTIFICATES 8.00
17. NOTARY 25.00
18. CLOSING COSTS ON SALE OF REAL ESTATE 2,182.61
TOTAL (Also enter on Line 9, Recapitulation) $
19 037.25
If more space is needed, use additional sheets of paper of the same size.
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
HAZEL M. MASSEY
Decedent's Name 21 10 0679
Page 1 File Number
Schedule H -Funeral Expenses >~ Administrative Costs - B7.
ITEM
NUMBER
DESCRIPTION
AMOUNT
19. I VITAL RECORDS -ADDITIONAL COPIES OF DEATH CERTIFICATES
18.00
SUBTOTAL SCHEDULE H-B7 ~ 18.00
REV-1512 EX+ (12-08)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE R
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, ~ LIENS
FILE NUMBER
HAZEL M. MASSEY 21 10 0679
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION VAOF DEATDHTE
1. BOROUGH OF CARLISLE - WATER/SEWER 203.17
2. CARLISLE BOROUGH TAX ACCOUNT -REAL ESTATE TAXES (2010)
642.69
3. CUMBERLAND VALLEY PAIN MANAGEMENT -MEDICAL 148.07
4. PP&L -ELECTRIC
227.44
5. SHIPLEY OIL -FUEL
237.73
6. (ASCENSION POINT ON BEHALF OF EQUABLE ASCENT FINANCIAL, LLC I 5,915.00
7. UGI -UTILITY
71.59
8. M&T BANK -REIMBURSEMENT OF OPM PENSION 1,358.00
9. (SOVEREIGN BANK -REIMBURSEMENT OF SOCIAL SECURITY I 418.00
TOTAL (Also enter on Line 10, Recapitulation) I $
9 221
If more space is needed, insert additional sheets of the same size.
Rtv-i5i:~ tx+ poi-ion
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
t~IAItUh:
FILE NUMBER:
HAZEL M . MASSEY 21 10 0679
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT
Do Not List Trustee(s) AMOUNT OR SHARE
OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).)
1. JENNIFER HOLLINGER Lineal 5
205
39
141 N. BEDFORD STREET ,
.
REMAINDER
CARLISLE, PA 17013
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN:
1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
Ir more space is neeaea, use aaartional sneers of paper of the same size.
LAST WILL AND TESTAMENT
I, HAZEL M. MASSEY, of the Borough of Carlisle, Cumberland County, Pennsylvania,
being of sound mind, disposing memory and full legal age, do hereby make, publish and declare
this to be my Last Will and Testament, hereby revoking all Wills and Codicils heretofore made
by me.
1. I direct my Executrix to pay all of my debts, funeral and administrative expenses as
soon as convenient after my decease. Furthermore, I direct that all state, inheritance, succession
and other death taxes imposed or payable by reason of my death and interest and penalties
thereon with respect to all property composing of my gross estate for death tax purposes, whether
or not such property passes under this Will, shall be paid by the Executrix of my estate.
2. My Executrix may, at her discretion, compromise claims, borrow money, retain
property for such length of time as she may deem proper; lease and sell property for such prices,
on such terms, at public or private sales, as she may deem proper; and invest estate property and
income without restriction to legal investments unless otherwise provided hereunder.
3. I authorize and empower my Executrix to sell any realty and/or personalty owned by
me at my death and not specifically devised or bequeathed herein, at public or private sale or
sales and to give good and sufficient deeds and/or bills of sale therefore, in fee simple, as I could
do if living. My Executrix is authorized and empowered to engage in any business in which I
may be engaged at my death, for such period of time after my death as seems expedient to said
Executrix.
5798
4. I give, devise and bequeath all of my estate of whatever nature and wherever situate to
my granddaughter, JENNIFFER HOLLINGER, and if she is not living, to my granddaughter,
MARLO STOFKO.
5. It is my desire that MARLO STOFKO take care of my animals and that she be
provided funds to do this.
6. I request that MARLO STOFKO oversee and assist JENI~TIFFER HOLLINGER
with the management of her affairs and with the assets of the estate.
7. I nominate and appoint MARLO STOFKO to be the Executrix of this my Last Will
and Testament.
S. No Executrix acting hereunder shall be required to post bond or enter security in this
or any other jurisdiction.
9. I hereby suggest that my personal representative retain the services of Irwin &
McKnight as attorneys in the settlement of my estate.
2
3~
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ` day of Ah,
2007.
'" (SEAL)
HAZEL M. SSEY
Signed, sealed, published and declared by the above-named Testatrix, as and for her Last
Will and Testament, in our presence, who, at her request, in her presence and in the presence of
each other have hereunto set our names as subscribing witnesses.
3
ACKNOWLEDGMENT AND AFFIDAVIT
WE, HAZEL M. MASSEY, KAREN S. NOEL and SHARON L. SCHWALM, the
Testatrix and witnesses respectively, whose names aze signed to the foregoing instrument, being
first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and
executed the instrument as her Last Will, and that she had signed willingly, and that she executed
it as her free and voluntazy act for the purpose herein expressed, and that each of the witnesses, in
the presence and hearing of the Testatrix, signed the Will as a witness and that to the best of their
knowledge the Testatrix was, at that time, eighteen yeazs of age or older, of sound mind and
under no constraint or undue influence.
KAREN S. NOEL
SHARON L. SCHWALM
COMMONWEALTH OF PENNSYLVANIA ;
COUNTY OF CUMBERLAND
SS:
Subscribed, sworn to and acknowledged before me by HAZEL M. MASSY, the
Testatrix herein, and subscribed d sworn to before me by KAREN S. NOEL and SHARON
L. SCHWALM, witnesses, this3t' day of 1``"~h, 2007.
~ -~
Public
COM ONtn!E.. TH OF PEPINSYLVANIA
Nofarial Seal
Roger B. Irni!n, Notary Public
Carlisle eoro, Cumberland County
My Commission Expires Oct. 3, 2008
Member, Pennsylvania Association Of Notaries
M T OF HOUSING AND URBAN DEVELOPMENT File Number: IARK9.11 PAGE 2
SETTLEMENT STATEMENT
~ Iw tea xulellRan o teen
L. SETTLEMENT CHARGES rnnu:0 UYILWLU77 at
PAID FROM 1ti:U4 JMR
PAID FROM
700. TOTAL SALESBROKER'S COMMISSION based on rice $20 000,00 = BORROWER'S SELLER'S
Division of commission line 700 as follows: FUNDS AT F
701. $ to
SETTLEMENT UNDS AT
S
702. to ETTLEMENT
703. Commission aid at Settlement
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Od ination Fee °~
802. Loan Discount % ___
603. A isal Fee
804. Credit Re rt
805. Lenderslns 'on Fee
806. Mort a ication Fee
807. Assum 'on Fee
808.
809.
810.
811.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From to $ Ida
902. Mo a e Insurance Premium for to
903. Hazard Insurance Premium for to
904.
905.
1000. RESERVES DEPOSITED WITH LENDER FOR
1001. Hazard Insurance mo. $ Imo
1002. Mo a Insurance mo. $ /mo
1003. Ci Pro Tax mo. $ Imo
1004. Coon Pro Tax mo. $ 34.19 Imo
1005. School Tax mo. 71.43 /mo
1009. A r e Mal is Ad'ustment 0.00 0.00
1100. TRLE CHARGES
1101. Settlement or dosin fee
1102. Abstract w title search
1103. Tice examina8on
1104. Title insurance binder
1105. Document Pre oration
1106. No Fees 5 ~
t 107. Altom s fees to IRWIN 8: MCKNIGHT P.C. 325.00
inductee atxwe items No: 1101 1102 11031107
1108. Tdle Insurance
inductee above items No:
1109. Lenders Covera e $ NONE
1110. Owners Covera a 20,000.00
1111.
1112.
1113.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES vE
1201. Recordin Fees Deed $ 62.00 • Mort a e $ • Release 61,00
1202. C' /Coup tax/stam Deed $200.00 • Mort a e 200.00
1203. State 7axlstam s DeeC $200.00 • Mort a 200.00
1204.
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Surve
1302. Pest Ins edion
1303.-
1304.2011 CO TAXES to CARLISLE TAX ACCOUNT 451.31
1305.2011-12 SCHOOL TAXES to CARLISLE TAX ACCOUNT 85711
1306. MUNICIPAL LIEN 03-1269 to BOROUGH OF CARLISLE 503 27
1307. Final WtdSwr#009195 to BOROUGH OF CARLISLE 170.92
1308.
1400. TOTAL SETTLEMENT CHARGES-_ enter on lines 103 Section J and 502 Section K 592.00 2182.61
HUO CERTIFlCATION OF BUYER AND SELLER
I h y levlewed the HU0.1 SetOement Statement antl to the best d my knewlstya antl WMf, It b a true and accurate statantem of aR raeaipls antl tlisbureamants matla on a try r
in s Tu ey/er~tNy that 1 haveLreeelved a copy of Me HU~D/1 Satll/ematK SWemmt my ecount or
TAAfCPROP~ERTiES, ~KCI „(~A .. _z~i ~i nv i ~) 7~ ~ (~~
HAZEL M. MASSEY
Hri.lY1Nt~~~~~C01'E7tl~i/O~~~R~
WARNUIG: IT IS A CWME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE Tha HUD-1 Settlement Statement wAkh 1 have yVtsparetl Is ^ true antl atxurua account of this tranaselion.
UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION I have wusetl or will cause the footle to ba tlisbunad M aeeertlmea vAM mh alalemant
CAN INCLUDE A FlNE ANO IMPRISONMENT. FOR DETAlt.3 SEE TRLE 73:
U.S. CODE SECTION 1001 AND SECTION 7070.
ay: ~ . ~~ y' ~, „
Te
~~ i .
g
'~ Court Ordered Processing \ Decedents - MA1-MB3-02-10 - P. O. Box 841005 -Boston, MA 02284
July 12, 2010
Roger B. Irwin
Erwin & McKnight
60 West Pomfret Street
Carlisle, PA 17013-3222
RE: Estate of Hazet M. Massey
Date of Death: 06/30/2010
Dear Roger B. Irwin:
Per your request, enclosed please find the account information as of the date of death
for the above-named decedent. For your information, accrued interest is not included in
the date of death balance.
Please feel free to contact me if I can be of any further assistance.
Very truly yours,
"` ~C/
Donna a
Lead Specialist
617-533-1789
a
C
`", €
i
d Sovereign Bank
ESTATE.OF Hazel M Massey
SOCIAL SECURITY #: 202-20-7167
DATE OF DEATH: June 30, 2010
Account #: 098 1 1 03 1 54 Type Checkin
g Open date: 2/1/2010
In the name of: Hazel M Massey
Date of Death Balance: $28.95
Int.(YTD) from 1/1/2010 to 6/30/2010 $0.01
Accrued interest to date of death: $0.00
Otherlnfo: Closed 7/7/10
Account #: 1674301872 Type: Statement Savings Open date 1/22/2009
In the name of: Hazel M Massey
Date of Death Balance: $245.82
Int.(YTD) from 1/1/2010 to 5/24/2010 $0.18
Accrued interest to date of death: $0.03
Otherlnfo: Closed 7/7/10
Account#: 0741163500
Type: Checking Open date: 1 /22/2009
In the name of: Hazel M Massey
Date of Death Balance Closed Prior
Int.(YTD) from 1/1/2010 to 2/9/2010 $0.08
Accrued interest to date of death: $0.00
Other Info: Closed 2/9/10 $101.92
~' G~v~l¢ed '~ n~ Checl~i~S o ~i & ~ ~~ -sy
Page 1 of 1
M~TBank
July 15, 2010
Law Offices
Irwin & McKnight, P.C.
West Pomfret Professional Building
60 West Pomfret Street
Carlisle, PA 17013-3222
499 Mitchell Street, Millsboro, DE 19966
RE: Estate of Hazel Massey
Date of Death: June 30, 2010
Social Security Number: 202-20-7167
Dear Mr. Irwin:
In response to your request, please be advised that at the time of death, the above-
named decedent had on deposit with this bank the following accounts.
1. Account Type ........................... Savings Account
Account Number ................... • •„ 15004208226793
Ownerstup (Names ofl .............. Hazel Massey
OPe~9 D~• • • • • • • • • • • • • • • • ...........04/21 /03 (account closed 07/07/ 10)
Balance on Date of Death .........$868.23
Accrued Interest $ 0 O 1
Total ...................................... $868.24
The above named decedent did not have a safe deposit box.
* If upon reviewing the information above, you believe there are additional accounts not
referenced, please provide us with an account number and/or the name of any possible
joint account holder. For any additional information on the above accounts, including
ownership and any changes, closures and/or reimbursement of funds, please contact
our High Street Carlisle Branch at 1 West High Street, Carlisle, PA 17013, or # 717-
240-4536.
Sincerely, '
n -=---~
'~.~Jw~1~~ C,~G~ z2~~' .-~al.~
Charlene Warrington, Adjustrrient Services
1-888-502-4349
CORNERSTONE
Federal Credit U n i o n
Member founded -Service based
July 9, 2010
Irwin & McKnight
Attn: Roger B Irwin
West Pomfret Professional Building
60 West Pomfret Street
Carlisle, Pa 17013
RE: Estate of Hazel M. Massey
Roger,
P.O. Box 1181, 5 East Gate Drive, Carlisle, PA 17015
Telephone (717) 249- 166 I FAX (717) 249-8208
vvww.cornerstonefcu.coop
At the time of her death, Hazel Massey was a single owner of a savings and a money market
account. Listed below is the information requested per your letter dated July 7tn:
1) Hazel M. Massey, single owner
2) Savings was established on June 1, 1998,
Money Market account was established on September 20, 2007.
3) Not Applicable
4) Not Applicable
5) Interest accrued for:
Savings account - 3.43'~'~
Money Market - $32.37
6) Date of Death balances for: /
Savings account - $49.78 /
Money Market - $7,861.76
If you require any additional information, please do not hesitate to contact me at 717-249-
1661 ext 240.
Sincerely,
Donna J. Mickey
Financial Services Administrator
MEMBER SAVINGS ACCOUNTS FEDERALLY INSURED TO $2SO,OOO BY THE NATIONAL CREDIT UNION ADMINISTRATION
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Prudential
/~~ .~ ~ ~ /
.~~ ~ ~' omputershare
~~
~ Computershare
lf~~~`~~ PO Box 43033
Providence, Ahode island 02940-3033
IMPORTANT TAX RETURN DOCUMENT ENCLOSED ~Nithin S , US territories 8 Canada 800 305 9404
Outside A, US territories 8 Canada 732 5123782
'**********AUTO**5-DIGIT 17013 000771~027237s 2 7 2 3 7 6 vuvvw.computershare.com/investor
II'111111'I'll'll1"111"1'III'III'I~IIII'Ii111'1111111'I'111'I'I
Recipient
HAZEL M MASSEY
141 N BEDFORD ST Holder,4ccount Number
CARLISLE PA 17013-2437 COOOOO50491 I N D
" Record Date Nov 24 2009
_ __ _ Check Number 0007581613
- SSNlilto i:ertdied 'r es
OOICSQ107.DOMLNGEQS PG LPRU.Ia580S_7a272376R72376li6
Prudential Financial, Inc. -Combined Dividend Paymer*t 12009 Tax Form 1099-DIV
Corrected (if checked)
Form 1099 -DIV -Dividends and Distributions 2009 Copy B -For Recipient
This is important tax information and is being famished to the Internal Revenue Service. I(you are required to file a return, a negligence
penalty or other sanction maybe imposed on you if this income is taxable and the IRS deternlnes that it has not been reported.
Recipient HAZEL M MASSEY
141 N BEDFORD ST
CARLISLE PA 17013-2437
Account Number 00000050491
Recipient's ID No. 202.20.7167
Payer's Federal ID No. 22.3703799
OMB No. '1545-0110
Deparlmenl of the Treasury - Inlemal Revenue Service
to Total Ordinary tbl Qualified ~a,I Nondividend 4 FEDERAL INCOME s Foreign Tax ~J Foregn Cour>by e.'Cash Liquidation
Dividends ($) Dividends ($) ~ Distributions ($) TAX WITHHELD (S) Paid ($) I or U.S. Possession DisUi. ($) Payer's Details
23.10 23.10 0.00 0.00 1:1.00 PRUDENTIAL FINANCIAL INC
CIO COMPUTERSHARE
P.O. BOX 43010
I - PROVIDENCE RI 02940-3010
Form 1099-DIV (Keep for your records)
Dividend Confirmation
Payment Date Class Description Participating
ShareslUnits Dividend
Rate Gross
Dividend ($) Deduction
Amount ($) Deduction
Type Net
Dividend ($)
18 Dec 2009 COMMON 33
Year-To-Date Paid $0.70000 23.10
23.10 0.00
0.00 N/A 23.10
23.10
® 46UTX
P R U ~'
002CS70004 OORX6A•PP~(F2) PLEASE CASHIDEPOSIT THIS CHECK PROMPTLY.
rtcu nistoricai rrices ~ Prudential r'inancial lnc Pruden Stock -Yahoo! Finance
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http://finance.yahoo.torn/q/hp?s=PRU&a=05&b=30&c=2010&d=05&e=30&1=2010&g=d 9/9/2010
From:Shipley Energy
a
,.~, ~
~rMR ~_
The energy [o hetp Usave.
717 854 5496 01/12/2011 14:1? #167 P.001/001
35743700000000000239732
Customer Nnmber: 357437
Statement Date: 12!25/10
Do you have an a-mail address?
HAZEL MASSEY
141 N BEDFORD ST
CARLISLE, PA 17013
6
.s ~.
~~
Total Amount Enclosed: $
1 INIII 111111111! 11111 IIIII IIIII illll IIIII 1111! IIIII IIIII IIIII VIII 1181 IIIII II81 VIII VIII lilll VIII Illil 81111111 IIII
if payment wcu made. n~ithtn the last /0 days, pletrse disre~grrf thrs statemenz. 1fie finance clwige is computed
F~r~ applying u r•crte oj1 1/2% per mo>rth(arinual percentage mute of I8%j on balances Iwt paid within 30 days
of tlae original.billingnnd afterii!! payments acrd rredtts are applted o Jhe clostt~g date afthis statement.
Shipley Energy.. (7.17,)848-~a 00 or 1'-800,$39-18x9 'r
550 £ast King Strc;et or
PO Box 3006 Visit our website
York, f'A 17405-5006. DOd;~S>f21~I~~,~:~®iid Page: I
~taf72b~a023973201D12M THE SERVICES AND PRODUCTS PROVIDED ARE SUBJECT TO THE TERMS AND CONDITIONS NOTED ONTHE BACK OE THIS IIJVOICE!STATEMEN
Dec zU lU U~: bUp Hoffman-Koth F . H. "!1'l~4~~'l~:i
~~ -
_.
.r
~'~ t=L?NI=R.~L II~~N~1~ ~ GRLM.~TC~R~C`, ING
p.~
219 North Hanover Street
Carlisle, Pennsylvania 17013
717.243,4511
toll free 1.866.451,4511
fax 717.243.3723
www.hoffmanroth.com
info:~`hoffmanroth.com
December 20, 2010
Marlo Stofko
83 Regency Woods North
Carlisle., PA 17015
Statement of Funeral Expenses for: Hazel M. Massey
Date of Death: June 30, 2010. Account Id: 15977-151
PACKAGE:
Traditional Funeral Service
TRADITIONAL FUNERAL SERVICE PACKAGE $ 4,550.00
Sub Total: $ 4,550.00
MERCHANDISE:
Casket: Spencer $ 1,730.00
Sub Totai: $ 1,730.00
TOTAL FUNERAL HOME CHARGES: $ 6,280.00
CASH ADVANCES:
8 Certified Death Certificates at $ 6.00 each $ 48.00
Newspaper Notice -Sentinel $ 123.60
Newspaper Notice -Gettysburg Times ~ 70.00
Flowers $ 159.00
Hairdresser $ 40.00
Sub Total: $ 440.60
Total Funeral Expense: $ 6,720.60
Total Payments Made: $ 3,279.00
Payments Made:
Allianz Check 506435 Ju120, 2010 3,279.00
Balance: ~ 3.441.60
Please return this portion with your Remittance.
$
Hazel M. Massey
Service ID#: 15977-151
Amount Enclosed
SERVING OUR COMMUNITY SINCE 1 907
p M~B~
*'~* This is an Advice ***
P.O. Box 4650
ACH/EDI Services
Buffalo, NY 14240-9975
(800)724-2240
HAZEL M MASSEY
MARLO STOFKO
83 REGENCY WOODS NORTH
CARLISLE PA 17015
Subject: Notification of Death /Reclamation
Case Number: 30511
Funds Deposited to Account:
Funds Owed to the U.S. Treasury:
******6793 $1,358.00
$1,358.00
Date: Monday, October 25, 2010
Due to the fact that HAZEL M MASSEY has passed away prior to the issuance of the credit, the Treasury of the
United States is requesting reimbursement. In accordance with Federal Regulations, direct deposits may not be
retained by the beneficiary unless the beneficiary lived through the entire month prior to the date of issuance.
Our records indicate that the non-entitled benefits have been withdrawn from the account of deposit or the
account has been closed. If you have already returned these funds, please send us a photocopy of your
remittance check. If these funds have not been returned, full payment for the balance above is immediately
owed to the U.S. Treasury. Please remit payment payable to M&T Bank. Aself-addressed stamped envelope is
enclosed for your convenience. Please reference the case number above on all correspondence.
Should you have any questions about the remittance of the outstanding amount, please call and refer to the case
number above.
Respectfully,
1
ACH/EDI Services
M&T
ru iu nur ue~ i Csui Hale aia~ei i lei a wee rceverse d 4 U U U U U ~ """" ""'~ ''" "-""""
Side "Notice to Account Owners" Copy
~ ~ , ~~~~~ FROM: DEPARTMENT OF THE TREA SURY
t=L~CTRONICFUNDSTRANSFER FINANCIAL MANAGEMENT S ERVICE
SF REGIONAL FINANCIAL CENTER
FEDERAL RECURRING PAYMENTS
PO BOX 24760
OAKLAND, CA 94623
NOTICE OF RECLAMATION 510-594-7183
I IIIIII VIII VIII VIII VIII VIII "III "III VIII I'll) IIII Illl DATE: 09/07/2010 20742995
4005800080
RECIPIENT AND/OR BENEFICIARY NAME CLAIM NUMBER DATE OF DEATH
HAZEL M MASSEY 1189773WF 06/30/2010
AGENCY
DATE OF AND/OR TRACE
M O T NUMBER
PAYMENT pA TYPE OF DEPOSITOR
ACCOUNT ACCOUNT NUMBER AMOUNT
Y
07/01/2010 OPM-CSF 12173615 1400296 S 00015004208226793 1,358.00
AMOUNT OF PAYMENT RECEIVED
WITHIN 45 DAYS OUTSTANDING TOTAL
1,358.00
NOTICE TO ACCOUNT OWNERS FROM THE GOVERNMENT
The Government has received information that the person named on this notice is deceased. The purpose of this notice
is to inform you that by law entitlement to Government benefits for this person ended at death. Therefore, the
Government must recover all payments made after the date of death. If there has been an error and this person is not
deceased, or if the date of death is wrong, this notice explains how to correct the mistake. If you do not understand
this notice, please get help from either your financial institution or the Government agency that was making payments.
PAYMENTS TO THIS PERSON HAVE BEEN STOPPED
Your financial institution has been asked to return the payments shown on this notice to the Government because
they were issued in error. The Government has asked your financial institution to send this notice to you, the account
owner. Your financial institution must notify you if it has taken action to recover these funds from the account.
Contact your financial institution immediately if you do not understand its actions. If the Government is unable to
collect from the financial institution the full amount of the payments made after death, you may be contacted by the
agency which made the payments.
IF THE PERSON IS NOT DECEASED
If the person is not deceased, immediately contact both your financial institution and the agency that made the
payments to correct the error. The Government regrets any inconvenience this error may cause. Your financial institu-
tion can correct the collection action if it is given satisfactory proof that the person is alive. NOTE: YOU MUST
CONTACT THE AGENCY THAT MADE THE PAYMENTS BECAUSE THIS ERROR HAS STOPPED FURTHER
PAYMENTS. ONLY THE AGENCY CAN RESTART THE PAYMENTS.
NOTICE TO ACCOUNT OWNERS
S®vereigri
September 23, 2010
The Estate of Hazel Massey
C/O Executor
i41 N Bedford St
Cazlisle PA 17013-2437
Subject: U.S. Treasury Reclamation
On August 5, 2010, Sovereign Bank received a notice of reclamation from the U.S. Treasury for
Federal payment(s) deposited to the account of Hazel Massey. The Treasury has advised us that
Hazel Massey `s date of death was 06/30/10 and that all payments made after that date must be
returned to the Treasury.
This reclamation requested the return of $418.00. These funds were nqt available. When funds
are not available for return. the Treasury requires that we provide the name(s) and address(es) of
all individuals who_withdrew funds from this account We have provided them with this
information.
We are requesting payment, by October 7.20.10 for the full amount of $418.00. This can be
paid with a check or money order made payable to `Sovereign Bank' and returned in the
envelope provided. If you have already repaid these funds please return a copy of the cancelled
check and the receipt to me by the above due date so that I may provide the proof to Treasury
If you have any questions regazding this reclamation or need any additional information, please
call our customer service center toll free at 1-877-768-2265 or please take this letter to your local
community banking office.
i lianlc you.
Sincerely,
chrirtine ~oay
Sovereign Bank
ACH Department
Enclosure
For Paperwork Reduction Act Statement
anr+ Burden Estimate Statement See Reverse 28045300 OMB NO.: 1510-0043
Side "Notice to Account Owner" Copy Expiration Date: 04i3o~zoo3
~ ~ ~~'~ FROM
ELECTRONIC FUNDS TRANSFER U.S. DEPARTMENT OF THE TREASURY
FEDERAL RECURRING PAYMENTS FINANCIAL MANAGEMENT SERVICE
AUSTIN RFC
PO BOX 149058
8714-9058
NOTICE OF RECLAMATION 512-3427300
I IIIIII VIII VIII VIII IIi'I VIII VIII "III VIII VIII IIIIII III IIII DATE 07/29/10 20519872
RECIPIENT AND/OR BENEFICIARY NAME CLAIM NUMBER DATE OF DEATH
HAZEL MASSEY 202-20-7167 A 06-30-10
AGENCY
DATE OF AND/OR TRACE TYPE OF DEPOSITOR AMOUNT
NUMBER
PAYMENT A
N ACCOUNT ACCOUNT NUMBER
T
'ME
07-02-10 RSI SSA 03173601 0803356 C 0981103154 418.00
OUTSTANDING TOTAL
418.00
NOTICE TO ACCOUNT OWNERS FROM THE GOVERNMENT
The Government has received information that person named on this notice is deceased. The purpose of this notice
is to inform you that by law entitlement to Government benefits for this person ended at death. Therefore, the
Government must recover all payments made after the date of death. If there has been an error and this person is not
deceased, or if the date of death is wrong, this notice explains how to correct the mistake. If you do not understand
this notice, please get help either your financial institution or the Government agency that was making payments.
PAYMENTS TO THIS PERSON HAVE BEEN STOPPED
Your financial institution has been asked to return the payments shown oTi this notice to the Government because
they were issued in error. The Government has asked your financial institution to send this notice to you, the account
owner. Your financial institution must notify you if it has taken action to recover these funds from the account.
Contact your financial institution immediately if you do not understand its actions. If the Government is unable to
collect from the financial institution the full amount of the payments made after death, you may be contacted by the
agency which made the payments
IF THE PERSON IS NOT DECEASED
If the person is not deceased, immediately contact both your financial institution and the agency that made the
payments to correct the error. The Government regrets any inconvenience this error may cause. Your financial institu-
tion can correct the collection action if it is given satisfactory proof that the person is alive. NOTE: YOU MUST
CONTACT THE AGENCY THAT MADE THE PAYMENTS BECAUSE THIS ERROR HAS STOPPED FURTHER
PAYMENTS. ONLY THE AGENCY CAN RESTART THE PAYMENTS.
NOTICE TO ACCOUNT OWNERS
000170 O5 OF OS
~;~ :~
~ T
•
~~'~~~~~
RECOVERY SERVICES, LLC
200 Coon Rapids Blvd., Suite 200
Coon Rapids, MN 55433-5876
Phone: 888-420-2510
Fax: 763-235-4055
8/31/2010 -
To Whom It May Concern:
We are filing a claim on a probate/estate filed in reference to the individual listed below.
AscensionPoint Recovery Services, LLC is filing this claim on behalf of Equable Ascent Financial, LLC,
Assignee of Daimler Chrysler. Please see our claim form (enclosed) for details.
Decedent Information:
Case Number: 21 2010-00679 ~~
Date of Death: 06/30/2010 ~~~~ ®4 ~?~'~'~9
Name: HAZEL M MASSEY p~~~~&~~c
~~OFF1CNi'aa,~,
If you have any questions please feel free to contact our office at your convenience.
Respectfully,
AscensionPoint Recovery Services, LLC
---------------------------------detach coupon-----------------------------------------------------
PLEASE SEND PAYMENTS & CORRESPONDENCE TO:
ROGER IRWIN ASCENSIONPOINT RECOVERY SERVICES, LLC
60 W POMFRET STREET 200 COON RAPIDS BLVD. SUITE 200
CARLISLE, PA 17013 COON RAPIDS, MN 55433-5876
y
NOTICE OF CLAIM
(Filed Pursuant to 20 Pa.C.S. § 3532)
COURT OF COMMON PLEAS OF
CU M B E RLAN D COUNTY, PENNSYLVANIA
-: - .,,;:: , ~, ,, ...,:: , _ .. ~ ,: -:-ORPHANS' COURT DIVISION
ESTATE OF HAZEL M MASSEY ,DECEASED
No. 21 2010-00679
T'o the Clerk of the Orphans' Court Division:
Enter the claim of AscensionPoint Recoverv Services LLC on behalf of Equable Ascent Financial LLC in the
(Claimant)
amount of $ $5,915.00 ,against the above entitled Estate.
The Decedent, who resided at 141 N. BEDFORD ST, CARLISLE PA
;(Street Address)
170132437,died on 06/30/2010. ,Written notice of said claim was given to
(Date of Death)
MARLO STOFKO
' (Personal Representative or his/her counsel)
at 83 REGENCY WOODS NORTH, CARLISLE 17013
(Address)
'on 8/31/2010.
(Date)
rir oP~etrn~r'
Claimant's Counsel)
~~ ~~n P~n~s~~~v~,~~e•~D
=' (Address
;Clz_ ~ ~~~ic~,;1M1~ ~~~~3~
----- ~j~"~ APRS Representative
(Claimant)
200 Coon Rapids Blvd. Suite 200
(Street Address)
Coon Rapids, MN 55433-5876
(City, State, Zip)
(Telepf~oneJ