HomeMy WebLinkAbout06-10-10J ],505607121,
REV-1500 EX (06-05)
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN
Harrisbur , PA 17128-0601 RESIDENT DECEDENT 2 1 1 0 0 1 2 7
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
Date of Birth
1 9 9 0 3 7 0 5 7 0 1 2 4 2 0 1 0 1, 2 1, 5 1 9 2 2
Decedent's Last Name
Suffix Decedent's First Name
H O O V E R MI
E T H E L H
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name
Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
FILL IN APPROPRIATE OVALS BELOW REGISTER OF WILLS
1. Original Return ~ 2. Supplemental Return
3. Remainder Return (date of death
4. Limited Estate
^X 6
D ~ prior to 12-13-82)
4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required
death after 12-12-82)
.
ecedent Died Testate
(Attach Copy of Will)
9
Liti
ati
P ~ 7. Decedent Maintained a Livin Trust
g 0 8. Total Number ~of Safe Deposit Boxes
(Attach Copy of Trust)
.
g
on
roceeds Received 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95)
(Attach Sch. G)
CORRESPONDENT - TH/S SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX
Nam
e INFORMATION SHOULD BE DIRECTED T0:
Daytime Telephone Number
Firm Name (If Applicable) 7 1 7 2 4 3 3 3 4 1
M A R T S O N
First line of address
1 0 E A S T
Second line of address
City or Post Office
C A R L I S L E
L A W O F F I C E S
H I G H S T R E E T
State ZIP Code
P A
PLEASE USE ORIGINAL FORM ONLY
__--
REGISTER OF WILLS USE QAI,i,Y
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DAT!?~ILED
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Correspondent's a-mail address: H G I L R O Y a9 M A R T S O N L A W• C O M
Under penalties of perjury, l 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. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
ADDRESS C~ ATE
~~- p-~6
912 sbur Road Carlisle ^~n
SIGNQ(`rU~~P,REP 1-JCOITLJA~~ nr P A ~~ ! 1 11.
ADDRESS
1,0 EAST HIGH BEET
15056071,21
r~crr[cJCIV IAI IVt
CARLISLE
Side 1
DA
- ~- ~~
~++ ~ uyJ
1505607121 J
~1 ~
J
1505607221
REV-1500 EX Decedent's Social Security Number
Decedent's Name: E T H E L H- H O O V E R 1 9 9 0 3 7 0 5 7
RECAPITULATION
1. Real estate (Schedule A) ........................................ 1 • •
2. Stocks and Bonds (Schedule B) .................................. 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. •
4. Mortgages & Notes Receivable (Schedule D) ........................ 4. •
7 4 7 9 . 0 3
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5.
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6• '
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ~ Separate Billing Requested ....... 7. •
8. Total Gross Assets (total Lines 1-7) ........................... 8. 7 4 7 9 . 0 3
9. Funeral Expenses & Administrative Costs (Schedule H) ................ 9• 2 5 6 2 . 1 6
2 8 9 8 1 1 1
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............ 10. .
11. Total Deductions (total Lines 9 & 10) ........................... 11. 3 1 5 4 3 . 2 7
12. Net Value of Estate (Line 8 minus Line 11) ......................... 12• - 2 4 0 6 4 . 2 4
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) .................. 13. •
- 2 4 0 6 4 2 4
14. Net Value Subject to Tax (Line 12 minus Line 13) .................. 14. .
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .0 15. •
16. Amount of Line 14 taxable
at lineal rate X .0 16. •
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.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
1505607221 1505607221
J
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
ETHEL H. HOOVER _
STREET ADDRESS - ---- ---
---- ---- ------
CITY
Tax Payments and Credits:
~~ Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
File Number
21 10 0127
----
STATE _ _ - - ZIP
(1)
3. Interest/Penalty ifapplicable Total Credits (A + B + C) (2)
D. Interest
E. Penalty
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.T otal Interest/Penalty (D + E) (3)
Fill in oval on Page 2, Line 20 to request a refund. (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(5)
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5AJ
(5B)
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; ^
...................................................................... D x
b. retain the right to designate who shall use the property transferred or its income; ............................... ^
c. retain a reversionary interest; or .... ^
............................................................................................ ^ X
d. receive the promise for life of either payments, benefits or care? ....................................................... ^ 0
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ...... ^
................................................................................. ^ x
3. Did decedent own an "in (rust for" or payable upon death bank account or securify at his or her death? ......... ^ 0
4. Did decedent own an Individual Retirement Account, annuify, or other non-probate property which
contains a beneficiary designation? ................................
................................................................ n n
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 of 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 (O) percent
(72 P.S. §9116 (a) (1.1) (ii)J. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax 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 (O) 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)J.
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)]. Asib~ing 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-1508 EX + (6-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, Ot MASC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF
ETHEL H. HOOVER FILE NUMBER
21 10 0127
Include the proceeds of litigation and the date the proceeds were received by the estate.
All properly jointty--owned with right of survivorship must be disclosed on Schedule F.
1 TEM
NUMBER
DESCRIPTION
1• Sovereign Bank Checking 1691023647
(See attached)
2. I CenturyLink., refund
VALUE AT DATE
OF DEATH
7,466.67
12.36
_ TOTAL (Also enter on line 5, Recapitulation) I $
(If more space is needed, insert add-tional sheets of fhe same size) 7,479.03
REV-1511 EX + (10-06)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
ETHEL H. HOOVER 21 10 0127
Debts of decedent must be reported on Schedule I.
1 TEM
NUMBER DESCRIPTION
A. FUNERAL EXPENSES:
1. Ewing Brothers Funeral Home, Carlisle, PA
2. Sandra E. Stuck, reimbursement for funeral flowers
3. Staples, funeral programs
B. ADMINISTRATIVE COSTS:
7• Personal Representafive's Commissions
Name of Personal Representative (s) Sandra E. Stuck
Street Address 912 Petersburg Road
City Carlisle State PA Zip 17015
Year(s) Commission Paid: 2010
AMOUNT
402.33
159.00
8.79
375.00
2, Attorney Fees MARTSON LAW OFFICES (estimated) 1,500.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4• Probate Fees Cumberland County Register of Wills 81.50
5 Accountants Fees
6. Tax Return Preparer's Fees
7. Filing fee, Inheritance Tax return 15.00
8. Certified mailing, PA Department of Public Welfare 5.54
9. Additional Probate fee 15.00
TOTAL (Also enter online 9, Recapitulation) I $ 2,562.16
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (12-03)
SCHEDULEI
COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT ~
ESTATE OF FILE NUMBER
ETHEL H. HOOVER 21 10 0127
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. Sovereign Bank checking 1691023647, outstanding check on date of death 1,296.00
(Payment to Sarah A. Todd Memorial Home)
2. CenturyLink, account payable 28 88
3. Commonwealth of Pennsylvania, Department of Public Welfare, claim for medical assistance 27,656.23
#517930109
TOTAL (Also enter on line 10, Recapitulation) I $ 28,981.11
(!f more space is needed, insert additional sheets of the same size)
~~ r_.._
LAST WILL AND TESTAMENT
OF
ETHEL H. HOOVER
SAIDIS
SHUFF, FLOWER
& LINDSAY
ATTOIZNEYS•AT•LAW
26 W. High Street
Carlisle, PA
I, Ethel H. Hoover of Carlisle, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and
understanding, do hereby make, publish and declare this as and
for r,11r cast Will and Testament, hereby revoking all other Wills
and Codicils heretofore made by me.
FIRST
I direct the payment of my just debts and expenses of my
last illness and funeral from my estate as soon after my death as
conveniently may be done. I direct that my body be interred at
the Westminster Cemetery in Carlisle, Cumberland County,
Pennsylvania.
Further, I authorize my personal representative to expend
funds from my estate, in such amount as my personal
representative shall consider necessary and desirable for the
purchase, erection and inscription of a suitable marker for my
grave.
SECOND
I give, devise and bequeath all the rest, residue and
remainder of my estate unto my children in the following
proportions:
~ .,
a. To my daughter, Sandra Barrick Stuck, Sixty-Five (65s)
Percent of my residuary estate; and
b. To my son, Timothy Hurley, Thirty-Five (350) Percent of
my residuary estate.
In the event that any of my children have predeceased me,
then I direct that their heirs receive their proportionate share
of the estate as listed above.
THIRD
I direct that any and all inheritance, estate, and transfer
taxes imposed upon my estate passing under this Will or otherwise
shall be paid out of the principal of my residuary estate.
FOURTH
In addition to the powers conferred by law, I authorize any
personal representative acting under this instrument:, in their
absolute discretion:
A. To retain in the form received, or to sell either at
public or private sale any real or personal property;
B. To exercise any options to subscribe fo:r stocks,
bonds, or other investments;
SAIDIS C . To j oin in any plan of lease, mortgage,
SHUFF, FLOWER
& LINDSAY
ATTORNEYS•AT•LAW consolidation, exchange, reorganization or forE~closure of
26 W. High Street
Carlisle, PA any corporation in which my estate or any trust. may hold
stocks, bonds or other securities;
D. To sell, transfer, convey, mortgage, pledge, lease
or exchange any property, real or personal, which at any
2
time may form part of my estate, for the payment of debts or'
taxes, or for any purpose of administration or distribution,
for such prices and upon such terms as my personal
representative, in their sole discretion, may deem wise, and
to execute and deliver deeds of conveyance or ttransfer
thereof;
E. To make settlements and compromises on such terms as
my personal representative in their sole discretion may deem
wise without the necessity of obtaining any court approval
thereof;
F. To make distribution hereunder either in cash or
kind, as my personal representative in their discretion may
deem wise.
FIFTH
I do hereby nominate, constitute and appoint my daughter,
SAIDIS
SHUFF, FLOWER
& LINDSAY
ATTORNEYS•AT•L.AW
26 W. High Street
Carlisle, PA
Sandra Barrick Stuck, to act as Executrix of this my Last Will
and Testament. Provided, however, that if she is unwilling or
unable to act as Executrix, I direct the duties of Executor to be
performed by my son, Tim Hurley.
SIXTH
I direct that no personal representative, guardian, trustee
or other fiduciary appointed under this instrument shall be
required to give bond for the faithful performance of their
duties in any jurisdiction.
3
IN WITNESS WHEREOF, I, ETHEL H. HOOVER, have hereunto set my
hand and seal to this my Last Will and Testament, consisting of
f ive ( 5 ) typewritten pages , al l f ive ( 5 ) pages of which bear my
signature in the margin for identification, this ~~ day of
January, 2003.
~~~~~cGG ~l ~v
ETHEL H. HOOVER
Signed, sealed, published and declared by the above-named
ETHEL H. HOOVER Testatrix, as and for her Last Will and
Testament in the presence of us, who have hereunto subscribed our
names at her request as witnesses thereto, in the presence of
said Testatrix and of each other.
ADDRESS ~ -~
~~) l~
'~l~ Jl
- ADDRESS ~(Q ~.
~ ~
SAIDIS
SNUFF, FLOWER
& LINDSAY
ATTORNEYS•AT•LAW
26 W. High Street
Carlisle, PA
4
/'
~ • a
COMMONWEALTH OF PENNSYLVANIA
COLmTTY OF CUMBERLAND
e, ~ HEL H. HOOVER and
the Testatrix an witnesses,
respectively whose names are signed to the foregoing or attached
instrument, being first duly sworn, do hereby declare to the
undersigned authority that the Testatrix signed and executed the
instrument as her Last Will and Testament and that she signed
willingly and that executed as her free and voluntary act for the
purposes therein expressed, and that each of the witnesses, in
the presence and hearing of the Testatrix signed the Will as
witnesses and that to the best of their knowledge the Testatrix
was at the time eighteen (18) or more years of age, of sound mind
and under no constraint or undue influence.
ETHEL H. HOOVER
,.
,Witness
G~~
,Witness
~',~ Subscribed, sworn to and acknowledged before mE~ by ETHEL H.
'~'~`~ HOOVER, the Testatrix, and subscribed to and sworn or affirmed to
before me by Lindsay Gingrich Maclav and Adele H. Group ,
witnesses, this 13th day of January ~'~ 2~_•
y -
~.~-~ ~~.
Notary Public
SAIDIS
SHUFF, FLOWER
& LINDSAY ~ NoTA~IA~- s~ai_
RENEE l.. MUFfRAY, Notary Public
ATTORNEYS•AT•LAW ~ CarltSle $qro, (;UmhAr!an~{ CO., PA
26 W. High Street My Comer,;;,;,-.~; r ~; „~ n r
-' ~^'~ .e„~m~er !3, 2005
Carlisle, PA _...~,..,-~r.....~._.....
5
Page: 1 Document Name: untitled
DDHIST Demand Deposit Display History
Acct 1691023647
Alpha key HOOVEEH.03
Request ALLTRANS
Last stmt 02/12/10
6017 02/19/10
S --Date-- ----Description----- -Serial Nbr- -Reference- ------Amount------
* O 1 14 10 DAI'~,Y BALANCE ~D ~ 7
4 6 6
6 7
* 01/25 10 #CHECk 2517 06116002310 ,
.
sc 1,296.00
* O1 25 10 DAILY BALANCE 170
67
* 01/28/10 #CHECK 2518 06386200260 ,
.
~, (g,79)
* 02/03/10 US TREASURY 303
00077900000
~~ w~~ '~1, 490.00
199057057A SSA
* 02/03/10 CenturyLink Telecom 00077900000 ~,~,~ (28,gg)
100202 7172492071888
* 02/03/10 DAILY BALANCE 7
623
00
* 02/12/10 INTEREST CREDIT 00000000000 ,
.
0
06
* 02/12/10 DAILY BALANCE .
7,623.06
_ DDDHISTREQ _ DDDHISTBAL DDDMAIN DDDACCT
DDDINT
Last page of information. _ _
_
GN20000I02
COMMAND =__>
F7=Backward
F2=Retrieve F3=Exit F4=CRFwindow
Date: 2/22/2010 Time: 10:54:43 AM
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF PROGRAM INTEGRITY
DIVISION OF THIRD PARTY LIABILITY
ESTATE RECOVERY PROGRAM
PO BOX 8486
HARRISBURG, PA 17105-8486
March 15, 2010
MARTSON LAW OFFICES
HUBERT X GILROY ESQ
10 EAST HIGH STREET
CARLISLE PA 17013
Re: Ethel Hoover
CIS #: 517930109
SSN: ###-##-7057
Date of Death: 01/24/2010
Dear Attorney Gilroy:
Please be advised that the Department of Public Welfare maintains a
claim in the amount of $40,828.79 against the above-mentioned estate. This
claim is for restitution of medical assistance granted on behalf of the
decedent for which the Probate Estate is now responsible to reimburse the
Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as
amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's
itemized statement of claim.
A portion of this medical expense, namely $27,656.23, was incurred
during the last six months of the decedent's life; therefore, it is a Class 3
claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries
Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $13,172.56, is
to be entered as a priority Class 5.1 claim against the estate.
Please acknowledge receipt of this letter and advise whether the
Commonwealth's claim is admitted and when payment may be expected. If the
estate accounting is complete, please provide a copy. If the estate coatains
real estate, please provide copies of the deed, the latest tax assessment,
and a curreat appraisal, if available.
Sincerely,
Judy E. Deaven
Claims Investigation Agent
717-214-1284
717- - FAX '
705-~1~
Enclosure