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HomeMy WebLinkAbout12-10-10J 1505610101 REV-1500 °` `O1-'°' ~' PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes """~"`""` ""`"°` County Code Year File Number PO Box z8o6ot INHERITANCE TAX RETURN Harrisburg. PA 17128-o5oi RESIDENT DECEDENT ~ ~ ~ D ~ 7 ENTER DECEDENT MIFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYW o ~3 II y ~ :aJ b / '~ o ~ I ~. o 19 ~ Decedent's Last Name Suffix Decedent's First Name MI o J3 ,~ u N J E_ N N~~,~^ (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 REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Retum O 4. Limited Estate li 6. Decedent Died Testate (Attach Copy of Will) O 2. Supplemental Return O 4a. Future Interest Compromise (date of death after 12-12-82) O 7. Decedent Maintained a Living Trust (Attach Copy of Trust) O 3. Remainder Return (date of death prior to 12-13-81) O 5. Federal Estate Tax Retum Required ~ 8. Total Number of Safe Deposit Boxes O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECT~FD T0: Name Daytime Telep a Number ~- CN c S ~/ ~bs ~• i ~ ~ c n_ _ REGIST S USi.ONLY ~ f ~_~ O ~ C Firstline of address c pop !J ~~ Second line of address City or Post Office State ZIP Code DATE FILED ~¢ / C 586lRG i7o 573 ~ IIIIIM iMOMM1 Correspondent's a-mail address: CeShlefdtS.3 ~(`oMC a C' C.7 '~ -.rte N ~ i~r"t ~ ` ~F, Under penalties of perjury, I declare that I have examined this return, including acx:ompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaretlon of preparer other than the pereonal representative is based on all information of which preparer has any knowledge. 51GNAT PERSON RESPONSIBLE F FILING RETURN DATE , ~~ ~ SS DATE FORM 1505610101 Side 1 1505610101 J REV-1500 EX Decedent's Name: d Decedent's Social Security Number RECAPITULATION 1. Real Estate Schedule A ................ ........... _ ® ~' ~ 2. Stocks and Bonds (Schedule B) .................................... ... 2. D ~ 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. 0 4. Mortgages and Notes Receivable (Schedule D) ........................ ... 4. d 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5. f ~ 8 T 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. '. ~{ ~ ~ / / ~ 7. Inter-vvos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested..... ... 7. q y / 4 8. Total Gross.Assets (total Lines 1 through 7) .......................... ... 8. '.~ $~ $ ,~ 3 9 D 3 9. Funeral Expenses and Administrative Costs (Schedule H) ................ ... 9. ~ t0 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ........... ... 10. '3 d 11. Total Deductions (total Lines 9 and 10) .............................. ... 11. f 9 b S y 7 12. Net,Value of Estate (Line 8 minus Line 11) ........................... ... 12. ~ ~ ~ O (. 13. Charitably and Governmental BequestslSec 9113 Trusts for which an election to-tax has not been made (Schedule J) .............-:....... ... 13. ~ ~ 14. Net Value Subject to Tax (Line 12 minus Line 13) ..................... ... 14. t . 6 b ~5 7 O (~ TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 ~^'yw' "~~' °~° "'"""h}'~ 16. Amount of Line 14 taxable at lineal rate X .0 ~ ~ ~ 7 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line .14 taxable at collateral rate X .15 , . . , 1505610105 15. 16. 17. 18. 19. TAX DUE ....................................................:....19: 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610105 1505610105 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 2~..~0_ ~/~7 DECEDENTS NAME 7'+1=i4~NAlE M. Ko~3.lFuGS~_ STREET ADDRESS o?b A,vD~E3 a2~vE _ - CITY /19E~~Nies~a~~ STATE ~~ ZIP ~7o ss Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments D A. Prior Payments B. Discount Total Credits (A + B) (2) 3. Interest (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) O ¢3(o0.2Z D 5. If Line 1 + Line 3 is greater than Line 2, enter the diiference. This is the TAX DUE. (5) f t ~~ 3 sS•~jO Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :............................................................................. ............. ^ b. retain the right to designate who shall use the properly transferred or its income : ............................... ............. ^ c. retain a reversionary interest; or ............................................................................................................. ............. ^ d. receive the promise for I'rfe of either payments, benefits or care? ......................................................... ............. ^ ,~ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................................................................................. ............. ^ 3. Did decedent own an "in trust for" orpayable-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. For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent p2 P.S. §9116 (a) (1.1) (ii)]. 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 21 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 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 4.5 percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent p2 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. R1=1/-1502 EX+ (6-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT _____ ESTATE OF FILE NUMBER Hot3A-uc,[,/~ JE~FNNE /j1. a/-/o - a f~7 All real property owned aobty or as s temmt In common must bs reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a wAling buyer and a willing seller, neither being compelled to buy or sell, botl~ having reasonable krawbdge of the relevant facts. Real properly which b )olMly-owned with rlgM of survivorship must be dl~loaed on Sdadub F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH t. A,// ,~ Carlin Parctl o~' he'sl esfett L4cd ~ ~Mpbv P1mrrnTs -16ie.1~ ercCt'cal how nq uM addntss of ~ f~ndc5 ~r~ ve, /Ylet'.4l~tn,i es burl ,,1 Cw~nlvc.vlwad ~'ettw~, t~enngy~varu.a, 1nu( being -na-e ~ar~+'C.ua...r(.r cksCr~6eal i,,; ~.t e,e~•+a~N decd Cl~~ Hcnry E. E-lo br.uc~l• armed ~tanne S. Ffobaup~, ~' •Tca.nnc S. Hnb~.gk, ~ncG'v;dti daat~1 J'wly 17,/g8~ aMSi reeoraled ru ~ie e~,tt e~ ~ i2eltor6~ea- ~ ~ktals ki r3ook `W, ~ vo ~. may, ~ sZd3, C w e„I~e,e-IqN,~ Coww~ Assletfsn~tr-~ 'Parcel No. ~~,d8 0~?/-.i(+ La.,nJ ~.l?, too 8)~0 ~,{~./ '1~3, s~o x !. 2G CoN„~ Ml-It~pl~cr ~ ¢ ISS, 698. ~o CS« c~ cF ¢sseas.nenf pr;~ta~t Q1~lactic~) TOTAL (Also enter on line 1, Recapitulation) I s I S:S L 98• zo (If more space is needed, insert eddidonei sheets of the same size) ,f;~:22PM C i FROMI- T-302 P.004/001 F-213 y :~.:.. ~ i~ ~~ ar~..~Y~ er~s~.~nylau . ~ WIC 13 10 SE Atl ~@~ xeaa rsx ~-,.k +ar N -~+-~~., .,1 w u~~ d ••. L.rd ee• tAa.eaal aiar xwdrM e~jlcy-cw psi .w s~erwes~v . lm~[ & s~1, of IlaQta4:rg, 17uegr, Yc-mylvroia aoa s. aaeallQl: ~ rr. oaehaelaod rpe~q, Paeusylvwtiis, • G+satera , cad JF1daE S. III. Stdividually. of 1!fe~miosha~, Qs~srlaod W~afty, Pwosylv~ia, . Grsatas wR7VE~i'7yif. Ntrt is eawtre+arta N oaa (31.Of» Dotfsrs, O calla ~ Iles K~n'!y1 11~RM~ r1 Arir~Dy edaNe~/Na[a, ~[ Iefd 97aatMa ~ atn-a /-aM1 aa/ eaK„ay a rAs aert yr.ldn • her heirs and asd.®a: AB. ~ t pdaae or parcel. of']aad sin~ta in•llppar ~~ P. Q'drrLmd mlm~y. . bou~dad and dsacs~sd as follows, m vst: 1lodntlnlG at a point an rho noedbtn line o! Mdes Delve ae ebe vmencn lim o! Inc Dw. 29,A as shown oa the hmistaitas mntiaacd Pls~ of Lxs; tliwrcay~py~ the slozd+am lies of A+das Ddvo soud~ II4 dadnp 53 ednuoes v.se aoa hmdciod ssvsn sd Lorry-a+a wry (107.4u lapc m rh eastaa ltas o! Applad~ Awtw: theoes alms tble aaatain i<.,- ad appalad-iasi Aavaela mesh 13 44 adroa+ Oast oos huodvd ttidstry-rive as~d d+a~ty-five one-hadndt9~ (133.23) Pest oo a . theaaa a]oas Ianda »ov or lace of Mc. Alton Caepoe~selao, encth 84 deyross ^iaamas eau sinCy-d~noe and sevanty~ns ms-ltatdtrddLS (63. Esst m a Pninc: thence alea6 eha tlcstosx lies o! Iet No. 29-A aoorh 5 desmos 7 oast sae hialdcal tvency-at,g1K (12B) flee m @fs plxe of BPiGndQDIC. >a:1H6 Inc No, ]O,A as ahaeet m RaalbdivL+ion of Iaea TS 30, Plan o£ Seadm 2, !t. Allan Ilaishts said Plan baitfg recorded is tlla AsoOSdar of Deeds OfSien is 47an Hadlc 14. Paso 5§. 000.[/~~. SASE it8;~ ~A:22PM FROM- ?-302 P.005/OOT F-213 `: t lII®ER /IHD m ~ B ad iua zest 2, Me. Alin Ae~j+q, zaoordod ~- !tlsesllarouy B~o1c iS4~, Pp+tQ g°D Plon of Secda~ AAVgIG f10aC1ED ifs, a brick sad alucuam bd.-level :caodf etyln dvelliug bs3~ 1a+oGn aad nod as 26 ~bdea Drive. Neelvsticsburtg, Pennsyltmcsis., ~ . eg[!oG a pact of eivs aans psmiass vi~idi i~erl, J., 9'r Jr., and Y~q H. Ra~dao~ky, Ms idfe, Dad daaod Not~ber 27. 1964 and iac+ordd in efia C~ahet7aad Couwty Raeosdsr o~peadv OEfias Sa Dsd Haolc '1C', ilbl~r 21. Pace 1003. ~oc~d aAd ti~,l~ E.. and Jeans S, Hub:v~-, Ma Wdfe. the 4a~tara ~ to wi~ua and ~strtcdops created DY. ~cc+mvate of prier bsie+ses ~°~y~8cfsam ehe pgmsoc of aaalry 3~a Tmref, bda~ a ~'+nsfer '. . ~. .. ... ~ ~~ +~ oM~tee a heresy eore~nal e.~d ep-ec Chet tBep CDHStAiix ~+ r~+r+~ty Asn6y eoeseysQ, . eaatl~t/2.9 r~ 2B4 i i ,4:23PM FROM- i t i I i i T-302 P.006/007 F-213 !N A71N8$S p'NERBOP. raid a^ytq+i Arva Arrrssb art W iy aad year ~ al.ar ~~ t3s1s ,Lads asd rq(s -.^ ~~~Wr pnstna~if ~ S, ~b N 'pr1~.yANLI Cossly rJ ~p' oy tAti, rAr 3Z~.. day o/ !D ~ , Ayery su, +~ sstrrriy~cd r'lerr, yn~, esno-rd ~j~pt~ S. }DMpii Asrww M sir (o- rsefr/aolrrity 71 to is tl1r yarros wJirw sans !+ a8eestird b W "d `rte tAat s~ rsss,tad ekr ra..r far tAe yyrpe..r fAsrriw IN 1i77'NL'SS WNlS'RSOP, ! Ar-reste ut sty Assd rsd sdeta! rat .., _ • ,~\N IIV ......~..¢ ~ p.. ~r~•a ~. wc«.dw.iwi'r.IMlry~h,:l~~~~i' r' Sfrtr y per. 1 C ~ ~ TM. 3c7F~ dq y JJ . J, e2 . Wws apt ~ t~afasad a/frn; r~rrsatly gyearad Ems[ E. NOBAUCH Irsens b•sw (a mtWsda>+Yy p"ares~/ b 6r Gle .•.....~... , al(G!a rJl~, aMd a woe urArre MaK le ~(~ ~ '•. r~110Mladppd IAe~ Ai eieC4bl t~r Nqr Jar tAr ' '° ~•V 's !N R77'~'L'$S W8BR60F, ! ~-.r+b as //~~//11 `~ $~°~/~11.w ! J3 ~~ ~( i~~ i_ i~ ¢~~~~ ~E~29 -,ux 285 JMVlCMW1gMTFA01p1(Ptlb~' s'•, +~sa~ur~'~~.- . "+~ u1Ofd•. s..rw ~wss wa d4:23PY FRON- T-302 P.001/OOT F-213 ! I ds ktee6y elrti1 lknl G~ pmirr rrrill Iggl caa5~'~jr~Hart e,0ite ~dd/h~ • t>/ leis eYlt4ne wawsd P~lertr~ tl1 [~ AtldMti DCLVQ 1 ~ ~ 1 r~yy] 1~1f.1 l~s. VVV ~~s 1~~ _ __.. • ., { _ -• • .. ' a { J~ ~ o, ~ ~ z ~ ~I c ~ - ~ ~ 3 `,; ;3.:~-~- eoa4.(/29 -~ 286 COAtxONtY FALPb [ O l P6NNSYLy.WI.t f ;: -_ ~ / ! - - , Ceraey M(.~(.~l~r ~'~SM~ .._ __..._._. a~ ~~ A~^ ; • :• • - .. .. Y~ a A la_._.._ n1 ek. reurJ.rs app r1 eke [..'•~.y~ ' Cireq mMar ^r~ kae/1 aMf eke real r/ tke .e(el r~i00. 1ko Psyabla To: UPPER ALLEN TWP TAX COLLECTOR 275 CUMBERLAND PARKWAY 83'25 MECHANICSBURG, PA 17066 Phone: (717) 79E-426 MAP NO: 42-28-2421-200 Dsac: ZB ANDES DRIVE 8 APPALACHIAN AVENUE Acres .270 Dsed: 002oW.002g3 MT ALLEN HEIGHTS LOT 30 A SEC 2 P814 PG 53 L~'~~ 51.00 FEE FOR ADDITK)NAL RECEIPTS HOBAP UpH, JEANNE S 28 ANDES DR MECHANICSBURG, PA 170565503 f .~.;. ~.. 'i: _. Y~~...::.:. ,. Offk;e Hours; WED, THURS 10AM-2PM, VyED 8-ppM gN ~; ~ 8 BYAPPOINTMENT-CLOSED HOLIDAYS Bql pate; 3V1/10 OFFICE AT 100 GETTYSBURG PIKE UA. TWP Control No: 42002720 BLDG ,~ PHONE (717)7064238 TAX ~ ~~ 1618.74 ~ti .36 K Date Of PaynrsrR Is On -311/10 fhru 4/3W10 SH/10 thru 8190/70 TAXPAYER'S COPY -KEEP THIS PORTION FOR YOUR RE ROC DS UPPER ALLEN TWP TAX COLLECTOR 275 CUMBERLAND PARKWAY s<325 MECHANICSBURG, PA 17055 RETURN SERVICE REQUESTED HOBAUGH, JEANNE S a7»r! ~~F, 26 ANDES DR MECHANICSBURG, PA 17055-55D3 ~NII~i1N11 7/1/10 a Lahr 8711GR.36362 a~--` '~ 3; ~ , N ,-„ .~` tt 4 s ~' t 5 , ~ f ~ , H dw i~ a4 y1 t ~` C , ~~j .t" ~ . ,? z~ . + ~ - ~ ~ ~ . ~ .. Peyeble To: UPPER ALLEN TWP TAX COLLECTOR 0111ce Hours: WED, THURS 10iAM-2PM, WED 69PM BIU No: ggg3 275 CUMBERLAND PARKWAYR325 b BYAPPOINTMENT-CLOSED HOLIDAYS BfU Dots: 3J1M0 MECHANICSBURG, PA 1705.5 OFFICEAT 100 GETTYSBURG PIKE U.A. TWP Control No: 42.005166 Pfwne: (717) 786.4238 BLDG PHONE (!17)7864298 31.00 FEE FOR ADDITIONAL RECEIPTS Tau Paysr: HENRY E. HOBAUGH III 26ANDE3 DR MECHANICSBURG, PA 17055••650,'! COUNTY OFCUM4~ i=R DlecoluN Fats ply COUNTY PC 34.90 ,00 ~,r~ TWP OF UPPER ~ ~~~ MUN PC . _ .. 30.00 30.00 30.00 MUN occ PA~~ 30.00 so 00 3000 '-'----"e''RRrsVii,:t~1 ~:i~Q-'34.90 SS.OO 36.50 If Date Of Payernt Is On 3I1H 0 thru 4/90N0 SNH 0 thru 6/90H 0 7/1/10 or Later TAXPAYER'S COPY - KEffP TH18 PORTION FOR YOUR RECORDS UPPER ALLEN TWP TAX COLLECTOR 275 CUMBERLAND PARKWAY #325 MECHANICSBURG, PA 17055 RETURN SERVICE REQUESTED a»~o-20842 HENRY E• HOBAUGH III 26 ANDES DR w J1ECHANICSBURG, PA 17055-5503 IIN1~~11111 87111YP-2aa4y µ Y~ ~ ~ r a ~ ~ . PArABLE TO TAX PAYER COPY Bql Nlx ~7Q MARtJITA. YOIiN, SR.,TREASURER Control No: 042 -002720 8 HICKORY LANE MECFUWICSBURCi, PA 17066 oESCromoa A.NO - 42002720 MAP NO: 42-28.2421-289 ~ ,'. ; , 28 ANDES DRNE ACRES .270 QED 0029VIP 00283 M7 ALLEN HEKiHTS Residentle SEC 2 P8 14 PO 63 RESIDENTI/~1L~~ Assess nand Laprovement Mi«aeral T ~ tal : 7/l)1/2009 Values 27,100 96,470 0 123,570 teed 8xc1 ion 9 846- 8;.0. Rat es 14.29000 14.29000 14.29000 2 S L R S 87.26 1 378.56 1 76 82 . 40.70- -; ~ : , U R E R TAB 11AA0UWT DUE -> ~ ~ t~.tata .a~u =1~7J!<t '~~~~ ~~ . __ '~ ~ ~ ~ ~ Ol o se 2009 10 31 2009 12131/2005 TAX PAYER ' r A 7yJ BEAU H, JEANNE 3 ! ~ p ~ ~E ~L ~ ~ ~ 28 ANDES DRIVE t , A' ~ L ~hI TD ~~B_Ri~RY 5 711ROUGH1Qy EM0 MECHANICSBURC3 PA 17056-6503 OFFl7CE HOURS VP~,THQRS, 10AM-2PM WED 69PM + BY APPOINTMENT+CLUSEp HOLIDAYS OFFICE AT 100 GETTYSBURG PIKE UA. TWP BLDG. -PHONE 786-4238 ~/ NOTICE OF PROPERTY TAX RELIEF Your enclosed tax bill irlchxles a tax reduction for your homestead artdror ferrnetead property. As an ~destead arxYor farmstead properly owner, you have ret~ived tax relief through a arxi/or farmstead exchrebn which hoe been provided under the PennsyNanla Taxpayer Relief Act, a law passed by the Pennsylvania General Assembly designed to reduce your property taxes. aEV.7508IX,17871 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RERIRN RESIOENr oECEOENr ESTATE F SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY 0 ND~~u`y~ .7~.~1yViVF ~ FILE NUMBER OZ/-~D-.ZS~7 Indude the proceeds of litigation and the date the proceeds were received by the estate. AN property jointly-owned wNh the rlpht of eurvkorship must be dlsebsed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH '' =nvUlto~y °~ ~,rseno~lt` ~j Houstkold Teems set a#fhc-tecl ; ~c-n-r~d Gsf,'n ~ '}~I.7S .? doo8 Toyet4 Camp , G,oov miles , SLL}l.~F Chevrolet deal eskm~ 'fls, coo, bo TOTAL (Also enter on line 5, Recepitulatian) (: 1 ~, 4 8 ~~ 7 S"' (If more space is needed, insert additional sheets of the same size) HOBAUGH INVENTORY LIVIIVG ROOM Old Upholstered Chair $ 6.00 Old beat up coffee table, chipped & wobbly 5.00 3 seat old couch 18,00 2 small tables 8c small table lamps 6.25 plastic flower design lamp 2.50 small corner padded chair 5.00 small stool 1.50 Piano - untuned Mason & Hamlin Baby Grand, scratched 50.00 DINING ROOM Small Round Oak Dining Table & 4 chairs $115.00 Small old hand held radio 2.00 2 small chairs purchased at auction 4.00 ,CASH IN WALLET $ 67.25 KITCHEN Old refrigerator $ 20.00 Misc. hand held appliances 3.75 Assorted pots & pans 6.25 SIDE ROOM Sewing machine $ 40.00 Record cabinet 3.50 Book shelf & Misc. novels, etc. 5.50 BEDROOM Small double bed, Bureau, (distressed & chipped) Two side tables & lamps, $ 97.50 Small table top chest 1.25 2 old wrist watches 4.00 Misc. knick knacks 1.50 Small radio 1.00 Old Washer & Dryer $ 15.00 TOTAL INVENTORY 5481.75 REV-1508 EX ~ (181) SCHEDULE F COMMOMNEALTHOFPENNSYLVANIA JOINTLY-OWNED PROPERTY INHERRANCE TAX RETURN RE DENT DECE NT °' ESTATE OF HOt3~-U 6 /% d~/FIVNE A~. FILE NUMBER oZ / -/D -~ ~7 M an asset Mss made joint within one year of tlls dacedeM's dab of death, h must be repwtsd on ScheduN d. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT q• Hang F, NobaK~fi ~ ~b I~ne/ts Ar. Son metshanicsbN--~, PA 17nss s. A/~ifq L. Ce'~nors .3SFG v~//e~ ~~ daughter nia~ys~:/k. P.~ /~osa c. JOINTLY-0WNED PROPERTY: fTEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRanION OF PROPERTY Indude nano of financial inetihdlOn and bank account number a Similar identityirp numbs. Attach deed for joMtly-l«3W lest estate. ~ DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST ~, q, Ps~CU I~tCoun7~S= ~¢fB /Al~i~o~ # 86o S37 33/ 8 ~iZB~ SS/,Y.Z Y3 IF der. =''t. ~/2, 9~ /•i. 5/$ ''1+$ ~~-/99 aR'Pio 637 33/ 8 fY, 8/Z,q~/ y3 i¢~ar. ~,t io.~o 0.20 ~yB 7/~/a~ st gio 537 33j 8 ~~f//.37 ya /FCCr. ant ~O.oi m, e6 t$ ~/~ /:: ,Or P~eo 537 3~l S 41, oZ j7, ~/ y3 (.sce l~t~u4/ioa /E~U ~ronn ~aECll 7~f ~.Z.3,30 -' 3= . 91./0 gay alfi.cltedJ ~ , TOTAL (Also enter on line 6, Rec~itulation) I ; ~ y, q y/. ~ o (if Hare space is sheets of the same site) NOTICE OF INHERITANCE TAX pennsylvania~ DUREAU OF INDIVIDUAL TAXES APPRAISEMENT. ALLOWANCE OR DISALLOWANCE DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION REV-154! EX AFP I12-09) PO t00tt 280601 OF DEDUCTIONS, AND ASSESSMENT OF TAX ON HIUBIISBUR6 PA 17128-0601 JOINTLY HELD OR TRUST ASSETS DATE 06-DS-2010 ESTATE OF HOBAUGH JEANNE M DATE OF DEATH 06-14-2009 FILE NUMBER 21 10-0247 COUNTY CUMBERLAND SSN/DC 206-32-4170 HENRY NOBAUGH ACN 09143347 26 ANDES DR APPEAL BY DATE:08-07-2010 MECHANICSBURG PA 17055 (Set reverse sideanderObjections) Awount Rewitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONC THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS t- ------------------------------------------------------------------------------------------- REV-1548 EX AFP C12-09) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS. AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 06-08-2010 ESTATE OF:HOBAUGH JEANNE M DATE OF DEATH:06-14-2009 COUNTY:CUMBERLAND FILE ND .: 21 10-0247 S.S/D.C. NO .: 206-32-4170 ACN: 09143347 TAX RETURN WAS: IX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PSECU ACCOUNT NO.: 8605373318 TYPE OF ACCOUNT: CX)SAVINGS C ) CHECKING C )TRUST C )TIME CERTIFICATE DATE ESTABLISHED 06-01-1999 Account Balance Percent Taxable Awount Subject to Tax Debts and Deductions Taxable Awount Tax Rate Tax Due 41,028.11 X 0.166 6,838.16 - .00 6,838.16 x .045 307.72 NOTE: TO ENSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY, ORBER PAYABLE T0: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID (-) AMOUNT PAID INTEREST IS CHARGED THROUGH 06-16-2010 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE 307.72 INTEREST AND PEN. 3.18 TOTAL DUE 310.90 * IF PAID AFTER THIS DATE. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ^ IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. Pennsylvania BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX DEPARTMENT OF REVENUE INHERITANCE TAX DIVISIDN APPRAISEMENT, ALLOWANCE OR DISALLOWANCE REY-1548 EX AFP c12-09) PO DOD( 28D601 OF DEDUCTIONS, AND ASSESSMENT OF TAX ON WIRRISDUR6 PA 1)126-0601 JOINTLY HELD OR TRUST ASSETS DATE 06-08-2010 ESTATE OF HOBAUGH JEANNE M DATE OF DEATH 06-14-2009 FILE NUMBER 21 10-0247 COUNTY CUMBERLAND SSN/DC 206-32-4170 HENRY HOBAUGH ACN 09143349 26 ANDES DR APPEAL BY DATE:08-07-2010 MECHANICSBURG PA 17055 (See reverse sideNnderObfecNons) A~ount RaBitted MAKE CHECK PAYABLE AND REMIT PAYMENT TOs REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONC THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS t- ------------------------------------------------------------------------------------------- REV-1548 EX AFP C12-09) NOTICE OF INHiERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD DR TRUST ASSETS DATE: 06-OS-2010 ESTATE OF:HOBAUGH JEANNE M DATE OF DEATH:06-14-2009 COUNTY:CUMBERLAND FILE NO.: 21 10-0247 S, TAX RETURN WAS: CX) FINANCIAL INSTITUTION: PSECU TYPE OF ACCOUNT: C )SAVINGS DATE ESTABLISHED 05-29-1999 Account Balance Percent Taxable Awtount Subject to Tax Debts and Deductions Taxable Awount Tax Rate Tax Due TAX CREDITS: S/D.C. NO.: 206-32-4170 ACN: 09143349 ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION ACCOUNT NO.: 8605373318 (X) CHECKING C )TRUST ( )TIME CERTIFICATE 4,812.94 X 0.166 802.17 - .00 802.17 x .045 36.10 NOTE: TO ENSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. NAKE CHECK OR MONEY ORDER PAYABLE T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RHCEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID INTEREST IS CHARGED THROUGH 06-16-2010 AT THE RATES APPLIh~ABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE 36.10 INTEREST AND PEN. .37 TOTAL DUE 36.47 ~ IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR). YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF'~TNIS FORM FOR INSTRUCTIONS. pennsylvania~ BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX DEPARTMENT OF REVENUE INHERITANCE TAX DriISION APPRAISEMENT, ALLOWANCE OR DISALLOWANCE PO BO)( 260L01 OF DEDUCTIONS, AND ASSESSMENT OF TAX ON REV-1548 EX AFP (12-09) NARRISBUR6 PA 17126-0601 JOINTLY HELD OR TRUST ASSETS DATE 06-08-2010 ESTATE OF HOBAUGH JEANNE M DATE OF DEATH D6-14-20D9 FILE NUMBER 21 10-0247 COUNTY CUMBERLAND SSN/DC 206-32-4170 HENRY HOBAUGH ACN D9143353 26 ANDES DR APPEAL BY DATE:OS-07-2010 MECHANICSBURG PA 17055 (SeertvtrsesidilrnderObjeclions) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SgUARE CARLISLE PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~' REV-1548 EX AFP C12-09) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 06-08-2010 ESTATE OF:HOBAUGH JEANNE M DATE OF DEATH:06-14-2009 FILE NO.: 21 10-0247 S.S/D.C. NO.: 206-32-4170 COUNTY:CUMBERLAND ACN: 09143353 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PSECU ACCOUNT NO.: 8605373318 TYPE OF ACCOUNT: CX)SAVINGS C ) CHECKING C )TRUST C )TIME CERTIFICATE DATE ESTABLISHED 12-28-2007 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 28,551.42 X 0.166 4.758.67 - .DO 4,758.67 x .045 214.14 NOTE: TO ENSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C~) INTEREST/PEN PAID C-) AMOUNT PAID INTEREST IS CHARGEID THROUGH 06-16-2010 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE 214.14 INTEREST AND PEN. 2.21 TOTAL DUE 216.35 ^ IF PAID AFTER THIS DATE. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ^ IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OFTHIS FORM FOR INSTRUCTIONS. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIYISIDN PO BOX 2!0601 IMRRISBUR6 PA 17128-0601 HENRY HOBAUGH 26 ANDES DR MECHANICSBURG PA 17055 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS Pennsylvania DEPARTMENT OF REVENUE REV-154! EX AFP Q2-09) DATE 06-08-2010 ESTATE OF HOBAUGH JEANNE M DATE OF DEATH 06-14-2009 FILE NUMBER 21 10-0247 COUNTY CUMBERLAND SSN/DC 206-32-4170 ACN 09143351 APPEAL BY DATE:OS-D7-2010 (See reverse side Wnder ObfecNons) A~ount Rs~itted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONC TNIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1548 EX AFP C12~09) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE DR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 06-OS-2010 ESTATE OF:HOBAUGH JEANNE M DATE OF DEATH:06-14-2009 COUNTY:CUMBERLAND FILE NO.: 21 10-0247 S.S/D.C. NO.: 206-32-4170 ACN: 09143351 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PSECU ACCOUNT NO.: 8605373318 TYPE OF ACCOUNT: CX)SAVINGS C ) CHECKING C )TRUST C )TIME CERTIFICATE DATE ESTABLISHED 07-28-2003 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Asount Tax Rate Tax Due TAX CREDITS: 411.37 X 0.166 68.56 - .OD 68.56 Y .045 3.09 NDTE: TO ENSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER DF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE T0: "REGISTER OF WILLS, AGENT." PAYNENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID 06-01-2010 SBADJUST .00 3.12 TOTAL TAX PAYMENT 3.09 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 ^ IF PAID AFTER THIS DATE. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. • IF TOTAL DUE IS REF4ECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. PSEC~ July 1, 2010 Charles E. Shields, III Attorney at Law 6 Clouser Road Corner of Trindle and Clouser Rd Mechanicsburg, PA 17055 Re: Jeanne S Hobaugh,.Deceased. Account # 8605373318 Deaz Mr. Shields: ~~-r+L ~ / z//° N.ob~yl ~ The account was opened on June 1, 1999 as a Tentative Trust Account. The Beneficiaries of the account were Henry E Hobaugh III and Anita L Connors. The Share accounts were held solely by Jeanne S Hobaugh. All loans were held solely by Jeanne S Hobaugh. The following aze the Date of Death Balances for Ms. Hobaugh's account with PSECU: Account Date of Death Balances Interest -June 1-14 Savings (S1) $ 41,028.1 l $ 6.72 Vacation (S2) $ 411.37 $ 0.06 Checking (S4) $ 4,812.94 $ 0.20 Money Mazket (S7) $ 28,551.42 $ 12.48 Loans: Persona! Service (I,1) Visa Loan $ 0.00 (L9) $ 127.51 The Visa was paid and the funds were released to the Beneficiaries and the account closed. Ms. Hobaugh did not hold a safe deposit box. with PSECU. If you have any questions, please contact me at (717) 234-8484 or toll-free at (800) 237-7328, then press 6, extension 3120. ~ ,~KJI Roxann Myers Service Advisor PSECU Pennarhrania State Employees Credit Union Moin Address: 1 Credit Union Place, Harrisburg, PA 1 71 1 0-2990 • 717.234.8484 • 800.237.7328 Mailing Address: P.O. Box 67013, Harrisburg, PA 1 71 06-701 3 • 717.777.2100 (TDD) • 800.472.1967 (fDD) pseeu.com This credit union is federally insured by the National Croda Union AdminishaKon. Equol Opporfuniy finder nev-imu u. ~ pail COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ~~~•,~~"r }-IOg~4lCGN~ JEMVUE M. rr~nunraert oZi--/O -'t~7 This schedule must be completed and ftled if the ansarer to arty of questions T ttuough 4 on the n~verse side of the REV-7500 COVER SHEET b yes. ITEM NUMBER DESCRIPTION OF PROPERTY ~~TME""wE°FTMET"""s~,TM°""ri"Ta~"'PT°°E°~"r""°TME°~re°Fi"""s~. A7LIC11 •COP1'OF TIE GEED PoR NEK EBf~Th . DATE OF DEATH VALE T 96 OF DECD'S INTEREST EXCLUSION rye TAXABLE VALUE ,. Mat ~%~ Secar~fi'es 2R~ ~er,Q,~¢,~ olD9Y6 ¢q5 411 48 loo'a --a- ~~js- 5~~7 9k , . . ~ $dnlt~i'ciariCS, ~~1 to son : Henr~+ E. Ho6aK~li ~ yg 1~ daw~tittr: ~n~fa [. Cennora (see Y~lk~fi:n ~ir% from brekcr rn~r~ Htnry atFa~-cd~ rora~ lvso e<rce<on i~~e~, ~ ~ : 9s, 417.98 is needed, insert additional sheets of ale same 07/23/2010 13:12 7323264169 FACSIMiI,$ 'fRANSMTTTAL SD$ET To: Charles E. Shields ~ Company: Metl#fe Fax Number 717-7957473 Prom: Mark Henry -.~ Date: 7/23/2010 -CQ.t.It! ~~~3/~ o PAGE 01/02 Ka ~. Phone Number: 732-326-7327 N O T ES/C O 1 II11 ~, E N T S Estate of ,Teanne M. Hobaugh -please see the attached date of death valuation. Any questions, feel free to contact me at 732 326-7327 485 F, ROUTE 1 SOUTH, ISEI.I7V, NJ 08830 07/23/2010 13:12 7323264169 Account # gA3p 10946 Jeanne Hobaugh Date of Death; June 14, 2009 ~. ~S>~~ ''' :' %~ ~,:...''ii1~'iin~.;i,:t:;'fi,7oliiit$,' •.~Opzuitilg~c: : ' 3ynibol Drat:riptSdn: ~ .' ~hai'ea,•. ~ : ;~~ti09 ~' .t111~1/ '~004 ~ c ~: :` . Dodge 8c Cox , pri eb), Valne DODIX tncomc Ftimd 1,333.618 $12.42 $11.•66 $12.04 $16,056.76 Fidelity Advisor FDV1X Diversified Int! Harbor Bond 382.230 $13.00 $12.80 $12.90 $4,930.77 HA$DX Fund Principal High 1,452.102 $11.82 $11.1 S $11.49 $16,677.39 CPHYX Yield II Royce Ponn 2,286.602 $7.07 $6.46 $6.77 515,468.86 PENNX Mutual Pund Vanguard Short• 688.048 $7.83 57.82 57.83 $5,383.98 Term Bond VBISX Port Vanguard Long. 1,326.593 $10.26 $10.00 $10.13 $13,438.39 Term Bond VBLTX Market Victory 901.651 $10.88 $10.32 510.60 $9,557.50 nivcrsi6ed SRVB}C Cash Stock Fund Cash 841.731 512.06 $11.94 $12.00 $!0 [00 77 3,803.56 , . Totnl Aecognt 53,803.56 Value on 6/14/2009 595,417.98 PA REV-1512 EX+, (12-03) SCHEDULE 1 COMMDNwEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN RESIDENT DECEDENT MORTGAGE LIABILtT1ES Ec LIENS ~ ESTATE OF ~„I o ,(ifFU G H, TFi~-NNE /N. FILE NUMBER Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death, including unrolmbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH t joust a~ Cards ! +l~.jyr ~• e T W~~~~~s H.I., n~ '`~o . s ~ 3- Norxe Shope:n4, Nd'w.rk ~/'f.7t/ N• Hemp $6opp.r~~ N~w•rk ~/7. ~'~' S, G.ini+e~l Uaa~er' e1~ po.• X30, zq 6. (~lawtf' WoUYW...r ~; ~ss ~!o .ao 7• Pla,tr,~- Nollywse./ ~'+-,ur fSo . ~y $- Tu-m;n;X r33.tt 9. Gm~,s~' ~a,l3 /o, Ver ~ z~n fit ~f. / 9 TOTAL (Also enter on line 10, Recapitulation) $ I ~0~ y8 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (10.06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE M FUNERAL EXPENSES 8~ ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Ho19/!-u6H, JE~'FNNE' M, al-to-a~7 Debts of decedent must be reported on ScMduls L ITEM A. FUNERAL EXPENSES: t ~ IYIa/JO[zzi Funcrt/ ft!o~e of /lkctianics6u.~ , O/} ~, Gin~rieh /NeAJOr%../s of /NeuUs+,:esba.~ B. I ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions AMOUNT ~~, Zo2, 77 ' /~ ~ d Name of Personal Representative(s) F•I tbn ru C . ~ D bemoan '~[[ W 4.+ t/G street Address ae M,des ~rIVQ city YYlech.rtil~! Sbu,ra state P/F rp 17osf Year(s) Commission Paid: 2. AttomeyFees C~ar~E$ ~, ShlG~o~S ,~, ~ S, 3a;~p,oo 3. Fatuity 6cemp6on: (If decedents address is not the same as claimant's, attach explanation) Claimant ~•le nru E. HdOdA41/i 1 ~ ~ 3 DSO O. DO Street Address _~(0 A•I1C~e5 ~rING City 1'Y1 Gc1~an ~ C sly ~ y.n State PR zip 17 o SS Relationship of Claimant to Decedent SOYt 4. Pmbate Fees and oria; na,l Shor}' a;~,••}-; ~+'ea.~',S FI 53t, So 5. Accountant's Fees (,t.Qoi~ M[l~er, TwX ~¢G~nKn'f'aNt ~ eloss eu~' !7040, p~•, Iv`F ~ , P~4 tFl Ceah~rn.) ~,'ts p, o0 6. Tax Retum Preparer's Fee 7. Tri- C'oa.'~ ~•bs~,} $.,.v~ce dor,~,nf' rL•frit~al and Q~p;cs X15. oa 4 ~~ /Jn FtG a- /lt9i 6fu' i~ 6Vil/o ~/T o, e o ~ fS, oa'r lo• A•.r~vc~fi•s:n~r Cwn4..l•.ul L.av .Tbw~n.~ t7S,oo l~• /~d~ioh's~.N CRrI,'sk ~Ser~finil ~!'/s, o(. O (Sew eorrfir~ shu~~ TOTAL (Also enter on line 9, Recapitulation) S .c% ~•~;~ pQ (If more space is needed, insert addttional sheets of the same size) ~. 2 s eHEv. H, e.~-~l ES% OF ~'7F-NNE M• NO[3A~lGH FI~ENv, ,7/-/O--o?~}7 -------- 1 `- _ Yatin, T~ Co~~e~vr- _____ _ P Pc --- __ __-_ ___~_._~ ~, S92 . (off ~` ~. s-~ -- - _- - - ! ~' --------1`S-' --___-- / 6. -- s/r~rcr ~ Lveks m ~ ~i, C~~Lo~C -~ r Se~lrrY~ -~ ~crr.I O,/ _ oSf s r r i Fr», ~SUr, /~ , li ~i.,sar, __ -- - - '~6 S~. 66 _ X36 - o0 s~o. Yf~ , ' _---_ _~_ l ~ ~ - r~ ' l -_-G~Z~Id~_~31`i~'f ~iisur. _/TZbY~ /113 d-sr ~I" :l6/. 8~ ---- L - - -- -_ f7i.27 _ 7l3 ~ N ~'M i11SK-:~ /SsOA'IOrIaJnLYr __-- f•5r1, y2 ~o/- -- ~ r r r X63./2 o?L. ofk IW~t~ f/i5 gsss/ fy3-,Sd ~ ~ ~ •L ~~ I ~W" %9.s" - -- ~ ~irr /~~C~r ~i ~Ctul,~' ! 1.!90 30. !/e~r+i z.o,~ ~ 3.7v -- vu"' 2s'- "23 70 _ 3z Y~rizda _ _- ~3,by ---~ _~~ ------~- ~~I4. b 8 3 _ - PPL -- --- - _ ~./Ft -- - -- -- - ~__-`__ 3~% _ r _ YDfk ~2srL Ait~s~---- --- ---- X~?.08- ~y3.~S7~ __._.-~_-._- ------------- - _ _ - - _ ___ See Co n~in ~~I c rf" d/~w. r~iul - p.3 _ ' s~tc~. /~. , Cent'r1 EST o NE . ~j~Df3/~116'N ~ILFND_ ~/ya- 2~7 38= PPL 70, ss' -3 r ~Z. o£' fgp,ov ii-K !~'4SyG .S.e. f'f ~ Sa Z. 4e; ~ l~a.I~Cr ~/y ~t/ y . u~.7~d w,~,- is~. Z$ yS.' .~// T ~//~. o0 Yf, l%r: zin K.?S~ /g 9~~, CPC ~~. ~c - - Yg S r Yi..o:P a. ~ w /Yi. LL ~%f4~ !~ ,7sas ____-~3- l~tr-i~on ~ .~ ~ u~,ra w~.t~- 3¢ ~~ .5s _ P~°C ~i, d~ r .~e,J u- ~ 3 .70 ~, vim: Boa z s~. i6 - - ~l, /'pc 63.5 6Z. ~L ~ 77.3 G 3. $1irl'i .-• Siisur. ~/2.43r Se+~ CoA~i~ S~ice~' a/~clcs~ p. 4r _ ~ se~E.v ~{, , e.~td F3T o ~l NF hl• J~/aC~ 6 1~'/[F N~. Z/-/D - 2.~~ ' INa~er ~ S ~S. 87 b e 6 rr <' r ~~, 9~ ~r __v_G.; ~ ~ xs~.~ C9 _ /LPG _ ____ %o/• 43 70• l%witon d 3 ~~ _ __1~_ PPc - r o.os -___Zi~ G[~~ ~~er " a . 07 -----___----__~~. /~r+'nraNrrliAwyf t' Chwr/mss' E cGi•' ~a/s ~ {sr .t~r~ su-1-~u/ _ _~~. _ ~~ ~-~%~~r.~.rtlnsiGJ~li !%wr ~b3..sa lyd E Sl..~dr ~- ,-- _ Z~'l YZC~Z MEMORIALS Since 1922 ?R FORM Flo. ~ A~~~d~ Foundation By ^ Carved Lettered Drawing Required ^ Drafter - 5243 Simpson Ferry Rd. Mechanicsburg, PA 17050 (717) 766-5622 • Fax: (717) 766-8007 vvww. einerichmemorials. com ronQgingrichmemorials.com SOLD TO:_~E,'~ t ~ ©5' Phone (H) ~ 0 - ~o ~ t (W) SaW~ ^ Sandblast By Manufacturer Date of Order Supplier Ack. # Date Recd Found. Ordered Position Ver'rfied Cemetery r{fst.. L~Y'b~5 T-» Location ~~r'i_ S Center Over ~_ Graves Lot # Approx. Date of Completion ^' MK~ SPa~Tten~~ Lettering fkTttE ~; NtOTH,Eiw' I.EW - 5 ~ . pA~AGrMTgj~ '~>G fitNl1 W. I9t~ - (t16a JEANi~lsi MR~tI~ sETii!!JO Bf4tf,~t1 14tT• 1461 1~U.C.2 tQ42 -• vo f ~vYreY 5 ~~~AN~ ~tE q~Ytit, w tApt( off t~ chas FRAM dEANIJE~s eNt~~R~N, ti~~.~ PNcV ~1td~"~'fl, DER ~aQA~T1C!'IILD}:ENr ANU #lER GR~II"{- [r,RAh)DCNt~-~fREN speuirn Type of Memorial ~,'}etRt`~ Material ~, ~4 L'~feL~r~wnt~E° Size. ~ '~ X ~~_ X 0~4 Finish n ~ ~ - Size ~ X ~_Xt"~1 F 4 Finish ~, Fi+ . y Misc.5~,. ~ «" T01Atht~i{Littn Design ~Y'OYfn YU~~unq • ~(ewt ~ ~I r }~ Q~ C ~vC~er t'o ~ -.._ pYtr 'bpkt~.~'tr `> ~osgt ~ SD 2 3 zo 2- 7 0 ^~,,~,~. ~~, 5 °O Location ~ ~ Ali ft+. Ar~~1ir ~ nZ ^ Vase ^ Corner Posts Agreement A 50% deposit is required ro commencement of work. Price /t $ ~l `mss Agree ro pay stated balance upon erection regardless of labor troubles or shipmeMS or any other good reasons. This order w confect FOUndation $ canner be cancelled by customer unless agreed by twtlt gentles. The article herein mentioned shall remain the property of James R. OMgrfch Msmaials untll paid in full and Utey reserve the right ro rertave the same is not paid as stated. ~ ~,py Oh $ 7 ~~. I agree ro carefupy proofread all names and dates for accuracy and acca~ full responsiMNry for arty errors or omis9liin$, THERE WILL BE AN ADDITIONAL CHARGE FOR ANY LETTERING ADDED TO THIS MEMORIAL AFTER ERECTED~ON THE clamEreRY. "~' TOTAL $ $ I further agree to pay the balance stated forihe work performed underthis contract within thirty (30) days of receipt of the fural irtvoice S• ,,,, ~ 6 Q and mNter agree that Nderest shall accrue at the rate of one and one-het(percent (134%) per month on the unpaid beNtnce owed ro DEPOSIT . $ j James R. Gingrich Memorials rrot paid wtlhin thinly (30) days of the invoice date. In addpion thereto, I agree if p becomes necessary for James R. Gingrich ro insttlute legal proceeding to coped erry furWS due from me for my account being past due thirty (30) days, Balance Due ~ 1 ro pay ap court costs and atrorneys fees incurred by James R. Gingrich Memorials ro collect the same. , ~ Upon Completion $ _ Dealer -~ESI-`rrf'tiR"- Customer ~" ~ I ~ (I further agree that the above names, spelling, and dates are correct) WHITE-0ffice YELLOW-Production PINK-Customer GOLDENROD-Branch Malpezzi funeral Home 8 Market Plaza Way Mechanicsburg, PA 17055 (717)697-4696 Michael J. Malpezzi, Owner, FD Jeremy J. Shartzer, FD Kyle C. Knipe FD July 27, 2009 Henry Hobaugh 26 Andes Drive Mechanicsburg, PA 17055 The Funeral Service for Jeanne S. Hobaugh We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING IS AN ITEMIZED STATEMII9T OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. SELECTED MERCHANDISE: Cremation Container $ ] 65.00 Solid Oak Urn $235.00 THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED 5400.00 C. SPECIAL CHARGES Direct Cremation w/graveside svc. $2895.00 AT THE TIME FUNERAL ARRANGEMENTS WERE MADE, WE ADVANCED CERTAIN PAYMENTS TO OTHERS AS AN ACCOMMODATION. THE FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES. CASH ADVANCES Opening Grave $575.00 Certified Death Certificates $90.00 Newspaper Notices -Patriot - $142.77 ClergyMlass Offering $IOp,00 TOTAL CASH ADVANCES AND SPECIAL CHARGES $3802.77 SUB-TOTAL $4202.77 INITIAL PAYMENT /DISCOUNT / CREDTTS --------------- TOTAL AMOUNT DUE $4202.77 Malpezzi Funeral Home 8 Market Plaza Way Mechanicsburg, PA 17055 (717}697-4696 Henry Hobaugh 26 Andes Drive Mechanicsburg, PA 17055 For receipt on the account of: Jeanne S. Hobaugh Date of Payment: 08/10/2009 Cash/Check #: 2024 Balance: $ 4202.77 Payment Amount: $ -4202.77 Balance: $ 0.00 REV-1513 EX+ (9-00) SCNEpULE J COMMONWEALTH OF PENNSYLVANIA BENEFKIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FlLE NUMBER Ho~~-user, ~F~NN~ ter. a/- ~o- ~~ ~ RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Llst Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] ' • Ht n r~ F. No b~r,~glj 7i1' Son Y2 c74 !{srdts I>r. /~@~T~1't r CS ~k/~~ Pi~ /705'S o~. I¢/1,'fq ~. (.vA'/lors dRUq~fftr tl ~2 34/4 va!/~•~r st m~~ys~,~~, o~ •053 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 TH ROUGH 18, AS APPROPRUITE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE L B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART Q -* ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (M more space is needed, insert addNanal sheets of the same sae) c~op~ L~.S`I ~ ZVIGG A.~D ~1'tES`IA9K~E~V7 OF ~ Q -~,,, -t~ ; ~~~ ~ ~c~ _ ~' ~ ~ ~ r,~ :~ .~ I, Jeanne S. Hobaugh, a resident of the State of Pennsylvania, c~.unty of ~ ~~ "' ~; Cumberland, and City of Mechanicsburg; and being of sound mind and disposing mind and memory, do hereby make, publish and declare this to be my Last Will and Testament, thereby, revoking and making null and void any and all other Last Wills and Testaments and/ or Codicils to Last Wills and Testaments heretofore made by me. All references herein to this Will shall be construed. as referring to this Last Will and Testament only. FAMILY CLAUSE At the time of executing this Last Will and Testament,l am unmarried. The names of my children are listed below. If I do not leave any property to any of my children, my failure to do so is intentional. Anita L. Connors Henry E. Hobaugh III RESIDENCY CLAUSE Having in mind the possibility that I may temporarily reside outside of, or simply be absent from the State of Pennsylvania, County of Cumberland, and City of Mechanicsburg, at the time of my death, I elect and hereby declaze that this Will and each and every disposition and provision contained herein shall be construed and regulated by and in accordance with the laws of said State of Pennsylvania. It is my desire that this Will be probated in the State of ( ,~ Page 1 of my Last Will and Testament .~ (Signature) #456881 ! I ifr COO ~V Pennsylvania, my place of domicile, and that the principal administration of my . estate be had in said State of Pennsylvania and that none of the assets of my estate which may be found in my place of domicile, be remitted to any other jurisdiction for administration or distribution. DEBT CLAUSE I direct that the executor named pursuant to this Last Will and Testament review (as soon after my death as practical) all of my just debts and obligations, including funeral expenses and the expenses incident .to my last illness; excepting those long term debts secured by real or personal property which may be assumed by the Heir of such property, unless such assumption is prohibited by law or upon agreement by the Heir. The executor shall pay these just debts only after the creditor provides sufficient evidence to support their claim. My executor shall pay out of my gross estate, as if they were my debts, and without proration or appointment, all estate and inheritance taxes, by whatever name called; (including any interest due thereon) becoming payable because of my death in respect to alI property comprising my gross estate for death tax purposes, whether or not such property passes under this Last Will and Testament. I further diret~t t}~at if any Heir or Heirs named in the Distribution Clause of this Last Will and Testament should be indebted to me at the time of my death, and evidence of such indebtecli~ess is provided. or made available to the Executor of my estate, then that share>~# my estate; which I give, devise, and bequeath to any anti: each such Heir shall be reduced in value by an amount equal to the proven indebtedness of such .Heir or Heirs, unless I have; specifically provided in the Distribution Qause of this Last Will and Testament for the forbearance of such debt; otherwise, the value of the unforgiven indebtedness shall be either added to the share given..to the remaining Heir, if these be only one remaining Heil naix-ed in the Distrtrbution Clause, or equally divided between or among the remaining Heirs, if there be more than one remaining Heir named in the Distribution ©ause(s). !`~ Page 2 of my Last Will and Testament ~~~ ~" (Si tore) ~~~~r COMMON DISASTER CLAUSE This clause is not applicable as to the Principal Heirs. PRINCIPAL DISTRIBUTION CLAUSE I give, devise, and bequeath to the persons named below (my "Principal Heirs'), if he or she, whichever the case may be, shall survive me, all of the residue and remainder of my gross estate after payment of all my just debts, expenses, taxes, administration and individual bequests, if any, as provided in the Distribution Clause, in the percentages set forth below. 1. Name: Anita L. Connors Relation: Child Percentage: 50% In case such Principal Heir does not survive me, I direct that the share of my estate which would have been given to sucr. Principal Heir shall be distributed for The children of l~nita L.-Connors to be divided equally 2. Name:.-Henry E. Hobatigh III Relation: Child Percentage: 50% In case such Principal Heir does not survive me, I direct that the share of my estate which would have been given to such Principal Heir shall be distributed. to: The children of Henry F.. Hobaugh III to be divided equally. If there are no children, my surviving child. DISTRIBUTION CLAUSE I give, devise, and bequeath M the persons named below if he or she, whichever the case may be, shall survive me, the following items of property: This clause is not applicable. ~~~ , Page 3 of my Last Will and Testament ~~,~,.,~ ~ ~p ,~-` ? (Signature) fi COO C~\i EXECUTOR APPOINTMENT CLAUSE (A) I nominate, constitute and appoint my child, Henry E. Hobaugh III, to be the Executor of my Estate. (B) If, for any reason, my first nominee Executor should fail to qualify or be unable or unwilling to accept or to continue as the Executor of my Estate, I nominate, constitute and appoint my child, Anita L. Connors, to be the Executor of my Estate. . (C) If for any reason, all of the nominees designated above in Paragraphs (A) and (B) should tail to qualify or be unable or unwilling or to continue as Executor of my Estate, I nominate, constitute and appoint my grandchild, Stephen P. Connors, to be the Executor of my Estate. EXECUTOR POWER OF APPOINTMENT CLAUSE (A) All directives. in this TNilI that use by reference the word Executor mean and include any person names herein as my Executrn {or personal representative, as may be defined under State Laws) and any persLZn who may be. acting in either capacity, at any time_ -.Such person shaII have reasonable discretion under the directives of thismy fast Will and Testament with respect to any property, real or. personal, left by or held by me, or acquired by my Executor on behalf :cif nay .Estate. ($) As I wish my Exeeutdx ~to exercise broad and reasonable discretion in dealutg with; my;Estate, so as to be able to do everything he ox she deems advisable for the best interest of my Estate and the Heirs thereof,. I direct that my Executor perform all .acts,: take altsuch proceedings, and exercise. all such rights and privileges; although not. specifically mentioned in this Will .with relation to any such property, as if the absolute owner thereof; and in connection therewith, to make, execote and deliver any instruments, and to enter into any covenants or agreements binding;my Estate t~r.anyportion thereof. (C) No such person Wanted in, or appointed in connection with this Will in a fiduciary Eapacity shallbe iequired to file any bond or other security for the faithful performance cif his or r4er duties as such fiduciary in any jurisdiction; and if, despite this directive, a bind should be required, I request that it be accepted without sureties and in a nominal amount. Page 4 of my Last Will and Testament _ .;L~--'~ (Si afore) U 1 ~ ~/ ~~G°~~,, NON-LLABILTTY OF FIDUCIARIES Any fiduciary, including my Executor and any trustee, who in good faith endeavor to carry out the provisions of this Last Will and Testament, shall not be liable to me, my estate, or my heirs, for any damages or claims arising because of their actions or inactions based on this Last Will and Testament. Ivry estate shall indemnify and hold them harmless. SAVING CLAUSE If a court of competent jurisdiction shall. at any time invalidate or find unenforceable any provision of this Will, such invalidation shall not be construed as invalidating the whole of this Will. All of the remauung provisions shall be undisturbed as to their Iega1 force and effect. If a court finds that an invalidated or unenforceable provision would become valiCi if it is limited, then such provision shall be deemed to be written, deemed,; construed and enforced as so limited. 1 t /~ Page 5 of my Last Will and Testament d (Signs., irP ~~ ,~ ~ ~~~. IIV WITNESS WHEREOF, I, the undersigned Testator, declare that I sign and execute this instrument on the date written below as my Last Will and Testament and further declare that I sign it willingly, that 1 execute it as my free and voluntary act for the purposes expressed in this document and that I am eighteen years of age or older, of sound mind and underno constraint or undue influence. n ,• it f tore o eanrie S. Ho ugh)f ~~ SSN: (~6~'~~~f ~~~ Date: ~~~ - Fage 6 of xnq Last Will and Testament ._ T -. J (S t•~re) w ,~ ~,~ ~ ~ ~, s--- ATTESTATION CLAUSE. This Last Will and Testament, which has been separately signed by Jeanne S. Hobaugh, the Testator, was signed, executed and declared by the above named Testator as his or her Last Will and Testament in the presence of each of us. We, in the presence of the Testator and each other, hereby subscribe our names as 'witnesses to the declaration and execution of the Last Will and Testament by the Testator, and we declare that, to the best of our knowledge, said Testator is eighteen years of age or older, of sound mind and under no constraint or undue influence. (Signature of witness) (Pratt Name) Date:~.~~/~_ ~ 1a~ l_~-l ~ r 5 ~rrt,_n~~ (Address) (City, state, ZII') v (Signature of witness) (Print Name) hate: ~ - J ~ " .~~ ~7~ ~'i~ lzer- J- ~~ P~~.vrl (Address) (city, State, ZII'1 ~ (Signature of wihiess) Date:l3 3 i -0 3 (Print Name) F~uDV3~~?A~A'(L1~. Address) (::ity, State, `LIP) i Page 7 of my Last Will and Testament ~ 7 _ _ (~Egi~atureti ,~ v SELF-PROVING AFFIDAVIT ~' ~~ ~`~'~ ,~- ,~ - - \ State of Pennsylvania County of Cumberland I, Jeanne S. Hobaugh, the undersigned Testator, being first duly sworn, do declare to the undersigned authority that I signed and executed the attached or annexed instrument as my Last WiII and Testament and tha# I signed it willingly, that I executed it as my free and voluntary act for the purposes expressed in that document and that at the time 1 signed the document I was eighteen years of age or older, of sound mind and under no constraint or undue influence. Date: -~ ~i _ ~ ~~-~Gr~-~ i tore of----~. Hobaugl~ We, the undersigned witnesses, being first duly sworn, do earhdeclaze to the undersigned authority the foIlowing•. (1) the Testator declazed to each of us that the attached or annexed instrument is his or her Last Will and Testament; (2).the Testator executed the will in oiar presence; (3) each of us, in the presence of the Testator, signed the will as witness; and (4) to the best of our knowledge the Testator is eighteen years of age or older, of sound mind and under nr, constraint of undue influence. (Signat~ue ci witness) (Print Alame) A-~-~ (signature ~ witness) ~~t Name) 3. ~~~~~ - ICJ u~~~c.r-Y/~_ ~~ ~ ~~ ~~ ~ , V t~1L (Signature of witness) AcknowIed~ement of Notarv Public: print Name) Subscribed, sworn and acknowledged to on thls~1 shay of ~~~X~j~._ , 20 O~ b~ nne S. F3obau , ~syT-. sta r, and '~~~ .~. ~' ~1'l~~w.. _ ~_ -. _ L-= ~I. ~-d5' and ~t'1~.1~L~__~-~ UL i C !~_~ as. witnesses. Witness my hand •ancI seal.. ? ,:~ ,3 ryry,~ Si~raatuae of hlotary Public ~,,n-r~ I~' ~I1,r~'„~r_-- ~ ~~ ~ ~~ STATEMENT OF INTERMENT, CREMATION and WISHES I, Jeanne S. Hobaugh, the undersigned, having previously executed a Last Will and Testament on the date hereof, hereby state that, in addition to the directives and bequests set forth in said Last Will and Testament, it is my desire that my remains be cremated. My further wishes and directives are as follows: Cremation is the preferred final resting place, however, the final decision and arrangements will be made by the immediate family. There will be no viewing under any circumstances. If a memorial service is required, or requested by the immediate family, it should be at the their convenience and to be attended by the immediate family only. - r---. Dated: 3/ G~ ~ ~ _ lure of J ` e S. Hobau l- ACKNOWLEDGMENT OF NOTARY PUB~.IC State of Pennsylvania -County of Cumberland On this,, j'~'`day of ~~ ~a rr ~ , 2003• before me, the undersigned Notary Public, personally appeared Jeanne S. Hobaugh, personally known to me (or proved to me on the basis of satisfactory evidence) to be the individual who signed the foregoing instrument and acknowledged M me that he or she . executed the same in his or her authorized capacity, and that by such signature, the person executed the instrument. Witness my hand and seal. ~ ,~f' ~ ~, Signature of Notary Public: ~~-- ~__11.a~-. ~~ m ~~ ~o~~~ '_ ~~ W ~ v CJ 0 ~ n Ha ~ ~ ON ~ a E o i ~ O _ ~: ~o ~ ~ m ~ C '~ N +- ~ •~ ~ O o ~m ¢ ~ UTN ~ ~ M ~ o~E ?1 H ~ ~ J j C'1 t~ ° L W orn o ooa ~ 0 n ~ U ~ LL~~~ 1 o U •- ~w~ c ^~ L nrn OZOa ~o~~~~ a ~, ~g=W W ~ H J ~'- W ~ fA J a a C'3~OO C ~ w~UQ C~ w OCU r wo =o[m .. u~ ac ~ ~p cnw- F~ aoW = y ~~ ~ ~ n.i _~ ~ "' ,.~~ o '~~ o ~~ m ~~ ru m _~ ~ ~~ o ~ o M1 CHARLES E. SHIELDS, III ATTORNEY-AT-LAW 6 CLOUSER ROAD Corner of Trindle and Clouser Roads MECHANICSBURG, PA 17055 GEORGE M. HOUCK (1912-1991) December 8, 2010 Register of Wills Cumberland County Court House 1 Courthouse Square Cazlisle, PA 17013 Re: Jeanne M. Hobaugh No. 21-10.0247 Deaz Register of Wills: TELEPHONE (717) 766-0209 FAX (717) 795-7473 Please fmd enclosed for filing 2 copies of the Inheritance Tax Return for the Jeanne M. Hobaugh Estate as well as Check No. 2047 in the amount of $12,355.90 for the Inheritance Tax due, Check No. 2048 in the amount of $170.00 for additional Probate and Check No. 2049 in the amount of $15.00 for the filing fee Thank you for your kind attention to this matter. Very truly yours, ~~~~e Chazles E. Shields, III Attorney-At-Law CES/mjj Enclosures ,., m m rn ~ ~ ~, ~~, :. ~ ~^ ~cn~ o ~o~ ° -a ss-~-a ~ c ~ z ~ ~_ 1 ~ ~ ~nQ i ~