HomeMy WebLinkAbout08-19-15 Pennsylvania
1505618403
DEPARTMENT OF REVENIN(03-14)
REV-1500 OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 14 1190
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
111 22 2014 06 04 1924
Decedent's Last Name Suffix Decedent's First Name MI
HAYES MARION M
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
FRI 1. Original Return 11 2. Supplemental Return 3. Remainder Return(date of death
prior to 12-13-82)
4, Agricultural Exemption(date of ❑ 5. Future Interest Compromise(date of 8. Federal Estate Tax Return Required
death on or after 7-1-2012) death after 12-12-82)
R7. Decedent Died Testate 8. Decedent Maintained a Living Trust 9. Total Number of Safe Deposit Boxes
(Attach copy of will) (Attach copy of trust.)
EJ10. Litigation Proceeds Received 11. Non-Probate Transferee Return 12. Deferral/Election of Spousal Trusts
(Schedule F and G Assets Only)
13. Business Assets 14. Spouse is Sole Beneficiary
(No trust involved)
CORRESPONDENT•THIS SECTION MUST BE COMPLETED,ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
LINDA J OLSEN 717 540 4332
First Line of Address
2000 LINGLESTOWN ROAD
Second Line of Address
SUITE 202
City or Post Office State ZIP Code
HARRISBURG PA 17110
Correspondent's email address: lolsen(7hazenelderlaw.com
REGIST�2 OF WILLS USEONLY, M r
C` a FTI 4
REGISTER OF WILLS USE ONLY :�? t�
DATE FILED MMDDYYYY
DATETILED'STANO 'T1
a G� r— r'n
Cn
w.
Side 1 '
� 1111111 Illll 11111 VIII illll VIII Bill lilll VIII Illll 1111 Illi
1505618403 1505618403
1505618411
REV-1500 EX
Decedent's Social Security Number
oecedenrs Name: Hayes, Marion M.
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... 1.
2. Stocks and Bonds(Schedule B)............................................................................. 2. 2`10,188-40
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C)......... 3.
4. Mortgages and Notes Receivable(Schedule D).................................................... 4.
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E).......... 5. 157-e070-83
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 19,0 2 3.91
7. Inter-Vivos Transfers&Miscellaneous Np Probate Property
(Schedule G) U Separate Billing Requested............ 7. 2 4 2,0 5 4 .6 0
8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 708,337-74
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 14,5 0 6-4 6
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 11,3691-913
11. Total Deductions(total Lines 9 and 10)................................................................ 11. 25-,876.3c]
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 682-e461-35
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. 682-e461- 35
TAX CALCULATION-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. 11-00
16. Amount of Line 14 taxable
at lineal rate X .045 6821461-35 16. 30-1710-76
17. Amount of Line 14 taxable
at sibling rate X.12 0.0 0 17. 0-00
16. Amount of Line 14 taxable
at collateral rate X.15 (3-00 18. 11-00
19. TAX DUE................................................................................................................ 19. 30,710.76
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Under penalties of perjury,i declare i have examined this retum,including ecoompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct and complete.Declaration of preparer other than the person responsible for filing the return is based on all Information of which preparer has
any knowledge.
SIGNA•AEOF PERSON RESPONSIBLE FOR FILING ETURN Virginia Gail Deneka DATE
ADDRESS CC!!
881 East Lake Rd.,Dundee NY 14837
SIGNATLtPF PREPARER ERP N ESENTATIVE Linda J.Olsen �+
S
2000 Linglestown oad, Harrisburg,PA 17110
111111111111111111111111111111111IIIIIIIIIIIIIIIIIIIIIIJill Slide cncr , II,,,,
REV-1500 EX Page 3 File Number 21-14-1190
Decedent's Complete Address:
DECEDENT'S NAME
Hayes, Marion M.
STREETADDRESS
333 N. Mountain Rd.
CITY STATE ZIP
Newvine PA 17241
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 30,710.76
2. Credits/Payments
A. Prior Payments 26,000.00
B. Discount 1,368.42
Total Credits(A +B) (2) 27,368.42
3. Interest (3)
q. 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) 3,342.34
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;............................................................................... ❑ ❑x
b. retain the right to designate who shall use the property transferred or its income;.................................. ❑ O
c. retain a reversionary interest;or............................................................................................................... ❑ x
d. receive the promise for life of either payments,benefits or care?............................................................ ❑ ❑x
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?.................................................................................................................... ❑ ❑x
3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?....... ❑x ❑
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 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 step-parent 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(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)]. A sibling is defined,
under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
Rev-1603 EX+(08-12)
SCHEDULE B
pennsylvania STOCKS & BONDS
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hayes, Marion M. 21-14-1190
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
I Charles Schwab Investment Acct.#7174-6716 201,340.40
2 US Savings Bonds-Six bonds,$5,000 each;-See attached 88,848.00
copies of bonds.
TOTAL(Also enter on Line 2,Recapitulation) 290,188.40
(If more space is needed,additional pages of the same size)
Copyright(c)2012 form software only The Lackner Group,Inc. Form PA-1500 Schedule B(Rev.08-12)
Rev-1508 EX+(08-12)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hayes, Marion M. 21-14-1190
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 VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
I Capital One 360 Savings Acct.#12195262 145.044.52
2 Glenwood Memorial Gardens--4 plots in the Garden of the Gospel. Current selling price for 9.580.00
a single gravesite is$2,395. Cemetery will not buy back the plots, must be sold if family
does not want to retain plots.
3 Refund from Sarah Todd Home 2,446.31
TOTAL(Also enter on Line 5, Recapitulation) 157,070.83
(if more space is needed,additional pages of the same size)
Copyright(c)2012 form software only The Lackner Group,Inc. Form PA-1500 Schedule E(Rev.08-12)
Rev-1509 EX+(01-10)
pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hayes, Marion M. 21-14-1190
If an asset was made joint within one year of the decedent's date of death,it must be reported on schedule G.
SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Joan E. Dandy 333 North Mountain Rd. Child
Newville, PA 17241
B.
C.
JOINTLY OWNED PROPERTY:
DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM LETTER DATE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECD'S DECEDVALUE OF
ENT'SINTEREST
NUMBER FOR JOINT MADE NUMBER OR SIMILAR IDENTIFYING NUMBER.ATTACH DEED FOR VALUEOFASSE7 INTEREST
TENANT JOINT JOINTLY-HELD REAL ESTATE. -
1 A 05/17/2011 Cornerstone Savings Acct.#26144-Jt.w/Joan 8,823.58 50.000% 4,411.79
Dandy
2 A 01/2011 TD Bank eking.#7861394927-Jt.w/Joan 12,156.61 50.000% 6,078.31
Dandy
3 A 1/2011 TD Bank eking.Acct.#787-1531104-Jt.w/ 17,067.61 50.000% 8,533.81
Joan Dandy
TOTAL(Also enter on Line 6.Recapitulation) 19,023.91
(If more space is needed,additional pages of the same size)
Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule F(Rev.01-10)
Rev-1510 EX+(08-09)
SCHEDULE G
pennsylvania INTER-VIVOS TRANSFERS AND
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hayes, Marion M. 21-14-1190
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE ONAME
^TRANSFERTRANSATTACJA COEIRPYOF THE RELATIONSHIP
OR REAL ESTATEDENT E. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1 Marion M. Hayes Irrevocable Grantor Trust Dated 242,054.60 100.000% 242,054.60
10/11/11 - Charles Schwab Investment Acct.#9799
-8869
TOTAL(Also enter on Line 7, Recapitulation) 242,054.60
(If more space is needed,additional pages of the same size)
Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule G(Rev.08-09)
REV-1511 11 9X+(08-13)
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN
RESIDENT DECEDENT ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Hayes, Marion M. 21-14-1190
Decedent's debts must boreported onSchedule|.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 2,949.36
B. ADMINISTRATIVE COSTS-
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
city State ZiD
Year(s)Commission Paid
2. Attorney's Fees Hazen Elder Law 10,500.00
3. Family Exemption: (if decedent's address is not the same as claimant's,attach explanation)
Claimant
Street Address
City State Zio
Relationshio of Claimant to Decedent
4. Probate Fees Register of Wills 610.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 446.60
See continuation schedule(s)attached
TOTAL(Also enter on line 9, Recapitulation) 14,506.46
Copyright(c)2O1Oform software only The Lackner Group,Inc. Form PA' 500GoheduleH(<ov 0843)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Hayes, Marion M. 21-14-1190
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Expenses
1 Hoffman-Roth Funeral Home 2,601.20
2 Rental fee for Hall for memorial celebration 200.00
3 Wegman's foods-food for memorial celebration 148.16
H-A 2,949.36
Other Administrative Costs
4 Central Penn Business Journal-estate notice 158.00
5 Community Banks-estate checking account check fees 16.40
6 Cumberland Co. Law Journal-estate notice 75.00
7 Home News-obituary 152.00
8 PA Dept. of Vital Records -fee to obtain death certificate for spouse 18.00
9 Postage-US Postal Service 17.20
10 Register of Wills-fee for additional Short certificates 10.00
H-B7 446.60
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98)
Rev-1512 EX+(12-12)
SCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF
RET
INHERITANCE TAXAXRETURN
MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hayes, Marion M. 21-14-1190
Report debts Incurred by the decedent prior to death that remained unpaid at the date of death,Including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Cumberland good will fire Rescue EMS-ambulance services 252.00
2 Hazen Elder Law 45.00
3 Millennium Pharmacy-costs of prescription medicines 111.20
4 PA Dept.of Revenue-2014 personal income taxes 343.00
5 Sarah Todd Home-rent 9,093.73
6 US Treasury-IRS 2014 personal income taxes 1,525.00
TOTAL(Also enter on Line 10, Recapitulation) 11,369.93
(If more space is needed,additional pages of the same size)
Copyright(c)2012 form software only The Lackner Group,Inc. Form PA-1500 Schedule I(Rev. 12-12)
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hayes, Marion M. 21-14-1190
NAME AND ADDRESS OF RELATIONSHIP TOSHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S)RECEIVING PROPERTY DECEDENTDo Not t T s (Words) ($$$)
I� TAXABLE DISTRIBUTIONS [include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
Joan Elizabeth Dandy Child One-fourth of the
333 North Mountain Rd. Residue of the
Newville, PA 17241 estate.
Virginia Gail Deneka Child One-fourth of the
881 East Lake Rd Residue of the
Dundee, NY 14837 Estate.
Thomas William Hayes Child One-fourth of the
311 Illinois Ave. Residue of the
Lynn Haven, FL 32444 Estate.
Susan Jane Winter Child One-fourth of the
801 Acorn Ln. Residue of the
Neshanic Station, NJ 08853 Estate.
Total
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate.
NON-TAXABLE DISTRIBUTIONS:
II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule J(Rev.01-10)
REGISTER OF WILLS CERTIFICATE OF
CUMBERLAND COUNTY GRANT OF LETTERS
PENNSYLVANIA
of CuM „
eF No. 2014- 01190 PA No. 21- 14- 1 190
.7 Estate Of: MARIONMHAYES
Q (First,Middle,Last)
�_ Late Of: UPPER FRA NKFORD TOWNSHIP
CUMBERLAND COUNTY
Deceased
1750 Social Security No: 198-12-2715
WHEREAS, on the 18th day of December 2014 an instrument dated
February 15th 1994 was admitted to probate as the last will of
MARION M HA YES
/First,Middle,Last)
late of UPPER FRANKFORD TOWNSHIP, CUMBERLAND County,
who died on the 22nd day of November 2014 and
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, LISA M. GRAYSON, ESQ. , Register of Wills in and
for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby
certify that I have this day granted Letters TESTAMENTARY to:
VIRGINIA GAIL DENEKA
who has duly qualified as EXECUTOR(RIX)
and has agreed to administer the estate according to law, all of which
fully appears of record in my office at CUMBERLAND COUNTY COURTHOUSE,
CARLISLE, PENNSYL VA NIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the 18th day of December 2014.
A4
Register of Wills
013—1
Deputy /
**NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST)
C15 CZ,
C= I
o M
Cm
ED a rn
l
M CO Q-11
I'D -I
LAST WILL AND TESTAMENT C-- t3
7J r") ril
OF
MARION MABEL HAYES
I, MARION MABEL HAYES, a resident and domiciliary of the Township of
Piscataway in the County of Middlesex and State of New jersey, hereby make,
publish and declare this my Last Will and Testament, revoking any and all wills
and Codicils thereto made by me at any time heretofore.
FIRST: I direct the payment of all my just debts, funeral and
administration expenses as soon after my decease as can conveniently be done.
SECOND: All the rest, residue and remainder of my estate, real,
personal and mixed, of which I die seized and possessed or to which at the time
of my death I may be or thereafter become entitled, wheresoever the same may be
situate of whatsoever the same may consist, including any property over which I
may have power of appointment, which power I hereby exercise, I give, devise and
bequeath absolutely and in fee simple to my husband, WILLIAM HENRY HAYES.
THIRD: If my said husband shall not be living at the time of my death,
or we shall both die in a common accident or catastrophe, and it cannot be
deter-mined which of UB died first, then I give, devise and bequeath and appoint
all my said Estate in equal shares to my four children, VIRGINIA GAIL DENEKA,
SUSAN JANE WINTER, THOMAS WILLIAM HAYES and JOAN ELIZABETH DANDY. If any of my
said children shall not be living at the time of my death, I order and .direct
that the share of my estate which would have passed to my said child predeceasing
me shall pass to his or her children, per stirpes, or if there be no such
children living at the time of my death, then I order and direct that the said
share shall pass to my surviving child or children equally.
FOURTH: A. I nominate, constitute and appoint my said husband, WILLIAM
HENRY HAYES, as Executor of this, my Last Will and Testament.
B. Should my husband die, resign, be disqualified, unwilling
or unable to act as such Executor, whether before or after entering upon his
duties as such, I nominate, constitute and appoint my daughter, VIRGINIA GAIL
DENEK:.'., as Executrix of this, my Last Will and Testament.
C. I direct that no bond or other security shall be required
of either appointee for the faithful performance of the duties of the office to
which appointment has herein been made in any jurisdiction in which either of
them may be called upon to act. If any such bond or other security shall
nevertheless at any time be required, I direct that the cost thereof and any
other expense in connection therewith shall be paid as part of the expenses of
administration of my estate.
FIFTH: I hereby authorize and empower my Executor to sell, convey and
dispose of any real estate of which I die seized, at either public or private
sale, at such times and upon such terms as shall be deemed best and to give good
and sufficient conveyance in the law for the same.
SIXTH: I give to my Executor full power and authority to agree upon
a compromise of any Federal, State or Foreign Estate, Succession, Inheritance and
Transfer taxes upon any interest, estate, trust or legacy created by this Will,
vested or contingent and full power and authority to pay any such compromised
tax, without liability to, any person who may be or become a beneficiary under
this Will.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 15 day of
February, Nineteen Hundred and Ninety-Four.
S.
MARION MABEL HAYES
J
C'-`.
Signed, saaled published and declared by the saki Testatrix, DiARION W%BEL
HAYES, as and for her Last Will and Testament in our presence and hearing and we
thereupon and at her request, in her presence and in the presence of'each other,
subscribed our names as witnesses ther'eto this 15 day of February, Nineteen
Hundred and Ninety-Four.
residing at
P
residing at
STATE OF NEW JERSEY:
SS:
COUNTY OF MIDDLESEX:
MARION MABEL HAYES, JOSEPH STEVENS, and PHYLLIS E. GARTEN, the Testatrix
and witnesses, respectively, whose names are signed to the attached 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 Testament, and
that she had signed willingly, and that she executed it as her free and voluntary
act for the purposes therein expressed; and that each witness states that he or
she signed Last Will and Testament as witness in the presence and hearing of the
Testatrix, and that to the best of his or her knowledge the Testatrix was at that
time 18 or more years of age, of sound mind and under no constraint or undue
influence.
` MARION MABEL HAYES
JOSEPH STEVENS
PHYL IS E. GARTEN
J
v '
V
c
V '
Subscribed, sworn to and acknowledged before me by MARION MABEL
HAYES, the Testatrix, and subscribed and sworn to before me by JOSEPH STEVENS,
PHYLLIS E. GARTEN, witnesses, this 15 day of February, 1994.
°-�` x'(/(71'1� 't%v'�^,,�1^r'�it/l•'tp/l/',,,
WEN01 J.ZIMMERMAN
A Notary Public of New Jersey
My Commissar Expires January 11,1995
i
Jan, 23. 2015 1 :36PM TD Bank Research 2077537840 No- 0736 P. 2
TD sank
AmorlWs Most Convenient sank'
Operations Center
P.O.Box 1377 Wbankxom
Lewiston,ME 04243-9377
T M 751 4000
January 23,2015
Hazen Elder Law
2000 Linglestown Road
Suite 202
Harrisburg,PA 17110
RE: The E,state of Marion Hayes
To Whom.It May Concern:
Below please find the Date of Death Verification information you requested on the above
referenced name.If you have any questions regarding the information provided,please feel free
to contact the Bank at 888-751-9000.
Account Type: Checking
Account Number: 7871531104
Date of Death Balance: $17,067.61
Interest Rate: NA°!o
Current Yeamo-date Posted Interest up to Date of Death: $1.69
Accrued Interest up to Date of Death: $0.10
Name(s)on Account. Marion Hayes;Joan E Dandy'
Safe Deposit Box: NA
Additional Information: NA
Sincerely,
Deposit Operations
TD Bank,N.A.
MG ��t"
Jan, 23, 2015 1:36PM TD Sank Research 2077537840 No. 0736 P. 3
To Bank
Rmadues Most Convenient Bank'
Operations Center
P.O.Sox 1377 tdban1(x*m
Lewiston,ME 04243-1377
T 989 7519000
January 23,2015
Hazen Elder Lave
2000 Linglestown Road
Suite 202
Harrisburg,PA 17110
RE: The Estate of Marion Hayes
To Whom It May Concern:
Below please find the Date of Death Verification i nformatiOA you requested on the above
referenced name.If you have any questions regarding the information provided.,please feel free
to contact the Bank at 888-751-9000.
Account Type: Checking
Account Number: 7861394927
Date of Death Balance: $12,156-61
Interest Rate: NAo/%
Current Year--to-date Posted Interest up to Date of Death: $2.12
Accrued Interest up to Date of Death: $0.11
Name(s)on Account: Marion Hayes;Joan E Dandy
Safe Deposit Box: NA
Additional Information: NA
Sincerely,
Deposit Operations
TD Bank,N.A.
MG
Calculated Value of Your Paper Savings Bond(s) Page I of I
Calculated Value of Your Paper Savings Bond(s)
Calculator Results for Redemption Date 12/2014
Total Price Total Value Total Interest YTD Interest
$30,000.00 $88,848.00 $58,848.00 $3,432.00
Bonds: 1-6 of 6
Issue Next Final Interest
Serial # Series Denorn Date Accrual Maturity Issue Price Interest Rate- Value Note
X3629245EE EE $10,000 02/1993 02/2015 02/2023 $5,000.00 $9,808.00 4.00% $14,808.00
X3629244EE EE $10,000 02/1993 02/2015 02/2023 $5,000.00 $9,808.00 4.00% $14,808.00
X3629243EE EE $10,000 02/1993 02/2015 02/2023 $5,000.00 $9,808.00 4.00% $14,808.00
X3629242EE EE $10,000 02/1993 02/2015 02/2023 $5,000.00 $9,808.00 4.00% $14,808.00
X3629241EE EE $10,000 02/1993 02/2015 02/2023 $5,000.00 $9,808.00 4.00% $14,808.00
X3629240EE EE $10,000 02/1993 02/2015 02/2023 $5,000.00 $9,808.00 4.00% $14,808.00
Totals for 6 Bonds $30,000.00 $58,848.00 $88,848.00
Notes
NI Not Issued
NE Not eligible for payment
P5 Includes 3 month interest penalty
MA Matured and not earning interest
littp://www.ti-easurydirect.p-ov/BC/SBCPi-ice 1 h/703 4
u
m
SERIES EE
INTEREST CEASES 30 YEARS
FROM ISSUE DATE
164 18 2384 02 1993
WILLIAM H HAYES
213 OVER BROOK RD,. ' j=VfA NY
NJ 08-854
PISCATAWAY F IS&s.All S'
r-te o 41,99
09 MARION HA Y-
X—O--003-629-240—EE
89103 5 0:0 0 7 5 013 4k;-3 A RA
X3629240EE
i:0000q000 71:09 �p
11 8000 36 29 2.4011'
IB
MZ.
Noll 3—: -01-TIM-111m
% SERIES EE
INTEREST CEASES 30 YEARS
-411
FROM ISSUE DATE
EFS c'
164 18 2334
02 1993'
Zo WILLIAM H HAYES
213 OVER6ROOK RD*- r-RB NY
ti .,.NJ 08854 I.AfiT..us
PISCATAWAY FISCsI
OR MARION HAYES ------
-
X-0-603—.629-241—,E—
B93035000752 018 4813 A RA
X362924 LEE
1:0000900071:09 900036 29 24 Lit"
W
go
SERIES EE
R,ON't 7-4-11�ufm�!-s m�;jb I a(I a�t.:,v� INTEREST CEASES 30 YEARS
FROM ISSUE DATE 0.
164 18 -384
d- 02
19.93
ly", 72i, WILLIAM H HAV-S
213 OVE
R8RQdK RD-
PISCATAWAY NJ 08854 FRO NY
0-61N.STAB 9
OR MARK N. ''AYES
89,3.03-.5001 0752 X-0-7003-629-242—EE
-
01 a3 , 4813 A RA
X36292LIHE�
1:0000900071:09 100036 292L. 2v
:\S+ ���`��;i i •'�'tl � � +'� � • •Y Y'•!1 � N _ �� 0 � 1 i 1 "��g•.h V''1'4 �� N� �'�
. � v �" � -. ..- •-,_ ... ,d 111 ate.
^a � tiaI�Sr��3 '_�, rusc� SERIES EE
_ je�.., `tj„•.. , r �r h ,1` INTEREST CEASES 30 YEARS
FROM ISSUE DATE
164 18 2364 {j2 1993
� ' . 7, WILLIAM H HAYES - -
J 213 flYERBF at1fC RD' FRB NY]j
PISCATAWAY -NJ 0,8854- FISC 19Afi�G EN{�+ 3.
�� OD9',�'ING 5�7 7 3' ,it
\ i�.
,l t
OR MARIGN MAYES ------
X-0-003-629-243—EE
----X-0-003-629-243—Ef
393035000752 0.18 481RA i
, A X3629243EE zl
1:0000900071:09 000036 29 21, 3118
e�vi� :iSSs .::n ' • u u:•e► _ 0�i 7a,
' o _ 1 0 1 flA 'R La�� ; ,rl;;he, Z�• vti
- ';PCPZ`•,31. d, sisi,... ��; ..' ` ,,,. .�..,.'., fi.,, ill_ :.`. , .•.' 1�II . ,
Y ' : � r�► ���ar� �t�itr» ?ws SERIES EE
bfJ•iF��2 1\ l �a'L.r s INTEREST CEASES 30 YEARS Cis.
,�����:;%`•C+' ee FROM ISSUE DATE
I~ ^
164 18,-2384 02 1993
:L to WILLIAM H HAYES
2173}}^''0'V. €i qi?y Cc t IRP
y 'F'R$ NY 15 1ys
• "�•'�IM1•. e i.?L A Ii i7i A L NJ iJ �f jos ClSS �16 J.T+✓<}}S`'. `T
F E\P VNONG S4 0 7 i lw
IS 1 SJR' �'�ARIGN �HAYES
1-0—D03-629-244—f-E
893035—ObO151 . 0.18 481 A ' RA X3629244EE
�:000090007i:09 L00036 29 24411'
_ >• , • u 11''1 1 _ e !! — — a 0 1 0 1
V. TR Z
111 R teLN-gli , ,1.a}11%'r'S�0a'AD,MI T.I`,iIM,la, SERIES EE
y- i y INTEREST CEASES 30 YEARS ��
f r.:riU•v�!'' II/:�� h�j�,,;Zy ��]• '��Ll. {C�ld� l`5� �:)(.��Iilic��l�` FROM ISSUE DATE
164 18 2384 OZ 1993
E ` o WILLIAM H HAYES �I
2�]1 1T3 GVERBROOK RD' fRa NY
T F
i �•� F- .. � - S C H T A Y9 M 7 NJ 08854 F I a1LTT1��54gg�1h�TGyp
ENU `S
� \'.
•i .- F E '47G'6l ING GT3M9 7 3' A
OR -MARION H AYES
t ` X-0--003-629-Z45-EE . 4
319:3035000752 . 013 431-,3 A 'RA X3629245EE
1:0000900071:09
2000362924Sil'
�
capital
January 22. 2015
Corinne Woodhouse
Hazen Elder Law
2000LinB|esbommRoad
Suite 202
Harrisburg, PA1711O
Dear Corinne,
Per your request, our records show the following Capital One 360 account(s) for Marion Hayes:
Account Type: Savings
Account Ownership: Individual
Open Date: 9/20/03
Balance asof11/22/14: $145.044,52
The others three accounts \nquestion are closed. The closing statements are included.
Questions? Call uaat1-888-464'O727from 8AW1ho8PM, 7days aweek.
Thanks.
CORNERSTONE
F e d c r o I C; r e l i t Ll n i o n PO`Box 1181,5 Eastgate Drive,Carlisle,PA 17015
Telephone (717) 249-1661 FAX (717) 249-8208
Member founded— Ses-vice based www.co rnerstonefcu.coop
Hazen Elder Law
2000 Linglestown Road
Suite 202
Harrisburg, PA 17110
Re: Estate of Marion M. Hayes
To Whom It May Concern:
Exact account number—26144-01
Ownership of account--Marion M. Hayes and Joan E. Dandy
Value of account as of November 22,2014-$8,823.58
Account type—Savings account
Interest earned-$3.33
Account made joint—5/17/2011
No change of ownership within one year prior to the date of death
Sincey,
(IT t
Kathy Keiser
Financial Service Representative
MEMBER SAVINGS ACCOUNTS FEDERALLY INSURED TO $250,000 BY THE NATIONAL CREDIT UNION ADMINISTRATION
Glenwood Memorial Gardens
January 28, 2015
Linda J. Olsen
Hazen Elder Law
2000 Linglestown Rd. Suite 202
Harrisburg, PA 17110
RE: Hayes, William H. & Marion M.
Dear Ms. Olsen,
William H. & Marion M Hayes are the original purchasers of the interment rights
in the Garden of the Gospel lot 105 Unit B graves #1, 2, 3, & 4. According to Pa law
Title 20 Decedents, estates and Fiduciaries, Chapter 25 Wills paragraph#14 states, if in a
will no express disposition or other mention is made of a cemetery lot owned by the
testator at his decease the ownership of the lot shall not pass from his lawful heirs by a
residuary or other general clause of the will but shall descend to his heirs as if he had died
intestate. I will need to see the lot owners will, if cemetery property was mention. If
cemetery property is not mention in their will then the remaining interment rights passes
to the children,then grandchildren etc. If the sole heirs want to relinquish their interest, I
will forward a quitclaim form for you to obtain the proper signature(s), if the sole heirs
are interested in assigning or transferring the remaining interment rights. The original
Certificate of Interment Rights (deed) needs to be returned. If lost, I will forward a lost
affidavit. I will also need to see William & Marion Hayes death certificates. There is a
$95.00 transfer fee for each new Certificate of Interment Rights issued.
Please feel free to call on me, if you have any questions or need further assistance.
Sincerely,
CK�a_J-9-0-- �Z%
Kathleen McCormick
Office Manager
SSVKO L-3 V
r � 0 42015
DigizityID
2321 \Vest Chester Pike • Broomall, PA 19008 • 610-356-1144 • Fax 61.0-325-01.60
www.DignityMemorial.com
GROUND BURIAL PRIGS LIST
4
k `$ 4 ,.k
� Garden Endowment Care Total 2nd Right
.,
Garden of Christus $416.72 $3,195 $2,597.5
Garden of the Good Shepherd $416.72 $3,195 $1,597.!
Garden of the Last Supper $416.72 $3,1.95 $1,597.!
_
Garden o#the Prayer $416.72 $3,195 $1,597,!
Section P $364.55 $2,795 $1,397.5
Sermon on the Mount $364.55 $2,795 $1,397..5
Garden of Peace $364.55 $2,795 $1,397.5
Garden of Agape $312.38 $2,395 $1,197.5
Garden of the Cross $312.38 $2,395 $1,197.5
' Section G $312.38 $2,395 $1,197."5
Section N $312.38 $2,395 $1,197.5+
Section i $312.38
2,395 $2,297.51
Section J
$312.38 $2,395 $1,197.51
Section K $312.38 $2,395 $1,297.51
Section Q and Q Annex $312.38 $2,395 $1,197.5(
Section $322.38 $2,395 $1,197.5[
,
„„.� arden of the Gospel $312.38 $2,3951 $1,297.5(
Garden of Nativity $247.16 $1,895 $947.50
F Section M $247.16 $1,895 $947.50
�
t Section N $247.16 $1,895 $947.50
6,
Section 0 $247.16 $2,895 $947.50
, n
Section R $247.16 $1,895 $947.50
w, Section S $247.16 $1,895 $947.50
Garden of Faith $247.26 $1,895 $947.50
Section F $247.16 $1,895 $947.50
r ` Section L $247.16 $1,895 $94750
Veteran's Annex $247.16 $1,895 $947.50
Veterans Garden $247.16 $1,895 $947.50
Veteran Z $247.15 $1,895 $947.50
# NOTES
ECF is calculated at 13.043%(0,13043)of the TOTAL selling price if any promotional price is used.
No Discounts on 2nd Right of Interment
} Outer Burial Containers are required for all ground burials as provided for in the cemetery regulations
All memorials must meet minimum cemetery requiremen
;. .
Effective:9/9/2024
m
0635-G)enwood Meortat Gardens
O
Schwab Ong Trust Account of
V DENEKA&J DANDY&S WINTER
M Ln
TTEE MARION M HAYES IRREV Account Number StatementPerlod N
GRANTOR TRUST DTD 1011112011 9799-8869 November 1.30,2014
x
a
Change in Account Value This Period Year to Date Account Value{ )Over Last 12 Months[in Thousands) z
r
r
StartingValue $243,894.21 $227,443.63 A
..-........... ..........................-_..........._...................................................._..............._........•.._...........................-....-I...._......
..........._. a of Purchases&Sales..............._..........................{10�U65:44)................................{��353.46.).. 270
ash Value
knvestments Purchased/Sold 10,065.44.................._._...,.....,7,353.4fi_ 225
..............,_.- -........-- ---......._.._.....,..,..._..._....._............ ...._.....
Deposits&Withdrawals 0.00 0.00 16D
Dividends&Interest 433.78 6,312.68 135
Fees&Charges...................................................................._...................... _00_.............._. {0.75} 90 -
........................ ....... .._ _
Transfers 0.00 0.00
a
Income Reinvested 0.00 0.00 00 m
— •---_.._..-_--_-......__..-..--_--............... ......._.._._.._.....—.—I.....-------._....----.._......._..........._..........._...._.....I...._..._..............._.
Ghange In Value of Investments 356.14 10,924.5712193 1/14 2114 3114 4114 5114 6/14 7114 8114 9114 10114 11/14 00
_. w
Ending Value on 1106012014 $244,680.13 ...._ . $244,680.13 M
Accrued Income' 1,131.85
&tding Value Wth Accrued lncomed $245,81 f.98
Asset Composition Market Value %of Account Assets Overview Gain or(Loss)Summary
Cash $851.49 <1% Realized Gain or(Loss)This Period
F;pihort Term 0.00
Ned Income 110,706.30 45 Jo
o
a Lo Term 146135
E uities 120,051.34 49� �9..,...._. ...'....._...._.._..................._...................._...... .
Other Assets 73,471.Od... 601. Unrealized Gain or(Loss)
Total Assets Long... $244,6813.13 All investments.... ...... 525,795.35_.-
Valuesmay not relied allof your gain's�losses.
in 49°Jo Equities
5%Other Assets Account Notes
45%Fixed Income •Accrued Interest is$796.55
e Accrued Dividend is$335.30
Schwab has provided accurate gain and loss Information wherever possible for most Investments.Cost basis data may be incomplete or your 1rnaen:invemcxrcr4s°r�snorcaed wAG arae users N
unavailable for some of your holdings. nwan mrd sctrtvab does rot sc�en95°orerdorse sheen.
Please see"Endnotes For Your Account"section for an explanation of the endnote codes and symbols on this statement. Page 4 of 17 0
w
a
01
Schwab OneO Account of Account Number Statement Period
MARION J HAYES 7174-6716 November 1.30,2014
Ln
Change In Account Value This Period Year to Date Account Value Over Last 12 Months[in Thousands]
Starting Value 201,276.29 $192,741.69
6 Value-�i*Purchases''--*' *" "a'le" .......... 270 Ln
........................ ... .. ... ....................--------
Investments Purchased/Sold-.-,....... ........ 225
b 6 p o-sh s" 6iiiwiii...... 0.00 0.00 180
a nds&I nter est 2 3`1.2 5 4,316.15
....... ................ ......................... 135 01
Fees
s 0.00 ........... 90
Transfers 0.00 0.00
I......... - ---------- ...... .......--...................--.- 45
income'.- ---Reinvested 0.00 -"0.00- 0
Chan a to Value of Investments 1,394.91 5,848.99 12113 1114 2114 3/14 4114 5114 6114 7x14 BM 9114 10114 11114 00
........ ... - -------- ......... .................................
Ending Value on 11130/20114 $202,902A5 $20Z902AS
Ao6iu '6C-.'0M-'O'X .................... 4
"60.1i
d $203,908.56
qMg Value with,Accrued,Income
Asset Composition Market Value %of Account Assets Overview Gain or(Loss)Summary
Money Market Funds J§�waepl $3,744.02 2% Realized Gain or(Loss)This Period
Fixed Income................... Short Term $0.00
100,807.81 50%
8 8,368.50 4 4% .................---......................
• Equities
_ 9,982.12 5%
4Unrealized Gain or(Loss)
Total Assets Lon 2049idA All Investments
$35� 4.1..
45
........... .I.I........-1-............-.1--.1—.......... .. .Vi6es may not reftect all b
ofyourgainMosses.
50%Fixed Income
5%Other Assets Account Notes
n 44%Equities *Accrued Interest is$784.23
2%mmr-s[Sweep] •Accrued Dividend is$221.88
C3
Schwab has provided accurate galn and loss information wherever possible for most investments.Cost basis data may be Incomplete or CD
unavailable for some of your holdings. Pt my w cn
Please see"Endnotes for Your Account section for an explanation of the endnote codes and symbols on this statement. Raga 4 of 16
Marion M. Hayes Trust
9799-8869
Date of Death Accrued Total Date of
Symbol Security Name Acquired Quantity Market Value Interest Death Value
09088RWC6 BIRMINGHAM AL 4%17DB LTX DUE 08/01/17 11/22/2014 5000 $5,395.85 $61.67 $5,457.52
172967GGO CITIGROUP INC. 1.25%16 DUE 01/15/16 11/22/2014 3000 $3,008.49 $13.23 $3,021.72
181144QZ2 CLARK CNTY WA SD 5.25%a16GO UTX DUE 06/01/16NATIONAL PUBLIC FINA 11/22/2014 5000 $5,325.75 $124.69 $5,450.44
25468PCV6 WALT DISNEY CO 1.1%17 DUE 12/01/17 11/22/2014 10000 $10,012.72 $52.25 $10,064.97
36159AWN6 SYNCHRONY BANK 2.4%15CD FDIC INS DUE 08/06/15DRAPER UT 11/22/2014 4000 $4,041.15 $28.48 $4,069.63
369604BE2 GENERAL ELECTRIC 0.85%15 DUE 10/09/15 11/22/2014 5000 $5,016.57 $5.08 $5,021.65
403720131-17 GWINNETT CNTY GA 5%19REV UTX DUE 09/01/19 11/22/2014 5000 $5,562.30 $56.25 $5,618.55
511074NN2 LAKE TRAVIS TX ISD 2%17GO UTX DUE 02/15/17 11/22/2014 5000 $5,148.05 $26.94 $5,174.99
511863CB6 LAKELAND WI UHSD 2.5%16GO UTX DUE 03/01/16 11/22/2014 5000 $5,110.25 $28.12 $5,138.37
56344ZBB4 MANITOBA PROVINC 5.5%18F DUE 11/15/18 11/22/2014 10000 $9,413.27 $10.58 $9,423.85
6054176X1 MISS PWR CO 2.35%16 DUE 10/15/16 11/22/2014 11000 $11,255.38 $26.57 $11,281.95
64966JJ23 NYC NY 5%17GO UTX DUE 08/01/17 11/22/2014 10000 $11,061.20 $11.07 $11,072.27
64990EEG8 NY ST DORM AUTH 1.19%17TAX SPL DUE 03/15/17TAXBL 11/22/2014 5000 $4,994.30 $154.17 $5,148.47
717081AQ6 PFIZER INC. 4.65%18 DUE 03/01/18 11/22/2014 4000 $4,402.68 $41.85 $4,444.53
73723RRM7 PORTSMOUTH VA 1.65%18GO UTX DUE 07/15/18TAXBL 11/22/2014 10000 $9,951.90 $58.21 $10,010.11
742718DQ9 PROCTER&GAMBLE 3.15%15 DUE 09/01/15 11/22/2014 5000 $5,079.62 $35.44 $5,115.06
927793UZO VA CMWLTH TRAN BD 4%15TRAN HWY DUE 05/15/15 11/22/2014 5000 $5,054.30 $3.89 $5,058.19
BCE B C E INC NEW F 11/22/2014 100 $4,531.00 $4,531.00
BMY BRISTOL-MYERS SQUIBB CO 11/22/2014 100 $6,011.00 $6,011.00
CBWBF CANADIAN WESTERN BANK F 11/22/2014 100 $2,352.21 $2,352.21
CYT CYTEC INDUSTRIES INC 11/22/2014 100 $5,156.00 $5,156.00
EEM (SHARES MSCI EMRG MKT FDEMERGING MARKETS ETF 11/22/2014 100 $3,983.00 $3,983.00
EEMV (SHARES MSCI ETF EMERGING MKTS MINIMUM VOLATILITY 11/22/2014 100 $5,840.00 $5,840.00
EMR EMERSON ELECTRIC CO 11/22/2014 100 $5,703.00 $5,703.00
ECA ENCANA CORP 11/22/2014 200 $3,712.30 $3,712.30
ENTG ENTEGRIS INC 11/22/2014 300 $4,065.00 $4,065.00
EWC (SHARES MSCI CDA ETF CANADA 11/22/2014 100 $2,764.00 $2,764.00
GE GENERAL ELECTRIC COMPANY 11/22/2014 200 $4,926.00 $4,926.00
GLW ICORNING INC 11/22/2014 500 $12,195.00 $12,195.00
GOOG IGOOGLE INC CL C NON VTG NON VOTING SHARES 1 11/22/20141 5 $2,667.55 $2,667.55
Date of Death Accrued Total Date of
Symbol Security Name Acquired Quantity Market Value Interest Death Value
GOOGL GOOGLE INC CLASS A VTG VOTING SHARES 11/22/2014 5 $2,681.40 $2,681.40
GSK GLAXOSMITHKLINE PLC ADRFSPONSORED ADR 1 ADR REP 2 ORD 11/22/2014 100 $4,605.00 $4,605.00
GXP GREAT PLAINS ENERGY INC 11/22/2014 200 $5,692.00 $5,692.00
INTC INTEL CORP 11/22/2014 100 $3,350.00 $3,350.00
IBM INTERNATIONAL BUSINESS MACHINES 11/22/2014 25 $4,047.63 $4,047.63
JNJ JOHNSON &JOHNSON 11/22/2014 100 $10,148.00 $10,148.00
KO COCA COLA COMPANY 11/22/2014 100 $4,158.00 $4,158.00
KO COCA COLA COMPANY 11/22/2014 100 $4,158.00 $4,158.00
LN DC LANDEC CORP NEW 11/22/2014 200 $2,764.68 $2,764.68
MSFT MICROSOFT CORP 11/22/2014 100 $4,229.99 $4,229.99
NWLTF NEWALTA CORP F 11/22/2014 200 $2,366.58 $2,366.58
OGE 0 G E ENERGY CP HLDG CO 11/22/2014 100 $3,399.00 $3,399.00
PFE PFIZER INCORPORATED 11/22/2014 100 $3,333.00 $3,333.00
SNHY SUN HYDRAULICS INC 11/22/2014 100 $3,785.00 $3,785.00
TMP TOMPKINS FINANCIAL CP 11/22/2014 100 $5,327.00 $5,327.00
XRX XEROX CORP 11/22/2014 200 $2,692.00 $2,692.00
Total Securities $241,215.61
Cash $838.99
Total account value as of date of death $242,054.60
Marion Hayes Individual
7174-6716
Date of Death Accrued Total Date of
Symbol Security Acquired Quantity Market Value Interest Death Value
00287YAK5 ABBVIE INC 2%18 DUE 11/06/18 11/22/2014 5000 $5,042.31 $4.44 $5,046.75
135087ZV9 CANADA 1.5%17F DUE 03/01/17 11/22/2014 6000 $4,886.42 $20.27 $4,906.69
26206IND2 DRIPPING SPRING TX 4%16GO UTX DUE 08/15/16 11/22/2014 5000 $5,286.35 $53.89 $5,340.24
355046JKO FRKLN TW SIVIRST CO N 3%15GO UTX DUE 05/01/15 11/22/2014 5000 $5,034.35 $8.75 $5,043.10
36158ZBH8 GE CAP CANADA F 5.53%17F D U E 08/17/17 11/22/2014 7000 $6,158.32 $103.16 $6,261.48
369604BE2 GENERAL ELECTRIC 0.85%15 DUE 10/09/15 11/22/2014 5000 $5,015.87 $5.08 $5,020.95
428236BC6 HEWLETT-PACKARD 2.125%15 DUE 09/13/15 11/22/2014 5000 $5,042.54 $20.36 $5,062.90
435169GV3 HOLLAND MI BLDG AUT4%15AUTH BLDG DUE 10/01/15 11/22/2014 5000 $5,110.55 $28.33 $5,138.88
587848AK8 MERCER COUNTY NJ IMPT 3.63%DUE 12/1/2014 11/22/2014 5000 $5,103.38 $86.21 $5,189.59
58933YAC9 MERCK&CO. INC. 1.1%18 DUE 01/31/18 11/22/2014 5000 $4,996.08 $17.11 $5,013.19
596566QR3 MIDDLESEX CN NJ IMP 5%18ENVR LAND DUE 09/15/18 11/22/2014 5000 $5,718.30 $46.53 $5,764.83
646080KRI NJ ST HGR ED STDT L 5%17EDUC STUD DUE 12/01/17 11/22/2014 5000 $5,551.00 $118.75 $5,669.75
680297HA9 OLD TAPPAN NJ 1%16GO UTX DUE 11/15/16 11/22/2014 5000 $5,045.05 $0.97 $5,046.02
6832341380 GOVT OF ONTARIO 4.4%19F DUE 06/02/19 11/22/2014 5000 $4,555.75 $104.56 $4,660.31
750667TXS RAHWAY NJ 3%17GO UTX DUE 09/15/17 11/22/2014 5000 $5,305.60 $27.92 $5,333.52
897217EH4 TROUTDALE OR 4%16GO UTX DUE 06/01/16ASSURED GUARANTY MUN 11/22/2014 10000 $10,456.20 $190.00 $10,646.20
906548BZ4 UNIONELECTRICC 4.75%15 DUE 04/01/15 11/22/2014 6000 $6,040.96 $40.37 $6,081.33
924214DY2 VERMONT MUN BD BK 3.0% DUE 12/1/2014 11/22/2014 5000 $5,079.88 $71.25 $5,151.13
ADT ADT CORP 11/22/2014 100 $3,562.00 $3,562.00
BCE B C E INC NEW F 11/22/2014 100 $4,679.00 $4,679.00
BMY BRISTOL-MYERS SQUIBB CO 11/22/2014 100 $5,928.00 $5,928.00
CSCO CISCO SYSTEMS INC 11/22/2014 200 $5,382.02 $5,382.02
DLB DOLBY LABORATORIES INC 11/22/2014 100 $3,856.00 $3,856.00
EEM (SHARES MSCI EMRG MKT FDEMERGING MARKETS ETF 11/22/2014 100 $4,031.00 $4,031.00
EMR EMERSON ELECTRIC CO 11/22/2014 50 $2,945.50 $2,945.50
EWC ISHARES MSCI CDA ETF CANADA 11/22/2014 100 $2,794.00 $2,794.00
GE GENERAL ELECTRIC COMPANY 11/22/2014 100 $2,446.00 $2,446.00
GLW CORNING INC 11/22/2014 100 $2,422.00 $2,422.00
GLW CORNING INC 11/22/2014 100 $2,422.00 $2,422.00
IHON HONEYWELL INTERNATIONAL 11/22/20141 50 $5,026.00 1 $5,026.00 1
FINTC JINTEL CORP 1 11/22/20141 1001 $3,342.501 1 $3,342.50 1
1
Date of Death Accrued Total Date of
Symbol Security Acquired Quantity Market Value Interest Death Value
JNJ JOHNSON &JOHNSON 11/22/2014 50 $5,083.50 $5,083.50
KO COCA COLA COMPANY 11/22/2014 100 $4,147.00 $4,147.00
LNDC LANDEC CORP NEW 11/22/2014 100 $1,348.00 $1,348.00
NEOG NEOGEN CORP 11/22/2014 150 $7,002.00 $7,002.00
PFE PFIZER INCORPORATED 11/22/2014 100 $3,160.00 $3,160.00
PLL PALL CORP 11/22/2014 50 $4,983.50 $4,983.50
SLB SCHLUMBERGER LTD F 11/22/2014 50 $4,385.50 $4,385.50
TMO THERMO FISHER SCIENTIFIC 11/22/2014 50 $6,304.00 $6,304.00
XOM EXXON MOBIL CORPORATION 11/22/2014 100 $9,167.00 $9,167.00
YAO GUGGENHEIM EXCH TRD FD CHINA ALL CAP 11/22/2014 100 $2,803.00 $2,803.00
Securities total $197,596.38
Cash
$3,744.02
Total account value as of date of death $201,340.40