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tAST WILL UD TBSTlMBNT
BE IT REMEMBERED THAT
J., HARRIET G. HOFFMANN, 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 TESTAM~NT, hereby revoking any and all Wills and codicils
previously made by me.
I
I declare that I am not married, my beloved husband, RICHARD
HOFFMANN, having predeceased me.
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 of my property whether real or
personal, whel.ever situate, including any prop8rty over which I may
have a power of appointment, as follows:
A. Fifty-five (55%) percent to my sister. MARY G. SWOPE,
per stirpes.
B. Fifteen (15%) percent to my niece, JOCELYN ZIMMERMAN, per
stirpes.
c. Fifteen (15%) percent to my nephew, ROBERT BRENT SWOPE, per
stirpes.
D. Fifteen (15%) percent to my husband's brother, WALTER
HOFFMANN, per stirpes.
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COMMONWEALT~OF PENNSVLVANIA 'llEPARTMENT Of HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
C/
ltEV1!1OOEX'11811 .i~t.
COM~ON~SYt VANIA
D,PARTMfNT Of R,V[NU,
[l!:PT 280001
H RW PA \7118 01
OfCmHfl'l] N.4Mr (lMil FIRS!, ANO~IIOOlf.INIlI~I,1 u~o 3~Ank twx~ ~ ,~p.v.. WOfd~
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SOCIAL Srr:UfllTY NUf..trll;R
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oATfcrDEAlH
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OA'~ OF lllRl1t
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PiS RETURN ~U5T BE FliED IN DUPL~ATE WITH THE
L REGISTER OF WILLS
IE 1, Original Holum [J 2. Supplornenlal Return [J 3. Rem~jnder Return (diMeo'!MllIhptiOl~ 12 lJ621 '
o 4. Limlled Estate [I 4a. fUlura Inlaresl CompJOmlsa Id',,''''.''''''' 12.12"1 [I 5 Fade,,1 Estate Tax ROlllm Roqulrad
~ fl. Decedent Died Testale l^~ilt,hCopvof\'l,II) D 7, Decedent Maintained a living llUSl (AnachCOl)yolT!U~t) "_ 8 Total Number of Safe DeposilBoxes
o 9. Lil~alioll PrO<>Joos Racolved 010. Spou,,1 Poverty Credlll'''''''''''''''''''" 12"" "'H'''I [] 11. Eleel~n 10 lax under Soc. 911J(A)I',,"I1S<oOI
THIS SECTION MUST BE COMPLETED. All CORRESPONDENCE AND CONFIDENTIAL TAM INFORMATION SHOULD BE DIR~CTED TO:
NAME_ '._ COMPlE'E~WLlNO.lODAESS '-"'" ci /./ "J
(c",be.rf- /1, .S\k'C'b~__92..:if ('lov",!,.,.1 1~1l
FIRMN,4ME 11'~pliClblei I ~ )
!-Iarl/_~k'"7J {-"'/')/"l-/f,,'/
(If' AJIIlUCAflU'1 flURVl'lING 5POUSE'S ~IAME llA!;'f, HRd AND MIDOl [ INIfI,l.L \
SOCIALS(CUAI1YNUMflEIl
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TElEPHot~ENUMBER
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1. Real Eslale (Schedule A)
(I)
(2)
(3)
(4)
(5)
(6)
(7)
, if..3 2. I P
(6)
1,:370,fo
, 8 ;( ~. ..9- 0
2. Slocks and Bonds (Schedule B)
on
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:l
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3. Closaly Held Corporalion.P8rtnelShlp or Sole.Propnelorshlp
4. Mortgages & Nole' RecolvablelSchedulo D}
5. Cash. Bank Doposlts & Mlscella"eous Personal Property
(Schedule E)
6. Jointly Owned Property (Schodule F)
7. InlorVlvos Transfe", & Miscellaneous Non.Probala Property
(Schedule G or l)
6. T 0111 Groll A..ela (IolalLlnes 1.7)
3,ti'S8.;';;
::z.. 0 ge I.
,1
o 9
;'!'i
9 Funeral Expenses & Admlnlslrall" Costs ISchedule H}
(9)
110}
10. Debls of Decedont. MortgageLlabllll~s, & Liens (Schedula I)
11. ToIII D.duetlona {Iolal Lines 9 & 10}
x 0
(II)
(12)
(13)
-
(14)
(15)
(16)
(17)
-
(16)
1 ~7'1.flf
,.1'J-'l-..t3
.2, I Y 3
1,1.,'11/-
:3 0
,98
-
12 HalVa'ua of Eatal. (L1na 6 minus Line 11)
13. Chantab~ and Govemmonlal Bequests/See 9113 Trusls lor which an elaellon 10 lax has nol bean
mede (Schedule J)
14. HelValu. Subjeetto T.. (L1no 12 minus Line 13)
15. Amounl 01 line 14 texable
allhe spousal lax rate , I
Soelnslructlons on re""" side lor applicable percentage
16 Amount olllne 14 taxable
016% role
17. Amounlolllne14taxablo
a115% rate
) , ~ 7 1-
! 5'
x .06
x .15
18. Tlx Due
19
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
Under ~~Ilalbes Ofpefjllry, j d6clar8 Ihall have examined this relurn, including axOlnpl1nying ~IledIIIeS Ind statements, and to 11ll) best of my knowledgo IInd tl6hflf, it i~ tflJe, corrf'Ct and C()nlploto OocIMtllion ofpfllDNer oltwr
than the corson. reoresenlltive is based on alllnlormaHon o/which prODater ~as alW knOWi"Ied<Jo _.__.~_.
SIGNATURE OF PERSON RESPONSIBLE FOR FlUNG RETURN ADDR~~S.:':l "" CO/Pi.,.t'" I~' r\!,,(cf DATE
lie, n/s.ln<LL._Y~'., / .?/t' f- /y,;;'? .3 - / ~ - f'r
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS // '/ DATE -----
Decedent', Complete Addre..:
STREET AD RESS -~_.-------.,::--~--_._~-_._-_._--~-----------~-_.--::--
, I. <I'; e, IrJ,:,"J:~!1L[I I ('&'11 I~ r
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CITV IYIlL,Q h(c II; cd ,b " ,. <j ell / 7' ,(J,t)-,;/
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Tax Payment, and Credit.:
1. Tax Due (Page 1 Lilla 15)
2. Cradlts/Payments
A Spousal Poverty Credit _---.-
8. Prior Payments
C. Discount
--J S1A1r
liP
(11
..:;; f -I. ,,,2 fL_
-- ~~ H--L~ i r
T-- Total Credit. ( A . 8 .C ) (2)
tf.l. '7;J
3. InterenVPenalty II applicable
D. Interest
E. Penalty
TotatlnteresVPenalty (D' E) (3)
4. II line 21s greater than line 1 . line 3, enter the difference. This is tho OVERPAVMENT,
Check bo. on Plge 1 line 10 to requeell relund (4)
5. II line 1 + line 3is greater than line 2, enler the differonce This Is the TAX DUE, (5) I (; <t, .t/ 7'
, ,
A. Enter Ihe Interest on the tax due. (5A) --
8. Enter the total of Line 5 + 5A. This Is the BALANCE DUE, (58) /" L -I tf
Make Check ~able to: REGISTER OF WILLS, A1ENT - I
PLEASE ANSWER THE FOLLOWING QUESTIONS
BV PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Old decedent make a transler end: Yes No
e. reteln the use or Income olthe property treneferred;............................................ ...0 [J
b. retain the right to designate who ehall use the property translerred Ilr lis Income; ................ 0 0
c. retain I reverelonlry Intereet; or.......................................... ....................................... 0 0
d. receive the prom lee lor life 01 either peymente, benefite or care? ......................................... 0 0
2. II delth occurred o~ or belore December 12, 1982, did dacedent within two yeare
preceding deeth trlnsler property without receiving edequete conslderetlon? If death occurred
efter December 12, 1982, did decedent trlnsler property within one yeer of death without
receiving adequate consideration?.......................................... ........... . .....................0 0
3. Old decedent own an "in trust for" or paYlble upon death bank account or eecurlty
at his or her death? ........ ............. . ..............0 0
4. Old decedent own an Ir,dlvldual ratirement account, annuity, or other non-probate ~roperty? ....0 0
IF THE ANSWER TO ANV OF THE ABOVE QUESTIONS IS VES,
VOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN
7Z P.S. ~9116 (a) (1.1) (I) provided for the reduction 01 the te. rate Imposed on the net velue of transfers to or for the uee of the
eUfl/lvlno epouse Irom6% to 3% lor dates of death on or after July 1,1994 and before January 1, 1995.
7Z P.S. ~9116 (e) (1.1) (II) provided for the reduction of the rete imposed on the net value oflransfers to or for the use of the sUNlvlng
spou~e Irom 3% to 0% lor dates 01 death on or after ,January 1, 1995. The statute do~ot exempt a transfer to a sUfl/ivlng spouse
Irom tex, end the statutory requirements for disclosure of assets and filing a tax return are stili applicable even If the sUfl/lvlng spouse
Is the only beneficiary.
FOR DATES OF DEATH ON OR AFTER JANUARV 1, 1995" Please answer theloltowlng question by placing an "x" In the
appropriate space.
Old the deoedent crelte e truet or aim liar arrangement which is solely lor the surviving apouee'a benefit for hla or her entire
lifetime? Vea 0 No [J
If you answered yes to the above question, the tax on the trust or similar arrangement Is postponed until the death of the second
spouse, at which time it will be lulty taxable at the rate(s) applicable to the remainder beneficlary(les). Enter the value of the trust on
Schedule J, Part II, in order to remove it from the calculation of the tax due In this estate You may wish to file Schedule 0 In order to
make the election available under Section 9113. II the election Is made, the trust or similar arrangement is taxed In the estate 01 the
first decedent spouse, the portion of the trust or similar arrangement which benefits the sUfl/ivlng spouse Is texed at the zero tax rete,
and the remainder Is taxed at the rate(s) applicable to the remainder beneficlary(les). II YOll choose to make the election, you must
attach Schedule 0 to a timely-filed tex return, along with Schedule(s) K and/or M In order to show the apportionment of the trust or
similar arrangement between the surviving spouse and the remainder beneficlary(ies).
THE UNION CENTRAL LIFE INSURANCE COMPANY
ORGANIZED IN 1887..,A MUTUAL COMPANY
CINCINNATI, OHIO
Policy Numb~r
Name of Insured
PAYMENT OPTION AGREEMENT
ALTERNATE ANNUITY OPTION
._---IRA....20Ql-=-..r~lli2...
Har~ G. Hofim~
$20.828.13
Amount of Proceeds
Type of Annuity
Payments Guaranteed For
Name of Payee
Name of Joint Payee If Joint and
Survivor Annuity
Amount and Mode of Each Payment
Date of lIirst Payment
-~~~IDr'rotal Procee<lsrarirTO"
_~al AmouQ~f Proceedp as Shown Above
___-Harr~.~. Hoffmann_
None
$
200. 97
October 17 , 1989
Mary G. Swope, sister of said payee
Payable
Monthly
Contingent Payee
THE UNION CENTRAL LIFE INSURANCE COMPANY shall retain the proceeds of the above
listed insurance and agrees to release the above stated payments to the Payee when due.
Upon receipt of proof of death of the Payee under an annuity other than a Joint & Survivor Life
Annuity, any guaranteed payments remaining unpaid shall be continued to the Contingent Payee. Upon
receipt of proof of death of either the Payee or the Joint Payee under a Joint & Survivor Life Annuity,
payments shall continue to the survivor for as long us the survivor shall live. If the Joint & Survivor Life
Annuity provides guaranteed payments, any guaranteed payments remaining unpaid upon receipt of
proof of death of both the Payee and the Joint Payee, shall be continued to the Contingent Payee.
Upon receipt of proof of death ofthe survivor of the Payee, Joint Payee and the Contingent Payee,
any guaranteed payments remaining unpaid shall be discounted at.-8. 25 % per annum compounded
annually as of the date of death of the survivor of the Payee. Joint Payee, and the Contingent Payee, and
paid in one sum to the executors or administrators of said survivor.
The proceeds retained will not be transferable or subject. to the claims of a Payee's, Joint Payee's,
or Contingent Payee's creditors, except as required by law.
The Payee may change any Contingent Payee named herein at any time with the approval of the
Company by returning this Payment Option Agreement to the Company's Home Office and signing
proper authorization for its reissue to show the IIllwly designated Contingent Payee.
This Alternate Annuity Option will not qualify for extra interest as may be determined annually
by the Company,
Issued at Cincinnati, Ohio, this 6tn__._ day of ._ November. , 19-1!.2....
THE UNION CENTRAL LIFE INSURANCE COMPANY
W-r~
Socrctllry
Prosidont
UC 2&18 He
""""""'1/'.
CO/,lMONWfAlltf Of P[NN9YIVANIA
INHEHI f ANC[ T ^)( r~r: TURN
.r! :,
ESTATE OF ,~--- - FILE NUMBER
__1<', 1"tLrJ~j2!~J.!"Jjl'\I1_!.W__.._._~.~_____._.__....!...2_J - /yti? --
, " /
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
lltbtl 01 dlCed.n! mu.t be r.ported on Schedule I,
,~-_.._-_.-
ITEM
NUMBER
A,
1.
..2.
_:1 ,
1"
s:
t.
B,
1,
DESCRIPTION
FUNERAL EXPENSES------.---------.-i-:Ad---' f3
P""'-J-,rt,'J F"U1C "Ii I A,'c<.u,,-t,... ,.; fret,A. . .-/" J.. (' " ~
Ce~",..t,'t:.^ .s'v".',i1 "f (~.., (""tV"H/ "lld<' /,,.," k.,.. ),I"~
Ih~ -H>-. (, v . 'f. fl <'<1 +~.~ - c;, ~ " k jJ.- ;~;i' I 7 . 1,:2../1 f /7 J
C,.rtLve.C'lP t' h ; hf~ Sltc"Fs C~ tI,. 1. '/1 NJ.J-! /7.." e h .t!-k j-y.r.1
!iL/...it:>/f7.. ;1: '., .1'1_ 1J-/..:2J/j-J
/)1"', /\;'f. '.J'< 'II F7c. :f/"""" C.. h d" ~.!J 17 '. / ~ k" P'~'1-''-
/i'<a..-, IJve, w,~/H!Jo.I.'"I'J",',,--/3" 11"'''7 V,' 114f< ~ . >~/lJJf~
p;rll'rtU'~/kf. "I ::s1'N/ti ..~ t-" hI:. "'_~'.'lJ/It.'!1...J. ~_^ (i)lh,lf. I
r'h<~. 9ud'od in 1.1f'r::.~'"'' .).,.,,/ M,trlC';/4~J ,...?
ADMINISTAA TIVE COSTS: , ~ I r/:I lIE' 0/ ;,.' t ~ /fd In> b 1,,/-, r c'- ,
Persone' Representellve's Comml..~ns
Name 01 Personal Represenlallve (s)
Soolal Securt~ Number(s)I EIN Numbor 01 Peffional R~presenlative(S)
Slreel Addre..
City
State --- Zip
Veer(s) Comml..~n Pa~
2, Attomey Fees
. 3. Family Exempl~n: (If decedent's addre.. ~ nolthe same as claimant's, allech explanallonl
C~lmanl
Slreel Addre..
4,
City.
Retal~nship of Claimant 10 Decedent
Slate__Zlp
';ti .
Probate Fees ..s p-e <1.//<1('. ~".J - de."f .57.11 - I~ :::)1'1
6. Accocntent's Fees
6. Tax Retum Prepare!s Fees
7.
Fi 1/117 Fe "-
-
I tJ ~--!:.~~~_____
AMOUNT
,f' it }J--;- " ~
'1;/,0 "
J .!r<', "<,
7 .:);' g (
7 .3'~ tI'
J'Ij, I' ~
..9~. ~ I
/Jrt t' P
TOTAL (Also enter on line 9. Recapltulallon) S / ~ :1 tJ, cf't'
(If more space Is needed. Insert additional sheets 01 the same size)
g ),~le r ~'Ij7i 3,;J..t"Y,j
JV' l.j'f, J" 7, c' t
,~ Co ~
N~ ),~~"r /b'7j, fJ f, j j
0rt. NIt' r-_ ; ". (0 l ;;91
h"'"
",,,,nt',,,",,.
coMMoNWLAll Ii or PrtiNSYI VANIA
INHIf~11ANCr tAx HUUflN
Ii :1'1 U) ~ I
SCHEDULE J
BENEFICIARIES
NUMBER
--
I.
_ _ J_ -=
FILE NUMBER
(~i it (i/L!..L1~UL'_h_____U_"_________ __. ,,1 I - ,/ '1/2,.:-
RELATIONSHIP TO D .CEDENT
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY 00 Not Lilt Trultee(11
TAXABl.E DISTRlilUTKiNS(IfICiudo"outrighl spoll"i dlHtriolltlollS) ----.-
S' ; ,$ t., r
ESTATE OF
I I '-I
'Te, I Tll:....___
1
'/ ( ') } /'/ Ii
Iv) tl r.7, (" ,) 1.-(.1 { )t'. -- ,_ '\
3 ,;J..2// (')t"<,'l.'.,/J Ftc;r, j
l-b rr/,r;):,u 7,/ ~~i ,? I/t .
J.:j-e 1'1 '" II c ,. ""7 ~ f ) (f fJ
Marl G, SLOtl/""---
,,) '['-'1 l'
,J "' t' " r-t;L 2,"~ ( )/1'" ~~ kh " :c _
{3o-j l.J<i J~fl~ (,n'II~) P'L. )l,f't.5"
(loher-th 13n'-n.1- SWDf"'-
(. .}L f" A 5" 1'0,0" '-:5' / l/ d ,
f{.t.d<' v,' II ~ I M d, .;c t' J ~-t'
W t.i /t.), /1 "II "I ...: III\..'
i-/-- ~ f 3 ~(/ 151! t )....a /) .~-,
$ ), " }) P <dl 5 ,J} 1..<//, R,. I 7,~ 3)
.,1.
3.
4/
-
',",p. J"
-"_..
AMOUNT OR SHARE
OF ESTATE
9.3';<, I d
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABl.E DISTRIBUTIONS:
A, SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B OHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1,
TOTAL OF PART II. ENTER TOTAL NON.TAXABl.E DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more 'paco I' needod, I",ert additional ,heols of Ihe sarno si,el
\'
~-'
- ~,,.-
CERTIFICATION OF NOTICE UNDER RULE 5.6(al
Name of Decedent: II a. ('r " b -t (,-, IIdll~OIW
Date of Oeath: /.2.- /t- If~7
W ill No. / r; .:j" '1_ 0 / d .t l$
----.,... ~ ;
Admin. No.
To the Register:
I certify that notice of beneficial interest required by
Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to
the fullowing beneficiaries of t.he above-capti.oned estate on
" f '. 1 t>.. 5' J~
~
Address
/,/1 axy c.. S' LJJ <J J...: oJ.:l...2d C Iv Vt rJ/ ell Rd. J:!..s.n'tj .6urr; !?t. / '> I" f
/ / . I J -N r-
_ VV(~ I fi!. r IV: Ii ",,/jJr/4.:" ~c! ,)U1J5t!/ id"e $It: th<"l.sh,u# R., /'7016'1
// ~~ ..,- If i) " ,
~ <!.. e../7 IV 2 i ,YII11 ~ I- m"'t.~~ 130)/ J"z,1 f?, 1/5 ;'J" I' e~:Ll..J..%(,>;- ~
{-?"b"/i/r,r !?,..t:.11( ,Slv/)/'",. (,,~Uhfe,... 81v'/ O~_E..J{y/J/~ M.d, A<',f..t;"""
/ I ~ J
Notice has now been given to all persons entitled thereto under
Rule 5.6(a) except
Da te : j __ I " - ,S'
I
)
__: ~J
()C'.
Name I?db~,-r re. S'~',yf,>L-
I
Addt"esS3.2-2~ {';onrj/f.;IJ Ri,
!lar,.., .5;'d<~ 1-::::. /7/<'7
/ . /'
Telephone("1"1)5'~...'.- I~ i":.o
? I
Capacity: X Personal. Representative
C'"
I;,'
l'T-'
.-..~
Counsel for per~onal l
l-epresentative _
'"
~? ,I '.'.' ('Y"'),.
:~, ";'0'111 o-1lil
?/ :'~;. :,"; .:1'
Jilll H) ",-,,('-'
0;.1;': H'j ..f'~;':
: u ( ~"
, 'j ,
"
- '
= -
~,.,
I j L~
~1
.
-:
!
.'" ~
.... .)
~ :1 ~
J ,.. r')
-
. :? "; 0
~ (..)
, f:
'~, ~ ..
r- \.4. ~
'~ c% 0 ~ ce
rt 2
~ Z; d J ,.
t::,r::i II ~
~ 't
~'+5_"-"j__
'."...,.,... .A .... --: ..J.
~.~ o:! ~
C) d
Z ~ > ~
U
;'S' ),,)../-/ t/
'UREAU Of INalVIDUAL TA~ES
INHEMJIANC[ YAK DIVISION
DEP1, 1I0601
tlARRI$lURO, f1A 111l8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE Of INHERITANCE TA~
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIUNS AND ASSESSNENT Of TA~
ROBERT R SWOPE
3224 ClOVERfIElORD
HARRISBURG PA 17109
OAT!
ESTATE OF
DATI OF DEATH
FILE NUHDER
COUNTY
ACN
05-25-98
ItoFrMANN
12-16-q7
21 Ql-1028
CUMBERLAND
101
--~
'W8
.1~-IHI U ." 1"'''1
HARRIET
G
[ .A.O,,"-=!~~j::_ _..:]
MAKE CHECK ~AYADLE AND REMIT PAYMENT TOI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV: is'4"j - Eif -Ai: 'Fj - i ilF 97T - HelT i or -oF - INHER i f Aifc E" 'fAx" APPRA-i 5 EHEHr; - AU:owANcE - iiR - - - - - - - - - - - - -" - --
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF HOFFMANN HARRIET G FILE NO. 21 97-1028 AtN 101 DATE 05-25-98
TA~ RETURN WAS I (X I ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE' INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..I estat. (Schedule AJ
2. stocks and 8ond~ (Schedule 8)
3. Clos.ly Held sto~k/P.rtn.rlhip Jnter.lt (Schedule C)
4. Hortg.g../Nota. Reoeivable (Schedule DJ
S. C..h/Bank Deposits/Hilc. P.rsonal Property (Schedule E)
6. Jointly Owned Property (Schedul. FI
7, Tranlfarm ~Sch.dul. G)
8. Total A..at.
III
12'_.
13.
141
15 I
161
171_
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Mile. El<pensas lSchadula H)
10, Debt./Kortgege Llebllltle./Llen. (Schedule II
II. Total Deduction.
12. Net Value of Tax Raturn
13. Charitable/Governnent.l Beque.ts; Non..lactad 9115 Trust.
14. Nat Valua of E.t.te Subject to Tax
191_
110 .
C Schaduh J)
NOTE:
TAX CREDITS:
PAYNEN,.
DATE
03-11-98
RECE!:'!
NUKBER
AA269S3S--
DISCOUNT 1+'
INTEREST/PEN PAID (-.
-----
8.92
I CHANGED
.00
.00
.00
.00
2,956.08
.00
932.10
181 __~~~
1,370.80
822.50
IIIJ
1121
(131
1141
.00 X' DO:
.00 ~.06:
1.694,88 K' 15:
1181
AMOUNT PAID
169.49
TOTAL lAX CREDIT
.-----
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
If an a.....m.nt was i..u.d previou.Iy, lin., 14, 15 and/or 1&, 17 and 18
refl.ct figur.. that includ. the total of ALL r.turn. a.s....d to dat..
ASSESSMENT OF TAXI
IS. A..ount of Lina 14 at Spousal rata (15)
16. A..ount of Lina 14 taxable at Line.l/Cl..1 A r.ta (16)
17. AMount of Line 14 taxable at Collatara1/Cla.. 8 rate (17)
18. Principel rax Dua
PAYMENT MUST BE MADE BY 09-17-98_.
NOTEI To insura propar
cradit to your account,
sub..it tha uppar portion
of this forn with ~our
tax pa~/!!lant.
~.193 ~n
1,694.88
.00
1,694.88
will
.00
.00
254.23
254.23
_,]78~41
75.82
.00
75.82
. If PAID AfTER DATE INDICATED, SEE REVERSE
fOR CALCULATION Of ADDITIONAL INTEREST.
If TOTAL DUE IS LESS THAN II, NO PAYNE NT IS REQUIRED.
If TOTAL DUE IS REfLECTED AS A "CREOn" (CRI, YOU KAY BE DUE
A REfUND. SF! REVEP~E SIDE Of THIS fORK fOR INSTRUCTIONS. I
0Cl t::~
15 'M ;:~ .
J9 rr
~ \E E~ ,)
t)
~
, !e ;\1
, ~I~
LJ ,:b
'-
r;.:l (j} ~S
lil&! ~
a:
R[SERIrIAlloth Est_'.. of dlWadentl dying on or befon Dec._" 12, 1912 -- If MY future lnt.r..t In tM ..t.t. It t,..",f.rrtd
I" po.....lon or flnJOYH"t to el... . (coUlt.rll) blfMf!,olarl.. of tn. declecMnt ~ftlr the IKPlr.Uon of MY ..tate for
11ft or for v..r., tt,. CollllOftWUlth Mlrlby l)Cpr,"b r...,.v.. thtt rltlht to ...,..111 .-ld ...... trMI'.r InhtirltlnClI llle..
It the llw'ul Cl... a (col1,te,..1) rltl on MY .~h future lnt.rl.t.
PURPOSl! Ill'
NOTICE I
To fulfUI tM rlqulr,....,tI of SICtlon 2140 of thl Inho;rltancl Ind Ellt,t_ hM AClt, Aot 21 0' 1995. 02 P.S.
$lotion 9140),
PAVMENT I
Detlch thl top portion of thh Notlcl m SUbia with your PI,,""\ to thl Rlght,r of Willi printed on t~ rIYI,.1 ,Id..
.-Mek. Clheck or Inn.v order plyablt tOI stEatlTER OF MILLS, AGENT
REFUND (eR) I
l refund of . tlX cr.dlt, which WI' not reque.tld on the TaM A,turn, May b. rl~.tld by co,plltlng an ".ppllc.tlon
far R.f\l"td of P.,lnsylllanl. Ioo.rltltnct and E.t.t. 111M" (REV-UI3). AppliclUon. arl Illllll.bl. It th. OffiCI
of tn. A.glat.r of ~11Ia, any of th. 2~ R.lIanoe DI.trlct O,flc.., Dr by calling thl .p.cl.l 24~hour
'"....ttn. ..rllicI nullb.r. for far.. ord.rlngl In P.nn.ylllanl. l-aOO-562~2050, out.id. P.nn.ylllanla. and
..Ithln loc.l Harrhbur. .r.. (717) 7a7~a094, TOOt (717) 71l-2Z!t2 (H..,-lng Ilpelr.d Only),
O.JECTI~'1
Any p.rh 1n Ii,tlr..t not utltU.d NHh th. .ppr.I....nt, .UO"'&n<l' or' dlullaN&nc' of d.duCltlon., or ....ot."'t
of t.~ (Includln. dllcount or Intlr..t) I' .hown an thl. Notl~. IU.t obj.ct Nlthln .INty (60) dlY' of r,cllpt of
thit Notlu bYI
-~"'rltt"l protut to thl PA nlpartl.nt of R.lIlnu" laird uf Appuh, OIPt. 211021, H.rrhbur.. PA 17UI-1021, 011
~-.I.cUon tn hili. thl tatt.r ~t..r.tn.d at ludlt of thl account of th. p.r.onal rii~pr...nt.thl', OR
napp..l to thl Orphan.' Court.
AO'UN
ISTRA~IIIE
CDRREC1JOMSl
faotuIl .rror. dl.cov.r.d on thlt ......-.ot .hoUld be eddr....a In ..rltlng tal PA Dlp.rt..nt of A.Ylnue,
BurellJ of Indlyldual TaMil, AlTNI Post b..""""t R."i.w Unit, D.p\' 210601, Harrisburg, PA 1712'-0601
Phont (111) 111.6505. Set P'" 5 of the bookl.t "Inltructlons fer Inhlrlt8nQ. t.N R.turn for I R..ldlnt
n.ctdtnt" (AEV-l~OI) for an 'MP1~.tlon of bOIlnl.tr.tlvlly eorraotlble Irror..
DJSCOUNT 1
If any ttM due I. p.ld within threw (.U cIlendtr ItOflth. after the dac.dent'. dllth, a fl.... plrcent (S;O dhcount of
the taM paid I. allo",ed.
PENALTYl
T~ lSX taM ..ne.tv non-participation penalty 1. eDSpUted on thl tot.1 of the t.~ ~ Int.r..t ....s..d, end not
Pltd bafor. Janulry II, 1996, the first dlY altar the end of th. t.. unllty pariod. Thh non~Ptrt1elp.tlOfI
p.naltY It appllhbl. In the; .... IIlM1r and In the the .... U... p.rlod u YOU would appe.l thl; t.M end Intlr..t
that h.. bailn ......ttI al lndlcatlld Of! this notiea.
INURE" I
Interllt II Clhar..~ bttlnnl". with fir.t du of dlllnquenoy, or nine f'J ~nth. .net Onl (1) d.y "rDIII the dlt. of
Math, to thtl d.t. of paYMnt. T.~a. Mhlch bee_ dallnquent beforl January 1, 19U bllr Intara.t at the r.t. of
.IM (6X) p.reent plr .nnUl ealeu1at.d at . d.lly rat. of .000164. All ta.al Mhleh bee..a d.llnquent on end .ft.r
Jsnu.ry 1, 1912 ",Ul b..r Intar..t .t . rate which ",Ill vary 'roa ul.ndar yair to caltnd.r y.ar ",lth thlt r.t.
ennounctd by tn. PA Dep.rt..nt of R.....nutI. nit IIfIfIlleabll tnt.r..t rat.. for 19&2 thraU$lh 1991 Ir.l
'tm Int.r.U Rat. O.lh Interfllt factor ~ Inttr'lt Rat. Dallv Intlr...t raetor
1912 lOX .000548 1981 OX .0002.,.1
l'es 16X .OOOIt18 19U.1991 III .000301
19I~ 111': .000501 1992 'X .000241
19" UI': .000!S6 19n-I'~ 7% .0001'2
191' )0;( .000214 19'5-I"1 .X ,000241
--lnterllt II ealoulahd .. foll8'fll
INTEREST 0 BALANCE OF TAX UNPAID X HUHBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notlo. I..ued aftar thl ta~ blc.... dallnqU$nt ..III r.fl.et an Intar..t c.leul~tlon to f1ftaen (I.) daYI
bevond thl dati of thl ...."..nt. If pay""t It lad. .,t.r thl Int.ra.t coaputaUon d.t. .hown on the
Notloa, additional Int.r..t .u.t bI oalculated.
'I
,
PA_"
DIIt-m tM top purUon of this Notic. Md Iut.H with YOUI' p.~...,t ... p.y.lbl. to thtl n-.. ... ~r...
prjnt~ on ~ r.V.r.. side.
If RESIDENT DECEDENl lNIka ctMtok or ltOMy order Plyabl. tOI REGISTER OF NILl.S, AGENT.
If NOH4RESJDEMr DECEDENT ..... ctMck or ltOMy order Plyable tOI COf1HONWEALTH OF PENNSYLVANIA.
ItEFUNb (CR)1 .r,fund of . tlX credit, which ..Ia not r.quellt.d on the TII( Return, .'V tM requested by coeeplaUng ....
wAppl'~t'on for ~.fund of Penn'yly~J. Innerltene. ~ Estat. Tlx" (AEY~1513), Application. ar. Iv.lllbl. at
the Of,lcI of the ~'Qi.t.r of Nilll, ~y of the 23 R,vlnYl DlatrJot Offic.~ or fr~ the o.p.rt-.nt'. 24~hour
1n.~rlng ..rviel ~r. for for.. nro.rlnol In Pennsylvania 1-800-362~Z050, out.ida Plnnlylvlr,l.
Ind within 10011 HarrisbUra arIa (711) 787-1094, TOU* (717) 77Z~2252 (~.rln. I~.lr.u only),
REPLV TOl
QuI.tlons rlgardlng ~rror. cont.l~ on thl. notlo. .hould b. addre..ed tal PA Dap.rt.~t of Hev~, lure~
of Indlvldu.l T.xe., ATTNI Po.t A.......nt Revlew Unit, D.pt. 2'0601, Harrl.burD, PA 17126-0601, phone
(717) 7'7-6505.
DISCOUNT $
If ~y t.x due 1. pald wlthln three (]l oalendar eonth. after the ~o.d.nt.s death, . flve percent (5X) dltcount
of the tax pald 11 allotted.
PENALTVl
The lSi: t.x ~tty non"parUclpaUon p.nalty h COIlflut.d on ttMI total of the tax and lnt.r..t ......ed, and not
pald bafon January la, 19%, the fir.t d.y after the .nd of the tax ..na.ty perlod.
INTmF.ST I
Inter..t h chllrted ba,lnnlng with Hr.t day of de1Jnqueno~, or nhMl (,) eonths end one (1) day fr_ the data of
death, to the date of paY..nt. Tax., which bee... d9llnquant bafor. January 1, 1962 be.r Int.ratt at t~ rat. of
.Ix (6~) percent par ~ calculatad at a dally rat. ~f .000164. All t8xa, Which bee... delinquent on and after
Jeou.ry 1, 1962 will bear lntwra.t at a rata whl~h will wary froa oalandar year to c.l~ar y..r with t~t rat.
1MOUnO" by the PA IMpart..nt :Jf Aevenue. Thtl appllcabl. jnt.r..t rat.. for 1'82 th"ough 1996 arll'
V..r Intere.. Rata DaUy Int.rut Factor Vaar Intore.t Rat. Dalh Int.re.t Factor
1912 20X .000548 1'87 OX .000241
1915 16i: .000458 1988-1991 Iii: .000301
19&4 lIX .0005Ul 1992 'IX .000l47
1ft" IS:< .000356 1991-1994 7X .000192
1916 10~ .00Cl27". 1995-1998 OX .000247
....[nt.r..t l, C81aulated .~ follow. I
INTEREST . BALANCE OF TAX UNPAID X NUNBER DF DAYS DELINQUENT X DAILY INTEREST FACTOR
....Any Hotloe I,sued aft.r the tax b.c~, d.llnquent wll1 r.flect ." lntare.t calculation to' flfteen (IS) day.
bawond the date of tho ........"t. If p.yaent I' .ade aftar tha Int.r..t o~ltation data shown on the
Notlce, addItional Intar.st ~.t ~ a.loulated.
, '
STATUS REPQRT UNDER RULE 6,12
Name ofoecedent :-1./o,IHHU\' (j. Hyr;p-I(II'J,./
Date of Death:
Will NO.~
Admin. No.
..,.,--.---
Pursuant to Rule (;.12 of the supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of th~ above-captioned estatel
1. State whether administration of the estate is completel
yes_L_ No__
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete I ---.
3, If the answer to No, 1 is Yes, state the following 1
d, Did the personal representative file a final
account with the Court? Yes to No . (
ple"~" .,"H'\\;....."k.~ \-:t.,~It,
b. The separate Orphans' Court. No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in int.erest7 Yes2-_ 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.
"
sB::~~\lJ tv
~c\' '<. it ~ ~~~c,
Name (Please type or print)
3:).~.'i e~cl,il!.~f,e\..l \{J, ~~V.\\"\\11'~fl..
Address \ I
(\\1 I S'iS'--\ O~S'
Tel. No.
Date:
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capacity: )(
Personal Representative
Counsel for personal
representative
(MAH HmU AM3)