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HomeMy WebLinkAbout09-23-09 (2)___ _ J 1505607121 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number Poeox28oso1 INHERITANCE TAX RETURN 2 1 0 8 0 4 4 1 Hanisburg PA 17128-0601 RESIDENT DECEDENT ENTER DECEbENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 7 4 2 0 9 6 4 8 0 3 2 6 2 0 0 8 0 9 3 0 1 9 0 5 Decedent's Last Name Suffix Decedent's First Name MI H O O V E R F R A N C E S D (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW ^ 1. Original Retum ^X ^ 4. Limited Estate ^ ^ 6. Decedent Died Testate ^ (Attach Copy of Will) ^ 9. Litigation Proceeds Received ^ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Retum ^ 4a. Future Interest Compromise (date of ^ death after 12-12-82) 7. Decedent Maintained a Living Trust _ (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death ^ between 12-31-91 and 1-1-95) 3. Remainder Retum (date of death prior to 12-13-82) 5. Federal Estate Tax Retum Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CDNFIDENTIAL TAX INFORxwTIaN snouLU tit unttu r to I u: Name Daytime Telephone Number S T E P H E N L B L O O M 7 1 7 ~4 9 2~ 5 3 ..1~ Firm Name (If Applicable) ~ ..o ' ' REGISTE'~ILLS US LY ,~ ,~ I R W I N & M c K N I G H T P C ~~ n ~° `'!' `' First line of address :~' ~ c ~ w ' ~~--~ 6 0 W E S T P O M F R E T S T R E E T ::~>©~~ ~ -- -~ Second line of address ~-~ ~ o t' r r Clty Or Post Office State ZIP Code DATE FILED r C A R L I S L E P A 1 7 D 1 3 Correspondent's e-mail address: Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of nhy knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer his any knowledge. 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HOOVER STREET ADDRESS 442 WALNUT BOTTOM ROAD CITY CARLISLE STATE PA ZIP 17013 Tax Payments and Credits: ~• Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments _ C. Discount 3. InteresUPenalty if applicable D. Interest E. Penalty 0.00 0.00 Total Credits (A + g + C) (2) 0.00 Total InteresUPenalty (D + E ) 4. If Line 2 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 1 + Line 3 is greater than Line 2, enter the difference, This is the TAX DUE. A. Enter the interest on the tax due. (3) (4) 0.00 (5) 0.00 (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : ...................................................................... b. retain the right to designate who shall use the property transferred or its income; ............................... c. retain a reversionary interest; or ................................................................................................. d. receive the promise for life of either payments, benefits or care? ........................................................ 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receivin ad uate consideration 3. Did decedent own angin trust for" or payable upon death bank account or security at his or her deat ~ ^ " h? ......... ^X 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. ~ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN For dates of death on or after July 1, 1994 and before January 1,1995, the tax rate imposed on the net value of transfers to or for the use df the surviving spouse is three (3) percent [72 P.S. §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 p2 P.S. §9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for discldsure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §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. §9116(1.2) (72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P,S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. 0.00 REV-1512 EX + (12,03) ' SCHEDULE 1 COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, IN REST DENT DECEDENTRN MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER FRANCES D. HOOVER 21 08 0441 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. INTERNAL REVENUE SERVICE - 2008 INCOME TAXES 29,680.00 2. SPA DEPARTMENT OF REVENUE - 2008 INCOME TAX'1 ES TOTAL (Also enter on line 10, Recapitulation) I S (If more space is needed, insert additional sheets of the same size) 95.00 775 REV-1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER FRANCES n H(~(~VFR ~~ n4 nAA4 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee~s~ OF ESTATE I TAXABLE DISTRIBUTIONS [nGude outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. I. BARBARA CRESKOFF Collateral 401 BEVERLY BLVD. 1/2 REMAINDER UPPER DARBY, PA 19082 2. ROBERT G. MAXWELL Collateral 3 ORCHARD HILL DRIVE 1/3 OF 1/2 REMAINDER ORCHARD PARK, NY 14127 3. DAVID H. MAXWELL Collateral 100 EWE ROAD 1/3 OF 1/2 REMAINDER MECHANICSBURG, PA 17055 4. KATHLEEN MAXWELL-CLEWETT Collateral 8 CAVE HILL DRIVE 1/3 OF 1/2 REMAINDER CARLISLE, PA 17013 5. WILMER B. MAXWELL Collateral 117 SOUTH ORANGE STREET 2 CERTIFICATES - CARLISLE, PA 17013 F&M TRUST ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. LUTHERN CHURCH OF THE HOLY TRINITY OF EPHRATA ($10,000) 167 E. MAIN STREET EPHRATA, PA 17522 2. EPHRATA COMMUNITY HOSPITAL ($5,000) 169 MARTIN AVENUE EPHRATA, PA 17522 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET S 0.00 ~Ir more space Is neeaea, Insert aaoltlonal sheets of the same size) ' COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX BUREAU OF INDIVIDUAL TAXES APPRAISEMENT, ALLOWANCE OR DISALLOWANCE INHERITANCE TAX DIVISION OF DEDUCTIONS AND ASSESSMENT OF TAX PO BOX 280601 HARRISBURG PA 17128-0601 REV-1547 EX AFP CO1-09) DATE 03-09-2009 ESTATE OF HOOVER FRANCES D DATE OF DEATH 03-26-2008 FILE NUMBER 21 08-0441 COUNTY CUMBERLAND STEPHEN L BLOOM ESQ ACN 101 IRWIN & MCKNIGHT APPEAL DATE: 05-08-2009 6 0 W POMFRET ST (See reverse side under ©bjections) CARLISLE PA 17013 Aeount Reeitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~- RETAIN LOWER PORTION FOR YOUR RECORDS 4'~' REV-1547 EX AFP CO1-09~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF HOOVER FRANCES D FILE N0. 21 08-0441 ACN 101 DATE 03-09-2009 TAX RETURN WAS: C X) ACCEPTED AS FILED C ) CHANGED RESERVATION CONCERNING FUTURE INTEREST.,- SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E] 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: C1) .00 NOTE: To insure proper c2) 322 , 159.15 credit to your account, C3) .00 submit the upper portion of this form with your c4) 167 ,512.31 tax payment. c5) 589 .179.70 c6)__ .00 c7) 65 ,174.70 (B) 1,144,025.86 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 46,218.21 C9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) C10)- 5.268 .68 11. Total Deductions cll) X7.486.89 12. Net Value of Tax Return C12) 1,092,538.97 13. Charitable/Governmental Bequests; Non-elected 9113 Trus ts (Schedule J) C13) 1 5,000.00 14. Net Value of Estate Subject to Tax C14) 1,077,538.97 NOTE: If an assess~ent was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate C15) .00 X 00 _ .00 16. Amount of Line 14 taxable at Lineal/Class A rate C16) •00 X 045 _ .00 17. Amount of Line 14 at Sibling rate (17) .00 X 12 _ .00 18. Amount of Line 14 taxable at Collateral/Class B rate c18) 1,077,538.97 X 15 = 161,630.85 19. Principal Tax Due (lg). 161,630.85 re]r rornrrc. DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID 06-23-2008 (0009918 8,081.54 160,000.00 TOTAL TAX CREDIT 168,081.54 BALANCE OF TAX DUE 6,450.69CR INTEREST AND PEN. .00 TOTAL DUE 6,450.69CR ^ IF PAID AFTER DATE INDICATED, SEE REVERSE C IF TOTAL DUE IS LESS THAN 41, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A DCCIINTI CCC DFVFDCF CTnF nF TNT( FnDM FnR TNCTDIICTTnNS.] v 2008 Individual Income Tax Return prepared for:. FRANCES D. HOOVER 117 S. ORANGE ST. CARLISLE, PA 17013 PATRICIA A. ROSENDALE CPA, LLC 255 HICKORY RD. CARLISLE, PA 17015 DECEASED FRANCES D HOOVER 03/26/2008 Department of the Treawry -Internal Revenue Service U.S. Individual Income Tax Return 2~~8 Label (See instrudions.) Use the IRS label. Otherwise, please print or type. Presidential Election Campaign For the year Jan 1 -Dec 31, 2008, or other tax year beginning Your first name MI Last name TRANCES D HOOVE If a joint return, spouse's first name MI last name Home address (number and street). If you have a P.O. box, see instructi 117 S. ORANGE ST. City, town or post oince. if you have a foreign address, See instructions. IRS Use Only - Do not write or staple in th(s space. 20 oMe No. t 5a5-oo7a Your social saeurily number 74-20-9648 Spouse's social security number Apartment no. You must enter your social security 1 number(s) above. Checking a box below will not change your tax or refund. You ~ Spouse Check here if you, or your spouse if filing jointly, uyant $3 to go to this fund? (see instructions) ................ - Filing Status 1 Single 4 Head of household (with qualifying person). (See 2 Married filing jointly (even if only one had income) instructions.) If the qualifying person Is a child ' but not your Dependent, enterthis child s Check only 3 Married filing separately. Enter spouse's SSN above & full name here one box. name here .. - 5 n Qualifying widow(er) with dependlent Child (see instructions) em t10n5 P Boxesehaeked a oursel . If someone can claim ou as a de endent, do not check box 6a ....... • • • y p oneeand6b.. 1 b Ouse ........... ..... ........................ ......................... No. of cbildren c Dependents: (2) Dependent's (3) Dependent's (4) If ~ IW a O0 social security relationship qwalifying child forchiid wi~You number First name Last nature to you tax crBdn • did trot <see in trs> live with you f more than four dependents, see instructions. otal number of exem tions claime ................... ............................ ... due to divorce orssppaaradon (sae instrs) .. . Dependents on 6c not anteredabove . add numbers on Ifnas above..... - 1 7 Wages, salaries, tips, etc. Attach Fprm(s) W-2 .......... ............................. 7 InGOme 8a Taxable interest. Attach Schedule B' if required .......... ........................... ... 8a 136 859. Attach Form(s) bTax-exempt interest. Do not include on line 8a ......... 9a Ordinary dividends. Attach Schedule B if required ....... .... 8b 4 37 . .............................. .~,''. 9a W-2 here. Also attach Forms W-2G and 1099-R b Qualified dividends (see instrs) ................................. 9b 10 Taxable refunds, credits, or offsets of state and local income taxes see instructions ............ ( ).......... %' 10 if tax was withheld. 11 Alimony received .................................... .............................. 11 i f 12 Business income or (loss). Attach Schedule C or C-EZ ... .............................. 12 I you d d not get a W-2, 13 Capital gain or (lass). Att Sch D if regd. If not read, ck here ......... ................ - ~ 13 see instructions. 14 Other gains or (losses). Attach Form 4797 .............. .............................. 14 15a IRA distributions ............ 15a ~ b Taxable amount (see instrs) .. 15b 16a Pensions and annuities ...... 16 a1 __ b Taxable amount (see instrs) > . 16b 7 2 58 . 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E .. 17 Enclose, but do 18 Farm income or (loss). Attach Schedule F .............. .............................. 18 not attach, any Al 19 Unemployment compensation ......................... .............................. 19 payment so, please use 20a Social security benefits ..........~ 20a~ 3, 013. ~bTaxable amount (see instrs) .. 20b 2 561. Form 1040-V. 21 Other income '21 22 Add the amounts in the far ri ht column for lines 7 throu h 21. This is our total income - 22 146 678 . 23 Educator expenses (see instructions) .................. .... 23 ,' Adjusted GI'O55 24 Certain business expenses of reservists, performing artists, and fee-basis government officials. Attach Form 2106 or 21p6-EZ ................ .... 24 ~-, Income 25 Health savings account deduction. Attach Form 8889.... .... 25 j 26 Moving expenses. Attach Form 3903 ................... .... 26 27 One-half of self-employment tax. Attach Schedule SE ... .... 27 28 Self-employed SEP, SIMPLE, and qualified plans ....... .... 28 29 Self-employed health insurance deduction (see instructions) ......... .... 29 '' ..: 30 Penalty on early withdrawal of savings ................. .... 30 ` ~'` 31 a Alimony paid b Recipient's SSN .... - .. 31 a ~, `` 32 IRA deduction (see instructions) ....................... .... 32 y, . , ~ °" 33 Student loan interest deduction (see instructions) ....... .... 33 ~~ -.,~ ,~„ 34 Tuition and fees deduction. Attach Form 8917 .......... .... 34 ';`'~; 35 Domestic production activities deduction. Attach Form 8903 ......... .... 35 ! i 36 Add lines 23-3laand 32.35 .............................. .............................. 36 37 Subtract line 36 from line 22. This is our ad usted ross income ..................... - 37 14 6 67 8 . BAA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see instructions. FDIA0112 10/i3/08 Form 1040 (2008) Form 1040 008 FRANCES D HOOVER 174-20-9648 Pa e 2 Tax and ~ Amount from line 37 (adjusted gross income) ......................................... 38 146 678 . Credits 39a Check ~ e You were born before January 2, 1944, B Blind. Total boxes lf: Spouse was born before January 2, 1944, Blind. checked - 39a 1 ~` b If your spouse itemizes on a separate return, ar you were adual-status alien, see instrs and ck here - 39b Standard ,~ ~ ? Deduction c Check if standard deduction includes real estate taxes or disaster loss (see instructions) ........ - 39c ` • ;> __ for - 40 Itemized deduction (from Schedule A) or your standard deduction (see left margin) .................... 40 15 67 0 . • People who 41 Subtract line 40 from line 38 ....................... 41 131 008 . checked any box ••••••••••••••••••••••••••••••••• on line 39a, 39b, 42 If line 38 is over $119,975, or you provided housing to a Midwestern displaced individual, see instructions. or 39c or who Otherwise, multiply $3,500 by the total number of exemptions claimed online 6d ......................... 42 3 500 . can be claimed 43 Taxable income. Subtract line 42 from line 41. as a dependent, If line 42 is more than line 41, enter -0- ...................................................... 43 127 508 . see instructions. q4 Tax (see instrs). Check if any tax is from: a B Form(s) 8814 • AI I others: b Form 4972 ........................... 44 2 9 6 8 0. Single or Married ~ ARemative minimum tax (see instructions). Attach Form 6251 .......................... 45 filing separately, ~ Add lines 44 and 45 .............................................................. - 46 29 680 . $5,450 47 Foreign tax credit. Attach Form 1116 if required ............. 47 ~` :''. ~, , <; Married filing 48 Credit for child and dependent care expenses. Attach form 2441 .......... 48 ~.'{:` jointly or 49 Credit for the elderly or the disabled, Attach Schedule R ..... 49 °~` Qualifying 50 Education credits. Attach Form 8863 .............. ` widow(er), • • • • • • • • • `~ ~" $10,900 51 Retirement savings contributions credit. Attach Form 8880... 51 ~ ~ 1 Head of 52 Child tax credit (see instructions). Attach Forn18901 if required .......... 52 household, 53 Credits from Form: a ~ 8396 b ~ 8839 c ~ 5695 ...... 53 $8,000 5q Other crs from form: a ~ 3800 b ~ 8$01 c ~ 54 =;- 55 Add lines 47 through 54. These are your total credits .................................. 55 56 Subtract line 55 from line 46. If line 5 is more than line 46, enter -0- . ................. - 56 29 680 . 57 Self-employment tax. Attach Schedule SE ..................................................... 57 Other 58 Unreported social security and Medicare tax from Farm: a ~ 4137 b ~ 8919 ...................... 58 Taxes 59 Additional tax on IRAs other qualified retirem$nt tans, etc. Attach Form 5329 if required ...... . ........... 59 60 Additional taxes: a ~ AEIC payments b a Household employment taxes. Attach Schedule H ........... 60 61 Add lines 56-60. This is our total tax ..... ............................................... - 1 2 9 680 . Payments ~ Federal income tax withheld from Foirms W-2 and 1099...... 62 If you have a 63 2008 estimated tax payments and amount appllied from 2001 return ........ 63 qualifying 64a Earned income credit (EIC) ............................... 64a child, attach b Nontaxable combat pay election ..... -~ 6~b~ ;__ Schedule EIC. ~ Excess social security and tier 1 RRTA tax wittlheld (see instructions) ...... 65 ~' 66 Additional child tax credit. Attach Form 8812 66 ' 67 Amount paid with request far extension to file (see instructions) .......... 67 2 9 g 42 , ~ '~ 68 Credits from Form: a ~ 2439 b ~ 413$ c ~ 8801 d ~ 8885 . 68 ,t~F # 69 First-time homebuyer credit. Attach Form 5405 ............. 69 ,• 70 Recove rebate credit see worksheet ~ ;' rY ( ) .................... 70 0 . 71 Add lines 62 thrau h 10. These are our total a menu ........................................ - 71 2 9 842 . Refund 72 If line 11 is more than line 61, subtract line 61 from line 71. This is the amount you overpaid ................ 72 162 . Direct deposit? 73a Amount of line 72 you want refunded to ou. If Form 8888 is attached, check here .. - ~ 7'3a 160 . See instructions - b Routing number ....... XXXXXX X - c T e: Checking Q Savings '' ' and fill in 73b, - d Account number ....... XXXXXXyCXXXXXXXXXX 73c, and 73d or _ Form 8888. 74 Amount of line 72 ou want a lied to our 2009 estimated tax ........ - 74 Amount 75 Amoulrt you owe. Subtract line 71 from line 61. for details on how to pay, see instructions ............... - 75 You Owe 76 Estimated tax enalt see instructions .................... 76 2 , ,;*+~. '''. ' ~ ' ,r._~;- Third Party Do you want to allow another person to discuss this return with the IRS (see instruPCIG~one )? .......... Yes. Come fete the following. No Designee's - rsonal identification Designee name no number (PIN) - .SI n Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to th! best of my knowledge and g belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has arty knowledge. Here yo Ig slur ~ ~/J~ Date Your occu anon Da ime hone number Joint return? ' f<tG4~ ~ p >rt p See instructions. RETIRED Kee a CO Spouse's signature. If a joint return, both must sign. Date Spouse's occupation for your records. Date Preparer's SSN or PTIN Preparer's Paid signature / PATRICIA A. ROSENDALE 08/21/2009 Check ifself-employed P00099907 Preparer's Firm's name PATRICIA A. ROSENDALE CPA LLC UseOnl seireursif EIN 20-5339904 y addresmsMand~'' 255 HICKORY RD. ZIP code CARLISLE PA 17 015 Phone no. 717 2 4 3 - 318 4 Form 1040 (2008) FDIA0112 10/13/08 SCHEDULE. A Itemized Deduction Dias "°. ,~.0°" (Form 1040) s ^oo~ Department or the Treasury Internal Revenue Service (99) - Attach to Form 1040. - See Instructions for Schedule A (Form 1040} L 5't uen~cenNo. ~7 Name(s) shown on Fonn 1040 Your so6lai security number FRANCES D HOOVER 174- 0-9648 Medical Caution. Do not include expenses reimbursed or paid by others. , and Dental 1 Medical and dental ex enses see instructions P ( ) ......................... 1 25 589. Expenses 2 Enter amountfrom Form 1040, line 38 .... 2 146 678 . 3 Multiply line 2 by 7.5% (.075) ................................ 3 11 001. ' 4 Subtract line 3 from line 1. If line 3 is more than line 1, enter -0 . . .............. ............ 4 14 58 B . Taxes You Paid 5 a State and local (check onl one box): Income taxes, or 8 n.a .. ,n~=' ~~ b General sales taxes 5 932'. .`- 6 Real estate taxes (see instructions) ........................... 6 ~,? '` - - (See 7 Personal property taxes ..................................... 7 , . ;..:;- instructions.) 8 Other taxes. List type and amount - _ _ _ _ - _ _ _ _ - - - ~~ ~~~' --- ~~ 9 Add lines 5 throw h 8 . ------------ ....................................... - ..... ---- ......... ------ ............ g 932. Interest 10 Home mtg interest and points reported to you on Form 1098 ......... 10 `° ~ You Paid 11 Home mortgage interest not reported to you on Form 1098. If paid to the person from whom you bought the home see instructions and show that person's name x.#"'~ ~ ~ '' ' ~' , identifying number, and address - _ ~ `~- , '' ,~ ;_ .~ , - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ------------------------------- ~.. Y~' 11 Note. 12 Points not reported to you on Farm 1098. See instrs for spcl rules ............ 12 Personal 13 Qualified mortgage insurance premiums (see instructions) ...... 13 interest is not 14 Investment interest. Attach Form 4952 if required. '~ deductible. (See instrs.) ................ ............ ...................... 14 _ ~„` 15 Add lines lOthrough 14 ...................................... ..... ......... ............ 15 Gifts to 16 Gifts by cash or check. If you made any gift of $250 or ' '~` ?~,: Chart ty more, see instrs ................... ......................... 16 15 0 # #, , If you made a ift and 17 y y gift of $250 or Other than b cash or check. If an '~,' . ' ~ a~ of a benefit more, see instructions. You must attach Form 8283 rf "~~' ~ , or it, see over $500 .................................................. 17 `: .. instructions. 18 Carryover from prior year ........................ ............ 18 . , '~<` , 19 Add lines 16 throw h 18 ...................................... .............. ............ 19 150 . Casualty and Theft Losses 20 Casual or theft loss es .Attach Form 4684. See instructions . .. .............. .......... . . 20 21 Unreimbursed employee expenses -job travel, union dues, ~-:; ~ ' ° job education, etc. Attach Form 2106 or 2106-E1 if ~ required. (See instructions.) - ~ ~ ,.. 3. __________ 21 „~~,, 22 _____________________ Tax preparation fees 22 1 `' (See 23 Other expenses -investment, safe deposit box, etc. List "" '~' instructions.) type and amount - _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 'M `` ~' ~" _ _ _ 24 Add lines 21 through 23 ................................... 24 ~" 25 Enter amount from Form 1040, line 38 ..... 25 26 Multiply line 25 by 2% (.02) .................................. 26 27 Subtract line 26 from line 24. If line 26 is more than line 24, enter -0• .. ......... ............ 27 Other ~ Other -from list in the instructions. List type and amount - Miscellaneous ' ''~ " Deductions ------------------------------- -------- ------ `` i Total 29 Is Form 1040, line 38, over $159,950 (over $79,975 if Itemized married filing separately)? Deductions © No. Your deduction is not limited. Add the amounts in the far right column for lines 4 through 28. Also, enter this amount on Form 1040, line 40. ~ - 29 15 67 0 . n Yes. Your deduction may be limited. See instructions for the amount to enter . 4 - - ~~ _u sff.~ . •%;~.. < 30 If you elect to itemize deductions even thou h they are less than our standard deduction, check here - ~ ._ ~ w~z ~ r ~' 9 Y ^ ~ BAA For Paperwork Reduction Act Notice, see Form 1040 instructions. FDIA0301 t tnaoa Schedule A (Form 1040) 2008 Schedule B (Form 1040 Name(s) shown on form 1040. FRANCES D HOC Part I 1 List name of payer. If any interest is from aseller-financed mortgage and the buyer used Amount Interest the property as a personal residence, see the instructions and list this interest first. Also, show that buyer's social security number and address ................................. - ADAMS COUNTY NATIONAL BANK ---------------------------- 2 32g, (See instructions RICAN HOME BANK forForm1040, ________ -------------------- 1 415. line 8a.) EPHRATA BANK _ _ _ _ _ -------------------------------------- 196 . F&M TRUST BANK _ ------------------------------------------ 3 861. M&T BANK ------------------------------------------- 389. Note. it you M&T BANK ____-___ receivedaFonn ----------------------------------- 1 266. to99-Irrr, Fom, ORRSTOWN BANK _ _ _ _ _ 1099-OID or -------------------------------------- 1 3 569 . , substitute statement PNC BANK finmabrokera e ------------------------------------------- 3 4 9 . g firm, list the arm's SUS UEHANNA BANK _____ name as the pa er --- ---------------------------------- 2 566. y and enter the total WACHOVIA BANK interests canon ------------------------------------------- 1 012 that corm. SERIES EE BONDS SEC 454 ELECTION ------------------------------------------- 31 872 . DEFERRED E BOND INTEREST SEC 454 ELECTION _ _ _ _ _ _ _ _ _ _ --------------------------------- 101 2 4 9 . SERIES HH BONDS _______-- ---------------------------------- 1 265. Subtotal ------------------------------------------- 151 337. LESS:AMOUNTS RECEIVED AFTER DOD TAXABLE TO ESTATE 77-627790'9 ------------------------------------ -14 478. 2 Add the amounts on line 1 ............................................................ 2 136 859. 3 Excludable interest on series EE and I U.S. savings bonds issued after 1989. Attach Form 8815 .................................................................... 3 4 Subtract line 3 from line 2. Enter the result here and on Form 1040 line 8a .............. - 4 136 859. Note. If line 4 is over $1 500 ou must com lete Part III. Amount 5 List name of payer ... - -------------------------------- Partll ------------------------------------------- Ordinary ------------------------------------------- Dividends (See ------------------------------------------- instructions for Form1040, ------------------------------------------- line 9a.) ------------------------------------------- ------------------------------------------- Note lfou ------------------------------------------- . receivedya Form 1099•DIVor ------------------------------------------- 5 substitute statement tromabrokera e ------------------------------------------- g firm, Ilst the firm's name as the pa er --------------------------------------- y and enter the ordinary dividends --------------------------------------- shown on that form. 6 Add the amounts on line 5. Enter the total here and on Form 1040, line 9a .............. - 6 Note. If line 6 is over $1,500, ou must com lete Part III. Part III You must complete this part if ou (a) had over $1,500 of taxable interest or ordinary dividends; or (b had a Foreign foreign account; or (c) received a distribution from, or were a grantor of, or a transferor to, a foreign (rust. Yes No Accounts and 7a At any time during 2008, did you have an interest in or a signature or other authority over a financial account Trusts in a foreign country, such as a bank account, securities account, or other financial account? See instructions for exceptions and filing requirements for Form TD F 90.22.1 ............................................. X (See b If 'Yes,' enter the name of the foreign country . -_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ : , instructions.) ------------ 8 During 2008, did you receive a distribution from, or were you the grantor of, or transferor to, a foreign trust? If 'Yes,' you may have to file Form 3520. See instructions ................................................ X BAA For Paperwork Reduction Act Notice, see Form 1040 instructions. FDIno4ol 09~2~oe Schedule B (Form 1040) 2008 Schedule B -Interest and Ordinary Dividends Sequence No. os FRANCES D HOOVER Additional Information IRS SEC 454 ELECTION 174-20-9648 EXECUTOR ELECTS UNDER IRS SEC 454 TO RECOGNIZE AS INCOME THE ACCRUED INTEREST ON SERIES E AND EE BONDS OWNED BY THE TAXPAYER AT DATE OF DEATH AND THE ACCRUED INTEREST ON H BOND CONVERSION AS OF TAXPAYER'S DATE OF DEATH. J REV-276 0803618127 Application for Extension of Time to File REV-276 EX (09-08) ,L 0 08 PA DEPARTMENT OF REVENUE OFFCIAL USE ONLY OFFICIAL US~LY F~C L ~ I"I O Print the first two (2) letters of the last name if for a PA-CO or a PA•41 Print the i~ NOT STAPLE first two (2) letters of the name if a PA-ggNRC, PA-40NRC-AE, or PA•20SIPA•65. See instructions for Fiduciary accounts. M PA-~ONRC, PA•40NRC•AE, or PAdeSIPA•65 enter the entity name pA-40, PA-41, PA-40NRC, PA.q~NR -AE, PA-20S/PA-65 ~ , starting with the first box of the Last, Estate or Trust, or Entity Name and continue until you have APPLICATION FOR EXTENSIONI O TIME TO FILE used ali the space available (If needed). If you do not have enough space for the name, do not use (~ tiBng instruetbns. Be sure to answer all quasNons.) the address Ilne. PLEASE PRINT OR TYPE ALL INFORMATION Your Social Security Number Spouse's Social Security Number Federal Empbyer Identification Number 174209648 PLEASE WRITE IN YOUR SOCIAL SECURITY, YOUR SPOUSE'S SOCIAL SECURITY, OR EIN NUMBER ABOVE Last, Estate or Trust, or Entity Name First Name Ml Check box if ftling in Pennsylvania for the first time HOOVER FRANCES D First Time PA Filer TYPE OF RETURN Spouse's Last Name or Name of Trustee for Estate or Trust Spouse's First Name MI Check box for the kind of PA return you will file )( PA-40 Individual Tax Return PA-40NRC Consolidated Nonresident Tax Retum P.O. Box, Apt No., Suite, Floor, RR No., etc Daytime Telephone Number pA-ggNRC-AE Nonresident Consolidated Tax Retum. Athlet6s/Entertainers Street Number and Name PA31 Fiduciary Income Tax Retum 117 S ORANGE S T pA-2051PA-65 Indicate the taxable year. Check twx. City or Post Office State ZIP Cade )( Calendar Year CARLISLE P A 17 013 Fiscal Year, beginning Taxpayer's Signature pate AMOUNT OF YOUR PAYMENT $ 102 Spouse's Signature pate An extension of time until 10152009 is requested to file the PA return of the above named taxpayer for the taxable year beginning 01012008 and ending 12312008 (See instructions regarding type and length of extension.) Has an extension of time to file been previously granted for this taxable year? N IF YOU ARE SUBMITTING A PAYMENT WITH THIS APPLICATION, COMPLETE THE 'AMOUNT OF YOUR PAYMENT' BLOCK ABOVE. State in detail the reason the taxpayer needs an extension. (Use additional sheet if necessary) AZNAITING ADDITIONAL RECORDS SIGNATURE AND VERIFICATION If Prepared by Taxpayer. -Under penalties of perjury, I declare that to the best of my knowledge and belief, the statements made herein are true and correct If Prepared by Someone Other Than Taxpayer. -Under penalties of perjury, I declare that to the best of my knowledge and belief, the statements made herein are true and correct, that I am authorized by the taxpayer to prepare this application, and that I am: A member in goad standing of the bar of the highest court of (specify jurisdiction) X A public accountant duly qualified to practice in (specify jurisdiction) PA A person enrolled to practice before the Internal Revenue Service. A duly authorized agent holding a power of attorney. (The power of attorney need not be submitted unless requested.) A person standing in close personal ar business relationship to the taxpayer who is unable to sign this appliratian because of illness, absence, or other good cause. My relationship to the taxpayer and the reason(s) why the taxpayer is unable to sign this application are: Relationship Reason(s) PATRICIA A ROSENDALE 08212009 SIGNATURE OF PREPARER OTHER THAN TAxPAYER DATE Where to Flle: Mail extension and payment, if applicable, ta: PA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO BOX 2805()4 HARRISBURG, PA 17128-0504 L, 0803618127 PAIZO3D1 nff~if0a 0803618127 J 0800111167 174209648 HOOVER FRANCES 117 S ORANGE ST CARLISLE PA-40 - 2008 Pennsylvania Income Tax Return ENTER ONE LETTER OR NUMBER IN EACH BOX. Do Not Use Your Preprinted Label Y Extension. N Amended Return. D Occupation RETIRED R Residency Status. PA ResidenUNonresidenUPart-Year Resident Occupation from to D SinglelMarried, Filing Jointly/Married, Filing Separately/Final ReturNDeceased Date of death 0 3 ~C 6 0 8 N Farmers. P A 17 013 School District Name CARLISLE ARE A 21110 1 a Gross Compensation. Do not include exempt income, such as combat zone pay and qualifying retirement benefits. See the instructions. 1 b Unreimbursed Employee Business Expenses. 1 c Net Compensation. Subtract Line 1 b from Line 1 a. 2 Interest Income. Complete PA Schedule A if required. 3 Dividend and Capital Gains Distributions Income. Complete PA Schedule B if required. 4 Net Income or Loss from the Operation of a Business, Profession, or Farm. 5 Net Gain or Loss from the Sale, Exchange, or Disposition of Property. 6 Net Income or Loss from Rents, Royalties, Patents, or Copyrights. 7 Estate or Trust Income. Complete and submit PA Schedule J. 8 Gambling and Lottery Winnings. Complete and submit PA Schedule T. 9 Total PA Taxable Income. Add only the positive income amounts from Lines lc, 2, 3, 4, 5, 6, 7, and 8. DO NOT ADD any losses reported on Lines 4, 5, or 6. 10 Other Deductions. Enter the appropriate code for the type of deduction. N See the instructions for additional information. 11 Adjusted PA Taxable Income. Subtract Line 10 from Line 9. PAIA0472 11/06/08 EC Page 1 of 2 FC 1a 0 1b 0 1c 0 2 3102 3 D 4 0 5 0 6 0 7 a 8 0 9 3102 10 0 11 3102 L 0800111167 m m 0800'.111167 J 08D0211161 PA-40 - 2008 Social Security Number 174209648 Name(s) FRANCES D HOOVER 12 PA Tax Liability. Multiply Line 11 by 3.07 percent (0.0307 13 Total PA Tax Withheld. See the instructions. 14 Credit from your 2007 PA Income Tax return. 15 2008 Estimated Installment Payments. 16 2008 Extension Payment. 17 Nonresident Tax Withheld from your PA Schedule(s) NRK-1. (Nonresidents only) 18 Total Estimated Payments and Credits. Add Lines 14, 15, 16, and 17. Tax Forgiveness Credit Submit PA Schedule SP. 19a Filing Status: 01 Unmarried or Separated 02 Married 03 Deceased 19b Dependents, Part B, Line 2, PA Schedule SP 20 Total Eligibility Income from Part C, Line 11, PA Schedule SP. 21 Tax Forgiveness Credit from Part D, Line 16, PA Schedule SP. 22 Resident Credit. Submit your PA Schedule(s) G-R with your PA Schedule(s) G-S, G-L and/or RK-1. 23 Total Other Credits. Submit your PA Schedule OC. 24 TOTAL PAYMENTS and CREDITS. Add Lines 13, 18, 21, 22, and 23. 25 TAX DUE. If Line 12 is more than Line 24, enter the difference here. 26 Penalties and Interest. See the instructions. Enter code: If including form REV-1630, mark the box. N 27 TOTAL PAYMENT. Add Lines 25 and 26. 28 OVERPAYMENT. If Line 24 is more than the total of Line 12 and Line 26, enter the difference here. The total of Lines 29 through 35 must equal Line 28. 29 Refund -Amount of Line 28 you want as a check mailed to you. Refund 30 Credit -Amount of Line 28 you want as a credit to your 2009 estimated account. 31 Amount of Line 28 you want to donate to the ~Id Resource Conservation Fund. 32 Amount of Line 28 you want to donate to the Military Family Relief Assistance Program. 33 Amount of Line 28 you want to donate to the Governor Robert P. Casey Memorial Organ and Tissue Donation Awareness Trust Fund. 34 Amount of Line 28 you want to donate to the Juvenile (Type 1) Diabetes Cure Research Fund. 35 Amount of line 28 you want to donate to the PA Breast Cancer Coalition's Breast and Cervical Cancer Research Fund. Signature(s). Under penaNies of perjury, I (we) declare that I (we) have examined this return, Including all axompanying schedules and statements, and to the best of my (our) belief, they are true, correct, and complete. Yom 19~ Dose's Signature, if filing jointly i Preparer's Name and Telephone Number ('] ], 7) 2 4 3 - 318 4 Date PATRICIA A. ROSENDALE CPA, LLC 08/21/09 255 HICFCORY RD. 1701 12 95 13 0 14 0 15 0 16 102 17 0 18 102 19a 00 19b 00 20 0 21 0 22 0 23 0 24 102 25 0 26 0 27 0 28 7 29 7 30 0 31 0 32 0 33 0 34 0 35 p Firth EIN PrepareYs SSN/PTIN 205334904 P00099907 L 0800211161 PAIR g220a Boa 0800211161 0801910027 PA SCHEDULE W-2S Wage Statemerrt Summary of PA Taxable Employee, Non-employee, and Miscellaneous OFFICIAL USE ONLY Name shown first on the PA-40 ('rf filing jointly) Sxial Security Number (shown first) FRANCES D HOOVER 174-2Q-9648 Use this schedule to list and calculate your total PA taxable compensation and PA tax withheld from all sources. Part A Instructions: List each Federal Form W-2 for ou and yours ouse, if married, received from your employer(s). In the first column enter T for the taxpayer's Social Security Number that appears first on the PA tax return and enter S for the second or spouse SSN. From the Forms W-2, enter each employer's Federal Employer Identification Number (EIN). Enter the amounts from the Forms W-2 in each column. IMPORTANT: You do not have to submit a copy of your Form W-2 if you earned all your income in Pennsylvania and your employer reported your PA wages correctly and withheld the correct amount of PA income tax. You must submit a copy of your Form W-2 in certain circumstances. See the PA Schedule W-2S instructions for a list of when a copy of a W-2 is required. Part B Instructions: List each source of income received during the taxable year on a form or statement other than a Federal Form W2. Enter each payer's name. List the payment type that most closely describes the source of your non-employee compensation. Enter the amount of other compensation that you earned. If the form or statement does not have separately stated amounts, enter the amount shown in both Federal and PA columns. IMPORTANT: You must submit a copy of each form and statement that you list in Part B, whether or not the pa er withheld any PA income tax and regardless of whether or not the income was taxable in PA. CAUTION: The federal and Pennsylvania (state wages may be different in Part A and Part B. If you need more sear_a_ vnu may nlfntn~nnv t6Ga ~..6ed~.ie .. .«.~l.e ................~r...~..~_.:_ a~e_ ~~~_. Part A -Federal Forms W-2 T/S Employer EIN from box b Federal wages from box 1 Medicare wages from box 5 PA compensation from box 16 PA income tax withheld from box 17 Total Part A -Add the Penns Ivania columns Part B -Miscellaneous and Non-employee Compensation from Federal Forms 1099R,1099MISC, and other statements YOU MUST SUBMIT COPIES OF EACH FORM OR STATEMENT LISTED IN THIS PART A vs B Type C Payer name D aee code E Total federal amount F Adjusted plan basis G PA compensation H PA tax withheld T I PIIBLIC SCHOOL 7 4840 0 T I Office of Pers 7 2418 p Total Part B -Add the Penns Ivania columns 0 TOTAL -Add the totals from Parts A and B 0 I Enter the TOTALS on your PA tax retum on: Line 1 a Line 13 Payment type: A Executor fee B Jury duty pay C Director's fee D Expert witness fee E Honorarium F Covenant not to compete G Damages or settlement for lost wages, other than personal injury H Other nonemployee compensation. Describe: Distribution from employer sponsored retirement, pension, or qualified deferred compensation plan J Distribution from IRA (traditional or Roth) K Distribution from Life Insurance, Annuity orlEndowment Contracts L Distribution from Charitable Gift Annuities 0801910027 PAIA0601 ,tr~~oa 0801910027 .. • 0801210022 PA SCHEDULE A/B Interest Income /Dividend~le~co(rne 2008 PA~40 Af8 OFFICIAL USE ONLY If you need more space, you may photocopy. Name shown first on the PA-40 (f filing jointly) Social Security Number (shown first) FRANCES D HOOVER 174-20-9648 CAUTION: Federal and PA rules for taxable interest and dividend income are different. Read the instructions. If your taxable interest and dividend income are each $2,500 or less, you must report the income, but do not need to submit any schedule. If either your interest income or dividend income is more than $2,500, you must submit a PA Schedule A andlor B. PA~o A (x-06) PA SCHEDULE A - PA Taxable Interest Income fSee ti,e ~nstn,~nons_~ 1 ~ AMERICAN HOME BANK 636. EPHRATA BANK 196. F&M TRIIST BANK 964. ORRSTOWN BANK 246. PNC BANK 349. SUS UEHANNA BANK 711. 2 Total Interest Income. Add all amounts listed includin amounts on additional schedules ....... . ........... 2 3 102 . 3 Distributions from Life Insurance, Annui , or Endowment Contracts included in federal taxable income ....... 3 4 Distributions from Charitable Gift Annuities included in federal taxable income ............................. 4 5 Distributions from IRC Section 529 Qualified Tuition Pro rams for non educational ur oses ................. 5 6 Distributions from Health/Medical Savin s Accounts included in federal taxable income ..................... 6 7 Interest income from PA S Cor orations and artnershi s ,from our PA Schedules RK-1 ................ 7 8 Total PA Taxable Interest Income. Add Lines 2, 3, 4, 5, 6, and 7. Enter on Line 2 of our PA-40 ............. 8 3 102 . 0801210022 PAIAO601 toz„oe 080121'0022 J fmrvrc f an ~ : wrapt[af cams ufstnlounons are arv~aena income for PA purposes. PA SCHEDULE B - PA Taxable Dividend and