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Home My WebLink About02-15-08 (2) -I 15056051058 REV-1500 EX (06-05) PA Department of Revenue '* Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 EI~TER DECEDENT INFORMATION BELOW Social Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Vear File Number 21 07 0287 Date of Birth 210-26-6641 03/19/2007 05/09/1932 Decedent's Last Name Suffix Hoffman Decedent's First Name MI Benjamin F (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix First Name MI N/A Spouse's Social Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW :.::: 1. Original Return C) 2. Supplemental Return C) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 4. Limited Estate (la:, r::::::::> 4a. Future Interest Compromise (date of death after 12-12-82) C) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) C::::::::> 10. Spousal Poverty Credit (date of death C:)( 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) C:ORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ."".......---------.......,."'.."...... .. 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received ...tm 8. Total Number of Safe Deposit Boxes ,f"""""""', ~"J Michael Cherewka, Esq (717) 232-4701 Firm Name REGISTER OF WILLS USE ONLY Law Offices of First line of FILED: 624 North Front Street Second line of address City or Post Office State ZIP Code Wormleysburg PA 17043 Correspondent's e-mail address:mcestateplanlaw@earthlink.net DATE DATE I AD RES . 624 North Front Street, Wormleysburg, PA 17043 PLEASE USE ORIGINAL FORM ONLY L 15056051058 Side 1 15056051058 -I -..J 15056052059 REV-1500 EX Decedent's Name: Benjamin F Hoffman RECAPITULATION 1. Real estate (Schedule A). .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3. 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. 6. Jointly Owned Property (Schedule F) c:::::> Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) c:::::::> Separate Billing Requested.. . . . . .. 7. 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . . . . . 10. 11. Total Deductions (total Lines 9 & 10). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14. TAX COMPUTATION. SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X.O 45 16. Amount of Line 14 taxable at lineal rate X.O_ 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 210-26-6641 Decedent's Social Security Number 232,240.00 0.00 0.00 0.00 90,075.00 0.00 589,904.00 912,219.00 64,087.00 5,211.00 69,298.00 842,921.00 0.00 842,921.00 15. 16. 17. 18. 15056052059 37,931.45 0.00 0.00 0.00 37,931.45 -..J REV-1502 EX+ (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE FILE NUMBER 21-07 -0287 ESTATE: OF Benjamin F. Hoffman All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION 1622 Holtz Road, Enola, Cumberland County (Assessed Fair Market Value) VALUE AT DATE OF DEATH 135,640.00 (Tax Parcel #09-11-3010-002) 2. 1624 Holtz Road, Enola, Cumberland County (Assessed Fair Market Value) 96,600.00 (Tax Parcel #09-11-3010-013) TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert addttional sheets of the same size) 232,240.00 Detailed Results for Parcel 09-11-3010-002. in the 2004 Tax Assessment Database DistrictNo 09 Parcel_In 09-11-3010-002. MapSuffix HouseNo 1622 Direction Street HOLTZ ROAD Owner! HOFFMAN, BENJAMIN F C/O & JACQUELINE M HOFFMAN PropType R PropDesc LivArea 1339 CurLandVal 33820 Curlmp V al 101820 CurTotVal 135640 CurPrelV al Acreage .64 CIGrnStat TaxEx 1 SaleAmt 40 SaleMo 04 SaleDa 04 SaleCe 19 SaleYr 96 DeedBkPage 00137-00142 YearBIt 1974 HF _File_Datc~ 01/27/2006 HF _Approvall_Status A http://taxdb.ccpa.net/details.asp?id=09-11-301O-002.&dbselect= 1 10/25/2007 REV-1~503 EX+ (6-98) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Benj;amin F. Hoffman FILE NUMBER 21-07 -0287 ITEM NUMBER 1. All property jointly-owned with right of survivorship must be disclosed on Schedule F. DESCRIPTION VALUE AT DATE OF DEATH None 0.00 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0.00 REV-1~)07 EX+ (6-98) SCHEDULE D MORTGAGES & NOTES RECEIVABLE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Benjamin F. Hoffman FILE NUMBER 21-07 -0287 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1 . None VALUE AT DATE OF DEATH 0.00 TOTAL (Also enter on line 4, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0.00 REV-1Ei08 EX+ (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Benj;amin F. Hoffman FILE NUMBER 21-07 -0287 ITEM NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. DESCRIPTION VALUE AT DATE OF DEATH 1. PNC Bank, Account No. 51-4011-2613 41,542.86 24,890.22 1,950.00 13,725.00 7,967.30 2. PNC Bank, Account No. 50-0718649 3. 1998 Mercury Grand Marquis 4. 2004 Ford F150 Pick-Up Truck 5. Sovereign Bank, Account No. 921705069 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 90,075.38 Kelley Blue Book - Trade-In Pricing Report - Mercury, Grand Marquis Page 1 of2 Kelley Blue Book THE TRUSTED RESOURCE ~~<<<~""-""<~'-~~ ltilo.at. 8 Send to Printer advertisement 1998 Mercury Grand Marquis LS Sedan 40 HlUE BOOK"; TRADE-IN VAWE advertisement Condition Value Excellent $2,275 Good $1/950 .t Fair $1/395 (Selected) Average Consumer Rating (71 Reviews) Read Reviews 4.7 out of 5 Review This Vehicle Vehicle Highlights Mileage: Engine: Transmission: Drivetrain: 100,000 V8 4.6 Uter Automatic RWD Selected Equipment Standard Air Conditioning Power Steering Power Windows Power Door Locks Tilt Wheel Cruise Control AM/FM Stereo Ca ssette Dual Front Air Bags Power Seat Blue Book Trade-In Value Close Window Trade-in Value is what consumers can expect to receive from a dealer for a trade-in vehicle assuming an accurate appraisal of condition. This value will likely be less than the Private Party Value because the reselling dealer incurs the cost of safety inspections, reconditioning and other costs of doing business. Vehicle Condition Ratings Excellent w'f_iw:ur.:i $2,275 "Excellent" condition means that the vehicle looks new, is in excellent mechanical condition and needs no reconditioning. This vehicle has never had any paint or bOdy work and is free of rust. The vehicle has a clean title history http://www.kbb.comlKBB/U sedCars/PricingReport.aspx?ManufacturerId=32& YearId= 199... 12/17/07 KeUey Blue Book - Trade-In Pricing Report - Mercury, Grand Marquis Page 2 of2 and will pass a smog and safety inspection. The engine compartment is clean, with no fluid leaks and is free of any wear or visible defects. The vehicle also has complete and verifiable service records. Less than 5% of all used vehicles fall into this category. Good w,rJOE.i $1,950 "Good" condition means that the vehicle is free of any major defects. This vehicle has a clean title history, the paint, body and interior have only minor (if any) blemishes, and there are no major mechanical problems. There should be little or no rust on this vehicle. The tires match and have substantial tread wear left. A "good" vehicle will need some reconditioning to be soid at retail. Most consumer owned vehicles fall into this category. ~ Fair (Selected) wwCl $1,395 "Fair" condition means that the vehicle has some mechanical or cosmetic defects and needs servicing but is still in reasonable running condition. This vehicle has a clean title history, the paint, body and/or interior need work performed by a professional. The tires may need to be replaced. There may be some repairable rust damage. Poor ~~ w "Poor" condition means that the vehicle has severe mechanical and/or cosmetic defects and is in poor running condition. The vehicle may have problems that cannot be readiiy fixed such as a damaged frame or a rusted-through body. A vehicle with a branded title (salvage, flood, etc.) or unsubstantiated mileage is considered "poor." A vehicle in poor condition may require an independent appraisal to determine its value. Kelley Blue Book does not attempt to report a value on a "poor" vehicle because the value of cars in this category varies greatly. N/A * Pennsylvania 12/17/2007 http://www.kbb.comlKBBIU sedCars/PricingReport.aspx?ManufacturerId=32& YearId= 199... 12/17/07 Kelley Blue Book - Trade-In Pricing Report - Ford, F150 Page 1 of2 Kelley Blue Book THE TRUSTED RESOURCE . ~~"-<-"w~'-~tlm.t.. Send to Printer advertisement 2004 Ford F150 Super Cab 5 1/2' l~lUE BOOK'" TRADE.IN VALUE advertisement Condition Value Excellent $14,600 ..t Good $13,725 (Selected) Fair $12,205 Average Consumer Rating (476 Reviews) Read Reviews 4.6 out of 5 Review This Vehicle Vehicle Highlights Mileage: Engine: Transmission: Drivetrain: 40,000 V8 4.6 Liter Automatic 4WD Selected Equipment Standard XL Air Conditioning Power Steering Tilt Wheel AM/FM Stereo Single Compact Disc Dual Front Air Bags ABS (4-Wheel) Alloy Wheels Blue Book Trade-In Value Trade-in Value is what consumers can expect to receive from a dealer for a trade-in vehicle assuming an accurate appraisal of condition. This value will likely be less than the Private Party Value because the reselling dealer incurs the cost of safety inspections, reconditioning and other costs of doing business. Close Window Vehicle Condition Ratings Excellent OOO-wO $14,600 "Excellent" condition means that the vehicle looks new, is in excellent mechanical condition and needs no reconditioning. This vehicle has never had any paint or body work and is free of rust. The vehicle has a clean title history and will pass a smog and safety inspection. The engine compartment is clean, with no fluid leaks and is free of any wear or visible defects. The vehicle also http://www.kbb.com/KBB/U sedCars/PricingReport.aspx?ManufacturerId= 15& YearId=200... 12/1 7/07 Kelley Blue Book - Trade-In Pricing Report - Ford, F150 has complete and verifiable service records. Less than 5% of all used vehicles fall into this category. .J Good (Selected) Li[JLiLi $13,725 "Good" condition means that the vehicle is free of any major defects. This vehicle has a clean title history, the paint, body and interior have only minor (if any) blemishes, and there are no major mechanical problems. There should be little or no rust on this vehicle. The tires match and have substantial tread wear left. A "good" vehicle will need some reconditioning to be sold at retail. Most consumer owned vehicles fall into this category. Fair LiLiLi $12,205 "Fair" condition means that the vehicle has some mechanical or cosmetic defects and needs servicing but is still in reasonable running condition. This vehicle has a clean title history, the paint, body and/or interior need work performed by a professional. The tires may need to be replaced. There may be some repairable rust damage. Poor N/A "Poor" condition means that the vehicle has severe mechanical and/or cosmetic defects and is in poor running condition. The vehicle may have problems that cannot be readily fixed such as a damaged frame or a rusted-through body. A vehicle with a branded title (salvage, flood, etc.) or unsubstantiated mileage is considered "poor." A vehicle in poor condition may require an independent appraisal to determine its value. Kelley Blue Book does not attempt to report a value on a "poor" vehicle because the value of cars in this category varies greatly. * Pennsylvania 12/17/2007 http://www.kbb.com/KBB/U sedCars/PricingReport.aspx?ManufacturerId= 15& Y earId=200... Page 2 of2 12/17/07 REV-1:.10 EX+ (6-98) *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF Benjamin F. Hoffman FILE NUMBER 21-07-0287 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECD'S ITEM INCLUDE THE NAME Of THE TRANSfEREE. THEIR RELATIONSHIP TO DECEDENT AND EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH A COpy OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1. Prudential Annuity, Contract No. E0122137 21,530.00 100 21,530.00 2. Prudential Annuity, Contract No. E0434991 327,564.00 100 327,564.00 3. Prudential Annuity, Contract No. 99289488 37,287.00 100 37,287.00 4. U. S. Savings Bonds, See Attached List 95,025.00 100 95,025.00 5. New York Life, Contract No. 58-115-414 108,498.00 100 108,498.00 TOTAL (Also enter on line 7 Recapitulation) $ 589,904.00 (If more space is needed. insert additional sheets of the same size) . December 3, 2001 New York Life IIl.urance and Annuity Corporation (A Delaware Corporation) P.O. Box 922 New York, NY l0159~22 1-8QO...S98-20 19 www.newyorklife.com Micbael Cberewka 624 N Front Street Wonnslingburg, PA 11043 . 001): IOt,....ftl.16 Dear Mr. Cherewka: Deceased: Benjamin Hoftinan Policy Number: 58 11' 414 The purpose oftbis letter is to advise you of the requirements needed to process your claim. Our records indicate the beneficiary is the Trust created under the Sixth Article of the Last Will and Testament dated 5/22/06. To finalize our handling of your claim, the requirements are as foUows: An original Certified death certifICate for Mr. Hoffman. Claim form completed by both the named trustees, including the name oftbe trust and the trust taxpayer identification number - not the trustee's personal social security number. IRS fonn W-4P completed by the named trustees, including the name of the trust and the trust taxpayer identification number - not the trustee's personal social security number. A statement on Hershey Trust Company letter head stating who can sign on their behalf Evidence that the will was admitted to probate with a personal representative appointed and a letter from the trustees indicating they accepted the appointment OR Letters of Trusteeship from probate court evidencing authority of trustees to act as trustees. The requirements listed above should be mailed to: New York Life, Variable Products Service Center, P.O. Box 922, Nc."'W York, New York 10159-0922. If you have any questions, or need any forms mailed to you, please do not hesitate to one of our customer service representatives toll-free at 1-800-598-2019. S~~ly, .. ~<:'f:)_..c"'c.o"'c'o""-,-,') '- .. ~___._.........o._......... 0' Rachel Azizollaboff Claims Analyst Variable products are offered through properly licensed registered representatives tngntFax 12/17/2007 11:22:02 AM PAGE 21 002 Fax Server f':<).. \.PrUdt~l~tia] Prudential .>\nnuitieli A Business of Prude;ntial Finae>c18l. rne. PO Bm 7960 Philadelphia. PA 19,76 (888) 778-5471 TrY: (300) 6547637 www,pmdenrial.eom Attorney Michael Cherewka Fax: 717-2324774 Owner: Benjamin F Hoffman Contracts: E0122137 ~. E0434991 - ~~>')<I." 992&lJ488 ;;!"I.l,. Decemher 17, 2oo7 Dear Mr. Cherewka: We are writing in regard to the contracts shown above. As requested, the date of death value for contract EOl22137 was $21,530.23. The date of death value f01' contract E0434991 was $327.564.13. The date of death value for contract 99289488 was $37,287.32 If you have any questions or would like more information, please call the Prudential Annuity Service Center at (888) 778-2888. We are available Monday through Friday betweel1 8:00 a.m. and 9:00 p.m. Eastem time. If you are using a telecommunications device for the hearing impaired (TDD), please call (800) 654-7673. Monday through Friday between 8:00 a.m. and 8:00 p.m. Eastem time. One of our customer service representatives will be glad to help you. Thank you for choosing us for your financial services needs. Sincerely, Angela Williams Angela Williams Annuity Death Claims Vanatole anneilies are issued by Ptuco Life Insurance Company (in New Yml., by Prlleo Lir" 1I1sulOn~<: Crmpanv or New .Icr,cy). Both companic, arc locatcd ill NC\\'3rk, NJ Varlahle an:1Ullics atc distributed hy l'rudcmial Annuities D1Slnhutors. Inc., Sildt,;r!, Ci Frxcd amm,tKs are i,sue<l hy The P'Jd."tial In'.T'dnce Company oi A mcr;c'?. !'II mc \'rudcmial bJ1llncial companlcs and cocl, i~ solely rcsl'omiblc fOT it, own tinancinl ccndinon and contract.al obligations. [Page 1 of I] U. S. Savings Bonds Estate of Benjamin F. Hoffman Date of Series Denomination Serial Number Issue Date Death Value E 100 C409204524E 6/1/1961 807.80 E 100 C406252029E 12/1/1960 788.72 E 50 L614924771E 12/1/1964 468.22 E 50 L614924769E 12/1/1964 468.22 E 50 L614924773E 12/1/1964 468.22 E 50 L614924772E 12/1/1964 468.22 E 50 L614924777E 12/1/1964 468.22 E 50 L614924775E 12/1/1964 468.22 E 50 L614924778E 12/1/1964 468.22 E 50 L614924764E 12/1/1964 468.22 E 50 L614924762E 12/1/1964 468.22 E 50 L614924761E 12/1/1964 468.22 E 50 L614924763E 12/1/1964 468.22 E 50 L614924767E 12/1/1964 468.22 E 50 L614924766E 12/1/1964 468.22 E 50 L614924765E 12/1/1964 468.22 E 50 L614924760E 12/1/1964 468.22 E 50 L614924759E 12/1/1964 468.22 E 50 L614924780E 12/1/1964 468.22 E 50 L614924774E 12/1/1964 468.22 E 50 L614924770E 12/1/1964 468.22 E 50 L614924776E 12/1/1964 468.22 E 50 L614924768E 12/1/1964 468.22 E 50 L614924779E 12/1/1964 468.22 E 25 Q1843407953E 12/1/1960 197.18 E 50 L1038416502E 3/1/1973 259.78 E 50 L1041630949E 4/1/1973 259.78 E 50 L1044291458E 5/1/1973 259.78 E 50 L1049727787E 7/1/1973 262.92 E 50 L1052829225E 8/1/1973 263.48 E 50 L1056026000E 9/1/1973 263.52 E 50 L2055311197E 11/1/1973 263.52 E 50 L2055311199E 12/1/1973 256.96 E 50 L2055311201E 2/1/1974 256.96 E 50 L2055311203E 3/1/1974 256.96 E 50 L2055311205E 4/1/1974 256.96 E 50 L2055311207E 6/1/1974 260.04 E 50 L2055311209E 7/1/1974 260.04 E 50 L2055311211E 7/1/1974 260.04 E 50 L2096184647E 9/1/1974 260.04 E 50 L2096184649E 11/1/1974 262.52 E 50 L2096184651E 12/1/1974 263.18 E 50 L2096184653E 1/1/1975 263.14 1 U. S. Savings Bonds Estate of Benjamin F. Hoffman Date of Series Denomination Serial Number Issue Date Death Value E 50 L2096184655E 2/1/1975 263.14 E 50 L2096184657E 3/1/1975 263.14 E 50 L2096184659E 4/1/1975 263.14 E 50 L2096184661E 5/1/1975 265.66 E 50 L2096184663E 6/1/1975 266.30 E 50 L2096184665E 8/1/1975 266.30 E 50 L2142425585E 9/1/1975 266.30 E 50 L2142425587E 10/1/1975 266.30 E 50 L2142425589E 11/1/1975 268.92 E 50 L2142425593E 12/1/1975 269.50 E 50 L2142425591E 12/1/1975 269.50 E 50 L2142425595E 1/1/1976 269.52 E 50 L2142425597E 2/1/1976 269.52 E 50 L2142425599E 3/1/1976 269.52 E 50 L2142425601E 4/1/1976 269.52 E 50 L2142425603E 4/1/1976 269.52 ]3 50 L2142425605E 5/1/1976 272.08 E 50 L2142425607E 6/1/1976 272.68 E 50 L2142425611E 7/1/1976 272.64 I~ 50 L2142425609E 7/1/1976 272.64 E 50 L2142425613E 8/1/1976 272.64 I~ 50 L2184263144E 9/1/1976 272.64 E 50 L2184263146E 10/1/1976 272.64 E 50 L2184263148E 10/1/1976 272.64 E 50 L2184263150E 11/1/1976 275.30 E 50 L2184263152E 12/1/1976 276.08 E 50 L2184263156E 1/1/1977 276.08 E 50 L2184263154E 1/1/1977 276.08 E 50 L2184263158E 2/1/1977 276.08 E 50 L2184263162E 3/1/1977 276.08 E 50 L2184263160E 3/1/1977 276.08 E 50 L2184263164E 4/1/1977 270.66 E 50 L2184263168E 5/1/1977 273.34 E 50 L2184263166E 5/1/1977 273.34 E 50 L2184263170E 6/1/1977 273.92 E 50 L2184263174E 7/1/1977 273.86 E 50 L2184263172E 7/1/1977 273.86 E 50 L2092657875E 8/1/1977 273.86 E 50 L2099844201E 9/1/1977 273.86 E 50 L2099877994E 10/1/1977 268.50 E 50 L2107446755E 11/1/1977 246.24 E 50 L2117535994E 12/1/1977 246.92 E 50 L2117539725E 1/1/1978 246.92 2 U. S. Savings Bonds Estate of Benjamin F. Hoffman Date of Series Denomination Serial Number Issue Date Death Value E 50 L2117848419E 2/1/1978 246.92 E 50 L2117852344E 3/1/1978 208.54 E 50 L2125499225E 4/1/1978 204.54 E 50 L2125622874E 5/1/1978 201.04 E 50 L2133418969E 6/1/1978 201.54 E 50 L2137772661E 7/1/1978 201.60 E 50 L2141746540E 8/1/1978 201.60 E 50 L2147690546E 9/1/1978 201.60 E 50 L2147694194E 10/1/1978 197.64 E 50 L2150307999E 11/1/1978 199.52 E 50 L2159336966E 12/1/1978 200.06 E 50 L2162165573E 1/1/1979 200.08 E 50 L2162169439E 2/1/1979 200.08 E 50 L2166598101E 3/1/1979 200.08 E 50 L2173511586E 4/1/1979 196.16 E 50 L2179176214E 5/1/1979 198.06 E 100 C2079984806E 1/1/1979 . 400.16 ]~ 100 C2083591960E 2/1/1979 400.16 ]; 100 C2087426752E 3/1/1979 400.16 I~ 100 C2087426765E 4/1/1979 392.32 I~ 100 C2090136413E 5/1/1979 396.12 E 100 C2093162523E 6/1/1979 397.04 I~ 100 C2093162541E 7/111979 397.04 E 100 C2078008199E 12/1/1978 400.12 E 50 L2179178978E 6/1/1979 198.52 E 50 L2183952487E 7/1/1979 198.52 E 50 L2186216218E 8/1/1979 198.52 E 50 L2186219996E 9/111979 198.52 E 50 L2190238428E 10/1/1979 194.62 E 50 L2197532297E 11/1/1979 196.46 E 50 L2198655657E 12/1/1979 196.46 E 100 C2093981114E 8/1/1979 397.04 E 100 C2093981126E 9/111979 397.04 E 100 C2096352845E 10/1/1979 389.24 E 100 C2098936499E 11/1/1979 392.92 E 100 C2098936508E 12/1/1979 392.92 E 50 L2198659029E 1/1/1980 196.46 E 50 L2197986935E 2/1/1980 196.46 E 50 L2205125716E 3/1/1980 196.46 E 50 L2205128883E 4/1/1980 192.60 E 50 L2205157270E 5/1/1980 194.56 E 50 L2205191175E 6/1/1980 194.56 EE 75 K15248460EE 7/1/1980 218.61 3 U. S. Savings Bonds Estate of Benjamin F. Hoffman Date of Series Denomination Serial Number Issue Date DeathValue EE 75 K15249126EE 8/1/1980 218.61 EE 75 K15249755EE 9/1/1980 218.61 EE 100 C4609704EE 1/1/1980 294.36 EE 100 C4609703EE 1/1/1980 294.36 EE 100 C4609712EE 2/1/1980 294.36 EE 100 C4609718EE 3/1/1980 294.36 EE 100 C4609734EE 4/1/1980 288.60 BE 100 C4609750EE 5/1/1980 291.48 EE 100 C4609749EE 5/1/1980 291.48 EE 100 C12636969EE 6/1/1980 291.48 EE 100 C 12636970EE 6/1/1980 291.48 EE 100 C13077808EE 7/1/1980 291.48 EE 100 C13077809EE 7/1/1980 291.48 EE 100 C13077818EE 8/1/1980 291.48 EE 100 C13077819EE 8/1/1980 291.48 EE 100 C12886616EE 9/1/1980 291.48 EE 100 C12886617EE 9/1/1980 291.48 EE 100 C12886626EE 10/1/1980 285.76 EE 100 C12886625EE 10/1/1980 285.76 EE 100 C16464513EE 12/1/1980 261.92 EE 100 C 16464512EE 12/1/1980 261.92 EE 100 C12886650EE 12/1/1980 261. 92 EE 100 C12886649EE 12/1/1980 261.92 EE 100 C16464534EE 1/1/1981 261.92 EE 100 C16464533EE 1/1/1981 261.92 EE 100 C16464547EE 2/1/1981 261.92 EE 100 C 16464548EE 2/1/1981 261. 92 EE 100 C17409895EE 3/1/1981 261.92 EE 100 C17409896EE 3/1/1981 261.92 EE 75 K14844522EE 10/1/1980 214.32 EE 75 K14954132EE 11/1/1980 196.44 EE 75 K14954696EE 12/1/1980 196.44 EE 75 K16091260EE 1/1/1981 196.44 EE 75 K16091779EE 2/1/1981 196.44 EE 100 C17409915EE 4/1/1981 256.76 EE 100 C17409916EE 4/1/1981 256.76 EE 100 C23025738EE 5/1/1981 245.84 EE 100 C23025707EE 5/1/1981 245.84 EE 100 C23025752EE 6/1/1981 245.84 EE 100 C23025751EE 6/1/1981 245.84 EE 100 C23073137EE 7/1/1981 245.84 EE 100 C23073136EE 7/1/1981 245.84 EE 100 C23073150EE 8/1/1981 245.84 4 u. S. Savings Bonds Estate of Benjamin F. Hoffman Date of Series Denomination Serial Number Issue Date Death Value EE 100 C23073149EE 8/1/1981 245.84 EE 100 C28114911EE 9/1/1981 245.84 EE 100 C28114912EE 9/1/1981 245.84 EE 100 C28114929EE 10/1/1981 241.00 EE 100 C28114928EE 10/1/1981 241.00 EE 100 C28114937EE 11/1/1981 241.00 EE 100 C28114936EE 11/1/1981 241.00 EE 75 K16093297EE 3/1/1981 196.44 EE 75 K16093805EE 4/1/1981 192.57 EE 75 K16092357EE 5/1/1981 184.38 EE 75 K16092851EE 6/1/1981 184.38 EE 75 K25800284EE 7/1/1981 184.38 EE 75 K25800803EE 8/1/1981 184.38 EE 75 K25801302EE 9/1/1981 184.38 EE 75 K25801834EE 10/1/1981 180.75 EE 100 C35176668EE 3/1/1982 241.00 EE 100 C35176667EE 3/1/1982 241.00 EE 100 C28460027EE 2/1/1982 241.00 EE 100 C28460026EE 2/1/1982 241. 00 EE 100 C28460012EE 1/1/1982 241.00 EE 100 C28460013EE 1/1/1982 241. 00 EE 100 C28459988EE 12/1/1981 241.00 EE 100 C28459989EE 12/1/1981 241.00 EE 75 K29952762EE 2/1/1982 180.75 EE 75 K29952322EE 1/1/1982 180.75 EE 75 K29951854EE 12/1/1981 180.75 EE 75 K29951341EE 11/1/1981 180.75 EE 100 C35176679EE 4/1/1982 236.28 EE 100 C3 517 6680EE 4/1/1982 236.28 EE 100 C38025634EE 5/1/1982 236.28 EE 100 C38025635EE 5/1/1982 236.28 EE 100 C38025649EE 6/1/1982 236.28 EE 100 C38025650EE 6/1/1982 236.28 EE 100 C38025660EE 7/1/1982 236.28 EE 100 C38025659EE 7/1/1982 236.28 EE 100 C38025671EE 8/1/1982 236.28 EE 100 C38025672EE 8/1/1982 236.28 EE 100 C39039764EE 9/1/1982 236.28 EE 100 C39039765EE 9/1/1982 236.28 EE 100 C39039779EE 10/1/1982 231.64 EE 100 C39039778EE 10/1/1982 231.64 EE 75 K29953203EE 3/1/1982 180.75 EE 75 K29953672EE 4/1/1982 177.21 5 U. S. Savings Bonds Estate of Benjamin F. Hoffman Date of Series Denomination Serial Number Issue Date Death Value EE 75 K32920072EE 5/1/1982 177.21 EE 75 K32920454EE 6/1/1982 177.21 EE 75 K32920873EE 7/1/1982 1 77.21 EE 75 K32921263EE 8/1/1982 177.21 BE 75 K32921642EE 9/1/1982 177.21 EE 75 K39028663EE 9/1/1983 139.53 EE 75 K39028322EE 8/1/1983 139.53 EE 75 K39028009EE 7/1/1983 139.53 EE 75 K39027677EE 6/1/1983 139.53 EE 75 K39027358EE 5/1/1983 139.53 EE 75 K39027052EE 4/1/1983 144.75 EE 75 K32986235EE 3/1/1983 147.57 EE 75 K32985913EE 2/1/1983 165.78 EE 75 K32985590EE 1/1/1983 165.78 EE 75 K32985245EE 12/1/1982 165.78 EE 75 K32984908EE 12/1/1982 165.78 EE 75 K32984550EE 10/1/1982 173.73 EE 100 C45730643EE 1/1/1983 221.04 EE 100 C45730642EE 1/1/1983 221.04 EE 100 C45730662EE 2/1 /1983 221.04 EE 100 C45730663EE 2/1/1983 221.04 EE 100 C48859997EE 3/1/1983 196.76 EE 100 C48859998EE 3/1/1983 196.76 EE 100 C48860013EE 4/1/1983 193.00 EE 100 C48860014EE 4/1/1983 193.00 EE 100 C48860028EE 5/1/1983 186.04 EE 100 C48860027EE 5/1/1983 186.04 EE 100 C45730627EE 12/1/1982 221.04 EE 100 C45730682EE 12/1/1982 221.04 EE 100 C39039792EE 11/1/1982 221.04 EE 100 C39039791EE 11/1/1982 221.04 EE 100 C48927563EE 7/1/1983 186.04 EE 100 C48927564EE 7/1/1983 186.04 EE 100 C48927571EE 7/1/1983 186.04 EE 100 C48927572EE 7/1/1983 186.04 EE 100 C48927600EE 8/1/1983 186.04 EE 100 C48927601EE 8/1/1983 186.04 EE 100 C52258182EE 9/1/1983 186.04 EE 100 C52258183EE 9/1/1983 186.04 EE 100 C52580018EE 10/1/1983 182.56 EE 100 C52580019EE 10/1/1983 182.56 EE 75 K39028964EE 10/1/1983 136.92 EE 75 K38334028EE 11/1/1983 133.89 6 U. S. Savings Bonds Estate of Benjamin F. Hoffman Date of Series Denomination Serial Number Issue Date Death Value EE 75 K38334345EE 12/1/1983 133.89 EE 75 K39630611EE 1/1/1984 133.89 EE 75 K39630909EE 2/1/1984 133.89 EE 75 K39631223EE 3/1/1984 131.37 EE 75 K46898112EE 4/1/1984 131.37 EE 75 C65059081EE 5/1/1984 128.52 EE 75 C65059082EE 5/1/1984 128.52 EE 75 C55761760EE 11/1/1983 133.89 EE 75 C55761759EE 11/1/1983 133.89 EE 75 C59414894EE 12/1/1983 133.89 EE 75 C59414893EE 12/1/1983 133.89 EE 75 C65059008EE 2/1/1984 133.89 EE 75 C65059009EE 2/1/1984 133.89 EE 75 C65059027EE 8/1/1986 118.74 EE 75 C65059026EE 2/1/1984 133.89 EE 75 C65059048EE 3/1/1984 131.37 EE 75 C65059047EE 3/1/1984 131.37 EE 75 C65059064EE 4/1/1984 131.37 EE 75 C65059065EE 4/1/1984 131.37 EE 100 C65172102EE 6/1/1984 171.36 EE 100 C65172101EE 6/1/1984 171.36 EE 100 C65172123EE 7/1/1984 171.36 EE 100 C65172124EE 7/1/1984 171.36 EE 100 C65246748EE 9/1/1984 171.36 EE 100 C65246747EE 9/1/1984 171.36 EE 100 C65246765EE 9/1/1984 171.36 EE 100 C65246764EE 9/1/1984 171.36 EE 100 C65246780EE 10/1/1984 168.00 EE 100 C65246781EE 10/1/1984 168.00 EE 100 C72067098EE 11/1/1984 168.00 EE 100 C72067099EE 11/1/1984 168.00 EE 100 C74508562EE 12/1/1984 168.00 EE 100 C74508561EE 12/1/1984 168.00 EE 100 C74508595EE 2/1/1985 168.00 EE 100 C74508606EE 2/1/1985 168.00 EE 100 C74508607EE 2/1/1985 168.00 EE 100 C74508596EE 2/1/1985 168.00 EE 100 C75438049EE 3/1/1985 168.00 EE 100 C75438050EE 3/1/1985 168.00 EE 100 C80022407EE 4/1/1985 164.72 EE 100 C80022406EE 4/1/1985 164.72 EE 100 C80022423EE 5/1/1985 164.72 EE 100 C80022422EE 5/1/1985 164.72 7 U. S. Savings Bonds Estate of Benjamin F. Hoffman Date of Series Denomination Serial Number Issue Date Death Value EE 100 K46898397EE 5/1/1984 171.36 EE 100 C89657617EE 10/1/1985 161.48 EE 100 C89657618EE 10/1/1985 161.48 EE 100 C89657605EE 9/1/1985 164.72 EE 100 C89657606EE 9/1/1985 164.72 EE 100 C89657591EE 8/1/1985 164.72 EE 100 C89657590EE 8/1/1985 164.72 EE 100 C80682378EE 7/1/1985 164.72 EE 100 C80682379EE 7/1/1985 164.72 EE 100 C80022439EE 6/1/1985 164.72 EE 100 C80022438EE 6/1/1985 164.72 EE 100 Cl18762704EE 9/1/1986 158.32 EE 100 Cl18762703EE 9/1/1986 158.32 EE 100 C118762722EE 10/1/1986 155.20 EE 100 Cl18762721EE 10/1/1986 155.20 EE 100 Cl18762747EE 11/1/1986 139.56 EE 100 C118762748EE 11/1/1986 139.56 EE 100 Cl18762777EE 12/1/1986 139.56 EE 100 Cl18762779EE 12/1/1986 139.56 EE 100 Cl18762789EE 1/1/1987 139.56 EE 100 Cl18762790EE 1/1/1987 139.56 EE 100 Cl18762814EE 2/1/1987 139.56 EE 100 C118762815EE 2/1/1987 139.56 EE 100 C125718184EE 3/1/1987 139.56 EE 100 C125718185EE 3/1/1987 139.56 EE 100 C125718206EE 4/1/1987 136.80 EE 100 C125718207EE 4/1/1987 136.80 EE 100 C125718226EE 5/1/1987 136.80 EE 100 C125718225EE 5/1/1987 136.80 EE 100 C133516442EE 6/1/1987 136.80 EE 100 C 133516443EE 6/1/1987 136.80 EE 100 C 133516467EE 7/1/1987 136.80 EE 100 C133516468EE 7/1/1987 136.80 EE 100 C171273046EE 9/1/1988 131.52 EE 100 C171273045EE 9/1/1988 131.52 EE 100 C171273021EE 8/1/1988 131.52 EE 100 C171273020EE 8/1/1988 131.52 EE 100 C171273004EE 7/1/1988 131.52 EE 100 C171273003EE 7/1/1988 131.52 EE 100 C171272977EE 6/1/1988 131.52 EE 100 C171272976EE 6/1/1988 131.52 EE 100 C150101037EE 5/1/1988 131.52 EE 100 C150101036EE 5/1/1988 131.52 8 u. S. Savings Bonds Estate of Benjamin F. Hoffman Date of Series Denomination Serial Number Issue Date Death Value EE 100 C133516493EE 8/1/1987 136.80 EE 100 C133516492EE 8/1/1987 136.80 EE 100 C142288046EE 9/1/1987 136.80 EE 100 C142288047EE 9/1/1987 136.80 EE 100 C142288125EE 10/1/1987 134.12 lEE 100 C142288126EE 10/1/1987 134.12 lEE 100 C 142288085EE 11/1/1987 134.12 EE 100 C142288086EE 11/1/1987 134.12 EE 100 C142288145EE 12/1/1987 134.12 EE 100 C142288146EE 12/1/1987 134.12 EE 100 C150100942EE 1/1/1988 134.12 EE 100 C150100943EE 1/1/1988 134.12 EE 100 C150100964EE 2/1/1988 134.12 EE 100 C 150 1 00965EE 2/1/1988 134.12 EE 100 C150100985EE 3/1/1988 134.12 EE 100 C150100986EE 3/1/1988 134.12 EE 100 C150101017EE 4/1/1988 131.52 EE 100 C150101018EE 4/1/1988 131.52 EE 100 C118762683EE 8/1/1986 158.32 EE 100 Cl18762684EE 8/1/1986 158.32 EE 100 Cl18762665EE 7/1/1986 158.32 EE 100 C118762664EE 7/1/1986 158.32 EE 100 Cll1838019EE 6/1/1986 158.32 EE 100 C111838018EE 6/1/1986 158.32 EE 100 C111838004EE 5/1/1986 158.32 EE 100 C118762649EE 5/1/1986 158.32 EE 100 C111295878EE 4/1/1986 158.32 EE 100 C111295877EE 4/1/1986 158.32 EE 100 C111295864EE 3/1/1986 161.48 EE 100 C111295863EE 3/1/1986 161.48 EE 100 Cll1295844EE 2/1/1986 161.48 EE 100 Cll1295845EE 2/1/1986 161.48 EE 100 C111295825EE 1/1/1986 161.48 EE 100 C111295826EE 1/1/1986 161.48 EE 100 C95015993EE 12/1/1985 161.48 EE 100 C95015992EE 12/1/1985 161.48 EE 100 C89657641EE 11/1/1985 161.48 EE 100 C89657642EE 11/1/1985 161.48 EE 100 C189857740EE 3/1/1989 128.92 EE 100 C189857739EE 3/1/1989 128.92 EE 100 C189857712EE 2/1/1989 128.92 EE 100 C189857711EE 2/1/1989 128.92 EE I 100 C189857675EE 1/1/1989 I 128.92 9 U. S. Savings Bonds Estate of Benjamin F. Hoffman Date of Series Denomination Serial Number Issue Date Death Value EE 100 C189857674EE 1/1/1989 128.92 EE 100 C171273153EE 12/1/1988 128.92 EE 100 C171273152EE 12/1/1988 128.92 EE 100 C171273111EE 11/1/1988 128.92 EE 100 C171273110EE 11/1/1988 128.92 EE 100 C171273072EE 10/1/1988 128.92 EE 100 C171273073EE 1011/1988 128.92 EE 100 C219699922EE 31111990 123.92 EE 100 C219699921EE 3/1/1990 123.92 EE 100 C189890938EE 2/1/1990 123.92 EE 100 C189890939EE 2/1/1990 123.92 EE 100 C189890909EE 1/1/1990 123.92 EE 100 C189890908EE 1/1/1990 123.92 EE 100 C189890876EE 12/1/1989 123.92 EE 100 C189890877EE 12/1/1989 123.92 EE 100 C189890829EE 11/1/1989 123.92 EE 100 C189890828EE 11/1/1989 123.92 EE 100 C189890759EE 9/1/1989 126.40 EE 100 C189890760EE 9/1/1989 126.40 EE 100 C189890736EE 8/1/1989 126.40 EE 100 C189890735EE 8/1/1989 126.40 EE 100 C189857850EE 7/1/1989 126.40 EE 100 C189857851EE 7/1/1989 126.40 EE 100 C189857825EE 6/1/1989 126.40 EE 100 C189857826EE 6/1/1989 126.40 EE 100 C189857801EE 511/1989 126.40 EE 100 C189857800EE 51111989 126.40 EE 100 C189857766EE 4/1/1989 126.40 EE 100 C189857767EE 4/1/1989 126.40 EE 100 C189890786EE 10/1/1989 123.92 EE 100 C189890785EE 10/1/1989 123.92 EE 1000 M64564321EE 5/1/1995 786.00 EE 1000 M64564325EE 5/1/1995 786.00 EE 1000 M64564319EE 5/1/1995 786.00 EE 1000 M64564323EE 5/1/1995 786.00 EE 1000 M64564327EE 5/1/1995 786.00 EE 100 C499230085EE 4/1/1995 81.76 TOTAL $95,024.67 10 REV-1E,11 EX+ (12-99)* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21-07 -0287 ESTATE OF Benjamin F. Hoffman Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: Richardson Funeral Home Rice Memorial Works Funeral Luncheon 7,665.00 580.00 600.00 2. 3. B. ADMINISTRATIVE COSTS: "I. Personal Representative's Commissions Name of Personal Representative(s) Sonya M. Montgomery Social Security Number(s)/EIN Number of Personal Representative(s) Street Address 1622 Holtz Road 25,700.00 City Enola Year(s) Commission Paid: 2008 State PA Zip 17025 2. Attorney Fees 28,900.00 :3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 400.00 5. Accountant's Fees 0.00 6. Tax Return Preparer's Fees 0.00 7. Administrative Costs 92.00 8. Legal Notices 150.00 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 64,087.00 M~ichardson guneral tf{ome, dnc. 29 SOUTH ENOLA DRIVE ENOLA, PA 17025 (7! 7) 732-0587 MICHAEL G. MURRAY STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED SUPERVISOR Charges are only for those items that you selected or that are required. If we are required by law or by a cemetery or crematory to use any items, we will explain in writing below. If you. selected a fune~al that may require embalming, such as a funeral with viewing, you may have to pay for embalming. You do not have to pay for embalming you did not approve If you lected arrangements a direct crem tion or immediate burial. If we charged for embalming, we will explain why below. For the Servlce of . . Date of Death '~//r/;;Loo 7 chargeto:"'&'6':c.r't::. ~~"'-? /{;;?-,:J., /IO/-/<......r?d. h<.../n..... /41. /7<J,;;J..'5""' Name 'Address City State A. CHARGE FOR SERVICES SELECTED: Other clothing I. PROFESSIONAL SERVICES Services of l'uneral Director/Staff Embalming Other preparation of body s_ .S_ S_ S_ SUB-TOTAL OF AUTOMOTIVE EQUIPMENT........ A3 S_ We charge you for our services in obtaining: TOTAL OF PROFESSIONAL SERVICES, (specify casb advances that are marked-up) ~~~II~~~r;/ND .AUT~M~TIVE. . . . . . . . . . . . . . . . . .. A s3LJl.: 0 ~ I agree that [ have examined the items of goods and services selected above and found them to be correct and according to the arrangements I have requested. I acknowledge receipt of a copy of this Statement of Funeral Goods and ~es Selected. I represen~t [ have sufficient funds available for payment of the cash. price for the goods and services selected. [ also agree to make payment of S . wllhm d~ys. [ agree to be Jomtly a~d severally hable',wlth.an~lse who signs below, A late charge of ,.... per month amountmg to - per year Will be apphed to the unpaid balance begmmng days from the date 9f.tljis agreemenvrwill al 0 pay to the Funeral Director all reasllnable costs paid by the Funeral Dirwor to collect amounts I owe under this agreement. Those costs may jnclude allorneys' fe s coun sts nd other costs. Any additional services or merchandise ordered or requested after the datI> of this agreement will be considb~p 25,0, tlID ajreement d t e ost ere w' I be fleeted on t~e final bill or statement. 3 Cj () '/ . (Seal)..1f..Xt:J. ~C1Z 0 ,/ (Purch ) , ,0 (Date) ~./.' ",. (Licensed uneral Directqr. YELLOW Funeral ~ior ....~~ .... f7L1L<-- ..........................S_ SUB-TOTAL OF PROFESSIONAL SERVICES......... Al S_ 2. FACILITIES AND SERVICES Use of facililties and services for viewing (Visitation/Wake). . . . . . . , .iZ""/?/c:..---' Use of facililties and services for funeral ceremony . . . . . . . . , , . . q/Y <--- Use of facililties and services for Memorial Service ........, Use of equipment and services for graves ide service. . . . . . . . . . . . . S_ Other use of facilities ..S_ ........... ................S_ SUB.TOTAL OF FACILITIES/EQUIPMENT. .. 3. AUTOMOTIVE EQUIPMENT Vehicle to transfer remains to Funeral Home. Local. cz':L1L.c../ Hearse (Casket Coach) Local.. ... fOj/~ Limousine . ~ }/ <:.---" Local..... ... ~ Family car .' '.. Local. ......... S_ Flower car or floral disposition Local....... ................. S_ Lead car/clelrgy car Local. .. .. .. .. .. Car for pallbearers Local. Out of town transportation. . . . .,..A2S_ S_ B. CHARGE FOR MERCHANDISE SELECTED:..,,,,, <. ~..., .-l.i) C k /" /, ~ -<.--' SI?'--v/O'" '"' as et ./;1...,. ".., .c "". . . . . ','j . . .~. _ (Description) /1/ e' .' ~ /.. ,<:,." <1 N4-==-- ~ f)/~~..77"';.vc- ~p;rcle ................. S_ (Description) Outer burial container.c ~'1/~" S~Glv :f~t~~f/"'/"''' Gtt~r~--;::- Ac nowled:gement cards ........... . /5.. C/<:> Register book(s) . . . . . . . . . . . . . . . . .. ~Q Memory follde,s .. S~ Cl Prayer cards. . . . . . . . . . . . . . . . . S_ Temporary grave marker ... S_ Burial clothing. . . . . . . . S_ (Seal) (Purchaser) @ Pennsylvania Fun~r21 Directors Association form - 600 Revised 4/94 S_ S_ .- Cremation urn . . . . (Description) OTHER .- S_ TOTAL MERCHANDISE SELECTED.... .S.~..... B S ~ 91;; . Va c. SPECIAL CHARGES: Forwarding of remains to S_ (Funeral Home) Receivipg of~ remains from . '.'l,. (Funeral Home) ImmediateBurial....... _.. ....... S_ Direct Cremation................. S_ S_ SUB.TOTAL OF SPECIAL CHARGES. . . . . . . . . . . . . . . . C S_ D. CASH ADVANCED Opening Grave .. . . . . . .. S~ <> " Cemetery Equipment.. ........... .~ (.).0 Lot and Deed. .. .. .. .. .. .. .. .. . .. S Newspaper Notices-Local ......... .f ~,1 J 'O<.J Newspaper Notices-Out-of-town.... ._ Telephone & Telegrams........... ._ Airfare .. .. .. .. .. .. .. .. .. .. .. ... S Clergy/Mass Offering _...... ....... V()O . ~C> Pallbearers _............. ......._ ~~~::~~~t;~Pk~ 9f the De~lh . '. . . . . S ~ L'" / <) " e. <r ~ 4 ~olice Escort .. .. .. .... . Flowers ...... ~DO .0'" Vault Service Charge. . . . . . . . . . S ,;) ()7c.n/,~ . l?<;"....; .- S_ S_ S_ S_ .- D sLS1z3 -C/o SUB.TOTAL OF ADVANCES. V'..l WHITE Funeral Director ORDER FORM RICE :MEMORIAL WORKS a division of I 9: 'h . :~C Since 1921 R.D. 2, Box GA-9, West Main Street, New Bloomfield, PA 17068 (% mile west of the square) (717) 582-2512. Fax (717) 582-3404 www.gingrichmemorials.com Foundation By D Carved lettered D Drawing Required D Drafter D Sandblast By Manufacturer No. 3- 30333 Supplier Ack. # Date Rec'd Found. Ordered Position Verified ....... SOLD TO: ~(' r\ ...>'{ ..~ i.'J1 /i, ~ ;~ f. ,.,.~ /,,,,, ~'1 '., ' Ir. Date of Order In ,"t '('. , Cemetery /) r/ .S' ( ;) >'I.t ~~ () tN'\ <=' r 1.4, ;""1'-.J Ie J ' (J / ~10 ,~~5 / ; J it /-) i'";) ..:~ 7 / ,,;2..,~:) 0 r( /.-/ , ~~ 1"\ \.:1 $I' (-' II\. '.::-' / I<,,(~-.{ t ) ,...-, p location Center Over (/1...)1',- ( ~. v, !I e Graves lot # I :J'.J I ,.1 f .r j Phone (H) /l~ .:$: ;t: ~ ...... ..... ":J' .t'"') CJ (,) ;.. ,7\ (W) Approx. Date of Completion -X.l t''\ e... lettering (^" C () \::::.> r- ? ...... _J $-~ ) c~ '..:.:> r ; '1 , "JJ /' \') (~! /' " j ;' I 1\ r I .....;-- J :) /, ~ .....::;, '::' .". \ .J ('~_ C ;"Ie ".\~ .,- f~ '0 I 'i:... 'S, ",,~~l t- i i \ \ t).J "..;;.....I.~ .'" '".~ y"V\ \ ,"'-. i ," 1 ,/.. ~f ;"."1, .. .~.}'..-1^.... .) _ Spelling and dates have been approved. Type of Memorial Size X Material Size Misc. Design X X X Finish Finish location D Vase D Corner Posts Agreement: A ,iO% deposit is required to commencement of work. Ag'ree to pay stated balance upQn erection regardless of labor troubles or shipments or any other good reasons. This order or contact . cannot be cancelled bYc.ustom~r unless agreed by both parties. The article herein mentioned shall remain the property of James R. Gingrich Memorials until paid in full and they reserve the right to remove the same is not paid as stated. I agree to carefully proofread ali names and dates for accuracy and accept full responsibility for any errors or omissions. THERE WILL BE AN ADDITIONAL CHARGE FOR ANY LETTERING ADDED TO THIS MEMORIAL AFTER ERECTED ON THE CEMETERY. I further agree to pay the balance stated for the work performed under this contract within thirty (30) days of receipt of the final invoice and further agr<3e that interest shall accrue at the rate of one and one.half percent (1 Y2%) per month on the unpaid balance owed to James R.' Gingrich Memorials not paid within thirty (30) days of the invoice date. In addition thereto, I agree if it becomes necessary for James R. Gingrich to institute legal proceeding to collect any funds due from me for my account being past due thirty (30) days, to pay all court costs and attorneys fees incurred by James R. G~ngrich Memorials to collect the same. ~/ "<,,1 __Il1. (1 j.~?I' ,""./""', .::::> 'oj .,/, ,) l~) ~r) ,,))$ Price Foundation ...._-~ $ $ $ C- 9 .') "0"- $ ~...)..),L~~Lr $ ...~ TOTAL DEPOSIT Balance Due $ Dealer ~...') /--~.~.......~. .~ ~. Upon Completion '',. . _. ''\. .;~ \\ 0 '~'\ \. ,'. . \.1....--/ Customer ,~'\. '\ '\A.\ \~. \.,j\t \, c"\\,.. , - : . \ . '.' 1-- . '", '---. 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Hoffman FILE NUMBER 21-07 -0287 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH Holy Spirit Hospital 541.28 2:. Sadler Oil Company 221.75 3.. Debbie Lupoid, Treasurer - 2007 Real Estate Taxes 825.62 4. Debbie Lupoid, Treasurer - 2007 Personal Taxes 9.80 5.. PPL Electric 74.06 6. Enola Sewer/Sanitation 43.00 7'. Comcast 192.50 a.. Quantum Imaging 72.00 91. Debbie Lupoid, Treasurer - 2007 Real Estate Taxes 1,628.36 101. Debbie Lupoid, Treasurer - 2007 Real Estate Taxes 1,159.68 11. Central Pennsylvania Pulmonary Association 263.63 12.. Daily Harvey Eye Associates 148.83 13.. Heritage Medical Group, LLP 30.34 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 5,210.85 ~. ~- ~ i ~ I I ~ I ~ ~ 1f>: i l 1! ~ ~ ~ ~.'.' ~. ~,; ~ I I ! I j; S ~ i ! 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Allentown, P A 18104-9392 www.pplelectric.com Electric KWH - Average Per Day Meter Reading Information Use 30 M.eter 25 tfar24 Actual 27793 This graph shows ar23 Actual 27075 your electric use 20 32 Davs KWH Billed --rr& over the last 13 months. 15 Average - Apr 2006 2007 TWRJrature 53F 48F ~es of K Per Day 13 22 eter Readings: 10 Yearly Use: Total A verhie Actual - 5 Use Mont b May 2005 - Apr 2006 8643 72 Estimated - May 2006 - Apr 2007 6240 520 . . 0 Customer 0 AMJJASONDJFMA 2006 Months 2007 Other important information on back ~ BECAUSE OF LATE BILLINGI DUE DATE EXTENDED TO MAY 18, 2007 Telephone 732-0711 SEWER/ Office Hours 8:00 to 4:00 Mon thru Fri SANITATION PRESORTED FIRST CLASS MAIL u.S. POSTAGE PAID ENOLA, PA PERMIT NO.9 nOl07 )40301 Charge dj. )1170, Y )6300 I TR 4650 -350 --4650 4650 IE!IIitD t t 4300 BENJAt1IN HOFFMAN 1622 HOLTZ ROAD ENOLA PA 17025 1'., j'lj ../'ji ..i.i..i,'....li ,,'i. ..Ii. I' I ./',/'..!' i.'. i! Iii Itl:: 2Iui::u ,Ii :::ud: id::ud i I: 1 l: Inl:!r: 7R BENJ HOFFMAN m ~ \(}:). Account Summary Previous Charges No Payment Received Past Due Charges (please pay now) New Charges Verizon (page 3) !~.!al New Charges Due Apr 30 Total Due: (Past Due + New) Questions about your bill? Call 1 800 660-2215 See page 2 for all other Verizon contact information, Change of billing address? Go to verizon,comfbillingaddress or see page 2. $ 25,15 ,00 $ 25.15 $ 27.16 $ 27.16 $ 52.31 'll. - Moving? 1-866-VZ-MOVES Across the street or across the nation, one call can do it all. Call us for internet, phone and entertainment in your new home, ~... ~........ Tired Of Dial-Up? Get Verizon High Speed Internet today with connection speeds up to 768 I<bps for only $21.99 a month when you sign up for a year. Call 1-866-696-6089. High Speed Intemet SeIYice based on DSL technology and not available on all lines or in all areas. ONE-BILL~ Are You A ONE-BILL Customer? Get your Verizon and Verizon Wireless charges on a single bill each month' Sign-up is easy at verizon.com Already a ONE-BILL customer? Find out about important changes in the "For Your Information" part of/his bill. 'T Detach & return payment slip with your check, payable to Verizon. ,- 7R BENJ HOFFMAN Account Summary Previous Charges ~~L~ent Received Apr 18. Thank You. Balance Forward New Charges Verizon (page 3) Total New Charges Due May 29 Total Due: (Past Due + New) Questions about your bill? Call 1 800660-2215 See page 2 for all other Verizon contact information. Change of billing address? Go to verizon.com/billingaddress or see page 2. $ 52.31 - 53.00 -$ .69 $ 41 .68 $ 41.68 $ 40.99 ". -- Moving? 1-866-VZ-MOVES Across the street or across the nation, one call can do it all. Call us for Internet, phone and enterlainment in your new home. CD Enjoy A Little Bill-Free Bliss Find out how at verizon.com/visa5k Sign up and pay your Verizon bill automatically with your Visa @ card. 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ENOLA DRIVE, ROOM 101 ENOLA, PA 17025-0769 RETURN SERVICE REQUESTED EAST PENNSBORO SCHOOL DISTRICT 2007108 REAL ESTATE TAX NOTICE TAXPAYER'S COpy · KEEP THIS PORTION FOR YOUR RECORDS MUNICIPAL CODE: 9 PROPERTY: 01622 HOLTZ ROAD MAP CODE: 09-11-3010-002 TAX MilLS: 12.25 ASSESSED VALUE: 135640 THIS TAX IS DUE AND PAYABLE, YOU ARE HEREBY REQUESTED TO MAKE PAYMENT THEREOF. .. ~~ 11587 - 2774 BILL DATE: 07/01/07 BILL NO.: 2774 TAXES PAYABLE TO: DEBBIE lUPOLD CASH OR CHECK # AMOUNT $ 2% DISCOUNT FACE PENALTY TO 08131/07 09/01/07 TO 10/31/07 11/01/07 TO 12/31/07 $1,661. 59 $1,827.75 FIRST PAYMENT SECOND PAYMENT FINAL PAYMENT $553.86 $553.86 $553.86 If Paid On or Before If Paid On or Before If Paid On or Before 8/31/07 9/30/07 10/31/07 HOFFMANr, BENJAMIN F & JACQUELINE !vI HOFFMAN 1622 HOLTZ ROAD ENOLA, PA 17025 FULL PAYMENT INSTALLMENT PLAN NO DISCOUNT SEE REVERSE SIDE FOR TAX NOTICE INSTRUCTIONS AND HOMESTEAD/FARMSTEAD EXCLUSION ..........................................................................u.....n.......................................................................~................................................................................................................................................. MAKE CHECKS PAYABLE TO: DEBBIE LUPOLD 98 S. ENOLA DRIVE, ROOM 101 ENOLA, PA 17025-0769 RETURN SERVICE REQUESTED EAST PENNSBORO SCHOOL DISTRICT 2007108 REAL ESTATE TAX NOTICE RETURN THIS PORTION WITH PAYMENT FOR FINAL INSTALLMENT BILL #: 2774 PROPERTY LOCATION 01622 HOLTZ ROAD LOT 2-A PB 71 PG 116 Residential Building HOFFMAN, BENJAMIN F & JACQUELINE M HOFFMAN 1622 HOLTZ ROAD ENOLA, PA 17025 o W N E R Please indicate: o FINAL INSTALLMENT 0 FINAL INSTALLMENT WITH PENALTY CASH CHECK # AMOUNT $ MAIL TO: DEBBIE LUPOLD 98 S. ENOLA DRIVE, ROOM 101 ENOLA, PA 17025-0769 1.,.111".11111,.,1.1.1.1.11...1'111,11,,1,1,,1 FINAL INSTALLMENT NO DISCOUNT If Paid On or Before 10/31/07 $553.86 If Paid After 10/31/07 $609.25 ............................................................................................................................................................................................................................................................................................................. MAKE CHECKS PAYABLE TO: DEBBIE LUPOLD 98 S. ENOLA DRIVE, ROOM 101 ENOLA, PA 17025-0769 RETURN SERVICE REQUESTED EAST PENNSBORO SCHOOL DISTRICT 2007108 REAL ESTATE TAX NOTICE BILL #: 2774 RETURN THIS PORTION WITH PAYMENT FOR SECOND INSTALLMENT PROPERTY LOCATION 01622 HOLTZ ROAD LOT 2-A PB 71 PG 116 Residential Building HOFFMAN, BENJAMIN F & JACQUELINE M HOFFMAN 1622 HOLTZ ROAD ENOLA, PA 17025 o W N E R Please indicate: o 2ND INSTALLMENT :J 2ND INSTALLMENT WITH PENALTY MAIL TO: CASH CHECK # AMOUNT $ DEBBIE LUPOLD 98 S. ENOLA DRIVE, ROOM 101 ENOLA, PA 17025-0769 1.,.111.11111,....1,1.1,1.11...1'111,11,,1.1,,1 , SECOND INSTALLMENT NO DISCOUNT If Paid On or Before 9/30/07 $553.86 If Paid After 10/31/07 $609.25 MAKE CHECKS PAYABLE TO: DEBBIE LUPOLD 98 S. ENOLA DRIVE, ROOM 101 ENOLA, PA 17025-0769 RETURN SERVICE REQUESTED EAST PENNSBORO SCHOOL DISTRICT 2007108 REAL ESTATE TAX NOTICE TAXPAYER'S COpy · KEEP THIS PORTION FOR YOUR RECORDS MUNICIPAL CODE: 9 PROPERTY: 01624 HOLTZ ROAD MAP CODE: 09-11-3010-013 TAX MILLS: 12.25 ASSESSED VALUE: 96600 BILL DATE: 07/01/07 BILL NO.: 2775 TAXES PAYABLE TO: DEBBIE LUPOLD THIS TAX IS DUE AND PAYABLE, YOU ARE HEREBY REQUESlrED TO MAKE PAYMENT THEREOF. AA~ ~~ ~ 11587 - 2775 OR CHECK # AMOUNT $ FACE PENALTY 09/01/07 TO 10/31/07 11/01/07 TO 12/31/07 $1,183.35 $1,301. 68 FIRST PAYMENT SECOND PAYMENT FINAL PAYMENT N/A N/A N/A If Paid 0/\ or Before If Paid On or Before If Paid On or Before 8/31/07 9/30/07 10/31/07 HOF~~, BENJAMIN F & JACQUELINE M HOFFMAN 1622 HOLTZ ROAD ENOLA, PA 17025 INSTALLMENT PLAN NO DISCOUNT SEE REVERSE SIDE FOR TAX NOTICE INSTRUCTIONS AND HOMESTEAD/FARMSTEAD EXCLUSION ...........u...........................................................40................................................................................................................................................................................................................................... MAKE CHECKS PAYABLE TO: DEBBIE LUPOLD 98 S. ENOLA DRIVE, ROOM 101 ENOLA, PA 17025-0769 RETURN SERVICE REQUESTED EAST PENNSBORO SCHOOL DISTRICT 2007108 REAL ESTATE TAX NOTICE RETURN THIS PORTION WITH PAYMENT FOR FINAL INSTALLMENT BILL #: 2775 PROPERTY LOCATION 01624 HOLTZ ROAD LAND APPRX. 2 ACRE seasonal-used < 50% of Year HOFFMAN, BENJAMIN F & JACQUELINE M HOFFMAN 1622 HOLTZ ROAD ENOLA, PA 17025 o W N E R Please indicate: o FINAL INSTALLMENT 0 FINAL INSTALLMENT WITH PENALTY CASH CHECK # AMOUNT $ MAIL TO: FINAL INSTALLMENT NO DISCOUNT DEBBIE LUPOLD 98 S. ENOLA DRIVE, ROOM 101 ENOLA, PA 17025-0769 1",111",11111",1,1,1,1,111111,111,11,,1,1,.1 If Paid On or Before 10/31/07 N/A If Paid After 10/31/07 N/A ...........................................................................u............................................................................................................................................................................................................................... MAKE CHECKS PAYABLE TO: DEBBIE LUPOLD 98 S. ENOLA DRIVE, ROOM 101 ENOLA, F>A 17025-0769 RETURN SERVICE REQUESTED EAST PENNSBORO SCHOOL DISTRICT 2007108 REAL ESTATE TAX NOTICE BILL #: 2775 RETURN THIS PORTION WITH PAYMENT FOR SECOND INSTALLMENT PROPERTY LOCATION 01624 HOLTZ ROAD LAND APPRX. 2 ACRE seasonal-used < 50% of Year HOFFMAN, BENJAMIN F & JACQUELINE M HOFFMAN 1622 HOLTZ ROAD ENOLA, PA 17025 o W N E R Please indicate: o 2ND INSTALLMENT :J 2ND INSTALLMENT WITH PENALTY CASH CHECK # AMOUNT $ MAIL TO: SECOND INSTALLMENT NO DISCOUNT DEBBIE LUPOLD 98 S. ENOLA DRIVE, ROOM 101 ENOLA, PA 17025-0769 1",111.,,111 "",,1,1,1,1,1111.1'111,11,,1,1,,1 If Paid On or Before 9/30/07 N/A If Paid After 10/31/07 N/A .... c .!!1 iil 0.. E e u. (I) :J Cl (I) o C III (ij m I C ~ (I) Q) E <~ .0.. . C "0 i (I) ~ t~13 - J III (I) ~ 0.. Cl , (I) (I) ) 0 0 cc_ III III C .... .... (I) :J:::J~G) ~~~p " .......... 00 .NN ,00 -- -- .......... -00 '1l, @omcast@ ACCOUNT NUMBER DATE DUE TOTAL AMOUNT DUE 09547 190588-01-8 06/07/07 $48.80 News from ~ DAILEY HARVEY EYE ASSOCIATES 1857 CENTER STREET CAMP Hill, PA 17011-1703 (717) 761-3011 STATEMENT DATE L BENJAMIN F. HOFFMAN 1622 HOLTZ ROAD ENOLA PA 1702S I~ r- ~ 14980.0 DATE I DESCRIPTION CHARGE i CREDIT BENJAMIN F. HOFFMAN (149 03/14/07 EYE, ESTABLISHED PATIENT, 9S.00 04/0S/07 Ins pmt-palrnetto GBA 0.00 $86.04 was applie to your de uctible BAL TO SECOND INSURANCE 04/0S/07 Adjustment 8.96 OS/10/07 Reject-AETNA 0.00 PT OWES DEDUCTIBLE 03/14/07 VISUAL FIELD, EXTENDED 90.00 04/0S/07 Ins prnt-palrnetto GBA 18.17 $44.96 was applie to your de uctible BAL TO SECOND INSURANCE 04/0S/07 Adjustment 22.33 OS/10/07 Reject-AETNA 0.00 PT OWES DEDUCTIBLE 'i 03/14/07 04/0S/07 04/0S/07 OS/10/07 PHOTOGRAPHY, FUNDUS Ins Pmt-Palmetto GBA BAL TO SECOND INSURANCE Adjustment Reject-AETNA PT OWES DEDUCTIBLE 80.00 53.1 13.S 0.0 TOTAL FOR BENJAMIN F. HOFFMA \~ 1[.1lJ::l:....liIIE' 148.83 Tax 10 # 23-2152651 0.0 Make Checks Payable To: HERITAGE MEDICAL GROUP, LLP For Billing Questions Call (717)-7618331 PLEASE DO NOT SEND CASH THROUGH THE MAIL EG2651-32 :lf90101tiGOO:lf PAGE 1 OF 1 01 5008 REV-1513 EX+ (9-00) .- COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Benjamin F. Hoffman FILE NUMBER 21-07 -0287 E RELATIONSHIP TO DECEDENT AMOUNT OR SHARE BER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE Ii TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] ,. Sonya M. Montgomery Granddaughter 232,240.00 3. Patricia Hoffman Daughter Balance ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET J] NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE None 0.00 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS None 0.00 TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00 NUM I- (If more space is needed, insert additional sheets of the same size) ~ ~",'ii .~ '. Q) 00 ;:l o Q)"c CJ ,IoJ ..-l H 4-l ;:l 4-l 0 QUQ)M H~ 00 >- Cll 0 ..-l,loJ;:l..... ..-l ~ O'~ .r-! ;:l tI.l :3 0 UQ)< 4-l 00 p.. o '0 ;:l ~ 0 HCll,.CQ) Q)..-l,loJ..-l ,IoJ H H 00 00 Q) ;:l .r-! ..-l"cO..-l bOSU H Q);:l C\1 P::U~U " ~ <",,0 m;g . ['.l ~. : . ....J .: c-:E ::! < :; ..c~:::o . i.l ,CH (;:> ^ ',," ':; () (")i~ () 0 "T'F'l14~ (-"C ~ ,. :-.... :0 :;'s? ---i M .....'<:t <........(])9