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Home My WebLink About05-28-10 (2)~ • ~ • T 1505610101 REV-1500 Excoi_lo, PA Department of Revenue Pennsylvania Bureau of Individual Taxes ~~~~~TMENTOR"~~"~~ Po Box 28o6oi INHERITANCE TAX RETURN Har-isbu PA 1 12$-0601 RESIDENT DECEDENT ENTER DECEDENT INFORIIaer~nu o~~ ...., ............... FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 4. Limited Estate C>D 6. Decedent Died Testate (Attach Copy of Will) O 9. Litigation Proceeds Received OFFICIAL USE ONLY County Code Year File Number ~ ~~ a ~~ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE , REGISTER OF WILLS O 2~ Supplemental Return O O O CORRESPONDENT - THIS Si=cnnu u. ~~T s,- .,_.._ 4a. Future Interest Compromise (date of death after 12-12-82) 7• Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) O 3. Remainder Return (date of death prior to 12-13-82) O 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes O 11. Election to tax under Sec. 9113(A) Name -- "-~• ~""" ~ oc ~~mrLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX fNFORMATfON' _..... . ............. ... John M. Eakin SHOULD BE DIRECTED TO: Daytime Telepho ne Number (717) 766-3172 ____ __ irst line of address __ __. _... REGISTER O~tNILLS USE OMILy, ............................. c~ ..... ~ _ . ___ . Market Square Bulldmg - ~ ~' , ~~ Second line of address _ _ _ -'? ~~ --~C _._ . ~_ .~-~ ~*~. ,~ ' -`~ . . ., ~~ ... _ ,. _ -. _ . ~ ..... City or Post Office ~--~ ~ ~ "a ` _ _ ... State 'Mechanicsburg f,_;; C." ZIP code DAT-'' LED -. _. .17055-6230 ............. Correspondent's a-mail address: N ~~ - -- .......... ............ . ~ ~~~ 5 U qr penalties of perjury I declare that I have examined this return, including accompanying sc ~ s true, correct and complete. Declaration of preparer other than the IG T hedules an d statem URE personal representative is based o ents, and to the best of my knowledge and belief, RS RESP NSI E FOR (LING RETURN n all information of which preparer ha ADD ESS s any knowledge. DATE 16 candy i I Road, D ~ cannon, PA 17020-9711 SIGNATURE O `~ EPAR THER THAN REPRESENTATIVE ADDRESS Market Square Building, Mechanicsburg PA 1 DATE , C m . ~~ , 7055-6230 PLEASE USE ORIGINAL FORM ONLY L Side 1 1505610101 1505610101 ~~ J REV-1500 EX 1505610105 Decedent's Social Security Number :............................. . ......................... __ Decedent's Name: Mildred L. HOCker 168-14-2692 RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. , 2. Stocks and Bonds (Schedule B) .............. . ................... ..... 2. ' 283,311.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages and Notes Receivable (Schedule D) ...................... .... . 4. 1,752,106.25 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)... ... , 5. 6. Joint) Owned Pro e g q Y p rtY (Schedule F) O Separate Billin Re uested ... . 6 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property ... . __ _ (Schedule G O Separate Billing Requested.... .... 7. 8. Total Gross Assets (total Lines 1 through 7) . .... .................... .... s. , 2 035 417 25 , , . 9. Funeral Expenses and Administrative Costs (Schedule H) ...... ... 9 ...... . ' .... 115,456.16 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ... 10 ....... .... . 8,141.38 11. Total Deductions (total Lines 9 and 10) .... ........ . ................ .... 11. 123,597.54 12. Net Value of Estate (Line 8 minus Line 11 ) .......................... 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which .... 12. - 1,911,819.71 - an election to tax has not been made (Schedule J) .................... .... 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ............... 14 ,..: ...... TAX CALCULATION SEE I ... . 850,000.00 - NSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0 _ _ __ 16. Amount of Line 14 taxable 15. at lineal rate X .0 - _ 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610105 1505610105 O J REV-1500 EX Page 3 Decedent's Complete Address: (1C/~rnr-..~...... _ Mildred L.Hocker _._ _ _ __ STREET ADDRESS Church of God Home _____ _ . __ __. __ _____ _- cITY _ _ _ Carlisle Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments File Number _.__ __ . --._._ _._.___. STATE _ __ _ __ PA B. Discount - - ___ 110,000.00 _____ __ _5,500.00 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAY Fill in oval on Page 2, Line ZO to request a refund. MENT. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (1) Total Credits (A + g) (2) (3) (4) (5) ZIP ___ __ __ 17013 116,100.00 115,500.00 600.00 Make check payable to: REGISTER OF WILL S, AGENT. PLEASE ANSWER THE FOLLOWING Q~E STIONS BY PLACING AN "X" IN THE APPROPRIATE BL 1. Did decedent make a transfer and: OCKS a. retain the use or income of the roe transferred•..,..,.....•.,.,., b. retain the right to designate who shall use the property transferre Yes No c. retain a reversionary interest; or.. d or its income : ................... x ......................... ~ 0 d. receive th ........................ e promise for life of ~~~~~~•~~•~•~~~~~~~'"""""""'•~•~~~••••• either p Y s, benefits or ~ ....................................... ^ 2. If death occurred after Dec. 12, 1982, did decedent transfer prope withi ~•~~•~~•~~•~•••""""" ~ x without receiving adequate consideration? . rtY none year of death ............. .. .. ......................................................................................... ^ x 3. Did decedent own an "in trust for" orpayable-upon-death bank account or securit 4. Did decedent own an individual retirement account, annuity or other non- ^ y at his or her death? .............. ^ contains a beneficiary designation? ....,,,,.•, probate property, which ........................ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES Y OU MUST COMPLETE SCHEDULE G AND FILE IT For dates of death on or after July 1, 1994, and. before Jan. 1 AS PART OF THE RETURN. 3 percent [72 P.S. §9116 (a) (1.1) (i)J. ~ 1995, the tax rate imposed on the net value of tr For dates of death on or after Jan. 1, 1995, the tax rate im ansfers to or for the use of the surviving spouse is [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a su posed on the net value of transfers to or for the use of the surviving s ouse filing a tax return are still applicable even if the surviving spouse is the onl b rviving spouse from tax, and the statutory requirements for disclosure of asset rcent For dates of death on or after July 1, 2000: Y eneficiary. sand • The tax rate imposed on the net value of transfers from a deceased child adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116 a 1.2 . 21 years of age or younger at death to or for the use of a natural arent a • The tax rate imposed on the net value of transfers to or for the) use)] p ~ n 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. of the decedent's lineal beneficiaries is 4. • The tax rate imposed on the net value of transfers to or for the use of the d 5 percent, except as noted in Section 9102, as an individual who has at least one parent in common with th ecedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)J. Asibling is defined, under e decedent, whether by blood or adoption. ,~ , REV 1508 EX+ (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA ~SN, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT w~n~~ yr Mildred L. Hocker FILE NUMBER 21-10-0237 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F ITEM . NUMBER DESCRIPTION VALUE AT DATE 1. __ 1st National Bank of Marysville Checking Account # 311723, see attached OF DEATH 68,82.,27 2. _ :. 1st National Bank of Marysville Money Market Acxount #900060, see attached _ _ _ 38,549.65 3. ' Nuveen Investments, see attached _ __ 708,783.91 4. Delaware Investments Account 6000090552 see attached , 83,957.43 5. 'Cash _ _ _ 178.85 6. 'Blue Shield- Refund 355.10 7. :Blue Rx- Refund _, 45.87 8. :Church of God Home- Refund _ 12,057.87 9. Public School Employees' Retirement System -Refund ,_ 2,359.27 10. 1st National Bank of Marysville CD# 3067170, see attached 129,469.63 11. ;1st National Bank of Marysville CD# 3067597, see attached 75, 779.17 12. 1st National Bank of Marysville CD# 3062860, see attached 115, 978.48 13. 1st National Bank of Marysville CD# 3064273, see attached 140,165.45 14. ' 1st National Bank of Marysville CD# 3064330, see attached ,_ 141,297.75 15. ' 1st National Bank of Marysville CD# 3055359, see attached __ _ 80,766.45 16. , 1st National Bank of Marysville CD# 3065823, see attached __ __ 153,535.10 I ~. P.O. BOX B MARYSVILLE, PA 17053 TELEPHONE (717) 957-2196 S Mildred L Hooker C/O Dorothy~Taylor 166 .Windy Hill Road Duncannon PA ~ 1702 0 Account Number Statement Ddte Page 311723 3/15/10 1 Now your funds will be available faster! Case by case delays will now be available on the second business day and special safeguard exceptions on the seventh business day. ,.~ TYPE OF ACCOUNT--Hometown Checking Statement Summary Beginning Balance 2/08/10 .De~~osits/Credits ChE~cks/Debits Interest Paid Enciing Balance Interest rate Annual Percentage Yield Earned 2009 interest 19,364.73 4 6 Credits 56, 610.13 4 Debits 7,064.87 159.03 . ~ 69, 069.02 . ~ 2.41$ 2.43 317.36 Credits/Deposits Date 2/09 2/~~9 2/:10 3/01 3/()3 3/~0 3/1.5 Amount Description ~ 50, 000.00 ~ 5, 505.06 83.72 ~ 106.63 ^' 831.00 ~' 83.72 159.03 Check# Date 2285 2/12 2286 2/16 Deposit. Deposit Eftpymnt From *Lincoln Nat L.itcxxxxx7110 Annuitypay From Met Life576713Rb02 Soc Sec From Us Treasury 303 Ssa Eftpymnt From *Lincoln Nat Lifcxxxxx7110 Interest Deposited Checks/Withdrawals Amount Check# Date Amount Check# Date ~ 6,965.84 2287 2/23 "39.75 ~ 5.88 2288 2/26 `53.40 Amount MEMBER F.D.I.C. ~ lW~ ~ - ~ ` ~ ~ ~~ t , ~, do 1 of Marysville Mildred L 'Hocker C/O Dorothy Taylor 166 Windy Hill Road Duncannon 'PA 17020 P.O. BOX B MARYSVILLE, PA 17053 TELEPHONE (717) 957-2196 Account Number . ~ .. Statement Date Page Daily Balance ~Information Date Beginning Balance Balance ..~19, 364 .73 Date Balance Date 2/09 2/?0 74,869.79 2/23 67,942.04 3/10 2/12 74,953.51 2/26 67,888.64 3/15 2/ 16 67,987.67 3/01 67,995.27 67, 981 .79 3/03. 68, 826.27 311723 3/15/10~~~ 2 Balance 68,909.99 69, 069.02 MEMBER F.D.I.C. P.O. BOX B MARYSVILLE, PA 17053 TELEPHONE (717) 957-2196 Account Number .900060 Mildred L Hockey . 166 Windy Hill Road Duncannon PA 17020 .. ~ ~~ ~ Statement Date 3/31/10 Page 1 Now your funds will be available faster.! Case .by case delays will now be available on the second business day and special safeguard exceptions on the seventh business .day. TYPE OF ACCOUNT--Money Market Account Statement Summary . Beginning Balance 2/26/10 35,981.62 1 Deposits/Credits 2 Credits 2,568.03. Checks/Debits ~ ~ 1 Debits 25,000.00 Interest Paid 9.75 Ending Balance ~ ~ 13,559.40 Interest rate ., ~ 0.50%. Annual Percentage Yield Earned 0.50% 2009 interest 180.04 Credits/Deposits Date Amount Description ~ . 3/03 ~-' 2,502..86 Investment From 1693: Pennmubd I9601039591 3/03 .y 65.17 Investment From.1693: Pennmubd~I11500347 3/31 ~ 9.75 Interest Deposited Checks/Withdrawals Check# Date Amount Check# Date Amount Check# Date Amount r 3/10 x-25, 000.00 Date Beginning Balance 3/03 Daily Balance Information Balance Date Balance Date 35,981.62 3$,549.65 3/10 13,549.65 3/31 Balance 13,559.40 MEMBER F.D.I.C. ~~ NUVEEN ''~~nvestmenfi~ ..,~; , ~I~~~II,IIIIIIII~,IIIIIII~ill~ll~lllll~l,l~l~ll~llllllll~llllll,~ MILDRED L HOCK6R C/0 DOROTHY A TAYLOR 000566 166 WINDY HILL RD DUNCANNON PA 17020-971.1 Mutual Fund summary Mutual Fund Account Statement Page 1 of .Product Account Shares Share X .. Markdt V Fund Name Code Number Owned Price -" 12/31/: Nuveen Pennsylvania Muni Bd I ~ 1693 11500347 1 , 737: 840 S 10.33 S 17, 951 Nuveen Pennsylvania Muni Bd I 1693 9601039591 66 , 743.036 S 10:33 5689 , 455 Total Mutual Fund Investment Value $707 , 407 -~I'-~a-t-=_~~F ~-a-t-t~::~C~iwfid=i~t~=~'~`tr~i~ti`u~~f~on:`-~~u`r~m~'ry Fund Narrye Tax-Free Taxable Short Term Lon ' Account Number Dividends Dividends Capital t3ains Capita < Nuveen Pennsylvania Muni lad I . 11500347 5759.42 50.00 S0.00 SC Nuveen Pennsyivania Muni Bd I 9601039591 S29,166.70 80.00 S0.00 SC Total Distributions by Distribution Type $29, 926.12 $0.00 $0.00 $t total Distributions of Your Mutual Fund Accounts $29, 921 ~ Mutuai Fund Account Activity Nuveen Pennsylvania Muni Bd Product Code 1693 Account Owner MILDRED L ROCKER Account Number 1 1500347-1 Account Type Investment Number Trade Share _ , of Shares 1 Date Description Dollar Amount r Price Transacted Shares Ov Beginning Balance S 15 , 675.32 1 , 737 . 01 / 30/ 09 INCOME DIV-ACH 0.0355 S 61 .69 S 0.00 0.000 1 , 737 . 02/ 27/ 09 INCOME .DIV-ACH 0.0365 S 63.43 5.0.00 0.000 1 , 737 . 03/ 31/ 09 INCOME DIV-ACH 0.0365 S63'. 43 50.00 0.000 1 , 737. 04/ 30/ 09 .INCOME DIV-ACH 0.0365 S 63.43 S 0.00 0.000 1 , 737 . • uou~i~uHU~u~W~u~u ° "` ~ y .~ NUVEE N Investments ~~~~~~II~~~~~~III~~III~~~II'~'I~II~II~~~~~I~~~~IIII~~I~I'll~l"~' MILDRED L ROCKER C/0 DOROTHY A TAYLOR 001647 166 WINDY HILL RD DUNCANNON PA 17020-9711 Mutual Fund Summary Product Account Shares X Share _ Market Value Fund Name Code Number Owned Price - 04/U1/2010 Nuveen Pennsylvania Muni Bd I 1693 1 1500347 1 , 737. 840 S 10.36 S 18, 004.02 Nuveen Pennsylvania Muni Bd I 1693 9601039591 66, 743.036 S 10.36 S691 , 457.85 Total Mutual Fund Investment Value $709 , 461 .87 T ~..~._ --- _ .. .. .. __._.. _ -- _ --._ - _ .,. ._ . _.__.. -_r _~_~ -- - -- C~-.-- - _ _. - .._ _. _ ~ ~-P~r- -#A- ~3t~..~Qi~V_i-Cl!~~--~J-St~_1-Qf7--~~~ - _ -_ - ~ - ---. . - ._ . --- Fund Name Tax-Free Taxable Short Term Long Term Account Number Dividends Dividends Capital Gains Capital Gains Nuveen Pennsylvania Muni Bd I 11500347 S193.77 50.00 S0.00 S0.00 Nuveen Pennsylvania Muni Bd I 9601039591 57,441.84 50.00 S0.00 S0.00 Total Distributions by Distribution Type $7, 635.61 $0.00 $0.00 $0.00 Total Distributions of Your Mutual Fund Accounts $7, 635.61 Mutual Fund Account Activity I Nuveen Pennsylvania Muni Bd 1 Product Code 1693 Account Owner MILDRED L ROCKER _ Account Number 1 1500347-1 Account Type Investment Number Trade Share _ of Shares Total Date Description Dollar Amount s Price ~ Transacted Shares Owned Beginning Balance S 17 , 951.89 1 , 737. 840 01 / 29/ 10 INCOME DIV-ACH 0.0365 S 63.43 S0.00 0.000 1 , 737.840 02/ 26/ 10 INCOME DIV-ACH 0.0375 S65. 17 S0.00 0.000 1 , 737.840 03/ 31/ 10 INCOME DIV-ACH 0.0375 S65. 17 S0.00 0.000 1 , 737.840 Ending Balance $18, 004.02 1, 737.840 ~=° I III IIII ~2ss (IIII II III a ~ , o 0 Mutual Fund Account Statement Page 1 of 3 ~''. ;. Delaware Investments• A rtternb~er of Macquarie Group w~ccuw~c Investment Update AT 02 041611 28232H2O7 A*s3DGT MILDRED L ROCKER 166 WINDY HILL RD DUNCANNON PA 17020-9711 January 1,2010 -March 31, 2010 ~ Page 1 of 4 Your Financial Advisor HOUSEACCOUNT DELAWARE DISTRIBUTORS L. P. 2005 MARKET ST FL 4 PHILADELPHIA PA 19103-1042 Branch Office Code 0000500 WOB 0001 II11'lllllllll'I'I""'llllllll~llllllllll'lll'llllllll'llllllll' Account Services Account Service 800 523-1918 8e.m. -7p.m. ET Mon. - k1. Web site www.delawareinvestments,com Dalaphona 800362-FUND (3863) 2anours,7daysawook Regular Mail Delaware Investments Soo Ravarsa forJnsirucL'ons. P.O. Box 219691 E-mail service~dalinvest.com Kansas City, M0 64121-9691 Portfolio Summary Year to Date Regular Account Activity Summary s Fund iWma IavastmaaW 'f' Witbdnwels/ Raiavasbd Cbaaga in _ Fund Coda/AoaouM No. Bopioainp Valuo Additions Roduadoas. Earniaps Market Valve - Eadiap Value ~ Delaware Lar a Ca Value Fund A ~ - ~ - 58I-i58.~ -Q--~-_.. _ _. _ _._ . _ _ .:0~00~. _ _ - -- ---:- - - -. fl,; OD - -~.__ _ _3;684: 52- -- --- - -- - - SBd-;~43 :32 - --~ - RsgularTotal 582,158.80 0.00 0.00 0:00 1,684.52 584,=43.32 ~_ Ysartodate Total Sr1,158.80 + =0.00 X0.00 50.00 X2,684.52 = 584,843.32 Quarter to Date Total 582,158.80 + $0.00 50.00 50.00 8~1,684.52 = 584,843.32 ~ Your Personal Portfolio Rate of Return is Yaarto Oata 3.65 % laoaptioa • 1%1'1/198! ~ .65 % Your personal rate of return represent: the performance of all the investment(s1 you have selected for your portfolio, including both your Regular Investment account(s) and Retirement account(s). The calculation includes any front-end :ales charges and all activity in your portfolio (such ea contributions, exchanges among investment options, etc.- using daily:hare price in effect when the acthrity occurred. Due to applicable sale:charges and the timing of your investments and withdrawals your personal investment resuha will generally not be the same as the investment returns quoted for the individual funds you have chosen. If you have questions, please call our shareholder service center at 800 523-1918 or a-mail :ervice~delinvest.com. *For accounts established prior to 1995, a January 3,1995 inception date will be used to calculate individual performance. Performance since inception is annualized t z e octet t/oooooo~ ~ . ~ ~ CD #' 3067170 Marysville Bank Principal $126,231.31 Issued 5/26/2009 Matures 5/26/2014 Interest 3.35% Interest capitalized Principal $126,231.31 Interest $ 3,38.32 $129,469.63 CD # 3067597 Marysville Bank Principal $ 75,655.06 Issued 1 /21 /2010 Matures 1 /21 /2014 Interest 1.95% Interest capitalized Principal $75,655.06 Interest $ 124.11 $75,779.17 CD # 3062860 Marysville Bank Principal $102,933.75 Issued 4/20/07 Matures 4/20/2011 Interest 4.2% Interest capitalized Principal $102,933.75 Interest $ 13 44.73 $115,978.48 CD # 3064273 Marysville Bank Principal $35,429.77 Issued 9/26/09 Matures 9/26/2013 Interest 4.1 % Interest capitalized Principal $13 5,429.77 Interest $ 4.73 5.68 $140,165.45 CD # 3064330 Marysville Bank Principal $140,83 5.29 Issued 12/ 14/2009 Matures 12/ 14/2013 Interest 4.0% Interest paid monthly Principal $140,835.29 Interest $ 462.46 $141,297.75 CD # 3055359 Marysville Bank Principal $69,477.85 Issued 9/23/2006 Matures 9/23/2011 Interest 4.4% Interest paid quarterly Principal $69,477.85 Interest $11.288.60 $80,766.45 . CD # 3065823 Marysville Bank Principal $138,933.56 Issued 12/26/2007 Matures 12/21 /2010 Interest 4.6% Interest capitalized Principal $138,933.56 Interest $ 14,601.54 $153,535.10 REV-1511 EX+ (10-09) ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Mildred L. Hocker 21-10-0237 Decedent's debts must be reported on Schedule I. ITEM AMOUNT NUMBER DESCRIPTION A. FUNERAL EXPENSES; __ i. Michael J. Shalonis Funeral Home 7,606.00 2. VFW Funeral Luncheon 635.00 __ _ __ __. s.' Rice Memorial Works, Marker 135.00 __ B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 53,000.00 Name(s) of Personal Representative(s) Dorothy A. Taylor Street Address 166 Windy Hill Road city Duncannon state PA ZIP 17020 Year(s) Commission Paid:...201.0 .......................... ................................................................................................................................................................................................................ 2. 3. Attorney Fees: Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant ~ Street Address City State ZIP 53,000.00 Relationship of Claimant to Decedent _ 4. Probate Fees: 758.50 5. Accountant Fees: 6. Tax Return Preparer Fees: ~. The Sentinel, estate notice. 198.16 __ _. 8. The Cumberland Law Journal, estate notice 75.00 s. Register of Wills -Filing Fee 30.00 ~o. Postmaster- overnight mail 18.30 TOTAL (Also enter on Line 9, Recapitulation) ~; 115,456.16 '' If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-08} ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ~~~~~~ yr Mildred L. Hocker Report debts incurred ti.. ~~._ ~___ SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS FILE N n ~ ~ ., ,.,.-- ITEM -- -• -••- ~~~~~~~~~ pnor to aeath that remained unpaid at the date of death, including unreimbur ed medical expenses. NUMBER _... DESCRIPTION VALUE AT DATE 1, _ __ _ _ _ OF DEATH R. Fertenbaugh Income Tax Prepera6on __ 275.00 2. Church of God Home, Inc. _ _ ___ 7,635.51 3. Continuing Care, Rx _ _ 4. Lincoln Financial Group 31.90 83.72 5• Darryl K. Guistwhite, DO Inc. - - 115.25 REV-1513 EX+ (01-10) ~ Pennsylvania SCHEDU D LE ~ EPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: Mildred L. Rocker FILE NUMBER: NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [Include o t i h RELATIONSHIP TO DECEDENT Do Not Llst Trustee(s) 21-10-0237 AMOUNT OR SHARE u r g t spousal distributions and transfers under Sec, 9116 (a) (1,1),] OF ESTATE 1. Lorraine F. Kaltreiter 205 Stevenson Ave., Beverly NJ 08010 _ _ _ Sister __ __ 2• 'Maryln V. Bowman 1059 North Duke St., York PA 17404 $190, 000.00 , 3 • Dorothy Boyer 2030 Staats Way, Santa Clara CA 95050 3 Brother $190, 000.00 - 333 4 Sister-in-Law $140,000.00 • Dorothy M. Rocker 3139 Clarendon Dri ve, Annapolis, MD 21403 Sister-in-Law _ 5• Marsha Rocker 1306 Albany Road, Harrisburg PA 17112 $50,000.00 , 6• Dennis Rocker 20 Windy Hill Road, Duncannon PA 17020 Niece $50,000.00 , 7• Yuichiro Oka 2505 Redstart Ct., Wilmington DE 19805 Nephew $50,000.00 , 8• William R. Haines 289 West Fifth St. A t. p A., Lewnstown PA 17044 Friend - $40,000.00 , _. 9. ' James L. Haines 175 Sand Mountain Road, Spring Mills PA 16875 Nephew __ $35,000.00 , _. 10. John E. Haines 630 Pleasant View Road, Port Royal PA 1708 Ne h p ew $35,000.00 , 2 ' ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 TH Nephew $35, 000.00 ROUGH 18 OF REV-1 II NON-TAXABLE DISTRIBUTIONS 500 COVER SHEET, AS APPROPRIATE A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION . TO TAX IS 1. NOT TAKEN: B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. Marysville ambulance Association 326 Cameron Street, Ma sville PA _ rY ~ 17053 10% of net residue 2• Mayrysvile Fire Company 326 Cameron Street, Ma sville PA rY 17053 10% of net residue " 3• Marysville-Rye Library 198 Overcrest Road, Marysville, PA 17053 10% of net residue 4• The Salvation Army 44p West Nyack Road, West Nyack, NY 10994-1739 5.' Big Brothers and Big Sisters of the Ca i 10% of net residue p tal Region 1500 N. 2nd St., Harrisburg, PA 17102 __ ___. 10% of net residue TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 •F REV-1500 COVER SHEET. If more space is needed, use additional sheets of paper of the same size. ~ ~i1~i~~~~' 0+~1 Qom' Pie REV-1513 EX+ (01-10) ~ pennsylvania SCHEDU DEPARTMENT OF REVENUE LE ` INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: Mildred L. Hocker FILE NUMBER: NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT 21-10-0237 I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE Sec. 9116 (a) (1.1).] .............. 1 • Jeffrey W. Haines 333 Mauger Path Road, Port Royal, PA 17082 :Nephew _ _ _ $35,000.00 __ .......... ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 II NON-TAXABLE DISTRIBUTIONS OF REV-1500 COVER SHEET, AS APPROPRIATE. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. - -- -• ..~. 1~w LwtK SKEET. ~ 850,000.00 If more space is needed, use additional sheets of paper of the same size. ~' t ~~~cc~.f i~X ~.z~t~ `~.e~~~rt.ez~~ OF MILDRED L. HOCKER I, MILDRED L. HOCKER, of Rye Township, Perry County and State of Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all Wills by me at any time heretofore made.. 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can conveniently be done. 2. I direct that there shall be paid out of my residuary estate all estate inheritance and like taxes together with any interest or penal thereon ' ty imposed by the Government of the United States, or any state or territo thereof rY , or by any foreign government or political subdivision thereof, in res ect t p o all property required to be included in my gross estate for. estate, inheritance or 1' ike tax purposes by any of such governments, whether the property asses under ' p this will or otherwise. 3. I give and bequeath the sum of ONE HUNDRED NINETY TH OUSAND ($190,000.00) DOLLARS to my brother, MARYLN V. B OWMAN. -1- 4. I give and bequeath the sum of ONE HUNDRED NINETY THOUS AND ($190,000.00) DOLLARS to my sister, LORRAINE F. KALT REITER. 5. I give and bequeath the sum of ONE HUNDRED FORTY THOUS AND ($140,000.00) DOLLARS to my sister-in-law, CATHERINE H AWES. 6. I give and bequeath the sum of ONE HUNDRED FORTY THOU SAND ($140,000.00) DOLLARS to my sister-in-law, DOROTHY BOY ER. 7. I give and bequeath the sum of FIFTY THOUSAND $50 000. ( 00) DOLLARS to DOROTHY M. ROCKER, widow of Ral h H p ocker, the deceased brother of my husband, John Rocker. 8. I give and bequeath the sum of FIFTY THOUSAND ($50,000.00) DOLLARS to MARSHA ROCKER, daughter of Ral h Hoc p ker, the deceased brother of my husband, John Hocker. 9. I give and bequeath the sum of FIFTY THO USAND ($50,000.00) DOLLARS to DENNIS ROCKER, son of Ral h Hocker p ,the deceased brother of my husband, John Rocker. 10. I give and bequeath the sum of FORTY THOUSAND DOLLARS tom ~' ($4Q,000.00) y lend, YUICHIRO OKA. 11. In the event my brother, MARYLN V. BOWMAN m y sister, LORRAINE ~r'~- Z~ `* V~ -2- . t F. KALTREITER, my sister-in-law, CATHERINE HAINE S, or my sister-in- law, DOROTHY BOYER, should predecease me the ift t g o him or her shall not lapse, but pass to his or her heirs per stirpes. 12. In the event YUICHIRO OKA, MARSHA HOCKER DENNIS HOCKER or DOROTHY M. HOCKER should redece p ase me, the gift to him or her shall lapse and fall into the residue of m estate. Y 13. All the rest, residue and remainder of my estate, real er p sonal and mixed shall be converted to cash by my personal re resentative p I glue and bequeath the net residue after payment of all debts, expenses ands ecific b p equests as follows: a•) Ten (10%) percent to MARYSVILLE MBULA NCE ASSOCIATION; b•) Ten (10%) percent to MARYSVILLE FIRE . COMPANY, c•) Ten (10%) percent to MARYSVILLE PUBLI . C LIBRARY, d•) Ten (10%) percent to SALVATION ARMY• e•) Ten (10%) percent to BIG BROTHER AND B IG SISTERS OF THE CAPITAL REGION; f•) Twenty (20%) percent to AMERICAN DIAB ETES ASSOCIATION, 2040 Linglestown Road, Harrisbur g~ g•) Thirty (30%) percent to SHRINERS HOSPIT AL FOR CHILDREN. 14. Lastly, I nominate, constitute and appoint m friend Y ,RAYMOND A. SMITH, to be Executor of this my Last Will and Tes Lament and I further direct that -3- .t no bond or other security be required of m erso Y p nal representative to guarantee faithful performance of his duties. IN WITNESS WHEREOF, I have hereunto s et my hand and seal this 2 ~ ~ ~ day of June, 2000. r `i a? i ~ ~ ~i ry r re oc er -'~' (SEAL) Signed, sealed, published and declared b the Y above named MILDRED I,, ROCKER as and for her Last Will and Test ament, in the presence of us who have subscribed our names hereto as witnesses at h er request, in her presence and in the presence of each other. -4- ~r COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF ' SS PERRY ) I,1V.~ILDRED L. HQCKERy the testatrix, whose name is si ned to the a or foregoing instrument, having been duly qualified accordin to law do h r ttached acknowledge that I signed and executed the same instrument as m Last e eby Testament; that I signed it willingly, and that I signed it as my free and volun and deed, for the purposes therein expressed. tary act and ' ~ ~ ''+ ~' d `f...p ~°' `r" ~- ~-~,;~~'~'` (SEAT-) i re c er Sworn and s}}~~bscribe o before me this xG7`~d.ay of ~,, fl ~~~--~ ~~ ^`~ '~ - ______~~ ~ NOTARIAL SEAL ~'~ -'~ '' QOROTHY A. TAYLOR, NOTARY PUBLIC `` ' O C ^ ~ ISSION EXPIRES MAY 27, 2004 ~ MARYSVILLE BOROUGH, PERRY COUNTY COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF PERRY) S S We, the undersigned, ~C~)Yl~l o ~ ~ r~. S` i~r i ; 1.~ and ~ ~~ ~, ,u ~) ~ L f~ z ~ ~_; the witnesses whose names are signed to the attached or fore oin i qgualified accordin to law depose and say that we were presen and sa~trument, being duly MILDRED L. I~OCKE the testatrix Testament; that the said tesRtatr ~ execut ecute the instrument as her Last Will and ' therein expressed; that each or us, in the hearin handrsi and voluntary act for the purposes as witnesses; and that, to the best of our knowledge, the test trlix wasatrix, signed the Will eighteen (18) or more years of ages, of sound mind, and under no cons t the time, undue influence. traint, duress or Sworn and subscribe to before me this a6 ~, day of s.- NO IAL SEAL DOROTHY A. TA LOR, NOTARY PUBLIC MY COFJIMISSION EXPIRES MAY 27, 2004 MARYSVILLE BOROUGH, PERRY COUNTY -$- ,~° ~,~ „