The URL can be used to link to this page

Home My WebLink About02-21-07 -.J 15056051058 REV-1500 EX (06-05) PA Department of Revenue '* Bureau of Individual Taxes . PO BOX 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year File Number INHERITANCE TAX RETURN RESIDENT DECEDENT ;{( a~ 9crr Date of Birth 177 -24-9516 11/03/2005 05/07/1931 Decedent's Last Name Suffix Decedent's First Name MI EBOCH JR JOSEPH o (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI EBOCH MARTHA 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) 5. Federal Estate Tax Return Required 4. Limited Estate 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) 8. Total Number of Safe Deposit Boxes . 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 11. Election to tax under Sec. 9113(A) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Day1ime Telephone Number MARTH EBOCH (717) 737 -~t42 Firm Name (If Applicable) -~-~ '} .,.~'-'~ REGISTER'Q';:"WU-l-S US~~NLY ,-'- ( ,- -.. N First line of address 1510 WALNUT ST. \-0 Second line of address .r::- C:::J City or Post Office State ZIP Code DATE FILED CAMP HILL PA 17011 Correspondent's e-mail address: Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. ~ATURE OF PERSON RESP~SI~LE FOR FILING RETURN DATE ) / J 2'1 I lJ6 ~.zkcy --5.:4CJ;v . I 10 WALNUT ST., CAMP HILL, PA 17011 . H~.AENTATIVE __ D;IJsI~_____ A RESS 1704 LINCOLN ST., CAMP HILL, PA 17011 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051058 15056051058 --.J --.J 15056052059 REV-1500 EX Decedent's Name: JOSEPH D EBOCH, JR RECAPITULATION 1. Real estate (Schedule A). 2. Stocks and Bonds (Schedule B) . . 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) . . 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). . . . . . . . . . . . . . . . . . 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . .. 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). . . . . . . . . . . . . . . . 10. 11. Total Deductions (total Lines 9 & 10). . . . . . . . . . . . . . . . . . . . . . . . . . ......11. 12. Net Value of Estate (Line 8 minus Line 11) . . . .. . . . .. .. . . . . . . . . . .... . 12. 13. Charitable and Governmental Bequests/See 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. 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.0~ 113,281.38 16. Amount of Line 14 taxable at lineal rate X.O_ 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X. 15 15. 16. 17. 18. 19. TAX DUE. . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 L 177 -24-9516 Decedent's Social Security Number 1. 2. 5. 8. 0.00 8,758.23 0.00 0.00 8,454.71 0.00 115,964.60 133,177.54 15,255.00 4,641.16 19,896.16 113,281.38 113,281.38 0.00 0.00 15056052059 -.J REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME JOSEPH 0 EBOCH STREET ADDRESS 1510 WALNUT ST. File Number DECEDENT'S SOCIAL SECURITY NUMBER 177-24-9516 ---- .-- 1 STATE PA .--------- -~rl ZIP 17011 CITY CAMP HILL Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 0.00 Total Credits ( A + 8 + C ) (2) 3. InteresUPenalty if applicable D. Interest E. Penalty Total Interest/Penally ( 0 + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. 0.00 (5) (5A) (58) A. Enter the interest on the tax due. 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. 0.00 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; or.......................................................................................................................... 0 d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 3. Did decedent own an "in trust for" 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 t. b f" d' t'? 'Kl con alns a ene IClary eSlgna Ion. ........................................................................................................................ ~ No ~ [iJ [i] [i] [iJ [iJ o 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 January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [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 zero (0) percent [72 P.S. 99116 (a) (1.1) (ii)]. The statute 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 July 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 zero (0) percent [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 four and one-half (4.5) percent, 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 twelve (12) percent [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. REV-1502 EX+ (6-98) SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JOSEPH D. EBOCH, JR FILE NUMBER 2105-0998 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. NONE DESCRIPTION VALUE AT DATE OF DEATH TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0.00 REV-1503 EX+ (6-98) r, SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JOSEPH D. EBOCH, JR FILE NUMBER 2105-0998 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 5 AT&T COMMON, CUSIP 1957505, 72 SHARES@ 22.42 MARKET AVAYA COMMON, CUSIP 53499109, 24 SHARES@ 11.21 MARKET VERIZON COMMON, CUSIP 77853109,119 SHARES@28.32 MARKET COMCAST COMMON, CUSIP 20030N101, 22 SHARES@27.36 MARKET LUCENT COMMON, CUSIP 549463107,60 SHARES @2.78 MARKET PRUDENTIAL FINANCIAL COMMON, CUSIP 744320102,37 SHARES@ 73.95 MARKET 1,614.24 2 269.04 3 3,370.08 4 601 .92 166.80 6 2,736.15 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 8.758.23 REV-1504 EX+ (6-98) SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JOSEPH D. EBOCH, JR FILE NUMBER 2105-0998 Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM NUMBER NUMBER 1. NONE DESCRIPTION VALUE AT DATE OF DEATH -- TOTAL (Also enter on line 3, Recapitulation) $ 0.00 (If more space is needed, insert additional sheets of the same size) REV-1507 EX+ (6-98) SCHEDULE D MORTGAGES & NOTES RECEIVABLE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JOSEPH D. EBOCH, JR FILE NUMBER 21 05-0998 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH NONE TOTAL (Also enter on line 4, Recapitulation) $ 0.00 (If more space is needed. insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH1 BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF JOSEPH D. EBOCH, JR FILE NUMBER 2105-0998 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH BELCO CHECKING, 186310-84 2,249.06 105.65 2 BELCO SAVINGS, 186310-S1 3 1986 SUBARU JUSTY, AUTOMOBILE 4 1998 NISSAN PATHFINDER, AUTOMOBILE 5 MISC HOUSHOLD GOODS AND PERSONAL EFFECTS 100.00 3,000.00 3,00000 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 8,454.71 REV-1509 EX+ (6-98) SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JOSEPH D. EBOCH, JR FILE NUMBER 21 05-0998 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. NONE B. C. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECDS VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE VALUE OF ASSET INTEREST DECEDENTS INTEREST 1. A. TOTAL (Also enter on line 6, Recapitulation) $ 0.00 (If more space is needed, insert additional sheets of the same size) REV-1510 EX+ (6-98) 9',f.tL:o ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF JOSEPH D. EBOCH, JR FILE NUMBER 2105-0998 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1. PENN MUTUAL IRA, 005705097 18,44492 100 18,444.92 2 BELCO VARIABLE RATE IRA, 044940-85 44,463.32 100 44,463.32 3 BELCO FIXED IRA, 044940-L5 53,056.36 100 53,056.36 TOTAL (Also enter on line 7 Recapitulation) $ 115,96460 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99)W COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF JOSEPH D. EBOCH, JR FILE NUMBER 2105-0998 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: FUNERAL HOME CEMETERY PLOT 6,15500 7,600.00 2 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 1,000.00 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 5. Accountant's Fees 500.00 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ 15,255.00 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+(12-03) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF JOSEPH D. EBOCH, JR FILE NUMBER 2105-0998 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. VISA REVOLVING CHARGE ACCOUNT 3,000.00 2 PRUDENTIAL LIFE INSURANCE LOAN 1,641.16 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 4,64116 REV-1513 EX+ (9-00) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF JOSEPH D. EBOCH, JR FILE NUMBER 2105-0998 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE t TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 MARTH EBOCH, SPOUSE 113281.38 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT I, JOSEPH D. EBOCH, JR., a resident of the Borough of Camp Hill, Cumberland County, Pennsylvania, being of sound mind, memory, and understanding, do make and publish ttis as and for my Last Will and Testament, hereby revoking and mald.ng null and voldllny and a'll"'W'I'fIs arid Testamlnts or writings 1n the nature tbereof by me at any time here- tof ore ma de . First: I direct that my enforceable debts and all charges against and expenses of my Estate and all inheritance taxes owing as a result of the dispos i tion of my Estate under this Will be paid out of my gross Estate as soon as possible. Second: I give, devise, and bequeath to my beloved wife, r'Iartba, Estate, both tangible and inta.rigibl real, or mixed. Third: If my wife, Martha, sha.ll die in a common disaster or otherwise simultaneously with me or under &D'J circumstances as to render it difficult or imp08~ttt. ~o determine who predeceased the other, I direct'.'l...l be deemed to have survived my wite and tb.tt_),~.l- of this, my Last Will andTestaaent.sbal::iJ.11"'-.'R.eCl upon that assumption, notwithstlUldluc u..~.t.f_. of any law establishing a different presumption of order of death or providing for survivorship for a fixed period as a condition for inheritance of property. {""" l_i C f . Fourth: Should my wife, Hartha, predecease me, I give and bequeath to my sons, Joseph D. Eboch, III, and James Patrick Eboch, my guns an.d all other bunting equipment, to be divided between them, per capita, as tbey see fit. Fifth: I specifically give and bequeath to my daughters, Mary Jo Ebocb and Susan Kay Eboch, all the jewelry and silverware that belonged to my wife -- their mother --, to be divided between them, per ca.pita, as they see fit. Sixth: I specifically give and bequeath unto all of my children all my books in my personal library and all my photograpbic equipment and photographs, to be divided between them, per capita, as they see fit. Seventh: All the rest, residue, and remainder of my Estate I give, devise, and bequeath to my children to be divided equally among them, per stirpes. Eighth: I appoint my father, Joseph D. Ebocb, Sr. (308 Mulberry Street, Hollidaysburg, Pennsylvania), or, should he predecease me or is unwilling or unable to serve, then my wife, Martha, as Executor or Executrix of this my Last Will and Testament, tbey to serve witbout bond. IN WITNESS WHEREOF, I, Joseph D. Ebocb, Jr., the Testator, bave to this my Last Will and Testament, set my hand and seal this:?-/tit.l day of April, One Thousand Nine Hundred and Sixty-eight (1968). ;....'.~:iI~""'''~- Signed, sealed, published, and declared by the above- named Testator as and for his Last Will and Testament, typewritten in three pages, in our presence, who, in his presence, at his request, and in the presenee of each other, have hereunto subscribed our names as attesting witnesses: (:htrUf' {('vb Mfu t ;/ / , residing at .fL.Q.,~\ On 4~Y\. ) \h , ! ! / ""'" r ',:' "1 ,/1,-, // /;>. ~/'''i/. if" . ~~!'. / ""j ",// "'_jL/ , residing at .. ) ~~., i ';; '7- ': L' fi i ' /l/-. ,. _ 1 . . 1_//--'/ j i t, /I " ./-'/ !/ ,! Ct, . i I! ()"i.90')MS REV.(5-05) This is to certify that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Records III accordance with Act 66, P.L. 304, approved by the General Assembly, June 29, 1953. WARNING: It is illegal to duplicate this copy by photostat or photograph. /7 J ~d VC5~ ~II~ No. Charles Hardester State Registrar Calvin B. Johnson, M.D., M.P.H. Secretary of Health 0702528 NOV 3 0 Z005 Date H105.143 Rev. 2/87 COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS CERTIFICATE OF DEATH ST....TE FilE NUMBER TYPEJPRlNT IN PERMANENT BLACK INK dol NAME OF DECEDENT (First, Middle, Last) 1. AGE (Last Birthday) SEX SOCIAL SECURITY NUMBER 5. 74 Yrs COUNTY OF DEATH Cumberland 8b. 2male 3. 177 BIRTHPLACE (City and P F TH h I n State or Foreign Country) HOSPITAL: Camden, NJ "'"'''''R1 7. Ba, FACILITY NAME (If not institution, give street and number) ~\~\ 24 Re.idellCeD ~~) 0 RACE - American Indian, Black, While, et (Specify) . t Whl e '0. DECEDENT'S USUAL OCCUPATION (':':~~~~;.~~ ~~teu~~rir~.:gt MARITAL STATUS - Manied, Never Married, Widowed, Divqrced lSpecify) w.arrled ~IfU~I~~~8~~~~) twp. DATE PRONOUNCED DEAD (Month, Day, Year) 20. \0"::0 a.M. 25. OIfQ.N\'oe., 3 dDO 27. PART I: Enter.... d........ InJurle. or compll~n. which cauMCI the death. Do not .n., the mod. of dying. euch.. CIIrdlac or ....pi~tory .rr..t, .hock or hI.rt f.i1ur.. U., only OM CIIU.. on uc:h line. 17d.JS. ~~:;e~~~:n~Of Camp Hill MOTHER'S NAME (First, Middle, Maiden Surname) '9. Alice Ceredwyn Davis INFORMANT'S MAILING ADDRESS (Street. cityrrown. State, Zip Code) 20b.1510 Walnut St., Cam Hill,PA 17011 PLACE OF DISPOSITION- Name of Cemetery, Cremalory LOCATION - CityfTown, State, Zip Code or Other Place J 7 n 5 5 of Heaven Cern. 2Bchanicsourg,PA NAME AND ADDRESS OF FACILITY Lemovne, PAl 7043 sselman FH&CS,324 Hummel Ave. LICENSE NUMBER DATE SIGNED (Month, Day, Year) 23b. 23c. WAS CASE REFERRED TO A MEDICAL EXAMINER ICORON~ 26, Yes 0 No ~ : Approximate PART H: Other significant conditions contributing to death, but : ~:a~~::,~ not resulting in the underlying cause given in PART I. citylboro. fil II> ::> II> < ::; < Sequentially list conditions { b. if any, leading to immedlate cause. Enter UNDERLYING CAUSE (Disease or Injury c. that initiated events resulting on death) LAST d. WAS AN AUTOPSY WERE AUTOPSY FINDINGS PERFORMED? AVAIlABLE PRIOR TO COMPLETION OF CAUSE OF DEATH? Accident MANNER OF DEATH ~ o o Homicide Pending Investigation Could not be determined DATE OF INJURY (Month, D.y, Ve.r) o o o TIME OF INJURY INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED. Natural Ves 0 No I8l VesO NoD Suicide Ves 0 No 0 30a. 30b. M. 3Oc. PLACE OF INJURY. At home. farm, street, factory, office building, etc. (Specify) 30.. 3.b. LICENSE N 3'0. f! z. <) I '{ () 3.d. NAME AND ADDRESS OF PERSON WHO COM'pLET,.F.D CAUSE OF DEATH (Item 27) Type or Print E<<~ VAP-pl\....::) ( Oe k wf'.'-'--< ~ 1/.;101" .J 32. DATE FILED (Month, Day, Year) 30<. " ! 03/ tJ'J 2Ba. 2Bb. CERTIFIER (Check onty one) .l;~-r:~:tGJ~~~~Jt7~th C:C~~iJ8d~::: g:~'=(:l~~jr;.g~~i~a~.h:t~r:r~~~~~.~~~~~,~~~.~?~~~~~~.~.i~~.~~).,.."..,......... 0 29. .... Z W C w () w C L>- o W ~ Z .p~O~:~I:fm~~;;I':csr:~:.~t~~:'C~: l~~ig:'.~~~~~~.~~:r d~r: ~e~j:~~~(~)~~ ~:~~.r a. .tat.d......,..,.......,.." 0 'MEDICAL EXAMINER/CORONER ~:~:rb::I:.:tf.:~~I.~~~I~..~~.~~~~ .I~~~~~~.~~~~.~: .I.~ .~.~~I.~~~: .~~~.~ .~~.~~.~. ~~~. ~I,~~:. ~.~~:. ~~~.~~~.~~:. ~~~.~~.~~ .t.~~..~~~~~,(.~~.~~.. 0 31a, REGIST b>2J/~/( I PC UPDEGRAFF & RUHL fJl CERTIFIED PUBLIC ACCOUNTANTS 4330 CARLISLE PIKE CAMP HILL, PENNSYLVANIA 17011 (717) 763-8038 FAX: (717) 763-8902 JEFFREY R. UPDEGRAFF, CPA CHARLES R. RUHL, CPA, MBA {i;- KEITH E. FOSTER, CPA Register of Wills Cumberland County Court House Carlisle, PA 17013 November 25, 2006 Re: Estate of Joseph o. Eboch Jr., SSN: 177-24-9516, Non-Filer Delinquency Notification. I am writing on behalf of my client, the Estate of Joseph SSN: 177-24-9516, 000: 11-03-2005, File Number 2105-0998. attached form REV-1500 in satisfaction of the requirement O. Eboch Jr., Please find to file. As you will note upon review of the copy of the will supplied with the return, Mr. Eboch's sole beneficiary is his wife, Martha. As such, no tax is due. Mrs. Martha Eboch was under the mistaken assumption that, with no tax due, a return was not required to be filed. We respectfully request the Court's (and Department of Revenue's) understanding concerning the late submission of this return. Sincerely yours, MR{)~ Charles R. Ruhl, CPA, MBA BIJPEd OF COLLECTIONS & TAXPAYERSERYlCES PO BOX 281041 HARRISBURG PA 17128-1041 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE Inheritance Tax Non-Filer Delinquencv Notification PA 17011 DATE: ESTATE OF: JOSEPH SSN: DATE OF DEATH: FILE NUMBER: REV-834 AFP (12-04) 10/06/2006 MARTHA EBOCH 1510 WALNUT ST CAMP HILL D EBOCH JR 177-24-9516 11-03-2005 2105-0998 A review of Department records has disclosed that you are responsible for the settlement of the above estate, or that you represent the responsible party. The above estate is in a delinquent status. According to Department's records, as of this date, the inheritance tax return has not been filed. The Inheritance and Estate Tax Act mandates the filing of a tax return and payment of all outstanding liabilities by a personal representative of the estate or a transferee within nine months of the decedent's death. If this estate was opened for the purpose of filing a lawsuit, please provide this office in writing with the court term and docket number of the proceeding. The Department may postpone any further action regarding the Estate pending the completion of the lawsuit. If there is any other reason that a return has not been filed, please contact this office. To avoid further action, a return must be filed within 15 days from the date of this letter. If the return has been filed recently, please disregard this notice. Harrisburg Call Center (717) 783-3000 TDD# 1-800-447-3020 (Service for taxpayers with special hearing and/or speaking needs) RETlJRNS SHOULD BE FILED AND PAYMENTS MADE AT THE REGISTER OF WILLS LISTED BELOW: CONTACT: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ~ ~ ~