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
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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.
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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/ '"
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PH. 717~17<H434
1000 SWARTHMORE RD.
NEW CUMBERLAND. PA. 17070
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BARBARA J HOOVER
ptt 717-774.3434
tooo SWARTHMORE RD.
NEW CUMBERLAND. PA 11070
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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
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SSN: ;,'c' \~_,
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DOB:
City: 1\1~, I" I )1',
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City: I I I I I I I I I I I State: I I Zip:
Co-Purc ser: Last Name.
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Dcceased Last Name:
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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"
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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):
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First:
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Veteran: 0
I Middle: I
leV" 1\ I
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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 .~
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:::h7ndise/serVice ..............1'.\?.....~..~..~O,..~.
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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
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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. ,,, ,
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...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
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HAROLD C. HOOVER. JR. 05-7S
BARBARA J. HOOVER
1000 SWARTHMORE
t NEW CUM8ERlAND. ~ . /J
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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:
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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
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$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
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HAROLD C. tiOO'IER, JR. QlS..7S
BARBARA J. HOOVER
1000 SWARntMORE RD.
NEW CVMBERtAND. PA 17070
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Bank # 096
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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
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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-
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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
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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
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S'c l~: ~S()f..v. S,S
Capacity: JZI Personal Representative
a Counsel for Personal Representative
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CER-r:IFI~D MAILm RECEIPT
(DomestIc Mall Only; No Insur~-C~rage Provided
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Certified Fee
$2.65
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March 3,2008
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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~~---"----"---'----"
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$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
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,j ) , Jr'
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U.S. Postal Service'11
CERTIFIED MAILr' '"RECEIPT
(Domestic Mail Only; No Ins~ra,,;;'~Co,V(~rage Provided)
March 3, 2008
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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-
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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
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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\
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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
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Elmo ar d fril~nds tum everyday moments into fun learning opportunities. Includes a DVD, a magazine for parents and caregivers, an activity
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\ 0111' '", l.' Hank \'isa Cheek <':anl oilers cOD\'cnieuec aud ("ewards. Use your card to set np automatic bill payments withollt stamps,
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