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HomeMy WebLinkAbout05-02-08 15056051047 REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 NTER DECEDENT INFORMATION BELOW ocial Security Number Date of Death OFFICIAL USE ONLY County Code Year File Number INHERITANCE TAX RETURN RESIDENT DECEDENT Date of Birth Suffix Decedent's First Name MI Suffix Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 4. Limited Estate c:::> 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 1. Original Return c:::> 2. Supplemental Return c:::> c:::> 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) CORRESPONDENT - 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 8. Total Number of Safe Deposit Boxes ~ State en DATE FILEDO\ Correspondent's e-mail address: SIGNATURE 0 ADDRESS / () () () f2 j) SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ;vet'\) DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051047 15056051047 ---l ~ --' 15056052048 REV-1500 EX 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . '" ..... ..... 8. Decedent"s Name: 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) ~ Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested. . 7. 9. Funeral Expenses & Administrative Costs (Schedule H). " ..... ....... 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). . . . . . . . . . . . . . . . 10. 11. Total Deductions (total Lines 9 & 10). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14. TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 16. Amount of Line 14 taxable at lineal rate X.O_ 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 15. 16. 17. 18. 19. TAX DUE. . . . . . . . . . ............................................ . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT c::::> Side 2 15056052048 15056052048 --.J 7' ~J7/ (3) 0 C) (4) 0.0 (5) 0,0 (5A) 0, 6 (5B) O. 0 File Number Oeced nt's Complete Address: DECEDEN 'S NA~E _~_WltrJt4 (! ~oreL~ J~.__ STREET A DRESS c / .I O{)O 0Ur f!tf k; /J)_~ ( c let CITY &r-m6et !/HJi) STATE I !l ments and Credits: (Page 2 Line 19) Credit Payments A. Spo sal Poverty Credit B. Prio Payments C. Dis ount (1) Total Credits ( A + B + C ) (2) 3. Interes Penalty if applicable D. Inte est E. Pen Ity Total Interest/Penalty ( D + E ) 4. If Line is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line t Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Ent the interest on the tax due. B. Ente the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT ZIP /70 7 () Ot ~ o ' (:) LE:ASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS '1. Did decedent make a transfer and: Yes a. retain the use or income of the property transferred;.......................................................................................... 0 b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 c. retain a reversionary interest; or... ..... ..... ..... ... ....... ..... ..... ....... ..... .......... ..... ..... .......... .,. ....... .......... ..... ..... ..... ....... 0 d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 ~1. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ D No ~ g] ~ ~ ~ IF THE A SWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of eath 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) rcent [72 PS. ~9116 (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. ~91 6 (a) (1.1) (ii)). The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax I' urn are still applicable even if the surviving spouse is the only beneficiary. For dates of eath 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 par nt, or a stepparent of the child is zero (0) percent [72 P.S. ~9116(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. ~911 (1.2) [72 PS. ~9116(a)(1)]. The tax rate i posed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent[72 P.S. s9116(a)(1.3)). A sibling is defined, under Section 910 , as an individual who has at least one parent in common with the decedent, whether by blood or adoption. --, .,'" '* COMMONWEALTH OF PENNSYLVANIA IIlHERfTANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP or SOLE-PROPRIETORSHIP ESTAl OF FILE NUMBER Schedu C-1 or C-2 (Including aU supporting information) must be attached for each cIoseIy-held corporation/partnership interest of the decedent other than a sole-proplietorship. See ins1 uctions for the supporting information to be submitted for soIe-proprietorships. lTE~ NUM ER 1. DESCRIPTION VALUE AT DATE OF DEATH See / U{ .~>. -{2fA" u' :} Z; 61 00 (p :J {),::, .1/ / TOTAL (Also enter oil Une 3, Recapitulation) $ - 5.;) 4 D . (fO (If more space is needed, insert additional sheets of the same size) REV.l EX + (lC57) ESTA EOF COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER I dude the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. DESCRIPTION Iq~7 Citev'yvle-r S,b -retAek Th. r;. ~YlVel f.t 'l!>J E:- len? ) 9 Y(p ~ f.. B () AT -rea I Ie.-r ;. ~iD UI'Y'l G- ,==-u rZi'\'l \-0.. r~ to. \\ Yl'\ 'f: S), 1\ r t S Y+-LAry c.-~l{ - cleQ,.bns {tQU. 7- <b. TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH .3 6 0 . DO ~ DO 00 I 00 00 ~OD. DO 300. 00 c:J S-oo 00 -- () 5"/5:5 Y'e) 3 REV-1511 EX+ (10-06) . *' . .., .: ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ES ATE OF tj jJ12/J 4) f FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NlJMBER f\. FUNERAL EXPENSES: DESCRIPTION 1. LlJr oj Aae;4L .jJJ) F I.t.IJ e~ 4- L Se/'t/lc f: H1C jJlheJ.lJ /7J<Jrt:. PI! nerd I-/om b EJn l3;Ume/}1+ Plowers) A?a l-ers (rJlsJ(e+ PlokH3/S-) roo J) :DO~ 1-/0 un t1fS mt?m 012/ 4<- serVJic rnemoltl4t- srm f foLL/ny ~lCc/1 (/~ml?ky B ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State_Zip Year(s) Commission Paid: Attorney Fees 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 ~. Probate Fees 5 PO$ t1fC:,t. eGTWlE f}O.,.-e~. Accountant's Fees 6 Tax Return Preparer's Fees 7 III fl~() 714 Y F~~ TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) AMOUNT 30CjD. 66 /()OO. (J 6 35"7 t, 7 c:J. 0 ;)9. f"fo 17q 7, tJO 100. 00 &,0(,. 7:). 06 1, o. ()D $ /1 S7S: (p I f RE ,1512 EX+ (12.03) SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LlABILmES, & LIENS COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ES ATE OF FILE NUMBER 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 UMBER DESCRIPTION OF DEATH 1. elf!/-> E C /4p1frr-t. ())J E f1...A}d/ ~., /,,--- /1f'f/, d.1 C/ /: ~ L. fo/;;2. 75:? 3 55 f, 1~ /) ': (''I . .'.., ',-,: ..:::..: 88>. 00 / 1/ /1. 5 3 , I J?; 6:7- crs I /' / - 3 /) I '/ d lLJ.!:> ,;:;.7'1;-../ ;Ji ~ i'" _-1-,,: U, . ) ,--. /-1 _..---- __-" I' y) C' 0)/" ,:1....! -(. ;;2?" 15..1/3 '~ /" ((~ J-- 35/ 9~ q, CZ1J I) /; i~ .; .1 l/LX,( ,t.::_C(, TOTAL (Also enter on line 10, Recapitulation) $ 33 8' 6. j. B (If more space is needed, insert additional sheets of the same size) SC J.tEDULE C Profit or Loss From Business OMS No. 1545.0074 (Fo m 1040) (Sole Proprietorship) 2007 = ~l of the Treasury .- partnershi~oint ventures, etc, must file Form 1065 or l065-B. Attacf1menl al Re.enue Setvice (99) '-Attach to Form 1040, 1 NR, or 1041. '-See Instructions for Schedule C (Form 1040). Seqoonce No. 09 Nam of ptclpfielor Sod. security number (SSM) Harold C Hoover. Jr 160-42-6184 A Prin(:ipal business or profession, including producl or service (see instructions) B Enter code from instructI0n5 I soorts eauioment sales .- 451110 C Business name. If no separate business name. \ea~e blank. D Employer ID num..... (ElM), if IIfllI Hoovers Sports Equipment E Business address (including suite or room no.)~ 1000 Swarthmore Road City, lawn or post office, slate, and ZIP code - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - . New Cumberland, PA 17070 F Accounting method: (1) ~ Cash (2) 0 Accrual (3) 0 Other (specify) ~ G Did you 'materially p~rticipa_te' in the operabon of this business during 20071 If 'No: see instru~ti~n~ io;-I;;:;,it ;;-nlo~s-;;. -:-. -:-I!T -ie;.HN; H Ifvou started or aCQUired thiS bUSIness dunna 2007, check here - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - . . . . - . . . . . . . . . . . . . . . . . . . ~ IPar I I Income 1 Gross receipts or sales. Caution. If this income was reported to you on Form W-2 and the I I 'Staitutory employee' box on that form was checked, see the instructions and check here. . . . . . .,. . ..~O 1 17.383. 2 Returns and allowances 0".. -.................'.......... . . -. ..' . .' . . . . . . . . . . -. . .... . ..., . . -. ..' . - . 2 3 Subltract line 2 from line 1 .... -.. .......... ... . .... . .,... . ...... . . . ... . ..... . .... . . . ... . ....... , 3 17 383. 4 Cost of goods sold (from line 42 on page 2) . . . -- .... . ....... . ..... . -. - .. . ... . .......... . '" . ....... . 4 17 167, 5 Gross profit. Subtract line 4 from line 3 . . . . . . . . . . - . . . . . . . - . . . . . . . . . . . . . . -." . .... . ... . ... . " . ...... . 5 216. 6 Othe'r income, including federal and state gasoline or fuel tax credit or refund (see instructions) . . . . . . . . . . ........... --.' ......... - . . . . . . . . ............ - ........ . ... . ..... . - . .." . 6 7 Gross income. Add lines 5 and 6 . . . . . . . . . . . - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........ . ~ 7 216. IPan II I Exoenses. Enter exoenses for business use of your home onlv on line 30. B Advertising. . . . .. . . . .. . . . . . . . . . 8 24. 18 Office expense .... - . . . . . . . ... . 18 9 Car and truck expenses 19 Pension and profit-sharing plans 19 (see instructions) . . . . . . . . . . . . . . 9 20 Rent or lease (see instructions): 10 Commissions and fees . . . . . . . . . 10 a Vehicles, machinery, and equipment .... . 20a 11 Contract labor b Other business property . - . . . . . ...... . .. . 20b see instructions) . . . . . . . . . . . . . . 11 21 Repairs and maintenance ........... . .. . 21 24. 12 Depll~tion ........ - . . . . . . . . . . . . 12 22 Supplies (not included in Part III) ... . 22 1 155. 13 eGfI~ciation and section 23 Taxes and licenses ...... _ . . . . . . . '.., . 23 7 expense deduction 24 Travel, meals, and entertainment: not included in Part III) see instructions) . . . . . . . . .. . . . . 13 a Travel ....... . .............. . ........ . 24a 14 ~ployee benefit programs b Deductible meals and entertainment other than on line 19) ...... - . . 14 (see instructions) .. . . . . . . . . . . . . ... .. ,.. . 24b 15 nsurance (other than health) -. . lS 25 Utilities ............ . . . . . . . . . . . . .' -..... 25 16 nterE!st: 26 Wages (less employment credits) . - .".. . 26 a ortgage (paid to banks, ate) ........ 16a 27 Other expenses (from line 48 on b )ther . . . . . . . . . . . . . . . . . . . . . . . . . 16b 60. page 2) ......... . . . . . . . . . . . . . ..... .- - -. 27 4.193. 17 eaal & orofessional selVices . . . 17 Z8 olal expenses before expenses for business use of home. Add lines 8 through 27 in columns . - . . . . . . . . - . ~ Z8 5.456. 29 entative profit (loss). Subtract line 28 from line 7 ...........- . ........ . .,..,..... . . -..... ..... . . . ... . 29 -5.240. 30 xpenses for business use of your home. Attach Form 8829 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - .... . . . . . . - . .. - 30 31 tlet profit or (loss). Subtract line 30 from line 29. If a p..St, enl.. M both F.... 1040, '..12, and Schedule So, ,... 2 0< un Funn 1 f 040NR,line 13 (statutory employees, see instructions). Estates and trusts, enter on orm 1041, line 3. . . . . . . . . - ..... . 31 -5.240. If a loss, you must go to line 32. - 32 I you have a loss, check the box that describes your investment in this activity (see instructions). ~ou checked 32a, enter the loss on both Form 1040, line 12, and Schedule SE, line 2, or on Form } ~ All investment is 1 HR, line 13 (statutory employees, see instructions). Estates and trusts, enter on Form 1041, line 3. 32 a at risk. I If you checked 32b, you must attach Form 6198. Your loss may be limited. o Some investment 3tb is not at risk. BAA ~or Paperwork Reduction Act Notice, see Form 1040 instructions, Schedule C (Form 1040) 2007 FDIZO 112 06/15/07 Sct IPa 33 dule~ C (Form 1040) 2007 Harold C Hoover, Jr III I Cost of Goods Sold (see instructions) Method(s) used to value closing inventory: a ~ Cost b 0 Lower of cost or market 160-42-6184 Page 2 c 0 Other (attach explanation) 34 Was there any change in determining quantities, costs, or valuations between opening and closing inventory? If 'Yes,' attach explanation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Invl~ntory at beginning of year. If different from last year's closing inventory, attalch explanation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ................ DYes DNo 35 17,167. 36 Purchases less cost of items withdrawn for personal use 36 37 Cost of labor. Do not include any amounts paid to yourself . 37 38 Materials and supplies . 38 39 Other costs . . . . 39 40 Add lines 35 through 39 . 40 17,167. 41 Inventory at end of year 41 42 Cost of goods sold. Subtract line 41 from line 40. Enter the result here and on page 1, line 4 ............ 42 1 7 , 167 . I Pal IV -' Infonnation on Your Vehicle. Complete this part only if you are claiming car or truck expenses on line 9 and are not required to file Form 4562 for this business. See the instructions for line 13 to find oul if you must file Form 4562. 43 When did you place your vehicle in service for business purposes? (month, day, year) .. 44 Of the total number of miles you drove your vehicle during 2007, enter the number of miles you used your vehicle for: ;: Business _ _ _ _ _ _ _ _ _ _ _ b Commuting (see instructions) _ _ _ _ _ _ _ _ _ _ _ cOther _ _ _ _ _ _ _ _ _ _ _ 45 Do you (or your spouse) have another vehicle available for personal use? ............ . .. 0 Yes 0 No DYes DNo 46 Was your vehicle available for personal use during off -duty hours? .. _ . . . _ . _ . . . . . . . . . . . . _ . . . . . . . 47 a Do you have evidence to support your deduction? . . . . . . . . . . . . . . . . . . . . . . . . . . . . DYes DNa .. nYes nNo b If 'YE~S: is the evidence written? ............ _ . . _ . . . . . . . . . . . . . _ . . . . . . . . . . . . . . . . . . . . _ . . . . . . . _ . . IPart V I Other Expenses. List below business expenses not included on lines 8-26 or line 30. _fE~ '!:9"E.~ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ . 1,053. .!>~~ _ .!'~~S_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ . 252. int _rE-'~~_ _ ___ _____ ____ _ _ _ __ __ _ _ __ ___ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __. 35. ~~~ ~.!:c~~ _~~;.t:..w~~~. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 223. ere _i .!-__ ~a~~ _f_e~~ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ . 1,430. te~ PE~~~e_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ . 1,200. ---------------------------------------------------------- -----------------------------------------------------. 48 otal other expenses. Enter here and on page 1, line 27 148 4,193. Schedule C (Form 1040) 2007 FDlza 112 06/15/07 SC iEOULE C Profit or Loss From Business OMS No. 1545.0074 (Fol n 1040) (Sole Proprietorship) 2006 Depa !ment of the Treasury .. Partnerships, joint ventures, etc, must file F Omt 1065 or 1065-B. Al1achmenl Interr I Revenue Service (99) "Attach to Form 1040, 1040NR, or 1041. "See Instructions for Schedule C (Form 1040). SeQuence No. 09 NamE of propnetor Social security number (SSN) B:AR.OLD C HOOVER, JR J.60-42-6J.84 A PrincIpal busInesS or protesslOf1. Including product or service (see .nstructions) B Enter code from instructions 1 SPORTS EQUIPMENT .. 999999 C Business name. If no separate business name. leave blank. 0 Employer ID number (EIN). if any .' E Business address (including suite or room no.)" J. 0 0 0 SWARTHMORE ROAD City, lown or post office. state. and ZIP code -- - -- --- - -- -- - - -- -- - - -- - - - -- _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ NEW CUMBERLAND, PA J.7070 F Accllunting method: (1) Ii] Cash (2) 0 Accrual (3) 0 Other (specify) .. G Did you 'materially particiPa.te' in the operat~~n of this business during 2006? If 'No,' see instruct~; fo~li;;,rt ;nl~~;.-:-.-:-1iT ~;..HN; H If you started or aCQuired thiS business dunn 2006. check here. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. IParl I Income 1 Gro~;s receipts or sales. Caution. If this income was reported to you on Form W-2 and the D 'Statutory employee' box on that form was checked. see the Instructions and check here. . . . . . . . . . .. .. 1 20,086. 2 Returns and allowances ..... .., ...... .... .......... .... ............ .......-................. -.......... 2 3 Subtract line 2 from line 1 .. -... .......... ...... ......... ............... .............................. - . 3 20,086. 4 Cost of goods sold (from line 42 on page 2) ................ ......................... ................... . 4 1J.,675. 5 Gross profit Subtract line 4 from line 3 ....... ....... ................ ...............................,. . . 5 8,411. 6 Other income, including federal and state gasoline or fuel tax credit or refund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 7 Gross income. Add lines 5 and 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 7 8,411. fPari II T Exoenses. Enter exo< nses for business use of your home onlv on line 30. 8 Adve:rtising . . . . . . , . . . . . . . . . . . . . 8 25. 18 Office expense ....................... _ . 18 170. 9 Car and truck expenses 19 Pension and profit-sharing plans 19 (see instructions) . . . . . . . . . . . . . . 9 20 Rent or lease (see instructions): 10 Commissions and fees . . . . . . . . . 10 a Vehicles, machinery, and equipment ... .. 20a 11 Contract labor b Other business property . . . . . . . . . . . . . . . . . 20b (see instructions) . . . . . . . . . . . . . . 11 21 Repairs and maintenance ............... 21 24. 12 Deph~tion " _ . ... .. ........... . 12 22 Supplies (not included in Part III) ....... . 22 6,16l. 13 Depreciation and section 23 Taxes and licenses ..................... 23 179 E!XpenSe deduction 24 Travel, meals. and entertainment: not included in Part III) see instructions) . . . . . . . . . . . -.. 13 O. a Travel . ..... ................... . ...... . 24a 14 mployee benefit programs other than on line 19) ......... 14 b Deductible meals and entertainment .... . 24b 15 nsurance (other than health) . . . 15 25 Utilities............................... . 25 16 nterest: 26 Wages (less employment credits) ........ 26 a ortgage (paid to banks, etc) ........ 16a 27 Other expenses (from line 48 on page 2) ........ . 27 2,694. b )ther .. . . . . .. .. .. .. . .. . .. . . . . . 16b 51. 17 eaal & orofessional services. . . 17 28 ota' expenses before expenses for business use of home. Add lines 8 through 27 in columns ............ . .. 28 9,125. 29 entaltive profit (loss). Subtract line 28 from line 7 ......................... .. ................ ............. 29 -714. 30 xpenses for business use of your home. Attach Form 8829 .. . . . . . . .'. . . . . . . . . .......... ........ .......... 30 31 et profit or (loss). Subtract line 30 from line 29. If a p<ofit, ente, on both Fo~ '040, 1;.e'2, on. Sehedule SE, lI.e 2.' on Fo~ 1 ~N1'&.t~i~; ~~tatutory employees, see instructions). Estates and trusts. enter on . . . . . . . . . . . . . . 31 -714. If a loss. you must go to line 32. _ 32 you have a loss, check the box that describes your investment in this activity (see instructions). If you checked 32a, enter the loss on both Form 1040, line 12, and Schedule SE, line 2, or on Form } ~ All investment IS O4ONR, line 13 (statutory employees, see instructions). Estates and trusts, enter on Form 1041, line 3. 32 a at risk. n Some investment If YOU checked 32b. YOU must attach Form 6198. Your loss may be limited. 32b is not at risk. BAA or Paperwork Reduction Act Notice, see Form 1040 instructions. Schedule C (Form 1040) 2006 FDlZ01l2 11/03106 160-42-6184 Pa e 2 Lower of cost or market c Other (attach explanation) Was there any change in determining quantities, costs, or valuations between opening and closing inventory? If 'VIes,' attach explanation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DYes ~No 35 Inventory at be9inning of year. If different from last year's closing inventory, attach explanation. . . . . . . . . . . . . . . . . . . . . . . . . - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 35 17,772. !7l-c.>' 36 Purchases less cost of items withdrawn for personal use ................................................ -. 36 11,070. /'1:7'0, 37 Cost of labor. Do not include any amounts paid to yourself. . .. . .. . .. . . . . . . . . .. . . .. . .. .. . .. . .. . . . .. . . .. .. . .. 37 38 Materials and supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 38 39 Other costs .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " 39 .... ........... .... ....................... ............ ............. 40 28,842. "!:2tJ1 ................................................................... 41 17,167.5,' oods sold. Subtract line 41 from line 40. Enter the result here and on a e 1. line 4 '" . . . . . . . . . . . .. 42 11, 675. - Information on Your Vehicle. Complete this part only if you are claiming car or truck expenses on line 9 and are not required to file Form 4562 for this business. See the instructions for line 13 to find out if you must file Form 4562. hen did you place your vehicle in service for business purposes? (month, day, year) .. f thE~ total number of miles you drove your vehicle during 2006, enter the number of miles you used your vehicle for: _____ ______ bCommuting (see instructions) ___________ cOther __ ___ ___ ___ 45 o you (or your spouse) have another vehicle available for personal use? .......... DYes DNo ~~--------------------------------------------------- DYes DNo DYes DNo No 654. 320. 349. 847. 349. 175. 46 as your vehicle available for personal use during off-duty hours? .... - . . . - . . . . . . - . . . . .. . . . . . . . . . . - . . . . . . . . . . . . . . . . . . . o you have evidence to support your deduction? . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 'Yes,' is the evidence written? ................................... . . . - . . . . . . - - . . . . . . . . . . . . . . Other Ex enses. List below business ex enses not included on lines 8-26 or line 30. X~~~________--_-_____--__________________________-___ ~!!D :! _1~A.!tQ Yl!l!l~ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ~~~E~Q~~___________________________-_____-______-_-_-_--- ----------------------------------------------------- ----------------------------------------------------- 48 T tal other ex enses. Enter here and on a e 1, line 27 .... - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " 48 2 , 6 94 . Schedule C (Form 1040) 2006 FDIZOl12 11/03/06 SC HEDULE C Profit or Loss From Business OMB No. 1545.0074 (Fo m 1040) (Sole Proprietorship) 2005 Oep ~t of the Treasury 99 .. Partnerships, joint ventures, etc, must file Form 1065 or 1065-8. Al1achment Inter I Revenue ServIce ( ) .. Attach to Form 1040 or 1041. .. See Instructions for Schedule C (Form 1040). SeQuence No. 09 Nam of pmprletor Social security number (SSM) HAROLD C HOOVER, JR 160-42-6184 A Prin<cipal busIness or profeSSIOn. Including product or service (see Instructions) 8 Enter code from instructions 1 SPORTS EOUIPMENT .. 999999 C Business name. If no separate bUSiness name. leave blank. 0 Employer ID number (ElN), if any E Business address (including suite or room no.)" 1000 SWARTHMORE ROAD City. town or posloffice. stale. and ZIP code ---- - - --- -- - - - - - - - - - - - - - - -- - - - - - - - _ - _ _ _ _ _ _ _ _ _ _ ___ NEW CUMBERLAND, PA 17070 F Accounting method: (1) I!J Cash (2) 0 Accrual (3) 0 Other (specify) .. G Did you 'materially participate' in the operation of this business during 2005? If 'No,' see ins;u-;;-tk;~ fo;:-,~it ~n1;~;.~.~ I!f Y;;~HN; H If vou started or acquired this business durinQ 2005, check here. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. IPa I I Income 1 Gross receipts or sales. Caution. If this income was reported to you on Form W-2 and the 0 'Statutory employee' box on that form was checked, see the instructions and check here. . . . . . . . . . . . ... 1 30,087. 2 Returns and allowances ,..... ... .... ....... ... ........ -... ..... ..... -, .............-..... .... 0... ... 0" 2 3 Subtract line 2 from fine 1 .. ,. ...... ..... ...... ............. 0..00.. 0.... . ..00......................... " 3 30,087. 4 Cost of goods sold (from line 42 on page 2) ....... ..... .... ........0 0... .. ". . ....... ............ 0........ 4 20,377. 5 Gross profit. Subtract line 4 from line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.. .. . 0 0 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 9,710. 6 Othli!r income, including Federal and state gasoline or fuel tax credit or refund ....... ............... ....... 6 7 Gross income. Add lines 5 and 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " .................. 0.......... .. 7 9,710. IPar II I EXDenses. Enter exoenses for business use of vour home onlv on line 30. S Advertising. . . . . . . . . . . . . . . . . . . . 8 18 Office expense ................. ...... o. 18 37. 9 Car and truck expenses 19 Pension and profit-sharing plans 19 (see, instructions) . . . . . . . . . ..... 9 20 Rent or lease (see instructions): 10 Commissions and fees . . . . 0" 0 10 a Vehicles. machinery, and equipment .... . 20a 11 Contract labor b Other bUSiness property. . . . . . . . . . . . . . . . . 20b (see instructions) . . . . . . . . . . . . . . 11 21 Repairs and maintenance ............... 21 12 Dep'letion ..................... 12 22 Supplies (not included in Part III) . . . . . . . . 22 867. 13 Depreciation and section 23 Taxes and licenses... .. . . . . .. . . . . . .. . . 23 179 expense deduction 24 Travel, meals, and entertainment: (not included in Part III) (see instructions) . . . . . . . . . . . . . . 13 937. a Travel .0.. . ..0. .... 0 0............ .... .. 24a 14 Employee benefit programs (other than on line 19) ......... 14 b Deductible meals and entertainment .... . 24b 15 Insurance (other than health) . . . 15 25 Utilities ............ 0.... .............. 25 245. 16 Interest: 26 Wages (less employment credits) ........ 26 ii Mo~,age (paid to banks, etc) ........ 16a 27 Other exper.sss (from line 48 on page 2) ........0 27 2,820. t Othm ......................... 16b 106. 17 Leoal & professional services . . . 17 100. 28 Total expenses before expenses for business use of home. Add lines 8 through 27 in columns ............ . ... 28 5,112. 29 Tentative profit (loss). Subtract line 28 from line 7 ...... ...... .... ..... 0... 0.............. 0...........0... 29 4,598. 30 Ex~mses for business use of your home. Attach Fonn 8829 .. . . . . . . . ... .. ................... ....... 0...... 30 31 Net ii>rofit or (loss). Subtract line 30 from line 29. · If a profit, enter on Fonn 1040, line 12, and also on Schedule SE, line 2 (statutory l employees, see instructions). Estates and trusts, enter on Form 1041, hne 3. 0" . 31 4,598. · If a loss, you must go to line 32. 32 If you have a loss, check the box that deSCribes your investment in this activity (see instructions). · If you checked 32a, enter the loss on Fonn 1040, line 12, and also on Schedule SE, line 2 } o All Investment is (statutory employees, see instructions). Estates and trusts, enter on Form 1041, line 3. 32 a at risk. n Some investment · If '\fOU checked 32b, YOU must attach Fonn 6198. Your loss may be limited. 32 b is not at risk. BAA For Paperwork Reduction Act Notice, see Fonn 1040 instructions, Schedule C (Form 1040) 2005 FDlZ0112 11/14105 , 160-42 -6184 Paoe 2 Lower of cost or market c Other (attach explanation) Was there any change in determining quantities, costs, or valuations between opening and closing inventory? If 'Yes,' attach explanation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., 0 Yes ~ No 35 Inv.entory at be!Jinning of year. If different from last year's closing inventory, attach explanation.. . . . . . . . . . .., . . .. . . . .. . . . . . . . . " . " .. . . . . . . . . . . . . . . . " . .. . . . . . . . . . . .. . . . . .. . . . . . . . . .. 35 14,917. 36 Purchases less cost of items withdrawn for personal use .................................................. 36 14,039. 37 Cost of labor. Do not include any amounts paid to yourself. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .. . . . . . .. 37 38 Materials and supplies . .. .. . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . .. . . . . . . . . . . . . . . . .. . . . .. . . . .. 38 9,193. 39 Oth1:!r costs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 39 40 Add lines 35 through 39 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 40 38,149. 41 Inventory at end of year ................................................................................ 41 17,772. oods sold. Subtract line 41 from line 40. Enter the result here and on a e 1, line 4 .... . . . . . . . . . . .. 42 20 , 377 . Information on Your Vehicle. ~mplete this ~art onlV if you a.re claiming car or. truck expen.ses on line 9 and are not required to file Form 4562 for thIS business. See the instructions tor hne 13 to find out If you must ftle Form 4562. 43 When did you place your vehicle in service for business purposes? (month, day, year) ... 44 Of the total number of miles you drove your vehicle during 2005, enter the number of miles you used your vehicle for: a Business __ ________ _ bCommuting ___ ___ _____ cOther _________ __ 45 Do y'ilU (or your spouse) have another vehicle available for personal use? ............................................. 0 Yes 0 No as your vehicle available for personal use during off-duty hours? .................................................... 0 Yes 0 No o you have evidence to support your deduction? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . .. . . . . . ... . . . . . . . . . . . . . . . . . . . . ., 0 Yes 0 No No 1,044. !!~~------------------------------------------------- 72. 419. ~~~~Q~T~~~___________________________________________ 747. I.:!' __~~ _F..!!l~l! _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 538. ------------------------------------------------------ ----------------------------------------------------- ----------------------------------------------------- 48 otal other ex nses. Enter here and on a e 1, line 27 .., .. . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . .. 48 2 , 820 . Schedule C (Form 1040) 2005 FDIZ0112 11/14105 p.o. Box 67013 (717) 234-8484 (Harrisburg) Harrisburg, PA 171 06-7013 (800) 237.7328 (NQtionwide) website - http://www.psecu.com 1 JOINT OWNER HAROLD HOOVER BARBARA J HOOVER 1000 SWARTHMORE RD NEW CUMBERLAND PA 17070-1729 M BER NUMBER STATEMENT DATE 016 XXXXXX OS/31/07 :s~ P st Eff Description Amount Balance OS 01 ID 01 REGULAR SHARES Beginning Balance '--- ,.~~//, 2S00.83 OS 10 Payment: Transfer From Share 04 - ,r:'~;") 100.00 2900.83 08 15 Withdrawal via Home Banking (-~ ~: 500.00- 2400.83 OS 16 Withdrawal via Home Banking Transfer 300.00- 2100.83 To HOOVER,AMERlKA S XXXXXXXXXX Share 01 OS 24 Payment: Transfer From Share 04 Q~--_.' 100.00 2200.83 08 29 Withdrawal via Home Banking ...-' 500.00- 1700.83 08 31 Withdrawal via Home Banking Transfer , 600.00- 1100.83 To HOOVER,AMERIKA S XXXXXXXXXX Share 01 08 31 Payment: Dividend 1.240% 2.53 1103.36 Annual Percentage Yield Earned 1.250% from 08/01/07 through 08/31/07 Based on Average Daily Balance of 2400.83 08 31 Ending Balance 1103.36 Dividend YTD: Year to Date 20.27 P st OS 01 08 01 08 02 OS 03 OS 03 08 06 08 07 08 07 08 07 08 07 OS 07 08 07 =========================================================================================== Eff Description ID 04 PSECU CHECKING Beginning Balance Check 072512 Withdrawal Direct Deposit PPL TYPE: E-BILL CO: PPL Withdrawal via Home Banking Transfer To Loan 09 Check 073101 Check 073007 BILLPAYER CHECK 080719 FOR $100.00 WAS MAILED.TO SWATARA TOWNSHIP AUTHORITY. BILLPAYER CHECK 080714 FOR $34.56 WAS MAILED TO GREENSWARD TURF CARE. ELECTRONIC BILL 0003 FOR $150.00 WAS SENT TO UGI UTILITIES ELECTRONIC BILL 0015 FOR $200.00 WAS SENT TO MCI RESIDENTIAL ELECTRONIC BILL 0016 FO~ $112.00 WAS SENT TO UNITED WATER ELECTRONIC BILL 0017 FOR $160.00 Amount Balance 4963.98 4898.23 4844.23 I 65.75- 54.00- 1000.00- 550.00- 460.00- 3844.23 3294.23 2834.23 p.o. Box 67013 (717) 234.8484 (Harrisburg) Harrisburg, PA 171 06.7013 (800) 237.7328 (Nationwide) website - http://www.psecu.com 3 HAROLD HOOVER BARBARA J HOOVER 1000 SWARTHMORE RD NEW CUMBERLAND PA 17070-1729 ME 18ER NUMBER STATEMENT DATE 08/31/07 ELECTRONIC BILL 0016 FOR $55.00 WAS SENT TO UNITED WATER Check 080714 Withdrawal Direct Deposit UNITED WATER TYPE: E-BILL CO: UNITED WATER Withdrawal Direct Deposit DISH NETWORK TYPE: E-BILL CO: DISH NETWORK ELECTRONIC BILL 0010 FOR $650.00 WAS SENT TO WELLS FARGO HOME Withdrawal Direct Deposit WELLS FARGO HOME TYPE: E-BILL CO: WELLS FARGO HOME Check 081620 Payment: Direct Deposit PA TREASURY DEPT TYPE: PAYROLL ID: 1236003133 CO: PA TREASURY DEPT Withdrawal Transfer ~o Share 01 Withdrawal Transfer To Loan 10 Withdrawal via Home Banking Transfer To HOOVER,AMERlKA S XXXXXXXXXX Share 01 Withdrawal Transfer To Loan 09 Withdrawal via Home Banking Transfer To HOOVER,AMERlKA S XXXXXXXXXX Share 01 BILLPAYER CHECK 083011 FOR $452.00 WAS MAILED TO ERIE INSURANCE GROUP. BILLPAYER CHECK 083007 FOR $460.00 WAS MAILED TO NATIONSTAR MORTGAGE. ELECTRONIC BILL 0009 FOR $54.00 WAS SENT TO PPL ELECTRONIC BILL 0015 FOR $70.00 WAS SENT TO MCI RESIDENTIAL ELECTRONIC BILL 0017 FOR $50.00 WAS SENT TO COMCAST - CENTRA Payment: Dividend 0.250% Annual Percentage Yield Earned 0.250% from Based on Average Daily Balance of 2861.59 --- Continued on following page --- 7 o o 08/ 1 08/ 3 08/ 3 08/ 4 08/ 4 08/ 4 08/ 4 08/ 5 08/ 9 08/ 0 08/ 0 08/ 1 08/ 1 08/ 1 08/ 1 JOINT OWNER J l/ '" (\ I, Q Ii) ot\ ' (o.. .t:(, \./' ., , \ ~ 00 ry-I ; ,,-. V) Gv' 34.56- 55.00- 2831.38 2776.38 85.00- 2691. 38 650.00- 2041.38 801.77- 1925.00 1239.61 3164.61 100.00- 157.97- 300.00- 3064.61 2906.64 2606.64 120.00- 2486 64 500.00-~~ 0.61 08/01/07 through 08/31/07 1987.25 ONT/BACK CHECK IMAGE VIEW Check #0101 ~ ~V\.e~ t' ~Vf\B Page 1 of 1 BARBARA J HOOVER PH. 717~17<H434 1000 SWARTHMORE RD. NEW CUMBERLAND. PA. 17070 Ii fi In DAtI - I $ ~4it IJcJ o ltc-.-, DOllARS W e:~.. PAY 10 THE I OlDER OF . M" ~ .. r~ -:" ... . 21195 11SSS7 582 346 "'__h_~_ -:.. .:.. . . ,. o t -:,' .. ~ :. ~ :~~~~..:.:; t 1 g ':.1 ::; ~ I;' ~ : ~-"' ~-:F. ~_i _~ . ~ .... I': ! :f.~ ;~ '" c.; . :.. . ..".;.2 : ;rzr:.::' ~=.. -:: at ~ I i ~:;!..::;r~1f'2 ~,. : f ~~~;~E} ~~ ..~';;;;':;'ft;' j ~... b ..........'_0;,,0 - :"1 ~ ~ f'J~'" D Q.' ~ =- ~ :;. c.~..!: .~::"'" "'<., r~ ;:."..;tzC';::~ ~l' "; r: 2;~~~i: it; ~ f .'I.',::!'~ = :-..: ':' ',2 ~ . ;.. f ~ =: ('t ~ ~ ;;~;~.?:t . >, , :;r.cl':' ~ . ( i: ~ ~~ \ I " J :~ r.... ~..'t d"''' i t ~~ !~~ . ..:.. ~~ :0 ~:b{33 J.: ,. ~ I ~ J.a:ni -" 'i t' ....., -a ~.-:-~ 0 0 .: ; ~ ~ ~..A r-o ~J:::o:.:z: ::0 . !r- ~cn ~~1i1~",,~ CJ tJ~ b~~~ :z m ~~ t:J .~ "A'en -0 c::: ~~ ~ ~:.- t;~~ 0 61. ~ V" . ,.0. . ....."... -.. .....Ta:,(\ d 0." ~'R:" -t VI .~31~~t<"~i1. S3J~1~~ ~ 6 <>- ~~;t_ ..tt~- ....~o>:z LN l'Ib~'1jir l.".tt" . ~"I: -- ~ :n _.~'l'! n.. u' is> - ~'.:' . 111:Z r- .. r:..; . - - - - - - - ~- ...- . CD rn ' ..,,: ; :.ii.\" .J::'" :.\-;... =-.1..'- f ... I 3' '\0.1''10,:., .. t.":.I.f... ,"'.:- ~ --- -< - - - - - - _... -.. ..... ::s : . {') ." . . .. P ease Note: Information written on a check using a Gel Pen may cause the information to not appear as part of the check image. View both front and back to print.. htt s:/)homebank.psecu.comlChecldmages/PrintView.aspx?ll 052007000 10100058203460902 3/26/2008 F ONT/BACK CHECK IMAGE VIEW Page 1 of 1 Check #0102 ~.' .0 'vP~ ~- BARBARA J HOOVER ptt 717-774.3434 tooo SWARTHMORE RD. NEW CUMBERLAND. PA 11070 61)-8111/2313 II /~i'7 $ JtJfo PAY 10 THE ~ ORDER Of J;. o fD ......" f..h.'.' I tI.... .. .... _ DOlLAIS PSEC4!Ii HARRISBURG, PA 17110-2990 / "_ · 11....01_----.--.---- ~A . J .'.0000 ~D CJOOD.,I FOR I: 23 1. 318 1. 1. 1. EwI:O 1.0 2 ..0... 55 q I; 1.1' '1}.,,1 --18664 11S787 567 SI~ '-I : '", ; :'_ 0 \ - .-'" , --. ' ~. .....-- (') >\J~iUUW';;V< tS o' . f:1"~ g 1 _.. m ~j N) 0: ::n ~ 'C). l\) C? ~g ~ -, ~":') '0:)1 ~ C;'j) 0 ~ ~ cr)"~ {~ (') r- 0 "- i C1J ~ Q e "" f03 rn'- m R) I -o::S-m=':": g~:;;-o ; f\)~;; ('):!l ~ r-~: . 0 nl ~ia- ; ::T a :;,:? ';;:! ''::: ~ (J) m.D ... :0;' ~:J 0 m (:)~ o g g~~c ....0- ?\- ~ "l~, ~ C"o.. (J') IO~...\<: f\ , ,; ... .... "- I\",) N iF~~~t;)e73e"'~~ . D' II'- ~ ~ :.&'lo P.At.'!l'Jlrot'4 CIl/'?:E::':J 'J~ -..I" ~~ v ~ I awl ~n.."IlY"""'~'"^" t;).;;...... .;:a,. >V.Ql:jQ.. .l~~1~'W l~PK~.; "--'. I -{:E?~': i9H:i{~D:;.' > ~ ~ y I;; r :-: ~'_:~' ~ ~ ~ ~ :-, "':'" -I' :;. " - \ -; ; .~; ~: I ;' :: ~ J ;:; ~ ! r:- ~ s: . ~ c.; . I' ~ . . . .' c ;-.= .:~ ==~~~ f;~i;~~ n;; Jmmuu !l _~ 0 ~ ;; s ~ ~ ~ : ~ .c Q . I::; ~:I ~ lIJ '2 ';'. n ~ ~ t,1 :} ~ ~~~~~.~. ~~ ~ ~ ~~~:~~; 'l -.... .. ') . < ~~{:~ .. ... ~ .., .... ::c ~ .. ~ ~ ~; - ... -, .' r'- lease Note: Information written on a check using a Gel Pen may cause the information to not appear as part of the check image. View both front and back to print... ttps:/lhomebank.psecu.comlCheckImageslPrintView .aspx?11 072007000 10200056700140902 3/26/2008 [ i~" \) ~~ i...:'\J;c_. .f) Contract File Folder Name/Number EMETERY INTERMENT RIGHTS, MERCHANDISE, AND SERVICES PURCHASE/SECURITY AGREEMENT THIS AGREEMENT PROVIDES FOR PERPETUALIENDOWMENT CARE. 1'1 The und rsigncd. referred to as 'Purchaser', hereby agrees to purchase the Interment Rights, Merchandise and Services described herein, subject to acceptance and approval of the abov named cemetery, hereafter referred to as 'Seller'. I Middle: I I SSN: ;,'c' \~_, -T- , ,.t.+ILK t J 1,~r\1 I I I I I First: DOB: City: 1\1~, I" I )1', Email: I. 1',1' I\,,/,:,. j d.. I i...) I"::.,'" " , ' ,., ;.k't.. f', I 'vI. .,1,+' Stale: l " t. J Zip: , Telephone SSN: First: I I t Middle: DOB: / I Email: City: I I I I I I I I I I I State: I I Zip: Co-Purc ser: Last Name. (--) -- I I It II I I I I I Address: I I It I I I I I Dcceased Last Name: I'" I '". I., \" / {. j k;1 \ I.. ~ / ", 000: Burial Date: 'vI , DOB: /....-. Descripti of Illtermen! Rights to he used: i - 'o.\ ., Address: INTER sf~t . Inter ent Rights . _ ';. (1 nclu es Pe'fpetual/Endowment Care of $~.::.;z;..-\ 1 1 . I. v,.. . Inter ent and Recording Fees . Outer Burial Container $ ~ " y" ~ ~ (\ C..." .,~ '-j suppr r Mode Design Materi l/Color . Outer Burial Container Installation MEMO IALlZATlON . Mem Design Size . Memo ial P,~rpetual/Endowment Care . Memo ial Installation Fee . Memo ial Inspection Fee . Namep ate/Scroll . Letteri g . Flower Vase Supplie Typc/C llor Design Size. . Vase B se Sizc/M teriall Notes & P yment Terms (where applicable): " '.\ ,.:-.." First: I I Veteran: 0 I Middle: I leV" 1\ I ..; I I :,' Memorializatioll Rights: City: State: Zip: MERCHANDISE & SERVICES Urn Supplier Type/Color Design/Size . Admin/Processing Fee . Other . Other . Other . Other . Other . Other TOTALS, ALLOWANCES & TAXES . Interment Rights............................................................... ( Reason .~ :::..d""..";~\;;\~~..)( :::h7ndise/serVice ..............1'.\?.....~..~..~O,..~. Reason ~ Apply to "T Sub Total Total Taxable ::::----------. . Sales Tax (if applicable) ......................................./::.:... .... .'. ... .... <,') TOTAL CASH(PRICE $. :,/(,,". ., .-:-~-- ~. .-,-- Less: Down Payment Other Total Down Payment ( Unpaid Balance of Total Cash Price $ It ", II. _'~' \ TERMS J Cash Price is due and payable as of the date ofthis Agreement. A delinquency charge of .::::::=_ percent will be assessed monthly on any balance not paid within 30 days f the date of this Agreement. If less than full payment is received. Seller shall deduct the accrued delinquency charge from the amount received and credit the remaind r qf the payment to the Unpaid Balance. Security Interest: Seller (or its assigns) will have a security interest in the Interment Rights and Merchandise being purchased as described above. Seller will retain title to said Inte ent Rights and Merchandise until the Total Cash Price, together with any delinquency charges thereon. have been paid by Purchaser to Seller. NOTIC : By signing this Agreement, Purchaser is agreeing that any claim Purchaser may have against the Seller shall be resolved by arbitration and Purchaser is giving up his/her ri ht to a court or jury trial as well as his/her right of appeal. Signed his. ,,, , ~,~ / I' ;- Purchase : ~':1'1 <" /I./}/;)/; ~ f'~'/CT ! ~"ft .-"$ /...." " i .: " day of r", '.',' ".\ - "-_...(; . ~ .~ J ,20 r~1 i J \ ~~, :::.~; ,; ,:. './t ..'.~, ~,.{ ~ ,t.-. r':}htER/\~ Relationship: ,.-~"~ ,:\: -C ... -- dh.{;'J !{Ott t f~~ c~ lBn ;A'lU$l.! lID GRtEh CEl,'ETf:RY '::-A:"'r< Htu,,, I'A l1Qt Counselo set:, \ : 1./ ,''''', }I "'--\ \ r- "~ .' \ I , I \ , '\ \ IV '-. J ~}_!, J<..J' # Date:_I_I_ ...NQ1.le-E: Se~ther Side for Additional Terms and Conditions which are Part of This Agreement Internal Purposes Only Title: Relationship: Accepted by: I attest (hat I have reviewed thi'!' document for accuracy and completeness Co-Purch Print Nam : SM I I - Dale - Reviewer ignature: Date:_I------1_ ( alt~st that I have completed/reviewed this document as required by t.he Company's Samanc$ O~ley Key ControJs Checklist. Form: 220 PA (02/07) Distribution Scheduk: White = Cemetery Copy; Yellow = Customer Copy - ~ ~,"y e# ()~\ s1"'- .yY\ Page 1 of 1 --. - . -., --~ ~-- ------:--- ---- .. , -- -- - -..... '"'- - -- - - . ~~. HAROLD C. HOOVER. JR. 05-7S BARBARA J. HOOVER 1000 SWARTHMORE t NEW CUM8ERlAND. ~ . /J i f'''YlOJ'HE ~ CJ1j .-' ~OF 1_ 1I4l/!.M. 'uJ.J.;.).,,;,..~~ ~ 11~~ db rJ . ----~ Wh40 '717-77'l-3i/3rj ______ J ~ I~~r _.. !I' ~Oll102qS5~ ~~q2200?~50~5 ~OOOOl?q?OO~ ~~6"3 / / 5035 O"TE~ $'.1797, 00 DOLLARS ~ ;ar;= ........~..~..,~~.v. _._.~~~~~"~._.~_":.."""~._~._ ~-- - - - II U~ r PHI !i,~'1 j[1 il__lt~ I 1;11'111' HI!t, 'I :::' Ii 1111! . Ill:f ~ ~8 I P.lt ~ S&.. I ~ ~~.. _-...JJ #' ':'."' ..- .. ~~ .. '. .. -~- ~ ,I t ~ ~. f . ~ ! - . ... -. , - I . ; . . . t ( i Posting Date 2007 Oct 17 Research Seq # 5110002015 Account # 43922007 Check/Store # 5035 DB/eR DB Dollar Amount $1,797.00 Bank # 096 Branch # 06113 Deposit Acct # 0 http://pc-ncrwebl.mandtbank.comlinquiry/servletlinquiry 3/28/2008 ac HOLLIDAY'S ~oP imekiln Road umberland, PA 17070 (717) 920-3627 Fax (717) 909-1403 DATE: September 2, 2007 INVOICE # 902012007 FOR: Barbara Hoover TOTAL Serv d Dinners 1 $1,611.00 1,611.00 SUBTOTAL $ 1.611.00 Non-Taxed. Items GRAND SUBTOTl\l. $1,!:,11.0Q GRATUITY 20% $322.2!i 6'Yc TAX $96.66 DEPOSIT TOTAL 32,029.86 ----. . Charges (Please see reYerse br important irOOrmalion) 'j Balana! rate Periodic Corresponding ANANCE I Payments, Credits & Adjustments applied to rate APR CHARGE S1,532.4O 0.07712% 0 28.15% $36.64 \1 T A..o.I SO.OO 0.07112% 0 28.15% SO.OO ranscn.uons .- . ) 1 04SEP OOCHOLUDAY'S.NEWCUMNEWCUMBERLANPA AlPERCENTAGE RATE applied 1his period: 28.15% // 2 27SEP PASTDUEFEE Al Your Service 1..aoo.867.0904 To call QJstomer Rela1ions or III report a lost or sl/llen card: ... . N Payments & Credits J-( $O.~+C FINANCE CHARGE $36.64 Page 1 of 1 ur Account Infonnation T TAL. CREDIT LINE T TAL. AVAILABLE CREDIT C EDIT LINE FOR CASH \ A AIU~E CREDIT FOR CASH ...... cf!IoHassle REWARDS i I $1,188.29 ) .-/ $3.200.00 $1,188.29 $3.200.00 Se,nd payments to: Capilal One Banlt . P.O. Box1ll884 . Cl1arlol\e. He 28272-1l884 SeI,d inquiries to: Capi1al One. P.O. Box 30285 . Saltl.ake City, UT 84130-0285 FOI'IlIOIe information on your Rewards: VISit WNW.capilalone .com/miles!llwardS Call: 1-1100-228-3001 Have a ques1ion about a charge on your statement? Please refer to the BiUng Rights Summary on the back of your statement or visit www.capilaIone.comldisputes. Transadions New Balance )+l~~~~=3.15 )=L $2,011.71lC Due Date ) ~ '\ lOct. 27, 2007 ) 'i Rewards Summary PrevioUs available balana!: Earned this period: (reflec1s tansaclioI1S posted during 1his biDing Lj'CIe) Forfei1ed this period: Available Balance; 15,878 1,854 1,854- 15,878 51,B54.15 539.00 You were assessed a past due fee because your minimum payment was not received by the due date. To avoid this fee in the future, we recommend that you alloW at least 7 business days br your rriIlimum payment tl reach Capital One. 6056 004& 586 1 07 Z1 1I70~Z1 PAGE 1 of 1 COlRZ39R 01Jl1t68S6 10154870 PLEASE RETURN PORTION BELOW WIT\-I PAYMENT OR LOG ON TO WWW.CAPITAlONE.COM TO MAKE YOUR PAYMENT ONLINE 10" -- ....- .._,..... -' r(7 6"\ Ov-l 't- f. . ~ '-. -"7- Page 1 of 1 ".....-- ..;;;, .. ... -- ~~ .. - --- ---y ._-~"1l""'" '.:. -~-...:.-... _.........- , i rAY ronrE 0lt0E& lJ" HAROLD C. tiOO'IER, JR. QlS..7S BARBARA J. HOOVER 1000 SWARntMORE RD. NEW CVMBERtAND. PA 17070 .2956113 31) 5021 r ~ ~ . DAtt /d IlG:MO .L ~ ~1 Jf1tq ~~SI.'I4' .J..~~RS ta ~-::- --_--_ AUL-_ ~ ~ rmM!:t~ : ....._ 0... -:0 3 ~ :10 2 q 5 51: ~~q2200?~502' I000003a?,q~ _.- L................--.~..~~_-_....~-,.....~--.-;.~ ...:!t~~...._~-.-.....-.-:---=:w...~ ~ -" ...... · J J 'J~ , PI ij . ~. 'J II tliIii! il ,. . . .. i~"jjJI)1 . ~3';t!! . ~ f- ~l::O~~i.: I ..- 110 11-1 f f ~,~ 'ilf I ' Ilt.~ !. I Piil .!l' .. a>.: ~g 1:' ~ ~ r"'".............~_= ~ " , - "' 8 KTL 0400593300 R016 B!t .pl0 JO/JJI'2Q01 .....: .. )()3J . UlERRY . "' I L~ ~ = ....!". 0: 'i~ 9i ~ :xl ~ ~I:J, ('1 -'\J f? m : a -n [!! ~; -:J '"Z" ,?-.... ell ;;...... ."11 .,,~ '., ..... .....l~. l -;; :...., --:1- ..... ," -.." '.. iii {.-} """,: l"" "1' ....... c i ~ I) ~ ; .:: lR; :t: o!< ". .. U>> (.~. , ,i -~ ,I'll .., I ~ ,.. I r J '" ... .... -i 4.; ..at at , I . .1- ;. , r i ~-.....r:: i ~ ~F r-; . . . '.1'" . ...- .~-... - - - . 6 S 1... .: 1:... ~l:: -: ~ --""'- ---.-......... Posting Date 2007 Oct 12 Research Seq # 5109124667 Account # 43922007 Check/Store # 5021 DB/CR DB Dollar Amount $387.69 Bank # 096 Branch # 06113 Deposit Acct # 0 ht:tp://pc-ncrweb 1.mandtbank.comlinquiry/servlet/inquiry 3/2812008 Proof of Notice of Publication in Dauphin County Reporter 213 North Front Street, Harrisburg, PA 17101 Under Acts approved May 16, 1929, P.L. 1784 and April 24, 1931, P.L. 67, 45 PS. 1 et seq. State of Pennsylvania } County of Dauphin 55: Donald Morgan, agent of the Publisher of the Dauphin County Reporter, of the County and State aforesaid, being duly sworn, deposes and says that the Dauphin County Reporter, a legal periodical published in the City of Harrisburg, County and State aforesaid, was established January I, 1898, and designated the Legal Periodical for Dauphin County, on February 5, 1919, since which date the Dauphin County Reporter has been regularly issued in said County, and that the printed notice of publication attached hereto is exactly the same as was printed and published in the regular editions and issues of the Dauphin County Reporter on the following dates, viz: MARCH 14, 21 & 28, 2008 Affiant further deposes that he is the Agent of the Publisher of the Dauphin County Reporter, a legal Periodical of general circulation, to verify the foregoing statement under oath, and that neither the affiant nor the Dauphin County Reporter is interested in the subject matter of the aforesaid notice or advertisement, ant that all allegations in the foregoing s ts as to time, place and character of publication are true. Copy of Notice of Publication 28th DECEDENTS ESTATES .t4" j _ U , i...._~m1"'l~ Notary Public NOTICE IS HEREBY GIVEN that letters testamentary or of administration have been granted in tbe following estates. AU persons indebted to the said estate are required to make payment, and those having claims or demands to present the same without delay to the administrators or executors or their attorneys named below. day of ;; COMMONWEALTH OF PENNSYLVANIA Notarial Seal Joyce A. Tambolas, Notary Public City Of Harrisburg.. Dauphin County My Commission Expires Oct. 5, 2008 Member, Pennsylvania Association of Notaries ESTATE OF HAROLD C. HOOVER, JR., lale of New Cumberland Borough, Cumberland County~ Pennsylvania (died August 30, 2007). Admmlstralrix: Barbara J. Hoover, 1000 Swarthmore Road, New Cumberland, PA 17070. m I 4-m28 Statement of AdvertisingS=osts: Estate of Harold C. Hoover, Jr. For publishing the notice or publication attached hereto on the above stated dates, , . . , . . " $ 70.00 Probating same. . , . . . . . . . . . . . . . . . . . . $ :; 00 Total. . . , . . . , . . . . . . . . . . . . . . , , . . ,. $ 75.00 Publisher's Receipt for Advertising Costs The Dauphin County Reporter, a legal periodical, hereby acknowledges receipt of the aforesaid notice and publication costs and certifies that the same have been duly paid. By RONT/BACK CHECK IMAGE VIEW ,:.:: 1/u ~L flhg ~ i .' PSEr~ ~~,.~W -- \.'P ~~ Check #0154 BARBARA J HOOVER PH. 717-774-3434 1000 SWARTHMORE RD. NEW CUMBERLAND, PA 17070 HARRISBURG. f\\ 17110.2990 fOR J/II,fPlb- f3 ~r:;: jVlfTl$ _: 2:1 3. :1S 3. . U;'I:O .5.. 1"0" 5 5 CU;' 3. ?? 3.11- r r""'- .' 5592 031388 524 152 Page 1 of 1 iI 154 31o~y ~"m:lI I $ 7S:n; Q 'hOll",. DOllARS l!J e-'~-:" M> ~ i 1 ~ ... . :; :; ; , ' : ! ~ ';r ~ ' .:.. - =- ). ., -- ,.... ..... :~ : ~ ....' c- .... (-~ t.., .-; ) ...... ....., t::. ' - :.: .:: i , t.' .' ". ';', ...~... :~:. '-:-.) ~ 4 0;-- '.. . . .:~ ~:; ..... ~t..~ ."000000'( 500." !J C f,... ~ C .." _J ...;, .... "'C 0 '.'; " " 6 ~2::a - ~~ :... N~O :0 .... "'" r.'l "';'Io!:S :~ .... ~co c,.:)='cn t.;1 ~~ ':- . -a..::DO ~Z t.... Q!< - "':,.) ? - CD - C... r .; ;; .:. lease Note: Information written on a check using a Gel Pen may cause the information to not appear as part of the check image. ,'~ - = .:J _ . ;1 ~~:! ttps:/ lhomebank.psecu.com/CheckImageslPrintView.aspx?03132008000 15400052401520902 , .~ ... 'i ~; .:. -.... ~ ;. ;,. ~.'=J: i; .: ~ . :,; ~ ~~~~ii~ n . . ~ '. :-; ~~ :.: ;: ;-..=' . :.i t~t.~}~i ~ Ii i ., , . ~ ,_ _ '" vlim;~ ~~, .~~: . ~~~4j31t~~3 ~3~1" a68-0~nr :. I . .. .. .- . ..I ~ .:~J.l. ,'" , . ,.. ... t .... . ..... ~.) '-- 3~:{~f€~~t[~ i 9 i. ~ ~.i~.~ .;. .~:.~ View both front and back to print... 3/26/2008 Page 1 of 1 -~ Butch Hoover From: Butch Hoover [butch@hooversport.com] Sent: Wednesday, March 05, 20086:54 PM To:: 'thepaxtonherald@verizon.net' Subject: Estate Notice (3 We.J:a) n you run this legal notice please? P ease inform me if this can be run and if there is a charge, let me know. ank you, B rb Hoover 7 7-774-3434 ESTATE NOTICE Letters Testamentary in the Estate of Harold C. Hoover Jr., who died 30 August 2007, late of New berland Borough, Cumberland County, Pennsylvania, having been granted to the undersigned, all p sons indebted to the said estate are requested to make immediate payment and those having all claims will pr sent them without delay to: B bara J. Hoover, Administrator, 1000 Swarthmore Road, New Cumberland, P A 17070 No virus found in this outgoing message. Ch eked by A va Free Edition. Ve ion: 7.5.516/ Virus Database: 269.21.4/1312 - Release Date: 3/4/20089:46 PM 3/2 /2008 /" ..,,~ 4H~11 (~~~ ;mid .JV/ ;lped-,f(, 9 !uJA2iZJ~ KJI//~A~ J1At-~; --- i .' \~J" ~;~i.(J' -.' .J' J '.' '~flfVXl-" i () f ./i/.Iur . IjJ . ' :5' ESTATE NOTICE Letters Testamentary in the Estate of Harold C. Hoover Jr., who died 30 August 2007, late of New Cumberland Borough, Cumberland County, Pennsylvania, having been granted to the undersigned, all persons indebted to the said estate are requested to make immediate payment and those having all claims will present them without delay to: Barbara J. Hoover, Administrator, 1000 Swarthmore Road, New Cumberland, P A 17070 Please submit a check in the amount of $75.00 with this form. Checks should be made payable to: The DAUPIDN COUNTY REPORTER Return to: 213 North Front Street, Harrisburg, PA 17101 NOTE: Estate notices are automatically run for three (3) consecutive weeks. You must also publish a notice with a paper of general circulation. You must also mail a CODY of the notice to one of the foUowin2: Two newspapers of general circulation (pick one) in Dauphin County: Patriot News P.O. Box 2265 Harrisburg, P A 17105 (717) 255-8121 Paxton Herald 101 Lincoln Street Harrisburg, P A 17112 (717) 545-8762 -y- PRENEED COUNSELOR SALES RECEIPT ROLLH'-JG GREEN CEMETERY COMPANY 1811 CARLISLE RD CAMP HilL, PA "17011 7'j 7 -761-4055 624 No,0007"i81 R E1VEDF~I~{tl.. -=cJlaO-Jd AMOUNTOFwx...~~Q~L~h1.,.7Jof~~~, l~DOUARS ~ A : DOWN PAYMENT 0 REGULAR PAYMENT 'fj(. , ~.c.q CREDIT CARD CHARGE 0 CASH 0 CHECK ~ CARD TYPE 0 DATE 10 - (S-C)~_ BY ABOVENAMEDCEMETER~ FOR THE PURCHASE OF INTERMENT RIGHTS AND/OR MERCHANDISE AND E G N 8002 (6102) ---- IMPORTANT NOTICE NOTICE OF ESTATE ADl\IINISTRATION PURSUANT TO Pa. O.C. Rule 5.6 TIDS NOTICE DOES NOT MEAN TRA. T YOU WILL RECEIVE ANY MOt-,TEY OR PROPERTY FROM THIS EST A IE OR OTHER W1SE Tt71ether you will. receive any money or property will be determined wholly or partly by the decedent's will. If the decedent died without a 'will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WlLLS, COUNIT OF (' Lt I'l l-)t' I' i (~ IKiL , PENNSYL V..6.NIA IN RE: ESTATE OF rfi,h' L L CJ t Ii [; ;_~ :' ..: , J eo . Deceased File Number ~C (, 1- '- c .~:} ,-{ TO: [~ H~,,-~- r; ih? Jot ' rl Dt t( ~. JL i(:~ _' ::>t.l.-'H-,tZ-M-t )nio~.-t:. n~ JL.fii,i" (';"u.o-?i'~i~{-l(.::. :-}.:4 /)11 (Beneficiary ) '1~: i- (Address) Please take notice of the death of the Decedent and the grant of Letters to the personal representative(s) named below. The Decedent died on the day of ilL! {' U :, j S: c_" 1 , a resident of (-..\ Illl)r f l-tj-'H) County, P A. The Decedent died: testate (with a will) or ~intestate (without a will). Yau may have a beneficial interest in the estate as follows: _ tv i \--6' - :'::.\J( u S'.i..,. (If additional space is needed, use separate sheet) The na.'11e(s), addressees) and telephone number(s) of all personal representatives appointed are: N..t\.\m} ADDRESS ,'_, .. TELEPHONe, ,. . ~i+iL~J;~ti T 'jll"v'c:r itf{l.) .::tii.:t---f-li,j},',.<i.Ak.-J IV$:.u./ {~({/J.usl"/L/f1u)l PN /70/0 7/7- 71y- 3<1' :JSy If the Decedent died testate, the will has been filed with Office ofthe Register of Wills of County . If the Decedent died intestate, a Petition for the Grant of Letters of Administration was filed with the Office of the Register ofWiUs of (A\. !l1l!l( I { it I ,f) Coun!";'. TheRegister'saddressis I!;(CS,J, -\.tlhl<.C' I. DC 1'-'<:.... (~\.-~!lit').:;,~(t;'.'I. /1-1 ile Ie , and telephone number is 71 7 - II tf. '5 Y 3;'; A copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the charges for duplication. . Date I Ir It. :i "f\-- . :t.;,1-/~f.!ltJ:.. J :', .tt;.h '-"~ I I Signature of Persall Filing this Form '~L, F:' -- S f'< \.A..":" l'\ Ai l~)rhZ It -:+' \'~l L'c 1;;: i P Name of Person Filing this Form. leu \L.J~i ~h Yilifl ( Address JUt..- elL H("~bL .t,-( S'c l~: ~S()f..v. S,S Capacity: JZI Personal Representative a Counsel for Personal Representative ()(. .1 r/If J 7(, 7C -~7/ ~I -- iI' .J Vi/". I"~ ~/;. -,/ "(.;," -~"") v - ~ ." --".01 / Telephone F017n RW-07 rev. 10.13.06 ; ,tv, t ~J\\ l\ '-, '/ ,,(/ - i L /j s/Jo;r {yL-U'ivtUv'I (ILi!,! ~i" . I ,- . G~ \)~woiu1 n s f {f'~ U.S. Postal Service"" CER-r:IFI~D MAILm RECEIPT (DomestIc Mall Only; No Insur~-C~rage Provided .:r ru ru o /T1 P- U"1 P- Certified Fee $2.65 $0.. 02 March 3,2008 o o Return Receipt Fee o (Endorsement Required) o Restricted Delivery Fee o (Endorsement Required) r-'l P- O Postmark Here Barbara J. Hoover 1000 Swarthmore Road New Cumberland, P A 17070 Total Postage & F~s $ Sent To ~ si;eei.APTNoif!!:!i1ltll.J!..:.- _____'!I!.fi!!__________ P- '!:_:_~_~~_"!r:_ / () 00 511./ f}J<. - J._ N26 L/ ,\ _____.m_._._____ City, State, ZJP+41Vi:;;--Z;-;;;~f>>'-'T7~~---"----"---'----" .. . :"'. If. $0.00 $3.06 0310512008 Barbara J. Hoover 1000 Swarthmore Road New Cumberland, P A 17070 I, Barbara J. Hoover, Executrice of Harold C. Hoover Estate, am writing to inform you that you may be entitled to inheritance from his estate. I will contact you if you are entitled to any portion of his estate. Sincere~~ 1IL- Barbara J. Hoover, E;Jnce ~ , '~ ,~ March 3,2008 Barbara J. Hoover 1000 Swarthmore Road New Cumberland, P A 17070 Barbara J. Hoover 1000 Swarthmore Road New Cumberland, PA 17070 I, Barbara J. Hoover, Executrice of Harold C. Hoover Estate, am writing to inform you that you may be entitled to inheritance from his estate. I will contact you if you are entitled to any portion of his estate. Sincerely, , I I ' I /__ ,'(',/_1.. <....- <<(.. --h ii f" /Cf...{ '1- l.~.....~.~~,,___. Barbara J. Hoover, Exe,cutnce I"~ ' ", ~'i. J'{ \: , ..j~ 0:::V i~\~j ~ 3/;/#;' ,j ) , Jr' (0 i)€...~ Sf ;'C;f {Jt1~J U.S. Postal Service'11 CERTIFIED MAILr' '"RECEIPT (Domestic Mail Only; No Ins~ra,,;;'~Co,V(~rage Provided) March 3, 2008 M rn ru a rn f"- Ul f"- a a a a a M f"- a Certilled Fee . . 02 Return Receipt Fee $0.00 Postmark (Endorsement Required) Here Restricted Delivery Fee $0.00 (Endorsement Required) Total Postage & Fees $ $3.06 ~/OS/2008 Barbara J, Hoover 1000 Swarthmore Road New Cumberland, P A 17070 Sent To .A...,., ~ ><--m----.-__f1..__fl(!.Lfej/J~ ~ iJ 612- a ~:r~~.:::.::.; '-17 t. I J. - , . Tu~>>-m--::;---.-.---------u--u---u- f"- -----m--__uu____mu____1Ll.. C d4/J. 5' City, State, ZIPS'1J 7j;; u-Pii---""j7/ij--------u----------- . . :"'. ". - ~ ... - - . Amerika S. Hoover 476 HigWand Street Steelton, P A 17113 I, Barbara J. Hoover, Executrice of Harold C. Hoover Estate, am writing to inform you that you may be entitled to inheritance from his estate. I will contact you if you are entitled to any portion of his estate. SinCerel,::1Y"; /., /:1J~~ -:1' Barb~J. Hoover, E#tl ~ v~ t for 80001lr.t number: 5466 6320 3284 2334 New Bala. Payment Due Date Past Due Amount Minimum Payment S6.275. 09/22107 $0.00 S125.00 CHASE 0 1$ l Make your check payabte to Chase Card Services. New add.ass O~ tl-mail? P1inlon back. i y..antto pymha8e OQlional Pay men Protector Plan'. I have read the enclosed offer and rr.ay cancel any time. -mwaTs.-- - ---ulYal{i- 5466 3203284233400012500006275835470824 SEX Z 24507 0 IAROLD C HOOVER JR 000 SWARTHMORE RD EWCUMBERLND PA 17070-1729 1",111.1.. '..1.1..'. .11.. .1.1... .11.1.1.. .11. .1.1. ..11..11..1 CARDMEMBER SERVICE PO BOX 15153 WilMINGTON DE 19886-5153 1...111...111...1...111... ".111. ..1..1.11.1. .11.. .11111.11..1 I: 5000 . b 0 281: 2 :1 ? 20 :1 2 B l. 2 :1 :1 ~ 5 U. Opening/Closing Dale: Payment Due Date: Minimum Payment Due: 08/03107 - 09102107 09122107 $125.00 CIJSTOMER SERVICE In U.S. 1-BOO-945-2000 Espanol 1-888-446-3308 TDD 1-800-955-8060 Pay by phone 1-B00-436- 7958 Outside U.S call collect 1-302-594-8200 Previous Payment, rediis Finance C arges New Bala ce CARD ACCOUNT SUMMARY Account Number: 546663203284 2334 S6 74319 ACCOUNT INQUIRIES -55' 00'.00 Total Credilline 514.500 PO. .Box 15298 532 64' Availahle Credit S8224 WIlmington. DE 1985o-S298 +. Cash Acc"!s$ Lint? 5 14.500 S6.27583 . -A,<ailal>le tor C"sh S8.224 PA YMENT ADDRESS PO Box 1:.153 INlimiroglon. DE 19886-5153 VISIT US AT: \\"::w .dl,:SE:.'~<.1Iiiicreditcl:lrds REW A OS SUMMARY Previous points balance Points e med lor finance charges Points e rned on purchaReS Tolal poi Is 8>:pired this period New lotr points balanCE: 1 119 33 o 49 Li03 I 0 r8,~l=~q~ /CLf pOInts .:.:.!~ trl8 !j:.,..l1:-;D~r on th6 back of your card or loy on to www.chase.comfcroollcards 46 poirli to 8)<pire on stal.:ment date in Odob"'f 2007 Trans Date Merchant Name or Transaction Description Amount Credit Debit I 08114 1 2.'?642QOOOOOOOO86999 PAYMENT - THANK YOU $500.00 E CHARGES Daily Periodic Rate Corresp. 31 days in cycle APA V .03901"/" 14.24% V .06641% 24.24% V .03901%, 14.24% .01641% 5.99% .01093% 3.99"/" Average Daily Balance 5214.94 50.00 50.00 55.490.38 $622.86 Finance Charge Due To Periodic Rate 52.60 50.00 50.00 527.93 $2.11 Transaction Fee 5000 5000 50.00 $000 $0.00 Accumulated Fin Charge SO.OO 5000 5000 $0.00 $0.00 FINANCE CHARGES 52.60 5000 50.00 $27.93 $2.11 - - - - - Return Mail Operations PO Box 14411 Des Moines, fA 50306-3411 1111,1111I 1111I1111I11I11.11.1.11.111111.1.11.111..11.11I.1.1 o 527,11 AS 0.341 7274'015274,007274072 01 ACtJOCW 70R E TATE OF HAROLD C HOOVER C 0 BARBARA J HOOVER 1 0 SWARTHMORE RD W CUMBERLAND PA 17070-1729 111.11I11I11111I111/11111/11111I11I1" I .11.1" II." II" '11\..\ 1 'I )yiYP~'( J+11f J/ J property Address " $649.02 11000 SWARTHMORE RD ~ $0.00 I NEW CUMBERU\ND PA 17070 $649.02 j Unpaid Principal Balance 541.064.65 I .,.." . . -...... __.....,.~.. ',' ,- .rr~.--. ....,...,.*-r"""',.. .....:0.., ,~;. .,-,' ''''',' "':Z. ~- ..~.~,..~/I:..: . f ......J ,--,... \.......-.~I ,,- ...~ . ~~ .. .' -.' ........-. ...-.... '-- . SO.cq . ---. c.O ~,1 Interest Rate .. ~ ::C', sn,vf Interest Paid '(uNo.Date :~ ~~~..:: .l \J.O Taxes Paid Year-to-Date ~..: I" 1.':': ; $649.0 Escrow Balance 3;~~;: i Summ ry Pay men (Principal and/or Interest, Escrow) Optional Pi"oduct(s) Current onthfy Payment TOTAL AYMENTDUE 12/01/07 Activi Since Your Last Statement Date 0 crlp,tion Total Principal 09/21 P INCIPAL PMT SO.98 SO. 98 09/21 P YMENT 5049.02 5258.69 Interest 5167.88 Please aelach ana Mum with your payment Loan Number Current Monthly Payment Due Total Payment Due 12/01/07 After 12/16/07 Add Late Fee Total Amount Due After 12116/07 heck here and see everse for address orrectlon. ESTATE OF HAROLD C HOOVER "----, ---_.__..__._----~_._,."._.-.~-----~./ Late Escrow Charge Other Monthly Mortgage Statement 0912~ "', '-, ..-J IN;J;J(j 961 ,.~, .: ...) ''i ,;., Statement Date Loan Numbe;-- Customer Service ~ Online wellsfargo .com m Telephone (866) 234-8271 ~ Fax (866) 278-1179 19 Payments PO Box 11701 Newark NJ 07101 TrY Deaf/Hard of Hearing (800) 934-9998 Correspondence PO Box 10335 Des Moines IA 50306 7274 Q15274 007274 072 01 ACMDCW 70J) 11.\.1111\11\11111.1.1.1.11\1111.11.1.11.1.1.11.11.111111..111 WELLS FARGO HOME MORTGAGE PO BOX 11701 NEWARK NJ 07101-4701 II 111I 11lI11lI1I 1If1 II II II .11I1I1lI1 1111I. 1111I1 II I 11I11I ,,1.1 5222.45 0033612961 $649.02 $649.02 $21.33 $670.35 Important :\Iessages REALIZE YOUR HOME FINANCING GOALS Pl;rchaslng a home? liVe have a Wells Fargo Closing Guaranteesm Looking !o shorten your term, looter your ra!e or cash-out equity? With the Wells Fargo Three-Step Refinance SYSTEM@ there are no clcsi.....;: ::JS!S. a:::'::,"a:S2i c~ a::,ollcation ~ees. ~ss:..:::-:.,.,: e::c. :; _s -::;.. ,:~:::' s a-: 866-846.9111 YOU COULD SAVE THOUSANDS ON YOUR MORTGAGE Coer a ',-= 3 ==..~:;:,-:-= ::;;~::E::~ :....:;:.::: Ca:::: a:::: s=."- :: ~:: "~::;:7:- .' :_.. ::......:'"'!ases to\,liar: ~;:__" . e- :: =:"";: -':~s ..',:.....:::5::e principaL Ca 888-333-1228 :- . 5: ;.\ielis Fargo BanKS- :::a: :: ea-- - :-e a-: cDDly' DO YOU REALLY NEED 1.1 ORE PAPER? Go green' PL.t an Eor::: :a:'O- s:a:a'i,ents and enjoy free, elec:r:J"': :a: -3-:5 ;:::or improved safety ana Don .e~e~: 5-. . :L.r statement is currently avaiia:,e :- '-'0 anytime. Sign on to yourwellsfargomortgage.com to enroll and stop paper today. 015274/007174 ACUOCW 721d ETM1COl"D 1 L 1\ ~ \ -~--- _~__,...,..., "en....nnnnnnn nnnnnnnrJnc:t1, I nC,D,:llJ 1 .... , N Payments & Credits FINANCE CHARGE $0.00 H $87.78 f+( $87.78 J I. 2B, 2007 - Aug. 27, 2007 Page 1 of 1 isa Business Card Account 791-2424-0514-3066 our Account Information OT AL CREDIT LINE OTAL AVAILABLE CREDIT REDIT LINE FOR CASH VAllABLE CREDIT FOR CASH flNoHassle REWARDS" $3,200.00 $3,118.08 $3,200.00 $3,118.08 anee Charges (Please see reverse tor important information) . Balance rale Periodic Corresponding FINANCE applied 10 rate APR - CHARGE $0.00 0.07712% 0 28.15% $0.00 Ca $0.00 0.07712% D 28.15% $0.00 . A NUAl PERCENTAGE RATE applied this period: 0.00% AI Your Service 1.800-867-0904 T G caU CustOOl8r Relations or 10 report a loslor slolen card: SeII1d payments to: Capital One Bank' P.O. Box 70884 . Charlotte. Ne 26272-0884 Send inquiries to: Capital One' P.O. Box 30285, Sa/I Lake City, UT 84130-0285 & ~ For more infonuation on your Rewards: Visit: Yo'ww.capilalone.comlmilesrewards Call: 1.800-228-3001 Transactions Due Date r Sep. 27, 2007 i i+1 l I $81.92 $10.00 -1-. I'\fASE PAY AT W\Sl nus AMOUNr Rewards Summ~ Previous available balance: Earned \his period: (reflects lransactions posled dlRing lhis b~ling cycle) Available Balaoce: 15.796 82 15,B78 ~mel!t~Credits & A~ustments 1 18 AUG ACH PAYMENT $87.78- T ranS8<!.t!.<!!'\s 2 21 AUG TEAMWORK ATHlETIC 800-345-3482 CA 3 21 AUG REACH SPORTS 586-978-7050 Ml $42.26 $39.66 6056 0048 506 1 07 27 070827 PAGE 1 of 2 COlRZ59A 01D1I6056 79412 PLEASE RETURN PORTION BELOW WITH PAYMENT OR LOG ON TO WWW.CAPITALONE.COM TO MAKE YOUR PAYMENT ONLINE Ca ib.'JIOne'! what's in your wallet?' Ne Balance Minimum Payment Due Date 81.92 " $10.00 \\ Sep.27,2007 !! !: PLEASE PAY AT LEAST THIS AMOUNT A ount Enclosed Ca ital One Bank p. . B,ox 701184 Ch rlotte. NC 211272-01184 'I" .11 1111111,1111,1,,1,11I11I1111,1,,1111,,11,,1,,1,,1111I11 1,1'11"1,11,, ,111'111 o 4791242405743066 27 0081920087780010002 Account Number: 4791-2424-0574-3066 Please print address or phone number changes below using blue or black ink. Address Home Phone E-mail address Alternate Phone @ 190240859783564871 MAIL ID NUMBER HAROLD C HOOVER 7~412 HOOVERS SPORTS EQUIPMENT 1000 SWARTHMORE RD NEW CUMBERLAND. PA 17070-172~ 1...111." III, 11111 ,III." ...111...11,1,11,1..11'1111'11111,,1 Please rite your account number on your check or money order made payable to Capital One Bank and mail with this coupon in the en dosed envelope. Harold C. Hoover Jr. Medical Debts for 2007 MEDICAL SERVICES _.__. _ W'_' ~_. DOCTORSITHERAPY _._--~~- -.-.. RX and MEDICAL SUPPLIES ------~-_._._-- ---_.~-_._._--~----_.- (reg~i Rt~) ... TOTAL SUB-TOTALS . _,_ ~~____'_~53.34 $999.61 $1,852.95 -' ...-- _.-_.._.--..__._._.~-~-_. VB M8!T BanJ.r =::~ . .. ACCOUNT NO. ACCOUNT TYPE , ,. STATEHEHTPERIOD AUG. 04-SEP. 04,2007 43922007 RELATIONSHIP CHECKING 00 o 06113H NH 017 6.5161 HAROLD C HOOVER JR OR BARB HOOVER 1000 SWARTHMORE RD NEW CUMBERLAND PA 17070-1729 HIGHLAND PARK ACCOUNT SUMMARY ECINNIHG BAL.ANCE DEPOSITS & OTHER ADDITIONS NO. I AMOUNT 71 1,669.65 CHECKS PAID NO. I AMOUNT 131 1,361.71 OTHER SUBTRACTIONS NO. -, AMOUNT 2 I 2.5 . 00 167.46 ~TI* D TE ACCOUNT ACTIVITY DEPOSITS, INTEREST & OTHER .flDDTTIONS CHECkS & OTHER ' SUBTRACTIONS TRANSACTTONDESCRIPTION 08-~4-07 BEGINNING BALANCE 08-~6-07 CHECK NUttBER 4982 08- 0-07 PA TREASURY DEPT PAYROLL 08- 0- 07 CHECK NUMBER 4983 08- 0- 07 CHECK NUMBER 4984 08- 4-0'7 DEPOSIT 08- 4-0:7 CHECK NUMBER 498.5 08- 6-0~7 DFAS-CLEVELAND FED SALARY 08- 7-0~7 PLA FIT HARRIS NENBER PAY 08- 0-0,' CHECK NUtfBER 4986 08-~ 1-07 DEPOSIT 08- 1-0i' CHECK NUMBER 4987 08-" 1-07' CHECK NUMBER 4989 08-22-07' CHECK NUtlBER 4988 08-2~-07' CHECK NUttBER 4990 08-2't-07 PA TREASURY DEPT PAYRDLL 08-2a-07 CHECK NUttBER 4993 08-2~-07 CHECK NUNBER 4991 08-3D-07 DFAS-CLEVELAND FED SALARY 08-30-071 CHECK NUNBER 4992 09-0 -07,CHECK NUNBER 4994 09-0 -07;SERVICE CHARGE 09-0 -07 DIRECT DEPOSIT REBATE 266.23 4.5.00 370.43 400.00 266.23 319.76 2.00 ENDING BALANCE CHECKS PAID SUHHARY 4982 4 85 4 88 08-06-07 08-14-07 08-22-07 70.00 200.00 90.82 4983 498& 4989 08-10-07 08-20-07 08-21-07 44.39 100.00 87.90 L008A 6/07) 4984 4987 4990 CURRENT INTEREST PO 0.00 70.00 44.39 20.00 200.00 15.00 100.00 100.00 87.QO 90.82 2.5.00 300.00 70.27 178.20 75.13 10.00 08-10-07 08-21-07 08-22-07 PAGE 1 DF 2 ENDING BALANCE 450.40 I5AILY BALANCE $167.46 97.46 299.30 144.30 514. 73 499.73 399.73 611.83 i 496.01 762.24 462.24 391.97 "533.53 --. ~ $450.40 I 20.00 100.00 2.5.00 p.o. Box 67013 (717) 234-8484 (Harrisburg) Horrisburg, PA 17106-7013 (800) 237.7328 (Nationwide) website - http://www.psecu.com 4 JOINT OWNEI3 HAROLD HOOVER BARBARA J HOOVER 1000 SWARTHMORE RD NEW CUMBERLAND PA 17070-1729 STATEMENT DATE 08/31/07 Ending Balance Dividend YTD: Year to Date 1987.25 4.95 ===========~======~===========================================================~=========== *** ANNUAL PERCENTAGE RATE 12.900% Eff Description ID 01 PSL LOAN (Open End) Beginning Balance Ending Balance Credit Limit 6875.00 Credit Available YTD Finance Charge: Year to Date *** Periodic Rate (Daily) Principal FIN CHG Fees .035342% Balance 0.00 0.00 756.98 0.00 ==~====~==============================================~====================================== *** ANNUAL PERCENTAGE RATE 5.490% t Eff Description 1 ID 10 1999 FORD EXPEDITION Beginning Balance o Payments Transfer From Share 04 *** Periodic Rate (Daily) .015041% Principal FIN CHG Fees Balance 5324.69 146.76- 11.21 5177.93 08/ 4 J081 1 Payments Transfer From Share 04 147.07- 10.90 5030.86 5030.86 Ending Balance A Payment of 157.97 is due on 09/07/07 YTD Finance Charge: Year to Date 226.94 ===,=============================================================================~======= Total Dividend YTD: Year to Date 25.22 II Total YTD Finance Charge: Year to Date 640.63 /~: .: j..... "'} / to 1./";) j.}' C/f v/'::;' t ,-~ ..---- Rc~tular Checking ACCOUllt Statenlent flJQ S Fo 24-hour information, sign on to PNC Bank Online Banking on pnc.(:om. ACCOl nt number: 514028-3121 - continued Onlin and Electronic Banking Deductions Date Amount Description O~~/01 "\' 5.9.5 (~orpor~'e ACll Collection Alller'ican Expl'css 2370373813 For the period 08/15/2007 to 09/13/2007 HAROLD HOOVER Primary account number; 51-4028-3121 Page 2 of 2 There was 1 Online or Electronic Banking Deduction totaling $5.95, Daily .alance Detail Date mV15 08/1G Balance 1,700.77 1,753,77 Date 08/20 08/:'1 Balance 1Gf';J,!l9 "'-"l,m~, -",.~-- - Date 09/04 Orl/13 Balance 1,:1I0.lH 1,2.'t.!.'IG Pick up fl bilingual Sesame Street "Happy, Healthy Ready for School" kit at any PNC Bank bmnch. It's all new and FREE. Elmo ar d fril~nds tum everyday moments into fun learning opportunities. Includes a DVD, a magazine for parents and caregivers, an activity book an activity cards. \ 0111' '", l.' 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