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Home My WebLink About03-14-12-~ REV-1500 Ex(01-10) ; ],5175610143 •: PA Department of Revenue ~ OFFICIAL USE ONLY Pennsylvania count code Year Bureau of Individual Taxes OEPARTMENTOFREVENUE y File Number PO 60X.280601 INHERITANCE TAX RETURN 2 1 11 0 9 2 4 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 210 26 9338 08 03 2011 10 12 1915 Decedent's Last Name Suffix Decedent's First Name MI HAZLETT LYDIA ~J (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 REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ® 1. Original Return ^ 2. Supplemental Return ^ 4. Limited Estate ^ qa. Future Interest Compromise (Cate of death after 12-12-82) ® g Decedent Died Testate ^ ~ Decedent Maintained a Living Trust (Attach Copy of Will) (Attach Copy of Trust) ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (date of deatn between 12-31-91 and 1-1-95) ^ 3. Remainder Return (date of death prior to 12-13-82) ^ 5. Federal Estate Tax: Return Required 8. Total Number of :Safe Deposit Boxes ^ 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number SEAN M SHULTZ 717 243 6222 First line of address 26 W HIGH STREET Second line of address City or Post Office State ZIP Code CARLISLE PA 17013 Correspondent'se-mail address: dhockenberry@ssr-attorneys.com REGISTER OF WILLS USE QN,LY -~ T C7 =.~y ,, ~. - ,~ .~_ - __t- _ _, _ - ~l _. DAT~~1L-~D ~ .A ~= _...I (~, ~iwei penairies or perfury, 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 teas any knowledge. SIGN E OF PERSON RESP SIBLE FOR FILIN RETURN DATE -~~1, r~c.~ Ik ,/ 1~ Lois H. Kielkopf .s~ `7r1 _ _ ~~ ~ .., -, 27 Greenfield Drive, Carlisle, PA 17015 IIGN~IRE OF PREPAR R OTHER THAN REPRESENTATIVE Sean M Shultz 3i~y7,~ '~-1 =1 r_... T' -J' c,. ~•'r' -= 26 W. High Street, Carlisle, PA 17013 Side 1 15E5610143 Z5E561t1143 J 1 '+`l -s,/ ADDITIONAL Personal Representatives Hazlett, Lydia V. SS# 210-26-9338 8/3/2011 Under penalties of perjury, the undersigned declare that they have examined this return, including accompanying schedules and statements, and to the best of their knowledge and belief, it is true, correct and complete. 2 Si nature ~ Name Linda H. Hamilton, a/k/a Linda L. Hamilton Address 37 Derbyshire Drive city, state, zip Carlislye~ PA 17015 Date ,3 ~) U ~ ~ ~~ ~ 3 Signature Name Address City, State, Zip Date 4 Signature Name Address: City, State, Zip Date 5 Signature Name Address: City, State, Zip Date 6 Signature Name Address: City, State, Zip Date 1505610243 REV-1500 EX Decedent's Social Security Number DecedenrsNeme: HAZLETT, LYDIA V. _- - - 210 26 9338 - - _ - ECAPITULATION - 1 . Real Estate (Schedule A} ............................._.............................._................... ..... 1. 7 5, 0 0 0. 0 0 2 . Stocks and Bonds (Schedule B) ...................................................................... .... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)..... .... 3. 4. Mortgages 8~ Notes Receivable (Schedule D) .................................................. ..... 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E} ........... ... 5. 5 , 4 5 8 . 6 3 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested .......... ... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested .......... ... 7. 8. Total Gross Assets (total Lines 1-7) ................................................................ ... 8. 8 0, 4 5 8. 6 3 9. Funeral Expenses & Administrative Costs (Schedule H) ................................... ... 9. 1 1 , 4 8 5 . 6 7 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ........................... .... 10. ~~ 4 , 5 0 2 8 $ 11. Total Deductions (total Lines 9 8~ 10} ............................................................. 11 8 5 , 9 8 8 . 5 5 12. Net Value of Estate (Line 8 minus Line 11) ....................................................... .... 12. -• 5 , 5 2 9 . 9 2 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............................................ .. 13. 14. Net Value Subject to Tax(Line 12 minus Line 13) ............................................ - - - - - ... 14. -• 5 , 5 2 9 . 9 2 - - COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES - - __ _ __ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .00 15. 16. Amount of Line 14 taxable at lineal rate X .045 16. 17. Amount of Line 14 taxable at sibling rate X .12 17 18. Amount of Line 14 taxable at collateral rate X .15 1 g. 19. Tax Due .............................................................. ................ .. 19. 0 0 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ Side 2 1505610243 1505610243 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 - 11 - 0924 Hazlett, Lydia V. -- STREET ADDRESS 505 S. Spring Garden Street CITY Carlisle -- - - STATE TZIP ~ PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 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. Check box 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 theTAX DUE Total Credits (A + B) Make Check Payable to: REGISTER OF WILLS, AGENT. (1) 0.00 (2) 0.00 (3) 0.00 (4) (5) ~.~~ 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 :............................................................ . . ............... x b. retain the right to designate who shall use the property transferred or its income :........................._.._.. i -' xJ 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? .............................. .................... L_ ,, I x~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death'?....... J I x] 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 RETUR 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 is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) ii)J. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory recpuirements 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 ears 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)]. • siblingXS definedounder Secti nt9102eas am Indiv'dua~who has ateea thoneepatlentt n common withPhe deceden, wh§ethes by)lilooc! or adoption. SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE ' INHERITANCE TAX RETURN i RESIDENT DECEDENT ~I ESTATE OF Hazlett, Lydia ~/. j FILE NUMBER p~ i 21 - 11 - 0924 a Iwh chpr op erty would be elxc an ed between ~a wommbu era d a willing sellet,fneither bean alcu~air market value is defined as the price p p Y ~ g 9 Y ompelled to buy or sell, both having reasonable knowledge of the relevant facts.Real property which is jointly-owned with nght o~ survivorship must be disclosed on schedule F. Attach a copy of the settlement sheet if the property has been sold. Include a copy of the deed showing decedent's interest if owned as tenant in common. ITEM _ - - - -- --_ NUMBER DESCRIPTION VALUE AT DATE OF - DEATH - _ --- __ - 1 505 South Spring Garden Street, Carlisle, PA (See attached copy of HUD-1) 75,000.00 - I - __ - TOTAL (Also enter on Line 1 Recapitulation) 75,000.00 A. Settlement Statement (HUD-1) ( )~ 1. FHA. I Settlement Statement- LL S. De artrnent of Housin and Uman Develo men[ Fonn US HUD - 1 Pa a No. 1 ( ) 2. FmHA 6. File Number 17. Loan Number 8. Mortgage Insurance ( ) 3 Conv Unins . . . Case Number ( ) a. vA ' RE3273 527838 ( )~ 5. Conv. ms ABST#6698 ACCt No. 00000767680018 i C. This form is famished to give you a statement of actual setLement costs. Amounts paid to and by the settlement agent are shown. Items marked "(p.o cJ" were paid outside of the Dosing; they are shown here for informational puryoses and are not inGuded in the totals. D. Name and Adtlress of Borrower E. Name and Address of Seller F. Name and Address of Lender: 1 i HARRIKLIA M. FOURLAS LOTS H. KIELKOPF MEMBERS 1ST FEDERAL CREDIT UNION 223 MCCALLISTER CHURCH ROAD LINDA H. HAMILTON A!K/A LINDA L HAMILTON ISAOA ATIMA CARLISLE, PA 17015 ESTATE OF LYDIA V. HAZLETT 5000 LOUISE DRIVE I_ MECHANICSBURG, PA 17055 i G. Property Location H. Settlement Agent: Settlement Date: 505 S. SPRING GARDEN STREET, CARLISLE, PA FREY & TILEY December 1, 2011 SOUTH MIDDLETON TOWNSHIP PlaceotSetaement 3:30 P.M. CUMBERLAND COUNTY 5 SOUTH HANOVER STREET PARCEL NO. 4D-22-0485-014 CARLISLE, PA 17013 100 Gross Amount Due From Borrower 400 Gross.Amount Due To Seller 101 Contractsales price 75,000.00 401 ConVact Sales price 75,000.00 102 Personal Property 402 Personal.property 103 Settlement charges from (line 1400) 1,958.25 403 -7D4 - ' 404 105 Settlement charges from Addendum 0.00 4os Adjustments far itemspaid by sellerin advance: AdjuslmenfsPoritems pardbysellerin advance: 108 Cityltowntaxesg2/1/11 ~ to 12/31!11 17.23 408.City/tdwntaxes.12/1/t1 to 12!31111 17.23 107County taxes 407.County faxes` tOBAssessments 408 Assessments 109 409 110 School razes 12!7/11 to 8/3D/12 423.15 410 School taxes 12/1/11 to 8/30/12 423.15 111 411 '. -112 - 412' 120 Gross Amount DueFromBorrower - 77,398.63 420 GrossAmount.Due to Sever 75,440.38 :200 Amounts Paid By Or In BehalfOf Borrower 500' Reductionsin Amount-Due To Seller 201 Deposit or eamestmoney 501: Excessdepdsit (sae instructions) .202 Pdndpalamount of now loan(s)"' Wlre:$75,000 75,000.00 502. Settlement charges tosellerjline 1400) 846.36 203 Existing loan(s) taken subfect to .503 Existlng loan(s) taken subject to 204 504 Payoff of first mortgage loan HUD 72,578.07 205 505 Payoff of second mortgage loan 20B 508 207 507 .208 .508 I 2os so9 Settlement charges from Addendum 184.00 AdjustmeMS for kerns upeld by seller ~Ad/usimenfs for items upatd:6y seler 210 City/town taxes 1/1!11 to 12/1/11 510:City/town taxes!/1/11 rtd.12/1l11 211 County taxes I 511 Countytaxes 212 Assessments 512'Assessments 213 -. 573 _ I 214 School fazes 711111 to 1211/11 514 Schooltaxes 7!1/11 to 12/1/11 ~ 215 515 218 518 217 5n: INHERITANCE TAX ESCROW -.INSOLVENT EST. 0.00 z1a ~ s1a 219 519 L 220 Total Paid By/For Borrower 75,000.00 520 Total Reductions to Amt Due Seller -- 73,608.43 300 Cash At Settlement Fromlfo Borrower: - IB00 Cash At SettlementTo/From Seller.. 307 Gross amount duefrom borrower (line 120) 77,398.63 1801 Grossamount to seller from (line 420) ~ 75,440.38 302 Less amounts paid by/for borrower jfrom line 220) ~ 75,000.00 ~ 802 Less reductions in amount due seller (fmm line 520): ~ _ (73,608.43) 303 Cash (X) From (J To Borrower 2,398.83 i 603 Cash ( )From (X) To Seller 1,831.95 ~ Inilials Page 1 of 4 Initials - -~ ~ f 700 Tdtal SalealBraker's Comm.based on: price: .75,000:00 -0:00 Division o/Commission (line 700) as follows: WA 701 to 702 to 703 Commission paid at Settlement 704 soo Items Payable In ConnectionVY[th Loan: (Mortgage Amt; 75,000.00) Total charges, Lines 801 through 808 : 0.00 801 Our origination fee f (fromGFE#1) 602 Your credit or charge (points)for the specific interest rate chosen S - (from GFE #2) 803 Your adjusted origination charges (from GFE A) 804 Appraisal fee to (from GFE #3) 605 Credit report to (from GFE #3) 806 Tax service to (from GFE #3) 807 Flood certificatlon Io (from GFE #3) 808 soo Items Requited By Lender To Be Pa[d In?Advance: 901 Dellylntereetcharpea 1-DeC-11 to @0.00000 (fromGFE#10) 902 Mortgage tnsurence Premium for months to (hom GFE #3) 903 Hazard Insurance 1 years to (from GFE #11) 904 ,... .. loco ReservesDaposited_W[thLander: ~ 1001 Initlal deposit for your esuow account (hom GFE #9) 1002 Homeownets insurance mds. (~ per month 1003 Mortgage insurance mas, ~ per month 1004 Property taxes mos. [TiL per month 1005 School tares mos. tlID per month 1006 .mos. _ ~ per month 1007 Aggregate Adjustment - 11go Title Charges: 1101 Title Services and lender's the insurance (from GFE #4) 1102 Settlement or Dosing fee FREY 8 TILEY $ - 1103 Owner's title insurance $ - (from GFE #5) 1104 Lender's title insurance $ 858,75 1105 Lenders tltlla policy limit S 1106 Owners tte policy limit .. - 1107 Agent's portion of total the insurance premium $ 729.94 1106 Underwriters portion of total title insurance premwm $ 128.81 1200 Government Recording and Transfer Charges: 1201 Govemmant Recording Charges 1202 Deed $74.50 Mortgage $64.00 Releases 1203 Transfer Taxes 1204 Clty/wunty tax Deed.$750A0 Mortgage: $ 1205 Stale tax/stamps: Deed $750.00 Mortgage: $ 1206 POA RECORDING FEE TORECORDER OF:DEEDS 13oe Additional Settlement Charges: 1301 Required services that you can shop for (from GFE #6) 1302 Pest inspection to ' 1303 Current Taxes due from BorrowerlSeller 13oa FINAL WATER AND SEWER CHARGES TO SMTMA -ACCT N0. 009004 13os RECORDING FEE TO RECORDER OF DEEDS ($62)/DEED PREPARATION FEE TO FREY &TILEY PsidFrom ~~ Paid From Borrowefs Sellers Funds at Funds at Settlement _ Settlement 0.00 ' 0.00 i o ao i 932.75 0.00 138.50 750.00 707 702 703 7(M aoo 901 eoz 903 ~ 804 805 ~ 906 907 909 90Q sal 902 903 904 1000 1001 1004 1005 1006 11007 j 1'00 1101 1102 1103 1104 '1105 11106 1107 1108 12001 X11201 '7202 12031 lzoa 750.00 'lzos 17.00 ~I lzos 137.00 11301 II 1302 1303 79.36 i 13oa ;1305 -- - " - - - - - • -----------1,958.25 --===846.36 ~1aoo I direct and authorize FREY &TILEY to make dlstributlons Indicated for my account on the attached HUD-1 Settlement Statement, approving the tax prorations indicated therein, and understand that prorations were based on figures for the preceding year, or estimates for the current year, and in the event of any change for the current year, all necessary adjustments must be made between Seller and Borrower direct; likewise any DEFICIT in delinquent taxes will be reimbursed to f=REY &TILEY by Seller. I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of elf receipts and disb(~rse~nents made on my account or by me in thistiansaction. I further certify that I have received a copy of the HUD-1 Settlement Statement. ' „ j ;: I t ., ~, f r'J ~~ / ~ i HARRIKLIA M. FOURLAS LOTS H. KIELKOP ; -- ,J L/~'! i LINDA H. HAMILTON A/K/A LINDA l_ HAMILTON To the best of my knowledge, the HUD-1 Settlement Statement which I have prepared is a true and accurate account of the funds which were recetived and have been or will b isburs by the undersigned as part of the settlement of this transaction. -:///J _ __ Decemoer 1.2011 F EY &TILEY, Settlement Agen Page 2 of 4 Date THUD-, ADDENDUM ~ - Additional Settlement Char es to Borrower: Additional Settlement Char es to Seller: --- -i INCOMING WIRE FEE TO ORRSTOWN BANK OVERNIGHT DELIVERY FEE TO FREY 8 TILEY 24 00 512 SEE LINE 1101 . (PAYOFF AND POA) CPL FEE TO CLTIC DEED PREPARATION FEE TO 575 SEE LINE 1101 0.00 ; LAW OFFICE OF SEAN M. SHULTZ, P.C. ~ 150.00 ELECTRONIC DELIVERY FEE TO FREY 8 TILEY I CERTIFIED CHECK FEE TO ORRSTOWN BANK 10 00 ESD SEE LINE 1101 . . OVERNIGHT DELIVERY FEE TO FREY 8 TILEY 512 SEE LINE 1101 Total to line 105 0 Total to Line 509 INFORMATION REPORTING ON REAL ESTATE TRANSACTIONS THIS HUD SETTLEMENT STATEMENT CONTAINS IMPORTANT TAX INFORMATION (BOXES E, G, H, I, M AND LINE 401) AND IS BEING FURNISHED TO THE INTERNAL REVENUE SERVICE. IF YOU ARE REQUIRED TO FILE A RETURN, A NEGLIGENCE PENALTY OR OTHER SANCTION WILL BE IMPOSED ON YOU IF THIS ITEM IS REQUIRED TO BE REPORTED AND THE INTERNAL REVENUE SERVICE DETERMINES THAT IT HAS NOT BEEN REPORTED. TAX PRO-RATION ADDENDUM Date of Pro-Ration: SCHOOL REAL ESTATE TAX i i December 1, 2017 from July i, 2071 to June 30, 2012 School Real Estate Tax- Face School Real Estate Tax- Per Day ASSESSMENT: COUNTY & MUNICIPAL TAX ham January 1, 2011 to December 37, 2077 Co. &Munic. Real Estate Tax- Face ~ Co. 8 Munic. Real Estale Tax- Per Day I See Settlement Sheet Lines Yes 706 8406, 170 8 410, Scncol taxes P.O.C. or charged to Seller li x 270 & 510, 214 8 574, School taxes P.O.C. or charged to Borrower i and 7303 for Co. 8 Munic. P.O.C. or charged to Seller : ~ x i Results of this Addendum. Cc. 8 Munic. P.O.C. or charged to Borrower l Page 3 of 4 5743.41 52.03674 Owes: 213.98 0.59 184 p.o.c I I p.o.c r- __ - - - --- - Comparison of Gootl.Faith`Estimate (GFE) and HUD=1 Charges 'Good Faith`Estimate - Huo-1 Charges That Cannot Increase HUD-1 Line Numher i Our origination charge #eot 0.00 Your credit or charge (points) for the specific interest rate choser # soz 0.00 Your adjusted origination charge #eos 0.00 ', Transfer taxes # 12oa 950.00 750.00 -- -- - Charges That in Totat:Cannat Increase Mare Than 10°~ Good Faithi'Estimate HUtI-1 Gorvernment recording charges # tzoz 130.00 138.50 Appraisal Fee #eos i Credit Report #eos Tax Service Fee #aoe Flood Certification #eq7 # i # ~! # 130.00 138.50 - 8.50 0.07 ty narges- fltaT Gan ettange Gtwd Faith Estimate HUO-1 Initial deposit for your escrow account # root Daily interest charges # soi Lm o.ooooo lday Homeowner's insurance # sos Title Services and Lender's Title Ins. #ttot 1028.75 932.75 Owner's Coverage #ltoa 120.00 0.00 Loan Terms Your initial Loan amount is $ 75,000.00 Your loan term is 15 years _ Your initial interest rate is i 4.15% Your initial monthly amount owed for princiipal, interest, and ----------------- ------ $ 560.55 includes ~ any mortgage Insurance is ~ X Prln Clpal I X Interest i __ I 1. Mortgage Insurance ~ - - - , Can your interest rate rise? ~ n NO _ 1'eS, R Car i f ISt to o i -iaxlmun~ G` iv Ti ~ , ~, C i ge dJIL be on and can change again every after Every change date, your interest rate can increase or decrease by _%. Over the life of the loan, your interest rate is guaranteed to nev_e_r_be ~, _ ___ lower than % or hi her than °/ . Even it ou make pa ments on time, can your loan balance rise? X No Yes it Can rise to a maximum of $ ~ Even if you make payments on time, can your monthly , _X_ No _ Yes, the first increase Can be On and the months amount amount owed for principal, interest, and mortgage insurance rise? owed Can rase to $ - - The maximum it can ever rise to is $ Does your loan have a prepayment penalty? X No Yes, your maximum prepayment penalt is $_ _ Does your loan have a balloon payment? _X_ No _ Yes, you have a balloon pahment of $ due in j ears on -----_ _ Totatmonthry amount owed including escrow account payments ~ _X_ You do not have a monthly escrow payment for items. such as property i taxes and homeowner's insurance. You must pay these items directly yourself. You have an additional monthly escrow payment of 0.00 that results in a total initial monthly amount owed of $ This includes principal, interest, any mortgage insurance and any items checked below. Property taxes Homeowner's insurance Flood Insurance I Note: If you have any questions about the Settlement Charges and Loan. Terms listed on this form, please contact you lender. Page 4 0(4 HUB-1 SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA ~.. PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ____ -- __ ILE NUMBER ESTATE OF Hazlett, Lydia V. 21 - 11 - 0924 - -_ -- -- Include the proceeds of litigation and the date the proceeds were received by the estate411 property jointly-owned with the right of survivorship must be disclosed on schedule F. -- ITEM -_ - -- _-_ -- NUMBER DESCRIPTION VALUE AT DATE OF _ __ - - DEATH 1 __ AAA Membership Refund __ 43.12 2 Sale of 1990 Buick Park Avenue 375.00 3 Proceeds of yard sale 155.25 4 M&T Bank Account No. 25004920125786 Christmas Club 100.01 5 M&T Bank Account No. 853151 Checking 1,905.93 6 M&T Bank Account No. 31003910849975 Certificate of Deposit 1,614.00 7 Rebate for recycling refrigerator 35.00 8 Refund from Highmark Health Insurance 175.51 9 Sentinel refund 13.67 10 Sale of furniture to Larry's Used Furniture 127.00 11 Sale of rug 30.00 12 Refund from magazine subscription 4.16 13 Comcast Refund 9.50 14 Refund from Peerless Insurance 127.25 15 Refund from IWS 13.11 16 Proceeds from Elmer Murry Auctions -sale of personal property 730.12 ---- -- -- TOTAL (Also enter on Line 5, Recapitulation) -- __ 5,458.63 SCHEDULE H COMMONWEALTH OF PENNSYLVANIA r~~ vY ~+ ~./ INHERITANCE TAX RETURN /~ry~~gw q~-Tp/~~ RESIDENT DECEDENT l1LJIYY~~~7 ~ fW ESTATE OF Hazlett, Lydia V. Debts of decedent must be reported on Schedule I. - -- ITEM _ _ -- NUMBER ' DESCRIPTION FUNERAL EXPENSES: --- -- __ --- - - A• 1 '~ Ewing Brothers Funeral Home, Inc. 2 Georges Flowers I 3 Carlisle Memorial Service, Inc. B. I ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) FILE NUMBER 21 - 11 - 0924 ----- ~__ _ _ __ AMOUNT ~ 8,228.42 172.78 581.00 Street Address ~ City State Zip Year(s) Commission paid 2. j Attorney's Fees to Law Office of Sean M. Shultz & Saidis, Sullivan & 1,800.00 3. I Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) i Claimant Street Address ' City State Zip Relationship of Claimant to Decedent 4. i Probate Fees to Register of Wlls I 269.50 5. Accountant's Fees i 6. I Tax Return Preparer's Fees 7. Other Administrative Costs 1 '~ The News-Chronicle Co. -advertise letters I 113.00 '' -- - -- - -- _- -_-- TOTAL (Also enter on line 9, Recapitulation) 11,485.67 C Schechde H COMMONWEALTH OF PENNSYLVANIA w Fumeral -r_"~ INHERITANCE TAX RETURN /~1L,~ Iti~~Y~lc ~~ ~.~..,. ,,,.,1 RESIDENT DECEDENT ~ R,R:7.~ - -- - ESTATE OF Hazlett, Lydia V. -- - __ _ - -- - __- 2 ,Cumberland Law Journal -advertise letters 3 'I Postmaster -Certified Mail regarding mortga e 9 4 ~ Lowes -supplies for house 5 ' Walmart -supplies for house 6 Weis -supplies for house 7 i Carlisle Barracks Commissary -supplies for house 8 Carlisle Barracks Main Store -supplies for house 9 Lee Zimmerman -trap groundhog at house 10 Checks for estate account 11 II Two trips to landfill _ __.. --- FILE NUMBER 21 - 11 - 0924 __ 75.00 3.29 57.38 72.02 4.65 4.08 1.05 30.00 13.50 60.00 Page 2 of Schedule H SCHEDULE I ~ j DEBTS OF DECEDENT, MORTGAGE ~ COMMONWEALTH OF PENNSYLVANIA LIABILITIES, ~ LIENS INHERITANCE TAX RETURN RESIDENT DECEDENT ~.. __. _ _l. -__ _. _- ESTATE OF Hazlett, Lydla V. FILE NUMBER 121 - 11 - 0924 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. -- ITEM - --- NUMBER DESCRIPTION _- -.- - -- -- -- - - - - 1 Reverse Mortgage to C&L Service Corporation 2 CenturyLink -phone bill 3 Walmart -paint tray 4 Peerless Insurance Company -property insurance 5 South Middleton Township Municipal Authority -water and sewer bill 6 PPL Electric Utilities 7 Cumberland County Landfill 8 Pharmacy 9 The Sentinel 10 West Shore EMS -BLS Ambulance 11 Peerless Insurance Co. -property insurance 12 Expenses from sale of real estate AMOUNT -_-_--- 72, 578.07 80.36 2.12 115.50 128.70 577.29 60.00 5.00 17.00 206.36 142.50 589.98 -- - -_ -------- TOTAL (Also enter on Line 10, Recapitulation) 74,502.88 REV-1513 EX+ (11-08) SCHEDULE) COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hazlett Lydia V. NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I, TAXABLE DISTRIBUTIONS[include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 Lois H. Kielkopf 27 Greenfield Drive Carlisle, PA 17015 2 ', Linda H. Hamilton, a/k/a Linda L. Hamilton 37 Derbyshire Drive Carlisle, PA 17015 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) daughter ~ daughter _ _ __ _. _ - FILE NUMBER 21 - 11 - 0924 _ - --.. - _ SHARE OF ESTATE AMOUNT OF ESTATE (Words) ($$$) _- _. 1/2 residue 1/2 residue !Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet, as appropriate. II. INON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II- ENTE - - R TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 LAST WILL AND TESTAMENT OF LYDIA v. HAZLETT I, LYDIA V. HAZLETT, of 505 South Spring Garden Street, South Middleton Township, Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my Last Will and Testament, U hereby revoking and making void all previous Wills and Codicils heretofore made by rrie. 1 I order and direct my personal representative hereinafter named to pay all of my just debts, funeral expenses and expenses involved or connected with the administration of my estate as soon after m}~ death as is reasonably possible. However, my personal representative need not accelerate and pay those unmatured obligations which, in his, her or its opinion, it might be proper and more advantageous to retain or renew and pay as they become due and payable. If I do not oven a burial plot or a grave marker at the time of my death, I authorize mw personal Page 1 of 8 LAST WILL AND TESTAMENT OF LYDIA V. HAZLETT representative, in his, her or its sole discretion, to purchase a burial plot and to erect a suitable grave marker at my grave, and to expend sums from my estate for this purpose. 2 I give, devise and bequeath the rest, residue and remainder of my estate, together with all insurance proceeds thereon of whatever nature and wheresoever situate as follows: a. I direct that members of my family shall have the first option to buy my home situate at 505 South Spring Garden Street, Carlisle, Pennsylvania; b. The rest, residue and remainder of my estate shall be distributed in equal shares to my children, LOIS H. KIELKOPF, of 27 Greenfield Drive, Carlisle, Penns lvania a.nd LI y NDA H. HAMILTON, of 37 Derbyshire Drive, Carlisle, Penns lvania rovided the y , p y survive me by sixty (60) days. J Should my children, LOIS H. KIELKOPF and LINDA H. HAMILTON predecease me or die on or before the sixtieth (60th) day following my death, then I give, devise and bequeath the rest, residue and remainder of my estate in equal shares to my grandchildren, per stirpes. Page 2 of 8 LAST WILL AND TESTAMENT OF LYDIA V. HAZLETT 4 I grant my personal representative the following powers in addition to and not in limitation of such powers as my personal representative shall hold by law: (a) To retain all property received including the stock of any corporatE; fiduciary acting hereunder, provided such property remains productive. (b) To join in any corporation, partnership, recapitalization, merger, reorganization or voting trust plan; to delegate authority with respect thereto; to deposit :investments under agreements and pay assessments; and generally to exercise all rights of investors, including but not limited to, the voting of shares. (c) To manage, operate, repair, improve, mortgage or lease on any terms any real estate held or owned by my estate. (d) To operate any business that I may own at my death. ~~~ (e) To invest any funds of my estate in any stocks, bonds, notes or other securities or ~O property, real or personal, without regard to the principle of diversification or any 1_ ~~ other statute or general rule of law in his, her or its absolute discretion, it being my intention to give my personal representative the broadest investment powers possible, providing such investments do not unnecessarily prevent the prompt settlement of my estate. (f) To sell or otherwise dispose of any property, real or personal, tangible or intangible, at any time forming a part of my estate in any manner acid on such Page 3 of 8 LAST WILL AND TESTAMENT OF LYDIA V. HAZLETT terms and conditions as my personal representative shall see fit in his, her, or its absolute discretion. (g) To borrow money for the payment of taxes or for any other proper purposes in the administration of my estate, and to mortgage or pledge estate assets as security. (h) To compromise claims without court approval including, but not limited to, any controversies with the United States of America or the Commonwealth of Pennsylvania concerning estate and inheritance taxes on any interests that may pass under this my Last Will and Testament. (i) To distribute in cash or in kind upon any division or distribution of my estate. `" (j) To undertake any and all acts deemed necessary and ro er b m ~ ersonal p P Y y P ~ representative for the proper, advantageous and prompt management of the ' settlement of my estate. (k} In general, to exercise all powers in the management of my estate v~hich any ~ individual could exercise in the management of similar property owned in his own right, upon )~ ,;" ~ such terms and conditions as to him, her or it may seem best and to execute and deliver all instruments and to do all acts which he, she or it deems necessary or proper to carry out the purposes of this, my Last Will and Testament. No interest of any beneficiary of my estate, either in income or in principal, shall be subject to anticipation or pledge, assignment, sale or transfer in any manner, nor shall any Page 4 of 8 LAST WILL AND TESTAMENT OF LYDIA V. HAZLETT beneficiary have the power in any manner to charge or encumber his interest either in income or principal, nor shall the interest of any beneficiary be liable or subject in any manner while in the possession of my personal representative for the liability of such beneficiary. 6 I nominate, constitute and appoint my children, LOIS H. KIELKOPF and LINDA H. ~, a ~~ HAMILTON, as Co-Executrices of this my Last Will and Testament. I direct that m.y personal representative shall not be required to give or post bond for the faithful performance; oI~ his, her or its duties in this or any other jurisdiction. 7 I hereby declare it to be my express desire that my personal representative employ the Law Office of Sean M. Shultz, P.C., of Cumberland County, Pennsylvania, for legal. advice and assistance regarding this my Last Will and Testament, he having considerable knowledge of my affairs, views and wishes respecting any matters that may arise at the probate of this instrument, the administration of my estate, and the execution of the powers herein mentioned. !fly mention of the Law Office of Sean M. Shultz, P.C. in this my Last Will and Testament, is m~,y free and voluntary act and through no influence by any person. Page 5 of 8 LAST WILL AND TESTAMENT OF LYDIA V. HAZLETT IN WITNESS WHEREOF, I have hereunto set my hand to this my Last Will and Testament this 1.0`h day of May, 2011. <~__ Lydia V Hazlett Page 6 of 8 LAST WILL AND TESTAMENT OF LYDIA V. HAZLETT ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS. I, Lydia V. Hazlett, the Testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly, and that I signed it as my free and voluntary act for the purposes therein expressed. C Lydia azlett Sworn or affirmed and acknowledged before me by Lydia V. Hazlett. the Testatrix this 10`~ day of May, ?011. COMMONWE.gLTM OF PENNSYLVANIA Notarial Seat Dolly M' HocicenbeiTY, Notary Public Carlisle Bono, Cumberland Coun DIY Corrrrrusslon Expires Se ~' Member. Pennsylvania ~' 24, 2014 assodatlon of Notaries Page 7 of 8 LAST WILL AND TESTAMENT OF LYDIA V. HAZLETT AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND WE, _~~~~.R,,n /"t~ ~y lT Z and ~< / the witnesses whose names are attached to the foregoing document, being duly qualified according to law, do depose and say that we were present and saw Lydia V. Hazlei:t sign and execute the instrument as her Last Will and Testament; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testatrix signed the Last Will and Testament as witnesses and that to the best of our knowledge the Testatrix was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. ~%. Sworn or affirmed and subscribed before me by _ -P~~ /~, JY~ ~ 1 Z. and ~ S °L~ /r this " ~`h ~aMMq---- Nw~L~~ QF pFNNSYLVANIq Notarial Sea! Dolly M. Nockenberry, Nota Carlisle 9oro, Cumberland ~~ is MY Commission Explr,es cam. 24, 2014 Member, Pennsvivanla Assodatlon o~ Notaries