HomeMy WebLinkAbout03-0582Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of Calvin A. Hoerneman
also known as
, Deceased
Ann V. Shults and Calvin A. Hoerneman, Jr.
Petitioner(s), who is/are 18 years of age or older, apply(les) for:
Social Security No. 284-14- 9582
(COMPLETE 'A' or 'B' BELOW:)
A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut ors named in the last Will of
theDecedent,N/A dated 03/20/2000 and codicil(s) dated None
State relevant circumstances, e.g., renunciation, death of executor, etc.
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents
offered for probate; was not the victim.of a killing and was never adjudicated incompetent:
N/^
B. Grant of Letters of Administration
(c.t.a.; d,b.n.c.t.a; pendente lite; durante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and
heirs:
Name
Relationship Residence
(COMPLY-rE IN ALL CASES:) Attach additional sheets if necessary,
Decedent was domiciled at death in Cumberland
County, Pennsylvania with his/her last family
or principal residence at 203 Todd Circle, Borou~;h
Decedent. then 87 years of age, died 07/14/2003
of Carlisle, Carlisle, PA 17013
(list street, number, and municipality)
at Borough of Carlisle, PA
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property
(If not domiciled in PA) Personal property in Pennsylvania
(If not domiciled in PA) Personal property in County
Value of real estate in Pennsylvania
(Location)
374,500.00
situated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of
letters in the appropriate form to the undersigned:
Sic~nature
Typedorprintednameandresidence
Ann V. Shults
9 Riddle Road, Camp Hill, PA 17011
Calvin A. Hoerneman, Jr.
5712 Lamplighter Lane, Midland, MI 48642
Prepared by the Pennsylvania Bar Association
Copyright (c) 1996 form software only CPSystems, Inc. Form RW-1 (1991)
Oath of Personal Representative
· Commonwealth of Pennsylvania
County of Cumberland
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true
and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of
the Decedent, Petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed
before me this/~ day of
No.
Estate of Calvin A. IRoerneman
Deceased
Social Security No: 284-14- 9582
AND NOW,
Date of Death: 07/14/2003
of the Petition on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters ~'] Testamentary ~ Of Administration
~, in ~sideratio9
are hereby granted to Ann V. Shults
(c.t.a.; d.b.n.c.ta.; pendente lite; durante absEq~tia; durante minoritate)
and Calvin A. Hoerneman, Jr.
in the above estate and that the instrument(s) dated 03/20/2000
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters ........... $
Short Certificate(s) ..... $
Renunciation ........ $
Affidavits ( ) ....
Extra Pages ( ) .... $
Codicil ........... $
JCP Fee .......... $
Inventory .......... $
Other .. : ........ $
TOTAL .........
Prepared by the Pennsylvania Bar Association
Attorney: James D. Bosar
I.D. No: PA 19475
Address: One West Main Street
Shiremanstown, PA 17011
Telephone: 717/737-8761
Copyright (c) 1996 form software only CPSystems, Inc.
Form RW-1 (1991)
Estate of
aJso known as
Register of Wills of Cumberland County, Pennsylvania
OATH OF SUBSCRIBING WITNESS
Calvin A. Hoerneman No. ~:~
, Deceased
James D. Bo~ar, Esquire
(each) a subscribing witness to the [] codicil(s) ~'~ will(s) presented herewith, (each) being duly qualified according to law
depose(s) and say(s) that she/he/they was/were present and saw the above Testator(rix) sign the same and that she/he/they signed as
a witness at the request of Testator(rix) in his/her/their presence and r~ in the presence of each other [-~ in the presence of the
other subscribing witness(es).
(Address)
(Signature)
(Address)
Sworn to or affirmed and subscribed
before me this ~/ ~Lj~.._. day
Notary Public
My Commission Expires:
(Signature and seal of Notary or other official
qualified to administer oaths. Show date of
expiration of Notary's commission.)
eo~ I.. mLUAM_S, ,OTA~ PueL=
~,REMANSTOWN BORO.. CUMBERLAND CO I
II COMIWI$$10N EXPIRES APRf~. IS, 2005 ]
NOTE:
To be taken by officer authorized to administer oaths.
Please have present the original or copy of instrument(s)
at time of notarization,
Prepared by the Pennsylvania Bar Association
Copyright (c) 1996 form software only CPSystems, inc. Form #RW-2 (1991)
REGISTER OF WILLS OF COUNTY
OAw SL SCRmm'G
codidl
(each) a subscribing wimess to the will presented here,~4th, (each) being daly qualified according to
law, deposes) and say(s) that present and saw
the testat , si~ the same a~d that sided ~ a wimess at the
request of testat in h presence and (La the presence of each other) (M the presence of the
ct,her subscribing wimess(es)).
Swora to or aff~med Md subscribed before
me tMs
day of
20
Register
(Name)
(Address)
(Name)
(Address)
REGISTER OF WILLS OF Cumberland COUNTY
OATH OF NON-SCBSCRIBING WITNESS
Ann V. Shults and Calvin A. Hoerneman, Jr.
(eac5)· a subscEber here:o, (each) being duly qu~Eed ac:ardin_*_ to law, de.~c=e,.)- ' "~ <d say(s) usa:
~ey fami~ wit~ the ':*~- ..... cf Calvin A. Hoe~e~
testator Cf L__ _ " the will presented herewkh and
tka: both beEevegr~e si~natur: cn the will is in ~e handw~t!ng cf
Calvin A. Hoerneman
Sworn to or affirmed and subscMbed before
me~~ day of
their knowledge and belief.
Ann XF. - Shult~s
(Name)
9 RicJ~e Roact~ Camp Hill, PA 17011
5712 Lanpli~hter Laner Midland, MI 48642
(.4 ddrers)
LAST WILL AND TESTAMENT
OF
C~LV~N ~. HOERNEI~N
I, CALVIN A. HOERNEMAN, of Carlisle, Cumberland County,
Pennsylvania, make, publish and declare this as and for my Last
Will and Testament, hereby revoking all other Wills and Codicils
heretofore made by me.
FIRST: I devise and bequeath all the rest, residue and
remainder of my estate of whatever nature and wherever situate,
including any property over which I hold power of appointment and
together with any insurance policies thereon, unto my wife,
LUCILLE A. HOERNEMAN, provided she survives me by sixty (60)
days.
SECOND: Should my wife, LUCILLE A. HOERNEMAN, prede-
cease me or die on or before the sixty-first (61st) day following
my death, I devise and bequeath all the rest, residue and remain-
der of my estate of whatever nature and wherever situate, includ-
ing any property over which I hold power of appointment and
together with any insurance policies thereon, in equal shares, to
my children, CALVIN A. HOERNEMAN, JR. and ANN V. SHULTS, provided
that should either of my children predecease me, I give and
bequeath such child's share unto his or her issue per stirpes by
representation, and if there be a failure of same, then I give
and bequeath such deceased child's share to my surviving child as
provided herein.
THIRD: In addition to all powers granted to them by
law and by other provisions of this Will, I give the fiduciaries
acting hereunder the following powers, applicable to all proper-
ty, exercisable without court approval and effective until actual
distribution of all property:
(A) To sell at public or private sale, or to lease,
for any period of time, any real or personal property and to give
options for sales, exchanges or leases, for such prices and upon
such terms (including credit, with or without security) or
conditions as are deemed proper. This includes the power to give
legally sufficient instruments for transfer of the property and
to receive the proceeds of any disposition of it.
(B) To partition, subdivide, or improve real estate
and to enter into agreements concerning the partition, subdivi-
sion, improvement, zoning or management of real estate and to
impose or extinguish restrictions on real estate.
(C) To compromise any claim or controversy and to
abandon any property which is of little or no value.
(D) To invest in all forms of property, including
stocks, common trust funds and mortgage investment funds, without
restriction to investments authorized for Pennsylvania fiduci-
aries, as are deemed proper, without regard to any principle of
diversification, risk or productivity.
(E) To exercise any option, right or privilege granted
in insurance policies or in other investments.
(F) To exercise any election or privilege given by the
Federal and other tax laws, including, but not necessarily being
limited to, personal income, gift and estate or inheritance tax
laws.
(G) To make distributions to my herein named benefici-
aries in cash or in kind or partly in each.
(H) To borrow money from themselves or others in order
to pay debts, taxes, or estate or trust administration expenses,
to protect or improve any property held under my will, and for
investment purposes.
(I) To select a mode of payment under any qualified
retirement plan (pension plan, profit sharing plan, employee
stock ownership plan, or any other type of qualified plan) to the
extent the plan or the law permits them to do so, and to exercise
any other rights which they may have under the plan, in whatever
manner they consider advisable.
FOUR?H: I direct that all inheritance, estate,
transfer, succession and death taxes, of any kind whatsoever,
2
which may be payable by reason of my death, whether or not with
respect to property passing under this Will, shall be paid out of
the principal of my residuary estate.
FIF?H: All interests hereunder, whether principal or
income, which are undistributed and in the possession of the
fiduciaries acting hereunder, even though vested or distribut-
able, shall not be subject to attachment, execution or sequestra-
tion for any debt, contract, obligation or liability of any
beneficiary, and furthermore, shall not be subject to pledge,
assignment, conveyance or anticipation.
BIXTH: I nominate and appoint my wife, LUCILLE A.
HOERNEMAN, Executrix of this, my Last Will and Testament. In the
event of the death, resignation or inability to serve for any
reason whatsoever of the said LUCILLE A. HOERNEMAN, I nominate
and appoint CALVIN A. HOERNEMAN, JR. and ANN V. SHULTS, Co-
Executors of this, my Last Will and Testament. I direct that my
Executrix or Executor, as the case may be, and their successors,
shall not be required to post security or a bond for the
performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and
seal to this, my Last Will and Testament, this ~c~ day of
I/V,~,~-'O~ , 2000.
CALVIN A. HOERNEMAN
Signed, sealed, published and declared by the above-
named Testator as and for his Last Will and Testament in our
presence, who, at his request, in his presence and in the
presence of each other, have hereunto subscribed our names as
attesting witnesses.
Address
Address
'03 JUL 18
P2 :~9
OF
CALVIN A. HOERNEMAN
JAMES D. BOGAR
ATTORNEY AT LAW
ONE WeST MAIN STREET
SHIREMANSTOWN, PENNSYLVANIA 17011
CERTIFICATION OF NOTICE UNDER RULE 5.6 (a)
Name of Decedent: Calvin A. Hoerneman
Date of Death: July 14, 2003
Will No. 21-03-0582 Admin. No.
To the Register:
I certify that notice of estate administration required by
Rule 5.6(a) of the Orphans' Court Rules was served on or mailed
to the following beneficiaries of the above-captioned estate on
July 22, 2003:
Name
Address
Ann V. Shults
Calvin A. Hoerneman, Jr.
9 Riddle Road
Camp Hill, PA 17011
5712 Lamplighter Lane
Midland, MI 48642
Notice has now been given to all persons entitled thereto under
Rule 5.6(a) except:
None
Date: 7/22/2003
Capacity:
Esquire
One West M~_z~ Street
Shiremanstown, PA 17011
(717) 737-8761
Personal Representative
Counsel for Personal
Representative
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD OO31 O9
BOGAR JAMES D
1 W MAIN STREET
SHIREMANSTOWN, PA
17011
........ fold
ESTATE INFORMATION: SSN: 284-14-9582
FILE NUMBER: 2103-0582
DECEDENT NAME: HOERNEMAN CALVIN A
DATE OF PAYMENT: 1 0/1 0/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 07/14/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 915,671.42
REMARKS:
TOTAL AMOUNT PAID:
ANN V SHULTS AND CALVIN
HOERNEMAN JR C/O JAMES D BOGAR
5,671.42
SEAL
CHECK//138
INITIALS: JA
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
RE.V- 1500 EX + (6-00)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. Z80601
HARRISBURG, PA 17178-0601
HP?
EP~t
CR~
KO~
cg
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P
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0
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Hoerneman Sr. Calvin A.
DATE Of DEATH (MM-DD-YEAR)
07/14/2003
DATE OF BIRTH (MM-DD-YEAR)
05/28/1916
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
OFFICIAL USE ONLY
FILE NUMBER
21-03-0582
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
284-14- 9582
THIS RETURN MUST BE FILED IN DUPUCATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
B1. Original Return ~ 247! Supplemental Return
4. Limited Estate . Future {nterest Compromise (date of death after 1Z-1Z-8Z)
6. Decedent Died Testate Decedent Maintained a Living Trust
(Attach copy of WilL) (Attach copy of Trust)
[---I s. Ut~gation Proceeds Received I I 10. Spousa~ Pover~
Credit
(date of death between 1Z-31-91 and 1-1-95)
(date .of .cl..e a.t ~h
3. Remainder Return priorm
5. Federal Estate Tax Return Required
1 8. Total Number of Safe Deposit Boxes
~ 11. under Sec. 91
Election
to
tax
13(A)
(Attach Sch O)
NAME
James D. Bo~ar Esquire
FIRM NAME (If Applicable)
TELEPHONE NUMBER
717/737-8761
ICOMPLETE MAILING ADDRESS
One West Main Street
Shiremanstown, ~A:~-1701~.:~.~
6o
9.
10.
11.
12.
13.
14.
Real Estate (Schedule A) (1)
Stocks and Bonds (Schedule B) (2)
Closely Held Corporation, Partnership or (3)
Sole-Proprietorship
Mortgages & Notes Receivable (Schedule D (4)
Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
Jointly Owned Property (Schedule F) (6)
~ Separate Billing Requested
Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
Total Gross Assets (total Lines 1-7)
Funeral Expenses & Administrative Costs (Schedule H) (9)
Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
Total Deductions (total Lines 9 & 10)
Net Value of Estate (Line 8 minus Line 11)
None
None
None
None
365,778.80
None
12,280.99
8,445.43
3,031.58
Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
Net Value Subject to Tax (Line 12 minus Line 13)
,: OFFiC[AL USE ONLY
(8) 378,059.79
(11) 11,477.01
(12) 366,582.78
(13)
(14) 366,582.78
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116(a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
366,582.78
X .0 0 (15) 0.00
X .0 45 (16) 16,496.23
X .12 (17) 0.00
X .15 (18). 0.00
(19) 16,496.23
Copyright (c) ZOO0 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
Todd Home
203 Todd Circle
CITY
Carlisle
STATE
?A
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
0.00
15,671.42
824.81
ZIP
17013
Total Credits ( A + B + C )
(1) 16,496.23
(2) 16,496.23
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E ) (3) 0.00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page I Line 20 to request a refund (4) 0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00
A. Enter the interest on the tax due. (SA) 0.00
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SB) 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- retaintheuseorincomeofthepropertytransferred; .........................
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 receiving adequate consideration? ............................... r-']
3. Did decedent awn an "in trust for" or payable upon death bank account or security at his
or her death? ..............................................
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.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it Is true,
correct and complete.~,claration~~ ~. __gl preparer other than the personal representative is based on all information of which preparer has any knowledge.
S'GNATO"SO~N~SPO~,FOy,L,NG,ETU,N Calvin A. Hoerneman, Jr. SATE
//.~/~...//~Z. ,4 5712 Lamplighter Lane
' //,-- ~ J. 8i¥~8,-,:*--~ i~-' -~ ~ ?:7~. ............................ ~oLt0 [e
SIGNATURE O~PREPARER OTHER THAN REPRESENTATiVE James D. Bogar Esquire DATE
/] ,/~ _ One West Main Street
r dates of death on or afte'¥~luly 1, 1994 and before January 1, 1995, the tax rate imposed on the net value'of transfers to or for the ~se of the
surviving spouse is 3% [72 P.S. 9116 (a) (1.1)
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 ~f the surviving spouse is 0%
[72 P.S. 9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statuto~ requirements for disclosure 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 0% [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 4.5%, 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 12% [72 P.S. 9116(a)(1.3)]. A sibling is defined, under
Section 9102. as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
Copyright ic) Z000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00)
ADDITIONAL Personal Representatives
Estate of Calvin A. Hoerneman Sr. SS# 284-14-9582 07/14/2003
Under penalties of perjury, the undersigned declare that they
have examined this return, including accompanying schedules and
statements, and to the best of their knowledge and belief, it is
true, correct and complete.
Signature
Name
Address Line 1
Address Line 2
City, State, Zip
Ann V. Shults
9 Riddle Road
Camp Hill, PA 17011
Date
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0801
SAFE DEPOSIT BOX
INVENTORY
Please Print or Type
MUST BE COMPLETED BY REPRESENTATIVE OF FINANCIAL INSTITUTION WHERE SAFE DEPOSIT BOX IS LOCATED AND RETURNED TO ABOVE ADDRESS
[~ COUNTY CODE ~.~ FILE NUMBER ~ SOCIAL SECURITY OR DEATH CERTIFICATE NUMBER
284-14-9482
Hoernem~n, Calvin A. ~-July 14, 2003
ADDRESS OF DECEDENT (STREET)
(C~TY)
Todd Home, 203 Todd Circle Carlisle
NAME AND ADDRESS OF PERSON REQUESTING THE OPENING OF THE SAFE DEPOSIT BOX
(NAME)
Jennifer B. Hipp, Esquire
(STATE)
PA
(ZIP CODE)
17013
(STREET NAME) (CITY) (STATE)
One West Main Street Shiremanstown PA
NAME, ADDRESS AND RELATIONSHIP (IF ANY) TO DECEDENT, OF PERSON(S) PRESENT AT THE BOX OPENING
(ZIP CODE)
17011
a. (NAME) (RELATIONSHIP)
Ann V. Shults Daughter
(STREET NAME) (CITY)
9 Riddle Road Camp Hill
b. (NAME) (RELATIONSHIP)
Jennifer B. Hipp, Esquire None
(STATE) (ZIP CODE)
PA 17011
(STREET NAME)
One West Main Street
(CITY) (STATE) (ZIP CODE)
Shiremanstown PA 17011
(RELATIONSHIP)
c. (NAME)
(STREET NAME) (CITY) (STATE) (ZIP CODE)
~ NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED
(NAME)
Orrstown Bank
(STREET NAME) (CITY) (STATE) (ZIP CODE)
427 Stone Hedge Drive Carlisle PA
~[1~ NAME OF PERSON MAKING LAST ENTRY
Calvin A. Hoerneman, Jr.
~ DATE OF CONTRACT TO RENT BOX ~j NUMBER OF BOX. 10/20/9867
~'1 NAME AND ADDRESS OF PERSON(S) HAVING ACCESS TO BOX
,~ DATE AND TIME OF LAST ENTRY
7/15/03
TITLE UNDER WHICH BOX IS REQUESTED
ICalvin A. Hoerneman, Sr.
17013
a. (NAME)
ArmY. Shults
(STREET ADDRESS)
9 Riddle Road
(CITY) (STATE) (ZIP CODE)
Camp Hill, PA 17011
RENAME AND TITLE OF EMPLOYEE TAKING THE/NVENTORY
b. (NAME)
(STREET ADDRESS)
(CITY) (STATE) (ZIP CODE)
(NAME)
(STREET NAME) (CITY) (STATE) (ZIP CODE)
c. Name and address of attorney, if any
(NAME)
(STREET NAME) (CITY) (STATE) (ZIP CODE)
SAFE DEPOSIT BOX INVENTORY Page_
of__
INSTRUCTIONS
(1) Cash: Report total only.
(2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box.-Stocks are to be
designated by name of company, certificate number, date of certificate, name in which stock is registered, and
number of shares and class of stock.
(3) Obligations of U.S. Government: Number of items, date of issue, face value, names in which registered and
type of ownership, i.e., jointly held, payable on death, etc.
(4) Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds)
(5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in book,
name of bank and branch, and balance.
(6) Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as fully as possible.
(7) Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: List and describe as fully
as possible.
(8) All other contents.
ITEM
NO.
ITEM DESCRIPTION
PERSON RECEIVING COPY OF
SAFE DEPOSIT BOX INVENTORY:
I CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD IS
CORRI~CT AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF.
$1GNAT~JRE yl ~
Jen~f{~ ~. H~pp, Esquire
PRINT NAME AND ~HECK APPROPRIATE BOX BELOW:
Ann V. Shults
CHECK APPROPRIATE BOX:
~ Executor(bix) [] Actrninistrator(tdx)
[] Estate Representative [] Joint owner of safe deposit box
PRINT TITLE
Attorney
DATE
NOTE: Attach additional 8V2" x 11" sheet(s) if necessary or use duplicates of this page of form.
REV- 1508 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Calvin A. Hoerneman Sr.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
SS~ 284-14-9582 07/14/2003 21-03-0582
Include 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.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 5,358.40
2
3
4
Waypoint Bank - Checking Account No. 90188319, date of death
balance $5,358.29, accrued interest $0.11
1999 Chevrolet Cavalier L.S. Sedan - VIN 1G1JF52T8X7151217
Contents of home and personal property per attached appraisal
Prudential Securities Inc. Individual Retail Account No.
044-324555-87, date of death balance $348,872.61, accrued
interest $1,205.79
TOTAL (Also enter on line 5, Recapitulation)
7,000.00
3,342.00
350,078.40
$ 365,778.80
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97)
Account Number
Class of Account
Date Opened
Principal Balance
Accrued Interest
Balance at Date of
Death
8/7/2003
JAMES D BOGAR
1 W MAIN ST
SHIREMANSTOWN PA 17011
The information which you requested on the account(s) of CALVIN A HOERNEMAN
(Social Security Number 284-14-9582) is/are as follows:
90188319
CHECKING
031583
5358.29
.11
5358.40
Account Ownership SOLE
Name of Joint
Owner, if any
Date Ownership 031583
Was Established
Account Number
Class of Account
Date Opened
Principal Balance
Accrued Interest
Balance at Date of
Death
Account Ownership
Name of Joint
Owner, if any
Date Ownership
Was Established
Additional
Information
Requested
Sincej. e4y, . ,~
SENIOR SERVICES REP.
P.O. Box 17l 1. HARRISBURG. PENNSYLVANIA 17105-17ll
· JL-l?-200~ 13:23 FROM:USED CgRS
"7 / 5-'/;~ /'7
FAkiR ~T VALU~ AS OF (insert_
'70OO
ABOVE INFOldS. AT!ON PROVIDED Bi':
?" (S.~na~u_ e)
_ ('/~c,Z L,,,/.,,-/ .f,.f,, .~...:~_,,
(Title)
SU'rLIFF CHEVROt.£T CO.
BOX ~307
H~U~. ~ ~?~05
www.$uUiffau~o.¢om
FAX
RT 2~ &
PHONE
To:
From:
Re:
James D. Bogar, Attorney
One West Main St.
Shiremanstown, PA 17011
William G. Rowe, Appraiser
211 Old Stone House Rd.
Carlisle, PA 17013
Personal Property Appraisal
Estate of Calvin Hoerneman
Todd Home - 203 Park Street
Carlisle, PA 17013
Date: July 24, 2003
LINDEN HALL ANTIQUES
211 OLD STONE HOUSE ROAD
CARLISLE, PA 17013
717-249-1978
Desk - hand crafted
Stand, TV- hand crafted
TV / VCR
Shelf
Lamps
Ruby glass
Table - hand crafted
Dishes
Stool
Upholstered chair
Grandmother's clock - hand crafted case
Chair- hand crafted
Wing chair
Frames
Coffee table
Victorian stand
Table, dropleaf- hand crafted
Music center
Knee hole desk I chair
China, transfer - plates & hollow ware
Butter dish
Opalescent glass
China cabinet
Glassware
KITCHEN
Table - hand crafted
Plank chairs
Knick knacks
Household items
Frames
Candle sticks
Steins
Flatware / dishes / pots & pans
Towels, etc (Bathroom)
$185.00
$75.00
$30.00
$30.00
$35.00
$30.00
$20.00
$40.00
$15.00
$25.00
$225.00
$40.00
$65.00
$40.00
$35.00
$145.00
$50.00
$25.00
$65.00
$215.00
$15.00
$10.00
$40.00
$7.00
$100.00
$30.00
$15.00
$40.00
$50.00
$30.00
$45.00
$35.00
$20.00
Hoememan Appraisal 1 7/24/2003
SMALL BEDROOM
Computer
Windsor chair - hand crafted
Chest of drawers
Single bed
TV, old
Hallway - Reading printer birth certificates
MASTER BEDROOM
Single bed
Exercise bike
Upholstered chair
Small chest
Doughtray
Stand, marble top
Box - hand crafted
Chest of drawers - hand crafted
School masters' desk - hand crafted
Clock - steeple
Night stand
Lamps
Spool stand
Small collectibles
Stackable book case
Frames / prints
Silver plate items
Cups / saucers
Sweeper
Dishes
STORAGE AREA
Shelving
Christmas items
Misc, household items
$115.00
$100.00
$50.00
$30.00
$5.00
$120.00
$30.00
$10.00
$10.00
$10.00
$40.00
$110.00
$15.00
$200.00
$150.00
$65.00
$10.00
$40.00
$75.00
$30.00
$150.00
$50.O0
$3O.00
$10.00
$10.00
$15.00
$10.00
$10.00
$15.00
TOTAL $3,342.00
William G. Rowe
Hoememan Appraisal 2 7/24/2003
Prudential Securities
A Division of WACHOVIA SECURITIES, LLC
July 30, 2003
Mr. ]ames D. Bogar
One West Main Street
Shiremanstown, PA 17011
RE: Estate of Calvin A. Hoerneman
3 Lemoyne Drive
Lemoyne, PA 17043
Tel 717 761-7344 Fax 717 975-8426
Raymond G. Woods Ir., CFP~'''
Senior Vice President - Investments
IYIV ~t~;~[,/~(~/../~!'h3',t'! . I"~:',',-'
Shelly A. Weibley
Registered Assistant
,¥hcllv ~rc/h/c~ ~;
Dear Mr. Bogar:
Please be advised that Mr. Hoerneman maintained a Prudential Securities Individual
Retail account (a/c//044-324555-87) at the time of his death. The account is
titled: Calvin A. Hoerneman and was opened on 6/8/00. Attached is a list of the
positions held in his account as well as the value a/o 7/14/03.
We have opened an Estate account to which you will be receiving copies of the
statements. The assets have been moved into the estate account and will then be
transferred to the Mrs. Shults ~ Mr. Hoerneman on August 6~. We will need
signed authorization from both executors to issue a check to a third party. I have
enclosed a blank form.
Also, I will need an original Short Certificate for our files. If there is anything else
you need, please call me.
Shelly A. Weibley
Registered Assistant
Enclosures
CC
Ann Shults
Calvin Hoerneman Ir.
Wach~'ia Sec~naes. LLC, Member NYSE/SIPC
CALVIN A HOERNEMAN
ACCOUNT 1 044-324555-87
VALUE A/O 7/14/03
QUANTITY SYMBOL/CUSIP DESCRIPTION SPER SHARE TOTAL VALUE ACCRUED INT
651 BLS Bellsouth Corp 26.46 $17,225.46
150 DQE DQE Inc. 14.26 $2,142.00
550 FE First Energy Corp 36.20 $19,910.00
_ 100.876 FPL FPLGroup Inc 63.76 $6,431.85
_ 1450 PPL pre PPL Cap 7.75% 5/18104 21.05 $30,552.50
200 SO Southern Co 28.91 $5,782.00
150 VZ Vedzon Communications 37.50 $5,625.00
1421 WYPT Waypoint Financial 19.18 $27,254.78
15,000 45920QBR4R IBM Corp Medium Term 101.293 $15,193.95 131.75
5.10% 11/10/03
15,000 37042GL61R GMAC Smart Notes 103.258 $15,448.70 149.14
6.00% 11/15/05
10,000 06050XEC3R Bank of America Sub Inter 106.616 $10,661.60 237.25
5.85% 2/15/12
1131.351 CAIBX Capital Income Builder A 43.83 $49,587.11
5654 USA Liberty Ail Star Eq Fd 8.50 $48,059.00
4400 PIM Putnam Master Inter Icm Tr 6.55 $28,820.00
10,000 CD-Q879 Amer Nat'l 6.90% 8/18/03 100.515 $10,051.55 282.17
15,000 25467BDX3R CD Discover Bk 6.70% 11/15/04 106.150 $15,922.64 163.35
11,000 CD-X375 CD Greenpoint Bk 2.70% 12/13t05 100.693 $11,076.23 25.50
10,000 CD-TO24 CD Providian Nat'! 5.40% 2/23/04 102.042 $10,204.24 216.63
.,.
600 TFD TransAmer Finance 7.10% 11/1/28 25.53 $15,318.00
PBMXX Money Market Assets A 1.00 $3,606.00
TOTAL $348,872.61
The information ccn[ained heron has bee.,' obtaiaec from sources be loved re!iabie =u.: ~ot -=~'=~ar Iv
complete and cannot be guaranteed Your Wac~c',ia Secur~ie$ Client stateme?t is the cffi,..'c:ai ,eccrd
of your account
REV-1510 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Calvin A. I~oerneman Sr.
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
SS~ 284-14- 9582 07/14/2003 21-03-0582
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
DESCRIPTION OF PROPERTY % OF
ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER.
NUMBER ATTACH A CQPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (~F APPLICABLE)
1 MetLife Insurance Co. 12,280.99 12,280.99
Annuity-Contract 077 906
683 AB
TOTAL (Also enter on line 7, Recapitulation) $ 12,280.99
(If more space Is needed, insert additional sheets of the same raze)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1510 EX (Rev. 1-97)
MetLife
Fax Covers
To: JAMES D BOGAR From: MICHAEL HERRIMAN
Fax: 7t7 737 2086 Page: 1
Phar~ Dine: ~ept~mber 30, 2003
Re: CALVIN HOERNEMAN Phone: 918 252 8261
Ce~ract: 077 90~ 683 AB ;mc. 918 2~;2 8273
I-I Urgent ~ F~' I~vlew l-I Pt~ Comment ~ P~eas~ Reply I-I Ple~m Recycle
The Infonna~on contained in the following pagee i~ conflden~d and Irg'ended only for the in. dual
named al~e. Any ~ter use, ~ssemlngdon or copying of ggs communlcaflon Is sf~lctly ~ and is
y~u, plee~e notify us IMMEDIA TEL Y at ~e number listed above and zften desm~.
The value as of the date of death of 07/14/2003:$12,280.99
REV-1511 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Calvin A. Hoerneman Sr.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
SS# 284-14-9582 07/14/2003
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-03-0582
ITEM
NUMBER
2
3
3
4
FUNERAL EXPENSES:
City of Colu~mbiana
Cremation Society of
Final Bill
O. T. Beight & Sons,
DESCRIPTION
Cemetary, Columbiana, Ohio Grave Opening
Pennsylvania, Harrisburg, Pennsylvania -
E. Palestine, Ohio Monument Lettering
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s) / EIN Number of Personal Representative(s)
Street Address
City State
Year(s) Commission Paid:
Zip
Attorney's Fees James D. Bogar Esquire
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
C~ty
Relationship of Claimant to Decedent
Probate Fees
State - Zip
Register of Wills
Accountant's Fees
Tax Return Preparer's Fees
Other Administrative Costs
Linden Hall Antiques - Appraisal Fee
AMOUNT
RESERVES: Costs to conclude administration of Estate including
filing fee for PA Inheritance Tax Return, Inventory and First &
Final Account; preparation of Personal and Fiduciary Income Tax
Returns
TOTAL (Also enter on line 9, Recapitulation)
Sprint Telephone - Final Bill
Verizon - Telephone Bill-Final
(If more space is needed, insert additional sheets of the same size)
150.00
100.00
100.00
6,650.00
339.06
85.00
950.00
69.52
1.91
$ 8,445.43
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97)
REV-151Z EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Calvin A. Hoerneman Sr.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, AND LIENS
SS# 284-14-9582 07/14/2003
FILE NUMBER
21-03 -0582
Include unreimbursed medical expenses.
ITEM
NUMBER
1
2
3
4
5
DESCRIPTION
Central Penn Medical Group - Emergency Services
General Motors Corp Account Card-Bill Final
Todd Home Bill Final
United Church of Christ Home - Final Bill
West Shore EMS BLS Emergency Service
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
AMOUNT
18.22
180.96
1,459.90
1,340.50
32.00
3,031.58
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-151Z EX (Rev. 1-97)
REV- 1513 EX + (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Calvin A. ~Ioerneman Sr.
NUMBER
I.
2
I1.
SCHEDULE J
BENEFICIARIES
SS# 284-14-9582
NAME AND ADDRESS Of PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and
transfers under Sec. 9116~1.2)]
Calvin A. Hoerneman, Jr.
5712 Lamplighter Lane
Midland, MI 48642
17011
Ann V. Shults
9 Riddle Road
Camp Hill, PA
07/14/2003
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Son
Daughter
FILE NUMBER
21- 03- 0582
AMOUNT OR SHARE
OF ESTATE
0ne-half (1/2)
of rest,
residue and
remainder
0ne-half (1/2)-
of rest,
residue and
remainder
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
0.00
Copyright (c)2000 form software only The Lackner Group, Inc. Form REV-1513 EX (Rev. 9-00)
LAST WILL AND TESTAMENT
OF
CALVIN A. HOERNEMAN
I, CALVIN A. HOERNEMAN, of Carlisle, Cumberland County,
Pennsylvania, make, publish and declare this as and for my Last
Will and Testament, hereby revoking all other Wills and Codicils
heretofore made by me.
FIRST: I devise and bequeath all the rest, residue and
remainder of my estate of whatever nature and wherever situate,
including any property over which I hold power of appointment and
together with any insurance policies thereon, unto my wife,
LUCILLE A. HOERNEMAN, provided she survives me by sixty (60)
days.
SECOND: Should my wife, LUCILLE A. HOERNEMAN, prede-
cease me or die on or before the sixty-first (61st) day following
my death, I devise and bequeath all the rest, residue and remain-
der of my estate of whatever nature and wherever situate, includ-
ing any property over which I hold power of appointment and
together with any insurance policies thereon, in equal shares, to
my children, CALVIN A. HOERNEMAN, JR~ and ANN V. SHULTS, provided
that should either of my children predecease me, I give and
bequeath such child's share unto his or her issue per stirpes by
representation, and if there be a failure of same, then I give
and bequeath such deceased chil~'s share to my surviving child as
provided herein.
THIRD: In addition to all powers granted to them by
law and by other provisions of this Will, I give the fiduciaries
acting hereunder the following powers, applicable to all proper-
ty, exercisable without court approval and effective until actual
distribution of all property:
(A) To sell at public or private sale, or to lease,
for any period of time, any real or personal property and to give
options for sales, exchanges or leases, for such prices and upon
such terms (including credit, with or without security) or
conditions as are deemed proper. This includes the power to give
legally sufficient instruments for transfer of the property and
to receive the proceeds of any disposition of it.
(B) To partition, subdivide, or improve real estate
and to enter into agreements concerning the partition, subdivi-
sion, improvement, zoning or management of real estate and to
impose or extinguish restrictions on real estate.
(C) To compromise any claim or controversy and to
abandon any property which is of little or no value.
(D) To invest in all forms of property, including
stocks, common trust funds and mortgage investment funds, without
restriction to investments authorized for Pennsylvania fiduci-
aries, as are deemed proper, without regard to any principle of
diversification, risk or productivity.
(E) To exercise any option, right or privilege granted
in insurance policies or in other investments.
(F) To exercise any election or privilege given by the
Federal and other tax laws, including, but not necessarily being
limited to, personal income, gift and estate or inheritance tax
laws.
(G) To make distributions to my herein named benefici-
aries in cash or in kind or partly in each.
(H) To borrow money from themselves or others in order
to pay debts, taxes, or estate or trust administration expenses,
to protect or improve any property held under my will, and for
investment purposes.
(I) To select a mode of payment under any qualified
retirement plan (pension plan, profit sharing plan, employee
stock ownership plan, or any other type of qualified plan) to the
extent the plan or the law permits them to do so, and to exercise
·,~:'~ any other rights which they may have under the plan,~ in whatever
-~'~ manner they consider advisable
FOURTh: I direct that all inheritance, estate,
~' transfer, succession and death taxes, of any kind whatsoever,
2
which may be payable by reason of my death, whether or not with
respect to property passing under this Will, shall be paid out of
the principal of my residuary estate.
FIFT~: All interests hereunder, whether principal or
income, which are undistributed and in the possession of the
fiduciaries acting hereunder, even though vested or distribut-
able, shall not be subject to attachment, execution or sequestra-
tion for any debt, contract, obligation or liability of any
beneficiary, and furthermore, shall not be subject to pledge,
assignment, conveyance or anticipation.
SIXT~: I nominate and appoint my wife, LUCILLE A.
HOERNEMAN, Executrix of this, my Last Will and Testament. In the
event of the death, resignation or inability to serve for any
reason whatsoever of the said LUCILLE A. HOERNEMAN, I nominate
and appoint CALVIN A. HOERNEMAN, JR. and ANN V. SHULTS, Co-
Executors of this, my Last Will and Testament. I direct that my
Executrix or Executor, as the case may be, and their successors,
shall not be required to post security or a bond for the
performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and
seal to this, my Last Will and Testament, this ._~C~Z~ day of
~-~;~,~. , 2000.
~ ~," /
CALVIN a. HOERNEM3LN
Signed, sealed, published and declared by the above-
named Testator as and for his Last Will and Testament in our
presence, who, at his request, in his presence and in the
presence of each other, have hereunto subscribed our names as
attesting witnesses.
Address
Address
3
Register of Wills of
CUMBERLAND
INVENTORY
County, Pennsylvania
Estate of Calvin A. Hoerneman, Sr.
aJso known as
, Deceased
No. 21-03-0582
Date of Death 07/14/2003
Social Security No. 284-14- 9582
Calvin A. Hoerneman, Jr. and Ann V. Shults,
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the
personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation
placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned
no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this
Inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein
are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Name of
Attorney: James D. Bo~ar Esquire
I.D. No.:
Address:
19475
One West Main Street
Shiremanstown, PA 17011
Signature:
Signature:
Ann ~7:- Sh~zlts '
Address: 5712 Lamplighter Lane
Midland, MI 48642
Telephone: 717/737-8761
Telephone: 989/835-8103
Dated:
Description
(See continuation page(s) attached)
Value
(Attach additional sheets if necessary) Total: 365,778.80
~IOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
include the value of each item, but such figures should not be extended into the total of the Inventory.
Prepared by the Pennsylvania Bar Association
Copyright (c) 1996 form software only CPSystems. Inc. Form #RW-? (199;')
Estate of:
Date of Death:
County:
INVENTORY
Calvin A. Hoerneman, Sr.
07/14/2003
Cumberland
CASH:
Waypoint Bank - Checking
Account No. 90188319, date
of death balance $5,358.29,
accrued interest $0.11
5,358.40
PERSONAL PROPERTY:
1999 Chevrolet Cavalier L.S.
Sedan - VIN
1G1JF52TSX7151217
Contents of home and personal
property per attached
appraisal
Prudential Securities Inc.
Individual Retail Account
No. 044-324555-87, date of
death balance $348,872.61,
accrued interest $1,205.79
7,000.00
3,342.00
350,078.40
TOTAL RECEIPTS OF PRINCIPAL ...............
5,358.40
360,420.40
365,778.80
BUREAU OF ZNDZVZDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 180601
HARRISBURGj PA 1711B-0601
CONNONWEALTH OF PENNSYLVANIA
DEPARTNENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLO#ANCE OR DISALLO#ANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
JAHES D BOGAR ESQ
I W HAIN ST
SHIREHANSTOWN
PA 17011
REV-1647 EX AFP (01-05)
DATE 12-01-1005
ESTATE OF HOERNENAN CALVIN A
DATE OF DEATH 07-1q-2005
FILE NUMBER 21 05-0582
cOUNTy CUHBERLAND
ACN 101
Amoun~ Remi~ad I
HAKE CHECK PAYABLE AND RENZT PAYNENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV-15q7 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLOWANCE OR
DZSALLO#ANCE OF DEDUCTIONS AND ASSESSNENT OF TAX
ESTATE OF HOERNEHAN CALVIN A FILE NO. 21 05-0582 ACN 101 DATE 12-01-2005
TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REV~S£
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Es~a~e (Schedule A) (1)
2. S~ocks and Bonds (Schedule B) (2)
$. Closely Held S~ock/Per~nership In~eras~ (Schedule C) ($)
q. Not,gages/No,es Receivable (Schedule D) (q)
E. Cash/Bank Deposi~s/Nisc. Personal Proper~y (Schedule E)
6. Jointly Owned Proper~y (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. To~el Asse~s
APPROVED DEDUCTIONS AND EXENPTZONS:
9. Funeral Expenses/Adm. Costs/Misc. Expanses (Schedule H) (9)
10. Debts/Hot,gage Liabilities/Liens (Schedule I) (10)
11. To,al Deductions
12. Ne~ Value of Tax Re~urn
565/778.80
.00
.00 NOTE: To insure proper
.00 credi~ ~o your account,
.00 submi~ ~ha upper portion
.00 of ~his form wi~h your
~ax payment.
12~Z80.99
(B) 578,059.79
5~051.58
(11) 1].~77.nl
(12) 566,582.78
1:5. Charitable/Governmental Bequests; Non-elected 911:5 Trusts (Schedule J) (1:5) . O0
lq. Ne~: Value of Es~:a~e Subject: ~o Tax (1~) 566,582.78
NOTE: Z~ an assessment ~as issued previously, 11nas 1~, 15 and/or 16, 17, 18 and 19
reflect flgures that lnclude the total of ALL returns assessed to date.
ASSESSNENT OF TAX:
15. Amount: of L/ne lq a~ Spousal re~a (15) . O0 X O0 = .00
16. Aeoun~ of Line lq ~exeble e~ Lineal/Class A ra~e (16) 566,582.78 X 0q5 = 16,q96.25
17. Aeoun~ of Line lq a~ Sibling ra~:e (17) .00 X 12 = .00
18. Amoun~ of L/ne lq ~:axeble a~ Collateral/Class B ra~e (18) .00 X 15 = .00
19. Principal Tax Due
TAX CREDITS:
PAYMENT RECETpT
DATE NUMBER
10-10-2005 CD005109
(19)= 16,q96.25
D/SCOUNT
INTEREST/PEN PAID (-)
821.81
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
ANOUNT PAID
15,671 .qZ
TOTAL TAX CREDZT
BALANCE OF TAX DUEI .00
ZNTEREST AND PEN. I .00
TOTAL DUE I .00
( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS RE~UZRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDZT" (CR), YOU NAY BE DUE
A REFUND. SEE REVERSE SZDE OF THZS FORM FOR ZNSTRUCTZONS.)
RESERVATION:
PURPOSE OF
NOTICE:
PAYMENT:
REFUND (CR):
OBJECTIONS:
ADHIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December 1Z, 198Z -- if any future interest in the estate is transferred
in possession or enjoyment to Class 8 (collateral) beneficiaries of the decedent after the expiration of any estate for
Iifa or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class D (collateral) rate on any such future interest.
To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (72 P.S.
Section 91qO).
Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side.
--Make check or money order payable to: REGISTER OF HILLS, AGENT
A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office
of the Register of Hills, any of the Z3 Revenue District Offices, or by calling the special Iq-hour
enseering service for farms ordering: 1-DOO-36Z-ZOSO~ services for taxpayers with special hearing and / or
speaking needs: 1-800-~7-30Z0 (TT only).
Any party in interest not satisfied with the appraisement~ allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must abject within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals~ Oept. ZDIOZl~ Harrisburg, PA 17128-1021~ OR
--election to have the matter determined at audit of the account of the personal represantative~ OR
--appeal to the Orphans' Court.
1982
1983
198~
1985
1986
--Interest is calculated
INTEREST =
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue~
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601~ Harrisburg, PA 171Z8-0601
Phone (717) 787-650S. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
If any tax due is paid within three [3) calendar months after the decedent's death, a five percent (SI) discount of
the tax paid is allowed.
The 15X tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and nat
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has bean assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became deIinquent before January 1, 198Z bear interest at the rate of
six (6Z) percent per annum calculated at a daily rate of .O0016q. All taxes which became delinquent on and after
January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 198Z through 2003 are:
Interest Daily Interest Daily Interest Daily
Rate Factor Year Rate Factor Yaa.~r Rate Factor
gOZ .000548 1987 9Z .O00Zq7 1999 7Z .OOO19Z
16Z .000q38 1988-1991 III .000301 ZOO0 8Z .O00Z19
llZ .000301 1992 9Z .OOOZq7 2001 9Z .O00Zq7
132 .000356 199S-199q 7Z .O0019Z ZOOZ 62 .O0016q
IOZ .DOOZT~ 1995-1998 9Z .O00Z~7 ZOOS 5Z .000137
as follows:
BALANCE OF TAX UNPAID
X NUIIBER OF DAYS DELIN{IUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. Xf payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
Calvin A. HOerneman, Sr.
Date of Death: July 14, 2003
Will No.
21-03-0582
Admin. No.
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
State whether administration of the estate is complete:
Yes xx No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes No X
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes XX No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
Date: 5/26/04~_
....?l~ S ~gnature q
- ' James D. Bogar, Esquire
Name (Please typ. e or print)
One West Main St.
-o Shiremanstown, PA 17011
Address
1717 ) 737-8761
Tel. No.
Capacity:
__Personal Representative
(MAH:rmf/AM3)
x
__Counsel for personal
representative
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Calvin A. Hoerneman
Date of Death:
July 14, 2003
Will No. 21-03-0582
Admin. No.
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
State whether administration of the estate is complete:
Yes xx No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes No X
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes X No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Or-phans' Court and may be attached to this report.
Date: 8/5/04
James . ogar,
Esquire
Name (Please tyre or print)
One West Main St.
Shiremanstown, PA 17011
Address
1717I 737-8761
Tel. No.
Capacity:
__Personal Representative
(MAH:rmf/AM3)
x
__Counsel for personal
representative