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Home My WebLink About01-0435 Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Forrest C. Hagen also known as No. ~ (- ~ ,- L.l3E' , Deceased Social Security No. 201-18-1962 Nancy S. Young Petitioner{s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW:) [K] A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut r ix named in the last Will of the Decedent, dated 02/02/2001 and codicil(s) dated None By Renunciations filed simultaneously herewith, Gary F. Hagen and Steven W. Hagen renounced their right to administer the Estate. State relevant circumstances, e.g., renunciation, death of executor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: n/a D B. Grant of Letters of Administration (c.t.a.; d.b.n.c.t.a; pendente lite; durante absentia; durante minoritate) Petitioner{s) aher a proper search has/have ascertained that Decedent leh no Will and was survived by the following spouse (if any) and heirs: r Name Relationship Residence I (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumb er 1 and County, Pennsylvania with his/her last family or principal residence at 218 Fox Drive, Hampden Township (list street, number, and municipality) Decedent, then ..!.1....-years of age, died 03/08/2001 at Borough of Mechanicsburg, PA (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PAl All personal property (If not domiciled in PAl Personal property in Pennsylvania (If not domiciled in PAl Personal property in County Value of real estate in Pennsylvania 270,000.00 $ $ $ $ situated as follows: Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the a riate form to the undersi ned: nature Nancy S. Young 134 West Siddonsbur Road, Dillsbur , PA 17019 \ lo - d- ~~- \ Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems. Inc. Form RW-1 (1991) Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Dec.d.n~ Pet~ioneris) will well and truly administer the estate according to law. D Sworn to or affirmed and subscribed '-1"'LaAU;j =:d...:. 4if- ,d Nancy S. ung before me this~ day of vflJat- ' dlt9tJ /_ 'mar ~ ~. LJ.ti.~.ir~<'7m~ For the Register ~- If No. 21-01-435 Estate of Forrest C. Hagen Deceased Social Security No: 201-18 -1962 Date of Death: 03/08/2001 AND NOW, MAY 2, 2001 I in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters []] Testamentary D Of Administration (c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia: durante minoritate) are hereby granted to Nancy S. Young in the above estate and that the instrument(s) dated 02/02/2001 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES '1mA, t". )jjLcUvJL(. lId, .:>r:;;;iTLu Q~,,~ ' Register of Wills / Letters. . . . . . . $ 270.00 Short Certificate(s). .7. $ 21.00 Renunciation. $ 10.00 Attorney: James D. Bogar, Esquire Affidavits ( $ 1.0. No: PA 19475 Extra Pages (3 ) . $ 9.00 Address: One West Main Street Shiremanstown, PA 17011 Codicil. . $ 5.00 Telephone: 717/737-8761 JCP Fee. $ Inventory. $ Other . . $ TOTAL. $ 315.00 Form RW-1 (1991) Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. 21-01-435 . REGISTER OF WILLS OF CUMBERLAND COUNTY OATH OF SUBSCRIBING WITNESS Judith A. Hagen codicil , ~h) a subscribing witness to the will presented herewith, Xoaxb) being duly qualified according to'. law, depose(s) and say(s) that she was present and saw Forrest C. Hagpn the testat or , sign the same and that she signed as a witness at the request of testat or in h is presence and (m the presence of each other) (in the presence of the other subscribing witness( es)). Swom to or afflI'llled and subscribed before me this t1~ day of Af(~l 200( ~. 'L. ~b' JU~# ~g~~ 218 Fox Drive ame Mec~~r;cBbYrg, p~ 17050 (Address) ~r Notarial Seal Joan E. Brothers, Notary Public Shlremanstown Boro, Cumberland County My Commission Expires Feb. 12,2002 Member. P,mnlylvinia Aaeac,atlon of Notaries (Name) (Address) REGISTER OF "lILLS OF COUNTY OATH OF NON-Sl.JBSCRlBING WITNESS (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) t.~at familiar w:m the signature of codicil testar of (one of the subscribing witnesses to) the will presented herewith and codicil that believes the signature on the will is in the handwriting 0 f to the best of k':lOwledge and belief. Sworn to or affirmed and 5ubsc:ibed before me this day of 19 (Name) (Address) Register (Name) (Address) 21-01-435 REGISTER OF WILLS OF Cumberland COUNTY OATH OF SUBSCRIBING WITNESS Susan M. Hudson codicil , ~) a subscnoing witness to the will presented herewith, iee.Jd:1) being duly qualified according to" law, depose(s) and say(s) that she was present and saw Forrest C. Haaen the testat or , sign the same and that she signed as a witness at the request of testat or in h ; ~ presence and (in the presence of each other) (in the presence of the other subscribing witness(es)). 1 . ~./n-~ Swcrn to or aff'mned and subscribed before me this 9H-- day of UplJ. 20,01 A O(~ J<JIt./v /~ Z:L.l";~ , . / [~~~~11 Susan M. HUdSOoq~~ ~~~gaHIg~Bfl~9~n~Re Ct78~o (Address) Register (Name) (Address) REGISTER OF WILLS OF COUNTY OATH OF NON-SUBSCRIBING WITNESS . . (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) t.~at f~T.Jliar '.'-lith the signature of codicil testar of (one of the subscribing witnesses to) the will presented herewith and codicil tl].at believes the signature on the will is in the handwriting of to the best of knowledge and belief. Sworn to or affirmed and subscribed before me this day of 19_ (Name) (Address) Register (Name) (Address) APR-12-01 THU 05:17 PM JAMES D BOGAR FAX NO. 717 737 2086 K.fJJ,'" U1....\,.;J.a.~ IV1~ P. 04 21-01-435 In Re Estate of Forrest C. Hagen deceased. To the Register of Wills of Cumberland County. Pennsylvania- The undersigned ' Steven W. Hagen of the above decedent, hereby renoun~e(s) the right to administer the estate ~nd respectfully ask(s) that Letters Testamentary be: issued to Nancy S. Younq, as the sole surviving Executri~. his (' atUJ:C:) steven W. Hagen 3200 Lynn Haven Drive Virginia Beach, VA WITNESS ,l!X 200..l (Addrcul (Signature) (Address) (Signature) (Address) 04/12/01 THU 17: 07 [TX/RX NO 5805] I4J 004 RENUNCIATION 21-01-435 In Re Estate of Forrest C. Hagen deceased. To the Register of Wills of Cumberland County, Pennsylvania. The undersigned , Gary F. Hagen, Co-Executor of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters Testamentary be issued to Nancy S. Young, as the sole surviving Executrix. WITNESS his hand this l 0 day of -Bp r~ I ,fi' 200.1 (Signature) Gary F. Hagen 4811 Beach Landing Court Virginia Beach, VA 23455 (Address) eft; ~gnatu~~ 1ft( $mc~ Lct-hd(;Jj C-J V it 'i? e~c:, h. ,v A:. ~J 'I !>T (Address) .5:s1f= J1t ~tf~ ~3 Lf ~ 7 (Signature) (Address) This is to certify that the information here given is correctly copied from an original ce_rrificate of death du!~ tlled with me as Local Registrar. The original certitlcate will be forwarded to the State Vital Records Office for permanent hllllg. WARNING: It is illegal to duplicate this copy by photostat or photograph. No. /_-"ti/iiljfii;;;~ /.I\,iiiIZ~\1~JF ef:i~ I,~i~j/ ~~~\. :~~~I ~~. \~~ if:fEr ..~ .' . \~~ \~ ~\," ,-{:~ ;,h~ \\ * ':\.. ..~- '.- ,/ * l \, <:::2 -..... , %. ~' /S;:-)' \""- -.,,;; ~ /t~\\~ V-'.. .., IT !~I-__. ..J (. ~'\; ,,-, ~~':':/IHENI \\\'I~I~I!.!-' ~~ ,/"J .-,',;'.,F'i // (~:.t'l{>~If./' ./ ( ;':>;~';;'-~-!:i..~,,"';-:<-~;'~:L..-. Local Registrar (f Fee for this certificate, S2.00 P 7178578 '0'1/" ;.{ 1;3 2001 Date 14JRev 21B7 COMMONWEALTH OF PENNSVLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH 5. 72 v~ COUNTY OF DERH .. {Jvmb~l'!and DECEDENT'S USUAL OCCUAVION (~':o.~lii~:i..~ ~:zt:'f 11&. Nav 111t. Nav DECEDENT'S t.WlING ADORESS (SIrlllll. C.-,ITOwn. SlaIe. Z., Codel 218 fox VJt.ive. Mechan.ic~bUJtg,PA 17050 UNDER I 0l1li - BlRTtiI'l.ACE (Coly ~r-<l Stale or fcreogn Counuy) STATE fILE NUM8ER :~Xff)~LE :~IAVECUR:NUMjg _ J 96-< :~TeOF3~'g::;oo I PUlCE OF oe.....H fCt>eck OPIy <lI'e -- __ ,nSlruc'.ons on othel _I HOSPITAL: ~.. OTHER: I~I~ e~..... 0 OOAD _E 0 ~CeDENT OF. HIS"".NIC ORIGIN? No ..... 0 "yee. opecIfy Cuben. XlCafl. Puerto Rocan, lICe t. ~nce 0 :=.-,)0 1. AGE (La51 B<<1!\Oay) esT n EJt.ie,PA RACE. _ ......n. 8lack, Wh~.. etc:. (SpectIy) Wh.ite 10. 17b. Coun Did ~ Min. Cu.mbeJtiand -....? 17d.0 ~-==':::OI Mechan.ic~bUJtg UOTHER'S NAME iF.... "'oddle. Malden Surname) MARITAL STATUS - Mamad N..... "'."'.lI. Wocmw.cI. ~(Speclly) 14. Ma.JtJt.ied 17e.0 _.~liwcIin I 'SURVIVING SPOUSE I" ...... ~ __ name) WM DECEDENT EVER IN U S. ARMEO FORCES? .....~NoO Ju.d.ith Ana~:t.a.dt 17.. 51a.. ,.:. eilyltM LICENSE NUMBER 221t. To lhe Ileal 01 my knowledga. death occurred althe I..... data and plac. Sl~ted (Sognalur. and Tille) 9 1 R F {] If 1)11 j UD _ PlACE OF DISPOSITION. Nwna 01 C_ary, Cr.matory Of 01_ Place CJt emat.io n Soc.iety 2tc. 0 P A CJtematoJttj NAME AND AOORESS OF FAClUTY Ha.JtJt.i~bu.JtQtPA 17109 22e. ---.L"1JVU A.'I"Inv I:If\MTI!TY 011' PENNBtLVAmA LIC 4100 JONESTOWN . ~:"'l 23b. R N /I~ltJBA PA 21!:08,41~r~A WJ.S CASE REFERRED TO MEDICAl EXAMINERICORONER? Va IRf' 8 L~ool 24. "'. 25. 27. PART I: EnI.r the diseases. inlur_ Of complocallona which C41used the death 00 not anl.r the mode of dying. such a. ca,di~c or respiratory arrast. shock or heart failur. Li8l 0IItt one causa on ..ch_. U)ool NoD M'r'rA&.'n.r'nr K L{ DUE 10 (OR AS A CONSEOUENCE Of): 21. I Approximat. I inletvaI_n : 0_ and daalll I I I PART H: 0Iflar sigrlillcanl condIIiona c:onIfiJuIing 10 death. but _.....ing in the uncIaflying _ g;.... in PART I. I : DUE 10 (OR AS A CONSEOUENCE Of): DUE 10 (OR AS A CONSEOUENCE OF): WERE AUlOPSY FlNOlNGS _ll.A8l.E PAlOR TO COMPLETION OF CAUSE OF DERH? MANNER OF DE.....H DATE OF INJuRV (MOflIll. Day. -.-.ar) TIME OF INJURY INJURV ..... WORK? DESCRIBE HOW INJURY OCCURRED. _0 No~ Nalural ;:3.. Aa:lde... D Suicide 0 HomICide Pending In..allllalion ..... 0 NoD Ves 0 .... Could noI be delarmoned ... 210. CERTIFIER tCheck OOy onel "CERTIFYING PHYSICIAN (Physoan cerblyong cause 01 dea.h when anolher phvs.c,an has pronounced dealh ana completed lIern 23) To ... _ 01 "'y knowledge. de.th occunad _10 ... c.u...(a).nd m.nna' .. al.ted. . . . . . . . . . . . . . . . . . . a. :ii :.~ . ..~~ .PRONOUNCING AND CERTIFYING PHYSICIAN (Physocoan botl1 ;).onoune,,,,,, Oe~lh and eer1IIY"'llIO c~u... of de~lh\ To'" _ ol"'y knowlaO;". dealll occurred al'" _. del.. and plac.. and dua \0 the cauN(aland mann., aa lIaled 'MEDICAl EXAMINER/CORONER On Ilia baal. of e..mination andJOIlnve.Ugation. in my opinion, de.lh occurred .t th. 11m., dale, and place..nd due to th. cau..(a) and m.nne, .. atated.. . . . . . . . . . . . . . . . . . . . . . . . . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31.. ~ --l . REGI _ 'SSIGNATU~~ 33 ~__ o .(Jl/~/.( I \ ,~ ~, \i i .~ ~ .j N ,~r:; u -\\. \ , ' . " t ~ 21-01-435 LAST WILL AND TESTAMENT OF FORREST C. HAGEN \J I, FORREST C. HAGEN, of Mechanicsburg, Cumberland County, Pennsylvania, make, publish and declare this as and for my Last will and Testament, hereby revoking all other wills and Codicils heretofore made by me. FIRST: I give and bequeath all of my household and personal effects, along with all other tangible personal property of like nature excepting and excluding therefrom, however, all cash, bank accounts of whatever nature and whatever type, securities and all other intangible personal property, together with any existing insurance policies thereon, to my children, NANCY S. YOUNG, GARY F. HAGEN, and STEVEN W. HAGEN, in such shares or by such items as they may agree, or if they are unable to agree, then in such shares or by such items of approximately equal value as they may select by lot. SECOND: I devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate, including any property over which I hold power of appointment and together with any insurance policies thereon, in equal shares, to my children, NANCY S. YOUNG, GARY F. HAGEN, and STEVEN w. HAGEN, provided that should any of my children predecease me, I give and bequeath such child's share unto his or her issue per stirpes by representation, and if there by a failure of same, then I give and bequeath such deceased child's share to my surviving children as provided herein. THIRD: In addition to all powers granted to them by law and by other provisions of this Will, I give the fiduciaries acting hereunder the following powers, applicable to all proper- ~ '4 \J ~.~ ~ ~ ,\ r \~ J ~ ty, exercisable without court approval and effective until actual distribution of all property: (A) To sell at public or private sale, or to lease, for any period of time, any real or personal property and to give options for sales, exchanges or leases, for such prices and upon such terms (including credit, with or without security) or conditions as are deemed proper. This includes the power to give legally sufficient instruments for transfer of the property and to receive the proceeds of any disposition of it. (B) To partition, subdivide, or improve real estate and to enter into agreements concerning the partition, subdivi- sion, improvement, zoning or management of real estate and to impose or extinguish restrictions on real estate. (C) To compromise any claim or controversy and to abandon any property which is of little or no value. '~ (D) To invest in all forms of property, including stocks, common trust funds and mortgage investment funds, without restriction to investments authorized for Pennsylvania fiduci- aries, as are deemed proper, without regard to any principle of diversification, risk or productivity. (E) To exercise any option, right or privilege granted in insurance policies or in other investments. (F) To exercise any election or privilege given by the Federal and other tax laws, including, but not necessarily being limited to, personal income, gift and estate or inheritance tax laws. (G) To make distributions to my herein named benefici- aries in cash or in kind or partly in each. (H) To borrow money from themselves or others in order to pay debts, taxes, or estate or trust administration expenses, to protect or improve any property held under my will, and for investment purposes. 2 (I) To select a mode of payment under any qualified retirement plan (pension plan, profit sharing plan, employee stock ownership plan, or any other type of qualified plan) to the extent the plan or the law permits them to do so, and to exercise any other rights which they may have under the plan, in whatever manner they consider advisable. FOURTH: I direct that all inheritance, estate, trans- fer, succession and death taxes, of any kind whatsoever, which may be payable by reason of my death, whether or not with respect to property passing under this will, shall be paid out of the principal of my residuary estate. FIFTH: All interests hereunder, whether principal or income, which are undistributed and in the possession of the fiduciaries acting hereunder, even though vested or distribut- able, shall not be subject to attachment, execution or sequestra- tion for any debt, contract, obligation or liability of any beneficiary, and furthermore, shall not be subject to pledge, assignment, conveyance or anticipation. SIXTH: I nominate and appoint my children, NANCY S. YOUNG, GARY F. HAGEN, and STEVEN W. HAGEN, as Co-Executors of this, my Last will and Testament. I direct that my Co-Executors, and their successors, shall not be required to post security or a bond for the performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last will and Testament, this J~day of \:::: ~'\.c €- u... 0... f'j ,2 0 0 1 ~~ 70~C /#J-~ FORREST C. HAGEN ( SEAL) 3 , , ' Signed, sealed, published and declared by the above- named Testator as and for his Last Will and Testament in our presence, who, at his request, in his presence and in the presence of each other, have hereunto subscribed our names as Address 2- l S f (:, X D~ ~'l'Q... ~"ec1auies\1u ('3J "? A- 1"1050 Address vi.l AlJ}A fl1.~ ~~l C\..~~ 4 -- t:: CERTIFICATION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent: Forrest C. Hagen Date of Death: March 8, 2001 will No. 2001-00435 Admin. No. To the Register: I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court RUles was served on or mailed to the following beneficiaries of the above-captioned estate on April 5, 2001: Name Address steven W. Hagen 4811 Beach Landing ct Virginia Beach, VA 23455 3200 Lynn Haven Drive #203 Virginia Beach, VA 23451 134 West Siddonsburg Road Dillsburg, PA 17019 Gary F. Hagen Nancy s. Young Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None , Esquire One West Mai street Shiremanstown, PA 17011 (717) 737-8761 Capacity: Personal Representative X Counsel for Personal Representative Date: May 8, 2001 rT f Name of Decedent: CERTIFCATION OF NOTICE UNDER RULE 5.6(A) #-<-b- ~0 t:L Date of Death: 2- ]- 0 2- , Will No.: LOoZ -f) () $I...3S- Admin No.: To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5 .6( a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on Name ~ /;5 -!-I~ Address iZl). f ~'X. ~3? ~fl(~ f..56?? Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: i - z/ -c1 L ~~ Signa re ~ ~ / s -Jl7J-~cL Name .... ... . ~Rb / ..~I( ~Ji 5kd~fX.; ~ /s rt g /' / Address orz L/ 596- z ere; y L Telephone Capacity: G1>ersonal Representative o Counsel for personal representative \, /.t ~~/?_ / BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT * RE~-1'07 EX AFP (12-00) Reco(( L~; Ref]; f -::If DATE ESTATE OF QATE OF DEATH FILE NUMBER COUNTY ACN 12-03-2001 HAGEN 03-08-2001 21 01-0435 CUMBERLAND 101 FORREST C NANCY S YOUNG 134 W SIDDONSBURG RD DILLSBURG te~rl7'019 ClunbB: .01 ole 17 Pl2 :02 Allount Rellitted !\j(t ......... j PA MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, subllit th~ upper portion of this forll with your tax paYllent. I i*~=i~~-j~E~t!~~Pl:fi~:OOl--~--..~~f~~-~Ri~-~~~;f~~I_t~J~~E~f~~/!~~-~6g*f--~------------------ --- ESTATE OF HAGEN FORREST C FILE NO.21 01-0435 ACN 101 DATE 12-03-2001 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 11-05-2001 P R I NC I PAL TAX DU E : ........................................................................................................................................................................................................................... 11,091.37 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 06-07-2001 AA496695 554.57 10,687.50 11-14-2001 REFUND .00 150.70- TOTAL TAX CREDIT 11,091.37 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 ., IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRl, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. l JJ 0 m )> ~ ni )> 0 ~ -n (f) ~:- ~ '., )> (-~ C'! t' \-i :: CEiI - r::~ ~ !:.J ~-< '" .- :.;t. !':" C .: t~l \._ ..;; \"" .~ JJ m o m <: <:m <:' T-, 0 .~~, ~~.. " . ~\. 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No.: Il/A- Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes Kl No 0 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes _ No .f1 b. The separate Orphans' Court No. (if any) for the personal representative's accountis:~ff c. Did the personal representative state an account informally to the parties in interest? Yes 0 No [i2 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court . . and ~ay be attached to this report. ,0 /!{ Date: lj-fCl-d.o2(3 ~~ J-.. ~rf Signature I ;J/I/ltf ~r >6(/(/ Name, / /134 .;J, &ddo/A.rb~1! Id Address .i1 ,C\ I/u-bt/Ilc;~ 111 ~ i JulY,' IJI J 7i J - 697--3sr r Telephone No. ~~~ .~~~ Capacity: K1 Personal Representative o Counsel for personal representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. za0601 r.~RRISBURG, PA 171Z8-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT 1 ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE ESTATE OF DATE OF DEATH FILE ~UMBER COUNTY ACN 11-05-2001 HAGEN 03-08-2001 21 01-0435 CUMBERLAND 101 Allount Ra..ittad NANCY S YOUNG 134 W SIDDONSBURG RD DILLSBURG PA 17019 * IEV-lS47 EX if' (11-ln FORREST C CHANGED (1) (2) (3) ('I) (S) (6) (7) .00 .00 .00 .00 253,154.95 .00 .00 (8) MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTiON FOR YOUR RECORDS ~ iffv=is4",-ix-AFP-fi'2-:oo1--NoTICE--OF-'rtiHiifITANci-TAitA-PPRA-isEi'-ENT~--ALrOWAiici-crR------------ - - --- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF HAGEN FORREST C FILE NO. 21 01-0435 ACN 101 DATE 11-05-2001 TAX RETURN WAS: (X) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Ra.l Estata (Schadula A) 2. Stocks and Bonds (Schadule B) 3. Closely Held stock/Partnarship Intarest (Schedule C) 4. Mortgages/Notas Raceivable (Schedule D) S. Cash/Bank Daposits/Hisc. Personal Property (Schedule E) 6. JointlY Owned Property (Schadule F) 7. Transfers (Schedule G) 8. Total Assats APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) 10. Debts/Hortgage Liabilities/Lians (Schedula I) 11. Total Daductions 12. Net Value of Tax Return 13. Charitable/Govarnllantal Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Valua of Estata Subject to Tax NOT~: I~ an asseSS.Sht was iS5ued previOUSly, lines r8~lect ~igures that include the total o~ abb ASSESSMENT OF TAX: 15. A.ount of Line 14 at Spousal rate (IS) 16. ~unt of Line 14 taxable at Lineal/Class A rate (16) 17. ~t of Line 14 at Sibling rate (17) 18. ~unt of Line 14 texable at Collateral/Class B rate (18) 19. Principal Tax Due S (+ INTEREST/PEN PAID (-) 554.57 DATE 06-07-2001 NUMBER AA496695 5/355.00 1.325.00 (II) (12) (13) (14) (9) nO) NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. 253/154.95 6.680 00 246/474.95 .00 246/474.95 l~, is and/or 16, 17, 18 ana 19 will returns assessed to date. .00 x 00 = 246/474.95 x 045 = .00 x 12 = .00 X 15 = (19)= AMOUNT PAID 10/687.50 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE .00 11/091.37 .00 .00 11/091.37 111242.07 150.70CR .00 150.70CR . IF PAID AFTER DATE INDICATED 1 SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( If TOTAL DUE IS LESS THAN $11 NO PAYMENT IS REQUIRED. If TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REfUND. SEE REVERSE SIDE OF THIS fOR" FOR INSTRUCTIONS.) RESERVATION: Estates of decedents dying on or before Dec.-ber 12, 1982 -- if any future interest in tile estate is transferred in possession or enjoy.ent to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Co..onwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: To fulfill the require.ants of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (12 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and sub.it with your pay.ent to the Register of Wills printed on the reverse side. --Make check or .oney order payable to: REGISTER OF MILLS, AGENT REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, .ay be requested by co.pleting an "Application for Refund of PennSYlvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of WillS, any of the 23 Revenue District Offices, or by calling the special 24-hour answering service for for.s ordering: 1-800-362-2050; services for taxpayers with special hearing and I or speeking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraise.ent, allowance, or disallowance of deductions, or asses~ent of tax (including discount or interest) as shown on this Notice .ust objpct within sixty (60) days of receipt of this Notice by: --written protest to the PA Depart.ent of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --election to have the .atter deter.ined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessaent should be addressed in writing to: PA Depart.ent of Revenue, Bureau of Individual Taxes, ATTN: Post Assess.ent Review Unit, Dept. 280601, Harrisburg, PA 17128-0601 Phone (717) 781-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1S01) for an explanation of ad.inistrativelY correctable errors. DISCOUNT: If any tax due Is paid within three (3) calendar .onths after the decedent's death, a five percent (Sr.) discount of the tax paid Is allowed. PENALrv: The 15~ tax a~esty non-participation panalty is co~uted on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax ..nesty period. This non-participation penalty is appealable in the sa.e .anner and in the the sa.e ti.e period as you would appeal the tax and interest that has been BSS8ssed as indIcated on this notice. INTEREST: Interest is charged beginning with first day. of delinquency, or nine (9) .onths and one (1) day fro. the date of death, to the date of pay.ent. Taxes which beca.e delinquent before January 1, 1982 bear interest at the rate of six (6~) percent per annu. calculated at B dailY rate of .000164. All taxes which beca.e delinquent on and after January 1, 1982 will bear interest at a rate which will vary fro. calendar year to calendar year with that rate announced by the PA Depart.ent of Revenue. The applicable interest rates for 1982 through 2001 are: Year Interest Rate Daily Interest Factor Vear Interest Rate Daily Interest Factor 1982 20;( .000548 1992 9;( .000247 1983 16;( .000438 1993-1994 n .000192 1984 11Z .000301 1995-1998 9;( .000247 1985 13r. .000356 1999 1Z .000192 1986 10;( .000274 2000 8Z .000219 1981 9Z .000247 2001 9;( .000247 1988-1991 11r. .000301 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any NotIce Issued after the tax baco.es delInquent will reflect an interest calculation to fifteen (15) days beyond the date of the assess.ent. If pay.ant is .ade after the interest co.putation date shown on the Notice, additional inter.st .ust b8 calculated. RE'o'1SOOEX(6-001 I!! "~r:! u..u Woo :c"'... U.... .. .. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY /6 - a~ ~- I FILE NUMBER ~L-tLL COUNTY CODE YEAR c.. I- Z w Q w o w Q DECEDENT'S NAME (LAST, FIRST. AND MIDDLE INITIAL) r res r e, DATE OF BIRTH (MM-DD-YEARI /0 -,;2.-0 - 02--7 ST. AND MIODLE INITIAL) ~ ,/ (/c;t;.j( DATE OF r"t/ JH (MM-DD- YEAR) 'I 3 s- - NUMBER - - SOCIAL SECURITY NUMBER ;2..0 I I !' /9'-2- THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS . SOCIMTY NUMBER 2. Supplemental Return o 4a. Future Interest Compromise (date of death after 12-12-82) o 7. Decedent Maintained a Living Trust (AlIaclliXlpyofTrust) o 10. SpoU~'1 Poverty Credit (dale ofdealh between 12.31-91 and 1-1-95) o 3. Remainder Return (da18otdealhpriaIo12.13-82) o 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (AtIacIl ScIl 0) 03 -0 g- 0 ( (IF APPLICABLE) SURVIVING SPi~E!;l,. (LAST, F ~ Original Retum o 4. Limited Estate o 6. Decedent Died Testate (AllacIlcopyotW~; o 9. Litigation Proceeds Received I- Z W o ~ .. w '" '" o u 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) COMPLETE MAILING ADDRESS I')~ w. ~/ctd'711f6VVf ~. /) ;'II~ 61/Ylt ~ / 70/'1 3. Closely Held Corporation, Partnership or Sole-Proprietorship TELEPHONE NUMBER 7/ 7 _ ~ Cf 7 - 3 S () 0 (1) -0- (2) 0 - (3) 0- (4) - 0- (5) ,;253. IS-'/. 95" , 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (ScI1edule E) 6. Jointiy Owned Property (Schedule F) D Separate Billing Requested 7. Inter~VIVOS Transfers & Miscellaneous Non-Probate Property (ScI1edule G or L) 6. Total Gross _ (total Unes 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been made (ScI1edule J) z o ~ :l l- ii: c( o w a:: 14. Net Value Subject to Tax (Line 12 minus Line 13) (6) 0- (7) -0- OFFICIAL USE ONLY (8) ;253,15'(. 9S- (9) (10) S,3SS".(J() I 3 :2.5,00 . SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ ... :l a.. :E o o ~ 15. Amount of Line 14 taxable at the spousal tax rate, Of transfer> under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at ~neal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax,. 20. IS2fI ;2.. 'I (;. '/7 t(. Ii S- , (11) 0/ '80. CJ 0 (12) ';''1(" ~7<!, '!s , (13) -0 - (14) ';/''1'/ ~7<(. '1S , x.O_ (15) x .0 '12.. (16) /~, 0 9/, 37 x .12 (17) x .15 (16) (19) II. (HI. 37 I >BE CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT CREe M.6; '-':1'-' AN Decedent's Complete Address: STREET ADDRESS ;2. I g Fo )( 01". CG-/'O.A/I cs" Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount CITY (1) /0 '87. SO '~~I/. S"" Total Credits (A+ 8 + C) (2) 3. InteresUPenalty if applicabie D. Interest E. Penalty (3) (4)' (5) (SA) TotallnteresUPenalty (0 + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the.<;lifference. This is the OVERPAYMENT. Check box on Page 1 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. ZIP 170SS- 1/,091. J 7 , II. 242.0~ , '.':;0, M .MI.' , f A. Enter the interest on the tax due. 8. Enter the total of Line 5 + 5A. This is the 8ALANCE DUE. (58) 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 a. retain the use or income of the property transferred;.......................................................................................... 0 b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 c. retain a reversionary interest; cr..m....n............................................................................................................... 0 d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 2. If death occurred after December 12, 1962, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 3. Did decedent own an 'in trust fo~ or payable upon death bank account or security at his or her death? .............. 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .......,................................................................................................................ D .l(j IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. No ~ ~ Under penalties of pe~ury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNAT RE OF PERSON RESPONSIBLE F ADDRESS ":.> For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. 99116 (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% [72 P.S. 99116 (aJ (1.1) (ii)]. The slaMe does not exemot 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 Juiy 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 99116(a)(1.2)). The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)). The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116(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. ~'''"','I'," '*' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RE IDENT DECEDENT ESTATEOF Fa I /1 rrC5r (...-. SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY I~e"'/ FILE NUMBER Indude the proceeds of litigation and the date the proceeds were rece~ed by the estate. All property jolntly-owned _ the right of IUlVivorshlp mUll be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. DrovCff's 8a./Vk C e-v- J. cI r:: O~~051+ #/2303'1 #12303'i5' :3 ,t " :# /23 I' 7 1 ~ ;2/7.$.8 It. / '18': 2./J / 02'1 ()~/. <II / 2. II N '( f1/I ell16erJ .ts~ ~4VI"'7 ) :Ii I' t '/3 g-tJ(j '-(s. ~ r s " 1:1 /6 ~ c..(JfJ- oS ,;20, <('1~' s 7 " " WOor /00..11- &.A/k.. Cert 4-F- V-e--toJ1).. #S(,/Ja, Ufo 13t~3/.70 ~, 9/(J.'i(' fJN L 8(;"/K ct~k.J~? :ti s (q' () VIS 2 '1S 7 7 gl(.o 2- Cerr d OC/,H if #: 'J / () 0 01 ~ 23 , 2.- III S- I' S" 37().8'1 II :If 3' <{1J0/8'9737 / Cj I' I I c'1 0 ~ 3. 12- jJ- J /2 00 198'/ 3g (/ II to 5 8'fS, '1'1 ,tJdNeI 5 1 II (/. S. SaVill?, S 1.2 (/ WI e. s~ Dive B~~dJ &.1'11<: 'it 1,10,(/0 TOTAL (Also enter 00 lineS, Recapitulation) $.253,' s<..(. 'IS (If more space IS needed, insert additional sheets of the same sIZe) REV'.1513 EX+ 19'00*, COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDIULE J BENEFICiARIES FILE NUMBER ESTATEOF fOrrcsl- C. I~e;r/ NUMBER I RELATIONSHIP TO DECEDENT NAME AND ADDRESS OF PERSON(S) RECEIVING PROPE"rY Do Not List Trustee(s) TAXABLE O1STRIBUTIONS {include outright spousal distributions, and ":7'3.nsfers under Sec. 9116 (')11.2)] AMOUNT OR SHARE OF ESTATE 1. Y3 tJo..A1c.'-{ S. YtJtJN'f Duv'14+er I!J<.{ (JJ. sicA.JOVI1'bV7tf ttd Dd(561J? f'.t f701'i G-o.""'1 ~, I.f....., eJ'l ~ 0 AJ l{ is 1/ B e.ac. 4. Lov.u,lj C -I- . V t\. Gou.""-. I II q. ;L3l(SS- Y3 :J.. 3 s+eo="/ W. l~cll1 S D N C(6 JdkrJ '{)D("Ct-V 121 (}__e.-.l 1-4-i{( 0 ('. Va... ~~, I/o.. .;21VSi{ Y3 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE::)N LINES IS THROUGH 16. AS APPROPRIATE, ON REV.1500 COVER SHEET n NON.TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICf" 4N ELECTION TO TAX IS NOT BEING MADE ,. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS I. TOTAL OF PART n - ENTER TOTAL NON.TAXABLE DISTRIBUTIONS ON LINE 13 OF REV.1500 COVER SHEET $ (If more space is needed, insen 3I1ditional sheets of the same size) REIJ-1511 EX. (12-99) l' . ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF t; rrC5 f t:.. //af~ Debts of decedent must be reported on Schedule I. FILE NUMBER ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1- {toj eN i oSO.oo ~ vd.y A- I B. ADMINISTRATIVE COSTS: 1- Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State _ Zip Year(s) Commission Paid: 2. Attorney Fees j ow... <.~ B O'i" r 3 990. ao I 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State _Zip Relationship of Claimant to Decedent 4. Probate Fees c,l1i/o1.bw-!r...-) 6:>v;.l+ y 6, </IrIs 31.$".00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ 5,3S5.00 (If more space is needed, insert additional sheets of the same size) REV.1512 E)(o [1.$7) . SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ~?c-.d . FILE NUMBER COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF L '- (llrrcsr c. Include unreimbursed medical expenses. ITEM NUMBER 1. P tAl All{ cl e I-\-co.l R DESCRIPTION I-i<>spr-t-...l AMOUNT I 32S. CO I TOTAL (Also enter on line 10, Recapitulation) $ /, 3,;1..5,00 (If more space is needed, insert additional sheets of the same size) . COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG, PA 17128-0601 '* No.AA 4 9 6 6 9 5 REV-l162 EX (11-96) PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT RECEIVED FROM: r BOGAR JAMES D 1 W MAIN STREET SHIREMANSTOWN, PA 17011 .- ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $10,687.50 -- FOlD HERE FOLD HERE -- ESTATE INFORMATION:l FILE NU~rER -2001-0435 SSN 201-18-1962 NAME OF ~G<tDENT ~LAS& (FIRST) (MI) H N FO RE T C DATE OF PAYM~T 6/0 /2001 POSTMARK DATE 6/07/2001 COUNTY CUMBERLAND DATE OF DEATH 3/08/2001 , uu,~"' REMARKS C/O JAMES D BOGER ESQUIRE CHECK# 1 SEAL TAXPAYER ...."." $10,687.50 TOTAL AMOUNT PAID RECEIVED BY MAR REGISTE ~