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HomeMy WebLinkAbout04-0567COMMONWEALTH 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 004055 FLOWER THOMAS E 2109 MARKET STREET CAMP HILL, PA 17011 ........ fold ESTATE INFORMATION: SSN: 197-07-8090 FILE NUMBER: 2104-0567 DECEDENT NAME: HOOVER EARL R DATE OF PAYMENT: 06/1 6/2004 POSTMARK DATE: 06/1 5/2004 COUNTY: CUMBERLAND DATE OF DEATH: 05/23/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $599.66 TOTAL AMOUNT PAID: 8599.66 REMARKS: PEGGY L RITTER SEAL CHECK# 110 INITIALS: VZ RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE21NUMBEE _ 04 C/~-/~,~ COUNTY CODE YEAR NUMBER t.u DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) EARL R. HOOVER SOCIAL SECURITY NUMBER 197-07-8090 DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 05~23~2004 09/13/1916 REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER JANET L. HOOVER r~l. Odginal Return ~-]4. Limited Estate ~]6. Decedent Died Testate (Attach copy of Will} ~---~ 9. Litigation Proceeds Received NAME THOMAS E. FLOWER FIRM NAME (if Applicable) SAIDIS~,SHUFF, FLOWER & LINDSAY TELEPHONE NUMBER (717) 737-3405 [~]2. Supplemental I I (dale of ~eath pdor to 12-13-82) Return 3. Remainder Return [] 4a. Future Interest Compromise (da~e of death after 12-12-82)[] 5. Federal Estate Tax Return Required r'~7. Decedent Maintained Trust 8. Total Number of Safe Deposit Boxes a Living (A~tach copy [] 10. Spousal Poverty Credit (da~ of death between 12-31-91 and 1-1-95) [] 11. Election to tax under Sec. 9113(A) (Aftach Sob O) COMPLETE MAILING ADDRESS 2109 MARKET STREET CAMP HILL, PA 17011 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash. Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) r'~ Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) 17,520.78 5,541.67 ©FFIC~AL USE ©NLY (8) 550.00 0.00 (11) (12) (13) (14) 23,062.45 550.00 22,512.45 22,5'12.45 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)(~ .2) 16. Amount of Line 14 taxable at lineal rate 8,485.39 x .o O0 (15) 14,027.06 x .o 45 (16) 0.00 631.22 17. Amount of Line 14 taxable at sibling rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) 631.22 · Dece~lent's Complete Address: STREETADDRESS 311 Church Street CITY Uarysville J STATEpA 7053 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Pdor Payments C. Discount (1) 599.66 31.56 631.22 631.22 0.00 0.00 0.00 Interest/Penalty if applicable D. Interest E. Penalty Total Credits ( A + B + C ) (2) Total Interest/Penalty ( D + E ) (3) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (4) (5) (5A) (59) 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 properly 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 receiving adequate consideration? .............................................................................................................. [] [] 3. Did decedent own 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 ccmplete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF ,P,F,~SON RESPONSIBLE FOR F~I[.ING RETURN ADDRESS ~ ~ ~ \ - Peggy L. Ritter, 311 Church Street, Marysville, PA 17053 SIG~J .RE ,OF PREPARER];~_ BR~EPRESENTATIVE ADD~ESS ' - } DATE DATE Saidis, Shuff, Flower & Lindsay, 2109 Market Street, Camp Hill, PA 17011 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [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 transfem to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exem~)t a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return ara 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. REV-1509 EX+ (6-98~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER EARL R. HOOVER N/A If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. JANET L. HOOVER SPOUSE PEGGY L. RITTER 311 CHURCH ST., MARYSVILLE, PA 311 CHURCH ST., MARYSVILLE, PA DAUGHTER JOINTLY-OWNED PROPERTY: LETi"ER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. ~,- Checking Account 339657, 1st National Bank of Marysville 1,312.32 1/6 218.72 2. B. ~'/~/~ ~ Checking Account 339657, 1st National Bank of aarysville 1 312 32 1 /6 21 8.72 3. A. 10/'10/1990 Dwelling house and lot, 303 Cassell St., Marysville, PA 51,250.00 1/6 8,541.67 4. B. 12/01/200'~ Dwelling house and lot, 303 Cassell St., Marysville, PA 51 1 /6 8,541 TOTAL (Also enter on line 6, Recapitulation)$ 17,520.78 (If more space is needed, insert additional sheets of the same size) REV-1510 EX+ (6-98~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF EARL R. HOOVER FILE NUMBER N/A This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is es. DESCRIPTION OF PROPERTY ITEM INCLUDETHE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENTAND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST liE APPLICABLE~ VALUE 1. Dwelling house and lot, 303 Cassell St., Marysville, PA 51,250.00 1/6 3,000.00 5,541.6 By deed dated 12/01/2003, decedent conveyed, without consideration, 1/6 interest to daughter, Peggy L. Ritter, as joint tenant with right of survivorship. TOTAL (Also enter on line 7 Recapitulation) $ 5,541.67 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF EARL IR. HOOVEIR FILE NUMBER N/A Debts o! decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION FUNERAL EXPENSES: Sally Hepple, for memorial luncheon at church following funeral 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 Zip Year(s) Commission Paid: Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State . Zip Relationship of Claimant to Decedenl Probate Fees Accountant's Fees Tax Retum Preparer's Fees (memorial luncheon and tax return preparer's fees paid by surviwng spouse and daughter from joint checking account declared on schedule F. $275 of deduction is apportioned to 0% transfers to spouse and $275 of deduction is apportioned to 4.5% transfers to daughter.) TOTAL (Also enter on line 9, Recapitulation AMOUNT 200.00 350.00 $ 550.00 (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF EARL R. HOOVER FILE NUMBER N/A NUMBER Il NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] PEGGY L. RITTER, 311 Church St., Marysville, PA RELATIONSHIP TO DECEDENT Do Not List Trustee(s) daughter AMOUNT OR SHARE OF ESTATE 14,027.06 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE JANET L. HOOVER 311 CHURCH ST., MARYSVILLE, PA B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 8,485.39 TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 8,485.39 (If more space is needed, insert additional sheets of the same size) PAYABLE OFFICE HOURS PARCEL PAYEE OCCUPATIONAL/PER ~APITA TAX NOTICE 2003-2004 SUSQUENITA SCHOOL DISTRICT (150) MARYSVILLE BOROUGH OFFICE EOb'RS DONat.n G. PAI~MER, SR., TAX COLLECTOR 440 CAMERON STREET MARYSVILLE, PA 17053 TUES., WED., THURS. 1=00 PM - 5=00 PM AUG 26, 27, 28, 29, 30 10AM-8PM OT~ER TIM~S BY APPOINTM~NT PHONE= (717) 957-2746 ~x wY 24101 ~CL'PAT. CODE 999 T~ HOOVER EARL R PAYEE 303 CASSELL STREET MARYSVILLE PA 17053 D~scription SCH'~ ~ ~REs PAID Total 0 Bill No: Control: Date: 00689 (15003-7} JUL 01, 2003 - Discount Face 4.90 5.00 M,~I~YSVILLE BOROUGH Rate 5.000 $ 5.0O0 $ 4.90 5.00 AU~ 2 5 D.j:I~IALD G. PALMER { ~ ~.~X?~O~ & Due ~PAID T~ES TO COLLE~ION AGENT 01/01/04 NO APPE~S ~TER SEPTEMBER 1, 2003 Return Bill with Payment. For Receipt, ~C ~!t~o w~ ~e~J~oN Enclose Self-Addressed Stamped Envelope c ns he ZF PAZ]5 { BET.EE~ { BEFORE J 09/01/2003{ 08/31/2003 I 10/31/2003{ Physically Impaired + Penalty 5.50 5.50 11.00 AFTER. 11/01/2003 03 DEC -5 AH 15 PARCEL #: MADE THE THIS DEED /'~._Z' day of ~el?6~/-~'l~)~'/'~- Thousand Three (2003) ., in the year of our Lord Two BETWEEN EARL RUSSELL HOOVER, by Peggy L. Ritter, his Agent, specially constituted by Power of Attorney dated August 25, 1983 and recorded in the Office of the Recorder of Deeds in and for the County of Perry, in Deed Book-~t~/~/~'69 page , as by reference thereunto being had, and JANET LARUE HOOVER, his wife, of Perry County, Pennsylvania, hereinafter (Grantors) and EARL R. HOOVER, JANET L. HOOVER and PEGGY L. RITrER, of Perry County, Pennsylvania hereinafter (Grantees) WITNESSETH, that in consideration of One Dollar (,$1.00) in hand paid, the receipt whereof is hereby acknowledged, the said Grantors do hereby grant and convey to the said Grantees, their heirs and assigns, as joint tenants with right of survivorship; ALL THAT CERTAIN piece, parcel and tract of land situate in Marysville Borough, Perry County, Pennsylvania, more particularly bounded and described as follows, to wit: BEGINNING at a post at the northwest corner of Bitting Alley and South Cassell Street; thence in a westerly direction along the north side of Cassell Street a distance of 44 feet to lands now or formerly of Mark Paul, et ux; thence in a northerly direction along the eastern side of lands now or formerly of Paul, a distance of 118 feet to a point at the northeastern corner of lands now or formerly of Paul, which was formerly the center of an unopened 12-foot alley; thence continuing in a northerly direction by lands now for formerly of David E. Ritter, et ux, 9 feet to a point; thence continuing by lands now or formerly of Ritter in an easterly direction 40 feet to a point on the western side of Bitting Alley; thence by the western side of Bitting Alley, 109 feet to a post at the northwestern corner of Bitting Alley and Cassell Street, the place of Beginning, HAVING thereon erected a two-story frame dwelling house, known and numbered as 303 Cassell Street, Marysville, Pennsylvania, BEING the same premises which Earl Russell Hoover and Janet Larue Hoover, his wife, granted and conveyed to Earl Russell Hoover and Janet Larue Hoover, as tenants by the entireties, by Deed dated October 5, 1990, which Deed is recorded in the Office of the Recorder of Deeds in and for Perry County in Record Book 0594 at Page 193, AND this is a tax-exempt conveyance between parents and child, AND the said Grantors hereby covenant and agree that they will warrant specially the property hereby conveyed. IN WITNESS WHEREOF, said Grantors have hereunto set their hands and seals the day and year above written. SIGNED, SEALED AND DELIVERED IN THE PRESENCE OF : Earl Russell Hoover, by Peggy L. Ritter, : his agent under power of attorney :~anet kartJe Hd(~ver .... COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND : ss On this, the / 5'~' day of ~/~/72/~/q , 2003 before me, the undersigned officer personally appeared Peggy L. Ritter, as agent for Earl Russell Hoover, and Janet Larue Hoover, known to me (or satisfactorily proven) to be the persons whose names are subscribed to the within instrument, and acknowledged that they executed the same for th.e.~purposes therein contained. IN WITNESS WHEREOF, I hereunto set my ha.p~Ond official ?al. I Sallie Ailshouse, Notary Public J Carlisle Boro, C_umberland County J My Commission ~xpires Mar. 29, 2004 ~ of OffiCer - I do hereby certify that the precise residence and complete post office addresses of the within named Grantees, is 303 Cassell Street and 311 Church Street, Marysville, PA 17053. DATED: [2~! .Z~ Thomas E. Flower, Esquire Attorney for Grantees COMMONWEALTH OF PENNSYLVANIA: County of Perry :SS RECORDED on this ~ day of ~ A.D. 2003, in the Recorder's office of the said County, in Deed Book VoI,¢~~__OO~ / g ~'~ ~ Page Given under my hand and the seal of the said office, the date above written. , Recorder. 6ARL R~HOCVER ~ANET L'HOOVER ~EGGY L~RITTER -~i1 CHURCH ST h%RYSVI LLE }ESCRIPTION tALANCE AS OF 05/22/2004 )TC !254 PA 17053-1208 CHECKS 108.14 ACCT.~ 396575 DEPOSITS BEGIN DATE 05/23/2004 DATE BALANCE 05/22/2004 1,312.32 05/25/2004 1,204.18 )TC 1255 200.00 06/02/2004 1,004.18 .................. (CHECKS REPRINTED IN CHECK NUMBER ORDER) .............. 1254 05/25/2004 108.14 1255 06/02/2004 AVERAGE BALANCE FOR THIS STATEMENT CYCLE: $1,567.07 200.00 BEGIN BALANCE 1,312.32 DEBITS ...... > < ..... CREDITS ...... > ENDING BALANCE 308.14 1,004.18 ENTER 'E' TO END, 'P' TO PRINT, '#' FOR PAGE ~ARL R* HOOVER iANET L'HOOVER ?EGGY ~i* Ri TTER ~1! CHURCH ST 4ARYSVI LLE )ESCRIPTION BALANCE .LAST STATEMENT }TC 1250 FED 1251 FED 1252 DTC 1253 ACCT.~ 396575 BEGIN DATE 05/11/'2004 PA 17053-1208 CHECKS 22 00 6 76 80 00 700 00 DEPOSITS DATE BALANCE 05/10/2004 2,121 08 05/12/2004 2,099 08 05/13/2004 2,092 32 05/18/2004 2,0!2 32 05/21/2004 1,312 32 DTC 1254 108 14 05/25/2004 1,204 18 DTC 1255 200 00 06/02/2004 1,004 18 ~ ............... (CHECKS REPRINTED IN CHECK NUMBER ORDER) .... J ............. 1250 05/12/2004 22.00 1251 05/13/2004 1252 05/18/2004 80.00 ~25~ 05/21/2004 1254 05/25/2004 108.14 1255 06/02/2004 AVERAGE BALANCE FOR THIS STATEMENT CYCLE: $1,567.07 6.76 700.00 200.00 BEGIN BALANCE 2,121.08 < ...... DEBITS ...... > 6 1,116.90 < ..... CREDITS ...... > ENDING BALANCE 1,004.18 ENTER 'E' TO END, 'P' TO PRINT, '#' FOR PAGE PN: ACCOUN'I' 296575 EARL R'HOOVER BRANCH 00 OFF 30 PREMIER ACCO~qT JANET L'HOOVER SS 19'7-07-8090 PEGGY L*RITTER HOME 000 0000 BRANCH 1 311 CHURCH ST BUS 000 0000 YARYSVILLE PA 17053-1208 DAF .0i6~ MEMO CURRENT DATE OF AMOUNT OF LAST DATE OF BALA~NCE OF DATE OF ., ~,.A~.,g~ ~..p~ ~~... LAST STM LAST STM LAST ACT 1,241.18 05/03/2004 1,695.42 05/10/2004 2,121.08 06/02/2004 AVAIL BAL -CHECK- 1,241.18 HOLD AMT ~Y~.LE LAST MAINT MEMO POST' 2 06/04/2004 237.00 2 UNPOSTED iTEMS 37 EARL DECEASED 5-23-2004 MSG SIG USR MET ENTER OPTION >LME~4001 V.1!.04 Pose Transacu!ons - 0000396575 ~vaiia~ie Balance: 1,241.18 DDA POSTING HRS TRA=N )ATE TIME TLR CD CD ~6/04 09:40 MDC* 0 17 Sub-Total 0 (Today) : Sub-Total 1 (Tomorrow): Grand Tosal: DEBITS .00 .00 .00 HOOVER EARL R CREDITS 237.00 237.00 .00 237.00 DESC BAT CORR. TERM CD NUM NL~BER NUM. 30 16 (HRS CD: 0=TODAY; !=TOMORROW) PRESS 'ENTER' TO CONTINUE: _ ARA P.* HOOVER ~{ET L'HOOVER ACCOUNT NO. 396575 DATE 05/10/2004 EGGY L*R!T?ER 11 CHURCH ST ARYSViLLE PA 17053-1208 ~ ............... (DEPOSITS) TC DESC CORR~ SEQ~ EFFECT POSTED AMOD~T GROUP# SRC P D T 17 ACH 1119 3099620 NONPOST 06/03/04 237.00 10 0 3 0 S TREASURY 303 PPD SOC SEC 17 ACH 926 3099557 NONPOST 06/03/04 551.00 10 0 3 0 SOC SEC S TREASURY 303 PPD ,, . .......................................................................... ~ ................. (CHECKS) TC DESC CORR# SEQ# EFFECT POSTED AMOUNT CK# SRC P D T 42 OTC 19 44 FED 641 44 FED 1894 42 OTC 511 42 OTC 175 42 OTC 166 BEGIN BALANCE 2,121.08 673798 05/12/04 05/12/04 678768 05/13/04 05/13/04 718019 05/18/04 05/18/04 746043 05/21/04 05/21/04 772053 05/25/04 05/25/04 841793 06/02/04 06/02/04 22 00 6 76 80 00 7O0 00 108 14 200 00 1250 1251 1252 1253 1254 1255 O0 0 0 0 O0 0 0 0 O0 0 0 0 O0 0 0 0 O0 0 0 0 O0 0 0 0 < ...... DEBITS ...... 6 1,116.90 < ..... CREDITS ...... > ENDING BALANCE 1,004.18 'ENTER' TO END, '~' FOR PAGE Current Date: Account Number: Capture Date: Item Number: Posted Date: Posted Item Number: Amount: Record Type: June 04,2004 396575 May 25,2004 30003772053 May 25,2004 3772053 $108.14 Debit EARL R HOOVER JANET L HOOVER 311 CHURCH ST MARYSVILLE, PA 17053-1208 O E~ :~3 m O O o) O O .o Current Date: Account Number: Capture Date: Item Number: Posted Date: Posted Item Number: Amount: Record Type: June 04, 2004 396575 June 02, 2004 30003841793 June 02, 2004 3841793 $2OO.OO Debit EARL R HOOVER JANET L HOOVER 311 CHURCH ST MARYSVlLLE, PA 17053-1208 ~RL R. HOOVER J~ L. HOOVER ~ . -vv PEGGY ~ R~ER ~ PREMIER CLUB O0'OOff$ :~unowv ~T ....... u .... - ..... ~S=?I ~O0~tlO/90 )WER AY ~treet 17011 'YCOURTHOUSE BUREAU OF INDIVIDUAL TAXES ZNHERTTANCE TAX DTVTSZnN DEPT. 280601 HARRISBURG, PA 1711B-060! THOMAS E FLOWER SAIDIS ETAL 2109 HARKET ST CAMP HILL PA 17011 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF /NHER/TANCE TAX APPRA/SEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ~ ~TE OF OF DEATH NUMBER 08-01-200q HOOVER 05-23-200q 21 0q-0567 CUMBERLAND 101 Amount Reei'l:'l:ed RE¥-1~7 EX AFP (OZ-OS) EARL MAKE CHECK PAYABLE AND RENZT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LZNE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-15q7 EX AFP (01-03} NOTICE OF INHERITANCE TAX APPRAZSEMENT~ ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF HOOVER EARL FILE NO. 21 0q-0567 ACM 101 BATE 08-02-200q TAX RETURN WAS: (X) ACCEPTED AS FZLED ( ) CHANGED RESERVATZON CONCERNZNG FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es~a~e (Schedule A) (1) 2. S~ocks and Bonds (Schedule B) (2) 3. Closely Held S~ock/Par~nership Zn~eres~ (Schedule C} q. Mor~gagos/No~as Receivable (Schedule D} $. Cash/Bank Deposits~Misc. Personal Proper~y (Schedule E) ($) 6. Jointly Owned Propar~y (Schedule F) (6} 7. Transfers (Schedule G) (7) 8. To,al Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs~Misc. Expenses (Schedule H) (9) 10. Debts~Mortgage LiabLIL~Les/LLens (Schedule Z) (10) 11. To,al Deduc~/ons 12. Ne~ Value of Tax Re~urn .00 NOTE: To /nsure proper .00 crad/~ *o your account, .00 submi~ ~ha upper portion .00 of ~his form wi~h your .00 ~ax payeen~. 171520.78 515fil .67 (8) 550. O0 .O0 23,062.q5 15. lq. NOTE: (11) (12) Zg,512.q5 .00 22,512.~5 599.66 ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ASSESSMENT OF TAX: 15. Amoun'~ of LLna lq a~ Spousal ra~a 16. Aeoun~ of L/ne lq ~axable a~ Lineal~Class A ra~a 17. Amount: of Line lq a~ Sibling ra~e 18. Amoun~ of L/ne lq ~axeble a~ Collateral/Class B ra~:a 19. Principal Tax Due TAX CREDITS: PAYMENT RECEIPT DTSCOUNT DATE NUMBER ZNTEREST/PEN PAID (-) 06-15-200q CDOOqO55 31.56 TOTAL TAX CREDIT 631.22 BALANCE OF TAX DUEI .00 INTEREST ANB 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 'CREDIT' (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) AMOUNT PAZD (1.6) 8,q85.39 X 00 = .00 (16) lq,027.06 X Oq5 = 631.22 (17) .00 X 12 = .00 (18) .00 x 15 = .00 (19)= 631.2Z reflect figures that lnclude the total of ALL returns assessed to date. Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) Ne~ Value of Es~a~e Subjec~ ~o Tax (lq) Zf an assessment was issued previously, lines 1~, 15 and/or 16, 17, 18 and 19 w111 RESERVATION: Estates of decedents dying on or before December 1Z, 1981 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decadent after the expiration of any estate for life ar for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such futura interest. PURPOSE DF NOTICE= PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section 2140 of the Inharltance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). Detach the top portion of this Notice and submit eith your payment to the Register of Mills printed on the reverse side. --Make check or money order payable to: REGISTER OF NILLS, AGENT A refund of a tax credit, which ems 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 25 Revenue District Offices, or by calling the special Z4-hour ansmaring service for forms ordering: 1-B00-561-Z050~ services for taxpayers with special hearing and / or speaking needs: 1-B00-447-5010 (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 object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. ZSlOZl, Harrisburg, PA 17128-1011, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. 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. 180601, Narrisburg~ PA 17118-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-150I) for an explanation of administratively correctable errors. If any tax due is paid within three (5) calendar months after the decedent's death, a five percent (51) discount of the tax paid is allowed. The 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same ties period as you Mould appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one El) day from the date of death, to the date of payment. Taxes which became delinquent before January l, 1982 bear interest at the rate of six (61) percent per annum calculated at a daily rate of .000164. AIl taxes which became delinquent on and after January 1, 1981 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 19BI through 2004 ara: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~ ZOZ .000548 ~'~-1991 Ill .000301 ZOO1 9X ,000247 1985 161 .0004S8 1991 9Z ,000247 ZOOZ 61 .000164 1984 11X .000501 1993-1994 7Z .O00Xgz 2003 52 .000137 1985 132 .000356 1995-1998 92 .000247 2004 42 .000110 1986 lOX .000274 1999 7Z .OOOlgZ 1987 102 .000174 ZOO0 7Z .000191 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAI'D X NUNBER OF DAYS DELINQUENT 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. If payment is made after the interest computation date shown on the Notica~ additional interest must ba caZculatad.