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Home My WebLink About95-00395 Oath of Personal Representative Commonwealth of Pennsylvania County of lOll!lXJi)lllItXX CUMBERLAND The Petltloner(s) above.named swearls) and afflrmls) that the statements In the foregoing Petition are true and correct to the best of the knowledge and belief of Petltlonerlsl and that. as personal representatlvels) of the Decedent. Petltlonerls) will well and truly administer the estate according to law. Sworn to and affirmed and subscribed before me this ~.2 day of ,%. ff./ #"_- .9//~.,- -t;;. 00 ; ~. ..,J .. r J1 ~:o . .1"'" I' I ';-~ 5::'; "" "I . . DECREE OF REGISTER '.' ;".-' co Estate of Kim M. Hoove r Deceased No. :-o~ "'" ..... (,0' ,..... 21 :.95 - 395 also known as N I A Social Security No: 207-44-5214 Date of Death: May 11. 1995 AND NOW. MAY 23. . 19~.ln consld~ratlon of the Petition on the reverse side hereon. satisfactory proof having been presented before me. IT IS DECREED that Letters []I Testamentary 0 of Administration w.I...II..."I.I'.............._..."..,'...._............,.."..........., are hereby granted to RICHARD HOOVER in the above estate and that the Instrument(s), if any, dated MAY 4. 1992 described In the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Short Certificate(sl....,J.Q.. $ Renunciation.................. $ Affidavit ( )................. $ Extra Pages ( )............ $ Codicil.......................... $ JCP Fee........................ $ Inventory & Tax Forms... $ Other............................ $ 30.00 ((~'(' Letters........................... $ BO .00 "0011111I'0' Will. 12.00 5.00 /~---. Ja~~annebnker YANN~HAK~K ANU JUN~~t P.G. 09667 40\10 Vine Street Middletown, PA 17057 Telephone: 717 944-1333 DATE FILED: 'I /)'//;.'/ . ,/Ill.", ,~.', 1':~., -:X"t"..' attorney on 5_23_95~'iW'5.11::.ij 9J:';;!/-'u- /' - r- Attorney: I.D. No: Address: TOTAL................ $ 127.00 RW-7. Mailed letters and order to 21 - 95 . 395 Oil) ")}~ , ~~; ,~~ .- ,....: () ~,'l ~ ~'h ~~ ....J :.'~ a't~ al ~? 0:0: CX) .::: ~ ., ~ ~ ...u ..:E Q)::1 Gu .~ ',,''Ii <,'I' ,,'" -~..;~~~~...:-...: ".,..-...~~ . . c..-~ .._ I ~1 M · .iiJ ~':~O ~ ~ 0 ~ ~ ~ !.. ~ ~ . ~ tS ~ :-: : ";.\. ;_h ,. -",' ,! ~ ~, . " ... ... ~ I Pi t -i ): JJj .. 'S r t;o:E; g,. J- - r ..:r;J.... = ,Il . ~.. ::e: == - . .u .. ~ ,~ I,. '. ,. " ., . . . . . . '.'. -', ,-, .t." -;; ", -' ,,-- .J __.,,'.f , ."-", ~: LAST WILL AND TBSTAKBNT I, KIM M. HOOVER, a resident of cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my LAST WILL and TESTAMENT, hereby revoking any and all wills and Codicils previously made by me. I I declare that I am married to ROBERT HOOVER and that I have one (1) child, AMY LYNN HOOVER, born February 17, 1976. II I direct that my debts and funeral expenses be paid as soon after my death as is practicable by my Executor out of my residuary estate, but not from any assets, funds, death benefits or insurance proceeds which are otherwise excludable or exempt from my gross estate for federal estate valuation or tax purposes. III I direct that all estate, succession, legacy, inheritance or other transfer taxes, however designated that shall become payable by reason of my death in respect of all property comprising my gross estate for death tax purposes, whether or not such property passes under this LAST WILL, shall be paid by my Executor out of my residuary estate, but not from any assets, funds, death benefits or insurance proceeds which are otherwise excludable or exempt from my gross estate for federal estate valuation or tax purposes. IV I give, devise and bequeath all my property, whether real or personal, wherever situate, including any property over which I may have a power of appointment to my husband, ROBERT, provided that he survives me by thirty (30) days. V If my husband, ROBERT, shall predecease or fail to survive me , by thirty (30) days, I give, devise and bequeath all of my property, whether real or personal, wherever situate, including any property over whioh I may have a power of appointment, to my daughter, AMY LYNN HOOVER, per stirpes, pursuant to the terms of the hereinafter inoluded Trust. VI GUARDIANSHIP If my husband shall predeoease me and my daughter, AMY, survives me and is under the age of eighteen (18) years, I appoint my husband's sister, BARBARA RICHARDS, as the Guardian of the person of suoh ohild. VII TRUST If my husband shall fail to survive me by thirty (30) days and my daughter, AMY, is under the age of twenty-one (21) years and survives me, I appoint my husband's sister, BARBARA RICHARDS, as Truste~ of the property that I have given to my ohild. B. The Trust estate shall be administered until my ohild reaohes the age of twenty-one (21) years. Until that time, the Trustee shall apply all net inoome and prinoipal of the Trust estate as follows: 1) So long as my ohild is under the age of twenty-one (21) years of age, the net inoome of the Trust shall be paid to, or applied for the benefit of my ohild at suoh times and in suoh amounts as the Trustee shall in his disoretion deem neoessary for his support, welfare, maintenanoe and eduoation. Eduoation shall be defined broadly to inolude not only that available in college, but also trade school and other similar training. In the event that the inoome shall be insufficient to provide my ohild with adequate maintenanoe, support, welfare or eduoation, the Trustee may invade the prinoipal of this Trust for this purpose. 2) The Trustee in exeroising his discretionary authority with respeot to the payment of inoome or prinoipal of the Trust Estate to my benefioiary, shall take into oonsideration any income or other resources available to my ohild from souroes outside of this Trust that may be known to the Trustee. The determination of the Trustee with respeot to the neoessity of making payments out of inoome or prinoipal to my benefioiary shall be oonolusive on all persons howsoever interested in the Trust. , 3) The Trustee shall accumulate and add to principal any net income of the Trust not paid out in accordance with the discretion hereinabove conferred on the Trustee. In the event my child predeceases me or dies prior to the termination of this Trust, the interest of my child in the Trust shall cease, except that, if she is survived by any children, then the Trustee shall pay net income of the Trust to or apply the same for the benefits of such children of my deceased child, in such amount or amounts as the Trustee in his sole discretion may determine for support, welfare and maintenance. When my child reaches the age of twenty-one (21) years, 4) c. a calculation of the property remaining in the Trust shall be made and the total thereof shall be distributed to her. D. My child, as beneficiary of this Trust, shall not have any right to alienate, encumber, or hypothecate her interest in the principal or income of the Trust in any manner, nor shall any interest be subject to claims of her creditors or liable to attachment, execution or other process of law. E. In order to carry out the purposes of this Trust established by this Will, the Trustee, in addition to all other powers granted by this Will, or by law, shall have the fOllowing powers over the Trust estate, subject to any limitation specified elsewhere in this Will: 1) To retain any property received by the Trust estate for as long as the Trustee considers it advisable. 2) To spend funds for the maintenance and repair of real property. 3) To s9ll at public or private sale, exchange or lease for a period of time, any real or personal property and give options for sale of the lease. 4) To execute and deliver any deeds, leases, assignments or other instruments as may be necessary to carry out the provisions of this Trust. 5) To borrow money and to mortgage or pledge any real or personal property. 6) The Trustee shall maintain accurate records and accounts and shall r.ender statements to my beneficiary hereunder showing receipts and disbursements of principal and income no less frequently than annually. The Trustee shall serve without bond and shall receive fair and . . reasonable compensation adlninistration of this Trust, exceed five (5%) percent of income. for not to annual 7) To distribute property in kind. 8) To do all other acts that are in his judgment necessary or desirable for the proper management, investment and distribution of the Trust estate. VIII I nominate, constitute and appoint my husband, ROBERT, as Executor of this LAST WILL, to serve without bond. If my husband is unable or unwilling to act in that capacity, then I nominate, constitute and appoint my husband's brother, RICHARD HOOVER, as Executor of this LAST WILL, to serve without bond. IN WITNESS WHEREOF, I, KIM M. HOOVER, have set my hand to this LAST WILL this ~ day of ma.y , 1992. ~l. ~h. ~~f'-'~.J . M. HOOVER signed, sealed, published and declared by the above-named KIM M. HOOVER, as and for her Last Will and Testament, in the presence of us, who, at her request and in his presence, and in the presence of each other, have hereunto subscribed our names s witnesses. ~~~~ ~ - . . . . . , ACDOWLBDGBJlBNT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss. . . I, KIM M. HOOVER, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my LAST WILL; that I signed it as my free and voluntary act for the purposes therein expressed. ~, el/7 ~htU/CK-- K M. HOOVER Sworn or affirmed to and acknowledged before me by KIM M. HOOVER, Testatrix, this ~'Yh day of Intil ' 1992. (?U/~ 4'~fri:wg~'J Notary Publ~ NotMaI Seal Carla F. BnlkenshIre. Notary Nllc ~ Bote. CUnberland CounIy My eon_ E><PrBS ApnI1. 1095 UJ'IDAVIT COMMONWEALTH OF PENNSYLVANIA ss. COUNTY OF CUMBERLAND We, lJ'lvrre! R M/kr.:1, III and /.~ //ku/:"-YI.O/1Jq..:, , the witnesses whose names are signed to the atta~hed or foregoing instrument being duly qualified according to law, do depose and say that we were present and saw Testatrix sign and execute the instrument as her LAST WILL; that KIM M. HOOVER signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the will as witnesses; and that to the best of our knowledge, the Testatrix was at the time 18 years of age or more, of sound mind and under constr,/).(Or/:d influence. r lu/( ~a.~ Sworn or affirmed to this /f"t-h day of and acknowledged before me /7/ct y , 1992. r0db /~ 4~ri,:t4id~ Notary Public NotMaI SeoI " CoM F. BnlkenshIre. NoIaty N*l I.4edw1I:::5Ilu Bote. CUrtllIrtiInd CounIy My ConmsSlon E>'J*8I -'!xl 1. 1995 , , Au;: ..1 nl,-,' ," CER'rIFICATION OF NOTICE UNDER RULE 5.6 ( a) '9J JUrI -1 ;\;) :5'" elL "~I :~i\ Date of Death: Name of Decedent: Kim M. Hoover CUll" Date: 5)(75 will No. May 11, 1995 1 Admin. No. 00395 1995 To the Register: I certify tha~ notice of beneri~ial Intereat 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 May 30, 1995 :dkm CERTNOT5.6 Address 1017 Hemlock Lane Enola, PA 17025 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Name Amy Lynn Hoover J~~ Signatu . Name James S. Pannebaker, EsquIre PANNEBAKER & JONES, P.C. Address 4000 Vine street Middletown, PA 17057 Telephone (717) 944-1333 CapacIty: Personal Representative Counsel for personal representative .., .' IN RE: ESTATE OF KIM M. HOOVER DECEASED, LATE OF ENOLA, CUMBERLAND COUNTY, PENNSYLVANIA IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' .COURT DIVISION . . . . . . . . . . NO. 00395-1995 .'. , '''1 " .D:IBCLAIMER (SEE ATTACHED) , ... , . DISCLAIMER AND NOW, this ;?8 day of August, 1995, the undersigned, Richard Hoover, Executor of the Estate of Kim M. Hoover, deceased, hereby disclaims and renounces all of the right, title and interest of Kim M. Hoover (the "Decedent") and her estate in the proceeds of litigation or the settlement thereof instituted with respect to the accidental death of Robert Hoover on May 11, 1995, and as to which the Decedent might otherwise be entitled as the surviving spouse of Robert Hoover, so that such proceeds shall be distributed to such persons as are otherwise entitled thereto as if the Decedent predeceased Robert Hoover. This Disclosure is unqualified and irrevocable. ESTATE OF KIM M. HOOVER BY:~~^,-- $~ chard Hoover, Executor Sworn to and subscxJbed befor~ !De, t}lis J'S' day of [.W.f<.L&(- , 1995. . In)/' ()tACL Notary Publ c My Commission Expires: NOTARIAL SEAL JODIE M.H, PIERCE, Nolary Public Mlddlalown. Dauphin Counly My Commllllon Explra. March 22. 10119 :dkm HOOVERDISC 14245 (SEAL) '. 'W IN RE: ESTATE OF KIM M. HOOVER ,DECEASED, LATE OF ENOLA, CUMBERLAND COUNTY, PENNSYLVANIA . . IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION . . : NO. 00395-1995 AND NOW, this 6 t- day of the attached Petition, it is ~() ~~ 1995, hereby ordered that upon review of the proposed Disclaimer by Richard Hoover, Executor of the Estate of Kim M. Hoover, in the proceeds of litigation or settlement thereof instituted with respect to the accidental death of Robert Hoover on May 11, 1995, as to which the decedent might otherwise be entitled as the surviving spouse of Robert Hoover, be approved so that such proceeds shall be distributed to such persons as otherwise are entitled thereto as if the decedent had predeceased Robert Hoover. BY THE /) I COUR'l'(I ..' J. :dkm HOOVERKORD 14245 / IN RE: ESTATE OF KIM M. HOOVER DECEASED, LATE OF ENOLA, CUMBERLAND COUNTY, PENNSYLVANIA IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 00395-1995 PETITION FOR APPROVAL OF DISCLAIMER AND NOW, comes your Petitioner, Richard Hoover, Executor of the Estate of Kim M. Hoover, deceased, by and through his Attorneys, Pannebaker and Jones, P.C. and Petitions this Court as follows: 1. Your Petitioner, Richard Hoover, is the Executor of the Estate of Kim M. Hoover who died on May 11, 1995. 2. Your Decedent died as a resl1lt of injuries sustained in an automobile accident which occurred on May 11, 1995. Said accident also claimed the life of your Decedent's husband, Robert Hoover, who predeceased your Decedent by approximately six (6) hours. 3. Your Petitioner, Richard Hoover, who is also the Executor of the Estate of Robert Hoover, deceased, has filed wrongful death and survival actions against the truck driver and owner of the truck involved in the accident causing the deaths of your Decedent and her husband. 4. Your Petitioner, along with Amy L. Hoover, daughter and the sole heir of Kim M. Hoover's Estate, have agreed to settle the wrongful death and survival actions against the Defendants in the amount of $750,000.00, which are the limits from the Defendant's - 1 - insurance company, plus the amount of $100,000.00, which represents the limits from your Decedents' under-insurance policies. 5. Pursuant to 20 Pa.C.S.A. 56202, your Petitioner on behalf of the Decedant, desires to disclaim any interest in the wrongful death benefits payable to the Decedent by virture of the wrongful death of her husband, Robert Hoover, pursuant to the wrongful Death Act and 52102 of the Probate Estates and Fiduciaries Code. 6. Pursuant to 20 Pa.C.S.A. 56202, this court, having jurisdiction over the Estate of Kim M. Hoover, may authorize the Disclaimer if this Court finds that it is advisable and will not materially prejudice the rights of creditors, heirs or beneficiaries of the Decedent. 7. Pursuant to the proposed settlement and the proposed Petition for Approval of Settlement, a copy of which is attached hereto, marked Exhibit WAW made a part hereof by reference thereto, there is a proposed payment from the settlement proceeds of $56,199.15 to the Estate of Kim M. Hoover under the Survival Act. These proceeds, along with other assets of Kim M. Hoover's Estate will be more than sufficient to protect the rights of any creditor of said Decedent. Furthermore, the only heir or beneficiary of the Decedent is the Decedent's daughter, Amy L. Hoover, to whom any benefits of the Disclaimer by your Executor will pass. - 2 - 8. Attached hereto as Exhibit MBM is a copy of the signed Disclaimer. WHEREFORE, your Petitioner respectfully requests that this Honorable Court authorize the Disclaimer, finding that it is advisable and will not materially prejudice the rights of any creditors, heirs or beneficiaries of the Decedent. Respectfully submitted, JONES, P.C. etitioner By ID. () 9 tC1' 4000 Vine Street Middletown, PA 17057 Telephone: (717) 944-1333 - 3 - . James B. Pannebaker, Esquire PANNEBAKER AND JONES, P.C. .4000 Vine Street Middletown, PA 17057 (717) 944-1333 I. D. No. 09667 Attorney for Plaintiff RICHARD HOOVER, Executor of the Estate of Robert Hoover, Deceased and the Estate of Kim M. Hoover, Deceased : COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA : CIVIL ACTION - LAW : No. Plaintiff v. WEAVER W. MARTIN and LEONARD H. MARTIN Defendants PETITION FOR APPROVAL OF SETTLEMENT Richard Hoover, as Executor of the Estates of Robert Hoover, Deceased, and Kim M. Hoover, Deceased, by and through his Attorneys, Pannebaker and Jones, P. C., and Amy L. Hoover, sole Heir of her Parents, Robert and Kim M. Hoover, petition this Court for approval of settlement of this claim, respectfully representing that: 1. Robert Hoover, age 44, of 1017 Hemlock Lane, Enola, Cumberland county, Pennsylvania, died on May 11, 1995, as thu result of closed head and internal injuries sustained in an automobile accident. 2. Kim M. Hoover, age 41, of 1017 Hemlock Lane, Enola, Cumberland county, Pennsylvania, died on May 11, 1995, as the result of a blunt head trauma sustained in an automobile accident. 3. Said accident occurred on May 11, 1995, on PA Route 41, one quarter mile south of Newport Pike, in Sadsbury Township, Lancaster - 1 - . ...~I I . ,- County, Pennsylvania when a cattle truck, owned by Defendant, Weaver w. Martin, and driven by Defendant Leonard H. Martin, swerved into the south bound lane, where it collided with the Hoovers' 1956 classic Chevrolet. 4. As a result of said accident, Robert Hoover, while alive immediately after impact, died shortly thereafter without regaining consciousness, and Kim M. Hoover, while never regaining consciousness, died approximately six (6) hours later at Lancaster General Hospital. 5. Defendants have denied all liability. Thus, a genuine dispute exists in this case as to the liability of any of the defendants for the deaths of Robert Hoover and Kim M. Hoover. 6. Amy L. Hoover, age 19, who resides at 1-A Southmont Drive, Enola, PA 17025, is the sole Heir of her Parents', Robert and Kim M. Hoover, Deceased, Estates. 7. The parties to this action and Amy L. Hoover have agreed, contingent on this Honorable Court's approval, to a resolution of this matter by payment of $850,000.00 in full settlement of all claims under both the Wrongful Death and Survival Acts in this matter. The $850,000.00 settlement is made up of $750,000.00 offered by the Defendants, Weaver W. Martin and Leonard Martin, and the remaining $100,000.00 is being offered by Erie Insurance Company as a result of the Robert and Kim M. Hoover's auto insurance policy which provided for $50,000.00 per person of under-insured motorist coverage of the Hoover's policy. - 2 - 8. Plaintiff respectfully requests that this Honorable Court approve the proffered settlement of $850,000.00 as fair and reasonable under all circumstances. 9. plaintiff, Richard Hoover, Executor of the Estates of Robert Hoover, Deceased, and Kim M. Hoover, Deceased, and Amy L. Hoover, sole Heir of Robert and Kim M. Hoover have agreed upon a 25% contingency fee based upon settlement of this case prior to the commencement of a suit. A copy of the Fee Agreement is attached as Exhibit "A". Plaintiff respectfully requests that this Honorable Court approve payment of 25% of the Settlement of the above captioned case for Robert Hoover in the amount of $93,750.00 and 25% of the settlement of the above captioned case for Kim M. Hoover in the amount of $93,750.00 as Attorney Fees to pannebaker and Jones, P.c. for the settlement of the claim against the Defendants, Weaver W. Martin and Leonard Martin; and 25% of the under-insured motorist claim being paid by Erie Insurance Company to the Estate of Robert Hoover, Deceased, in the amount of $12,500.00 and 25% of the under-insured motorist claim being paid by Erie Insurance company to the Estate of Kim M, Hoover, Deceased, in the amount of $12,500.00. 10. In the preparation of this case, it was necessary for counsel to advance various costs for medical records, consulting actuaries, etc. A tabulation of these costs paid on behalf of the plaintiff, is in the amount of $508.52 (see Exhibit "B") and it is requested that these costs be divided equally between the Estates of Robert and Kim M. Hoover. - 3 - 11. Plaintiff respectfully requests that costs in the amount of $254.26 from the settlement for Robert Hoover, Deceased and $254.26 from the settlement for Kim M. Hoover, Deceased, be awarded to pannebaker and Jones, P.C. for the costs incurred on behalf of Robert and Kim M. Hoover. 12. Upon approval of the aforesaid Attorney's Fees and Costs, the Plaintiff has a net recovery of from the above captioned case of $280,995.74 for the Estate of Robert Hoover and $280,995.74 for the Estate of Kim M. Hoover. The Estate of Robert Hoover will receive from Erie Insurance Company a net payment of $37,500.00 and the Estate of Kim M. Hoover will receive from Erie Insurance Company a net payment of $37,500.00. 13. A portion of the net settlement fund should be distributed under the Wrongful Death Act to compensate Amy L. Hoover for the pecuniary loss she has sustained as a result of the loss of her parents' contribution to her shelter, food, clothing, medical care, education, entertainment, gifts, recreation, etc. A report prepared by Economist, Harry M. Leister, Jr., F.S.A. of Harrisburg, Dauphin County, Pennsylvania, attached as Exhibit "C", indicates that Robert Hoover would have had a net loss after deductions for his cost of maintenance of 38% of earnings in the amount of $452,191.00 and Kim M. Hoover, attached as Exhibit "D", after deductions for the cost of her maintenance of 28% of earnings, would have had a net loss of $772,713.00. 14. Amy L. Hoover resided with her parents at the time of their - 4 - death. Amy L. Hoover is the only person to whom Robert Hoover and Kim M. Hoover were providing financial support at the time of their deaths. Pursuant to Disclaimer signed by Richard Hoover, Executor of the Estate of Kim M. Hoover, and approved by the Orphans' Court. by Order dated , the Estate of Kim M. Hoover disclaimed and renounced all of the right and interest of Kim M. Hoover to the proceeds of litigation or the settlement thereof instituted with respect to the accidental death of Robert Hoover on May 11, 1995, and as to which the Estate of Kim M. Hoover might otherwise be entitled as a surviving spouse of Robert Hoover. A copy of said disclaimer and order are attached hereto, marked Exhibit "E", and made a part hereof by reference thereto. Therefore, Amy L. Hoover is the only person who stands in a family relation to the deceased and is statutorily authorized to recover damages under the Wrongful Death Act. 15. Plaintiff therefore requests that $224,796.59 be distributed to Amy L. Hoover as the sole surviving Heir of Robert Hoover, Deceased, and that $224,796.59 be distributed to Amy L. Hoover as the sole surviving Heir of Kim M. Hoover, Deceased. 16. Pursuant to 42 Pa.C.S.A. S 8302, the remainder of the Settlement Funds, should be distributed under the Survival Action in the amount of $56,199.15 to the Estate of Robert Hoover, Deceased, for his Heir and $56,199.15 to the Estate of Kim M. Hoover, Deceased, under the survival Action for her Heir. 17. Plaintiff respectfully requests that the remainder of the net funds, after attorney fees, provided by Erie Insurance Company - 5 - as payments for under-insured motorist coverage in the case of Robert Hoover, Deceased, be distributed to Amy L. Hoover as sole surviving Heir in the amount of $37,500.00 and in the case of Kim M. Hoover, Deceased, the sum of $37,500.00 which will be paid to Amy L. Hoover under the Pennsylvania Wrongful Death statute. 18. The Plaintiff, Richard Hoover, Executor, and Amy L. Hoover, sole surviving heir, are agreeable to the payment of Attorney's Fees and Litigation expenses and requests this Honorable Court to approve settlement of this matter with distribution of the funds to be paid as listed below: a. Damages recoverable for Robert Hoover, Deceased, under the Wrongful Death Act to Amy L. Hoover in the amount of $224,796.59 b. Damages recoverable for Robert Hoover, Deceased, under the above captioned Survival Act to the Estate of Robert Hoover in the amount of $ 56,199.15 c. Damages recoverable for Kim M. Hoover, Deceased, under the Wrongful Death Act to Amy L. Hoover in the amount of $224,796.59 d. Damages recoverable. for Kim M. Hoover, Deceased, under the above captioned survival Act to the Estate of Kim M. Hoover in the amount of $ 56,199.15 e. Payment received from Erie Insurance Company under casualty - 6 - insurance policy of Robert and Kim M. Hoover for Robert Hoover payable under the Wrongful Death Act to to Amy L. Hoover in the amount of $ 37,500.00 f. Payment received from Erie Insurance company under casualty insurance policy of Robert and Kim M. Hoover for Kim M. Hoover payable under the Wrongful Death Act to Amy L. Hoover in the amount of $ 37,500.00 g. Reimbursement to Pannebake~ and Jones, pc for out of pocket expenses in the amount of $ 508.52 h. Attorney Fees due to Pannebaker and Jones, P. C. as a result of the above captioned case for Robert Hoover, Deceased, in the amount of $ 93,750.00 i. Attorney Fees due to Pannebaker and Jones, P. C. as a result of the above captioned case for Kim M. Hoover, Deceased, in the amount of $ 93,750.00 j. Attorney Fees due to pannebaker 'and Jones, P. C. as a result of the settlement of the under-insured motorist claims for Robert and Kim M. Hoover from Erie Insurance Company in the amount of $ 25,000.00 - 7 - WHEREFORE, Plaintiff and Amy L. Hoover, sole survivor of Robert and Kim M. Hoover respectfully requests this Honorable Court approve the settlement as proposed above and distribution as requested herein. PANNEBAKER AND JONES, P.C. By: /)~ - James ~: ..Jr'"~ker Attorney for Plaintiff 4000 Vine Street Middletown, PA 17057 (717) 944-1333 I.O; No. 09667 By: CL--~,h U. ~xr..A..J Amy L. Hoover Sole surviving Heir By: ~4 ~~~ RfJ~rd Hoover, Executor of the Estates of Robert Hoover and Kim M. Hoover - 8 - The above Petition has been reviewed and is approved on behalf of the Defendants, Weaver W. Martin and Leonard H. Martin as presented: ATTORNEYS FOR THE DEFENDANTS: FINEMAN & BACH, P.C. By: 1608 Walnut street philadelphia, PA 19103-5413 (215) 893-9300 - 9 - . u,.....__'-___-.....-.'_.__ __._~_~~._, _....,r VERIFICATION I verify that the statements made in this Petition are true and correct. I understand that false statements herein are made subject " to the penalty of 18 Pa. C.S. 4904, relating to unsworn falsification to authorities. ~~~w~ Amy L. Hoover Sole surviving Heir VERIFICATION I verify that the statements made in this Petition are true and correct. . .1 understand that: false statements herein are made subject to the penalty of 18 Pa. C.S. 4904, relating to unsworn falsification to authorities. .cd:::! d<. - Executor of the Estates of Robert and Kim M. Hoover SST/dkm HOOVERPET 14244 - 10 - '. PANNEBAKER AND JONES, P.C. . r' J-/r)1'1 CONTINGENT FEE CONTRAc:::.""J oj;!' /I,Jdl-tr 1-IIJDvetf A ~m~~-. '1Ict'./M() HoOv.dP L/,f&vl'D.f 0 , CLIENT(S) ~,/4M7 J./"vJ:'1 hereby employes) PANNEBAKER AND JONES, P.C. as attorneys to fv~v/~/N'~ negotiate a settlement, institute, conduct, superintend and L'pp~)fr&'" prosecute to final determination by suit or action, if a claim arising out of an accident or incident o@the necessary, p.. 4 /1 day ..... of , 19~, against any person, firm or corporation A A "'I I who. may..in. the' judgment of our attorneys be responsible therefor, including LcON.tltf'f) /-1 Mpt17/N ,4</0 t-o"7Zll/td? .Lv .sir 't /' Uo 1'71 >,),://11 Dr- /I/,_~A,;;~l7r c:. Jo.__ r 1 ,fJ"o" ""~II' rl //I' rdf1 A I"',DCC:/tu"",r I"'i n.c ... .I _ U:>.1'<.a J'/J.. '\ '/-"""" INVESTIGATE We agree that the said attorneys accept said employment on the condition that they will investigate the claim and, if it appears to be a justifiable and recoverable claim in their judgment, they will proceed to handle the same; but if, after investigation, the claim does not appear to be either justifiable and/or recoverable, then said attorneys shall have the right to rescind this Agreement and under no circumstances shall our attorneys have the responsibility to prosecute the claim for any amount in excess of the uncontested liability insurance coverage applicable to the claim. -1- Exhibit "A" . ._-_____.-."__ _A_ COSTS AND EXPENSES OF LITIGATION We understand that we must pay all of the necessary costs and expenses incident to this case, including costs of investigation, clerks' fees, court reporters, depositions, stenographers, transcripts, witness fees, appeal fees, notary fees, long distance telephone calls, travel expenses, photocopy costs and anY.9ther costs deemed necessary by our attorneys in order to properly pursue this claim. We also understand that we are solely responsible for and shall pay all medical bills, including hospital, nurses, doctors, medicines, x-rays, special studies, ambulance and the like. In.' the event of a recovery, we agree that all of these costs and the aforesaid expenses of litigation shall be paid from our share of the recovery. Should suit be unsuccessful and we recover nothing, we understand that we are solely responsible for these costs and expenses of litigation and our attorneys are not personally responsible for any of these costs and/or expenses. We understand that we will be billed monthly for the costs and expenses of litigation which are paid by pannebaker and Jones, P.C. on our behalf. We also understand, that payment of the monthly invoices are due upon receipt. If the payment is not made in full within thirty (30) calendar days from the date of -2- receipt, pannebaker and Jones, P.C. will charge us interest at the rate of 1 1/2' per month (18% per annum) on the unpaid balance, and pannebaker and Jones, P.C. may cease providing services under this agreement and we hereby consent to Pannebaker and Jones, P.C. removing any court appearance that may have been filed for us and withdrawing from representing us in this matter due to our non-payment of monthly invoices. " ATTORNEY FEES Should our case not result in recovery, either by settlement, trial, re-trial, appeal or otherwise, we unqerstand and agree that we are to owe our attorneys absolutely nothing for their time and service. In the event of a recovery, our attorneys shall be entitled to the following contingent fee from any recovery made or secured of: ~({) foll }f ~'J..5ra (a) Thirtr t.lu'ee and one- tl.irJ (3J-1/.l%) percent.of.gross amount if settlement is made t'q!!~:~:'i~ 1:ommenced; ,.'tlf' )'313 t11 (b percent of the gross amount I ~::~~::i~::~;;:e~:N:Jle~ :l:~eC{)j) eefI~ tdr eveJJf cl'\q~/ \to ~ A~~C6U'h. W J It is recognized and acknowledged that we want to reserve the right to consider a structured settlement of our claim and, in the event that this claim is settled in whole or in part on a -3- , . structured settlement basis, it is agreed that our attorneys' fee shall be calculated as previously set forth on the basis of the present value cost of the future payments to us as opposed to the actual payments themselves. It is also acknowledged and agreed that if we agree to settle our claim on a structured settlement basis, that our attorneys will have the option to structure all or part of their attorneys' fee. WITHDRAWAL We agree that our attorneys may withdra~ from this case at any time after reasonable notice to us, and we agree to keep our attorneys advised of our whereabouts at all times and to cooperate at all times in the preparation and trial of this case, and to appear upon reasonable notice for depositions, court appearances, hearings and the like, and to comply with all reasonable requests made of us in connection with the preparation and presentation of this case. CO-OPERATION All matters of policy, including but not limited to questions as to the preparation and presentation of the case, costs, expended or to be expended, the question of settling, trying or -4- --~ - appealing, or any other such questions as they arise, shall be determined together by our attorneys and ourselves in a cooperative effort. AUTHORITY TO PAY CLAIMS We further authorize our attorneys to make payment from any recovery proceeds any outstanding costs, subrogation claims, medical or other bills and expenses relating to or arising from said claim or litigation. IN WITNESS WHEREOF, the parties hereto qave se their hands and seals this /~ day of ~ ' 19!12. P./~/#4- (S;:AL) 1../ /Cb~N'g0~n 1- dUd'i 1- ~etC'~ 't)d~1 r~ (SEAL) a~~ c:../-/t?O//~9r )(SEAL) CLIENTV' IVITNESS: (SEAL) PANNEBAKER AND JONES, P.C. BY: (~~ ATT~EY (SEAL) BY: ATTORNEY (SEAL) ljs(1:31) -5- : Conrad M. Siegel, Irl Actuaries/Benefits II . - - _ _... _ ..r -: - -.. --..~ .: :'::. -.: ..... 11 __.___ I_WI ... -- 500 Nationwide Drive P. O. Box 5900 Harruburg, PA 17110-5900 (717) 652-5633 Fax (717) 540.9106 Conr:ld M. SI'a,l. F.S.A. . HillT}' M. leister. 1,.. F.S.A. Brillll S. Sonn. F.S,A. Clyd, E. Olnarich. F.5.A. Earl L Mummen, M.A,A,A. Rob,n 1. Dolllll. A.S,A. O..ld F. SlIlIlna. A.5.A. Roben 1. M=11c. F.5,A. O"ld It Kllllck. F.5.A. I,rr..y S. Myen. F.5,A. Thorn.. L Zlmmel11\llll. F.S.A. Ol,nn A.lWcr. F.S.A. Piyals, Oooncllll,kc. A.S.A. Fronk S. Rhodes. F.5.A.. A.C.A.S, Chari.. B. Fri,dlondcr. A.S.A. Holly A. Ross. F.5,A. . Enrolled Acnwl" (ERISA) Kevin A. Em. A,S,A. HcaJlhAcUlIJ'}' July 6, 1995 James B. Pannebaker, Esq. Pannebaker and Jones, P,C. 4000 Vine Street Middletown, PA 17057 RE: Robert Hoover Dear Mr. Pannebaker: You indicated that Robert Hoover was born on September 10, 1951 and that he died on May 11, 1995. ' As of the date of his death, Robert Hoover was 43.7 years of age. The life expectancy for a white male age 43.7 is an additional 30.7 years. This implies an expected age at death of 74.4 (43.7 plus 30.7). The life expectancy is based upon a publication of the U.S. Department of Health and Human Services entitled "U.S. Decennial Life Tables for 1979-81. " Robert Hoover was employed by Alling & Cory. In 1994 he earned $27,571. He did not miss any days of work during 1994 and 1995 up until his death except for vacation and holidays. Alling & Cory, his employer, provided information concerning the value of the medical benefits provided on behalf of Robert Hoover. This value was $2,930 (10.5% of earnings) for 1994. His employer also provided information indicating that Mr. Hoover was covered under a defined benefit pension plan. I assume that the annual value for this fringe benefit was 4.5% of earnings. This provides a total value of fringe benefits of 15% of earnings. In a death case, it is necessary to deduct the cost of maintenance. The cost of maintenance consistent with the McClinton vs. White decision consists of the necessary and economical sum which a decedent would be expected to spend, based upon his station in life, for food, clothing, shelter, medical attention and some recreation. Information published by the U.S. Department of Labor, Bureau of Lnbor Statistics indicates that the cost of maintenance would amount to about 38% of earnings. The following table shows the total value of the net loss on the basis of the date of previously described: Earnings Capacity Fringe Benefits Cost of Maintenance Net Loss $ 587,262 88,089 -223.160 $ 452,191 Exhibit "e" . " 'ai' Co~ad M. Siegel, Ine. \'-' Jamos B, Pannobakor July 5, 1995 Pogo 2 The figuros In the above table are based upon a work life expectancy to age 65. Tho calculation of the value of the future amounts does not take into account a discount for Into rest In view of the Kaczkowski vs. Bolubasz decision. This Is 0 preliminary report. Please note that this preliminary report does not take into account any Increase In earnings since 1994. any increase in future earnings attributable to gains In productivity, etc. With best regards, HML:bah Yours sincerely, H~ ..'1'1. CL",;I'~7 C)). Harry ~;,. Leister, Jr., F.W . COns1ing Actuary , .., ._.m_T~'-~~f~-~~~C~"~'~--~~,\'~~~'-~-~~------'-~,--------~~,~-~-~.~';~:,'i-~~_,,~:,::~2i~f~~~'-'-~--~'-~~~~-;'~;;~rrj~"~-----;'~ . J Conrad M. Siegel, ~ . -.. ..' . , . ~Actuaries/Benefits ~ (Q)lPlf _ _'. _ .r.. 500 Nationwide Drive : ==~ ':"~ l; P. o. Box 5900 .:.. -=::~= ~] Harrisburg. PA 17110.5900 . - (717}652.5633 Fax (717) 540.9106 July 6, 1996 James B. Pannebaker, Esq. Pannebaker and Jones, P.C. 4000 Vine Street Middletown, PA 17057 RE: Kim M. Hoover Con1'lld M. SI,g,l. F.S.A. H"'TJ' M. lei...,. I,.. F.s.A. Brion S. SaM. F.s.A. Clyd, E. Oingrlch. F.s,A. E..I L Mummen, M,A.A.A. Rob,n I. Dolan. A.S.A. David F. Stirling. A.S.A. Raben I. Mrazik. F.s.A. David It Kllllck, F.s.A. I,ffrey S. My,n. F.s.A. Thomas L. Zlmmcnnon. F.s.A. Olenn A. Hafer, F.s.A. Piyal S. Oooncdll,kc, A.S.A. Frank S. Rhodes, F.5.A.. A.C;A.S. Ch..I" B. FrI,dlander, A.SA Holly A. RoSl. F.s.A. EnNllcd Al:warlu (ERISA) Kevin A. Em. A.5.A. HeaJthActuuy Dear Mr. Pannebaker: You indicat~d that Kim M. Hoover was born on April 3, 1954 and that she died on May 11, 1995. As of the date of her death, Kim M. Hoover was 41.1 years of age. The life expectancy for a white female age 41.1 is an additional 39.1 years. This implies an expected age at death of 80.2 (41.1 plus 39.1). The life expectancy is based upon a publication of the U.S. Department of Health and Human Services entitled "U.S. Decennial Life Tables for 1979.81. " Kim M. Hoover was employed by Pennsylvania Blue Shield. In 1994 she earned $37,696. She did not miss any days of work during 1994 and 1995 up until her death except for vacation and personal days. Pennsylvania Blue Shield, her employer, provided information concerning the value of the fringe benefits provided on behalf of Kim M. Hoover. This value was $5,190 for 1994. In a death case, it is necessary to deduct the cost of maintenance. The cost of maintenance consistent with the McClinton VS. White decision consists of the necessary and economical sum which a decedent would be expected to spend, based upon his station in life, for food, clothing, shelter, medical attention and some recreation. Information published by the U.S. Department of Labor, Bureau of Labor Statistics indicates that the cost of maintenance would amount to about 28% of earnings. The following table shows the total value of the net loss on the basis of the date of previously described: Earnmgs Capacity Fringe Benefits Cost of l\Iaintenance Net Loss $ 900,934 124,041 -252,262 $ 772.713 Exhibit "0" . J!Ui C~nrad M. Siegel, Inc. James B. Pnnnebnker, Esq. July 6, 1995 Page 2 The figures in the above table are based upon a work life expectancy to age 65. The calculation of the value of the future amounts does not take into account a discount for interest in view of the Raczkowski vs. Bolubasz decision, This is a preliminary report. Please note that this preliminary report does not take into account any increase in earnings since 1994, any increase in future earnings attributable to gains in productivity, etc. With best regards, HML:clf Yours sincerely, "'. 1,1'"\ M. Ct~ ~~W Harry M. Leister, Jr., ~. ConsuYing Actuary . .' l' l\ , ',(<! :;;,. ~~~ it. t. '1!; ~, t: " ,i"f f~' DISCLAIMER ~ II-- AND NOW, this ~ day of August, 1995, the undersigned, Richard Hoover, Executor of the Estate of Kim M. Hoover, deceased, hereby disclaims and renounces all of the right, title and interest of Kim M. Hoover (the NDecedentN) and her estate in the proceeds of litigation or the settlement thereof instituted with respect to the accidental death of Robert Hoover on May 11, 1995, and as to which the Decedent might otherwise be entitled as the surviving spouse of Robert Hoover, so that such proceeds shall be distributed to such persons as are otherwise entitled thereto as if the Decedent predeceased Robert Hoover. This Disclosure is unqualified and irrevocable.. ESTATE OF KIM M. HOOVER _''0- . BY:~/~ ~h4~ R chard Hoover, Execu or Sworn to and subscxibed before me, this .:Jlr'-day of tlu.SUJ: , 1995. ~.nd'i 111 /.{ Qf'" Notary Publ c My Commission Expires: NOTARIAL SEAL ( SEAL) JOOIE M.H. PIERCE. Notary Publlo Mlddlalown. Oauphln County My Comml..lon &pl,a. March 22, lQllIl :dkm HOOVERDISC 14245 ___,.u_~~,~. IDCHI.IT B : VERIFICATION I verify that the statements made in this Petition are true and correct. I understand that false statements herein are made subject to the penalty of 18 Pa. C.S. 4904, relating to unsworn falsification to authorities. ~~/4~.. - ~,~~ chard Hoover Executor of the Estate of Kim M. Hoover :dkm HOOVERKPET 14245 " - 4 - ft;;::r.,;,;~::;~~--r~'-c-:"""T'--''''''':'''._''_'''''''''~-~''''-''.'~''''''~P....,.."""""~.~-"~-;~._--~_"--<~.,,' '0 '.<- ~47 EX AFP (12-95. COHHOHWEAlTlt OF PENNSYlVANIA OEPARTHENT OF REVENUE BUREAU OF INDIVIDUAL TAkES OEPT. Z8D6Dl HARRISBURG, PI l11Z8-0601 ...~.. . . . j',....... -" _.~ ACN 101 NOTICE OF INHERITANCE TAX APPRAISEHENT. ALLOWANCE OR DISALLeWANCE OF DEDUCT leNS AND ASSESSHENT OF TAX DATE 04-01-96 ESTATE OF FILE NO. DATE OF DEATH 05-11-95 COUNTY CUMBERLAND NOTE, Te INSURE PROPER CREDIT Te yeUR ACCOUNT. SUBHIT TNE UPPER PORTION OF TNIS FeRH WITH YOUR TAX PAYHENT Te THE REGISTER OF WILLS. HAKE CHECX PAYABLE Te "REGISTER OF WILLS, AGENT" REMIT PAYMENT TO: JAMES B PANNEBAKER ESQ PANNEBAKER S JONES 4000 VINE ST MIDDLETOWN PA 17057 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 AMount R...1thd 7 / K. en CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ii'iv:i5'4j-EX-Aiij>--(i-:f:9SrNoYicniF-YNHEifITANcE" TAit 'AP'PRA':i'SE'tiiiil:r, --ALrciwAiic~-ijR---U_----------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX KIM M FILE NO. 21 95-0395 ACN 101 DATE TAX RETlJRN WAS, I I ACCEPTED AS FILED I Xl CHANGED SEE ATTACHED If an assessment was issued previously, lines 14, 15 and/or 16, 17 and 1B will reflect figures that include the total of abh returns assessed to date. ASSESSMENT OF TAX: 15. Amount of LinB 14 at Spousal rata CIS) 1&. Amount of Line 14 t.~8bl. at Linaal/Class A rat. (16) 17. Amount of Lina 14 t.~.bl. .t CoI1al.reI/Class Brat. (17) 18. PrincIpal Ta. Due ESTATE OF HOOVER RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPP~ISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN 'i. R..I Est.t. (Schedule A) ell 2. stocks and Bonds (Schedule 8) (2) 3. Clo..ly Held stock/Partnership Intarest (Schedule C) 13J 4. Hortseges/Hotes Receivable CSchedule D) (4J 5. C.sh/Benk Deposits/Hisc. Personel Property ISchedule E) 15) 6. Jointly Owned Property ISchedule F) (6) 7. Transfers ISchedule OJ (7) 8. Tat.l A..eh APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral E~penses/Ad.. Costs/Hisc. E~p.nses ISchedule HJ (9J 10. Debts/Hartgage Liabiliti.s/Li.ns CSchedul. I) (10) 11. Total Deductions 12. Net Value of Tax R.turn 13. Charitable/Government.l Bequest. CSchedule J) 14. Net Value of Estet. Subject to T.~ NOTE: TAX CREDITS: PAYHENT DATE 09-14-95 02-02-96 RECEIPT NUHDER AA082134 REFUND DISCOUNT 1+1 INTEREST (-I .00 .00 INTEREST IS CHARGED FROM 02-12-96 TO 04-09-96 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM 04-01-96 NOTICE NO. 02 .00 20.808.00 .00 .00 .De .00 .00 lal 20,80B.00 .00 8.995.00 1111 1121 1131 1141 R.qq~ nn 11.813.00 .00 173.124.00 .00 173.124.00 .00 x . DO: X .06: X .15: 1101 .00 10.387.44 .00 10.387.44 AMOUNT PAID ).2,884.55 3,205.89- TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST TOTAL DUE 9,678.66 708.78 10.15 7l8.93 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1. NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE eF THIS FORH FeR INSTRUCTIONS. I ,.-' ~ ; , ~ Vd "00 putlpeqwn:> lJ~CY.J 6.U':'1,UO'l\J91:> lS l\'d . 8- lIeN 96. ,....- SII\M 10 JO\a\rJo\:j 10 O:l\!I0peOlOO9\:j IN RE: ESTATE OF KIM HOOVER Deceased IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION : COUNTY CODE 1995-00395 RECEIPT AND RELEASE KNOW ALL MEN BY THESE PRESENTS that I the undersigned, Barbara Richards, Trustee of the Trust set up for Amy L. Hoover, of' ill 1.&...J now known as Amy L. Umholtz, by my late si~Kim M. Hoover, for the benefit of Amy L. Umholtz, do hereby acknowledge that I 1- 1'rd...t<J...... have reviewed the First and Final Account of my late siste7l Kim M. Hoover's Estate dated November 15, 1996 which shows $315,864.36 dollars have been transferred to me as Trustee for Amy L. Hoover, now known as Amy L. Umholtz. Therefore, since the full residue of the Estate has been transferred to me as Trustee for Amy L. Hoover, now known as Amy L. Umholtz as set forth in the First and Final Accounting above referred to, I hereby intend :k in Lo,,,V to release Richard Hoover as Executor of my late sisteF~Kim M. Hoover's Estate. IN CONSIDERATION of said full payment set forth above by Richard Hoover as Executor to me as Trustee, I therefore, the undersigned do hereby release, remise, quit claim and forever discharge the said Richard Hoover, Executor of the Estate of Kim Hoover of and from all actions, suits, payments, accounts, reckonings, claims and demands whatever for or by reason thereof, , undersigned do hereby release, remise, quit claim and forever discharge the said Richard Hoover, Executor of the Estate of Kim Hoover of and from nIl actions, suits, payments, accounts, reckonings, claims and demands whatever for or by reason thereof, or any other account, matter cause or thing whatever relating to the estate of the said decedent, AND the undersigned does hereby agree to indemnify and save harmless the said Executor, to the extent of the full distribution received, against any and all losses, damages, costs, verdicts, judgments, awards and expenses which said Executor may suffer, incur, be put to, payor layout by reason of having made full distribution to the undersigned and agrees to refund said distribution to the Executor upon receipt of such a request from the Executor. AND the undersigned does hereby release all real estate of the decedent and of the said Executor from all liens, claims, actions, suits, payments, accounts, reckonings and demands whatever for or by reason thereof, or of any other account, matter, cost or thing, whatsoever. ~\!;: ,.or' " ;oil:._ " ';;\'~ ,'t:', -~--p, " t. , , COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN SS. On this, the '1"<< day of J):oa'...~ , 1996, before me a Notary Public in and for said State and County, personally appeared Barbara Richards, Trustee, under the Last Will and Testament of Kim M. Hoover for Amy L. Hoover, now known as Amy L. Umholtz, known to me (or satisfactorily proven) to be the person whose name is subscribed to the foregoing Receipt and Release and acknowledged that she executed the same for the purposes therein contained and desires that the same be recorded as such. IN WITNESS WHEREOF, I seal. hereunto set my hand and official ~.~ " ,a Not Public (SEAL) ._ .~-===a NOTARIAL SEAL ESPIRIRRtON A, COLUIlGA, Notary Publ tc MIddletown PA, Dauphin Co~nty My Commission E.plros May 7, 1998 :dkm HOOVEREL __r RECEIVED FROM. _".... _.......,. ....t...... . _ , ;.;...'........_------~~---- ---------.------ .------- -_._------- --- t .' ~ ",' . COMMONWEAL!.HOF PENNSYLVANIA D ~O;:~Ai0,82~34 DEPARTMENT OF REVENUE ".v.\:" ."....,. OFFICIALRECEIPT. PENNSYLVANIA INHERITANCE AND ESTATETAX . ,~.!.,L.() ~ fI ACN ASSESSMENT I!' CONTROL ... NUMBER AMOUNT PANNEBAKER JAMES B 4000 VINE ST 101 .ll:!,el:l'+.oo MIDDLETOWN, PA 170:57 ESTATE INFORMATION, ~ FilE NUMBER 1iI 21-199:5-039:5 EJ NAME OF DECEDENT . OVE II D~E OF PAYMENT EJ POSTMARK OA E COUNTY SSN 207-44-:5214 (FIRSt) (Mil CUMBERLAND DATE OF OEATH REMARKS RICHARD HOOVER SEAL CHECK" 1013 REGISTER OF WILLS .------ ----------- ---- - -- - -----.-.- - - - - -----;- -,- -.- --",- v. . .. . . .,---- -- _ J/1'~. ...~-- ---~._---:-,--............~.11 , ..' .. ..cY.UOO EX. (7.9'" ~ ..:s.. tlf~ =o~ u.... ll: '" , . 15 - 3 5. I INHERITANCE TAX RETURN RESIDENT DECEDENT (TO BE FILED IN DUPLICATE WITH REGISTER OF WILLS) FulUrI Inl.'.I' Compromh. (lor do'.. 01 d.o,h ohor 12.12.82) Dte.d.nt DI.d T..lol. 0 7. D.e.d,nt Maintained a living TruI' (Alloth tOpy 01 WillI (Alloth tOpy of Tru.'1 AlL'.CORRE5P~NDENCE:AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO. ~~ ';;1: l;,,~.. ~' ~'~ ':~'1',:-:,:. .,,'. .., HAMor. (0""1111 "'AllINO ADDUn Jomes B. Pnnnebaker. Es uire PANNEBAKER AND JONES, P.C. mlrNOHIHUM'" 4000 Vine Street . Ei III u ... o COMMONWfALTH Of PENNSYLVANIA DePARTMENT Of IUVfNUr. D!PT. '10001 HARAISlUItO. 'A 17121.0601 D1CIDINI'$ NAM!: IL....r. 'IUl. AND MIDDLllNIIIAlI Hoover Kim M. IOCIAL Ileumy NUMIlIt DAn 0' DeAtH 207-44-5214 5/11/95 I'll ...''''''''tul.U......,IHQ lPOUII" ..._. ru.". ""' ANO ,,1I0PIS 'NmAll N A liil1. 04. liil6. O"g'nal R,turn o 2. 040, limited Estall :!lEi "0 "z ::lie z o S ::> t: :'i tl .. 1. R.ol E..o.. ISth.dul. A) 2. S'Otl, ond Bond. (Sth.dul. BI 3. Clollly H.ld S'otk/P.rtn.nhlp In'.".' (Sth.dul. C) ... MOrlgog.. and NollS Receivable (Sch.dule D) 5. Cash\ Bonlc D'polll1 & Mhcelloneoul Personal Prop Illy (St..dul. E) 6. Joln'ly Own.d Propor'y (Sth.dul. Fl 7. Tron.'", (Sth.dule GIISth.dul. l) 8. Total Gran Auell (lolaIUn.. 1.7) 9. funeral Expenlel, Admlnt1lrall...e C0111, Mhcellaneaul Expenles ISchedule H) 10. Debts, Morlgage Uabllitlel, liens ISchedule I) 11. Total Deductionl ItolalUnes 9 & 10) 12. Nel Value of Ellate (line 8 minus line 11) 13. Chariloble and Go...ernmental Bequests (Schedule JI U. Nel Value Sub.et to Tax (line 12 mlnull1n. 13) 15. Spoulol Transfers (for dotes 0' deoth aher 6.30.9AJ Sa. Inllructlonl for Appllcobl. Percentoge on R....erse Side. (Include valul1 ham Schedule K or Schedule M.) 16. Amount 0' lIn. 14 taltable at 6% ral. (Include valu" from Schedule K or Schedule M.I 17. Amount of llno 14 taltable at 15% ralo (Includ. values from Schedul. K or Schedule M.) 18. Prlnclpaltox due IAdd lox from lInll1 15, 16 and 17.) 19. Credil1 Spoulal Po...erty Credll Prior Payments + :z o 1= ~ ::> 0.. '" o u >< ~ fOR OATIS Of OIATH AnlR 12/31/9\ CHICKHIRI If A SPOUSAL POYIRTY CRlOIT IS CLAIMIO 0 fill NUMIIR 1995-00395 COUNTY COOE YEAR OlctDtNI', COMPU r: ADDlln NUMBER 1017 Hemlock Lane Eno1n, PA 17025 COIIIlI., Cumberland "MOUN' IlCUVlD ISIl INSUUClIONSI Supplemental Return o 3. Remainder R.lurn (lor do... 01 d.o,h prlor.o 12.13.821 o 5. Federal Eltal. Taa Return Required -D8. Total Number of Safe Depollt Boa" 119 . 000.00 20.808.00 -0- (1) (2 ) 13 ) 141 -n- (51120.649.04 (6) (71 (8) 260.457.04 (9) (10) 19.584.14 26.130,40 Ill) 45.714.54 112)214.742.50 (13) (14 (151 1161214.742.50 (171 )C._II x .06 II 12.884.55 )C .15 a (1BI Discount Inlerell + (19) (20) 20. If line 191s greoter than llno 18, enler th. dlffer.nce on line 20. This h the OVERPAYMENT. aD 21. If line 18 Is greoler than lint 19, enler the difference on lint 21. This 11 the TAX DUE. A. Enltr the Inler,,' on tho balance due on line 21A. B. En'" 'h. '0'01 of line 21 ond 21A on line 21B. Thll II ,h. BALANCE OUE. Mak. Check Payabl. '01 R.gl.t.r of Will., Agent Check here If you aro requesting a refund of your overpayment. \ ~ :'~!':::-~ i~jj':' . ::<:. .::!:.- '-, (211 12.884. ~~ (21AI (2\B) , . ~.' .f;...~ 7,', ~ Act '48 of 1994 provide. for the reduction of the tax rate. Imposed on the net value of transfer. to or for the u.e of the .pou.e. The rate. a. pre.crlbed by the statute will bel e 3% (.03) will be applicable for estate. of decedents dying an or after 7/1/94 and before 1/1/96 e 2% (,02) will be applicable for e.tate. of decedents dying an or after 1/1/96 and before 1/1/97 e 1% (.01) will be applicable for e.tate. of decedents dying an or after 1/1/97 and before 111/98 e Spou.al transfers occurring on or after 1/1/98 will be exempt from Inheritance tax. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK (....) IN THE APPROPRIATE BLOCKS. YES NO 1. Old decedent make 0 tronsfer and: o. relain the use or income of the properly tronsferred, ....................................................... b. retain the righllo designote who sholl use the properly transferred or its income, ............... x x c. retain a reversionary interest; or ................................................................................... x d. receive the promise for life of either poyments, benefits or carei ....................................... 2. If death occurred on or before December 12, 1982, did decedent within two yeors preceding deoth tronsfer properly without receiving odequate conslderotloni If dealh occurred after December 12, 1982, did decedent transfer properly within one yeor of death without receiving adequate .constdoratlonV .. to....... 10..... .......... ........,.......... ........................ ...... I..............to..... x x ,- Ll:; 3. Old decedent own on 'In trust for', bank occounl ot his or her deothL.................................... x C) , ' ~ .- '- . IF THE' ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. -. rL , L. J ':i ~...., .l :J 0u \. " J , ' " ) .'.1' W . . 1 \" ~ .' ~ --..II .~-~._--------_.--. ..--.--- LAST WILL AND TESTAMENT I, KIM M. HOOVER, a resident of cumberland County, Pennsylvania, being, of sound and disposing mind, memory and understanding, do make, and TESTAMENT, hereby t,~ "fl"" 1:\:1;1" previously made by me. publish and declare this to be my LAST WILL reVOking any and all Wills and Codicils ;, ". ~-l . i '. ,I . .' "li'. I I declare that I am married to ROBERT HOOVER and that I have one (1) child, AMY LYNN HOOVER, born February 17, 1976. II I direct that my debts and funeral expenses be paid as soon after my death as is practicable by my Executor out of my residuary . :;'.' .... from any assets, funds, death benefits or insurance .0" I. ,"If,- "i' :.:~: ar.; are otherwise excludable or exempt from my gross estate, but not proceeds which estate for federal estate valuation or tax purposes. .,' ',I"" ... ':~.." .,'j , ;. ',", 'oj; ~ '''.. "1.: .:J U'''1t t..i.li."l.. Lh,-' X direct that all estate, succession, legacy, inheritance . ' 'r ,~. 1;:r,...1 j~r\;,r.rt or other transfer taxes, however designated that shall become payable by reason of my death in respect of all property comprising my gross estate for death tax purposes, whether or not such property passes under this LAST WILL, shall be paid by my Executor out of my residuary estate, but not from any assets, funds, death' benefits or insurance proceeds which are otherwise excludable or III " exempt from my gross estate for federal estate valuation or tax t': purposes. ',:", I IV , , I give, devise and bequeath all my property, whether real or .....\. . '. personal, wherever situate, including any property over w~ich I may have a power of appointment to my husband, ROBERT, provided that '. he survives me by thirty (30) days. V If my husband, ROBERT, shall predecease or fail to survive me by thirty (30) days, I give, devise and bequeath all of my property, whether real or personal, wherever situate, including any property over which 1: may have a power of appointment, to my daughter, AM~ LYNN HOOVER, per stirpes, pursuant to the terms of the hereinafter included Trust. V1: ~UARDIANSHIP 1:f my husband shall predecease me and my daughter, AMY, " t" i V:x::x: TRUST If my husband shall fail to survive me by thirty (30) days and my daughter, AMY, is under the age of twenty-one (21) years and survives me, I appoint my husband's sister, BARBARA RICHARDS, as Trustee of the property that 1: have given to my child. B. The, Trust estate shall be administered until my child reaches the age of twenty-one (21) years. until that I ,time., ,. the Trustee shall apply all net income and principal of the Trust estate as follows: So long as my child is under the age of twenty-one (21) years of age, the net income of the Trust shall be paid to, or applied for the benefit of my child at such times and in such amounts as the Trustee shall in his discretion deem necessary for his support, welfare, maintenance and education. Education shall be defined broadly to include not only that available in college, but also trade school and other similar training. In the event that the income shall be insufficient to provide my child with adequate maintenance, support, welfare or education, the Trustee may invade the principal of this Trust for this purpose. 2) The Trustee in exercising his discretionary authority with respect to the payment of income or principal of the Trust Estate to my beneficiary, shall take into consideration any income or other resources available to my child from sources outside of this Trust that may be known to the Trustee. The determination of the Trustee with respect to the necessity of making payments out of income or principal to my beneficiary shall be conclusive on all persons howsoever interested in the Trust. ,.\,,"':> 1) ". .' ,\ Ir?i' ," "d ,'... ,I.. .... ....;{Ilw,..:.....~;,~~' ;..' "" " ., .. 1, ~ ",.AI": ...4'..-'.( . I. ,.,V~It:1 The Trustee shall accumulate and add to principal any net income of the Trust not paid out in accordance with the discretion hereinabove conferred on the Trustee. 4) In,the event my child predeceases me or dies 'prior'to the'termination of this Trust, the interest of, my child in the Trust shall . cease, except that, if she is survived by any children, then the' Trustee shall pay, net income of the Trust to or applY the same for the benefits of such children'of 'my deceased child, in such amount or amounts as the Trustee in his sole discretion may determine for support, welfare and maintenance. 3) c. When my child reaches the age of twenty-one (21) years, ',' . a calculation of the property remaining in the Trust shall be ~~de ~. . .' . , and the total thereof shall be distributed to her. D. .My child, as beneficiary of this Trust, shall not have any right to alienate, encumber, or hypothecate her interest in the principal or income of the Trust in any. manner, interest be subject to claims of her creditors attachment, execution or other process of law. nor shall any . '.,' . .::. ;. ~: t.:. or liable to E. In order to carry out the established by this will, the Trustee, purposes, of this . . .' .' '~1. .. .,', -. , in addition' €i:i' 'ali. Trust other powers granted ~y this Will, or by law, shall have the following powers over the Trust estate, subject to any limitation specified . ,. elsewhera in this will: 1) To retain any property received by the Trust estate for as long as the Trustee considers it advisable. 2) To spend funds for the maintenance and repair of real property. .' , ' 3) To sell at public or private sale,. exchange or lease for a period of time, any real or personal property and give options for sale of the lease. To execute and deliver any deeds, leases, assignments or other instruments as may be necessary to carry out the provisions of this Trust. 4) " 5) To borrow money and to mortgage or pledge any real or personal property. 6) The Trustee shall maintain accurate records and accounts and shall render statements to my beneficiary hereunder Showing receipts and disbursements of principal and income no less frequently than annually. The Trustee shall serve without bond and shall receive fair and ,';. reasonable oompensation administration of this Trust, exceed five (5%) percent of income .. for not to annual . , 7) 8) To distribute property in kind. , To do ~ll other acts that are in his .r ,t I' tl'..~ judgment necessary or desirable for the " ': i-.ld proper management, investment an'd \ I '.:j(hll~.-'ltl distribution of the Trust estate. ",,,' , .. .\1' ,U / r..r:<.:tU t\llt)' VIII ','," .' 'I' . ."\l~ ':! ; I nominate, constitute and appoint my husband, ROBERT, as Exeoutor of this LAST WILL, to serve without bond. If my husband is unable or unwilling to act in that capaoity, then I nomina~e, . ',.",', ,_tl I constitute and appoint my husband's brother, RICHARD'HOOVER, as Exeoutor of this LAST WILL, to serve without bond. IN WITNESS WHEREOF, I, KIM M. HOOVER, have set my hand to. this LAST WILL this If'th day of ma. y , 1992. ~~, ~~;; . ..M. HOOVER signed, sealed, published and declared by the above-named KIM M. HOOVER, as and for her Last Will and Testament'; .in. 1;he1i presenoe of us, who, at her request and in his preseric~".'li.nq:'~r\';;ti'\~",\ presenoe of each other, have hereunto subscribed' our names, s witnesses. . .' . ~~~..' " . TI I :. '. ,J\ ~ i ;.....1 " .' ,~.... \," ~,..' . , .. AClQIOWLBDGBKENT COMMONWEALTH OF PENNSYLVANIA . . ss. COUNTY OF CUMBERLAND, I, KIM M. HOOVER, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified aocording to law, do hereby acknowledge that I signed and executed the instrument as my LAST WILLI that I signed it as my free and voluntary act for the purposes therein expressed. ,. . ,." , , v 7h (I - ~A g~. HOOVER~ Sworn or affirmed to and acknowledged before me by KIM M. HOOVER, Testatrix, this -'Tfh day of ma.l ( 1992. (juh 4 ~J~ Notary Publ[o.J'" ..~;,,:....i:-"''''':''. ",", .,~.--........ i.fI, ;~'. .~f..'~'.l", ....-=.~..~.r:.:~... '. '-I. .", 'r^~ e-' 4 . /~\...~":":;;-.~"" .1..... fr!;!:;r.!~;... r"": : r.r.-:- :~.'l L _ . :2'" ._' i\~~r~,),?~~.t '.' .........;. . :'~. -' -,;,~~... -..t,.,."" NolaIIaISeaI COlla F.1lnlI<8nsIWe, NoWy P\.IlIC MecI1:lt1IcsIlLr Boto, Cirnbeftilnd Cou!1lY MtCc<MiSSlonElcplresApl1l I, 1095 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA : ss. COUNTY OF CUMBERLAND We, !l1urre.k R Waller"" fll an~ fiJ. l11a.r1!~omE{...5 , the witnesses whose names are signed to the attabh~d or foregoing instrument being duly qualified according to law, do depose and say that we were present and saw Testatrix sign and execute the instrument as her LAST WILLI that KIM M. HOOVER signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses I and that to the best of our knowledge, the Testatrix was at the time 18 years of age or more, of sound mind and under n constr'j) or d influence. r rt ~..- and acknowledged before me ;?1a. (' , 1992. r1tuh :;j 4~~L Notary Public Sworn or affirmed to this If"th day of .~~..,~~..,.,...,. ,,(, CMaF.~~ . ~'.' I'. M~Boro. ~:.I, :1' M1CorrmsS1onE>P~ 1,1 .. , , ' .. , f' . 'j~ .;;;. P 102-DEED-WARRANTY IND. OR CORP. AOD Copyrlghl1010' bV ALL.STATE LEOAL SUPPLY CO. On. Commlfc. Orlvl, Cr.nlold. N. J. 07016 ml1ill IDe.ell,lIll1dollto 6th November 19 07 dUll uf llJrlluftll Band D LllND CO., INC" ^ Pnnnsylvania Corporation I/Urdu de8il/llIIl,'d II.' IIIe Gmulllr.., All II '. ROBERT HOOVER and KIM M. HOOVER, his wife, I",reiu de..iYllulerlu.. IIIe Gn/lllcc..; IDltnrllrUf, fltut lito Gmntors. for alld in callsidemlion of EIGHTY-EIGHT THOUSAND NINE HUNDRED ISBO,900.00) DOLLARS lawful/llonell IIf tlto Ullited Stules of II 1Il01;CU, to tlto Gnllllor.. in ltulIll wdl 11I111 Indy IlIdd by lite Gmlllee.., at or before flte sealillY ullll delivory of tltese 1,,'e8ellls, lite receipt wllerell/;s here/,y Ilc!wllwlcd//ed ","I Ihe Grantors beillY tlWI'OWitlt fu/lll srlli..jiod, do bll tltese I,resellls yn/lll. bur//u;II, sell flllIl CUlwCII 1111111 Ihe Grallfoos forever. 1\11 that certain tmct or /lurcd oJ'lulld and wellli.es. sitllule, IY;IIY lIIul beillY iu Ihe Township oj' East Pennsboro ill till! Cllllllty IIf Corrber1and ullll COlllllWllweult1t IIf /'OIllISlllvUlliu, /IIore IJrtrlicularl1l desclibed us )'o/l",es: BEGINNING at a point on the northern right of way line of Hemlock Lane, a common corneL of Lots No. 106 and 107 as shown on the hereinafter named plan of Lots; thence along Lot No. 107 North 12 degrees 54 ' West 105 feet to a point at other lands of Grantors; thence along said lands North 77 degrees 06' East 79.55 feet to a point, common corner of Lots No. 105 and 106; thence along Lot No. 105 South 15 degrees 53' 24" East 104.31 feet to a point on the Northern right of way line of Hemlock Lane; thence along said Hemlock Lane by a curve having a radius of 610.0 feet and an arc distance of 31.03 feet; thence along same South 77 degrees 06' West 53.17 feet to a point; the point and place of BEGINNING. BEING Lot No. 106 on Final Subdivision Plan No. 3 of Treemont, recorded in the Cumbeland jCounty Recorder's Office in Plan Book 34, Page 131- CONTAINING 8,631 aquare feet. UNDER AND SUBJECT, NEVERHELESS, to restrictions, conditions and easements of prior record, pretaining to said premises. BEING PART OF THE SAME PREMISES WUICH Newton C. Landis, Executor of the Estate of John L. Gutshall, by Deed dated January 10, 1973 and recorded in the aforesaid Recorder's Office in Deed Book Z, Volume 24, Page 461, granted and conveyed unto the Grantor herein. " t. ,hi f J.=.-(/4/~4..51..., l'O I ,~. l,P 0 .................... ;;.= d .s Z I ~ 'I 'lu' J 0 "'. Cumb, Co., P.. 5 h r Dl t C b C P tll Roof EII.,. T....r.. Tn c 00 s. urn. 0" a. _ \.'.F , J t '0 ...---.... ~ <;(. 5 -e If' ,'T-' - ;;.1". Ru~ E'~.I. Tun.I., Tn '.. .', ...) ~. .........\-.4~Aml\~.. ro. - 6'v~' 't't+J7.' I ;~:;::::::;:..:~ .,)_ _~ r-"lU O.'.Cl......~U.. AmI. ......;-; -.....;:'m),~I. <;:.. A~i. ---..; --Tr;::.,"',..-="n IT: \ ~ ," ~"',~ ~-'-.J~ .' . . eoct/J!33 ?AGE 775 . , ;'i, ; ,~,;..~ " iIlourl/rrr wilh all and sillunlar Ihe buadillus, improvomonls, wails, woods, walers, watercourses, riUltls, liberties, PI-iVaeuos, heredilamenls alld al'pnrlenallees 10 Ihe same belollUI'nu er in anllwise allperlaillinu: alld Iho reoersion and reoersiolls, remainder /lIIII romaillders, renls, isslles alld llI'O)ils Ihereo): alld oj' every pari alld I/nrcel Ihereo!: AIIIl alBo all Iho eslale. I-iUhl, tille, illleresl, nse, Ilosimssiell. Ill'Operlll, claim alld demalld wlllllsoeoer of 1110 Gralllers bolh ill law and ill equitll, of. ill alltllo 11I0 Ilremises hereill dcscribed alld every pari aml'larcel lIIereof with 1110 IlllllUrlenallco". iIlD I,nur nnll Ie 110111 ull alltl sinUlllllr IIIe /lI'cmises IIereill described 10yellwl' wilh IIw IlerolUlllmellls/llll1 lIllllUrlelllll/Co., Ill/III lite Gmlllcos Illltllo Grulltee.,'llro/ler use alld belleftl forever. AlIll Ihe Gmlllors COOOIltll/llllal. exccpl lIS mall bo llerdll sel)urlil, Iltey do und will forrurr warrant alld llrfrnllllw lallds UlIII'I/'ellll:'cs,lwrellitumellls /llIIlallllUrlellttl/ces horebll cOllvellet/.uyaillsl IlIe Gllmlors alld all oilier I'ersells lawfully clnilllinll lite sllmo or lu claim IIIe .,ume. Irl all r'lferellCCs "ereill 10 lI11Y I.".lie., Ilel~lII'H, ell lilies ar eO/7ll/mlia/lH, llee "He a}' /11'1/ Ilorlielllllr O.IIder ar lI.e 1II0ral oraillDolor /III/libel' i. i/llewlod III i/lel/lde /I.. IIIII/1Vllrill/e oewlOrar/lllmberlls /I.. Ic.rl a}'t1.. wille ill illslnlflwIII 11/110 requi'TVherever ill ihia inslnm,e", fJIly'lmrty !huu be (/C!siUIIClled ur "f1Jrrrcd to by 'unite ur ucrwrollvJereJlCfJ, Buch deai""u_ lioll is illlel/ded 10 alld .leall leave I.e SIlII/O ol}'ec/ '13 V llee ward. ""ei,., c.reelllars, o"millis/I'Illars, I'ersollol ar leyol repreaelllativel, !llcee.taor.! ami fUlsr'yrrs" hllei bee" iuser/cd tlJler each amI every sIIeh deaiYllutiull. III mllllfDS Blt,rrrol, Ihe Gral/lors IIave 1""01/1110 sel Ilteir "alltls II/1d sOllls, ar if I. e0l7/Orulial/, illllls caused I"ese pre.ellls 10 bo siYl/ed by ils Imlller corpol'alo o)lieors ulld ils corporule so1l1 10 bo 11ITIXcd Ilerelo, Ihe day alld Ileal' firs I above Wril/oll. .' 1L~~. --::::';;;L..r--' ............;r,d....~.:.::-::..... ..... t:'.((;""'~..........,S~,~ .."" ,0oiO .' 'l>t .........1.'" .0'- /1 '. -, .. 0"11. .' '''' If:' to ~.' ~.',..l, 'r;. ~,,".<J'" .::....:..' .- .~. .. : ;7.": ::: ~ r.~') ,~. t~J : tf,) . ..~ "~":J'''~'~' ", ~ r' ...... '.:"I .: ::-':..' l"'('~ . ~.'~.' '~/!I,'II.. .;.~..... b .. ........,.,.\\~.. 1'/1.11. ,...., ," 'Io'~l; 8 and 0 Land Co., Inc. B'y' Samuel L. Reed, .............................................................................. . <l!ullIUUll\wrulll, IIf ~rltltll!lluul\lu. <l!ultl\'!Il1f iIIr It iIlrlllrlllbrrrll, Iltal all ,,~ c,. IBB.: 1!J 8. -, , be)bru 1110 litO Hllbscriber lJer.'OIlt,lIy uPI,ollred Samuel L. Reed, Sr. " kl/oWII 10 11I0 (or slllis/flcIO/oj/y 1,,'ovolI) 10 bo lite /lersoll wltose Iltllfle subscribed 10 lito wilMII tleed Imd flckllowletluetllltal Ite excculed lite SU1ll0 )ur Ihe 11/1I1/rmes IIw/,e;,/ cultlflil/etl. mUllrDa lilY Ituwlmlll .'!111 lite ./flll Wid Y'!II/, IJjil/wuill, ,So' '.':" ;?~;~ ~~ Q. . . .',7;. :!J.!"" .. Q.J...: 'I:).., ,I. ...-.....,.. . wI - - . ,. . \ '. ................................Q.............,.. .. \ r....".....'....r. (\);;~ ~. . 'J. i' '''''''l \ . .... . '. ......., ....-i. '\ -. .,0"" /;.....,....:: ;"; :-;'l';'~:,. ; ,,-,;;..h ,t, . t" ....,.. ". (''S'" r .... ::"'1," ",.''..1,'.''':/ ~ .,1.;',' i .~. ..~.., " . ":.';, ~ BMSARA n. PHil II'S. VQr^~y PIIBIIC CAMP IIIlL upronUGII. ~1:~\Ufl:lANl' ~UUNIY MY COMMISSlv"I;~I.mi G JUn lG, I~n Mlnlb;r. Pcnnl)'f13nl1/l1,ucl~UlJn IIf Hot,.,l.. ~:QOK'i1133 PACE 776 . . ",1\' }f~: ((lomlllollutrultl, of lll'lI1111!1luulllu. ((lullllt!lllf CUMBERLAND /1IB,: llb It illrlllrlllbrrrb, 111111 011 19 B7 . buJill'11 '110 1110 slIbscnbur, November 6, Ilorsollallll al'l,earor/ Samuel L. Read wllo ackllowlel/oed him solf 10 bo III~ Pros1dan t oj' B & D LAND COMPANX, INC. a Cm710ralloll, and IlInl beino alllllOn:er/ fo I/O so a,l sllcll cOr[lOralo ojJicor exoculur/ Ow JiJruyoillfJ illslnunolll lor IlIe IllIrposos tlloroill cOllf"illorl 011 bellalf 0/1110 'cor}loralioll, , DIltl1rD8 mll/wllII alii/ slial file dall "1lI/lIoar "Iorcsrn'd. /' . ''-J f ":..",.,,,/ :. ( / ~ U , .', I. ~ '.. .J .,.....~(~..g_........,... II . ~. ..... ~....... 1"\ ,,:." I:'.... '.' . ). ,,'_ ,I.. 't I, .., . ^1U:! 'I. DYnllC, IIOTr.n~ runll.c'J:' ....;:i... '..:. ': IWOVII[ SOIIO, CUIAB[fIWlU C~e//TV 'In.. ," :.t i ~ I.1Y COL1MISSIOH EXPIHIS AUG. 26"Ul . ." '. t, ,',' 'I ember, r,n;llylnnla Amc/aUou o"~,!!,!~~r.... . ..:?.:.l'./ .,...........'....f.',. ... .' ,,1.....,... .\' .' ./:1':"'l""'.'. \ " . " u :';',,' \1 ." . ,..,..-..... ..... , 1-' ~..'-....~:'. .. . SlillG' ol:rn~Ar;~~i/i~;~" \- C~li;,ly.jd~1un.111{:..r4Ii\1~t 88 RaGl;1rae9: In-mc!'.orIiJq' ,~i.lhe recordlno of Doetls ,fll~i~n.:i ,3. n~!c.>r~tjr!an.'a County PII. 1~I'abcW:' ~;.:;""l~'" . -nr '" 1('" \, . '. ,V.91-:v-..:!... Page ,'.~~~,'my.~~anar'a(l" seal of floe at C . ., #0 ~U~t. .. }f.. , ar . p., "'...' .:-":.\......; yo ( . ',/ '. '., .... . ~ ,I ,,;. .. ~.I ~ ..... . ". .:'1 ,.., . ." . ' ...,'....::',: .{!o\\ ~"l" .,.' A d "0, .'..:I~"J'''.. .... acor ar .p~ 10"," "0' 0 1 9 9 7 f'- ~ .;~.~ en '" x',~, !Uo ... ~r.: po. ~..; ;F]$: "II'~ iii) :J:z l~ .;. -1~ .. om .. ". . "',- ~ '" ~-~ ;":r ~ t'(~'~.0'~ C fI Mt~'" 100 E-o .', .)<:~ I ..:.. "n . ("'-"<I "~ fit) 8 \l) r.l~ 2. -, ~ "'" 0') I j; (Q / ;s .:::: 'J ~ c:l :;; ~ ~ 'tI -- > .. 1I1111iilllllll ~ .. lQ l:l r E 1/ II~ S DOV UU. ... .. ~l'l .~ 'S f\I e ...'Qo .;:\~ " .. "'tl j " ... .. -s'1:l ;tl tI ~ -slf!. ~ ~ ~tl r~' !Sa t~ ~ ;! t; ... u~ 'tI'" t~ . '1:1 ~jl .~ 'tI ~,!1 5~~ .j 15 ... '13 l:l ~...~ . '."1' ,:.. J. : ,,' ; ! ~ _I : ~ . J ,'; " ' I . .. .. "-' "ll"',M ,.., ,I 't.i', :j{1 ':: C'fi'lO:,,'1 "", ,'...., :,'_." -. .1 ;~ 01.. .:f',' ;'. If:' ,; I:" ,'; ;:;~:J;~.~;jLJ IlDD~m 33 rAGE 777. ..' ",..1503 EX. 1'.161 ~ COMMONWEALTH OF peNNSYlVANIA INHfRlTANCE TAX RETURN RESIDENT DECEDENt SCHEDULE B STOCKS AND BONDS . ESTATE O. F E NUMBER Hoover, Kim M. 1995~00395 (All proporty lolntly-ownod with RIght of SurvivorshIp mUll bo dllclolod on Schodulo F,) NulTMEMaER DESCRIPTION VALUE AT DATE OF DEATH 1. PPG Industries, Inc. 544 Shnres Common stock @ per share 38,25 20,808,00 " TOTAL (AI.o onlor on IIno 2. Roco lIulollon) (IF more space is neeaea, Inserf aclcJilionol sh..,s of some size.) S 20 808 IlVoI'" U. p.II, *' SCHEDULE D MORTGAGES AND NOTES RECEIVABLE Ploa.. Print or i 0 FILE NUMBER 1995-00395 COMMONWUUH O. ,ENNSYWANIA INHII,TANCI T.lC InUIN ..IIDIHT DICIDIN' ESTATE O' Hoover, Kim H. (All property 1.lnll.,....n.d with the Rllht.f SUf'Vlvorthlp mUlt be dl.clo.... on Schedule P.) ITEM NUMBER VALUE AT DATE OF DEATH DESCRIPTION None .' S None ,,, more space is n..ded, Insorl additional sh..1s 01 same sin.' . '1~1JOalhn"71 . ESTATE OF .-!;,~ SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY COMMONWUlTH 0' peNNSYLVANIA INHUITANCI TAX lnulN IUIDINT DICIDINT Pleas. Print or r e FILE NUMBER 1995-00395 Hoover, Kim M. (All property lolnlly.owned with the Right o' Survlvonhlp mud b. dl.c1o.ed on Sched"l. PI ITEM NUMBER 1. 2. .' ." VALUE AT DATE OF DE-!\TH 574,89 994,22 2,473.65 876.08 315,52 J 5,255,77 i 28,970.54 I 100,00 802.73 457,44 3,300.00 291.00 275.00 1,030,00 74.932.20 DESCRIPTION 9. DOT Co. 43973647 10. US Savings Bonds Interest United Concordia Paycheck United Concordia Paycheck 3. United Concordia Paycheck 4. 5. 6. US Savings Bonde (See attached) PPG Industries, Inc. stock dividends DOT Co, 7. Pa. Blue Shield voluntary investment plan 8. Blue Shield payment for Uto10gica1 Assoc. of Lancaster 11. Kelly S. Lippy-'89 Cavalier 12. Refund of Insurance Premium. Erie Insurance Company 13. Po. Blue Shield reimbursement for Lnncaster Orthopedic and Surgical Association of Lnncaster 14. Brickers Auction (personal property) 15. Proceeds of Survival Action by Richard Hoover, Executor of the Estate of Kim H. Hoover RICHARD HOOVER, Executor of the estate of Robert Hoover, Deceased and the Estate of Kim H. Hoover, Deceased Plaintiff v. WEAVER W. MARTIN and LEONARD H. MARTIN Defendants (See attnched Court Settlement) COURT OF CO~~ON PLEAS OF CUMBERLAND COUNTY, PENNSYLV IA CIVIL ACTION - LAW No. 95-4605 TOTAL Also enter on line 5, R~'ca S120.649,04 (AlIach additlanal aYJ" )( 11" ,h..1I If more .pac. h n..d.d,l \ , 'f i~-.' '. .... -.,..--...---.--.-......--......--,.. 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II .' lit. , '. ..' h\' "" ...u......" '"Iulh''' uzou__..f.: ' I 047ZUSlDI ~~\11. WW\,I !!.~.~A.~~g~;:: t :C'I"2Sb3DD.LEE ~..'I:OOOOqOOO?I:O~ g /O~?I5'300 l~ 8ELUliS EK ..................... I ~~-;fM (~;~, ~ 41 " ;I ;, if ~: James B. Pannebaker, Esquire PANNEBAKER AND JONES, P.C. 4000 Vine Street Middletown, PA 17057 (717) 944-1333 I. D. No. 09667 Attorney for plaintiff RICHARD HOOVER, Executor of the Estate of Robert Hoover, Deceased and the Estate of Kim M. Hoover, Deceased : COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : CIVIL ACTION - LAW ~ No. c;f- ~G()~~;j~ . . plaintiff . . . . v. '.. '". . . WEAVER W. MARTIN and LEONARD H. MARTIN Defendants . . ORDER l:p;~.".. - /' Petition for AND NOW, this /~ day of , 1995, upon Approval of Settlement consideration of the Plaintiff's in the above captioned case and the under-insured motorists benefits offered by Erie Insurance company, IT IS HEREBY ORDERED as follows: 1. The settlement of $750,000.00 in the above captioned case and $100,000.00 from Erie Insurance company in payment of its under-insured motorists benefits for Robert and Kim M. Hoover, Deceased, is approved and the fol~owing distribution of the proceeds shall be made: a. Damages recoverable for Robert Hoover, Deceased, under the .wrongful Death Act to Amy L. Hoover in the amount of $224,796.59 ." - 1 - g. Reimbursement to pannebaker and Jones, P. C. for out of pocket expenses in the amount of $ 508.52 h. Attorney Fees due to Pannebaker and Jones, P. C. as a result of the above captioned case for Robert Hoover, Deceased, in the amount of i. Attorney Fees due to pannebaker and Jones, P. C. as a result of the above captioned case for Kim M. Hoover, Deceased, in the amount of $ 93,750.00 : $ 93,750.00 j. Attorney F~es due to pannebaker and Jones, P. C. as a result of the settlement of the under-insured motorist claims for Robert and Kim M. Hoover from Erie Insurance company in the amount of $ 25,00D.00 BY THE COURT: j,J C:L,,", , g A .I.y 'I d /. :dkm HOOVERORDR J.4244 - 3 - J. James B. Pannebaker, Esquire PANNEBAKER AND JONES, P.C. 4000 Vine Street Middletown, PA 17057 (717) 944-1333 I. D. No. 09667 Attorney for plaintiff RICHARD HOOVER, Executor of the Estate of Robert Hoover, Deceased and the Estate of Kim M. Hoover, Deceased COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW .: No. Plaintiff v. , -~ C: .., u.) = WEAVER W. MARTIN and LEONARD H. MARTIN Defendants CJ:) .: ;. -. .:"~ 111 PETITION FOR APPROVAL OF SETTLEMENT:~~~ 0 I.. ',' :::- 1';' -~;." ::J: Richard Hoover, as Executor of the Estates of Rob~~t H~er, , .-: c...n Deceased, and Kim M. Hoover, Deceased, by and through his Attorneys, pannebaker and Jones, ,P. c., and Amy L. Hoover, sole Heir of her Parents, Robert and Kim M. Hoover, petition this Court for approval of settlement of this claim, respectfully representing that: 1. Robert Hoover, age 44, of 1017 Hemlock Lane, Enola, Cumberland county, Pennsylvania, died on May 11, 1995, as the result of closed head and internal injuries sustained in an automobile accident. 2. Kim M. Hoover, age 41, of 1017 Hemlock Lane, Enola, Cumberland county, Pennsylvania, died on May 11, 1995, as the result of a blunt head trauma sustained in an automobile accident. 3. Said accident occurred on May 11, 1995, on PA Route 41, one quarter mile south of Newport pike, in Sadsbury Township, Lancaster - 1 - . , county, Pennsylvania when a cattle truck, owned by Defendant, Weaver W. Martin, and driven by Defendant Leonard H. Martin, swerved into the south bound lane, where it collided with the Hoovers' 1956 Classic Chevrolet. 4. As a result of said accident, Robert Hoover, while alive immediately after impact, died shortly thereafter without regaining consciousness, and Kim M. Hoover, while never regaining consciousness, died approximately six (6) hours later at Lancaster , General Hospital. 5. Defendants have denied all liability. Thus, a genuine dispute exists in this case as to the liability of any of the defendants for the deaths of Robert Hoover and Kim M. Hoover. 6. Amy L. Hoover, age 19, who resides at 1-A southmont Drive, Enola, PA 17025, is the sole Heir of her Parents', Robert and Kim M. Hoover, Deceased, Estates. 7. The parties to this action and Amy L. Hoover have agreed, contingent on this Honorable court's approval, to a resolution of this matter by payment of $850,000.00 in full settlement of all claims under both the Wrongful Death and Survival Acts in this matter. The $850,000.00 settlement is made up'of $750,000.00 offered by the Defendants, Weaver W. Martin and Leonard Martin, and the remaining $100,000.00 is being offered by Erie Insurance company as a result of the Robert and Kim M. Hoover's auto insurance policy which provided for $50,000.00 per person of under-insured motorist coverage of the Hoover's policy. - 2 - 8. Plaintiff respectfully requests that this Honorable Court approve the proffered settlement of $850,000.00 as fair and reasonable under all circumstances. 9. Plaintiff, Richard Hoover, Executor of the Estates of Robert Hoover, Deceased, and Kim M. Hoover, Deceased, and Amy L. Hoover, sole Heir of Robert and Kim M. Hoover have agreed upon a 25% contingency fee based upon settlement of this case prior to the commencement of a suit. A copy of the Fee Agreement is attached as ~ Exhibit "A". Plaintiff respectfully requests that this Honorable court approve payment of 25% of the Settlement of the above captioned case for Robert Hoover in the amount of $93,750.00 and 25% of the settlement of the above captioned case for Kim M. Hoover in the amount of $93,750.00 as Attorney Fees to Pannebaker and Jones, P.C. for the Settlement of the claim against the Defendants, Weaver W. Martin and Leonard Martin; and 25% of the under-insured motorist claim being paid by Erie Insurance company to the Estate of Robert Hoover, Deceased, in the amount of $12,500.00 and 25% of the under-insured motorist claim being paid by Erie Insurance company to the Estate of Kim M. Hoover, Deceased, in the amount of $12,500.00. 10. In the preparation of this case, it was necessary for counsel to advance various costs for medical records, consulting actuaries, etc. A tabulation of these costs paid on behalf of the Plaintiff, is in the amount of $508.52 (see Exhibit "B") and it is requested that these costs be divided equally between the Estates of Robert and Kim M. Hoover. - 3 - . 11. Plaintiff respectfully requests that costs in the amount of $254.26 from the settlement for Robert Hoover, Deceased and $254.26 from the settlement for Kim M. Hoover, Deceased, be awarded to Pannebaker and Jones, P.C. for the costs incurred on behalf of Robert and Kim M. Hoover. 12. Upon approval of the aforesaid Attorney's Fees and Costs, the Plaintiff has a net recovery of from the above captioned case of $280,995.74 for the Estate of Robert Hoover an~~$2~O,995.74 for the Estate of Kim M. Hoover. The Estate of Robert Hoover will receive from Erie Insurance Company a net payment of $37,500.00 and the Estate of Kim M. Hoover will receive from Erie Insurance Company a net payment of $37,500.00. 13. A portion of the net settlement fund should be distributed under the Wrongful Death Act to compensate Amy L. Hoover for the pecuniary loss she has sustained as a result of the loss of her parents' contribution to her shelter, food, clothing, medical care, education, entertainment, gifts, recreation, etc. A report prepared by Economist, Harry M. Leister, Jr., F.S.A. of Harrisburg, Dauphin County, Pennsylvania, attached as Exhibit "C", indicates that Robert Hoover would have had a net loss after deductions for his cost of I maintenance of 38% of earnings in the amount of $452,1~1.00 and Kim M. Hoover, attached as Exhibit "0", after deductions for the cost of her maintenance of 28% of earnings, would have had a net loss of $772,713.00. 14. Amy L. Hoover resided with her parents at the time of their - 4 - death. Amy L. Hoover is the only person to whom Robert Hoover and Kim M. Hoover were providing financial support at the time of their deaths. Pursuant to Disclaimer signed by Richard Hoover, Executor of the Estate of Kim M. Hoover, and approved by the orphans' Court. by Order dated , the Estate of Kim M. Hoover disclaimed and renounced all of the right and interest of Kim M. Hoover to the proceeds of litigation or the settlement thereof instituted with respect to the accidental death. o~ Robert Hoover on May 11, 1995, and as to which the Estate of Kim M. Hoover. might otherwise be entitled as a surviving spouse of Robert Hoover. A copy of said disclaimer and order are attached hereto, marked Exhibit "E", and made a part hereof by reference thereto. Therefore, Amy L. Hoover is the only person who stands in a family relation to the deceased and is statutorily authorized to recover damages under the Wrongful Death Act. 15. plaintiff therefore requests that $224,796.59 be distributed to Amy L. Hoover as the sole surviving ~eir of Robert Hoover, Deceased, and that $224,796.59 be.distributed to Amy L. Hoover as the sole surviving Heir of Kim M. Hoover, Deceased. 16. Pursuant to 42 Pa.C.S.A. S 8302, the remainder of the Settlement Funds, should be distributed under the survival Action in the amount of $56,199.15 to the Estate of Robert Hoover, Deceased, for his Heir and $56,199.15 to the Estate of Kim M. Hoover, Deceased, under the survival Action for her Heir. 17. Plaintiff respectfully requests that the remainder of the net funds, after attorney fees, provided by Erie Insurance company - 5 - , .. ..._-~ - ---.."-~- .-.... "")1< " as payments for under-insured motorist coverage in the case of Robert Hoover, Deceased, be distributed to Amy L. Hoover as sole surviving Heir in the amount of $37,500.00 and in the case of Kim M. Hoover, Deceased, the sum of $37,500.00 which will be paid to Amy L. Hoover under the Pennsylvania Wrongful Death statute. lB. The Plaintiff, Richard Hoover, Executor, and Amy L. Hoover, sole surviving heir, are agreeable to the payment of Attorney's Fees and Litigation expenses and requests this Honor~ble Court to approve ",. .... . settlement of this matter with distribution of the funds to be paid as listed below: a. Damages recoverable for Robert Hoover, Deceased, under the Wrongful Death Act to Amy L. Hoover in the amount of $224,796.59 b. Damages recoverable for Robert Hoover, Deceased, under the above captioned Survival Act to the Estate of Robert Hoover in the amount of $ 56,199.15 c. Damages recoverable for Kim M. Hoover,' Deceased, under the Wrongful Death Act to Amy L. Hoover in the amount of d. Damages recoverable for Kim M. Hoover, $224,796.59 Deceased, under the above captioned survival Act to the Estate of Kim M. Hoover in the amount of $ 5'6,199.15 e. Payment received from Erie Insurance Company under casualty - 6 - '. f. g. insurance policy of Robert and Kim M. Hoover for Robert Hoover payable under the Wrongful Death Act to to Amy L. Hoover in the amount of Payment received from Erie Insurance company under casualty insurance policy of Robert and Kim M. Hoover for Kim M. Hoover payable under the Wrongful Death Act to Amy L. Hoover in the amount of Reimbursement to pannebaker and Jones, PC for out of pocket expenses in the amount of $ Attorney Fees due to Pannebaker and Jones, P. C. as a result of the above captioned case for Robert Hoover, Deceased, in the amount of Attorney Fees due to Pannebaker and Jones, P. C. as a result of the above captioned case for Kim M. Hoover, Deceased, in the amount of Attorney Fees due to Pannebaker and Jones, P. C. as a result of the settlement of the under-insured motorist claims for Robert and Kim M. Hoover from Erie Insurance company in the amount of - 7 - $ 37,500.00 ..' ~ $ 37,500.00 508.52 h. $ 93,750.00 1. $ 93,750.00 j. $ 25,000.00 . <'''.-''.' WHEREFORE, plaintiff and Amy L. Hoover, sole survivor of Robert and Kim M. Hoover respectfully requests this Honorable Court approve the settlement as proposed above and distribution as requested herein. PANNEBAKER AND JONES, P.C. By: a~M'. W~ Amy L. Hoover sole surviving ~ .By,i~~~ Executor of the Estates of Robert Hoover and Kim M. Hoover - 8 - . . . , . , ~he above petition has been reviewed and is approved en behalt , of the O~fendants, Heaver w. Martin nnd Leonard H. Martin as presented: ATTORNEYS FOR 'rHE OEFENDANTS: , I.., - ~ - ,o..^.- : .. VERIFICATION I verify that the statements made in this Petition are true and correct. I understand that false statements herein are made subject to the penalty of 18 Pa. C.S. 4904, relating to unsworn falsification to authorities. , ~MJ.'W~~ Amy L. Hoover Sole Surviving Heir VERIFICATION I verify that. the statements made in this Petition are true and correct.. I understand tha~ false statements herein are made subject '. to the penalty of 18 Pa. C.S. 4904, relating to unsworn falsification to authorities. ~~~ Executor of the Estates of Robert and Kim M. Hoover ,SST/dkm HOOVERPET 14244 - 10 - " PANNEBAKER AND JONES, P.C. CONTINGENT FEE CONT~C:""-J OJt.' IlJdMr', r~:/o:eif w/ ~ 'Till!' .,.r.-- '1 C""MCJ HoOI/.df'l";'(e~r/).f 0 '.,CLIENT(S) d-,!JM1N~v&'1 hereby employ ( s) PANNEBAKER AND JONES, P.C. as attorneys to fl/I?f//v'';{. negotiate a settlement, institute, conduct, superintend and i/pv~)lr&1(' prosecute to final determination by suit or action, if a claim arising out of an accident or incident on) the .' necessary, p.. # II day ,,..- of , 192.2, against any person, firm or corporation />11J'I 1 who. may_.in. the. judgment of.our attorneys be responsible therefor, including LtrOH.<ltff) ;-1 Mpt7 7'/111' .4-.10' ~'71IAdi .Lv /??,/J~'r//I/ !<.ft1 A I"',DCt:,t)/:''''1 . ........ st7't /. Uo "', >,)//rJl Or- /1",.,-:...l'anr' n J(t:'" ;_ U>.1'<.t>f/J.!,\ ~~,-,./rl rfJ, INVESTIGATE '~e agree that the said attorneys accept said employment on the condition that they will investigate the claim and, if it appears to be a justifiable and recoverable claim in their judgment, they will proceed to handle the same; but if, after investigation, the claim does not appear t9 be either justifiable and/or recoverable, then said attorneys shall have the right to rescind this Agreement and under no circumstances shall our attorneys have the responsibility to prosecute the claim for any amount in excess of the uncontested liability insurance coverage applicable to the claim. -1- COSTS AND EXPENSES OF LITIGATION We understand that we must pay all of the necessary costs and expenses incident to this case, including costs of investigation, clerks' fees, court reporters, depositions, stenographers, '. transcripts, witness fees, appeal fees, notary fees, long distance telephone calls, travel expenses, photocopy costs and anY.9t~er costs deemed necessary by our attorneys in order to properly pursue this claim. We also understand that we are solely responsible for and shall pay all medical bills, including hospital, nurses, doctors, medicines, x-rays, special studies, ambulance and the like. In the event of a recovery, we agree that all of these costs and the aforesaid expenses of litigation shall be paid from our share of the recovery. Should suit be unsuccessful and we recover nothing, we understand that we are solely responsible for these costs and expenses of litigation and our attorneys are not personally responsible for any of these costs and/or expenses. We understand that we will be billed monthly for the costs and expenses of litigation which are paid by Pannebaker and Jones, P.C. on our behalf. We also understand, that payment of the monthly invoices are due upon receipt. If the payment is not made in full within thirty (30) calendar days from the date of -2~ , receipt, pannebaker and Jones, P.C. will charge us interest at the rate of 1 1/2\ per month (18\ per annum) on the unpaid balance, and pannebaker and Jones, P.C. may cease providing services under this agreement and we hereby consent to Pannebaker and Jones, P.C. removing any court appearance that may have been filed for us and withdrawing from representing us in this matter due to our non-payment of monthly invoices. " ATTORNEY FEES Should our case not result in recovery, eithe~"by~ se~tlement, trial, re-trial, appeal or otherwise, we unqerstand and agree that we are to owe our attorneys absolutely nothing for their time and service. In the event of a recovery, our attorneys shall be entitled to the following contingent fee from any recovery made or secured of : ~(() ~oJl j' ~ 1).5'2 . (a) Tl.ir~x tR=ee and one- thirJ (33-1/jf) percent.of.gross amount if settlement is made ~g~~::~::'i~1~ommencedl Pf'l. ).~ 3 r;b (b percent of the gross amount I t~::~~::i~::~;:e~:N:J~e~ :l:~eNJh f4/~ ~c.tr evej)f of~~7 \~o ~ A~~C6utt. W ~ It is recognized and acknowledged that we want to reserve the right to consider a structured settlement of our claim and, in the event that this claim is settled in whole or in part on a -3- .. . ;1'.":;"',,,. , . , structured settlement basis, it is agreed that our attorneys' fee shall be calculated as previously set forth on t~e basis of the present value cost of the future payments to us as opposed to the actual payments themselves. It is also acknowledged and agreed that if we agree to settle our claim on a structured settlement basis, that our attorneys will have the option to structure all or part of their attorneys' fee. WITHDRAWAL ... We agree that our attorneys may withdra~ from fhi~ case at any time after reasonable notice to us, and we agree to keep our attorneys advised of our whereabouts at all times and to cooperate at all times in the preparation and trial of this case, and to appear upon reasonable notice for depositions, court appearances, hearings and .the like, and to comply with all reasonable requests made of us in connection with the preparation and presentation of this ca5e. CO-OPERATION All matters of pOlicy, including but not limited to Questions as to the preparation and presentation of the case, costs, expended or to be expended, the Question of settling, trying or -4- f " appealing, or any other such questions as they arise, shall be determined together by our attorneys and ourselves in a cooperative effort. AUTHORITY TO PAY CLAIMS We further authorize our attorneys to make payment from any recovery proceeds any outstanding costs, subrogation claims, medical or other bills and expenses relating to or arising from said claim or litigation. '. . . IN WITNESS WHEREOF, the parties hereto qave se their hands and seals this /p day of ~ ' 191J5. y:'j~/tt14-- (Sf:AL) 1..1 /Ct;~N~~n.1- dl.liZi '1 ~pt'~ ,/-):11<1 r~ (SEAL) c2~Jfi'. C;(/t'XV~~ )( SEAL) CLIENTV lVITNESS: (SEAL) PANNEBAKER AND JONES, P.C. BY: (~~ ATT~EY (SEAL) ljs(1:31) BY: ATTORNEY (SEAL) -5- "EXHIBIT B" COST ADVANCES MADE ON BEHALF OF ROBERT AND KIM M. HOOVER, DECEASED 05/19/95 05/31/95 Pa. State police-Accident Reports Barry Walp, Lancaster County Coroner Coroners Reports, Autopsies, etc. 05/30/95 Lancaster County prothonotary- Filing Fee, Writ of Summons Sheriff of Lancaster-Deposit sheriff's Service Fee WGAL-Copies of film of Accident Report Airborne-Express mail to Great Divide Insurance Company 07/13/95 Fine Art Photos-pictures of car before accident OS/25/95 07/07/95 JPL-Video productions, Inc. VHS tape TOTAL COSTS ADVANCED: :dkm HOOVERCOST 14244 '16.00 275.00 55.50 .. 76.70 31.80 15.25 27.67 10.60 $508.52 '. .:';:.,~,- .---"- '.--'~-"" , : '-~I dM S' . 1 T~L..~l.I U . A LAO. _a. lege, lli"t" ~ Actuaries/Benefits _ _'. _ ......~ 500 Nationwide Drive : ==~ :-~ t -.,. P. O. Box 5900 =- -=:::..: ~ J Harrisburg, PA 17110-5900 - (717) 652-5633 Fox (717) 540-9106 July 5, 1995 James B. Pannebaker, Esq. Pannebaker and Jones, P.C. 4000 Vine Street Middletown, PA 17057 RE: Robert Hoover Dear Mr. Pannebaker: . Conr-.d !.t. Slo.ol. F .s.A. . Hmy ~t LelslU.lr.. F.s.A. Brion s. SllM, F.s.A. Clydo E. Olnlricb, F.s.A. E:1rll. Mumll1<l1, M.A.A.A. Rabon 1. Dol"" A.S.A. David F, Slidlnl, A.S.A. Raben 1. Mr.W1e, F.s.A. David It KlIII.1e, F.s.A. l.ffn:y S. My..., F.s.A. Tho.... l. Zlmll1<lTlW1. F .s.A. OleM A.1W.r, F.s.A. Plyol S. Ooon.~II.,"" A.S.A. Fr>nk S. Rhodes, F.s.A., A.l=-A.S. Chorles B. Fri.dland..., A.S.A. Holly A. Ross, F.s.A. . Eonlllol A....rf.. (ERISA) K<vln A. Eri>, A.S.A. H.~<IlACOlIr'J -. You indicated that Robert Hoover was born on September 10, 1951 and that he died on May 11, 1995. . As of the date of his death, Robert Hoover was 43.7 years of age. The life expectancy for a white male age 43.7 is an additional 30.7 years. This implies an expected age at death of 74.4 (43.7 plus 30.7). The life expectancy is based upon a publication of the U.S. Department of Health and Human Services entitled "U.S. Decennial Life Tables for 1979-81. " Robert Hoover was employed by Alling & yory. In 1994 he earned $27,571. He did not miss any days of work during 1994 and 1995 up until his death except for vacation and holidays. Alling & Cory, his employer, provided information concerning the value of the medical benefits provided on behalf of Robert Hoover. This value was $2,930 (10.5% of earnings) for 1994. His employer also provided information indicating that Mr. Hoover was covered under a defined benefit pension plan. I assume that the annual value for this fringe benefit was 4.5% of earnings. This provides a total value of fringe ben.efits of 159'0 of earnings. In a death case, it is necessary to deduct the cost of maintenance. The cost of maintenance consistent with the McClinton vs. White decision consists of the necessary and economical sum which a decedent would be expected to spend, based upon his station in life, for food, clothing, shelter, medical attention and some recreation. Information published by the U.S. Department of Labor, Bureau of Labor Statistics indicates that the cost of maintenance would amount to about 38% of earnings. The following table shows the total value of the net loss on the basis of the date of previously described: Earnings Capacity Fringe Benefits Cost of Maintenance Net Loss $ 587,262 88,089 -223,160 $ 452,191 .' , . ~ ConracUvl Siegel, Ine. James B. Pannebaker July 6, 1996 Page 2 The figures in the above table are based upon a work life expectancy to age 65, The calculation of the value of the future amounts does not take into account a discount for interest in view of the Kaczkowski vs. Bolubasz decision. ." This is a preliminary report. Please note that this preliminary report does not take into account any increase in earnings since 1994, any increase in future earnings attributable to gains in productivity, etc. With best regards, HML:bah Yours sincerely, H, /1-1. lk; (.~ ,.c:::n, Harry M. Leister, Jr., F.W . cOnS~ing Actuary , . '. . ,.. . . '. .4 em... ad M Siegel, ~ . ~~ .' ." ~ Actuaries/Benefits ~ ~ lP u - -'. - ....;; 500 Nationwide Drive : =.:~ ':'~ t;. P. O. Box 5900 =- -:::-:.= ~~ H......uburg, PA 17110-5900 . _ (717) 652-5633 Fax (717)540-9106 Conrod M. SIOlol, F.s..... ' H:ury M. Lclsll:r, Ir. F.s.A. Bri"" S. S..., F.s..... Clyde E. Oinlrich, F.s.A. Em L MummeR, M.A.M Roben I. Dolon, A.S..... David F. Sdrlinl, A.S..... Raben I. Mnzlk, F.s..... David II.lOlIJek, F.s.A. Io/l'rcy S. My.... F.s.A. 1110_ L 2JmlllClTlWl. F.s..... Olcnn A.lla(cr. F.s..... Plyal S. OooncdUekc, A.S..... FnnIc S. RluxIes. F.s...... A.C:A.S. Chari.. B. Friedlander, A.S~ HoUy A. Ra...F.s..... ' Em.Ual....Wsrics (ERISA) Kovln A. Etb, A.S..... H"hll A"""l' July 5, 1995 James B, Pannebaker, Esq. Pannebaker and Jones, P,C. 4000 Vllle Street Middletown, PA 17057 RE: Kim M. Hoover Dear Mr. Pannebaker: -. You indicated that Kim M. Hoover was born on April 3, 195:! and that she died on May 11, 1995. As of the date of her death, Kim M. Hoover was 41.1 years of age. The life expectancy for a white female age 41.1 is an additional 39.1 years. This implies an expected age at death of 80.2 (41.1 plus 39.1). The life expectancy is based upon a publication of the U.S. Department of Health and Human Services entitled "U.S. Decennial Life Tables for 1979-81. " Kim M. Hoover was employed by Pennsylvania Blue Shield. In 1994 she earned $37,696. She did not miss any days of work during 1994 and 1995 up until her death except for vacation. and personal days. Pennsylvania Blue Shield, her employer, provided information concerning the value'ofthe fringe benefits provided on behalf of Kim M. Hoover. This value was $5,190 for 1994. In a death case, it is necessary to deduct the cost of maintenance. The cost of maintenance consistent with the McClinton vs. White decision consists' of the necessary and economical sum which a decedent would be expected to spend, based Upon his station in life, for food, clothing, shelter, medical attention and some recreation. Information published by the U.S. Department of Labor, Bureau of Labor Statistics indicates that the cost of maintenance would amount to about 28% of earnings. The following table shows the total value of the net loss on the basis of the date of previously described: Earnings Capacity Fringe Benefits Cost of Maintenance Net Loss $ 900,934 124,041 -252.262 $ 7i2,713 . . ~ James B. Panneboker, Esq. July 6, 1995 Page 2 The figures in the above table are based upon a work life eltpectancy to age 65. The calculation of the value of the future amounts does not toke into account a discount for interest in view of the Kaczkowski vs, Bolubasz decision, .. This is a preliminary report. Please note that this preliminary report does not take into . . account any increase in earnings since 1994, any increase in future earnings attributable to gains in productivity, etc. With best regards, HML:clf Yours sincerely, r---.. rl,M'~:~~~/f Harry M. Leister, Jr., ~:A. ConsuYi!"g Actuary . .... . -; . IN.1S09lhllt.II' .. ,. COMMONWfAlfH 0' PENNSYlVANIA INHeRITANCe: tAX .nURN RI!SIDI!NT DfCfDfNT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF Hoover, Kim M. FILE NUMBER 1995-00395 Joint t.nantl.l. NAME ADDRESS RELATIONSHIP TO DECEDENT A. B. C. Jolntly-own.d prop.rty. ITEM LmER DATE FOR TOTAL VALUE DECD'S DOLLAR VALUE OF NUMBER JOINT MADE DESCRIPTION OF PROPERTY OF ASSET '!bINT. DECEDENT'S INTEREST TENANT JOINT 1, None , TOTAL (Also enler on line 6, Recapitulalion) ~one (" more spoce is needed insert aclclilionalsheels 01 some size) . UVo1510 U. 12"1) ~ SCHEDULE G TRANSFERS ~ COMMONWfALt" O' '!NNSYlVANIA INHII1TANC. TAX .nUIN IUIDIHT DlerDINT PLEASE PRINr OR TYPE ESTATE OF FILE NUMBER Hoover. Kim M. 1995-00395 THIS SCHEDULE MUST BE COMPLETED AND FILED IF THE ANSWER TO ANY OF THE QUESTIONS ON THE REVERSE SIDE OF THE COVER SHEET IS YES. ITEM DESCRiPtiON Of PROPERlY TOTAL VALUE DE~D. 8?bltc~~t~V,\ NUMBER 'ndlJd, nom, 0' 'hi 'rani"''','''''' ,.IotlOnlllIP 10 d,c.d,n'. dol. ol',onl"', EXCLUSION Of ASSET INTEREST None " TOTAL IAllo .nl., on IIn. 7. R.capltulallon) 5 '" more 'POCI jlll.,J,d, jn'It' oddifionol.h..,. 01101711 siu.} None -........ -- ..._-_.~-..-......_-~..._.. . auUlllh(7.It, ESTA E OF .t~ COMMONWEALTH 0' 'fNN~YlVANIA IHHfltlTANCf TAX II.I!TURN IUIDfNf DECEDENT SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES Ploasl Print or Tvpo MBER FILE Hoover. Kim M. ITEM NUMBER A, 1995-00395 DESCRIPTION AMOUNT Funeral Expon..s. Neil Funeral Home 5.949.00 1. B. Admlnlstratlvo Casll. 4. C. t. 2. 3. 4. S. 6. 7. B. 1. Richard Hoover. Executor Perianal Repr.aentative Camml..lans Social Securlly Number of Perianal Repr..entallve: Year Commission. paid 1995 9,209.00 2. Attorney F... Pannebaker and Jones, p, C. -0- 3. Family Exempllan Claimant Amv L. Hoove r Addre.. of Clalmanl 01 decedent's death Slreel Addre.. 1017 Hemlock Lane Clly Eno1a , Stole PA Zip Code 17025 Relallon.hlp DauRhter* 3.500.00 Probate Fee, Pannebnker and Jones. P.C. reimburaement for Cumberland County Register of Wills Miscellaneous Expense.. Cumberland Law Journal 787.20 40.00 68.84 The Sentina1 Pannebaker and Jones, P,C. reimbursement for fax copies 30.10 TOTAL (AI.a enler on line 9, Recapitulation) $19.584.14 (If more spacI Is needed, Insert additional sheets of saml slzo.) 11'llBIUhll.", .' . SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS COMMONWU.UH 0' 'tNNIn\IANIA INHUlTANCllAx .nUIN IUIOINr OICtolNr ESTATE OF Hoover Kim M. Plio,. P,lnt 0, T . FILE NUMBER ITEM NUMBER DESCRIPTION 8. 9. 10. U, 12. 13. 14. 15. 16. 17, 18. 19. 20. 21. 22. 23. 24. 25. 26, 1. Fine Art Photo PP & L Mellon Bank Check Printing Mellon Bank Check Service Fee-Returned Depoait Fee Urological Aaaociatea of Lancaater East Pennsboro Twp. - Sewer and Trash Banc Boston Mortgage Company Davis E. Kauffman, title report: Weaver Martin PP & L' Pa. American Water Company Banc Boston Mortgage Company PP & L Lancaster Orthopedic Group, Inc, Surgical Association of Lancnster Pannebnker and Jones, P.C. reimbursement for copying and faxing CMI - medical records 2. 3. 4. 5. 6. 7. .' Erie Insurance Co. - Auto Boscov's Po. American Water Co. Boll Atlantic Conrad M. Siegel, Inc. First Card payoff Banc Bas ton Bnnc. Boston Carom. of Pa,. Po. State Police Phot~ Graphic Lab Pannebnker and Jones, P.C,-Surviva1 Action Attorney Fees TOTAL (AI.o .nl., on IIn. 10. R.copltulotlon) (II more spoce is needed, inser' odditionol shee/s 01 Some size.) AMOUNT 27.67 23.99 50.86 4.00 100.00 87.75 784.06 50.00 26.93 8.90 784.26 8.72 65.00 210.00 40.50 103.06 399.00 609.47 9.49 22.69 800.00 1,361.74 816.16 784.26 218.84 18,733.05 $26,130.40 , , i ~.. - llY",Ulh 12.(7) " ,. COMMONWULlH c. 'tNNn~Y"'N1A INHIIITANCI 'AX .nUIN IUlllINfOICIOINf FILE NUMBER SCHEDULE J BENEFICIARIES ESTATE OF Hoover, Kim M. 1995-00395 ITEM NUMBER RELATIONSHIP AMOUNT OR SHARE OF ESTATE NAM~ AND ADDRESS OF BENEFICIARY 1. A. Taxabl. Seque'''1 Barbara Richnrde. Trustee for Amy Hoover (Surviving daughter - see will attached) clo Pannebaker and Jones. P.C. 4000 Vine Street Middletown, PA 17057 Daughter 100% .' ITEM NUMBER AMOUNT OR SHARE OF ESTATE NAME AND ADDRESS OF BENEFICIARY B. Charitable and Governmental Bequells: 1. TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (AI. 0 onlor on line 13. R.capltulollon) (If more .pace Is n..ded, In..rt addltlonal.h..tl of lame size) S None IN RE: ESTATE OF KIM M. HOOVER DECEASED, LATE OF ENOLA, CUMBERLAND COUNTY, PENNSYLVANIA IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 00395-1995 ORDER AND NOW, this tot/... day of ~~ , 1995, upon review of the attached Petition, it is hereby ordered that the proposed Disclaimer by Richard Hoover, Executor of the Estate of Kim M. Hoover, in the proceeds of litigation or settlement,thereof instituted with respect to the accidental death of Robert Hoover on May 11, 1995, as to which the decedent might otherwise be entitled as the surviving spouse of Robert Hoover, be approved so that such proceeds shall be distributed to such persons as otherwise are entitled thereto as if the decedent had predeceased Robert Hoover. .. . BY THE COURT: ISI ~ g. Rn:t.U J. :dkm HOOVERKORD 14245 A TR'.'!: CC'i'Y FROM R~CORD In Tosllroolil' \'.'li':;fC"J1, I h'.l;'~lInl\) tet my htmd end tiu, o.>':ll c~ l"-lld Court at 02.1'11510, PA l"I(l_~dJ.Y 01 ~f-p. 1e~ Ik.,-L;,.L.-& Q .1:. O!erll c1 tile Or .h:mll Court r ~ Cumberland Count'} "..... ," ,....t ,:! .;i.'\;,. ..'.',:",z. 'j'-':"~ '.~I~.'.: Ii 'f !u::;. ":x, '! . ,~',. :1"'::" .,' ..~.{ ','."" '''' ;~. '~,/";- Register of Wills of QaW;{lliNn County, Pennsylvania CUMIIERI.ANIl r INVENTORY Estate 01 Kim M. Hoover No. lqq~-001q~ also known as DalO 01 Death Nav 11. 1995 . Deceased Social Security No. 207-44-5214 Pellonal Reprolln181ivelll 01 the above Ellalt, deceased, verily thai the item. appearing In lhe follo'r'ling In\lllnlOfV include all of lhe pl"lonelllllell where....er ,ilullle and all of the reol eslole in the Commonwealth 01 Pennsylvanllll 01 u.d Decedent. thot the \l8lu8lion placed oppollle each item of said I""oolory repreunt. ii, loi, value 01 Dllhe dole ol1he Decedent', death. and thai Decedant owned no real.'late oullld. 01 the Commanwulth of Pennlylvonie e.copl1hot which appear. in 8 memorandum 01 the end of thi,lnventory. Itwe \I"ilV that tho ,talemon'. mOdel" IhllllnvontofV are Hue and COllect. 1m, underlland Ihal fat.. Ilatamentl herein are made lubiecllo the penalllll 01 18 Pa. C.S. Seclion 4904 relaung 10 unlworn lel.ilicotion to authoritie.. Personal Repfllltnlah"e: Name 01 Allorney: James B. Pannebaker Richard Hoover, Executor , 1.0. No.: 09667 Add,,,s: PANNEBAKER AND JONES, P. C. 4000 V1ne Street Mirl'"t'lt-nt..fn, PA '7n57 405 Casso 1 Street. Marvsville. PA 17053 Dated T.I.phons: 717 944-1333 Oescription 1. United Concordia Paycheck 2. United Concordia Paycheck 3. United Concordia Paycheck 4. US Savings lIonds 5. PPG Industries, Inc. Stock Dividends 6. DOT Co. Value 574.89 994.22 2,473.65 876.08 315.52 5,255.77 28,970.54 100.00 802.73 457.44 3,300.00 291.00 7. I'a IIlue Shiold Voluntary Investment Plan 8. Blue Shield payment for Urological Assoc. of Lancaster 9. DOT Co. 43973647 10. US Savings Bonds Interest 11. Kelly S. Lippy - '89 Cavalier 12. Refund of Insurance Premium, Eric Ins. Company 13. Pa. Blue Shield reimbursement for Lancaster Orthopodic & Surgical Assoc. of Lancaster 14. Brickers Auction (personal property) 15. Proceeds of Survival Action by Richard Hoover, ExelS\WO'2/i AlJ&illO\\SI St\Vi:\,,,tA '~~c:!~~1'Y1H. Hoover 275.00 1,030.00 TOI~{I' 932. 20 $120,61,9. ai, t;01E: the Memo,~ndUIII 01 rc~l UI3!~ oll!lldl! the (0",,,,ol",,c31111 oll'rl\l\I~l\lnni.1 flU;. al lhe elrClion of the pc'~o";Jlleplt.'ll"lIt;JII"Il. inclul1c Iha \1111110 ot C;Jch hem, bu' lueh ltUWIlI IIlOll1c111ll1 bl! t.'1',wdl'd inlo Iha tlll.1 01 tI,a 1l\,,~nl(,'1' ml-B ~~-r PANNJIIDAJDIIR AND JONJIIl!J, P. C. FOUIl. mOUMND VINE STIlEET MIDDLETOWN, PENNSYlV^NI^ 17057-3596 TEll.rtIONt 711~044'1333 TEUCOrlEI\ 111-044'4004 mI'" "'.Il!NNINGU./"" DONAlD L./ONES lAMES II. PANNUAKIR. September 15, 1995 Mary C. Lewis, Register of wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 RE: Estate of Kim M. Hoover File No. 1995-00395 Our File No. 14245 Dear Ms. Lewis: Enclosed please find an Amended (9/15/95) Inventory and Inheritance Tax Return with Schedules E, H and I (two copies) to be filed in the above referenced estate. A check in the amount of $25.00 is enclosed to cover the supplemental filing fee. The revisions that have been made on this return result in a lower inheritance tax due than was calculated on the original return. We would appreciate receiving a refund of the difference which has been computed as $3,205.89. Should you have any questions regarding the foregoing, please feel free to call our office. yours, Jame pannebaker :dkm L 09/15/95 Enclosures ce: Richard Hoover . REY.l"OO U+ 17.9') W 0- ..S" ...",.. w"'U =09 u"'... ~ :iJffi "'0 "'z 8~ 15 -35 - I AKENllllll (9/15/95) f '*' INHERITANCE TAX RETURN RESIDENT DECEDENT (TO BE FILED IN DUPLICATE WITH REGISTER OF WILLS) FOR OATIS O' DEATH A"ER 12/31/91 CHICK HERE If A SPOUSAL POVERTY CREDIT IS CLAIMED 0 PILE NUMBER 1995-00395 ffi Ii! III o COMMONWEALTH Of PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 210001 HARRISlURO. PA 17121.0601 DECEDtN"~ NAMEI1"ST, 'IUI. AND MICDH INIII"'\I Hoover. Kim M. $OCIAl neUlnl HUMIII DAn 0' DEATH 207-44-5214 5/11/95 II' "'''1101111 'UIVIVING 'I'OUU.' HAMlllAU, flUI AND MIODII INmAl1 N/A rn 1. Orlginol Relurn VEAR NUMBER COUNTV CODE OICIDlNl" COMPU II ADO.U$ 1017 Hemlock Lone Enolo. PA 17025 (Ollnt Cumberland "MUUNT UCIlVlD t$U IN51RU(110N$1 4/3/54 o 2. Supplemental Relurn o 3. Remainder Relur" (for dotl' of death prior to 12.13.82) o S. Federal Ellal. Tax Return Required o ... limited ellolt 0 AD. Fulur. Inlerlll Compromise (for dOl.. of death aft., 12.12.82) [iI 6. O.cedenl Di,d Teslal, 0 7. Dec,denl Malnlalned 0 living TruSI (Allach copy of Will) (Mach copy of Tru"l ALL'CORRESPONDENCE'ANDCONFIDENTlAL TAX INFORMATION SHOULD BE DIRECTED TO,. . NAM( COM'UI( MAILING ADDIUS James 11. Pannebaker. Es uiro PANNEBAKER AND JONES. futrHON( NUMIU 4000 Vine Street 44-1333 z o S E ~ III '" 1. Real Eslole (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held SlockJPartnershlp Interesl (Schedule C) 4. Morlgoges and Not.. Reteivable (Schedule OJ S. Cash, Banle Deposits & Miscellaneous Personal Properly (Schedule E) 6, Jalnliy Owned Properly (Schedule FI 7. Tran,fe.. (Schedule GI (Schedule L) 8. Total Gran Anets (Iotallln.. 1.7) 9. Funeral Expens.., Admlnlstrotive Costs, Miscellaneous Expenses (Schedule H) 10. Debts, Mortgage lIobililies, liens (Schedule I) 11. Tolal Deductions (10101 lines 9 & 10) 1:2. Nel Value of Estole (line 8 minus line 11) 13. Chorlloble and Governmental Bequests (Schedule J) lA. Nel Value Sub eet to To)l, (line 12 minus line 131 15. Spousal Tron,fers (for doles of death after 6.30.94) See Inltruellons for Applicable Percentage on Reverse Side. (Include volues from Schedule K or Schedule M.I 16. Amount of LIne lA ta)l,oble ot 6% role (Include values from Schedule k or Schedule M.) 17. Amount 0' line 14 taxable 01 15% role (Include values from Schedule K or Schedule M.) 18. Principal lox due (Add lox 'rom lines 15, 16 and 17.1 19. Credill Spoulol Poverty Credit Prior Payments + + :20. If line 191s orealer than line 18, enler the diHerence on line 20. This Is the OVERPAYMENT. aD 21. If LIne 18 Is greater Ihan line 19, enter the difference on line 21. This Is Ihe TAX DUE. A. Enter thelnleresl on ,he balance due on line 21A. B. Enter the total of line 21 and 21 A on line 21 B. This Is Ihe BALANCE DUE. Male. Check Payable tOI Register 0' Will., Agent " ~ ~ BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH -<-< Under penalties of perlury, I declare that I have III a mined this return, Including accompanying schedule, and statemlnts, and 10 ,he bill of my ~nawled9' and beU.f, Ills frue, cO"lcl and comple'e. 1 declare I at all real..lale has been reportea at true markel value. Declaration of prepar.r olher thon the penonal reprellnlalive Is based Informallon of wh h pr p It has any knowledge. Richard Hoover. Executor SIGN1U..,;U(N"l~'~~S ('all GUTUU' ADDRUS 405 Cassel Street OAH1,/r:1-'f' vv. .~ c. PA 170~3 V~ 51 AT It( 0"11 ARU 0 ""I AOolIUS J 11 P b k E i DAne) ames . none a cr, squ rc /). J EBAK~R ^ND lnN~~. p r. 4000 Vine Street. Midd1otown, PA 17057 z o E => ... '" o u S _ 8. Total Number 0' Safe D.posil Boxes ., " ':,;,.. I tf\ l ''::~'f '_'0 P.C. (11119.000.00 (21 20,808.00 (3) -0- (41 -0- (51120,649.04 (61 ( 71 (81260,457.04 (9) (101 20,188.85 78.957.19 (111 99.146.04 (121 161.311.00 (13) (141 (151 (16)161.311.00 (171 X._II x .06.. 9.678.66 )( .15 II (181 Discounl Inler,,' (191 120) Check hero if you oro ,equesling 0 refund of your ovorpaymont. 9.678.66 (21) (21.0.) (2181 Act #48 of 1994 provide. for the reduction of the tax rate.lmpo.ed on the net value of transfer. to or for the u.e of the .pou.e. The rate. o. pre.crlbed by the .tatute will bel e 3% (.03) will be applicable for e.tate. of decedent. dying on or after 7/1/94 and before 1/1/96 e 2% (.02) will be applicable for e.tate. of decedents dying on or after 1/1/96 and before 111/97 e 1% (.01) will be applicable for e.tate. of decedent. dying on or after 111197 and before 111/98 e Spou.al transfer. occurring on or after 111198 will be exempt from Inheritance tax. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK (.--) IN THE APPROPRIATE BLOCKS. YES NO 1. Old decedent make a tronsfer and: x a. reloln Ihe use or Income of Ihe property Ironsferred, ....................................................... b. retain the right 10 designate who sholl use the property transferred or Its Income, ............... x x c. reloln 0 reversionary Interest; or ................................................................................... x d. receive the promise for life of either payments, benefits or carei ....................................... 2. If deolh occurred on or before December 12, 1982, did decedent within Iwo yeors preceding deolh transfer property without receiving odequote conslderotloni II deoth occurred ofter December 12, 1982, did decedenl Iransfer property within one year of deolh wlthoul receiving adequate consideration'. to.. .................... ..... .......................... ................ .... ........... ............ x x 3. Old decedenl own an 'In trust for'. bank account ot his or her deolhi...................................... x Ch '__'.1 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST,COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. .'- r' ~ "I ,,-J llJiJ.:: cc I.. ~:F\ :;~ ;; ou 'l~l'o.lll. 12.'71 ESTATE OF Please Print or l' e FILE NUMBER 1995-00395 .~~':1n ,..~ COMMONWfALTH or 'ENNlYWANIA INHlllTANel TAX anuaN IUIDINT DlelDINT AMENDED (9/15/95) SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY Hoover. Kim M. (All property lalntly.owntd with tht Right of Survlvonhlp mu.t be dl.clo..d an Schtdule f) ITEM NUMBER 1. 2. 3. 10. DESCRIPTION United Concordia Paycheck United Concordia Paycheck United Concordia Paycheck 4. US Savings Bonds (See attached) 5. PPG Industries, Inc. stock dividends 6. DDT Co. '.. ~ 7. 8. Par Blue Shield voluntary investment plan Blue Shield payment for Utological Assoc. of Lancaster 9. DDT Co. 43973647 US Savings Bonds 11. Kelly S. Lippy-'89 Cavalier 12. Refund of Insurance Premium. Erie Insurance Company 13. Par Blue Shield reimbursement for Lancaster Orthopedic and Surgical Association of Lancaster 14. 15. Brickers Auction (personal property) Proceeds of Survival Action by Richard Hoover, Executor of the Estate of Kim N. Hoover RICHARD HOOVER, Executor of the estate of Robert Hoover. Deceased and the Estate of Kim N. Hoover. Deceased Plaintiff COURT OF COMMON PLEAS OF CUNllERLAND COUNTY, PENNSYLV IA CIVIL ACTION - LAW No. 95-4605 v. WEAVER W. MARTIN and LEONARD H. MARTIN Defendants (See attached Court Settlemont) TOTAL Also ontor on \Ine S, Reeo (Allo(h addillonal BY," x 11H .h.tll If mate .pote It needed,) VALUE AT DATE OF DE!loTH 574.89 994.22 2.473.65 876.08 315.52 5.255.77 28.970.54 100.00 802.73 457.44 3.300.00 291. 00 275.00 1,030.00 74,932.20 SI20,649.04 Hoover. Kim M. ITEM NUMBER A. .l.",lJII fll.I7"" . 1. . ~I (OMMONWI!AUH 0' Pt:NNSYLVANIA INHUITANCI! TAX UTU.N Rt:SIDI!NT DECID!N' AMENDED (9/15/95) SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES PI.a.. Prlnl or T . F EMBER 1995-00395 DESCRIPTION AMOUNT Fun.ral Exp.n'.'l Neil Funeral Home 5.949.00 B. Adm!n1.lrallv. Co.lI. 2. 4. C. 1. 2. 3. 4. 5. 6. 7. 8. 1. Richard Hoover, Executor Personal Repre.entallve Comml..lon. 192 - 30 Social Security Number of Pellonal Repre.entatlve: .' Vear Comml..lon. paid 1995 9.813.71 .0437 Attorney Fe.. Pannebaker and Jonea, P.C. -0- 3. Family Exemption Claimant Amv L. Hoover Relatlon.hlp DauRhter'" Addre.. of Cloimonl 01 decedent'. death Slreel Addre.. 1017 Hemlock Lane 3.500.00 City Enola. Slale PA Zip Code 17025 Probate Fee. Pannebaker and Jones. P.C. reimbursement for Cumberland County Register of Wills MI.e.llaneou. Expen.... Cumberland Law Journal 787.20 40.00 The Sentinal 68.84 Pannebaker and Jones. P.C. reimbursement for fax copies 30.10 TOTAL (AI.o enler on line 9, Reeapltulotlan) (If mar. .pae. I. n..d.d, In..rt addlllonal .h..I. of lam. Ilze.) 520 188.85 IIV-II,n/'.I,..1t '* AMENDED (9/15/95) SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS COMMOHWIALlH O' 'INN",..,.NI" IHMUIIANCI tAl "IUIN InlDINIDICIDINI PI.a.. Print or T . FILE NUMBER ESTATE OF Hoover Kim M ITEM NUMBER 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. DESCRIPTION 1. Fine Art Photo PP & L Mellon lIank Check Printing Mellon Bank Check Service Foe-Returned Doposit Foe Urological Associates of Lancaster East Pennsboro Twp. - Sewer and Trash Banc Boston Mortgage Company Davis E. Kauffman, title report: Weaver Martin PP & L 2. 3. Pa. American Water Company Banc Boston Mortgage Company PP & L Lancaster Orthopedic Group. Inc. Surgical Association of Lancaster Pannebaker and Jones. P.C. reimbursement for copying and faxing CMI - medical records Erie Insurance Co. - Auto Boscovts Po. American Water Co. lIe11 Atlantic Conrad M. Siegel. Inc. First Card payoff Banc liDS ton lIanc Boston Corom. of Po.. Pa. State Police Phot~ Graphic Lab Pannebaker and Jones, P.C.-Surviva1 Action Attorney Fees lIancBoston Mortgage Corporation - principal balance due on Real Estate at 1017 Hemlock Lane, Eno1a. PA 17025 TOTAL (,1,110 enler on line 10. Recapitulation) {II more Ipoce is needed, insert oddilionol shoels 0' lome lin.} AMOUNT 27.67 23.99 50.86 4.00 100.00 87.75 784.06 50.00 26.93 8.90 784.26 8.72 65.00 210.00 40.50 103.06 399.00 609.47 9.49 22.69 800.00 1.361.74 816.16 784.26 218.84 18.733.05 52,826.79 $78,957.19 , , Register of Wills of Dauphin County, Pennsylvania AKENIlEll (9/15/95) INVENTORY ESl3te of Hoovor. Kim N. No. 1995-00395 Date of Death Mnv 11. 1995 also known as . Deceased Social Security No. 207-44-5214 Potlonol Rapronntalivetsl oltha above Estote. deceased. vorily Ihol tho itoms appooling in tho following invontory includo 011 01 tho porlonal aue1l1 who rever ,ituato and 011 o' tho reol asUl10 in tho Commonwealth of Pannsylvonul 01 SOld Dacodent, thul Ihe valulItion placod opposite oach itom 01 laid Inventory roptllSontlltll fair vuluo os 01 tho do to 01 lho Decodent', doath. and lhol Decedent owned no fool 011010 outside 01 tho Commonwoolth of Ponnsylvanla allcoptlhot which appears in 0 momorandum 01 the end of thlalnvontorv. l(Wa varlty thot tha Ilolomonts mado in this Invontory 010 Hue and correct. IfWo under8tnnd lhot lolsa ,Ialamanl. horoln ora modo lubiacl to lho penollin 01 1 B Pa. C.S. Seclion 4904 rolotinu 10 un. worn tul.iticolion 10 authorilies. Porsonnl RflproaenWIIVO: Nome of Anornev: James 11. Pannebaker Richord Hoovor 405 Cassel Street. Narysville. PA 17053 1.0. No.: 09667 PANNEBAKER & JONES. P.C. 4UUU Vine Street Middletown. PA 170~7 Telephone: (717) 944-1333 OlUed Addrass: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. Doscription United Concordia Paycheck United Concordia Paycheck United Concordia Paycheck US Savings Bonds PPG Industries. Inc. Stock Dividends DOT Co. Po. IIlue Shield Voluntary Investment PIon IIlue Shiold paymont for Urological Assoc. of Loncastor DOT Co. 43973647 US Savings Bonds Kelly S. Lippy - '89 Covalier Refund of Insurance Premium. Erie Ins. Compony Pa. Blue Shield reimbursement for Lancaster Orthopedic & Surgical Assoc. of Lancaster IIrickers Auction (personal property) Proceeds of Survival Action by Richard Hoover, Exocutor of the Eetate of Kim M. Hoover PPG Industries. Inc. (544 Shares Common Stock @ 38.25/shnre) Roal Estate at 1017 Uemlock Lone. Enola, PA. (Appraieod value $119.000.00 less principal due on Mortgage $52,826.79) 14. 15. 16. 17. IAttach Additional Sheets if necessarvl VDlue 574.89 994.22 2.473.65 876.08 315.52 5.255.77 28,970.54 100.00 802.73 457.44 3,300.00 291. 00 275.00 1,030.00 74.932.20 20.808;00 66.173.21 TotDI: $207.630.25 NOTE: Tho Mllmofllldllln OIICDI ellatu Quaido the COlnlnollw"Dllh oll'llll11sylvtllllall1.1Y. .llhe electlOll of UlU pllllollallllp'lIIenllltive, includll Ihe value 01 each ite"'. bul IUcI; Ilgure. should 1101 bft ekrlllldud into tho total of lhll Invento'V RW-B J 15. :b'.- / tV REV.1S41 EX AFP 112.9S*, Cr""nNWEtlT" OF PENNSVLVANIA O[PANrHENf OF REVENUE IUAUU OF INDIVIDUAL TAXES DEPT. Z80601 HARRISIURO, PI 1112'~0601 NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ACN 101 DATE 01.02-96 FILE NO. 05-11-95 COUNTY CUMBERLAND NOTE. TO INSURE PROPER CREOIT TO YOUR ACCOUNT, SUBHIT THE UPPER PORTION OF THIS FORH WITH YOUR TAX PAYHENT TO THE REGISTER OF WILLS. HAKE CHECK PAYABLE TO "REGISTER OF WILLS, AGENT" REMIT PAYMENT TO: JAMES B PANNEBAKER ESQ PANNEBAKER & JONES 4000 VINE ST MIDDLETOWN PA 17057 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 .1Iount R..Ht.d CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ..... ifEv:is4'j.Eif-iiFp.-1Ti:9sY"iliii"icE"oj:."iNHEiiifANci!.TAinippjiiiisEifEil'r-;-ALLOWANCi!.OJi....---...------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX KIM M FILE NO. 21 95-0395 ACN 101 DATE TAX RETURN WAS' C J ACCEPTED AS FILED ( Xl CHANGED SEE ATTACHED ESTATE OF HOOVER 01-02-96 NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL AND SUPPLEMENTAL RETURN NO. 01 1. R.d E.t.to (Sch.dub AJ IlJ 119.000.00 2. Stock. and Bond. (Sch.dul. BJ C21 20.808.00 3. Clos.ly Hald stock/Partnership Int.r.at (Schedule C) (3) . DO 4. Harig.g../Hot.. Receivable (Schedula DJ (4) ,DO 5. C..h/Bank DapoaUa'Hhc. p.,.son.1 Property eSchedul. E) (5) 120 1649.04 6. Jointly Own~ Prop.rty (Sch.dul. FJ 16J .00 7. Transfers (Schedul. C) (7) .00 a. Tot.l A...to (al _ 260.457.04 APPROVED DEDUCTIONS AND EXEMPTIONS: t 20,188.85 ,. Fun.,.al Expan.../Ad.. Co. ./Hlao. Expans.. (Schedule H) (9' 10. O.blo/Hartg.g. U.bllitl../U.n. (Sch.dule II (lOJ 78.957.19 11. Tot.l Deduotions (1) qq. 14~ 04 12. N.t V.lu. of T.. R.turn (12J 161,311.00 15. Charitable/Govern.antal a.quad. (Schedula J) (13).00 lit. N.t V.lu. of Eltato Subj.ot to TI. (14J 161,311.00 NOTEs If an aasessment wae issued previOUSlY. lines 14. 15 and/or 16. 11 and 18 will reflect figures that include the total of ~ returns assassed tD data. ASSESSHENT OF TAXI 15. A.aunt of Lina 14 at Spous.l rat. US) 16. A.aunt of Lina 14 tawable at Lina.I/CI... A rat. (16) 17. A.aunt of Llna 14 taxabla at Collat.raI/CI... Brat. (17) 18. Prinolpal TaM Due TAX CREDITS: PAYHENT DATE 09-14-95 .00 161.311.00 .00 X .00. X .06. X .15. l1el .00 9,678.66 .00 9,678.66 RECEIPT HUHBER AA082134 DISCOUHT INTEREST l+l (-J .00 AHOUHT PAID 12,884.55 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST TOTAL DUE 12,884.55 3,205.89CR .00 3,205.89CR . IF PAID AFTER DATE INDICATEO, SEE REVERSE FOR CALCULATIDN OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN .1, NO PAYHEHT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YOU HAY BE DUE A REFUNO. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. I RESERVATIONI E.t.t.. of d.c~ent. dying on or ~far. D.c.-ber 12, 19a2 ~- If eny future lnt.r..t In t~ ..t.t. I. tren.f.rr.d In po.....lon or enJoyeent to CI... I (call.t.r.l) beneflcl.rl.. of the d.cedent .ft.r t~ ..plr.tlon of eny ..tst. far Ilf. or for v..r., thl C~.lth her.by 'MPr...ly r...rv.. the right to sppr.I.. and ...... tran.f.r Inherltanc. TaM" .t the I~ful CI... I (call.t.r.l) r.t. an eny such future Int.r..t. PURPOSE OF HOTletl To 'ulfUl the requlr..~t. of Section 21"D a' the Inhlrlt;lf1c, end Estill T.. Act, Act 22 of 1991. 7Z P.I. S.ctlon 21..D. PAYHENTI OltllCh the tap portion of thh Notlc. end .tbllt Nlth your pav.~t to thl RlVht.r of WUh printed on thl rev.rI. aide. --H.kI check or .ontIy ordar p.vabl. tal REGISTER OF MILLS, AGENT AU p.y...,t. rec.lv~ IhIll flr.t b. 1IPP1l~ to ....y Int.n.t which -v tMI dI.MI Nlth ."y re..lncl.r 1PP1l1d to thI ta.. REFUND (CA)I A refund of . tax cr.dlt, which .... not requlltld on th. T.x A.turn, a.y bl r.qu..t.d by cOllPIIUng an "lpplluUon for Aafund of Penn.ylvlnle Inhlrltsnc. and E.tete T..- (REV-ISIS). Appllc.tlon. .rl .v.llebl. .t thl OfficI of thl A.,I.t.r of Will., InV of thl rs A.venus Dl.trlct Dfflc." or by calling the .p.cl.l r"-hour In....rlna .arvlc. nusblr. for 'or.. ord.rlngl tn Penn,vlvanl. 1.100-S62.2050, out.ld. P.nn.ylvlnl. and .Ithln locel Mlrrl.burg .r.. (717) 717.aO''', TOOl (717) 772-2252 (HI.rlng I.,alr.d Only). OIJECTlONSI Any p.rtv In Intlr..t not .athfl.d with th. IIfIPrll...~t, .1laNIII'ICI or dl..llowanc. of dlductlon., or ......HRt of te. (Including dl.count or Int.r..t) .. shown on thl. Notlc. .u.t obJ.ct Nlthln .I.ty (60) d.y. of rec.lpt of thl. Hotle. bVI --Nrlttln protist to thl PA DIp.rt.ent of A.v...., ~o.rd of App..h, D.pt. !IU21, H.,.rhbUrg, PA 17UI-I021, OR --.I.ctlon to h.v. thl .,u.,. d.t.,.llned .t IUdIt of thl ICCOl.W1t of the p.,..DnIII repr....,t.tlv., OR -.app..1 to the Orphan.' Court. ADMIN ISlAATlVE CORAECTIONSI tNTERESTI F.ctu.1 .rror. dl.cov.r.d an thl, ........nt .hould b. .ddr....d In Nrltlng tal PA Dep.rtl,"t of A.venue, Bur.au of tndlvldu.1 T.ns, ATTNI Post A......~t A.vl'N Unit, n.pt. 280601, f!lrrhbura, PA 17UI-0601 Phon. (717J 117-6505. S.. P.... S of the bookl.t -Instruction. 'or InhsrltBnCI T.. A.turn far. A..ldlnt Dlc.dlnt" (REY-1S01) 'or en ..plsn.tlon of .dllnl.tr.tlv.lv corr.atabl. .rrars. If sny t.. due I. p.ld Nlthln thr.. (S) c.lendlr eonthl .,tlr th. d.c.dent". dt.th, . flv. p.rclnt (5X) dl.count of thl t.x paid 1. .1IOM.d. Int.r..t I. ch.rg.d b.glnnlng Nlth flr.t d.y of d.llnquInCY, or nln. (,) eonths ~ one (1) day 'r08 thl date of d..th, to the d.t. 0' p.y.~t. T.... which bee... d.lInquent blforl J......,.y 1. 1912 b..r lnt.r..t .t thl nt. of sl. (6X) p.rclnt p.r tnnUI c.lculat~ at . d.lly rat. of .000164. All t.x.. which b.c... d.llnquent on tnd .ft.r JlI'IU8ry I, 1912 NI11 b..,. Intlr..t .t . nt. Nhlch NIlI vary fr08 c.l.ndar v..,. to c.l.ndar y..r with that nt. snnounc:td by ttM PA Dep.rt.~t of A.vlll"lUll. ThI sppllclbl. Inhr..t rat.. for 191% through 1996 .,..1 DISCOUHTI !!!! tnt.r..t A.t. Dally Int.,.lIt Factor !!!!' Int.r..t R.t. D.lly Int.r..t Factor 1912 "X .0110541 1981 OX . DOorn l'lS lOX .DOOOI 1'81-1991 ItX .GOOSDl 191.. ItX .aDDSDl 1992 OX .ooorU 1915 ISX .OOOSS6 199J-I994 7X .ODOl'Z 1916 lOX .1I00Z" 1995-1996 OX .000Z47 .-tnt.,...t I. c.lcul.tld .s follaw.1 INTEREST . BALANCE OF TAX UNPAID X NunDER OF DAYB DELINQUENT X DAILY INTEREST FACTOR --Any HollcI Issued .ft.,. thl ,.. bee... d.U".,."t ..111 rlUact en Int.,...t c.lcul.Uon to ,1ft.", CIS) day. b.vand th. d.lI of th. ........nt. If P'yNnt Is .~. .'hr the Inhr.at COlPUt.Uon d.t. shown on the Hollc., ItddltlDf'llI tnt.,...t .u.t b. c.lcul.t.d. u......lOUI..1tI . INHERITANCE TAX EXPLANATION OF CHANGES COMMONWEALTH OF PENNSYlVANIA DEPARTMENT OF REVENUE . BUREAU 0' INDIVIDUAL TAXIS DEPT. 280601 HARRIS8URG. PA 17128.0601 DECEDENT'S NAME FilE NUMBER r. ACN SCHEDULE ITEM NO. EXPLANATION OF CHANGES mCOlllblnod..roturnll SUbQl tted.. to date ... .- .". ~ "H_,"" ~. _.__. . ._._..__~__v_~_.~ . ._.. .. ___.___.~~~ ,_.".~_ .._~ - ".. -~'-".'-"'---'."'" ."." ._----~_."-~._. '-'~....~ - -~~_...~- ~-_.._--_. .., ... ~___~'~_'._"'____~_M"____'O>""_ "._.~__.~.~__.M..~ ..~...~+..__ _ __.. "_'_'__'4_".~'_"_"~___'M __.__~., _~_,---"'~._._..__...~ _'_._' ~____..."_..__ _.. .. "_~~_'_ ..'~.~ .,..~~.~ .~. ~.~..._~"~.~_.___~__..~_.-.,_._.~.__..~ __ .___, __ _.,~.,,___~_.._~ -.. .~._......,.. ...~-_.- -_ -._.__. "'_'~".".>" ....._.__..__._...~._M____ ~__~._" .-,.-, ---,..,- - -...._,_....,_.__._._4.__.___~___,~._~__.._ _"'___""~"_<h _.-.. ~__~ ,0__.'._... __......._,._.~ '__ _ _'U_'_" ..... _ ._~.. _ ,._.~_.. ..,...." ....__. _.._--.._.._~----- ~.- _.. M'~"'_"."m_'_' ._.__~~_.,. .~._..._ ._.. .. ,_ _,_, _,~,,_'.__"_'._. _~."~______ ............ '_T ~._,,_~~_.__. ...__> _~_.~_....__~__~__._ _.__.. --_.___-._. _'._.L "..___~_. ___, ..c.. ,,>_ __ .... _._~m___ __ _ ___ .,,*" . .- . __U._~ . _.~ ..____.____.._.._..,..._.__..,..__.._...~. ',~..'_ .._..h_..,C__."_~._._,,._ TAX EXAMINER: Dcbornh Ilnsh Ington PAGE __ -".." ~..~,j.".." ,#. IIf\'\15oo EX. (7.9.&) w .... ..:5'" u"''' wo.U :"'9 u B:m :c /6 -~s. I SUl'l'LENENTAL INHERITANCE TAX RETURN RESIDENT DECEDENT (TO BE FILED IN DUPLICATE WITH REGISTER OF WILLS) c... I FOR DATES OF DEATH AmR 12/31191 CHECK HER! If A SPOUSAL POVERTY CREDIT IS CLAIMED 0 FiLl NUMBER 21-95-0395 is fil u w '" ~ COMMONWEALTH O' PENNSYlVANIA DEPARtMENT O' REVENUE DEPT. 210601 11,\1I1I15IUIIO,'/I. 111211.0601 DIClCENT', NAM! (LA:!.'. 'IU . AND MIDDLE INITIAll Hoovur, Kim H. IOClA\ SfCU_ITY NUMIU 1017 Hemlock Lone Enola, l'A 17025 CouIlly Cumber land AMOUNT RECEIVED I5fE INlTRUCTlOHSI COUNTY COOE 00395 YEAR 1995 D1CEDtNT'1 COM'ltTf ADORUS NUMBER DAn Of DEATH 207-44-5214 5/11/95 4/3/54 II' ."\101111 IUIY'YlhO IPOuU'1 H.'" (1..'''. '11" A'tO IIuQOIIIHIII"'11 o 1. Original Rolurn EB\ 2. Supple menial Return 03. 05. Remainder Return (for dalo. 01 doa.h.prlo, 10 12.13.82) Federal Eslate Tax Return Required Tolol Number of Safe D.p~slt Boxes "".... wi5 cc'" "'z "'''' Uo. o A. lImlled Ellal. 0 40. Future Int. rest Compromise (for dalo. of doa,h aho, 12.12.821 o 6. Oecedent Died T.slal. 0 7. Decedent Mainlalned a living Trust IAllach copy of Will) (Anoch copy 01 Trull) ALL'CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED.TOI~~.'~l.I.ii..'7.iUr.M!r.ti'!-liw(.W7.i"lt NAME COMPU.1E MAllINO ADDIUU James 11. l'annebaker. Esquire l'annebaker and Jones, P.C. 4000 Vine Street Hiddletown PA 17057 _8. 944-1333 - 10.000.00 28,808.00 % '" 3 = .... 0: "' u w cc 1. Roal E.,o'o (Schodul. A) (I ) 2. Slock. and 80nd. (Sch.dulo 8) (2) 3. Clo.oly Hold Slack/Porfno"hlp In'o,o.' (Schodulo C) I 3 ) ~. Marlgages and NOI" Receivable (Schedule 01 ( 4 ) 5. Cash, Bank Depolill & Mllcelloneous Penonal Property (5) (Schodulo EI 6. Jointly Owned Properly (Schedule f) 7. Tran.f... ISchodul. G)ISchodulo L) 8. TOlol Gran Auetl (Iotallinl" 1.71 9. Funeral E)(pen..s, Adminillrative COSII, Miscelloneous bpenses ISchedule H) 10. Debls, Morlgage liobilili.., liei'll (Schedule I) 11. Tolal Deductions (tolallines 9 & 101 12. Nel Volue of Eslal. (line 8 minus line 111 13. Charitable and Governmental BequolII (Schedule JI 1~. Nel Value Sub ectlo Ta)( (line 12 minus Une 13) 15. Spousol Tronlfen I'or dalll of dealh after 6.30.94) See Inslruclians for Ar.pllcable Percentage on Revene (15) Side. (Include volu.. ram Schedule K or Schedule M.) 16. Amaunl of Uno 14 la)(able 01 6% role (Include values from Schedule K or Schedulo M.) 17. Amaunl of Une 1A la)(able at 15% role (Include values From Schedule K or Schedule M,I 18. Principal 10)( due (Add 10)( From lines 15, 16 and 17.) 19. Credits Spaulal Poverty Credit Prior Paymenls + 12.884.55 + 20. If line 191s grooler Ihan LIne 18, enler Ihe difference on line 20. This Is Ihe OVERPAYMENT. Ii! 21. IF Une 181s grooler Ihan Une 19, enlor Ihe difference on Une 21. This Is the TAX DUE. A. Enler Ihe Inler"t on the balance due on line 21 A, 8. Enlllr Ihe 10101 of line 21 and 21A on Une 21B. This Is Ih. BALANCE DUE. Mak. Check Payable tal Register of Wills, Ag.nt (21) 121A) 121B) (6) 171 (B) 10 RnR 00 (9) (101 8,995.00 8.995.00 (111 (12) (131 (14) Rll nn 0.00 Rll on )(._a (161 1,8lJ.OO )( ,06 a 108.78 (171 )( .15 :: z '" ;:: "' .... => 0. '" '" u S (IB) 10R.78 Discaunl Inlerell (191 120) ~ Chock here if you arc requosting a refund of ydur overpaymont. " >- >- BE SURE TO AN5WER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH -<-< " Under penahies of perjury. I dedarethat I hove e)(amined this relurn, Including accompanying scheduleu and slalements, and 10 the bill of my ~nawledge and belief, 11 Is true, correct and camplele. I declare thai all real aslole has be,!, raporlac ollrue market value, Declaration 01 proparer olher Ihon Ihe pellonol reprllenlotive it based on nformalion of which prepo r s any ~nowledge. Kicllard Hoover t Executor 51GNAT R Of' IUONll ONStllff ,al vII URN AOORUS 405 Cassel Street DAlf t:<,~ Har Aville PA AUOAE5~ James P. Panncbakcr t Esqur Ic , ~, . . , I, ~'^,: ~ . . . .. ""l .- ,-,- . '~,'.' ~l~~ '>' '~$~~:\,:" ., ~~i 6~~1~ ,~' ~,i'{~;f~~!1;' '.' :.' " ,.:,;""., <;'.'.:i;. :;'.', :.,.:..' ..:;n..')'; :,,:.'" .' . :'.<:': ,.....e.. . :L'C,',.,::; ,'.; .;'> 'c:' J. .;">,, '>,' ".'. , ' ,.:e: ,". i';,"", " . :: ":, ',.> ,:>,;~.':"'." ,'. '",.,,' ;:""'" .::' <,....:' '."'~ '>,". ,::"F".'.', c '..>i';~>:C """.,":.;Y: ".' . ' . ,.',: ...,;.:~"; ".<,': ',:.,.":.;,.: ,":' ':,', '.' . .;:~', .,:':; i::,: ':".' :>;:):~ :.;,~,;, /"",::> ,..... ':::': ';.,: ':" ' ; . .. ;~~tl:!.::'.:'/', ,.,:.,.',' " , ;;'::': L ',.~;; ~ ,5 ;_ ,. ." !'.~/ :L,,"I>: " 'i\,11r:' '''i ~,:, ,'; , " ",;:'" , "\'0. '. ",,; , " '. :, " , :: :.: .'; ':.: ''', ..,,',:..',::i;"," ".' i,'" ;":;. ..,' ~/j~; ,/~:;,::' .'/~~>~: ~':"~".. ;'/"'(,:J.~;::/,:::', ".' "".:~~""::",., :<.'" ,/ ;;::"C ':-i";',:'.:.> :.;:,,;:',. "':, ",'" ,'~ ",.~"/ :',':,,' . .:, ..'::." ,.' i ',' '. ":, . , , '0, "p . ,: " ,'; ;~_i>::':<:o:'~/",> . , d. :;~,~":.' ~,< ."; "',,,) " -" .'-'."' -- -! -.'. '. '-"'">_"1:- "". 'oj' - 1. -,-' q;. : - r'" . RfY.I~02 EX + 112.151 . COMMONWfAlTH 0' 'fNN~nYANt4 INHUnANCf 'AX RUURH REiIDEN' ~fCfDfN' ::-:=-::'::--'"7.;;;,;: ESTATE OF SUI'PLF.MENTAL SCHEDULE A REAL ESTATE .- .._---,._----_._---_..__._-----~---_... .~ ---------- - ~-._--_._---------".- -..--..-.-- - .--~. ~Fitf'NUMBER HOOVER, Kim M. ____ 1<195:00395_ (Prop.rty '.Intly..wn.d with Rlght.f Su..I....hlp mu.1 b. dlscl...d .n Sch.dul. Fl All ...I..I.t. .h.uld b. r.p..t.d .t 1.1. ma.k., valu. which Is d.lln.d .. tho p.lc. at which p..p.rty w.uld b. ...h.ng.d b.lwun a willing buy.r and a willing ..11.., n.llh.. b.lng camp.lI.d fa bu or 1.11, bath havinG ,.alonabl. ~n~~~~!~~!t!_~..tt~!.!.I.vl!."_t ractl. ITEM NUMBER I. DESCRIPTION VALUE AT DATE OF DEATH Reel Estate Proporty, situate 1017 Hemlock Lane, Enola, PA initially reported and valued atl 17025 property as $ 119,000.00 109,000.00 Actual Sale Agreement - Property Value Change ;..!..!2~99g~g2 $10.000.00 TOTAL Ab. .nl., .n IIn. I, R.,. lIulollon (If mar. spac. ;s n..d.d, ins.rt addi'ianal.he.,s a( some size.) s _..._~_._._..... _";::':;..:~..L'Y" ".-.- --~ -"It '-....~'~~.,;;4'~~..:......;~~~_,-.~~ f ,r-- \ ,..- . . r.'~f?.;....o:;. I" , i:l -......-... ..--.._--........._~. ._...._u._. _._...._... ._._ ... 6oUI13 iJ v (.., l..: ....""T --I", .,.......". 01""'" v ,.J ',..1 '., '..,1 .J '.' '" AGlmEl\mNT FOil TilE SAI.E ANn l'lInC:IIMm CW IlI':,\!. ESTA'n: 'i'hls (otlli 1I~r.llrnll1\'llllcu 31111 UI'I\rU\ll:d (url IIlIllIul ICShl~tl:lt cnl lI~e by m~"'btrs 1)( Ihe (1rC'3Icf JlM,hllurg ^"\Udlllltlll IIr IUil\I,lOIt:-i" ","NT "'''RI.'.RI' _.- ., [-SUI1 AnENT FOR SIH.I.I'II--- --.-- M1lJNT l'OIl IIIJ\'H1l .---.... :Inc..v. (";I~U ~11F. JJ ..j}lltl! ~.~il(/:.. 6f11'(J hr.,.,~j<ml()f!. ---1',\. LICENSEI) 1l1l0KEIl. - 1',\. J.ICENS1J8 111101\1111 h. "-1'1\. I.ICl!NSlil.l IlIIOKJ!lI-- Thl' "81"""'" lila". thl< ._";?,/.i~____.....u_. ,'ay "f .. ,t [((i/I/.6/:.'I:... , _'_' ___...._. ...:____, 19_Y'~:... I. l'IIINCll'^I.~ IIt"",,,,---I:kr...'U.6N. 1.~'>/l1-16~-, ., .. .._..,..__.._ ..u.....___,..._._... ....__.__,_,. ~;;,'~;::~~,::' e-';ii;;jSelle!l!!'d -~tQIVJ.:-:,.m'~ ':b7()l6^~1..:YSr;;;"-~::"~/~;~:~:::A... .":~,;~;".~~..:-_~~~-::'~~~ (,,",11118 al .~'l-(:,,__.d!r:I_'::'-fO.It; '11'4,. .._._:s.a;')llfJ\~)({f)iE.:.~tf._._L:1w'6'_..__n_._..) herelnolle, called IIIIY". , 2. I'ROI'F.RTV: Seller hereby IIgree. 10 \ell illI,j convey '0 Illlyer. "ho herehy agre" III 11I1l~1Jl!'e: ALl. TIl^'I~r:I!IIT^IN.J hili ur I'I... of "~rz,'PY'~'.~'~'~nR< nnd i'"nrovemellu 'h'.':'r:'~.e~~~'_~'~..~~''',,~:~~.~~.:~~ ~~~/.1.-..(f~/J~-!!..~~~,~~-n:..==-. J. ZONING, Zunlns 1:'""I(lcn,lon _,. . ___ .__.. _ .__....___.____ Failure of Ihl, "greement '0 conlnln Ihe lllnlns cl."llIe'llun "c,,"ln co... ..here Ih'III"lleIlY (or each p"cellhu,eof, Ir,nhdlvhlabr'l I, zone,l ,olely 1lI prlm"lIy to po,rnll.I"Blc.fnrnill' ""eIlIIlS' ,h.1I Icn,'er thl. ,\sreeulelll vold.hln ,',h, unlloll ur ,he IlIIVl!r o"d Ir v,'lded deposits tendered hy the 1111yer 511:111 he rCllllnfjU h}~le HUYf; wIlJIIJ~1l JI fCllll~fI11CIlI.#?( ';011I1 acljp.lI. . 1\ .J-aICS 4. TmlMSI (n) Purdl." I',ko .... _1.f?.~,"(Je(..u_r,We_II(/I.aCh:LIJNQ ..,..,tV JAlt:_J(jJJ{JSI!I::!J~_.J!all' l. _ ANti /jJJ _ ,._. ..._____. IL/P'.~ p{ltJ ~, hy Ih, B"ye, n. follows: 1111 IJlil'O~l'r Chr-:k nf. Cllh U~ Null' CJ .11111, 'linIn, 11f Ih., S(JO Illfttmtnl. '"C1rlllr Ilfhl"h II h",hy atltno\lOlnJud ....... ..... ... .... ....' S_.. II NOle. In be telllcm.d nn 0' bllo" lit, .........._ ll.,,-II( __ H__,I'I__...._ (~) "UIJIIIONAL OEl'OSIT dut on or t~Vll'e II" !J" J/S-() III ~J. .sr .1.,.., ..rrlrlK,c J ,--. ....--....., ",(,l~_. L....L<'=L. .----'.--..:..--1- \ ft~ ,.) n^'.,'Nen 01' l'UltCII,'\lIl'~"l! II """."., 16!? (}~() I}!~ I~" lu,ll, \'trllfl~,1 ,.!ttl''', "n.flo' mon,_,t' 'ur""1 ". . , ... . .... S. .f_'-=.t.J.__..... . J",.l:-.. t' 'IOrAI. .;""." (~S.e..~-J(JiJ..!1-.98 X.;.}f1~ Wrlll'" '.N""I M 5<11" 10 h... ., .,role .1.. _ --2(P~.., . __." "r ~t:s:... ._... , 10 ~8.-... I:~. z I"~,l"'" SlllIrmlllllil bt nUltl"' en 0' litfrHI' Ihe _.<...qL.:fr. . _ dilY vI _1lJ11!!.(b___ .___.. 199~_. lht Inllowlnl Ih.III'e IIrr.,,1I0Iltd prcHII. II of .nd al Ilml III UIII'IIltnl: I'uu II It_If'llllnll ,ltltlh-,I, Itnll, IAlcrCl' un InI'tl.,,11 oIUUIIlI'llofll. ~"nJ...mll\hlln I,u "ul t1umMWlllt '1I1l('I.IIC1n 'rulll,"", ".Ief 1I,lll/fIt Itlt" rr'tllll' Iny. III.elhu _'Ih .IIy ulflu IItn,hlt OIulIl\.l,.al unlc....AU ItClllly l'Un.'" Tnu.hlll tIC dhhlN evenl, unlen vlh""h.. rro_loItll hr,tln , 5. PROrF.RTY 51:rrLUft:Nr c.:ONflN.r.ENC.VI Thh I.rttrncnl II luhjhllll1h.. Itllltlllrlll 01 lIuUI'1 PII'I't..t 1.ll.'aIClt" ______-._.,_____ .--.....-. .-,-.-...l I.' 10 "' ----'--_...~..,....._._,._.____..._ 'HIIIII,tl',lr ..__.._.~ _ ...._._......._.__.___...____..___...___, ~. JIN.\Nf'INU ('IINIINI;t:f'oi(;\','rhh I.,ttnltnl h Illt'i"1 hllhl: li'loll'ld",.u ,..lh)\l"I~ hI pn'N<:Il'^', ^~ll)UNT ,./t).B1_OXQ '.._ TI'.r. Ch911___, _. _, . .. ._ MIIIIMUM T1i1'~1 _3.h d.._ _, MASIMIJM 'NITl^t", ".. t,1) INTEIU!ST nAIl! _U!J~ .... M.o\XIMUM TOTAl. "(UNI.'), INl'UJ~)I,.,n I.OAtI OHIOIN~1l0~~ TO DE PAIU I I I ~YYU/, /4~ TF.RMIN^I. O^TII '.r ml,I.I.. fi.,.,I"R Cno".."","" _~ l!Ifl/!fi._ .~ Q.Z;J1Z I x .....;"l1!'>L; ,~__ Drnlrirr may Ilhlu Ihlrer or p\mlblt 'Quieti or mort",e (IIndl, hul UnIIlJI au 11m, lUJ'flmlbililr ror alilllnln, 1I11)'rrl. mOll"le. It lalll lOin c.nflt111.c't1bUln,J IS hurln rrovhltd.lhh ^.rtfn\tlll \h:lll btI NU1.I_ ANO \'nm .n.111I d'NltllllIOnlt, ,h.1I ht IthlfllN lU lilt f1~",r un ur berOfe c1.lt I)t Jftll.mcnl.. prtl\'I.led hml.l, .ubJtcl IIu"e"Cf 1IIIhe ~'o'f'hlont In 1'1lI",.ph. 6(bl 0111I1 h(('). ~'''.J .r '. , lb) IIt/tlr s11,1.111113k1. I.'omplertfl .ppltrallon IIJ II ft1po)nllbtf "'hUn, Inllllllllon ror 111, ul\J hUll 1.11I1111 .2.,tO.Y _ ul.n~at d~t. rrOlnllhe Seller'. '"Plo~al hmu'. Should Ihe Duyn hilln mllh lu~h ,,;oll'lrICI(,t IlJlI,UUllnn Wllhllllhe IpcelrietJ Ilnlt'. II ,h.lIl" "'he t'l'llIm oUlht Sollie' within nVI U, ullnll.u lI.t. Ihll,urltf lilt (I) nC'\.I;,rllhh AII'fmf1l1 NUl.I. ANn YO II). .1 ""hi," U"lt', ,1.1111I011111 rtlll Oil ''',mJIII "111 bt ,'U .11'1110 Stller ullquhllll'l \I.IIII',U, .ulljc,'11U Ih. !tul.. ..11<1 RfllUrlllonl nf Ihe J'ennIYlv'nl. Uull!llll" f.'lUllnlhulIfl, III III) In IIl'1\1,I", o'wlllltn nl)lItlllo Ihe Ilu)'e, by the Selin t1t\IHIII,lhh ^~lttmnll ,mll. Aim \'Oln.lh, l"t-l...hllIUl ,lIld eonlhl,.lIllY 1l,.nlJ,d 101 In Ifill (,.I",oIl,h. IOlelhn "'lIh AIlV Illhft '11l1"~11I1I (Onlln.tl1tIUlll"III,Y bc lieu hi 0' tl'lIlorjtJ IIUWl,llI,lIlln IVI'ler fllr,.II. .n,llflll A,lCell1ellllh.1I Uutllll d'"lI~c "'01<11'. 10 II. IUlUlln lilt' Il'lmc mllnlln 1'1 If Ihe !;l.nllhl"" 11111 tonlln,tlle)' "ell: IIlJll. 1'''1 "tUlI' 10:) StU" f1t Afent rrl\l'1 fC~,tive" ....'111'11 rOnlmllmtnl "IIM unltllht lI.alt 0( "Illfmtnl, 'Oil/It Illd 1(1.11', Oil." h.,,,,,.. Ilullfllnln.1 IIl1le ,'II'I(\.In,II. I( Ill' 'IIM clUllIllllmenl II MI 'ullllhed ....lth Ihe 'Clint III trtclnt11 htftl'l. l1t nn II1Iltr lelWI nUN'" In \.t.II11I. by Ihl'hlHl, UII (If l,ct",,,. Ihl Ipfdllc,l,hlC', Sell" ,!.,II ha" Ih. of-lIml, ;\llhU ,bit. Of' any olhu lime Ihuufletl durin, th, Will II' 11111 ^lltclllelll. 1111111, bUllIlIlllt)'ulhllllC ,llle ullu&ll'l 0' Ih, ~,",u\II,llIlIClIl by 1111 Sellet. ur ^1'"I, hi declare lhit ^lfUll\tllf NUI.L AND YOU" by ....tIIlrn nallu to Ih, IIny" 0' ItI./llu dn.hloIlIIJUII~.I. ,II ../11. h 110". 1IIIIt('OIII 11I0111., p.I.1 un .n,\lunIIILIUltc "'ulI\eJ hllhCl UU)'tl. luliJ~IIO Ihe p.)'menl "QI1IUII, It 1ny. l'fII~I,le.lluf 1III'.r'."I'Ih, nib): tII, till. "IJ lUll. '. . ....' '1 (d) StUn htUby .lluelln N/lIllllntlVcllnnl by a..Umllltd ,prlllltefl, ,el'llll.lIlt UIUlItll Inllltl' IhltCl "I 'll'~' 1111 h'lllhe.t by Ih. IIIlJln.llluhul!UIl ut lnlllllll, 111I\Litl. (el !l,U" !IuthV ,s,ret ID Il'r. .dJlllonftl mOil.... ,.lIl1,:Hunlll\llllu an,l/o, I,un nllllnlll'm Ire ill \.\1' IIf a bll~t, IJl,llllllill1 Ihl.n~lrlll rWlIllI lenJhlt j'ulllllllul1 ffllllllh1d Iny one or 1111 (If olrulC'1il1l Ifn, tlttl~hllnillllt lulll of 1.1I111 lut dl~' 11"1 e'~fCd _u~__._f', Ilf Ihe I/nOIIlII u, IlIe 11I1I1l"le. 1. tlr^'III~ or WATp.n ANn st\\'F.nl Stlltl ..../lIritnl1lhU 1"'11 rhl~ll)' It Itl~ictlJ by _H'Ui"".__._.... '1....-.. -illu "nJ ..P!:!bl.i.'-_____ ,tW"t. FUllhrr. StUtt .....trnn" IhM lh~u nt/tllll." rully r,ald fOI and, U ullll, lI.1lt "'11111 'I'Wlltnl .fe In UI.(ulnl, upelalln. ~ollt1ltlt)n. T( ellhcr """lIlttl,lllIl1 It Jlrlvtle. SeliC! IUlunlt Ih.ll ht/lh. hat no nollee ftnm I II "1111'11\;1(1.111)' 01 f,om mlllllclll.I.1lIh1Ilillu Ih,1.1 flulillc Wiler .mUor ""Cf \lllIIb. IIIClU'11 lI' hUlaUtJ. I..]~. II. MItNIr.lIIAI. IMPRU\'EMI.NTSISC'lIcr h.t nu IlMkt. of llIunklnal IrnJlfOVtrnenll hu~h 11 t"h~.tlh, cUII'I, "...) ClU(lI__._.. ._. -. . . - ^\WUln" flllhh" '(lllt fMyrc'lllllt lthl'lI~e 01 . IfI,h'l'lIf ''''1I11Iln.:)' !'Itllllll 'Iom Iho IJlllllflllIellln( l'UnlJlt1ll.lIll11. , ., ..3 oJ',\''::''\tn---G ''''-'''-t f''' ~t:rrl""nl"''' J- J ~-,.., ~~.,. e',," frIO" ..../ 9, ~n~I^" cl.^tf'r.\II~_'l. .., ..;J~'~li~ll1I''''""N .. .11... ,... " ""-'.. ,._H!l'Wi.,. ""''''.. . =-' 1_._ ':b-z/f0'IILi: 11- O^,-'L 1fJl,.t:..O&-O~I--.fiUi^1l-._Tqt""PPL..~1lJIL/}l/umf.A.JL!?E. ~~ '-';;'1-- _.., "'_ .S(iIlE:~ J~OiiiD..6:...:pR(jg-E:...:.Ir~~(;p.Hi~~iQ~'bC~ei?,,~l1iA r.tli,fii.:':i":':'iillifJ.SJ:irit.:UT_.l:l.:lilii,-=. _1r;L..MlJJ..5~__~.,__ ,_~,_____...f'_..._ ..,0,. .'___.__._, '..__. 10. ATfACIu:n MIllt.:NuA I'.. 11I1,1, . "JfI.af Ihh "I,,,.,,..,nl' r(}"\I,'I\O.IIIlf"I.llnn l\'1hdulI IJh~"'11111l n 11,I~m Waln/On.SIII SI\lrAIC r1FIIA/VA iV'1hl:iIAg'MyCnn,rrll UOlh"hl; _._________.., ._..____.____h_ ....-._ ....________._ II. rUtIH'N^I.TYI All nhllnlllllllmhin.. hUIIIl., .1"(,,nllilhlt,llI, ..ltllf)lhlln_ fhlllltl jlll~!lltlln. ..h"hltltttl.t,,'ullI"II,.unJ "II" 1,11,,1'1 '11PUIlflllllllllllClo .ml ,.Jlml." a (Iltllllucor. .nd olhrr pelmnnenl rhlu"" 31 ""II at ,lIlltll'" 1.,lI\tJlY h,Io\, 'LV. '"llnltll, 11I1111 IIflJ WI,II Hll'"Il,IU,tlhlf ",Uh ".1110 "".11 u,,,,,lIn., "'renl Il\mn Ilt,h alHlIor "'~)'" '''Iclt., .....nll1f" unelllln h1in~", ..111l1,11r11l".u .Illllllll"llc "lIIluII .U1<J II,,,,.. tit:. "IUoIIII' UI~II', ~",nlcft. ......" .ullfnru, UI~""1 "IMIlCII IIUptlY UII", d"!1('Y fod hllfllwlIC, f11ll:l1l'1 ,I)dl, l'Ilfl.in Inri h,,.J...are, "UIII(I tIiU,",If'IY, 1111111111111 III1W 111111 fillll"'ft'llY, 'III,. dOOI upcnc... ,llt.hllt allY unlellll:nln.auy uU('Ilt.1 IlIlhh ^lrumrnl,llt: Ine111lJc11 I" 1hl ",It .I11III'Ull'/IIIU 11111'1'. tit'''' "' Ihe ,llltv, IIltllllllllrt!lltrlll \11011 t" III!toullllf tllhUIIIII"III~ Ill, Sill" INnl prrmhu din .hlr n' Ihl. ^lfCC'nlelll. ,\IIY ,tlll,II,lnllhullnll arlll/", u"'~h'. 'ue . IlnUII,lIIlh, I,umllll "lllllle "' 1I111'llItlll 'Ie .hlll",III.',J undtrlhtt \i1luUlrul. Seller hlllh)' \II,'unl. Ihnlltt/lht"' llllth~" /lHIt,I tult 1111111'" II" .1I1It'll' ,1'"IIIIt,1 III III" 11.1"",11,11.1.,,,1 "'y 'lUlU "tlUIU t'l ilellll'" IlClIHn,lIy tllClIflull, hll(IIIII"llo) IIf lnclllllfollu IIIIt ,lilt. ">dlu "'''11"1' ,,111,11111I111,'.. hullnlf. II, l'(lIl,IIII"ni"". Il\t~I,..nl. .,I.1n.1 tl",'III,'.1 'UltITlt .nll ell"lllIll1..1 .11111 'JlIIIIIIIl\'U IU lie 11I1'IJIlj\ft "",UII,llIlln 11111.." t\( tclll'/II'IlI. Thit ....III,I/'Iy lInn "I'IIUI'o'I\'(' d.lll"l. ._---_._..---~--.._.. .....-.-..--. ", ~\. " I \" , .. /, ,I.' ,. (1)1l Nul Wrlle In Thl,~ SllIu'('1 GO'd ~:(I(1' 01'/ /;-:" : .~ T :; (. . I~'.;~ ) till ')~:,~;-I!-,~~;I:,...,~ r,~-I ' ''II 1:11 ,,1111 '111 'I.i 11:i11'Ijj/i'l I-III;" I I I I I ,",' ... ~ ,-' '....' .~wi "" ,~ ,.. ~ '-" ..:J ...... ..... ',"".. . ,t, 'I'~"I., '~4""II\.'f.I'" ....1.11 ..,1,' ..)01"....' .~ :: '.~: '-r.-'< 'II.' ",.1", .~~..:',,: '.:. ~~: 'n. TITI.'. ANII c.:mfT~1 ", I' . " . I'.. . I. .' . I . (.., Thr Jlumhu a" It\ t'tc(unvrYfd In I" d",,,lt by 'ptelll .tlIIIlIY tJ,,~, rfl'lllnd (Iu, Dr .1I11tll., ,"~\u"brlln(U ."d ,.wnlml'. ~~tlll'r1NU IIOWI!.V1!A.lhlt 1011.:1...1"11 etltll". bulldl", ,uul,lIon.. 'l"Jln.nulo uk""nlt"r filII", rflll'n'lfl N ,I.lln 01 tlubllf ItI"ler romf\lnlrt,1t Inri 0' "..mfnl. Of rUUltllon. "hlb!' II""" ,he I' :Jund. l'lh"fWhr Ihc thl, 10 Ill, nbuII" dnulb,d rUI ellll'" ,hili tic ,ood IllJ ,Iu'hl_bl, or lueh II \1111I tI, 1..'IIIN tit. upulIblr 1111, IllUIIA"Cf cump''')' .1 lhe It.ul., nlll. Cbl Tht Du)'n will r.'" lor .ht (0111)\011'1"1: . . I ' , '1' I j .! , ' . III rhe pfCm um lor 1111. 1"".tflRu, nltthanll" tI." l"llll.nn .nd/ol 1111. 1I',~h, or fu 101 Clf1(tll.llulI n' um., If Ill,. 'I n. pfCmlum 10' n<ll)l.lln'llnnu .rl.J/l)f III. Inl\l'nnn _jah nl"I.JIl.l un.tllllf, Inlu,".I\.t bllld., ,hll'" or nnull.lIn., It.. It In.,. .. (III Appnlul/.., and ehu,u (1'ld I" IlllY"nct III mOil I"". It Inr, (I") nu~cr', nefm.lnlll.m."1 ~UUI and Ittlualt u"I," elbn..I,. 11.1...1 hll.ln. (l'J ^nr .uluy 01 .uIY't' which "'.)' bt flqulrfl,l b, Ihe Till' I",u,un r;o'"ru, 01 IhC' .hIU,hlh'l oItlllln.., (01 Ih. 111I1'.IIlllIn t".n .drqullc Itl.1 dtltlll'lllln nr I~' Cremh" (0' Ih. .uurellnn Ih.IIM., ,hllll be ,r.:u,td ,".J ratd IUI b, Ihe 8,lf",lIu...,u,. fl"Y III1U, 01 IIUV.,I ~nfr"l br Ih. Pu)'n 0' nqul"... tly hll ,"Uflll'" .h.lI I "","d ud raid 10' hr Ihe Ou,e,. C") ~In the eunl Ih, tlell.. I. unl~l. Ip Iht A .lXld .nli mll"I."I. Illlt or .uch II ..III b, hl'U'N b, . npul.bl. 1111, el1llll""I', ,ubJrtl .1 .rO!Uallt. Bur~' .hllll h.". lht o(llh'llll)r IlIklna ,ueh 1111..1 lfrt Seller fIIn ,I.. "llho'llll~lltmtnl 01 flllf' 01 II' bel'" up.hl IUllIonlll rtlcl b, Ih. Butt" 10 1'" Rllltt on .ccounl or Ih. purch... p,lce .nd .h, R.Il., ...11I ,elmbuuc Ih. nUl" ru' .nreoUllntuI,...1 br Ihe Bu)'tt fOl Ihnlf lI.mllrWned In P."IIIr'ih 121") hem. In. CII),_(1I1) Ind In rUIII'Iph 12(c1i Inll Illlht 'i1ller tvenllhrr. thall bt no ullhn 11,1.11I1)' u, u~Jf(lfon on ellh" "' Iht rUlltl hmlo and 111I, ^llccmcnllhall bttolll. ~lJ..LL AND VOID.., I. IJ. PA VMt:N'r or UEPO~lrl lJ'Jlotlu. "JudICII 01 11'1, r~lm 0' pI,menl Ind Ih, JlCllcon dullnlled II I"~ft, ,h. II be raid to A,enl fot Iht ~lIttl whu ,hili ,rUin .hem In /In emow It('ounl unlll ,"un'lImmallo" 01 l.tr"lll.lI~'n of Ihl. A.IUII""lln conformll)' willi .11 'rl,II~'ble I.w. .nd ",lIlulnnl. ^,..ll fu, Ih. Sri tf m.,. .1 hi. Oft hft 11)1, 0111h1.., huM 11ft' unulhed (111(11 'Indt"d .1 d'llmlt, I'fndlnllhe UUP""" IJf Ihll offer. , . . II Ihtlt II . dhrUI. tlll....u" Iht Duy" '1I~ Ihc Seller 0'" ..hn It 1.lllled 10 Ihe depotll, A,elll will nul bt rnra:nllbl,ln ,.,o",.lh.1 dhpult .lId..1II nOI h,lIabl. 'lJ .llhn Au)" 0' Ih, Stlltt fo' 'du,ln, hi u'rue Ih. d'DvlIl .."hoUI.. .dtqU'I' "'rlllen a.rumenl belw"" OU)'" IInll Selin 01. nlld toUrl nhltr. Ourl,lllnd Selin II'" Ihlll In Iht ",enllh. ^Iflll AnlUO, Sub'ltnl I,./h luinrd In 111'1.1101' fUI Ihe trlllln 01 del\tl,llllll'lllle'. Ih. A,enl" .nd/ol ftuh..,nl" I...unable 'lIome)'. "" aniJ Will -II b, lulil h, Ihe plUl, Jolnlll' Ih. ^.,nl III ~\lbfll'"l. I J I". l'USU,s"ION ANlJ If,Nm:n, (II>> PontnlM II lu ~I drlh..ltd b, """. hr' .nd ph)lklll ,"mlullln fa . WlUlll hllllJlnl (II ""rl .t &I., .11..1 111"'1.11 ,,"I,melll, 0' by dud Illd ."II...M,nl 0' "'talln! It;t'I('lllllhr IllIlt or (fUI'm.nl If Pllmhu h I,nll"t tJ(cupled .llh. '11111.... 0' thl. "'lItenltnt, ulIl." IllllU...h. 'p(C1l1ed heuln. UII,II -ill IId,no'lllltdIC uhlln, l"uII 10, lnul.lln. .,,1,' I.,u,hl III lime 0' 111..1111 1.11 Ihl. AI",nltnl III Nail it I,nlnl ~culll'.J. ..'.. t~) SeU" _11I11101 'nltr Inlo all)' n'.. I....CH, ..,!lU" UII.ltl,," vr "lllln.ln"I,).lr .n" III IIdlllllonlllllelltU) (tll th, rUlIII". _lIhuul Upltll W,IIl'" .:nn,."1 'Ir Ih, nu)'t" (el "n'Ill.III",I" of In ,Ul'UII.J dUll and purdl.l" '''lint, II hlub, ""'llull. . h.ll Durer mnyu Ih. el.hllo mlh . PI'lfUI'lnl"l Inlpn:lIon of ,h. h,bJUI pllml.t.. Ind v.lIl "I~UI. IIrproPII.ft docu.n'nl.1l1111 II' ,urh In.pttlIM. . . . IS. RISK,C).' '.U~51 ' ',.' I' " , . "'." .' , ' ... '. !.. , . ,; , .(.). StUu.lh.llmalllll1ln Ihe r'opCIlY fIMh"Jln,lIl1l1em'lIIellllnnN.ln p.rll.llph II~ hlt,IlIt .lIlll1n, Ptrlpnll P'OI'lC{I)' Ir"f(IRJ'U, .(h.rr1ule,l h~'~h\ In It, pr,ltnl condlllon, noftn,1 "UI nnd lur ""'IIN. , . " . '.1 ..', . (1.1) !i.llu ,hilI! bu, ,hk 11' 11m nom flit 0' l)lhtr ll;.atUIIl, unlllllm, ur tllll.mtnl:ln Ih, Cftlll or d.ll"''Ilt 10 thl propttl,.-by'nU'nt Vlhcr ulu.IIY: au,'' th.1I h.". Ih. uPllon ot ,..dlldln. Ihll ",celll'llI 'n.J uui,jnl h.nd mnll')' pllhl on .ccounl or at 1m pI In. Ihe Plop"I)' In IIllh." cundlllo,. "Ub. ,hf pl,OCHt.b of 11\1' In,ullnet r<<ovuy nhl.lnabll b, 5,11". ""r" II hrrcbr nOlln.d ItI.1 h. ml)' Inlut' till fllllll.\lI, I"wellln ItllI r'"rl"~ I' or Ih, IInlt or 1M .",ptane. or ,hU .,r...m'"I. I'. REPRESENrA'IIONSIII II ulld,rtlnlk.llh.1 Durer hat 1'''rt~llIllhe proptll)'. ",11mb, wfll'n Ihe 'If hi In dll to .nd ht/.tI. hll ..,"d 10 punh...11 II' mull or .U(h In'fW:CIll1n .nd nol bee'Ulfllr ur In "I/.nu UIl.hI 'n)' npltltnl."o.. niall, b, tht Selltl or .n, nlta.. u nCct. p.r1n" tI, ,,"pIOu, ut Sell"t 01\' b)' Ih. "MI ot th. "II" 01 .nr or Ihc 1.1Iu', ttlurmon. tnd e'"IlI'I)'CI or b, a CDnpl'uII". o,o.u, Ir .ny, n, any ur hh/hu ..lul'ff1l)nl .nll.mpIOJ'ft:t'ud ehlt "' h. ".. .timllo purrh...1I In II ptfUIII (flnlllllon unl,.. ulh"...hl trrcl{lrd hell I" .1/11i fvllhu aCknO'A'".Jle, Ih.llhe lfol'lIIellllo..cLl pulla a.. AOI qualln,d 10 """" In uplnlon."n.OOO"''''lli'Il'll ,",'n."ln., ur c",,1I0UIIl'"I,1 mJlltu .nd Ihlllh. hll)''' hfll been ..Jvlltd Ihlll hili he m.y "quirt (If _lIh 10 .nk Ih.IIII'III1qt ,,'Uprllt In lho.. n.ld.. lilt rullh.. "ndlUIMCI Ihnllhlt ""rUln.l\! ,:vI'lllln'lhc whol, '1'''",'"1 belwtcn Ih. ~.II., II"d Duru '11..1 Ih". Ie. nu ,"hcrlum.. obU..IIIlII'. cl)vcrl.nll. rcPlfUplllloll., ,111,nllnlt qr lIjondlllon'f onl "', IIlhllWh, or .nr Und "h..uue'n foncelllln, Ihl, '..Ie. PUllhtrmolt, IhI, ^1,umenllh,lIuOI lit "1",\1. .mlnded'. cll.nl,1i 0' I1Itk1ln.... fU'rf In _rllll'l, UlculN b, Ih. ,uu.ln h,.,,.'n, ' . . , 'I' 17. R[CnHUlNOI TIlIt 'l"elll.nllh.1I nOI be 'feold,~ In Ih. omu 101 .It. htfo'lIhJi". of I)u", 0' I., illY ",hn oUlce or pl.e, or f1ubll~ ttn",I, Ind II Du,er .h.lI I<<n,Lllhlt _.,u,nt"l or (lUll Ilr ,..,mlllhe tlm. 10 b. Ihll"lld, SllIfl Ill", " 1II"hn option, tlfrt 10 !rUI "',"h 1111 II .b"~(h lJ' Ihl'.""'"1,.nl. ': " .' . I III. A!;!U(JNMENTI 'rhl. ^Irumenl .hall h., blnllln. llpon Ihr '.'Illlll"e h,I", taeCUlnrl, IJIlIIIII'UnlUII, tucreuo" "ld,",,, Ih. IIlln( u.lanabl'l on Iht ull,n' 6, Iht &MIllin herein. II b.lnl ellprelll)' urld,ttll\od. ho'AC\t'" Ih,U Ihl Ou)'u .h.IIII...1 lu".r" or fllll,n Ihh AI""n.nl "'llhoul Ih, WIUU" (4)nunl ur Ih. Selltt btlnl nUl obllrntd. II. NON.I.IADILlTV or /un:NTI EllCCpl &.I PI")' bl provided by. Ur.lull. ,,"umenl 0' ..Jd'lIIh,m 10 Ihla AlmnlCnl, A..nIC" It, 'fub'^ltnlf.), If In" '" Ifpnunlln. Stlln, nollht Buyer, lilt .'"remly unJCftlMd .IId ",lted btlWlIIllh. pili In h"tlO Ih., 111. herrin n'hlcd If till. hh/"" ,a1raprupnl Ind .."plutHJ u, ..nl' oroeer 0' plflllet Of jlltnl ,"d nn, toOlltnlllll brukcr Ind hll/hlt "'I"f.lnon. and .mplOlU' IInd .n, officer 4)1 pallner 0 Ihe eool__"IIII, bro", .""lIn, It I..nl 01111'" be"'.ln,lhc BUYrl and .stir" "'1lflher. .lId will In n" cu, _h.!toner '. h.ltlll,ble Joint, lit 'r""aUy 10 .Uhn Ilanr for Ihe ptrfolmancc nf .n, II em or ca_,nanl O'lhl.^."eM'n~ 0' tOr d.m.... rOl Ihc nonper(o,manc, IhuNf. . ., ., .. . ' ". ,. '. , . 1 ,. ..' .. 10. UEFAUI.T _ riM" 15 OF lilY. t'Ji5t:I'WE1"TII. uld 11m, ,,,' nllltmelll .nd sll ,lIhft html "Iwrd In 'M Iht I"Crf."",.ncc or In, or III, obl,..llon, of .hl. A,'tfmenl .alt hereby .,reed 11111. t.1 Ibc ,ucnu or Ihl, ^Irrtmenl, Shnull) Ihc 1I11~1'fI . .' ..., c.) F,UIO ",lilt In1.ddllllo1l1.1 p.a)'mtnl. u ,pn:lfIN,ln rAlI.tlph 41, ," ., 1'1, '...,'. II.' . II.' t I. I' I~' I'" 1'1 , Cto) rUlnhh I.IU l)lln\t'mpltlc In'0Illllll(\1110 Ihe Selltr, Ih, Sell,,', .unl, 01 Ihl ,"1,)1I11I,I'IIIItr. umcu"l". Ih. Du,,,..I,,al 01 nn.ndaJ 1IIIuI, 0' r,lI'o ~l)Ore...1I I., Ihl r'lXellln. of Ih. mOlllflU loan 'ppllullun, _hleh .('11 \Yould IUlll, In Iht tlUuII 10 oblaln Ih. lI1'r,oral 0 . mOIlI'" lo.n commllln,n., or (c) Vlolal, Ot ,alllu (\emll.nd pelrorm u, ut the Willi Of clll\.Jhlun' ollhl. ^,rr,nltlll. Ih.n In ,lIlh flllC. In depcdl 11101114' 'Jhl olher 'umt ppJjl b,.lh. Ou)'er 01' I(CO\ln, '" the rufthllc prltt. M'hClhcr ft1Ulftd by Ihlt ^Ircemtnl or nOl, IIU)' \If Ifllllnrdl (II bYlht 5.11.. un arcounl 01 he Jlllrrhu. Ilrlr', Ihould Ihe teUer drm.nd.lhc tullllurdl.llf rrlr.. or . I'" . . C1) l' t"(Inln 10 b. .pplI.d 1I'Ilhe Sellu', ",nUl'" UI ' , " ., (Ill) It IIquldll,d Jam 'I'" 'or.,u('b.blueh. " .' 'II " . ;t, Ih. Selltr Inl)' ,It('I, on\lln Ih. tyrnl 'hlllh. ~,1I1f el".. 10 IIlIln Ih. monlrt IllIquldlled .".mlllll In .t('ord,nu *Ilh Pa"I'''rh lO(cHlln, Iftt SIUn ,hln b. ullllm) trom IUlI,bIUIV 1,)' utlll,ltlon II Ihlt Allllm.nl Ihlllll ~ NUL'. AND VOID. ,.' . "" I . " I " U. ht:COVJ;RV FUNOI A fullll." IrcOyuy tullJ ..11.. 10 rrlmbull' "'y fllllon. _ho hit oblalntd I '.n.1 chll Jlldlm,nl .,.Inll I ",nn.,11'Inl. 1..1 ul.I..Ucenlll 011I'1,1. If) Irud, mhrtpuulullllJnt 01 dr.:,llln'I,"1 tll.nle Itlntlttlon lln.J ..ho hll been un,bl. 10 1'1l1l1'li11h. jud"mtnlllur uh,\,uIIlIIUlel.llnd cqull.bl. ,rmtdl". fUI com. Jllrle dtlllll.bl)\ll nil 'una, ull (711) 7111.,MA U. nr.Al. ESTA lE UI,.'UTE nESOLU1'ION n5TEPoh An~ "IIDIII. UI ~llJm IIhlnl aUI M Or UIAlln! 10 Ihlt "11t,mflll,llIt br,uh or Ihla A,'tlm.lIl 0;'111,. ..,.,1" cno"ldtd In "llIlon II) lhl. AlltenUllllh.l1l be lubmllled 10 ,"l\1l"lon In Ic('oldlnc, ~lIh Ihc Rulea and r'd>:,. lur,l)( 1111 Rnll!.&lll' Dllptlll Mtloll1llon S",.m, Oltpultt th.n Illdu~, "pmtnllllon, mhl, b)' Ihtbv,CI, IIlffl, (I, Allr b,okel..,rnl, mbllltnl, elolhlt ptUM." 'nlll~ In eonntrllon wllh ItI. ..,1,/ puMuc, flnaarllll. ('<11141114)111, (II olhu Upetl 01 Iht 111011111)' 10 whIch Ihll ^Jlcrmenl ptlla 1lIllIdullln., ",llhoUI J!lIlllllhm. .lIe,Ulon. 0' (~\n(ulm,nl, mlmp,rttnl.1 9nl n..II,.n.:. .nllfo,.rnud. I . Thc peovhlontlJf Ihll palll"f!h'ul,lllnl'o medl.IIM .h.tlllurrlve Jetll.nltlll on Ihl .ubl<<1 p,optflY or ullln 11I!'lln'llon of lhll A,'"mflll. . Uu)er and "II" :I,knu~l.dle Ihlllh,y hilu I"ulved, ,uLJ. anJ'lMlIIIII.nd Ih' Ilalldud o'InnuunURltlll b,nchllr, .nd rylu uiJ prCfrdlllu rOl Ih, Rul ""a!tUllplll' Rttolu. .1,19n,S).lcm, '" .. ..., .. .'. . . ,.:, ' . " ' .. 1). lIt;.lJCRlPTIYE IIEAIJINU. The dU(,llpllvt ",."'Inl' "lilt htfcln arc (", eonunlenu only and Ihf' flll nollntended 10 11l&llfo'll,.1l 0' Ih. laltln In Ih, 'Wlont ",tlleh follow Ihen!. ^c.:or"'lnal1, tht, ,hln ha'" no ,lItcl.wh.II",,,., In deltlmlnlnllhe If.hll 0' oblll.llon, nr Iht 1'.&111.." ' ... ACRF.P.MF.NII TillS AORDDMI!NTCQNTAINS TIIlI WIIOI.DAORDet.iUNT DDTWDp.NTIle~RII "" ANI> IIUYIIR, TIIP.RP. ARD t/OOTIIDR TDRMS, OOLln^. nONS. COYDNAN'IS. "ePRDSeNrA'III)N~. STATEMEIrr, OR CONDITIONS. f)1I^'.I)R OTlIeRWlslI. oP At/Y KINI> WIIATSOIIVUR COt/CP.IININO TillS !i^I.H. r'xr:PPT ^.'J ArTACIlOO TO TillS COr'HJl^CT. . .. . [Do Not Wrl'e III This SIJIlCC[ .'. This 15 II IcaRlly blndlllg conlracl: It no. undrrslood, "lIl1.ull your nllorncy. F.. 1"1"''''lnll Thb Oocunllill 1ft'" In, Im,ndnlenu 111"-'1'. mar he euculed hi lt1ulllple CDtlllltlpl1ll bYlh. 1'''IIt1 and cJcll.,,,td b, .'1 or Inn.mllllon Ih'O"lh . (,ulmll. . CFAX) m.chlne In.! 'uth counlrrp.r1l Ih.1I 1I,_e Itll ..me 1r..1 .nlMeubUlIr .nd blndln. .rr"" It 'hOlllh II 'IIlell .I.n.d by an p.rll" r" 1I,lfln.1 lorm. Ilnlll w'mnr.I" p'"Il1 .m,..lnlf,d1nl,n .,1...11, boum! .mb~"'~d;l:"I'llr'''dl.nd ...1. __, ,.__ nllYf.R~_.-:..~ -. 1-----(IIIAI.l . .,. ....__ nUYllR. ~ ._~_.U". .__n_ I~EAII ,/:;.,..,n'"''II''' .------"PI. ;;;~~J?~~-.19~ 1!tL:Y~---., . . .....__ ~"l.fJ'~~. .. ______ .. '''PAl' .!);:LT S6'!);; :"'1] 9S~I7-2.SI)-.!.'.!.-T'OH l31 ::IO.llf.l3t.l tI311~lltl~ ;IJl:lf Wi'f'iir.,;.^lj'JOQlIH'fl ."....'..r" ~O'd ...... .... 800' ON " j ti;, , ., . ,.~- .' IIIY.ISO:' fl+ 11.161 *' COMMONWEAlTH O' PENNSYLVANIA INHfRllANCl TAX InURN IUIDEH' DECEDENT ESTATE Of Hoovor, Kim M. 'i' "<!e':;'"~"':.'!j;~i~y"'~~:~i~ SUPPLEMENTAL SCHEDULE B STOCKS AND BONDS fILE NUMBER 1995-00395 (All proporty 'olnlly.own.d with RIght 01 Survivorship mUll b. dl.clol.d on Sch.dul. f., ITEM NUMBER DESCRIPTION 1. PPG Industries, Inc. @ 38.25 per share VALUE AT DATE OF DEATH - Additional 544 Shares Common Stock ........-. $ 20.808.00 TOTAL AI.o .nlor on IIno 2. Rocopllulollon) (11 more space is n..d.cJ, ins.rt additional shllh: o( 10m. size.} 5 20.808.00 ,I 'IV'lSU~.,.I'D...,I. (OMMOHWIAUH O' PlNN,nY...,..I... INHU,'AHCI u.. UtUIH ,UIDINt DfelDINT SUPPLEHENTAL SCHEDULE I DEBTS OF DECEDENT, MORTGAGE L1ABLlTIES AND LIENS ESTATE OF ITEM NUMBER 1. 2. 3. Hoover, Kim M. FILE NUMBER 1995-00395 DESCRIPTION Pace & Pace Realtors, Marysville, PA - Commission for sale of property Cumberland County - Transfer Tax, (1.0% of $109,000.00) Other settlement costs - Deod Preparation Disbursement Fee Termite Report !louse Inspection .,1,". ..:!..,. '", TOTAL (AI.o onlo' on IIn. 10, Rocopllulo.lon) (II mort .pace i. need.d In.ert addi'ional ,h..Is o( same Jize) AMOUNT $ 7,630.00 1,090.00 100.00 35.00 40.00 100.00 $ 8,995.00 . (~ r::-_,\ r-/~. '\\ /i' , - I {il' \; II '\." --- j;' . / REV"1547 EX AFP (12"95.' . ' ' " II COHHONWEALTH OF PENNSYLYANIA DEPARTHJ:HT OF REVENUE NOTICE OF INHERITANCE TAX BUREAU c.~. INDIVIDUAL fAXES Ai"PRAISEHENT, ALLOWANCE DR DISALLOWANCE :!Ji:lB~~~lpA 17121.0601 OF DEDUCTIONS AND ASSESSHENT OF TAX RECEIVED J. 1 6 1996 ACN 101 DATE 01-02-96 FILE NO. 05-11-95 COUNTY CUMBERLAND NOTE. TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBHIT THE UPPER PORTION OF THIS FORH WITH YOUR TAM PAYHENT TO THE REGISTER OF WILLS. HAKE CHECK PAYABLE TO "REGISTER OF WILLS, AGENT" REMIT PAYMENT TO: JAMES B PANNEBAKER ESQ PANNEBAKER & JONES 4000 VINE ST MIDDLETOWN PA 17057 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 AMount R..itted NOTE: CUT ALONG THIS LINE _ RETAIN LOl/F.R PORTION FOR YOUR RECORDS ~ iiEV:isl;j-ixuAFi.-"n'if:iisT"NiificnjF"'INHEiffTAiicE-;:AX"jipPRiiisEifiN'i'";-AU"ciwANCE"ciR' .n -------" - ----- DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX KIM H FILE NO. 21 95-0395 ACN 101 DATE TAM RETURN WAS, I ) ACCEPTED AS FILED t XI CHANGED SEE ATTACHED ESTATE OF HOOVER 01-02-96 NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL AND SUPPLEHENTAL RETURN NO. 01 1. Rool Estat. (Sch.dule Al III 119.000.00 2. Stack. and Bond. (Schedule BJ (2) 20 .808.00 3. Clo..ly Held stock/Partnership Int.r.st (Schedule C) (3) .00 4. Hartg.g..IHot.. Receivable (Schedule DJ (4) .00 5. Cash/Sank Deposits/Hisc. Per sand p,.operty (Schedule E) (5) 120.649.04 6. JoJntly Owned p,.ope,.ty (Schedule F) (6).00 7. T,.ansfe,.s (Schedule OJ (7).00 B. Totd Au.ts 181 260,457.04 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Fune,..l Expenses/AdM. Costs/Hisc. Expenses (Schedule H) (9) 10. Debts/Ho,.tgage lJabJliUes/LJens (Schedule X) nO) 11. Total DeductJons 12. N.t Value of Tax Retu,.n 13. Cha,.itable/Gove,.n~ent.l Sequest. (Schedule J) 14. Nat Value of Estat. Subject to Tax 20,188.85 78.957.19 1111 1121 1131 1141 99,146 04 161,311.00 .00 161,311.00 If an assessment was issued previously, lines 14, 15 and/or 16, 17 and 18 will reflect figures that include the total of 81b returns assessed to date. ASSESSHENT OF TAX: 15. Allount of Una 14 at Spousal ,.at. US) 16. Allount of lJne 14 taxable at lineal/Cl.ss A ,.at. (16) 17. Anount of lJne 14 taxable at Collat.,.al/Class B ,.at. (17) 18. p,.incipal Tax Due .00 161,311.00 .00 M .00= M .06= M .15= 1181 .00 9,678.66 .00 9.678.66 TAX CREDITS: PAYHENT DATE 09-14-95 RECEIPT NUHBER AA082134 DISCOUNT I-I INTEREST (-I AHOUNT PAID 12,884.55 .00 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST TOTAL DUE 12.884.55 3,205.89CR .00 3.205.89CR . IF PAlO AFTER DATE INOICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" feR), YOU HAV BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. I , i I ! ...I - <C :E en en <C ...I o I- ~ - LL . ....,,~t,:<I_~"" 1" '. .'? , ., .!!J P\ ~~ii5 811I< u@;~gl'" s~~I~ ~S~~8 --' <( - I- Z w C - Ll- Z o U . ~ U...,. p..;~ ..~ (f) · ~i QJ . 0] ZJ <~ vi t\r'- Lv REV-1607 EX AFP (12-95>* CQHHONWEALTH OF PENNSYLVANIA DlPARTttEHT Of REVENUE lUAEAU OF JNDIVlDUAl TAXES DEPT. zaa6Dl HARRISBURC, PA 1112a-0601 15 36-1 INHERITANCE TAX STATEMENT OF ACCOUNT DATE 02-20-96 ACN 101 S TE OF HOOVER DATE OF DEATH 05-11-95 KIM M FILE NO. 21 95-0395 COUNTY CUMBERLAND NOTE. TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBHIT THE UPPER PORTION OF THIS FORH WITH yeUR TAX PAYHENT TO TNE ADDRESS SHOWN. HAKE CHECK PAYABLE AND REHIT PAYHENT TO. , JAMES B PANNEBAKER ESQ PANNEBAKER a JONES 4000 VINE ST MIDDLETOWN PA 17057 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 AMount R..itt.d CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR FILES ~ ifiv:i6iWEX-"j:p-iiz-:9sy------iiil.--iilif€RiTAiic'E-fAX-si'iifEiiE"lif-OF-Accc3i:iiif--iili.--------------------- ESTATE OF HOOVER KIM M FILE NO. 21 95-0395 ACN 101 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE. AND. IF APPLICABLE. A PRO~ECTED INTEREST FIGURE. DATE 02-20-96 DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT. 12-26-95 PRINCIPAL TAX DUE, 9,678.66 PAYMENTS (TAX CREDITS). PAYMENT DATE 09-14-95 02-02-96 RECEIPT NUMBER AA082134 REFUND DISCOUNT (+) INTEREST (-) .00 .00 12,884.55 3,205.89- AMOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST TOTAL DUE 9,678.66 .00 .00 .00 . IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. I IF TOTAL DUE IS LESS THAN '1, ND PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. I , .. . - ~ n PAYfl[HTI o.hch the top portion of thl. Notic. WMI .ubelt with your PI~t ...,. pI.I. to thS n... end eddn.. prlntld on thII r.v.r'l .Ids. If RESIDENT DECEDENT ukl chick or .onIV order paYable tal REGISTER OF WILLS, AGENT. If NOH-RESIDENT DECEDENT aak. chack or aon.y ard.r p.vlbl. tal CGttttONWEALTH OF PENNSYLVANIA. All PI,.ent. r.c.lvld .h.11 b. appll.d flr.t to any Int.r..t which "V be due with InV r...lndar IPplled to ~ t.x. AEfUND (CA)I A r.fund of . tlx crldlt, which WI' not r.qu..tld on the Tlx A.turn, .IY b. requl.tld bV ca~l.tlng en "Appllutlan for Rlfund of P~.vlv.,la Inherltll1cI snd E.tlta T.." (REV-UU). Application. Ira 1Y.llabl. at the OfficI of the Rlgl.tlr of Will., any of the ZS Rlv~, DI.trlct OfficI' or froe thl DIPlrtaant'. Z'-hour ..,.",rlng ..rvlc. nuMi.r. for far.. ard.rlngl In P....,.ylvanl. J-IOO-S6Z-Z0S0, out.ldl p.m.vlvanl. end ~Ithln local H.rrl.burg .r'l (717) 717-1094, TOOl (717) 77Z-ZZSZ (Hllrlng I~alr.d onlv). REPLY TOI ou..Uon. nglrdlng .rrors conhlned on thl. notlc. .hould be eddra...d tal PA a.pert.ant of A.vlnuI, lun.. of Indlvldull Tax.., ATTNt Pa.t A......ant Rlvl.w Unit, o.,t. Z10601, Harrl.burg, PA 17121-0601, phone (717) 717-6505. DISCOUNT I If any tex dUe I. plld within thr.. (Sl cIl.ndlr lanth' aft.r the deeldent"s dI.th, . flv. p.rc.nt C5X) dl.count of the tax p.ld 11 IIlIawld. 1NTERESTt Inter..t 11 charg.d blglMlng ..lth first dew of d.lInquencv, or' nine t9l aonth. IInd one (I) dill' frGII the dlt. 0' d..th, to thl data of pIYlant. '1.1' which blca.. dlllnqulnt blfar. January I, I,IZ b.ar Int.r..t et thl rlta of .Ix (6Xl perclnt p.r ~ cllculat.d It a dlllv ratl of .0001~. All taxI' which bec"l dlllnquent on Bnd aft.r Janu.ry ., 1'12 ..III b..r Jntar..t .t . r.t. which ~III v.rv froe c.lend.r V"r' to cIlandar y.ar' with th.t rete ~ad by the PA D.p.rt..nt of A.vlnUl. Th. IPpllcabl1 Intara.t r.t.. 'or 1'12 through 199' .rll V..r Inhr..t Alt. DIUy 1nter..t Fec:tar' V..r Int.r..t Rat. Dilly 1nt.r..t Feetar 1982 ". .0005U .917 .. .000n7 1'15 16:C .OOOUI I'M-I991 II' .000501 .'84 11> .DOUOl 199Z .. .0002'7 1'15 15X .GOUS' .995-199lt r.c .000192 1... 10' .000274 1995-1996 .. .000Z47 --Inter..t I. calcul.ted .. fallow.. IIITEREST . BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Hot Ie. l.sUld .ft.r the tlX baeoaa. delinquent will raflact an Intlre.t c.lcul.tlon to fi'teen (15) 017' b.yond the d.t. of the .......ant. I' p.y.ant 1..1de .'tlr' the Int.r..t eoaput.tlan data .hown on the Hatlc., additlonel Intlr..t au.t be c.lculetld. .--.,.-..- . " - -- --- ~- --- ---'- ..-- -.-- .,.._~ ___ _"H_ .__ ____ .___. ..___ ,... .-- -'...- ..~- ~--- --- _.- .-. - - .~- "- - --- ji -::f~}t:'/-7':~,~:(i:':~J;."iY-:rR:.,}~~~tl-t~'Mrrlr!:~~r~:\iJ~;):?XftP~:} ~~t;~:~:/.>i(';r<{::','_:. --':7<'-;\., :^;',"<-,:.-j\[,.:_ ;."_ ,i" .'j,:'.'_.'{;: ;tit.vL~i' ~-.""';A\;f/~1;}},;1::-'" l'\:i: ~\~ ~".rg;1(1~2' '~O'71:",COMMONWEALTH~O'~PENNSYLVANIA, ,', "~,>[:'i~:~::,'.':,l~: .., . ;:,', ,'" ': ~ _<il\)"'it..'li'!i'~~' "I'~~'~ ...... -'," ".'>"---'.~..' 'I" "."" '----C'-X';':'._ '"--'_C_O~"';""__';-">;""""":~':C;-;i.';_'~-'i"~'_~".,.,_;,,-,.,,__.,.,: " tfO"li.A t," ',. '" ,.,,,.'It"."\._e~l;l",v'''''''-''INT OP RIVINU.", :. t, ',." '. " :,:;, , ", ,',' .' , r ).",.. ,.. "..r',;":"'X'i':';'~I"'i"~',,!i.;r""i'''''';'M~''J;,,'r,;" ~!m,,,,,,, .'" "''' ,.."',,:e..';'.' .., "', . '" """";:.'.i~'.'':,T'.',,:~';;{ ~~,~~' ' :;"."!';.i\~1(':'.()ffl~IAI;'RIC.~I~i.;P~NSYLVANIA INHIRITANCI ~ND,mATI TAX ;;", \:{,':';, \,~\i RECEIVED FROM. ACN ASSESSMENT P:' CONTROL iii NUMBER & AMOUNT PANNEBAKER JAMES B 4000 VINE ST Ivl ./1 CI. T.;j MIDDLETOWN, PA 17057 ESTATE INfORMATION. m fiLE NUMBER U 21-1995-0395 m NAME Of DECEDENT (lAST) SI HOOVER KIM M II DATE Of PAYMENT EI POSTMARK DATE COUNTY lOtOHIt' SSN 207-44-5214 (fiRST) (MI) CUMBERLAND DATE Of DEATH m TOTAL AMOUNT PAID $718.93 CW C/O PANNEBAKER & JONES P C SEAL ''It'l ,/ " ~., ,- CHECK* 1056 -' ., (J'I,.../;,J '... _,' ~(.' .' '-'(' REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS ~ -- - - - - -- - - - -- -- - - -,-, - -- - --,- - -- -'- - - - --, -- -, -- - J >'. , " - ---- '", - ft,.....,. ....... --._.__.:-..-........_Jl"Pli.,. _ -, , - .....- . /5- :'\.? . / RIV-1547 IX AFP 112-951*, CO""ONWUlllt or PENNSYlVANIA DlPA..IHlN' Of REVEHlJ( IU.fAU Of INDIVIDUAL fAMES Dr.PI. nUll IIAAMlnUlla, PA 11111-D601 'i/ ACN 101 NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIDNS AND ASSESSHENT OF TAX DATE 04-01-96 JAMES B PANNEBAKER ESQ PANNEBAKER 8 JONES 4000 VINE ST MIDDLETOWN PA 17057 ISTATE OF HOOVER FILE NO. DATI OF D1tATH 05-11-95 COUNTY CUMBERLAND HOTE. TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBHIT THE UPPER PORTION OF THIS FORH WITH YOUR TAX PAYHENT TO THE REGISTER OF WILLS. HAKE CHECK PAYABLE TO "REGISTER GF WILLS. AGENT" REMIT PAYMENT TOI CUT ALONG THIS LINE . RETAIN LOWER PORTION FOR YOUR RECORDS .... iiE'j:i5'4"7"EiC"FP-nZ:9SY"NOYicE--Oj:-YNHEiiifiitiCE-YAX-APPRAiSEHENT-;-"LLOWANCE-ijli----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX KIM M FILE NO. 21 95-0395 ACN 101 DATE TAX RETURN WAS. ) ACCEPTED AS FILED I XI CHANGED SEE ATTACHED RISERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN 1. Raal E.t.te (Schedule A) (1) 2. stock. and Bond. (Schadule 8) (2) 5. Clo.aly Hald stock/Pa~tn.~.hip Inte~..t (Sch.dul. C) (3) 4. Ho~taaa../Hote. Racaivabla (Sch.dul. 0) (4) 5. Ca.h/8ank Dapo.U./Hhc. Pa~.onal Prop.~ty (Sch.dule E) (5) .. Jointly Ownad p~oP.rty (Sch.dul. F) (6) 1. T~an.f'~' (Schadule 0) (7) 8. Total A...t. APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Fun.~.l h:pan.a./Ad... Co.te/Hila. Exp.n." (Sch.dul. ", 10. Dabt./Ho~ta'a' Li,biliti../Liana (Sch.dul. I) 11. Tot,l D.duction. 12. H.t Value of Tax Ratu~n 15. Cha~ltabl./Oov.~n..ntal a.qu..t. (Schedule J) 14. Hat Value of Eatat. Subj.ct to Tax NOTEI If an assessmant was issued previOUSlY, lines raflect figures that include the total of ALL ASSESSMENT OF TAX: 15. A.ount of Lin' 14 at Spou.al ~at. (15) 16. A.ount of Lin. 14 taxable at Lin..l/CI... Ant. (16) 11. A.ount of Lin. 14 taxable at Coll.t.~.l/Cl.a. a r.t. (17) 18. Princip.l T.x Du' TAX CREDITS: PAYHENT DATE 09-14-95 02-02-96 RECEIPT NUHBER AA082134 REFUND DISCOUNT ItJ INTEREST (oj .00 .00 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 Allount R..ttt.d 04-01-96 NOTICE NO. 02 .00 20.808.00 .00 .00 .00 .00 .00 ISI 20,808.00 19J_ nOI .00 8.995.00 Ill) 1121 IUJ 1l4J R.QQI; nn 11.813.00 .00 173,124.00 14, 15 snd/or 16, 17 and 18 will returns sssassed to date. .00 X .00. 173,124.00 x.06. .00 x.15. IlS1 .00 10.387.44 .00 10.387.44 AHOUNT PAID 12,884.55 3,205.89- INTEREST IS CHARGED FROM 02-12-96 TO 04-09-96 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST TOTAL DUE 9,678.66 708.78 10.15 718.93 . IF PAlO AFTER OATE INDICATED, SEE REUERSE FOR CALCULATION OF ADDITIGNAL INTEREST. I IF TOTAL DUE IS LESS THAN 11, NG PAYHENT IS REllUIRED. IF TOTAL DUElS REFLECTED AS A "CREDIT" ICRI, YOU HAY BE OUE A RCFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.J ~ RESERVATION. Elt.t.. of dec~t. dylng on or before Dac.-ber 12, 1'.' w. If ~v future Int.r..t In ~ ....t. I, 'tln.fatred In po.....lon or enja~t to CI... . (collat.r.l) b~flcJ.rl.. of the decedent .,t.,. the ..plr.tlon of '"1 ..'at. for 11'. or for y..r., the Co-.onw..lth har.by Iwpr...lw r'l.rv.. the rloht to ~r.J.. and ...... 'tln,'.r rnherlt~ ,..., at the lawful Cl,.. . (col1.t.r.l) r.t. on eny such future Inter..t. PURPOSE OF NOTICE. To fulfill the r.quJr.-.ntl of Slctlon 2140 of the rnherlt~. and Eat,t. Tlx Act, Act 22 of 1991. 12 P.I, SMUon Z14D. PAYHEHTa o.tach the top portion of thh HoUel and lubIllt with waul' pay.."t to the Rqllt.r of NUls prInted on the r.vI,.s ,Ide. --"aka check or ~y ord.r p.y.11 tal REGISTER OF HILLS, AOEHT All p.~t. r.calved ~11 flr.t bl applIed to any 1nt.r..t which ..y be due with any r...lndal' ~lJed to the t... REFUHD (CRlI A nf~ of . t.M cnd1t, which .... not r.qw."d on tM 'ax R.turn, .ay ba request.d by cOlllpI.t1ng WI "Application for R.fund of Penn.Ylvanla Inherltanc. and E.t.t. T.x" CREV-l)l)). application. ar. .v.llabl. .t the Qfflc. of the R.aht.r of Wllh, any of the 2J R.v.... Dhtrict Dfflc.., or by ulllng tM .p.ct.l 24-hour an.w.rlng ..rvlc. ~r' for fora. ord.rlngl In P~.yivanl. 1-100.362-2050, out.ida Pann.ylvanla and within loc.1 H.rrl.burg .r.a (717) 717-1094, TOO' (717) 772-2252 CH..rlng 1~.lrad Only). OBJECTIONS I Any plrty In Inter..t not ..thflH with tI'M .ppr.ls....t, .llowanc. 01'" dls.llowanc. of deductions, 01'" ..........t of t.x Cincludlng dl.count 01'" Intlr..t) .. .hawn on thl. Hatlc. au.t obJlct ..Ithln .Ixty (60) d.y. of r~.lpt of thh NaUca bYI --..ritten prota.t to tha PA O.p.rtaent of R.venu., Bo.rd of Appa.l., Oapt. 211021, Harrl.burg, PA 17121-1021, OR .-.llctlon to h.v. tha ..tt.r d.t.ralned at audit of tI'M ICCount of the p.r.onal repra.antatlv., OR --appl.l to tM Orphan." Court. ADHIH ISTHATlVE CORRECTIONS I Faatual arror. dl.cov.rld an thl. .......ent .hould b. addrl..ld In writing tal PA n.partaent of R.vanua, BurllU of Indlvldu.l Tax.., ATTHI Po.t A.,.,.aant R.vl... Unit, D.pt. 210601, Harrl.burg, PA 17121-0601 Phon. (717) 7.7-6505. SI. peal 3 of the bookllt "In.tructlon. for Inh.rltanc. Tlx R.turn far. R..ldant O~adant" CREV-ISDI) for an .xplanatlon of .~lnl.tr.tlv.IY corrlctabl. .rror.. If any tax due I. p.ld within thrl. (3) c.llndar aonth. aft.r the d.c.dant.. d..th, . flvl p.rcant C5~) dl.count of the t.x paid h .Uowed. Int.r..t i. cha,aad blalnnlng with flr.t dlY of d.llnquency, or nine (9) eonth. and one (I) dlY f,oe tM dlta 0' d..th, to the dlt. of p.~t. Tlx., ~Ich b~... d.linquent blforl January 1, 19.2 ba.1'" Int.r..t .t the 'ata 0' .ix (6~) parcant p., ~ c.lcul.tad .t a dally rat. of .000164. All tIX.I which baa... d.ll~t on ~ .,tll'" J~I')I' 1, 1912 will b..r Int.,..t at . ratl Which will v.,y fl"''' c.land.r ya.1'" to c.lend.r YI.I'" with that ,ata BnnOUnCad by the PA O.p.rt-.nt of R.v~. The appllcabl. Int.ra.t rata. for 19.2 through I'" al"'a, OISCOI..WTI INTEREST I '!!!! In"r..t Rata 0.1l>> Intar..t Factor ~ Int.r..t Rat. DaUy Int.n.t 'IICltOI'" 1912 ..~ .00054. 1917 .~ .GOOZ47 1913 16~ .0GOn. 19..-1991 11~ .GOnn 19.. 11~ .aaUGl 1992 .~ .000n7 1915 In .000356 1 "3~ 1994 7~ .oooln I... 10~ .000274 1"5-1996 .~ .OUZU --Int.rast h calculatad u foU OWIl INTEREST a BALANCE OF TAX UNPAIO X NUNBER OF DAYB DELINQUENT X DAILY INTEREST FACTOR --Any Notlc. i..ued .ftar tha ta. baco... d.llnquent will rlfl.ct an Int.r..t calcul.tlnn to flftean Cll) day. b.yand the d.ta of tha ......eant. If pav-ant I. aade aft.1'" the Intlr..t c.-put.tlon d.ta shown on tI'M Hotlea, eddltlan.l Jnt.r..t au.t be c.lculat.d. ~~ UV.I.,01.IU'j * INHERITANCE TAX EXPLANATION OF CHANGES COMMONWEALTH Of PENNSYLVANIA DEPARTMENT Of REVENUE BUREAU Of INDIVIDUAL TAXES DEPT. 280601 HARRIS8URG. PA 17128.0601 DECEOENT'S ~AME filE NUM8ER 1I00ve r f:i", II. 2195-0395 ACN 101 SCHEDULE ITEM NO. EXPLANATION OF CHANGES For\iar<y!L~9. .1'()~..t ..AS.S~.s6."'ent.R.eyiew. \In.! t.. Cor p.osB1lJl". adJ'!!JtCltl'!~!!.._, ....m. \ \, , ._."_._.,-._._._~._..- - -_...,-_...~_.~.' ..~~._-~._,.~_._._--_.~---_.-._.__._--_..~.- - . ".. ..'- h" ..__.____._ ...~_. _~_.. ___"'-". ... -"--",' .._~.,."." .._....-~----.~-- -_..-- ---- ---.-.---... . --. '. __'__ _. ._ _...___ _._.__. AJ._._...... ___.___ __..".__ "__~'.'_'_"._'__'________'._"'].'._'_ ~...~ -" ..- --'. -~.- - .--.-- - .--..- \ .----.:... \ \ \ ~ _. ~...__..__._.___ ~_____"r__._.. ...~~_., ~_ ..,' ,..'...--'._ , ...,.. '''-. -.... ~... "'--', ---."" ---...--~.~_. .--. ._...__......,._.__._---_._~~----.- ~_. ',~" " .. --'_." ~...~.-.-._.._--.-----~.~~~.~ ,.-..._- _.~-.--.7'-t'..- -_._..~.._-_. . "~ ... ~\----- -~ _.~--, ._..:.~~..- ~ ~........ ~._~.;, .....~. ...-- -~._......'-~.. ~-~---_.._<_.- <"-_..;.:,.;.'~ -- - .-:-.--~~~~--~--~..__.~ ~ .. - - _.~ - . . -'~~ ''';) :; 0i~;'1 ,.~~_~ '''-':-." .._"..... .....__+_.__ _~._____. ...._..__n..".._~ _~._~~___~_~_..~'__" ~ .....__~_._..~___~.___,_..__ .__r'-_~~~__ _..__.r'__'r'_' <.- I TAX EXAMINER: Deborah WAshington PAGE - ,I'; ;1,j}""; '/{!;;.; ..,' , - 1'"\ Os t') .~~ "'5 N ~..~ C- O"" ....8 Q l' c ' - TJ ~' (";1'''0 en .!B ~ .ft', ,. e tn L.t(n 8'6> ,,-',- r":i. c5 ~~ ~ ~~ '; 00 .,r ',i /5: ,-:)$"' I COHHONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RECORD ADJUSTHENT DATE ESTATE OF DATE OF DEATH FILE NUHBER COUNTY ACN C.v BUREtU OF INDIVIDUAL TAKES IHHl~h"HC[ 1':.)( DIVISION OEPI. ZII060l tlARRISIIURG, PA 111:8.0601 09-20-96 HOOVER 05-11-95 21 95-0395 CUHBERLAND 101 JAMES B PANNEBAKER ESa PANNEBAKER & JONES 4000 VINE ST MIDDLETOWN PA 17057 A,.ount Ranlthd f* .n-I"III "'111'''1 KIM M HAKE CHECK PAYABLE AND REHIT PAYHENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 HOTEl To insure proper credit to your account, subMit the upper portion of this forn with your t.~ payne"t. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ..... Rifv=isiij-Ex--AFP--ioi-:9&i------.-.-iN-HERi-fANc:€-rA-i-RE-CORii-Aoj-usri1€NT--..----------------------------- ESTATE OF HOOVER KIM M FILE NO. 21 95-0395 ACN 101 ADJUSTHENT BASED DN. VALUE OF ESTATE: 1. R..I Est.t. (Schedule A) 11) 2. stocks and Bonds (Schedule OJ C2J 3. Clos.ly Held stock/Partnership Inter..t (Schedule C) (3) 4. Hortg.De./Not.. Rec.ivabl. (Schedule OJ (4) 5. C..h/Bank Deposit./Hi.c. Perlonal Property (Schedule E) (S) 6. Jointly Owned Property (Schedule FI (6) 7. Transfers (Schedule G) (7) 8. Total AI..t. DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expan.../Adniniatratlve COlt., Mile.llenaaUI Expan... (Schedule H) (9) 10. Dabl./Hortgage Liabiliti../Liens (Schedule I) CI0) 11. Tot.l Deduction. 12. Hat V.lue of raM R.turn 13. Charitable/Government.l aeque.t. (Schedule J) 14. Hat V.lue of eat.t. Subject to rax TAX: 15. Anount of Lina 14 at Spousal rat. (15) 16. Anount of Lin. 14 ts.able at Line.l/CI... A rat. (16) 17. Anou"t of Lina 14 t.xabl. .t Coll.t.raI/CI... 8 rat. (17) 18. PrincIpal Tax Due TAX CREDITS: PAYHENT RECEIPT DISCDUNT ('1 DATE NUHBER INTEREST (-I BOARD OF APPEALS REFUND 109.000.00 41.616.00 .00 .00 120.649.04 .00 .00 C81 20.188.85 87.952.19 CllI U21 U31 U41 .OOK.OO' 163 .124.00 K. 06' .00K.15' U81 AHDUNT PAID 09-14-95 02-02-96 04-04-96 AA082134 REFUND AA112707 .00 .00 1.42- 12,884.55 3.205.89- 718.93 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE DATE 09-20-96 271,265.04 108.141.04 163.124.00 .00 163.124.00 .00 9.787.44 .00 9.787.44 10 396.17 608.73CR . DO 608.73CR . IF PAID AFTER DATE IHOICATEO, SEE REVERSE (IF TDTAL DUE IS LESS THAN II, NO PAYHENT IS REQUIRED. FOR CALCULATION OF ADDITIDNAL INTEREST. IF TDTAL DUE IS REFLECTED AS A "CREOn" CCRI, YDU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. I '. PAVttEHTI D''',h tho t.. .arU.n .1 thl. H.U" .nd ....11 .lth y.ur .....nt ..d. ....bl. .. tho n... .nd .ddr'" p~lnt.d on the rev.r.. ,Ide. .. Hok. chIck or eonlY order payable tal REGISTER OF WILLS, AGENT. All ..y..n', r.,.I..d .h.11 b. ...Il.d Ilr.t t. .n. In..r..t .hl,h ... b. duo .l.h .n. r...lnd.r ...II.d t. tho t... A refund of a taM crldlt, which wa. not requ..tld on thl 'ax Return, .ay ba rlqua.tld by co.plltlna an ....Il..tl.n I.r ..,und .1 ..nn..lv.nl. lnh.rlt.n,. .nd ....t. T.." 1...-1.1.1. ...,l...l.n. .r. .v.ll.bl. .t tho DIll'. .1 tho ...l.t.r ., will.. .ny .1 .h. ,. ..v.nu. Dl.trl.. Off I..' .r fr.' tho e...rt..n'" "-h.ur an,wlrlng .srvle. nuab.r. for for.' orderlnGI tn Plnnsvlvanla 1~aOD.S62.205D, out, Ida Pennsvlvanla and within local Harrisburg ar.. (711) 7a7.aD9~, TOOl (717) 772-2252 (H..rlng tapalred only). Ou..tl.n. r...rdln. .rr.r. ..nt.ln.d .n .hl. n..I.. .h.uld b. .ddr....d .., .. D...rt..nt .1 ..v.nu.. .ur..u .1 IndlvldU.1 T..... 'TTH' ...t ........nt ..vl.. Unit. D..'. ,.0601. H.rrl.bur.... 171"-0601. .hDn. (717) 767-6505. REfUND (eA II REPLY TO' DJSCOUNTI II .ny t.. duo I. ..Id .Ithln thr.. I') ,.l.nd.r 'Dnth' .ft.r tho d...d.nt', d...h. . flv. ..r..nt 'S'I dl"Dunt of thl tax paid h .llowed. Th. IS' t.. .....ty nDn-..r'IDl...IDn ..n.I'y I. .D..u..d on .h. '0..1 01 .h. ... .nd In..r..' .......d. .nd not paid before January la, 1996, thl flr.t day .ftlr thl and of thl tax ..n..tv period. PENALTY I INTEREST I In..r..' I. .h.r..d b.. Inn In. .I.h Ilr" d.. of d.llnqu.n.y .r nln. '0' .Dn.h. .nd on. III d.y fro' ,h. d.'. 01 d...h '0 .h. d.'. of ..y..n.. T.,.' .hl,h b..... d.llnqu.n' b.fDr. J.nu.ry I. 10" b..r In..r..' .. .h. r.'. 01 .1. '6" ..r..nt ..r .nnu. ..I.ul.t.d .. . d.ll. r.'. of .00016'. .11 t.,.. vhl.h b..... d.'lnqu.nt on .nd .f'., J.nu.ry 1. 10" .111 b..r In..r..' .. . r.'. .hl,h .111 v.ry fro' ..,.nd., y..r '0 ..I.nd.r ...r .I.h .h.' r.'. announced by thl PA alpart..nt of R.v.nue. The applicable lntere.t rate. for 198Z through 19'6 arel ~ tnterut Rat. DallY tnter..t Factor ~ tnt.rut Ratg DallY tnt.r..t Factor 1982 ZD~ .000548 1981 o. .OOOZ47 1983 16~ .ODDU8 1988.1991 II> .000501 1984 ll~ .000301 199Z O. .000247 1985 U~ .000356 1995~1994 7> .000192 1986 10~ .000274 1995.1996 O. .aoOZ47 "Inter..t ls ca1cu1at8d .. follo"'.l INTEREST = BALANCE OF TAX UNPAID X NUNBER DF OAYS DELINQUENT X DAILY INTEREST FACTOR ~.AnY Notiu iuuad aft.r the tal( beco.U da11nquent ",Ill rsfl.ct an Intar.st calculatlon to flft..n (15) day. bayond the data of tha ........nt. If pay..nt 1. aad. aft.r the Int.re.t co.put.tion date .hown on the Hotlc., addltlon.l Intar..t su.t b. calculat.d. BOARO OF APPEALS OEPT ;'81021 HAH:1ISBURO. plllw'712B.t021 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE PHONE: 717-7B3'36601 FAX: 717-7B7-7270 JAMES B PANNEBAKER ESe PANNEBAKER AND JONES PC 4000 VINE ST MIDDLETOWN PA 17057 IN RE PETITION OF: ESTATE OF KIM M HOOVER DOCKET NO.: 9609618 TAX TYPE: , INHERITANCE TAX APPEAL TYPE 8EFUND FILE NO.: 121 95-0395 ASSESSMENT NO.: 1101/ APPRAISEMENT: 01-02-96 PETITION FILED: 04.11-96 EXAMINER: WILLIAM J ZDRADZINSKI MAILING DATE: SEP 1 1 1996 DECISION AND ORDER The Board finds that the Petitioner has supplied sufficient documentation to show that the taxable value of Schedule A, Item 1, real estate situated at 1017 Hemlock Lane, Enola, Pennsylvania should be reduced by $10,000.00. Accordingly, It is hereby, Ordered, that the petition for refund is granted. The Department Is hereby directed to reduce the taxable value of Schedule A, Item 1, as appraised and assessed on January 2, 1996 from $119,000.00 to $109,000.00. It is further, Ordered, that a.~dbe made of any resulting overpayment, plus appropriate Interest. FOR THE BOARD OF APPEALS ~~eJkJc Jo eph R. Sleek, Member Page 1 of 2 KIM M HOOVER . . BOArd Docket No. 9609618 Page 2 of 2 ANY APPEAL FROM THIS DECISION MUST BE FILED WITH THE BOARD OF FINANCE AND REVENUE, 132 FINANCE BUILDING, HARRISBURG, PA 17120, WITHIN NINETY (90) DAYS OFTHE MAILING DATE OF THIS DECISION. A CASH REFUND CHECK WILL BE MAILED TO THE ESTATE REPRESENTATIVE BY THE BUREAU OF INDIVIDUAL TAXES. IF YOU REQUIRE THIS INFORMATION IN AN ALTERNATIVE FORMAT UNDER THE PROVISIONS OF THE AMERICANS WITH DISABILITIES ACT OF 1990, CALL (717) 783-3664 OR TOO (717) 772-1763 (HEARING IMPAIRED ONLY). JN96:ck ./ i5--jS---1 ftUREAU OF INDIVIDUAL TAXES INHERITANCE 'AX DIVISION DEPT. 28060 I HARRISBURG, PA 1712e-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT C". 1(....".. "..11.'" JAMES B PANNEBAKER ESQ PANNEBAKER 8 JONES 4000 VINE ST MIDDLETOWN PA 17057 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 09-23-96 HOOVER 05-11-95 21 95-0395 CUMBERLAND 101 KIM AJlaun t R..l t hd MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 HOTEl To in lure proper cr.dit to your .ccount, sub..!t the upper portion of this forn with your l.x p.y...nt. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS .... RW=ilocj'j"ix--AFP-ijii-.:9loY------.iiii-iNif€iiiTANCE"-f;.x-STAfEHE-tif-oF-iicciiu'Nf--ii..--------------------- ESTATE OF HOOVER KIM M FILE NO.21 95-0395 ACN 101 DATE 09-23-96 TNIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT DALANCE, AND, IF APPLICABLE, A PRO~ECTEO INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT, 09-19-96 PRINCIPAL TAX DUE ,______ 9.787.44 PAYMENTS (TAX CREDITS), PAYMENT DATE 09-14-95 02-02-96 04-04-96 RECEIPT NUMBER AA082134 REFUND AA112707 DISCOUNT (+) INTEREST (-) .00 .00 1. 42- 12,884.55 3,205.89- 718.93 AMOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 10,396.17 608.73CR .00 608.73CR . IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADOITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN 'I. NO PAYHENT IS REQUIREO. IF TOTAL DUE IS REflECTED AS A "CREDIT" (CRI, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FDR INSTRUCTIONS. I M 111 ..' ., ~-:, " ; - CJ ,,", f'1 , PAYHENTI ': J) ~. ~.t.Ch thl ~top por~ thh Notln and lub.U '11th yaur plw..ni ..d. pa...lbl. to thl n_. end addr... prlntad on thl rlv",' ,Ida. If RESIDENT DECEDENT aaka chick or IlOna... ord.r pIYlble tal REGISTER OF WILLS, AGEHT. If NOH-RESIDENT DfCEDt"T ..k, chick or .onl'" order plyable tal COHHONWEAlTH OF PENNSVLVANIA. All p.y..nt. recelv.d aha" bl appllld flut to any Int.r..' which ..... ba dUI wUh any n...nd., applied to thl t... RUUHD (CAh A refund of I t.. credit, which wa. not r.qu..tld on thl Tax A.turn, ..... b, nqu,,'ad by co.platlng an "Application far R.fund of Plnnnlvlnll Inh.rltlnu and htat. 'a.- (REV-UU). Application. .r. avallabla .t thl Qfflcl af tM Rlglthr of Will., ."y of thl U RI",anu. all'rlct Offlc.. Dr fro. thl D.p.,...nt', ZIt.hour ....,,,.rlng .ervlel huaber. 'or for.. ord.rlt\il In P.nn.ylv."l. I.UO.S62a205D, out.ld. P'fV1.ylvanl. IIftd within loul HarrhblJrg .r.. (71''' 7Ila809~, TOO' (1111 lUaUS! (H.lrlng IIIP.lr.d onlyl. AEPLY TOI Ou..tlonl r.g.rdlng .rror. cont.lned on thl, not Ie. .hoUld b. .ddr....d tal PA DIP.rt..nt a' R.venue, lur.eu a' Indlvldu.l Taltll, ATTN' Po.t A.......nt Rnl." Unit, D.pt. 2'110601, H.rrlsburg, PA 11126-0601, phone (7111 717-6505. DISCOUNT I l' anv t.1t dul I. p.ld within thr.. e)1 c.landlr lIonth. ,'t.r thl d.cad.nt'l d..th, . 'Iva parcant 15~1 discount a' the tilt paid I. Illo.ed. PENALTY I Tha 15X t.. .ene.ty nonap.rtlclp.tlon p.nalty I. caaput.d an the tot.1 a' thl t.. and Inter..t .......d, .nd not plld be for. Jlnu.rv la, 1996, the flr.t d.y Iftlr the .nd a' thl ta. aan..ty periOd. INTEREST I Int.,..t II chargtd bllllMlng with flnt dlV of d.lInqulncy, or nlnl I'll .onthl and on. Cl I dlY fro. the data of dl.th, to the d.tl of Ply.,nt. T.It.. which blca.' d.llnquant before Janulrv I, 1982 b.ar Int.rl.t at the rlt. of .1_ C6XI perclnt p.r ~. calculi tad at . dlllv rat. of .oDOI6~. All t.... which b.c... d.llnquent on and a'tlr Januarv I, 19.2 ..UI b..r Intar..t at . rata which ..Ill ".rv fro. ul.ndar y..r to c.landar yllr ..lth that rata announcld bv the PA Olp.rt..nt of RI".nu.. 'h. .ppllc.ble Int.r..t rat.. 'or 1982 through 1996 .r'l V.., Intar..t bt. O.lh Intar..t factor V..r Int.r..t A.t. DallV 1nt.r..t f.ctor 1982 m .OODSU 1987 9X .OOO2~7 1.85 16X .000411 1916-1991 m .000501 1981t m .000)01 1992 'X .000241 1915 m .000:556 1995al99~ 7X .0001'2 1916 lOX . 00027~ 1995-1996 'X .000247 ulntar..t h calculltld a. 'allow" INTEREST . BALANCE OF TAX UNPAID X NU"BER OF DAYB DELINQUENT X DAILY INTEREST FACTOR --Any Notlc. I"uld .ftlr the talt baco... dlllnqu.nt .111 r.fl.ct an Int.r.st c.lculatlon to flft..n II~I dlY' b.yond the dlt. of th. ........"t. If ply..nt Is .Id. .fhr th. Inhralt coaputlUon dlte .hown on the Notlc., .ddltlonll Intaralt IUlt b. c.lcul.t.d. 16 - 30-'- I COHHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT ~ - BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. "D6Dl I~RlSIURG. PA 111'1-0601 In.UIIII In CU,"I JAHES B PANNEBAKER ESQ PANNEBAKER 8 JONES 4000 VINE ST HIDDLETOWN PA 17057 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 10-15-96 HOOVER 05-11-95 21 95-0395 CUHBERLAND 101 Allaunt R..Hted KIM H HAKE CHECK PAYABLE AND REHIT PAYHENT TOI REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE~ To insure proper credit to your account, sub.it the upper portion of thl. for. with your t.x pay.ant. CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ..... iiEV :i61i7"Eic--AFP-ioY:96j------ii.ii-iiiiiiiiiTANi:'E-i';.if-sTii'fEIiENi'-OF-;.C-ciiuiif--iiiii--------------- ------ ESTATE OF HOOVER KIH M FILE NO.21 95-0395 ACN 101 DATE 10-15-96 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW IS A SUHHARY 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. 09-19-96 PRINCIPAL TAX DUE., 9,787.44 PAYHENTS CTAX CREDITS). PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID DATE NUHBER INTEREST C-) 09-14-95 AA082134 .00 12,884.55 02-02-96 REFUND .00 3,205.89- 04-04-96 AA1l2707 1. 42- 718.93 09-25-96 REFUND .00 608.73- TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 9,787.44 .00 .00 .00 . IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. I IF TOTAL DUE IS LESS THAN '1, NO PAYHEHr. IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. I 00 ~~ . I J::-~ PA YltEHT I DetKh the printed on top portion of thh NoUe. end ,utt.1t wUh your P8YHnt ..t. PBy.oh to thII "... end .dell:... -.! the rev.r.. .td.. If RESIDEH1' DECEDENT .... check Dr ItOMV ord.,. Plvabh tal REGISTER OF WILLS, AGENT. If NON-RESIDENT DECEDENT .... chKk Dr 110MV' orde,. payable tal COHHONWEAL TH OF PENNSYLVANIA. All pIYMnh ncalved IhIIll be eppllitd flnt to MY Int.,...t which ..y t. ctu. wIth MY ,....lnde,. 1IIPP1Ied to u,. hll. REfWCD (CRU A refund of . talC crltd1t, which .... not nquuted on the Tile Return, ..y be r.qu..tec:l by cupl.tlng Dn "Appllcltlon far Refund of Penn.yl".... InherltBnCI end E.t.t. Tax" (REV-ISIS). Appllc.tlonl ara avlllBbl. .t thl Office of the Regl,t.,. of Willi, eny of thl 23 R.v~ District OffiCI' Dr fr~ the 0.,.,.....".', 24-hour "Iw.rlna ..rvlc. ~r. for for.. orderlngl In P~.ylYBnI. l-IOD-36Z-ZaSD, out,lde Penn,ylvants end wIthin loce. Harrisburg er.. (717) 7.7-1094, TOni (717) 712-2ZS2 (H..rlna 1~.lred only). REPLY TD. au..Uon. r.gardlng .rrar. cantaln.d an thh naUc. 1hDu1d be IKIdr....d tal PA o.parbtent af R.vW1Utl, Buneu of Individual t.x.., ATTH. po.t A.....-.nt Rlv1.w Unit, D.pt. 210601, Harrisburg, PA 11121-0601, phone (117) 787-6505. DISCDUlT. If any t.x due I. paid within thr.. (3) calendar aantha .ft.r the dec.dent'. d.ath, . f1v. percent (5~) d1.count of the t.. Plld I. .11owed. PENAL TV. The 15X t.. eane.ty non-partlclp.tlon ~lty I. c~t.d on the tot. 1 af the tax and Int.r..t .......d, and not p.ld b.for. Janulry 11, 1996, thl f1r.t d.y .ft.r the Ind of thl ta. lenl.tv period. INTEREST I Int.r..t I. cheraed b.g1nnlng with f1r.t day of d.llnquency, or nine (,) aanth. end one (I) d.y froe the d.t. af d1.th, to t~ det. of pay.-nt. T.... which bee... d.1lnquent b.far. Janu.ry 1, l,a2 bI.r Int.r..t It the rat. of .1. (6X) p.rcent p.r annu. c,lcul.tld at , d.lly r.t. of .000164. All t"I' which ~ delinquent an and aft.r Jenuary 1, 1912 will b.ar Int.r.at at . rat. which will v.ry frol callAdar y.ar to calendar y..r with that rat. ~Id by thl PA D.partlent of R.V8nU.. Th. appllclbl. Int.r..t r.t.. for 1912 through 1996 .r'l V..r Int.r..t R.t. D.lly Int.r..t Foetor v.., Inter..t R.t. DIlly Int.r..t Foctor 1912 ZOX .000541 1'17 .. .000247 1983 lOX .ooooa 1911-1991 11. .000301 I'" IIX .000301 I'" .. .000247 1915 UX .000356 199]-1'94 T.< .000192 I." lOX .000274 1995-1996 .. .000247 --Intlr..t I, ellculetld .. foll~'1 INTEREST = BALANCE OF TAX UNPAID X NVIlBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Hotlc. "sued aU.r the tl. bleOlfl. d.llnquent will r.f1ltCt en Int.,..t ~lcu..tlon to flU.... US) dau b.yond the d.t. af the ........"t. If p.y.."t Is .Ide Ifter the Int.,.at COllpUtlUon det. shown on tM MoUe., eddltlDfWlI Int.r..t .....t be ca1cullted. ., STATUS REPORT UNDER RULE 6.12 Name of Decedent I J<,,,,, M. Date of Deathl 5111 /qc:- Will No. o tV c- 1-10 cJ t~u:. Admin. No. Jq9~'- oo':)9S'" Pursuant to Ruie 6.12 of the Supreme Court Orphans' Court Rules, I report the follow.lng with respect to compietion of the administration o( the above-captioned estatel 1. State whether administration ot the estate is completel Yes X No 2. If the answp.r is tlo, state when the personal representative reasonably believes that the administratIon will be complete I J. If the answer to No. 1 is Yes, state the following I a. Did the personal representative file a final account with the Court? Yes No X . b. The separate Orphans' C'.Jurt No. (if any) (or the personal representative's account iSI c. Did the personal representative state an account informally to the parties in interest? 'les)( No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. Datel /l/~~-.lJh , N ~~ - r;") o.!!l O?~ - ,0 no 'J :- 3~ 0 'JC; \0 ,,;r~ .C .... - '" oJ) 0' c..::J ffi or:; Q c: ~.- _I CIJ gg' ~ 8~ a: a: Signat .:TnM P. (J?-v;t.liL r31fK.Lt~ RtllwIi&ll!::e.,e t,'~. f! (. Name (Please type or' print) 'f-ooe/ l'I;t.IE S17 nlliJO'E/e/.VIfJ ~4 17t:JS? Address QO.J. 9JLJI - /3 3' ~ 'l'el. No. (NAill rmt/ AMJ) Cdpacity: Personal Representative _)(.,Counsel for personal , representative nW-27 -- . IN RE: ESTATE OF KIM HOOVER Deceased IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION COUNTY CODE 1995-00395 RECEIPT AND RELEASE KNOW ALL MEN BY THESE PRESENTS that I the undersigned, Amy L. Umholtz, formerly known as Amy L. Hoover, beneficiary of the trust set up by my late mother Kim Hoover for my benefit naming my aunt, Barbara Richards as trustee, being the sole heir of the decedent, do hereby acknowledge that I have reviewed the first and final account of my late mother, Kim Hoover's Estate dated November 15, 1996 which shows $315,864.36 dollars have been transferred to my aunt and my trustee, Barbara Richards on my behalf. Therefore since the full residue of the estate has been transferred to my aunt Barbara Richards, trustee, as set forth in the first and final account above, I hereby intend to release my uncle, Richard Hoover, as the Executor of my late mother, Kim Hoover's, Estate. IN CONSIDERATION of said full payment set forth above by my uncle, Richard Hoover, as Executor to my aunt Barbara Richards, as trustee, I therefore, the undersigned do hereby release, remise, quit claim and forever discharge the said Richard Hoover, Executor of the Estate of Kim Hoover of and from all actions, suits, payments, accounts , reckonings, claims and demands whatever for or by reason thereof, or any other account, matter cause or thing whatever relating to the estate of the said decedent. " . , , AND the undersigned does hereby agree to indemnify and save harmless the said Executor, to the extent of the full distribution received, against any and all losses, damages, costs, verdicts, jUdgments, awards and expenses which said Executor may suffer, incur, be put to, payor layout by reason of having made full distribution to the undersigned and agrees to refund said distribution to the Executor upon receipt of such a request from the Executor. AND the undersigned does hereby release all real estate of the decedent and of the said Executor from all liens, claims, actions, suits, payments, accounts, reckonings and demands whatever for or by reason thereof, or of any other account, matter, cost or thing, whatsoever. It is the intention of the undersigned to be legally bound by this instrument . IN WITNESS WHEREOF, the instrument to be executed on the und~rsigned hq~ caused this /71'/ ,o,?CI R.lnDer '-;I' "I day of tle"ll!llllber, 1996. WITNESS: ~~p OmAf a-rY'-',,~x. ~&nho dj AMY L. UMHOLTZ ctr.umholrel #14245 ~<'-fi Jzf. WoCV-e.Jv a/k/a AMY L. HOOVER ....,..." . ) . FIRST AND FINAL ACCOUNT OF RICHARD HOOVBR, BXBCUTOR FOR THB BSTATB OF KIK K. HOOVBR, DBCBASBD CUMBBRLAND COUNTY - CODE NO. 1995-00395 Date of Death: 5/11/95 Date of Executor's Appointment: 5/23/96 The Estate advertisements were in the following pUblications on the following dates: A. Cumberland Law Journal: June 9. 1995 June 16.1995 June 23. 1995 B. The sentinel: June 5. 1995 June 12. 1995 June 19. 1995 Accounting for the Period: November 15. 1996. From Mav 19. 1995 to purpose of Account: Richard Hoover. Executor offers this account to acquaint interested parties with the transactions that have occurred during his administration. The Accountant also indicates the proposed distribution It is important that the account be carefully examined. Requests for additional information or questions or objections can be discussed with: James B. Pannebaker, counsel Pannebaker & Jones, P.C. 4000 Vine street Middletown, PA 17057 (717) 944-1333 File No. 14245 1 ..." ',. . , SUMMARY OF ACCOUNT PrinoiDal ReoeiDts Reoeipts/Assets Add: Inoome/Interest & Dividends Total Assets $415,375.31 +8.813.51 $424,188.82 Less Disbursements: Debts of the Deoedent Administration Expenses Federal and state Taxed Funeral Expenses Fees $63,633.70 1,062.03 13,886.48 14,281. 00 15.461.25 Total DiSbursements -108.324.46 Balanoe Before Distributions/Transfers $315,864.36 Transfers Barbara Riohards, Trustee -250.808.00 Balanoe to be Distributed to Barbara Riohards, Trustee for Amy Umholtz 65.056.36 2 . . . . RECEIPTS OF PRINCIPAL Assets Listed In Inventory: (valued as of Date of Death): 1. United Concordia Paycheck 2. United Concordia Paycheck 3. united concordia paycheck 4. US savings Bonds 5. PPG Industries, Inc. stock Dividends 6. DOT Co. 7. Pa. Blue Shield Voluntary Investment Plan 8. Blue Shield payment for Urological Assoc. of Lancaster 9. DOT Co. 43973647 10. US savings Bonds 11. Kelly S. Lippy - '89 Cavalier 12. Refund of lnsurance Premium, Erie Ins. company 13. Pa. Blue Shield reimbursement for Lancaster orthopedic & surgical Assoc. of Lancaster 14. Brickers Auction (personal property) 15. Proceeds of survival action by Richard Hoover, Executor of the Estate of Kim M. Hoover 16. PPG Industries, Inc. (544 Shares common Stock @ 38.25/Share 3 .. .,. Value $ 574.89 994.22 2,473.65 876.08 315.52 5,255.77 28,970.54 100.00 802.73 457.44 3,300.00 291. 00 275.00 1,030.00 74,932.20 20,808.00 _.__. -_..,,~-~ .".-.i.___....-,.~"._._............___~._~....--._.~"~ .- ...-.,<...'''..'.....'...-.'<'\o."I'.,;.''''''.."e;.-'.".'-'.'..-.'..'. . , . . .. " 17. Real Estate at 1017 Hemlock Lane, Enola, PA (Appraised value $119,000.00 less principal due on Mortgage $52,826.79) Total Inventory 66,173.21 $207,630.25 9/11/96 ADJUSTMENTS TO INVENTORY Real Estate Property - Actual Sales Proceeds Less: Mortgage Payoff Net Proceeds Less: Estimated Real Estate Valued at 0.0.0. $108,900.00 - 51.263.38 $ 57,636.62 - 66.173.21 Net Inventory Value Reduction Total Adjusted Inventory 8.536.59 $199,093.66 4 ~ . . RECEIPTS SUBSEOUENT TO INVENTORY 6/19/95 Erie Insurance Group - Funeral Death Benefits 6/27/95 Erie Insurance Group - 1st party Accidental Death Benefits 6/30/95 ITT Hartford Life Ins.-Blue Cross/Blue Shield, Life Insurance Proceeds 7/17/95 Neil Funeral Home - Refund, Robert & Kim Hoover 7/28/95 Keystone Ins. Co. - American Automobile Assn., Life, Death Benefit 9/20/95 Brickers Auction - Proceeds from Sales 10/3/95 PA Blue Shield - compensation Benefit 10/10/95 Robert Hoover - Repayment of Loan 10/12/95 Banc Boston Mortgage corp. - Refund of Escrow to Mortgagor 1/21/96 John M. Butensky - Rent Deposit 2/7/96 John M. Butensky - Rent, February 2/20/96 PA. Dept. of Revenue - Refund if Inheritance Tax Return 5 '. ., $ 1,500.00 5,000.00 172,000.00 100.00 1,000.00 3,274.25 160.00 12,500.00 136.88 700.00 700.00 3,205.09 . . . . . . .. . . 2/26/96 Erie Ins. Group - Refund on Cancelled H/O Ins. policy 17.00 3/1/96 Neil Funeral Home - Refund of Robert Hoover Funeral 6,539.00 3/11/96 John Golden - purchase of Estate Personal Property 308.00 3/22/96 John M. Butensky - March Rent 700.00 4/3/96 John M. Butensky - April Rent 700.00 4/16/96 Internal Revenue Service - Refund, 1995 personal Income Tax Return 2,022.00 4/18/96 Jack Gaughen Realtor - partial Refund of Buyers Escrow Deposit 1,300.00 5/7/96 Banc Boston Mortgage Co. - Refund of Escrow Account 345.65 9/23/96 capital Region and Transfer - Refund of (96-97) School Taxes 10/7/96 FA Dept. of Revenue - Refund of Inheritance Taxes pd 1,265.73 624.21 10/7 /96 Homeside Lending Inc. - Refund of Remaining Escrow Account Balance 1,011.67 10/11/96 PA. American Water Co. - Refund, Water service 8.38 6 ~ ' DEBTS 6/19/95 correspondence Management Inc. - Lancaster General Hospital Medical Records $ 103.00 6/19/95 Erie Ins. Group - Auto policy 399.00 6/19/95 Boscov's - Payoff charge Acct. 609.47 6/19/95 First Card - Payoff charge Acct. 1,361.74 6/22/95 Banc Boston Mortgage Co - June Mortgage 816.16 6/22/95 Banc Boston Mortgage Co. - July Mortgage 784.26 6/26/95 Commonwealth of PA - State Police Photographic Labatory, (3X5) Photos 218.84 6/28/95 Fine Art Photo - (8x10) Photo of Car 27.67 6/28/95 PP&L Co. - Electric Service to 6/20/95 23.99 7/17/95 Urological Associates of Lancaster - Prof. Medical Services 100.00 7/17/95 East Pennsboro Twp. - Sewer/Trash Removal 87.75 7/17/95 Banc Boston Mortgage Co. - August Mortgage 784.26 7/19/95 PA American Water Works - utility services to 7/5/95 9.49 8 , . . . " ., " 7/19/95 Bell Atlantic - Phone Services $ 22.69 7/25/96 Conrad M. siegel, Inc. - Actuarial services 800.00 7/26/95 D.E. Kauffman - Title Report 50.00 8/2/95 PP&L Co. - Electric service 26.93 8/2/95 Estate of Robert Hoover - To Payoff Truck 12,500.00 8/11/95 PA American Water Co. - Water services to 8/2/95 8/31/95 Banc Boston Mortgage Co. - Mortgage September 8.90 784.26 8/31/95 Pannebaker & Jones, P.C. Estate Plan and Costs for: Amy Lynn Hoover - 787.26 8/31/95 PP&L Co. - Electric service 8.72 9/16/95 Lancaster orthopedic Group, Inc.- Prof. Medical Services 65.00 9/16/95 Surgical Associates of Lancaster 210.00 9/15/95 Banc Boston Mortgage Corp. - Mortgage, October 784.26 9/15/95 PA American Water Co. - utility service 8.63 9/20/95 Brickers Auction - Sales commission 1,090.25 9 . .. _......_~.._......-.,.,.;,~......."""..._.~~". . . ... f '1 10/2/95 Mette, Evans & woodside - Prof. Services 1,284.00 10/10/96 pannebaker & Jones, P.c.-survival Action Attorney Fees 18,733.05 10/12/95 Bane Boston Mortgage corp. - Nov. Mortgage 785.09 10/12/95 East Pennsboro Twp. - Sewer and Trash service 87.78 10/23/95 PA American Water Co.- Water Service 8.35 10/23/95 Pannebaker & Jones,P.C. - Fee for Amy L. Hoover, Letter/Estate Plan 18.00 11/18/95 PP&L Co. - Electric service PIE 10/19/95 11. 81 11/1/95 Dr. Daniel Good, - Prof. Medical Service 160.00 11/22/95 PA. American Water Co. Water service to 11/2/96 8.76 11/22/95 Bane Boston Mortgage corp. - Mortgage Dec. 785.09 11/22/95 P.P.&L Co. - Electric service to 11/16/96 63.21 12/14/95 Bane Boston Mortgager Corp. - Mortgage Jan. 785.09 12/18/95 PA. American Water Co. - Water service 8.50 12/27/95 PP&L Co. - Electric service 114.02 1/11/96 PP&L Co. - Electric Service 39.56 10 . . . . 1/11/96 American Water Co. - Water service 1/22/96 East pennsboro Twp. - Sewer and Trash Service 2/1/96 Banc Boston Mortgage Co. - Feb. Mortgage 2/15/96 PA Water Co. - Water Service 2/15/96 Lancaster Orthopedic Group, Inc. - Prof. Medical Service 3/1/96 Banc Boston Mortgage corp. - March Mortgage 3/1/96 H&R Block - preparation of 1995 Tax Returns, state & Federal 3/11/96 Alicia D. stine, Treasurer - Real Estate Taxes for East Pennsboro Township 3/18/96 Dodge Insurance Inc. - Lititz Mutual Home Insurance pOlicy, (3/20/96-3/20/97) 3/29/96 Banc Boston Mortgage Co. - April Mortgage 4/1/96 PA American Water Co. - Water service 4/4/96 East Pennsboro Twp. - Sewer Service 4/5/96 PA American Water Co. - Water service 4/18/96 Banc Boston Mortgage Co. - May Mortgage 11 , , 34.60 87.72 785.09 4.34 185.00 785.09 123.00 345.62 422.00 785.09 25.98 87.75 53.20 785.09 ~-::~~"~~-"~-_"""'.~"l'""P"."'''''''h''''' ....,.,....,..,.~"~"..,-OjH'_.I_.~""~...~...:./.....,.."'c.".,. " . I, . . 5/29/96 Bane Boston Mortgage Co. - June Mortgage 785.09 5/30/96 PP&L Co. - Electric Service 7.47 6/11/96 PA American Water Co. - Water service 9.77* 6/24/96 PP&L Co. - Electric service 6/17/96 8.05 7/2/96 Bane Boston Mortgage Co. - July Mortgage 785.09 7/5/96 PP&L Co. - Electric service 4.26 7/15/96 PA American Water Co. - Water service 8.63 7/15/96 East pennsboro Twp. - Sewer and Trash 87.75 7/29/96 Homeside Lending, Inc, - Mortgage, August 821. 03 7/31/96 PP&L Co. - Electric Service, July 5.64 8/9/96 PA american Water Co. - July Water Service 8.38 8/28/96 PP&L - Electric service, Aug. 22 10.58 8/31/96 Homeside Lending, Inc. - Sept. Mortgage 821.03 9/9/96 PA American Water Co. - Water Service, Sept.4 8.38 9/17/96 PP&L Co. - Electric service, Final 8.22 12 . . 9/17/96 PA American Water Co. - Water Service, Aug. 9/30/96 Melon Bank - Checking Acct., Service Charge 9/11/96 C.M. Detweiler, Inc. - Real Estate Sales Commission 9/11/96 Remax Realty Assoc's Inc. - Real Estate Sales commission 9/11/96 Mark Hilbert Appraisals - Inspection Fee 9/11/96 Barnett Mortgage Co. - Tax Service Fee 9/11/96 Barnett Mortgage Co. - Document Prep. Fee 9/11/96 Capital region Land Transfer, Inc. - Fee 9/11/96 Notary Fee 9/11/96 Capital region Land Transfer, Inc. - Express Mail 9/11/96 Recorder of Deeds - Deed 9/11/96 Capital Region Land Transfer, Inc. - Satisfaction Fee 9/11/96 Bower Pest Control - Pest Inspection 13 . , 10.34 4.00 $3,639.00 3,689.00 65.00 81. 00 149.00 35.00 6.00 15.00 1,089.00 25.00 30.00 ~-t"'~"~~7- ~...,~: ."... .....-....--..--...... ,-~.: , \, . . . " . .. 9/11/96 Alicia D. stine - 1996-1997 School Tax 1,265.73 9/11/96 Tim Xollen - Repairs 264.86 9/25/96 PP&L Co. - Electric Service Total Debts 11. 99 $63.633.70 INCOME EARNED INTEREST 4/18/96 .Mellon Bank, CDI 00234511 4/18/96 Mellon Bank, CDI 00188942 10/31/96 Mellon Bank - Estate Checking Account I 000-258-3292 From: 6/1/95 To: 5/31/96 From: 6/1/96 To: 10/31/96 $2,084.51 5,491.40 681.03 230.17 Total Interest Income . $8,487.11 DIVIDENDS 9/15/95 P.P.G Industries, Inc. 326.40 Total Interest and Dividend Income $ 8.813.51 14 '. ' . . . . . ADMINISTRATIVE EXPENSES 6/28/95 cumberland Law Journal- Estate Advertising $40.00 6/22/95 Mellon Bank - Estate Checks 50.86 7/17/95 The centinal - Estate Advertisement 68.84 9/15/95 Richard Hoover - Bank signature Guarantee Fee 5.00 9/15/95 Register of Wills - Fee for supplement Tax return 25.00 9/20/95 Register of Wills - Probate Fee 190.00 Sub-Total $379.70 pannebaker & Jones, P.C. - Reimbursement for Costs paid on Behalf of the Estate for: 6/14/95 Faxing to IRS - Phil. PA and coping charges Additional Death certificates of Kim and Robert Hoover 10.50 30.00 7/18/95 Misc; zeroxing & Faxing charges 30.10 9/15/95 Misc; Zeroxing, Faxing, Mailing & prothonotary Fees, File #14244 216.02 9/15/95 Misc; Zeroxing, Faxing, Mailing & Prothonotary Fees, File #14244 131.40 15 . , .' . . . . .. , 10/23/95 Mise; Zeroxing Various Documents 5 sets, Including Bills, Deposits, Insurance Records & Bank statements 48.30 10/23/95 Register of Wills - Filing Fee, Cumberland County Inheritance Tax Return 25.00 10/23/95 Airborne Express - Express Mail Re: Hoover Negligence File 26.00 11/22/95 Mise; copying, Faxing, postage, certified Mail 18.20 3/1/96 Mise; U.S Postage 1.24 3/1/96 Register of wills, Supplemental Estate Inheritance Tax Return 15.00 3/18/96 Mise; Faxing and copying 6.50 5/30/96 Mise; u.s. postage and Faxing charges 12.52 6/26/96 Faxing to Dodge Insurance Co. 1.50 9/27/96 Faxing services to Remax Real Estate and Bennet Mortgage Co. Re:Settlement 11.50 16 (~"'"""~ . . , . . . . . , , . . 11/15/96 Register of wills - Filing Fee, Receipt and Releases, 1st and Final Accounting. Zeroxing of Fiduciary Tax Return, 1st and Final Accounting, Receipt and Releases, and status Report. 98.55 Total P & J, P.C. Reimbursement 682.33 Gross Total Administrative Expenses $ 1.062.03 17 ... , FEDERAL AND STATE TAXES 3/1/96 PA. Dept. of Revenue - 1995 State Income Tax Return (Kim) $36.00 3/1/96 PA. Dept. of Revenue - 1995 State Income Tax Return 1.00 9/13/96 Register of Wills - cumberland County Inheritance Tax Return 12,884.55 4/3/96 Register of Wills - supplemental Inheritance Tax Return 718.93 11/11/96 PA Dept of Revenue - 1995, (6/1/95 to 5/31/96), Fiduciary Income Tax Return 240.00 11/12/96 PA Dept. of Revenue - 1996 (6/1/96 to 10/30/96), Fiduciary Income Tax Return 6.00 Total Federal and State Taxes $13.886.48 18 . . . '. . ... ..... FUNERAL EXPENSES 6/28/95 Neil Funeral Home Kim Hoover, Funeral & Equipment Services Robert Hoover, Funeral & Equipment Services 4/3/96 Rice Memorial Works - Headstone Total Funeral Expenses ~ 4/3/96 Richard Hoover - Executors Progress Fee 11/15/96 Richard Hoover - Balance of Executors Fee 10/30/96 Pannebaker & Jones, P.C. Attorneys Fee for the Estate Total Fees TRUSTS TRANSFERS $5,990.00 6,589.00 1. 702.00 $14.281. 00 $ 9,813.71 5,647.54 $ 0.00 $15.461.25 4/18/96 Barbara Richards, Trustee - Cash Barbara Richards, Trustee - PPG Industries, Inc. (544 Shares, Common stock at 38.25 Per Share) Total Transfers 19 ",,",,-"i~~.__,,__.._.,.. . , ""':~,"r_"""d?~-.;.l"!~""'''';''''''''''''''''''~'''''''''''''''''A.''''._''''-_""" $230,000.00 20,808.00 $250.808.00 , . .. t. ESTATE OF KIM M. HOOVER PROPOSED DISTRIBUTION Cash-----$65.056.36 SCHEDULE OF DISTRIBUTION Beneficiarv Relationshic * Amy Lynn (Hoover) Umholtz * To Be Distributed To: Barbara Richards, Trustee Total for Distribution Daughter 'I 20 "., ..... Amount of Share $65,056.36 $65.056.36 . " '. . .. '" <to .,,- , IN THE ORPHAN'S COURT IN AND FOR THE COUNTY OF CUMBERLAND AND STATE OF PENNSYLVANIA ESTATE OF KIM M. HOOVER DECEASED No. 1995-00395, Year of 1995 CERTIFICATE OF MEMBER OF BAR AND NOW, TO WIT, THIS 12th Day of November, 1996 THIS IS TO CERTIFY that the undersigned James B. Pannebaker, a practicing attorney and a member of Bar of Orphan's Court of Dauphin county, pennsylvania, being familiar with the administration of the above captioned estate and having examined the items of credit and debit set forth and contained in the foregoing First and Final Account of Kim M. Hoover of the estate of Kim M. Hoover, Deceased, certifies that according to his knowledge, information and belief. all such items are true and correct without any exception whatsoever. James nebaker, Esquire 4000 ne Street Middletown, PA 17057 (717) 944-1333 21 , .. . .. " - ~ "'" , . . DBCLARATION OF EXECUTOR Richard Hoover, Executor of the Estate of Kim M. Hoover, deceased hereby declares under oath [penalties of perjury] that he has fully and faithfully discharged the duties of his office; that the foregoing First and Final Account is true and correct and fully discloses all significant transactions occurring during the accounting period; that all known claims against the estate have been fully paid in full; that, to his knowledge, there are no claims now outstanding against the Estate; and that all taxes presently due from the estate have been p '" Ri hard Hoover, Executor of the Estate of Kim M. Hoover ubscribed to , this ? r<. , 1996 (. . . . , Public li01AQIAL SEAL ES'lRlnr.ION A. tOLU:iGA, lIotary PuUltc Mlddleto.n PA. Oauphln Co,nty M) Commission [,plre, Hay 7. 1996 JBP/slw HOV.1st :14245 22 . ... - ;;u - ()5. 3(/ S .:!/ -lfS-Yll.; , . Ik ! !'f '97 ;:,jJ~ 21\ '.~~l :j9 Ck CI! This receipt, release, approval of account and indemnity agreement (hereinafter called the "Release") is given this ,710 day of ~/7Vj;--CJ/1 , 1997, by Amy L. Umholtz, an adult individual who resides at lA Southmont Drive, Enola, PA 17025, (hereinafter called the "Beneficiary"), to and in favor of Barbara Richards, as Trustee and Hershey Trust Company with its principal office located at Hershey, Pennsylvania 17033, as Agent for the Trustee, (hereJ.nafter called the "Fiduciary"). RECEIPT, RELEASE, APPROVAL OF ACCOUNT AND INDEMNITY AGREEMENT For the purpose of inducing the FiduCiary to make the ctintribution described herein and intending to be legally bound, the Beneficiary hereby represents, warrants, covenants and agrees as follows: 1. l3.ackaround. A trust for the benefit of the Beneficiary was created under the Will of Kim M. Hoover and Robert Hoover, (both deceased). The beneficiary is entitled to the balance of the trust upon attaining the age of twenty-one (21) years on February 17, 1997. As the beneficiary, I request that the a~nJ.nistration of the trust be completed by Release and that the a~count not be filed for audit. 2. AQknowle~ent of ReceiDt and Release of Trust Company~ The Beneficiary acknowledges that on this day she has received of and from the Fiduciary the balance, consisting of cash in the .unount of Two Hundred Forty-Three Thousand, Seventy-Six Dollars and 'L'hirty-Four Cents ($243,076.34) and securities having a market value of Olle Hundred Nineteen Thousand Eight Hundred Thirty-Five Dnllars ($119,835.00) as indicated on page 6 Proposed Distributions to the Beneficiary of the Fiducia~J's First and Final Account in ,~'ull paym\3nt and satisfaction of benefits to the Beneficiary created under and by l'eason of the WJ.lla of Kim M. Hoover and HODEu:t Hoover. In consideration of the foregoing distribution heing made at this time, the Boneficiary releases absolutely and discharges the Fiduciary and its representatives, successors and assigns from any liability whatsoever in connection with both such d.ir,tri.bution and the administration generally of the trust created under the Wills of Kim H. Hoover and Rober.t Hoover (now deceased) to ~..hich thts distribution relates. ....,..... 3. Indemnitv Aareement. The Beneficiary agrees to indemnify the Fiduciary and hold it harmless, to the extent of any funds or assets received by the Beneficiary from the Fiduciary hereunder, from and against the Beneficiary'S share of any and all liability (including attorneys' fees and other costs or expenses of defense) to which the Fiduciary may be subjected by reason of its administration of the Kim M. Hoover and Robert Hoover T/U/W. In connection with this Agreement, the Beneficiary agrees to: (a) Refund or return, promptly upon the Fiduciary written demand, any funds or assets distributed by the Fiduciary to the Beneficiary, if the distribution thereof is determined at any time to have been an erroneous or negligent distribution to the Beneficiary, whether such error or negligence was or was claimed to have been premised upon a mistake of law or of fact; (bl Modify and displace any otherwise applicable period limiting the time within which the Fiduciary's action to collect an erroneous or negligent distribution must be commenced, so as to provide that the Fiduciary need not commence an action to collect an erroneous or negligent distribution to the Beneficiary until two (2) years after such time as the Fiduciary shall have obtained actual knowledge of such error or negligence. 4. Acoroval of Accountina. The Beneficiary has examined the attached account of the Fiduciary and accepts and approves it as being true, correct and complete in all particulars. 5. Miscellaneous. The construction, effect, validi ty and performance of this Release shall be governed in all respects by the internal substantive law of the Commonwealth of Pennsylvania. The provisions of this Release shall be deemed severable in the event that anyone or more thereof shall be deemed invalid or unenforceable, with the effect that the remaining provisions shall persist as if such invalid or unenforceable provision had never been a part hereof. This Release shall bind the Beneficiary and her heirs, representatives, successors and assigns, together with any children with respect to whom the Beneficiary is a natural guardian. . "1 l' R~"'-'T ....I .......'.,... of t>",";... ,.1..._, . r;--~.' . :,L~ COURT OF COMMON PLEAS OF CUMBERLAND COUNl]( WH 24 '":7 :110 PENNSYLVANIA ORPHANS' COURT DIVISION C' " CII, FIRST AND FINAL ACCOUNT For KIM M. HOOVER T/U/w AND ROBERT HOOVER T/U/w BARBARA RICHARDS, TRUSTEE Stated by HERSHEY TRUST COMPANY, Agent for Trustee Date of Trustee's first receipt of funds Date Amy Umholtz Hoover attained age 21 Account Stated for the Period April 29, 1996 February 17, 1997 April 29, 1996 , to February 17,1997 Purpose of Account: Barbara Richards, Trustee, offers this account to acquaint Interested parties with the transactions that have occurred during her administration of the trust. It is Important that the account be carefully examined. Requests for additional Information or questions or objections can be discussed with: Barbara Richards, Trustee 160 Rebecca Drive Duncannon,PA 17020 SUMMARY OF ACCOUNT Fiduciary Current Acquisition Paga Value Value Proposed Distributions to Beneficiaries 6 $362,911.34 $352,950.34 Principal Receipts 2 $355,618.99 Net Gain (or Loss) on Sales or Other Dispositions 2 (250.00) 355,368.99 Less Disbursements: General Disbursements 2 0.00 Fees 2 10,000.00 10,000.00 Balance before Distributions $345,368.99 Distributions to Beneficiaries 3 0.00 Transfers to Income 3 0.00 Principal Balance on Hand 3 345,368.99 For Information: Investments Made 3 Changes In Investment Holding 3 Income Receipts 4 $9,788.93 Less Disbursements 4 2,207.58 Balance Before Distributions 7,581.35 Distributions to Beneficiaries 4 0.00 Income Balance on Hand 5 7,581.35 Combined Balance on Hand - $352,950.34 1 RECEIPTS OF PRINCIPAL BECEIPTS FROM ESTATE KI~..HO~~QE.CEASEO 4-29-96 Cash $230,000.00 544 shares PPG Industries, Inc. 20,808.00 12-13-96 Final distribution from the Estate of Kim M. Hoover 65,056.36 $315,864.36 BEC.EIEIS.EBOM..ESIA TE ROBERT HomlEILDECEASED 5-21-96 Cash 39,636.34 8-13-96 Balance of checking account from Robert Hoover Estate 118.29 39,754.63 Total Receipts $355,618.99~ GAINS AND LOSSES ON SALES OR OTHER DISPOSITIONS Gain Loss 12-20-96 Maturity $50,000 US Treasury Bill 12119i96 Net Proceeds $48,667.86 Fiduciary Acquisition Value 48,667.86 $0.00 1-10-97 Maturity $50,000 US Treasury BiII1/9i97 Net Proceeds 48,632.50 Fiduciary Acquisition Value 48,632.50 0.00 2-3-97 Maturity $40,000 US Treasury Notes 6.25% 1/31/97 Net Proceeds 40,000.00 Fiduciary Acquisition Value 40,250.00 (250.00) Total Gains and Losses Less Losses $0.00 (250.00) ($250.00) ($250.00) Net Gain DISBURSEMENTS OF PRINCIPAL General Disbursements None Fees Barbara Richards, trustee fee $10,000.00 $10,000.00 2 DISTRIBUTIONS OF PRINCIPAL TO BENEFICIARIES NONE TRANSFER TO INCOME None PRINCIPAL BALANCE ON HAND Current Value As of 2-17-97 FIducIary AcquIsItion Value $40,000 US Treasury Notes 6.15% 2/28/91 $50,000 US Treasury Bill due 2/20/91 544 shares PPG Industries, Inc. Cash and temporary Investments $40,050.00 49,865.00 29,920.00 235,494.99 $40,362.50 48,103.50 20,808.00 235,494.99 $355.329.99 $345,368.99 INFORMATION SCHEDULE. PRINCIPAL Investments Made Units of Temporary Investment Fund were purchased or redeemed as funds were available or required. 5-1-96 5-6-96 6-20-96 1-11-96 8-22-96 $40,250 US Treasury Noles 6.25% 1/31/97 $40,000 US Treasury Notes 6.15% 2/28/97 $50,000 US Treasury Bill due 12/19/96 $50,000 US Treasury Bill due 1/9/91 $50,000 US Treasury Bill due 2/20/97 $40,250.00 40,362.50 48,661.86 48,632.50 48,103.50 Changes In Investment Holdings None 3 Interest 5-1-96 5-6-96 8-1-96 9-4-96 12-20-96 1-10-97 2-3.97 RECEIPTS OF INCOME Accrued Interest purchased $40,000 US Treasury Notes 6.25% 1/31/97 Accrued Interest purchased $40,000 US Treasury Notes 6.75% 2/28/97 $40,000 US Treasury Notes 6.25% 1/31/97 $40,000 US Treasury Notes 6.75% 2/28/97 $50,000 US Treasury Bill due 12/19/96 $50,000 US Treasury Bill due 1/9/97 $40,000 US Treasury Notes 6.25% 1/31/97 ($625.00) (491.58) 1,250.00 1 ,350.00 1,332.14 1,367.50 1,250.00 $5,433.06 Interest from temporary Investment funds 1996 April May June July August September October November December 1997 January 66.04 749.11 738.14 480.85 348.38 201.74 207.02 202.05 475.87 886.67 4,355.87 Total Income Receipts $9,788.93 DISBURSEMENTS OF INCOME Hershey Trust Company, Agent's fee $2,207.58 $2,207.58 NONE DISTRIBUTIONS OF INCOME TO BENEFICIARIES 4 " --".\,,~---,-,...~....._~ BALANCE OF INCOME ON HAND Current Value As of 2-17.97 FIducIary AcquIsition Value Cash and temporary Investments $7,581.35 $7.581.35 . ,','- -" - 'c' -~-~- 5 .\-11I14' . . '. PROPOSED DISTRIBUTIONS TO BENEFICIARIES Per Item VII C of Last Will and Testamant of Kim M. Hoover dated May 4, 1992: Current Fiduciary Value AcqulslUon As of 2-17-97 Value PRINCIPAL: TO: Amy Hoover Umholtz $40,000 US Treasury Notes 6.75% 2/28/97 $40,050.00 $40,362.50 $50,000 US Treasury Bill due 2120/97 49,865.00 48,703.50 544 shares PPG Industries, Inc. 29,920.00 20,808.00 Cash 235,494.99 235,494.99 Total PrincIpal $355,329.99 $345,368.99 INCOME: TO: Amy Hoover Umholtz Cash $7,581.35 $7,581.35 Total Income $7,581.35 $7,581.35 Combined Total , $362,911.34 $352.950.34 6 -,._...,'''''"N'$.'''''''''"'....~_....~'.-.,.'..,:~,,~.,..,. , . . BARBARA RICHARDS, Trustee under the Last Will and Testament of Kim M. Hoover and Robert Hoover for the Benefit of AMY HOOVER UMHOLTZ, hereby declares under oath that said Trustee has fully and faithfully discharged the duties of her office; that the foregoing First and Final Account Is true and correct, and fully discloses all significant transactions occurring during the accounting period; that all known claims against the trust have been paid In full; that, to her knowledge, there are no claims now outstanding against the trust; and that all taxes presently dua from the trust have been paid. /J .2 K);1' I h,u) /iA"v/t It-L"'aJ Barbara Richards, Trustee Subscribed and sworn to by BARBARArflCHARDS before me this P< tJ day of 'r1.tn..l..J41, ,1997. ~1Y!. (~.44<- Nota PUblic Nolarlal 5001 Mary E. Lohmon. Nolary Publio Corry lWp.. Cauphln Couoty My Commlaaloo e,plros Nov. 23. 1999 ... I \ \ " " ~.. ' 1 ! i ) , I I i I (I I '/ i. ;.. ;\'j \;\ 'I'! f) '/'1 ) J. ..~~.. , . ./.." "1 .. I. i "i- ., ! ~\:\;'t(!~\ . .', 0 ! '" '.~ , '. " ~. .-' 0 : '\.. / f ; 1"! ~tJ.;.t--z::,.'"JiI~~m ,I / .~ I :," ~\ {...'; ..' ":I' ',' ," '. ,- i ~., ii: "0' \ ,,' l'- -"c', I t, \:""-.t :, W "'~([tt a.. L!l ~ , .I ') '~ ] j I I j ;~ I*j .',., ' '!.l '1----.,- -~::. j- t::!~.... _ ':,::g"/.'.; : /:,..- ~ \., \ -.--,....." -..-." ~ tIl :j .... ~ r.. '" o tIl ~ => '" 0 (-<lQ~ ~bJ~ C1f;;;=>!9 l:j....8~.., :s~0'..... 1:: ,(-<tIlO ~<~",::; O>lOtll ;~ii; gj..el8~ ~5~~t3 .- -- --~ -.. ,,"- ~ u~ ,,':;: ~t: "":; tilE::: ~~~ o:'!= ~.~ ~~ <~ " . , ~ N \'1:1 ~j r~ ro) I (0;" ... ~ I" ... .' ,,' . ~ ~ ~ I j"- ~ ,.' . -J . ~ i '" / -f" . ..t. I' " I I . "- " ... .1 C I ..: ~ " : .. F' :- '.. " 't., . i r .~ '"1 " ~ '.\ , .. '(.. . :., I' '.._ , . .~ , ..., J " - ., '. , . . .: r - .,...,-- t... _ i, "1.-.," . . -~-~ -'~:- i ~:tI. ~~vtJ~' 1".\.NNIIIDAKIUl ANlJ .JON1llH, I", C, FOIlR 1110llMND VINE SFRHT MIDDLt:TOWN. PF.NN5YI.VANIA 17057-3506 rELEMIONE 1I1-o.t,t.I:\33 nu.COfl[t\ 117-{}44.4O().t PmR k.IIENNINCEIl.JFl. DONALD L.JOHU IAMU B. MNNUAKEk February 2, 1996 Ms. Mary C. Lewis Register of wills cumberland county 1 Courthouse square Carlisle, PA 17013-3387 RE: Estate of Kim County Code: Our File No. M. Hoover 00395 1995 14245 Dear Ms. Lewis: Please find enclosed three (3) sets of the Supplemental Inheritance Tax Return for the above named estate. upon receipt, please time stamp and return our file copy in the envelope provided. Thank you for your assistance. Very truly yours, ~~A-- Legal Assistatft' :dkm L020296 ~ I~' .' ',-. .' I ,;-. -' ., .}() J -- -., -j~ :.' - ~ . . . .