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Home My WebLink About11-03-14 J R►EV-1500 E"c°,-,°, ,� 1505610143 �' OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code Year File Number Bureau of Individual Taxes �EPARTMENTOFREVENUE Po Box.2so6o� INHERITANCE TAX RETURN 21 12 0 3 71 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 02 29 2012 04 23 1932 DecedenYs Last Name Suffix DecedenYs First Name MI HAZELL NANCY (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 � 3. Remainder Return(date of death prior to 12-13-82) � 4. Limited Estate � qa. Future Interest Compromise � 5. Federal Estate Tax Return Required (date of death after 12-12-82) g Decedent Died Testate � � Decedent Maintained a Living Trust � 8. Total Number of Safe Deposit Boxes � � (Attach Copy of Wilp (Attach Copy of Trust) 9. Liti ation Proceeds Received 10. Spousal Poverty Credit(date of death � ��,Election to tax under Sec.9113(A) ❑ 9 � between 1231-91 and 1-1-95) (Attach Sch.O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Numher, JOHN R BEINHAUR ESQUIRE 717 6�1 910Qy� -:? �-� � r � �� _,`.. _ .:-. - REGISTERlJF`-iNt��,S US�ONLY> -�� _., _ .. . . , . ,_ w . � , � 1 First line of address . <> 3964 I�EXINGTON ST -T� �`' i �� _.r � , = �:> Second line of address �—' � " t 7 �-� �,,� c "DATE FILED .-= �� City or Post Office State ZIp Code HARRISBURG PA 17109 CorrespondenYse-mailaddress: jrb@bClegal.Com Under penalties of perjury,1 declare that I have ex ed this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete.Declaration of parer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE F ILING RETURN DATE n Edwin A. Hazell ADDRESS 103 Manchester Rd, Camp Hill, PA 17011 SIGNATUR OF PREPARER OTHER THAN REPRESENTATIVE DATE John R Beinhaur Esquire ADDRE 39 4 Lexington St., Harrisburg, PA 17109 Side 1 � 1505610143 1505610143 � 4 � . � 1505610243 REV-1500 EX DecedenYs Social Security Number oe�ede�t�5 Name: H AZ E L L� N A N C Y RECAPITULATION 1. Real Estate(Schedule A).......................................................................................... � 90 , 000 . 00 2. Stocks and Bonds(Schedule B)............................................................................... 2. 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C).......... 3. 4. Mortgages&Notes Receivable(Schedule D).......................................................... 4. 5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)................ 5. 1 2 , 0 7 2 . 1 2 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. 1 0 2 , 0 7 2 . 1 2 9. Funeral Expenses&Administrative Costs(Schedule H)......................................... 9. 1 2 � 8 9 2 . 3 3 10. Debts of Decedent,Mortgage Liabilities,&Liens(Schedule I)................................ 10. 1 9 , 5 8 6 . 1 8 11. Total Deductions(total Lines 9&10)...................................................................... 11. 3 2 � 4 7 8 . 5 1 �Z• Net Value of Estate(Line 8 minus Line 11)............................................................. 12. 6 9 , 5 9 3 . 61 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. 6 9 , 5 9 3 . 6 1 TAX 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 16. 3 , 1 3 1 . 7 1 at lineal rate X .045 6 9 , 5 9 3 . 61 17. Amount of Line 14 taxable at sibling rate X .�2 �7. 18. Amount of Line 14 taxable at collateral rate X .15 �$' 19. Tax Due..................................................................................................................... 19. 3 , 131 . 71 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑ Side 2 � 1505610243 1505610243 � REV-1500 EX Page 3 File Number 21 - 12 - 0371 Decedent's Complete Address: DECEDENT'S NAME Hazeil, Nancy STREET ADDRESS 103 Manchester Road C��. STATE ZIP Camp Hill j PA 17011 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (�) 3,131.71 2. Credits/Payments A. Prior Payments B. Discount Total Credits(A +B) (2) 0.00 3. Interest (3) 179.50 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) 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 the TAX DUE. �5) 3,311 .2� Make Check Payable to: REGISTER OF WILLS, AGENT. , , . r�..... ;, ;, _, PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred:.................................................................................. ❑ � b. retain the right to designate who shall use the property transferred or its income:.................................... ❑ � c. retain a reversionary interest;or.................................................................................................................. ❑ � d. receive the promise for life of either payments,benefits or care?.............................................................. ❑ � 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receivingadequate consideration?....................................................................................................................... ❑ ❑X 3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?......... � � 4. Did decedent own an Individual Retirement Account,annuity,or other non-probate property which containsa 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 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)]. 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 applicabie 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 decedenYs 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 decedenYs sibiings is 12 percent[72 P.S.&9116(a)(1.3)1. A sibling is defined under Section 9102,as an individuai who has at least one parent in common with the decedent,wfiether by blood or adoption. SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF Hazell, Nancy 21 - 12 -0371 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 wilfing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survrvorship 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 DESCRIPTION VALUE AT DATE OF NUMBER DEATH 103 Manchester Road 90,000.00 Camp Hill, PA 17011 Lower Allen Township, Cumberland County Parcel No.: 13-23-0545-271 Value by realtor valuation attached. TOTAL(Also enter on Line 1, Recapitulation) 90,000.00 I SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTHOFPENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF Hazell, Nancy 21 - 12 - 0371 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH Pro-rated school real estate taxes from HUD-1 554.09 Pro-rated sewer and trash from HUD-1 69.15 Ameriprise Portfolio Account 7,972.33 Jewelry-all costume 100.00 ATT common stock- 10.583217 shares- may 2014 closing share price 35.58 376.55 Rolling Green Cemetary plot 1,000.00 Household contents-furniture, misceilaneous 2,000.00 TOTAL(Also enter on Line 5, Recapitulation) 12,072.12 SCHEDULE H � , � FUNERAL�CPOVSES& COMMONWEALTH OF PENNSYLVANIA I �� INHERITANCE TAX RETURN � RESIDENT DECEDENT I FILE NUMBER ESTATE OF Hazell, Nancy 21 - 12 -0371 Debts of decedent must be reported on Schedule I. ITEM AMOUNT NUMBER FUNERAL EXPENSES: DESCRIPTION A. 1 Parthemore Funeral Home & Cremation Services, Inc 3,822.�� 1303 Bridge St, New Cumberland, PA 17070 � ; I ( B. ADMINISTRATIVE COSTS: �. Personal Representative's Commissions Name of Personal Representative(s) Street Address ' City State Zip Year(s)Commission paid 2. Attorney's Fees Curcillo Law, LLC ' 8,500.00 3. Family Exemption: (If decedent's address is not the same as claimanYs,attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Filing 332.50 5. AccountanYs Fees 6. Tax Return Preparer's Fees � 7. Other Administrative Costs Cumberland Law Journal 75.00 Estate Advertising TOTAL(Also enter on line 9, Recapitulation) 12,892.33 Schedule H Fur�eral E�er�ses& i COMMONWEALTH OF PENNSYLVANIA � INHERITANCE TAX RETURN A�dminisfiaiive Cosfis conUnued RESIDENT DECEDENT FILE NUMBER ESTATE OF Hazell, Nancy 21 - 12 - 0371 i The Sentinel 147.06 i Estate Advertising Tri County Abstract 15.00 Deed copy I � I � i I ( Page 2 of Schedule H � SCHEDULEI � DEBTS OF DECEDENT, MORTGAGE COMMONWEALTHOFPENNSYLVANIA LIABILITIES, 8� LIENS INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF Hazell, Nancy 21 - 12 -0371 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM DESCRIPTION AMOUNT NUMBER Curcillo Law, LLC 250.00 Deed preparation -from HUD-1 Lower Allen Township 52.80 Street light assessment-from HUD-1 M&T Bank 27.00 payoff first mortgage loan -from HUD-1 Ascension Point 4,594.34 200 Coon Rapids Blvd Coon Rapids, MN 55433-5876 dcm Services 5,723.49 7601 Penn Ave, Suite A600 Minneapolis, MN 55423-5004 Comcast 315.73 1555 Suzy St Lebanon, PA 17046-8317 Boscov's 728�81 PO Box 17642 Baitimore, PA 21297-1642 ��p 118.72 PO Box 960090 Orlando, FL 32890-0090 Central PA Eye Institute 49.36 825 Fishburn Rd Hershey, PA 17033 TOTAL(Also enter on Line 10, Recapitulation) 19,586.18 SCHEDULEI DEBTS OF DECEDENT, MORTGAGE COMMONWEALTHOFPENNSYLVANIA LIABILITIES, & LIENS INHERITANCE TAX RETURN II RESIDENT DECEDENT conti n ued FILE NUMBER ESTATE OF Hazell, Nancy 21 - 12 -0371 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM i DESCRIPTION I AMOUNT NUMBER HTT 8.00 PO Box 39127 i Cleveland, OH 44139 Bonnie K. Miller, Treasurer ' 11.00 2233 Gettysburg Rd Camp Hill, PA 17011 personal tax outstanding j Bonnie K. Miller, Tax Collector 10.00 Tax Certification Fee from HUD-1 i UGI Utilities Inc II 179.23 � PO Box 15523 �! Wilmington DE 19886-5523 i i 452.22 Nestico Druby PC 840 East Chocolate Ave � Hershey PA 17033-1213 ' prior legal fees of decedent � �I Tina Fullerton 10.00 Notary Public from HUD-1 1st Advantage Settlement Services, Inc. ' 20.00 Overnite Fee- payoff-from HUD-1 Recorder of Deeds 55.50 Record Satisfaction -from HUD-1 � � � ; Page 2 of Schedule I i SCHEDULEI i DEBTS OF DECEDENT, MORTGAGE � COMMONWEALTHOFPENNSVLVANIA LIABILITIES, 8� LIENS I INHERITANCE TAX RETURN I RESIDENT DECEDENT co nti n ued I I FILE NUMBER ESTATE OF Hazell, Nancy 21 - 12 -0371 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. NUM ER DESCRIPTION I� AMOUNT 1 st Advantage Settlement Services, Inc. 50.00 � Satisfaction of Mortgage document-from HUD-1 i I i Cumberland County Tax Claim Bureau ' 4,875.20 j 2012-13 delinquent taxes-from HUD-1 I I Lower Allen Township 409.35 li Sewer and Trash billing -from HUD-1 Pro-rated county and township real estate taxes �' 78.11 , From HUD-1 I West Shore EMS 'I 1,007.62 I emergency medical I Penn State Hershey Medical Center 365.00 medical invoice Commercial Acceptance Company II� 194.70 Camp Hill Fire Co. No. 1 emergency transport balance i i i i i'I I � � Page 3 of Schedule I REV-1513 EX+(11 AS) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Hazell, Nancy 21 - 12 -0371 I RELATIONSHIP TO ', SHARE OF ESTATE 'AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT , (Words) � ($$$) RECEIVING PROPERTY Do Not List Trustee�s) I. TAXABLE DISTRIBUTIONS[include outright spousal ', distributions,and transfers under Sec.9116(a)(1.2)] 1 Edwin A. Hazell ; Son ' home and contents % 103 Manchester Road i Camp Hill, PA 17011 i I 2 Patricia M. Hazell Daughter-in-Law ', Rolling Green j 3814 Dawn-Mar Street ', Cemetary plot i Harrisburg, PA 17111 i , �, 3 Jessica E. Hazell Granddaughter ! Costume jewelry and! 3814 Dawn-Mar Street ', 1/2 residual j Harrisburg, PA 17111 , I I ' � I Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 coverlsheet,as appropriate. �i II. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN I I I B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET O.00 REV•1513 EX+(9-00) SCHEDULEJ COMMONWEALTHOFPENNSYLVANIA gENEFICIARIES continued INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hazell, Nancy FILE NUMBER 21 - 12 -0371 RELATIONSHIP TO ', SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT ' (Words) ($$$) RECEIVING PROPERTY Do Not List Trustee�s) � I� TAXABLE DISTRIBUTIONS[include outright spousal distributions,and transfers � under Sec.9116(a)(1.2)] I 4 Ryan W. Hazell Grandson 1/2 residual 3814 Dawn-Mar Street �, Harrisburg, PA 17111 � i � I ' i I , i� , I 'I i I ' � i I I I II, � ' � i j � Page 2 of Schedule J REGISTER OF WILLS CERTIFICATE OF C�IMBERLAND COUNTY GRANT OF LETTERS PENNSYLVANIA +�_ � - No. 20�2- 00379 PA No. 2�- 12- 037� Es ta t e Of: NANCY HAZELL (Fiist,Middle,LasU a/k/a : NANCY W HAZELL NANCY L HAZELL Late Of: LOWERALLENTOWNSHIP CUMBERLAND COUNTY Deceased Soci al Securi ty No: 203-24-854� WHEREAS, on the 28th day of March 2012 an instrument dated August 15th 2003 was admitted to probate as the last will of NANCY HAZELL /Fiist,Middle,LasU a/k/a NANCY W HAZELL NANCY L HAZELL late of LOWER ALLEN TOWNSH/P, CUMBERLAND County, who died on the 29th day of February 2012 and WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA FARNER STRASBAUGH , Register of Wills in and for CUMBERLAND County, in the Commonweal th of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: ED WlN A HAZEL L who has duly qualified as EXECUTOR(R/X) and has agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HDUSE, CARLISLE, PENNSYL VANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 28th day of March 20�2. �" ,f,, �� t �' C /t,!� � 'r Register of' i s � �� - i � , 1.�.� y � -1c � � ;��. ,, _��,,.,,�, epu.Z,Y b' **NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) � - - =� _' -_�, = :�-1� -_ _, �-,-�'� .. � LAST WILL AND TESTAMENT :�=='i>�� •�� - �:.-'.-,-, �, ._ . -. `�_�` OF � ��:;,-� ,..., ' =�; ,-,%_,-,, .._., _ -�, = -- -- _� ;_=: NANCY HAZELL ��' ��' == r`' _� --+ �� -�r� c;, I, Nancy Hazell, now domiciled in Cumberland County, Pennsylvania, declare this to be my Last Will and Testament. I revoke all other wills and codicils that I may have previously made. ARTICLE I The expenses of my last illness, cremation, and administration of my estate may be paid by my Executor from the principal of my residuary estate as soon as practicable after my death. My cremation arrangements have been pre-arranged with the exception of a marker. It is my desire upon my death to be cremated and my ashes mixed with those of my deceased husband. It is also my desire to have a funeral service held at the Grace Lutheran Church in Camp Hill. ARTICLE II All inheritance, estate, and succession taxes (including interest and penalties thereon, but not including any generation skipping tax) payable by reason of my death shall be paid out of and be charged generaiiy against 'tne principal of i�zy residua�y estate without reimbursement from any person. This provision is not a waiver of any ,_ right which my Executor has to claim reimbursement for any �,lch taxes which become payable as the result of any property over which I have the power of appointment. ARTICLE III I give, devise and bequeath all my property, real and personal, and mixed, as follows: 1. To my son, Edwin A. Hazell, I leave my hoine and all its contents located at 103 Manchester Road, Camp Hill, Pennsylvania; 2. To my daughter-in-law, Patricia M. Hazell, my second burial plot at Rolling Gre�n; 3. To my granddaughter,Jessica E. Hazell, all my jewelry, wherever located; 4. All the rest, remainder and residue of my estate shall be disposed of as follows: A.) Divided equally between my Granddaughter, Jessica E. Hazell, and my Grandson, Ryan W. Hazell, in accordance of the provision set forth in Article IV hereof. ARTICLE IV If my grandchildren are entitled to take under Article III hereof, then I give my grandchildren their shares of my estate in the following manner: If a grandchild has reached the age of THIRTY-FIVE (35) years at the time of my death, then I direct my Executor to distribute each such grandchild's pro rata share of rny estate to such grandchild at the time of my death. If any grandchild has not reached the age of THIRTY-FIVE (35) years at the time of my death, then each such grandchild's pro rata share of my estate shall be placed into a trust for each such grandchild's health, education and welfare as provided in Article V hereof. If any grandchild of mine fails to survive me by thirty (30) days, or dies before receiving all property passing into a trust for his or her benefit as provided for herein, then i give, devise and bequeath each such grandchild's pro rata share of my estate equally unto such of his or her issue as shall survive me. If any grandchild shall predecease me lea�.��ng no surviving issue, then such predeceasing grandchild's pro rata share of my estate shall .pass to my surviving grandchild or his or her issue, as the case may be. 2 ARTICLE V I hereby create the Nancy Hazell Testamentary Trust (hereinafter the "Trust") for any property passing into trust under Article III hereof. I appoint my daughter-in- law, Patricia M. Hazell, as the Trustee of any property passing into the Trust (hereinafter the "Trust Property") for the benefit of my grandchildren, Jessica E. Hazell and Ryan W. Hazell. The Trustee shall administer the Trust Property in his sole discretion for the health, education and welfare of my grandchildren, in accordance herewith. The Trust established herein is for the health, education and welfare of my grandchildren above named for whom the Trust is created. In addition to the powers given by law, I authorize the Trustee (a) to use such amounts of both income and principal of the Trust Property as he in his sole discretion deems proper for the support, education and welfare of any such child without leave of any Court, and (b) to invest any Trust Property. The Trustee shall not be required to give bond or furnish sureties in any jurisdiction. In addition to the aforesaid, the Trustee shall distribute the Trust Property as follows: upon each child reaching the age of TWENTY-FIVE (25) years, the Trustee shall distribute to that child ONE-THIRD (1/3) of the remaining share of the Trust Property to said child, and upon each child reacning zhe age of THIP.TY-FIVE (35; years, the trustee shall distribute to that grandchild the remainder of that grandchild's pro-rata share of Trust Property to said grandchild, absolutely and without reservation. All principal and income shall be free from anticipation, assignment, pledge or obligation of beneficiaries or remaindermen and, while in the hands of my Executrix or Trustee, the same shall not be liable to any levy, attachment or execution. 3 ARTICLE VI In addition to the powers conferred by law, I authorize my Executor in his absolute discretion: 1. To retain in the form received and to sell either in public or private sale, any real estate or personal property except that which I specifically bequeath herein, and pursuant to my directions set forth in this Will. 2. to manage real estate; 3. to invest and reinvest in all forms of property without being confined to legal investments, and without regard to principal of diversification; 4. to exercise any option or right arising from the ownership of investments; 5. to compromise claims without court approval and without the consent of any beneficiary; 6. to file any federal income tax return for any year for which I have not filed such return prior to my death; 7. to make distributions in cash or in kind, or in both, and to determine the value of any such property; 8. to employ any attorney, accountant, investment advisor, or other agent deemed necessary by my Executor; and to pay f�om� my estate reasonable compensation for all of their services; and 9. to conduct along with or with others, any business in ��rhich I am engaged in or have an interest in at the time of my death. ARTICLE VII I nominate, constitute and appoint my daughter-in-lav��, Patricia M. Hazell, to act as the Executrix of my Last Will. In the event of her renunciation, death, resignation, or inability to act for any reason whatsoever as my Executrix, I nominate, constitute and 4 appoint my son, Edw�in A. Hazell, as my Executor. I hereby relieve my Executor whether original, substitute, or successor, from the necessity of posting security in connection with her duties as such in any jurisdiction in which she may be called upon to act so far as I am able by law to do so. My Executor shall receive reasonable compensation for services rendered to my estate. IN WITNESS WHEREOF, I NANCY HAZELL, hereby set my hand to this my Last Will, on this /'�� day of August, 2003, at Hershey, Dauphin County, Pennsylvania. � U NAN HAZELL In our presence, the above-named Testatrix signed this and declared this to be her Last Will and now at her request, in her presence, and in the presence of each other we sign as witnesses. Name Address ��.;�` �L��C\ ' � "��'r��fifiL�.ti� i � � � 5 I, Nancy Hazell, Testatrix, who signed the furegoing instrument, having been �Uly ilUailfi�Ci aC�vTuiii� tv la'vV, aCi<iluwicu�c i�"lat i signed and executed this instrument as my Last Will, and that I signed it willingly as my free and voluntary act for the purposes therein expressed. Nancy� azell COMMONWEALTH OF PENNSYLVANIA ) ) ss: COUNTY OF DAUPHIN ) On this, the ��day of August, 2003, before me, a Notary Public, the undersigned officer, personally appeared NANCY HAZELL, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. � � ` ' . � NOTARY PUSLIC Notariai Seal �� Michele L. Pritchard, Notary Public Derry Twp., Dauphin County My Commission Expires Mar.22, 20Q4 Member,PennsylvarnaAssoca:a��o��{No;arlo5 6 We, the undersigned witnesses who signed the foregoing instrument, being duly qualified according to law, depose and say that the Testatrix executed this instrument as her Last Will; that she signed and executed it willingly as her free and voluntary act for the purposes herein expressed; that each us in her sight and hearing signed the Last Will as witn es; and that to the best of our knowledge, she was at the tirne eighteen (18) �; � r ore age f sound mind, and under no constraint or undue influence. , / / , ,:=" -..-_.. __ C, �G�1ct-� =-l%>��y�f � Sworn to and subscribed before me a Notary Public this j�`�'1 day of �U�;,�-�- , 2003. ,\(, , _ �, �' No ary Public iVotarial S�ai.�_�__�._---� �7iCh212 L.Pritchard, Notay i'ublic D2;ry Twp., Dauphin Counry My Commission Expires Mar.22, 2t10h � Member,Pennsylvanla Ass��c:ahon oi Naiarie�; � OMB Approval No.2502-0265 '�''iiiiilii';.�� A. Settlement Statement (HUD-1) 1.�FHA 2.Q RHS 3. X❑Conv.Unins. 6.File Number: 7.Loan Number: 8.Mortgage Insurance Case Number: 13401 7700409338 4.Q VA 5.Q Conv.Ins. C.Note:This form is fumished to give you a statement of actual settlement costs.Amounts paid to and by[he settlement agents are shown.Items marked "(p.o.c)"were paid outside the closing;they are shown here for informational purposes and are not included in the totals. D.Name&Address of Borrower: E.Name&Address of Seller: F.Name&Address of Lender: Jessica E.Hazell,Edwin A.Hazell Estate of Nancy L.Hazeli Mortgage Nehvork,Inc. 3814 Dawn-Mar Street,Hartisburg,PA 17111 3964 Lexington Street,Hamsburg,PA 17109 300 Rosewood Drive,Danvers,MA 01923 G.Property Location: H.Settlement Agent: I.Settlement Date:0?J14/2014 103 Manchester Road 1st Advantage Settiement Services Inc. Disbursement Date:02/14/2014 Camp Hill,PA 17011 6375 Mercury Dnve,Suite 102,Mechanicsburg,PA 17050 Lower Allen Township 717-591-7755 Place of Settlement: TitleExpress 6375 Mercury Drive,Suite 102,Mechanicsburg,PA 17050 Printed 02/14/2014 at 1134 am by TF 100. Gross Amount Due from Borzower 400. Gross Amount Due to Seller 101. Contract sales pnce 47,000.00 401. Contract sales price 47,000.00 102. Personai ro ert 402. Personal ro e 1D3. Settlement charges to borrower(line 1400) 5,321.98 403. 104. 404. 105. 405. Ad'ustments for items paid b seller in advance Ad'ustments for items paid b seller in advance 106. City/town taxes to 406. Cityltown taxes to 107. County taxes to 407. County taxes to 108. School Taxes 02/14l2014 to 06/30/2014 554.09 408. School Taxes 02/14/2014 to O6l30/2014 554.09 109. Sewedirash J/F/M 02l14/2014 to 03/31/2014 69.15 409. SewerlTrash JIF/M 02114l2014 to 03/31/2014 69.15 110. 410. 111. 411. 112. 412. 120. Gross Amount Due from Borrower 52,945.22 420. Gross Amount Due to Seller 47,623.24 200. Amounts Paid b or in Behalf of Borrower 500. Reductions In Amount Due to Seller 201. Deposit or eamest money 501. Excess deposit(see instructions) 202. Principal amount of new loan(s) 37,000.00 502. Settlement charges to seller(line 1400) 5,737.85 203. Existin loan�s taken sub'ect to 503. Existin loan s taken sub'ect to 204. 504. Payoff of first mortgage loan to M&T Bank 27.00 205. 505. Payoff ofsecond mortgageloan 206. 506. 207. 507. 208. 508. 209. 509. Ad'ustments for items unpaid b seller Ad'ustments for items unpaid b seller 210. City/town taxes to 510. Cityltown taxes to 211. County taxes 01101/2014 to 02/t412014 78.11 511. County taxes 01/01I2014 to 02114/2014 78.11 212. SchoolTaxes to 512. SchoolTaxes to 213. 513. 214. 514. 215. Gift of Equity 15,867.11 515. Gift of Equity 15,867.11 216. 516. 217. 517. 218. 518. 219. 519. 22�• Total Paid b Ifor Borrower 52,945.22 520. Total Reduction Amount Due Seller 21,71U.07 300. Cash at Settlement fromfto Borrower 600. Cash at Settlement tolfrom Seller 301. Gross amount due from borrower(line 120) 52,945.22 gp�, Gross amount due to seller(line 420) 47,623.24 302. Less amounts paid bylfor borrower(line 220) 52,945.22 602. Less reductions in amount due seller(line 520) 21,710.07 303. Cash QX From ❑ To Bortower 0.00 603. Cash ❑X To ❑ From Seller 25,913.17 �5 co e on o rtna ion is e ima e a minu es per res0o�se orco e mg,2viewing en repo ing e a a. is agenq may no co ec is in ortna�on,ano you are no reQwre o compe e t�is foml l�nless k tlisplays a wrtan�y veli0 OMB con�mi num�ers No con(tlentiality is assuretl;lhis tlisUosure is manCatory.TTis is tleSiB^etl lo pmvitle the parties to a RESPA coveretl trdnsac�ion wk�Information EunnB Ne settlement pmcess Previous editions are obsolete Page 1 of 4 HUD-1 700. Total Real Estate Broker Fees Paid From Paid From Divisionofcommission Iine700 asfollows: Bo��owe�'S Selle�'S �o�. $o.00 to Funds at Funds at �02 $o.00 to Settlement Settlement 703. Commission paid at settlement 800. Items Payable in Connection with Loan 801. Our origination charge (Includes Origination Point 0.000%a or$0.00) $974.00 (from GFE#1) 802. Your credit or charge(points)for the specific interest rate chosen $103.60 (from GFE#2) 803. Your adjusted origination charges (from GFE A) 1,077.60 804. Appraisal fee to Affirmative Certified A raisers (from GFE#3) 575.00 805. Credit report to Birchwood Credit Services,Inc. (from GFE#3) 120.00 806. Tax service to from GFE#3 807. Fiood certification to LPS National Flood (from GFE#3) 10.00 808. FNMA LQI Update to Birchwood Credit Services Ina (from GFE#3) 50.00 900. Items Re uired b Lender to be Paid in Advance 901. Daily interest charges from from 02114/2014 to 03101/2014 @$5.32001day (from GFE#10) 79.80 902. Mortgage Ins.Premium for months to (from GFc#3) 903. Homeowner's insurance for 1 ears to The Bo er A enc (from GFE#11) 923.34 904. months to from GFE#11 1000. Reserves De osited with Lender 1001. Initial deposit for your escrow account (from GFE#9) 1,36774 1002.Homeowner's insurance 3 months � 76.95Imonth $230.85 1003.Mortgagelnsurance months � O.00lmonth $ 1004.City Property Tax months � O.00lmonth $ 1005.County Property Tax 13 months � 62.921month $817.96 I 1006.School Taties g months � 114.701month $1,032.30 1007.AggregateAdjustment $-7t3.37 1100.Title Char es 1101.Title services and lender's title insurance from GFE#4 897.50 1102. Settlement or closing fee to $ 1103. Owner's title insurance-First American Title Insurance Company $ from GFE#5 63.00 1104. Lender's title insurance-First American Title Insurance Company �770.50 1105. Lenders title policy limit$37,000.00 Lender's Policy 1106. Owner's title policy limit$47,000.00 Owner's Policy 1107. AgenPs portion of the total title insurance premium $644.72 to 1 st Advanta e Settlement Services inc, 1108. Undenuriter's portion of the total title insurance premium $188.78 to First American Title Insurance Com an 1109. 1110. Tax Cert Fee to 1 st Advantage Settlement 10.00 Services Inc. 1111. Notary Fee to Tina Fullerton 10.00 1112. Ovemight Fee-Payoff to 1 st Advantage Settlement 25.00 Services Inc. 1200. Governme�t Recordin and Transfer Char es 1201. Govemment recording charges $ (from GFE#7) 158.00 �2�z• Deed$69.00 Mort a e$89.00 Release$ 1203.Transfer taxes $ (from GFE#8) 1204. City/County tatilstamps Deed$ Mort a e$ 1205. State Ta�stamps Deed$ Mort a e$ 1206. Deed$ Mort a e$ 1207. Satisfaction Recording Fee 55.50 1300.Additional Settlement Char es 1301.Requiretl services that you can shop for (from GFE#6) 1302. Survey to � 1303. to 1304. to 1305. Sat Piece Doc Prep to 1st Advanta e Settlement Services Inc. 50.00 1306. 2012/13 Delinquent Taxes to Cumbedand Count Tax Ciaim Bureau 4,87520 1307. SewedTrash Past due thru March 20 to Lower Allen Townshi 409.35 1308. Deed Prep Fee to Curcillo Law 250.00 1309. Delinquent Street Light Assesment to Lower Allen Townshi 52.80 -�� . i 5,321.98 5,737.85 `Paid outside of closing by(B)orrower,(S)eller,(L)ender,(I)nvestor,Bro(K)er."'Credit by lender shown on page 1."'Credit by seller shown on page 1. Previous editions are obsolete Page 2 of 4 HUD-1 Com arison of Good`Faith Estimate GFE and HUD-1 Char es Good Faith Estimate HUD-1 Char es That Cannot lncrease HUD-1 Line Number Our origination charge # 801 974.00 974.00 Your credit or charge(points)for the specific interest rete chosen � 802 103.60 103.60 Your adjusted ongination charges # 803 1,077.60 1,077.60 Transfertaxes # 1203 0.00 0.00 Char es That inTotal Cannotincrease More Than10%a Good faith Estimate HUD-1 Govemment recording charges # 1201 200.00 158.00 Appraisal fee #B04 425.00 575.00 Creditreport �805 60.00 120.00 Flood,certification # 807 21.00 10.00 FNMA LQIUpdate # 808 25.00 50.00 Title services and lender's title insurance # 1101 1,025.00 897.50 Owner'stitle insurance # 1103 400.00 63.00 # 2,156.00 1,873.50 � �" -282.50 p� -13.1030% Char es That Can Chan e Good Faith Estimate HUD-1 Initial deposit for your escrow account # 1001 1,903.49 1,36774 Daily interest charges from # 901 $5.3200Ida 79.80 79.80 Homeowner's insurance # 903 923.34 923.34 # # # Loan Terms Your initial loan amount is $37,000.00 Your loan term is 30.years Your initial interest rate is 5.2500% Your initiai monthly amount owed for principal,interest,and any mortgage $204.32 includes insurance is QX Principai ❑X Interest ❑Mortgagelnsurance Can your interest rate rise? QX No. ❑Yes,it can rise to a maximum of °/a. The f rst change will be on l I and can change again every years after I l Every change date,your interest rate can increase or decrease by %. Over the life of the loan,your interest rate is guaranteed to never be lower than °/or higher than %. Even if you make payments on time,can your loan balance rise? QX No. ❑Yes,it can rise to a maximum of� Even if you make payments on time,can your monthly amount owed for ❑X No. ❑Yes,the first increase can be on I I and the monthly pnncipal;interest,and mortgage insurance nse? amount owed can nse to$ The maximum it can ever rise to is$ Does your loan have'a prepaymentpenalty? OX No. ❑Yes,your maximum prepayment penalty is$ Does your loan have a balloon payment? QX No. ❑Yes,you have a balloon payment of� due in years on ! / Total monthly amount owed inciuding escrow account payments ❑You do not have a monthly escrow payment for items,such as property taxes and homeowner's insurance. You must pay these items directly yourseif. QX You have an additionai monthiy escrow payment of 5254.57 that results in a total initial monthly amount owed of$458.89. This includes principal,interest,any mortgage insurance and any items checked below: ❑X Propertytaxes Q Homeowner'si�surance �Flood insurance QX School Taxes ❑ ❑ Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form,please contact your lender. Previous editions are obsolete Page 3 of 4 HUD-1 — ._ _ . ..,. HUD CERTIFICATION OF BUYER AND 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 all receipts and disbursements made on my account or by me in this transaction.I further certify that I have received a copy of the HUD�1 Settlement Statement. ? n � � / � r" Jessida E.Hazeil � � J � __ Edwin A.Hazell ESTATE OF NANCY L.HAZELL /� _. The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction.I have caused or wili cause the funds to be disbursed in accordance with this statement. � ��Y //�/ SETTLEMENT AGENT DATE WARNING:IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM.PENALTIES UPON CONVICTION CAN INCLUDE A FINE AND iMPRISONMENT.FOR DETAILS SEE TITLE 18:U.S.CODE SECTION 1001 AND SECTION 1010. Previous editions are obsolete Page 4 of 4 HUD-1 - � � - 1 1 � 1' Name of Borrower. Name of Seller: File Number Jessica E.Hazell Estate of Nancy L.Hazeil 13401 Edwin A.Hazell TitleExpress Prepared 02/14/2014 at 11:12 am Note: This page is furnished to give you an itemization of the amounts shown on ;Faid FroRi ' ". P.aid':F�om Lines 1101, 1103 and 1104 of the Settlement Statement(HUD-1).This page `Bor�oweGs°:; T"Seller'S` . accompanies but is not a part of the settlement statement. If a discrepancy �FGnds at : - 'F.unds.at.'. exists,the information shown on the Settlement Statement(HUD-1)applies. Settlement: :Settlemenf` 1100.`Title"Charges =;y . 'Amountsincluded , ... -� ., , ,..� . �� > � � �in;Line'�1101 � �� .�, . 1101. Title services and lender's title insurance 897.50 a.Wire In Fee � 12.00 b.Email\Doc Copy Fee 50.00 I c. Ovemight Delivery Fee-Package 25.00 d. Notary Fee 40.00 $ 127.00 1102. Settlement or closing fee 1103. Owner's title insurance (policy) $ 63.00 fi3.00 1104. Lender's title insurance (policy) 545.50 � 770.50 a. Endorsement 900 EPL-Residential 50.00 b. Endorsement 100(No Violation) 50.00 c. Endorsement 300 Survey 50.00 d. Closing Service Letter 75.00 (Total 1103+1104) $ 833 50 1105..Lender's fitle policy:limit$37;OD0.00 5012742h2831 1106. OwnePs`title policy'-limit:$47,000.00 5011442-63545 1107:Agents portion of the total title insurance premium $ 644:Z2 1108. Underwriters portion of thetotaftitle'insurance prem. - '188:78 (Tota111 W+1108)' $ `833:50 1109. 1110. 1111. 1112. .. . . . � , . �. , ;_Total Borrower ;.,:Borrower., . Seller 1100:Jitle Cha es'with'Pa ee � ` `Char e POC or Credit " Line 1101 " Paid 1101. Title services and lender's title insurance $ a.Wire In Fee to 1st Advantage Settlement Services Inc. 12.00 12.00 b. EmaillDoc Copy Fee to t st Advantage Settlement Services Inc. 50.00 50.00 c. Ovemight Delivery Fee-Package to 1 st Advantage Settlement Services Inc. 25.00 25.00 d. Notary Fee to Tina Fullerton 4D.00 40.00 1104. Lender's title insurance to 1st Advantage Settlement Services Inc. 770.50 770.50 :$ 89Z:50 C 897.50 ,