HomeMy WebLinkAbout04-14-08
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15056041147
REV-1500 EX (06-05)
PA Department of Revenue
Bureau of Individual Taxes ~
PO BOX.280601 ~
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
County Code Year
File Number
INHERITANCE TAX RETURN
RESIDENT DECEDENT 2 1 0 8
b G
Date of Birth
181 32 5181
01 12 2008
03 10 1906
Decedent's Last Name
Suffix
Decedent's First Name
MI
HOFFMAN
o
S
(If Applicable) Enter Surviving Spouse's Information Below
SpolJse's Last Name
Suffix
Spouse's First Name
MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
1. Original Return D 2. Supplemental Return D 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate D 4a. Future Interest Compromise D 5. Federal Estate Tax Return Required
(dale of death alIer 12-12-82)
[K] 6. Decedent Died T eslale D 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
9. Litigation Proceeds Received D 10 Spousal Poverty Credit jdate of death D 11 . Election to tax under Sec. 9113(A)
. between 12-31-91 and -1-95) (Attach Sch. 0)
CORRESPONDENT. THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
City or Post Office
LEMOYNE
State
PA
ZIP Code
17043
Daytime Telephone Number
(717) 761 4540
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DATE'FILED ~ . .
Name
EDMUND G. MYERS
Firm Name (If Applicable)
JOHNSON DUFFIE
First line of address
301 MARKET STREET
Second line of address
PO BOX 109
Correspondent's e-mail address:
Undelr penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
~RE OF PERSON RESPONSIBLE F FILING RETURN i J DATE
~ .. ~ Eleanor H Parmer "+' - J-
ADDRESS
517 North Enola Drive, Enola, PA 17025
SIGNArRE OF PREPARER OTHER THAN REPRESENTATIVE
Sl)~ \!Jtt{-
ADDRESS I
EDMUND G. MYERS
DATE r J
+JJ -0 '6
301 MARKET STREET, Lemoyne, PA 17043
Side 1
L
15056041147
15056041147
--I
--.J
15D56D42148
REV-1500 EX
Decedent's Name: 0 Serena HOFFMAN
Decedent's Social Security Number
181 32 5181
RECAPITULA TION
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) D Separate Billing Requested............. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) D 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, of
transfers under Sec. 9116
(a)(1.2) X ~
16. Amount of Line 14 taxable
at lineal rate X .045
17. Amount of Line 14 taxable
at sibling rate X .12
'18. Amount of Line 14 taxable
at collateral rate X .15
0.00
15.
101,631.14
16.
0.00
17.
0.00
18.
'19. Tax Due........................................................................ ...................... ..................... ~.9.
:~O. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
L
15D56D42148
110,497.23
110,497.23
8,465.00
401.09
8,866.09
101,631.14
101,631.14
0.00
4,573.40
0.00
0.00
4,573.40
D
15D56D42148
--.J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-08-
DECEDENT'S NAME
o Serena HOFFMAN
STREET ADDRESS
517 North Enola Drive
CITY I STATE IZIP
Enola PA 17025
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
4,573.40
228.67
3. InteresUPenalty if applicable
D. Interest
E. Penalty
Total Credits (A + B + C)
(2)
228.67
Total InteresUPenalty (0 + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 2 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3)
(4)
(5)
(5A)
(58)
4,344.73
4,344.73
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;.................................................................................0 0
b. retain the right to designate who shall use the property transferred or its income;.................................... 0 0
c. retain a reversionary interest; or.................................. ............................ .................................................0 0
d. receive the promise for life of either payments, benefits or care?............................................................0 0
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?... ........................................................................ .................................... .....0 0
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?........ 0 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .,. ...... .............. ................... .... .... ................................................................ 0 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is three (3) percent [72 P.S. 39116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero
(0) percent [72 P.S. 39116 (a) (1.1) (ii)]. The statute does not exempa transfer to a surviving spouse from tax, and the statutory requirements
for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates 01' death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a
natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. 39116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent,
except as noted in 72 P.S. 39116 1.2) [72 P .S. 39116 (a) (1)].
The tax rate imposed on the net value of transfers to or for the use ofthe decedent's siblings is twelve (12) percent [72 P.S. 39116 (a) (1.3)]. A
sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
Rev.150l~ EX+ (6-98)
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
HOFFMAN, 0 Serena
FilE NUMBER
21-08-
If an asset was made joint within one year of the decedenfs date of death, it must be reported on schedule G.
SURVIVING JOINT TENANT(S) NAME
A. Eleanor H Parmer
ADDRESS
RELATIONSHIP TO DECEDENT
Daughter
517 North Enola Drive
Enola, PA 17025
B.
c.
JOINTLY OWNED PROPERTY:
DESCRIPTION OF PROPERTY %OF DATE OF DEATH
LETTER DATE
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR VALUE OF ASSET INTEREST DECEDENT'S INTEREST
JOINTLY-HELD REAL ESTATE.
1 A Commerce Bank 50 Plus Checking 26.180.40 50.000% 13.090.20
Account No. 0513305029
2 A 10/28/1983 Real Estate located at 517 North Enola 191.418.00 50.000% 95.709.00
Drive, East Pennsboro Township -
Property was owned jointly with
Daughter, Eleanor H. Parmer, by Deed
dated october 28, 1983. Value of
property is based on Assessment Value x
Common level Ratio of 1.22
3 A Various United States Series EE Savings Bonds 3.396.06 50.000% 1.698.03
(45) - Valued using US Department of
Treasury, Savings Bond Calculator.
Joint Bonds owned with Eleanor H.
Parmer, Daughter.
TOTAL (Also enter on Line 6, Recapitulation) 110.497.23
(If more space is needed, additional pages of the same size)
Copyright (e) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule F (Rev. 6-98)
REV-1151 EX+ (12-99)
*'
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
HOFFMAN, 0 Serena
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-08-
ESTATE OF
ITEM
NUMBER
A. FUNERAL EXPENSES:
DESCRIPTION
AMOUNT
See continuation schedule(s) attached
5,800.00
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
B.
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City
Year(s) Commission paid
State _ Zip
2.
Attorney's Fees
JOHNSON, DUFFIE, STEWART & WEIDNER
2,500.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant Eleanor H. Parmer
Street Address 517 North Enola Drive
City Enola State PA Zip 17025
Relationship of Claimant to Decedent Daughter
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
Other Administrative Costs
See continuation schedule(s) attached
165.00
TOTAL (Also enter on line 9, Recapitulation)
8,465.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
Rev-1502,EX+ (6-98)
.
SCHEDULE H-A
FUNERAL EXPENSES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
HOFFMAN, 0 Serena
FILE NUMBER
21-08-
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Richardson Funeral Home
5.800.00
Subtotal
5.800.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
Rev-150H:X+ (6-98)
SCHEDULE H-87
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
HOFFMAN, 0 Serena
FILE NUMBER
21-08-
ESTATE OF
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Cumberland County Register of Wills Office - Filing Fee for Inheritance tax Return
15.00
2
Reserves: Closing Costs for Estate Administration
150.00
Subtotal
165.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B? (Rev. 6-98)
Rev-1512.EX+ (6-98)
*'
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
HOFFMAN, 0 Serena
FILE NUMBER
21-08-
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1 Checks Clearing After Date of Death
VALUE AT DATE
OF DEATH
85.00
2 Quantum Imaging
36.00
3 State Employees Retirement System
265.40
4 Verizon
14.69
TOTAL (Also enter on Line 10, Recapitulation)
401.09
(If more space is needed. additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group. Inc.
Form PA-1500 Schedule I (Rev. 6-98)
REV-1513EX+ (9-00)
SCHEDULE .J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
NUMBER
HOFFMAN, 0 Serena
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal
Clistributions, and transfers
under Sec. 9116(a)(1.2)]
FILE NUMBER
21-08-
RELATIONSHIP TO
DECEDENT
Do Not List Trustee(s)
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
I.
36
Eleanor H Parmer
517 North Enola Drive
Enola, PA 17025
Daughter
Entire Estate
101,631.14
Total 101,631.14
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE
0.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule J (Rev. 6-98)
EXHIBIT A
EXHIBIT B
EXHIBIT C
EXHIBIT D
:329554
ESTATE OF O. SERENA HOFFMAN
SCHEDULE OF EXHIBITS
Last Will & Testament for 0. Serena Hoffman dated May 26, 2006.
No Need to Probate Will.
Death Certificate for 0. Serena Hoffman
Tax Assessment for Joint Real Estate located at 517 North Enola
Drive, East Pennsboro Township
Savings Bond Calculator
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Last Will and Testament
OF
O. SERENA HOFFMAN
I, O. SERENA HOFFMAN, also known as OLIVE SERENA
HOFFMAN, of East Pennsboro Township, Cumberland County, Pennsylvania,
declare this to be my Last Will and Testament.
I.
DEBTS
I direct my Executrix hereinafter named to pay my just debts and funeral
expenses as soon after my decease as conveniently may be.
II.
TANGIBLE PERSONAL PROPERTY
I give and bequeath unto my daughter, ELEANOR L. PARMER, my
household goods and other items of tangible personal property.
III.
REST, RESIDUE AND REMAINDER
All the rest, residue and remainder of my estate of whatsoever nature and
wherever situate, I give, devise and bequeath unto my daughter, ELEANOR L.
P ARMER, if she survives me. If my daughter predeceases me, I give, devise and
bequeath the same unto my son-in-law, HERBERT F. PARMER, if he survives
me.
IV.
ALTERNATE DISPOSITION OF REST, RESIDUE AND REMAINDER
Should my daughter, ELEANOR L. PARMER, and my son-in-law,
HERBERT F. PARMER, both fail to survive me, I give devise and bequeath the
residue of my estate as follows:
A. TWO- THIRDS (2/3) thereof unto my mece, NANCY V.
KAISER, or her then-living issue, per stirpes, if she fails to survive me; and
B. ONE-THIRD (1/3) thereof unto the then-living Issue, per
stirpes, of my son-in-law, HERBERT F. PARMER.
V.
UNIFORM TRANSFER TO MINORS
In the event any beneficiary of my Will has not reached the age of twenty-
five (25) years at the time for distribution of his or her share, distribution of said
share may be made in the discretion of my Personal Representative after
2
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considering the age and needs of the beneficiary, either directly to the beneficiary
or to a Custodian for such beneficiary until age twenty-five (25) under the
Pennsylvania Uniform Transfers to Minors Act, 20 Pa. C.S.A S 5301 et seq., or the
applicable Uniform Gifts to Minors Act or Uniform Transfers to Minors Act in the
state of residence of such beneficiary as the case may be. My Personal
Representative may designate as such Custodian any institution or person,
including my Personal Representative, qualified to act as a Custodian for such
beneficiary under such Act in effect at the time such distribution is made. A
receipt for any payment or distribution so made shall be a full discharge therefor to
my Personal Representative, who shall not be responsible to see to, or be liable for,
the application of such proceeds thereafter.
VI.
PERSONAL REPRESENTATIVE
I appoint my daughter, ELEANOR L. PARMER, to be Executrix of this
'Will. Should my daughter, ELEANOR L. PARMER, fail to survive me or fail to
complete for any reason the administration of my estate, I appoint my son-in-law,
HERBERT F. PARMER, to be the Executor in her stead, and if he should also
fail to survive me or fail to complete administration, I appoint WANDA P. KING
Alternate Executrix. I direct that no fiduciary appointed herein should be required
to post bond for the faithful administration of the duties required in any
jurisdiction.
3
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Signed, sealed, published and declared by the above-named Testatrix, as and
for her Last Will and Testament, in the presence of us, who, at her request, in her
presence and in the presence of each other, have hereunto subscribed our names as
witnesses.
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ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF CUMBERLAND
I, O. SERENA HOFFMAN, GfllJ1f/ V J) a.. /)1 f e~S
and /Yl A-~ b /r'R-t-r 6. R t( rf- , the Testatrix and the
witnesses, respectively, whose names are signed to the attached or foregoing
instrument, being first duly sworn, do hereby declare to the undersigned authority
that the Testatrix signed and executed the instrument as her Last Will and that she
had signed willingly and that she executed it as her free and voluntary act for the
purposes therein expressed, and that each of the witnesses, in the presence and
hearing of the Testatrix, signed the Will as witness and that to the best of his/her
knowledge the Testatrix was at that time eighteen years of age or older, of sound
mind and under no constraint or undue influence.
(~.,/ ~ t!J
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O. SERENA HOFFMAN
w~h~
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Subscribed, sworn to and acknowledged before me by o. SERENA
HOFFMAN, Testatrix, and 1:3])/11<< iJ]) C- iJ1jtf,PS and
. ;UAfC,,Ai?f7 C' J! II f f ,witnesses, this ,;{ 6 fJ. day of
JJ1~
, 2006
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otafy Publib---/
My Commission Expires:
\
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COMMONWEALTH OF PENNSYLVANIA
NOTARIAL SEAL
CARLEEN S. JENSEN, Notary Public
Lemoyne. B~ro., Cumberland County
My CommissIon Expires Dec. 17.2007
6
Hl1l5.805 REV (Ol/07l
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate. $6.00
P 14120523
ntitjation N,3mber
SHOULD READ AS FOLLOWS:
....~ltl:.l!-:--~I..~t.~=..
~/J;~
This is to certify that the information here given is
correctly copied from an original Certificate of Death
duly filed with me as Local Registrar. The original
certificate will be forwarded to the State Vital
Records Office for permanent filing.
/) h'J tJt-: JAN 1 9 Z008
~"</~/ /
Local Registrar Date Issued
l REV 11/2006
I PAINT IN
MANENT
~CK INK
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
(See Instructions and examples on reverse)
5. Age (LaS! Birthday)
1. Name 01 Decedent (FltSt, miOjle, last, suffix)
O. Serena Hoffman
6. Date of Birth (Month, day, year)
181-37:-518+
12 2008
101
3/10/1906 Marysville, PA
8d. Facility Name (11 not inslkution. give street and number)
0t11e,
o Inpat~nt 0 ER I Outpatient OOOA 0 Nu"'ng Home rn Residence OOth". Sp.d~,
9. Was Decedent of Hispanic Origin? lJ No 0 Yes 10. Race,: American Indian, Black, WIlile, ete
(If yes, specify Cuban, lS~iM
Mexican, Puerto Rican. etc.) Wh ~ t e
YIS
8b. County of Death
Cumberland
Twp.
517 North Enola Dr.
11. Oecedenrs Usual Occu lion Kind of worll done dtJrin most of wo IHe. Do not state retired
Kind of WorK Kind of Business IIrn1ustry
Teacher Adams SchoolEnola
12. Was Decedent ever in the
U.S. Armed Forces?
DYes IKINO
13. Decedent's Education (Specify only highest grade completed)
Elementary I Secondary (0-12) College (1.4 or 5+)
12 5+
. 16. Decedent's Mailing Address (Street. cily / town, slate, zip code)
517 North Enola Dr.
Enola, PA 17025
Oec&dent's
AcltJal Residence 17a. Stale
PA
17b.Coun~ Cumberland
14. Marital Status: Married, Never Married.
Widowed, Divorced {SpecifY!
Widowed
~~e~edent 17C.~ Yes. Decedent Lived in East Pennsboro
Township? 17d.D No, Decedent Uvedwilhin
Aclual Limits of
Twp.
City/Bore
18. Father's Name (First, middll~, last, suffix)
Newton Kapp
208. Informant's Name (Type I Print)
Eleanor H. Parmer
19. Mother's Name (First, middle, maiden surname)
Jessie V. Gra bill
2Ob. Infonnanl's Mailing Address (Street, cily , town, state, zip code)
517 North Enola Dr. Enola, PA 17025
21 d, Location (City ftown, state, zip code)
21c. Place 01 Disposition (Name of cemetery, crematory or other place)
. ~
Rolling Green Cemetery
22c. Name and Address of Facility
Richardson Funeral Home
Items 24.26 must be completed by person
. who pronounces death.; \
CAUSE OF DEATH (See Instructions and examples)
1Iem 27. Pan L Enter the ~tliiL.m.~ - diseases, injuries, or complications - that directly caused the death. DO NOT enter t
respiratOfY arrElst, or ventricular fibrillation without showing the etiology. List only one cause on each line,
Lower Allen Twp. PA 1701 I
;?-DIU? C.
Approximate interval: Part II: Enter olher sianificant conditions contributino to death, 28. Did Tobacco Use Contribute to Death?
Onset to Death but not resulting in the underlying cause given in Pan I 0 Yes 0 Probably
~o 0 Unknown
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5 'ff$
Due to (or as a consequence of):
Sequential~ist cor'lditions. if a~1Y,
~t~~ UND~,m:~~AU~ree a.
(disease or injufy that initiated 'the
events resulting In dealh) LAST.
Due to (or as a consequence of):
Due to (or as a consequence of)
d.
3Oa. Was an Autopsy
PerfOl'lT\8d?
JOb. Were Autopsy Findings
Available Prior to Completion
of Cause of Death?
Dyes ~o
31. Manner of Death
~atural 0 Homicide
D Accident D Pending Investigation
o Suicide 0 Could Nol be Determined
tJlA-
321. If Transportation Injury (Specify)
o Driver I Operator 0 Passenger DPedestrian
o Other. Specify:
33b. SignatureandlitleotCertilier
,..JfA
t.,J(/+
32d. Ttme of Injury
DVes ~NO
33a. Certifier (check only ooe)
~:~~~sf~r~~i~:~=n ~::y~~~:: ~~~~~h:hceanu:~;:r~h~~~~rh:: ~~;:,,~_ed_ ~a~h ~:d ~_m~I~~ ~~ ~~ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 0 ...
~~~~u:ec~~~,a~~ ~~~~~~~hJ:~~a~~~:r:i~~ t~~~l~~~n;n~e;:~:~~~n~:i;~::~~~~a~~ manner as stated.. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 0
~::~~:~sm~;'::~;f~:t~~~ and' or investigation, in my opinion, death occurred at the time, date, and place, and due 10 the cause{s) and manner as stated_ 0
33c. Ucense Number
29.~ale:
~Not pregnant within past year
o Pregnant at time of death
o Not pregnant. but pregnant within 42 days
of death
o Nol pregnant, but pregnant 43 days to 1 year
before dealh
o Unknown if pregnant WIthin the past year
32c. Place of Inj~ry: Home, Faf!Tl, Street, Factory,
Office Building, etc. (Specify)
32g, location of Injury (Street, city f town, state)
'^ D - 0 t;';'Zf1" p L-
33d, Dale Signed (Monlh, day, year)
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I 0(11 /1 ~I "1 I' I
36. Date ~led {Monlh,jaY, year}
/ / /c./dCJt?f"
34. Name and Address of Person Who Completed Cause of Death (Ilam 27) Type I Print
f. W 1'-'4"" ':)IKICS,,"-J CO fir,...'
'fZ$ /oJ, Z.I~ S7.
35. Registrar's Signat
~
Disposition Permrt No, ~ 6 <1 3 ~ 7 ~
TaxDB Result Details
Detailed Results for Parcel 09-12-2992-024. in the 2004 Tax Assessment Database
Page 1 of 1
DistrictNo 09
parcel_ID 09-12-2992-024.
MapSuffix
HouseNo 517
Direction N
Street ENOLA DRIVE
Ownerl HOFFMAN, 0 SERENA & ELEANOR L
C/O
PropType R
PropDesc
Liv Area 2104
CurLandVal 35000
CurImpVal 121900
CurTotVal 156900
CurPreIVal
Acreage .46
CIGrnStat
TaxEx 1
SaleAmt 1
SaleMo 10
SaleDa 28
SaleCe 19
SaleYr 83
DeedBkPage 0030K-01167
YearBlt 1954
HF File Date 06/14/2007
HF Approval_Status D
) 5lP, qOD.
1 1.21..
-.~,._.>_....". ...--. _....._.~_.._.._-
IqIYI~.6D
I
http://taxdb.ccpa.net/details.asp?id=09-12-2992-024.&dbselect= 1
03/03/08
Calculated Value of Your Paper Savings Bond(s)
Calc,ulated Value of Your Paper Savings Bond(s)
Page 1 of2
Calculator Results for Redemption Date 01/2008
Total Price Total Value Total Interest YTD Interest
$1,125.00 3 396.06 2,271.06 5.70
Bonds: 1-45 of 45
Serial .# Series Denom Issue Next Final Issue Interest Interest Value Note
Date Accrual Maturity Price Rate
L2279554;~5EE EE $50 12/1986 06/2008 12/2016 $25.00 $47.60 4.00% $72.60
L218562022EE EE $5009/1985 03/2008 09(2015 $25.00 $59.00 4.00% $84.00
L218562174EE EE $50 11/1985 OS/2008 11/2015 $25.00 $59.00 4.00% $84.00
L188472201EE EE $50 06/1985 06/2008 06/2015, $25.00 $60.68 4.00% $85.68
L183 304 728EE EE $50 04/1985 04/2008 04/2015 $25.00 $60.68 4.00% $85.68
L1~84 72117EE EE $50 05/1985 OS/2008 OS/2015 $25.00 $60.68 4.00% $85.68
L178730514EE EE $50 02/1985 02/2008 02/2015 $25.00 $60.68 4.00% $85.68
L178730359EE EE $50 12/1984 06/2008 12/2014 $25.00 $62.40 4.00% $87.40
L175995618EE EE $50 10/1984 04/2008 10/2014 $25.00 $62.40 4.00% $87.40
L155330804 EE $50 06/1984..06/2008 06{2014 $25.00 $64.14 4.00% $lJ~~.~4
L253620708EE EE $50 03/1986 03/2008 03{29.16 $25.00 $57.36 4.00% $82.36
L2536209~~ 1 EE EE $5005/1986 OS/2008 OS/2016 $25.00 $57.36 4.00% $82.36
L262015020EE EE $50 06/1986 06/2008 06/2016 $25.00 $57.36 4.00% $82.36
L155250800EE EE $50 01/1984 07/2008 01/2014 $25.00 $67.80 4.08% $92.80
L151853368EE EE $50 11/1983 OS/2008 11/2013 $25.00 $67.80 4.08% $92.80
L262014990EE EE $50 06/1986 06/2008 06/2016 $25.00 $57.36 4.00% $82.36
L155330803EE EE $50 06/198406/2008 06/2014 $25.00 $64.14 4.00% $89.14
L155330681EE EE $50 05/1984 OS/2008 OS/2014 $25.00 $64.14 4.00% $89.14
L1553305l5EE EE $50 03/1984 03/2008 03/2014 $25.00 $66.14 3.67% $91.14
L437890133EE EE $50 06/1990 06/2008 06/2020 $25.00 $38.20 4.00% $63.20
L437890086EE EE $50 06/1990 06/2008 06/2020 $25.00 $38.20 4.00% $63.20
L411102256EE EE $50 04/1990 04/2008 04/2020 $25.00 $38.20 4.00% $63.20
L411102131EE EE $50 03/1990 03/2008 03/2020 $25.00 $38.20 4.00% $63.20
L411101985EE EE $50 01/1990 07/2008 01/2020 $25.00 $39.46 4.00% $64.46
L411101813EE EE $50 11/1989 OS/2008_~1/2019 $25.00 $39.46 4.00% $64.46
L411101664EE EE $50 09/1989 03/2008 09/2019 $25.00 $39.46 4.00% $64~46
L384279612EE EE $50 06/1989,06/2008 06/2019 $25.00 $40.76 4.00% $65.76
L384279499EE EE $50 05/1989 OS/2008 OS/2019 $25.00 $40.76 4.00% $65.76
L384279407EE EE $50 03/1989 03/2008 03/2019 $25.00 $40.76 4.00% $65.76
L384279238EE EE $5002/1989 02/2008 02/2019 $25.00 $40.76 4.00% $65.76
L36648337'5EE EE $50 12/1988 06/2008 12/2018 $25.00 $42.06 4.00% $67.06
L366483194EE EE $50 10/1988 04/2008 10/2018 $25.00 $42.06 4.00% $67.06
L366482970EE EE $50 06/1988 06/2008 06/2018 $25.00 $43.40 4.00% $68.40
L366482924EE EE $50 06/1988 06/2008 06/2018 $25.00 $43.40 4.00% $68.40
L366482710EE EE $50 04/1988 04/2008 04/2018 $25.00 $43.40 4.00% $68.40
L310899607EE EE $50 03/1988 03/2008 03/2018 $25.00 $43.40 4.00% $68.40
L310899324EE EE $50 01/1988 07/2008 01/2018 $25.00 $44.78 4.00% $69.78
L310899026EE EE $50 11/1987 OS/2008 11/2017 $25.00 $44.78 4.00% $69.78
L308808144EE EE $50 09/1987 03/2008 09/2017 $25.00 $44.78 4.00% $69.78
L297876348EE EE $50 07/1987 07/2008 07/2017 $25.00 $46.18 4.00% $71.18
L297876117EE EE $50 05/1987 OS/2008 OS/2017 $25.00 $46.18 4.00% $71.18
L297875909EE EE $50 04/1987 04/2008 04/2017, $25.00 $46.18 4.00% $71.18
L297875684EE EE $50 02/1987 02/2008 02/2017 $25.00 $46.18 4.00% $71.18
http://www.treasurydirect.gov/BC/SBCPrice 03/03/08
Calculated Value of Your Paper Savings Bond(s)
L262015595EE EE $50 12/1986 06/2008 12/2016
L262015339EE EE $50 10/1986 04/2008 10/2016
Totals for 45 Bonds
Notes
NI Not Iss ued
NE Not eligible for payment
P5 Includes 3 month interest penalty
MA Matured and not earnin interest
http://wv.'W . treasury direct. gov/BC/SBCPrice
$25.00 $47.60
$25.00 $55.74
1,125.00 $2 271.06
Page 2 of2
4.00% $72.60
4.00% $80.74
$3 396.06
03/03/08
JERRY R. DUFFIE
RICl-IARD W. STEWART
C. ROY WEIDNER. IR
EDMUND G. MYERS
DAVID W. DELuCE
JOHN A. STATLER
JEFFERSON J. SHIPMAN
JEFFREY B. RETTIG
KEVIN E. OSBORNE
RALPH H. WRIGIIT. IR
MARK C. DUFFIE
JOHi'i It NINOSKY
MICHAEl. J. CASSIDY
LAW OFFICES
JOHNSON
DUFFIE
MELISSA PEEL GREEVY
ROBERT M. WALKER
WADE D. l\IANLEY
ELIZABETH D. S\JO\EH
KELLY L. BONA\JNO
OF COUNSEL
HOHACE A. JOfINSO\j
F. LEE SIIIP\IA\j
(1% 3.20ilhi
April 11 , 2008
RE:
Estate of O. Serena Hoffman
Date of Death: January 12, 2008
Our File No. 5940-1
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Register of Wills Office
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
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Dear Register:
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Enclosed for filing please find the following documents for the above referenced decedent:
1. 2 Original PA Inheritance Tax Returns with tax due in the amount of $4,573.40. This payment also
reflects the 3 month early prepayment of inheritance tax. Check No. 1034 is attached to this
Return
2. Two copies of Pages 1 of the Pa Inheritance tax return, which we ask that you time-stamp and return to
us in the enclosed envelope.
3. Check No. 1035 is attached to this correspondence in the amount of $15.00 representing the filing
fee for the Inheritance Tax Return. There was no need to probate this estate so an estate number will
b to be issued.
Should you have any questions, please do not hesitate to contact our office. Thank you for your attention to this
matter.
Very truly yours,
~~ER
Estate Administration Paralegal
Ene:.
cc: Eleanor Parmer
:329543
301 MARKET STREET PO. BOX 109 LEMOYNE. PENNSYLVANIA 17043-0109
WWW.JDSW.COM 717.761.4540 FAX: 717.761.3015 MAIL@JDSW.COM
JOHNSON, DUFFIE, STEWART & WEIDNER, r.c.