HomeMy WebLinkAbout11-04-13 i
I
5
` yA 15!75610143
•mil REV-150V Ex(a2-11) OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania County code Year Fre Numoer
Bureau of Individual Taxes 0ENkRTaENT OF RIVEN°`
PO BO?C280601 INHERITANCE TAX RETURN 21 13 0489
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
04 02 2013 04 04 1963
Decedent's Last Name Suffix Decedent's First Name MI
HOOVER JOEL L
(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 Return 2, Supplemental Return 3. Remainder Return(Date of Death
Prior to 12-13-82)
4. Limited Estate 4a.Future Interest Compromise 5. Federal Estate Tax Return Required
(dale of death after 1242-82)
8 Decedent Died Testaae 7. (Apede&M.inf,,ed wing Trust _ 0 8, Total Number of Safe Deposit Boxes
(Attach Copy of Will)
9. Litigation Proceeds Received ❑ 10.beiw eni2 311 eesi({Oa95of Death 11.Election to tax antler Sec.9113(-8)
(Attach Schedule O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED,ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
GEORGE F DOUGLAS III ESQ 717 249 6333
REGISTER OF WILLS USE ONLY
First Line of Address C O �
354 ALEXANDER SPRING RO o
M z r;F
Second Line of Address 1> T-
s :;u rrI tni
� v
C7 IJITE Ftk7fD O
City or Post Office State 21P Code CD 'r1
CARLISLE PA 17015 ry M
t —� r—
r crT crs -°,T
u
Correspondent's e-mail address: g dou las g @ salzmannh g hes.com °
Under
isdtruee,,coR2Ctantl r PleW Declaration of pre�panir examined than me personal ieore�ttative is�bassed on as imam statements,ofnwhich preparerihas any knicMedge belief,
SIGNATURE O P SON RESPONSIBLE FOR FILING RETURN DATE
)=4"e Christine L. Gutshall
ADDRESS �
164 Bulls Head Road Newville PA 17241
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE_ DATE
� A_0 George F Douglas, III Esq. j ) 1 13
ADDIIESS
354 Alexander Spring Road Suite 1 Carlisle PA _
Side 1
1505610143 1505610143
1505610243
REV-1500 EX
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... i.
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.
747 . 37
5. Cash, Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 12 , 747 . 37
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 556 . 95
7. Inter-Vivos Transfers&Miscellaneous Nt Probate Property
(Schedule G) a Separate Billing Requested............ 7,
8. Total Gross Assets (total Lines 1 through 7)........................... ..... .. - 8. 13 , 304 . 32
9. Funeral Expenses and Administrative Costs(Schedule H)...........
9. 11 , 028 . 18
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................ 10. 11 r 815 . 88
11. Total Deductions(total Lines 9 and 10)................................................................ 11, 22 , 844 . 06
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. -9,539 . 74
13. Charitable and Governmental Bequests/Sec 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. -9 , 539 . 74
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 15 0 . 00
(a)(1.2)X.00
16. Amount of Line 14 taxable 0 . 00 16. 0 . 00
at lineal rate X .045
17. Amount of Line 14 taxable 0 . 00 17. 0 . 00
at sibling rate X.12
18. Amount of Line 14 taxable 0 . 00 18. 0 . 00
at collateral rate X.15
19 0 . 00
19. TAX DUE................................................................................................................
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
1505610243 1505610243
n
t
REV-1500 EX Page 3 file Number 21-13-0489
Decedent's Complete Address:
DECEDENT'S NAME
Hoover,Joel Lincoln -_-
STREETADDRESS
961 Green Spring Rd.
CITY STATE ZIP
Newville PA 17241
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1} 0.00
2. Credits/Payments
A. Prior Payments
B. Discount 0.00
Total Credits(A +B) (2) 0.00
3. Interest (3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) _
Check box on Page 2,Line 20 to request a refund
5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 0.00
Make Check Payable to: REGISTER OF WILLS, AGENT,
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred6..-................. ❑
b. retain the right to designate who shall use the property transferred or its income;...... ........ ❑ x
c. retain a reversionary interest;or......................... ..................__..._......................................................... ❑ x
d. receive the promise for life of either payments,benefits or care?............................................................ ❑ x
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without ❑ ❑
receiving adequate consideration?..._................._...._.__.....................___..._...........................__.._.._..._.... x
3. Did decedent own an"in trust for' or payable upon death bank account or security at his or her death?,,,,... ❑ ❑x
4. Did decedent own an individual retirement account,annuity,or other non-probate property which ❑ ❑
contains a beneficiary designation?..................____....__...... ...................__..._.............._..-.........._.......
...... x
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)O]_
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 0 percent
172 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
172 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[72 P.S.§9116(a)(1.3)]. A
sibling is defined under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
Rev-1509 Ex.t11.10)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT REVENUE PERSONAL PROPERTY
INHERITANCE TA TA X RETURN
RESIpENT DECEDENT
ESTATE OF FILE NUMBER
Hoover,Joel Lincoln 21-13-0489
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with the right of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 American Independent Insurance Company, ISI Claims Account-property damage liability 3,503.77
for leased car
2 Commonwealth of Pennsylvania -vacation pay and back pay 9,194.91
3 SafecoInsurance-refund 48.69
TOTAL(Also enter on Line 5, Recapitulation) 12,747.37
(If more space is needed,additional pages of the same size)
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev. 11-10)
Ray-1509 EX-(01-10) SCHEDULE F
pennsylvania
DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT OECEDENT
ESTATE OF FILE NUMBER
Hoover Joel Lincoln 21-13-0489
If an asset was made joint within one year of the decedent's date of death,it must be reported on schedule G.
SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Christine L. Gutshall 144 Bulls Head Rd. Sister
New,ville, PA 17241
B.
C.
JOINTLY OWNED PROPERTY:
DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM LETTER DATE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECD'S VALUE OF
FOR JOINT MADE NUMBER OR SIMILAR IDENTIFYING NUMBER ATTACH DEED FOR VALUE OF ASSE INTEREST
DECEDENT'S INTEREST
NUMBER TENANT JOINT JOINTLY-HELD REAL ESTATE.
1 A 02/14/2012 Metro Bank,Totally Free Checking Account 1,113.90 50.000% 556.95
No. 2840225847-joint with Christine L.
Gutshall,sister
TOTAL(Also enter on Line 6, Recapitulation) 556.95
(If more space is needed,additional pages of the same size)
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule F(Rev.01-10)
REV-0511 Ex.(10-04)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
RESIDENT DE ED RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hoover Joel Lincoln 21-13-0489
!_ Decedent's debts must be reported on Schedule 1.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s)attached 8,395.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zip
Year(s)Commission Paid
2. Attornev's,Fees Salzmann Hughes, P.C. 2.000.00
3. Family Exemption: (if decedent's address is not the same as claimant's,attach explanation)
Claimant
Street Address
City State Zio
Relationship of Claimant to Decedent
4. Probate Fees 318.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 314.68
See continuation schedule(s) attached
TOTAL(Also enter on line 9, Recapitulation) 11,428.18
Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev. 10-09)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Hoover,Joel Lincoln 21-13-0489
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral ExRenses
1 Egger Funeral Home, Inc. -funeral services 8.075.00
2 Food-luncheon after memorial service 200.00
3 Organist-memorial service 20.00
4 Pastor-memorial services 100.00
H-A 6,395.00
Other A ministrative Costs
5 Harland Clarke -estate checks ordered 24.52
6 Metro Bank-business checking fee 15.00
7 Salzmann Hughes-reimbursement for payment to Cumberland Law Journal for legal 75.00
advertising
6 The Sentinel -Legal advertising 200.16
H-B7 314.68
Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98)
Rev-1512 EX*(1248)
SCHEDULE I
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hoover Joel Lincoln 21-13-0489
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 American Honda Finance Corporation-balance due for leased car that was damaged in an 3,917.73
accident before death
2 American Honda Finance Corporation-monthly payment for leased car 314.99
3 American Honda Finance Corporation-monthly payment for leased car 314.99
4 American Honda Finance Corporation-monthly payment for leased car 314.99
5 Commonwealth Financial Systems, Inc.-balance due on collection for Providian 2,204.14
8 Convergent Outsourcing,Inc.-balance due on collection for Palisades Collection 1,28918
7 Enhanced Recovery Company,LLC -balance due on collection for AT&T 1,043.44
8 Safeco Insurance-automobile insurance 12.82
9 Smigel,Anderson&Sacks,L.L.P.-balance due for estate planning document preparation 1,220.00
10 Smigel,Anderson&Sacks, L.L.P.-balance due for Corporate matters 205.54
11 Susquehanna Township Emergency-medical transport 58.50
12 Tate&Kirlin Associates -balance due on collection for ACT Security Systems Inc. 938.98
TOTAL(Also enter on Line 10,Recapitulation) 11,815.88
(If more space is needed,additional pages of the same size)
Copyright(c)2008 form software only The Lackner Group,Inc. Form PA-1500 Schedule I(Rev. 12-08)
REVA 511 EX.(01-10(
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hoover,Joel Lincoln 21-13.0489
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(SS RECEIVING PROPERTY DECEDENT (Words) ($$$}
Do Nrt '
I. TAXABLE DISTRIBUTIONS [include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
1 Christine L.Gutshali Sister Schedule E
164 Bulls Head Road
Newville, PA 17241
2 Gregory Lynn Hoover Brother Entire Residue
961 Green Spring Road
Newville, PA 17241
Total
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate.
NON-TAXABLE DISTRIBUTIONS:
II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule J(Rev. 01-10)
11065-1-5/Wi11?1iDRAmc 4/8/11 2:37 PNI
C)
C=
YI C) -7)
LAST WILL AND TESTAMENT
-- ri
OF
JOEL LINCOLN HOOVER
1, JOEL LINCOLN HOOVER, presently of Cumberland County, Pennsylvania, declare
this to be my Last Will and Testament hereby revoking all Wills and Codicils previously made
by me.
MARITAL STATUS
I declare that I am a single man.
CHILDREN
I have two (2) children, now living, whose names and dates of birth are as follows:
JENELLE LEANN HOOVER BUTT born March 2, 1984
JEFFREY LYNN HOOVER born May 21, 1986
All references in this Will to my children include only the children named above.
PERSONAL PROPERTY
ARTICLE I
I direct that all of my household furnishings and tangible personal property be sold and
the proceeds added to my residuary estate.
If, however, I leave a memorandum setting forth directions as to the distribution of
certain items, I direct that my Executor take into account any such directions and make every
effort to distribute such property in kind consistent therewith.
RESIDUE
ARTICLE II
I give the rest, residue and remainder of my estate to my brother, GREGORY LYNN
HOOVER, presently of Nevwille, Pennsylvania. Should my brother, GREGORY LYNN
HOOVER, fail to survive me,then I give the rest, residue and remainder of my estate to my
mother, SHIRLEY LOUISE STITT HOOVER, presently of Newville, Pennsylvania. Should
my mother, SHIRLEY LOUISE STITT HOOVER, fail to survive me, then I give the rest,
residue and remainder of my estate to my sister, CHRISTINE LOUISE HOOVER
GUTSHALL, presently of Newville, Pennsylvania.
EXECUTOR
ARTICLE III
A. Appointment. I appoint my brother, GREGORY LYNN HOOVER, as
the Executor of this Will. In the event of the death, resignation, renunciation or inability
to act of GREGORY LYNN HOOVER in that capacity, then I appoint my mother,
SHIRLEY LOUISE STITT HOOVER, as the Executrix of this Will in his place and
stead. If my mother, SHIRLEY LOUISE STITT HOOVER, is unable or unwilling to
Page 2 of 8 Pages
act in that capacity, then I appoint my sister, CHRISTINE LOUISE HOOVER
GUTSHALL, as the Executrix of this Will.
B. Bond. No bond or other security shall be required of any Executor or .
Executrix appointed in this Will.
C. Compensation. The Executor or Executrix shall receive reasonable
compensation for his or her services performed as determined by the Court in which this
Will is admitted to probate. .
EXECUTOR POWERS
ARTICLE IV
I give my Executor in addition to and not in limitation of the powers given by law or by
other provisions of this Will, the following powers with respect to settlement of my estate, to be
exercised from time to time in the discretion of my Executor without further order or license of the
Register of Wills or of any court:
A. Investments. To retain any property, pending distribution hereunder, to
invest in or purchase any property without restriction to legal investments for fiduciaries, to
compromise claims, and to sell any property at public or private sale;
B. Securities. To hold shares of stock or other securities in nominee
registration form, including that of a clearing corporation or depository, or in book entry
form or unregistered or in such other form as will pass by delivery;
Page 3 of 8 Pages
C. Litigation. To engage in litigation and compromise, arbitrate or abandon
claims;
D. Distributions. To make distributions in cash or in kind at current values, or
partly in each, allocating specific assets to particular distributees on a non-pro rata basis, and
for such purposes to make reasonable determinations of current values;
E. Tax Returns. To make elections, decisions, concessions and settlements in
connection with all income, estate, inheritance, gift or other tar returns and the payment of
such taxes, without obligation to adjust the distributive share of income or principal of any
person affected thereby;
F. Loans. To pay off any loans I may have taken against any life insurance
policies owned by me that remain unpaid at the time of my death;
G. Borrowing and Encumbering. To borrow money from any person
including any fiduciary acting hereunder, and to mortgage or pledge any real or personal
property;
H. Propertv Management. To manage, control, repair and improve all real
and personal property;
I. Insurance. To procure and carry at the expense of the estate, insurance of
the kinds, forms and amounts deemed advisable by the Executor to protect the estate and the
Executor against any hazard;
I Employment of Attorneys, Advisors and Other Agents. To employ any
attorney, investment adviser, accountant, broker, tax specialist or any other agent deemed
Page 4 of 8 Pages
necessary in the discretion of the Executor; and to pay from the estate reasonable
compensation for all services performed by any of them;
K. Business Operation. To conduct alone or with others any business in which
I am engaged or in which I have an interest at my death, with all the powers of any owner
with respect thereto, including the power to delegate discretionary duties to others, to invest
other property held hereunder in such business and to organize a partnership or corporation
to carry on such business;
L. General. To do all the acts, to take all the proceedings, and to exercise all
the rights, powers and privileges which an absolute owner of the property would have,
subject always to the discharge of his fiduciary obligations. The enumeration of certain
powers in this Will shall not limit the general or implied powers of the Executor. The
Executor shall have all additional powers that may now or hereafter be conferred on the
Executor by law or that may be necessary to enable the Executor to administer the
provisions of this Will, subject to any limitations specified in this Will.
NO ALIENATION
ARTICLE V
No interest of any beneficiary under this Will or any codicil hereto shall be subject to
anticipation or voluntary or involuntary alienation.
Page 5 of 8 Pages
NO CONTEST
ARTICLE VI
If any beneficiary or remainderman under this Will in any manner, directly or indirectly,
contests or attacks this Will or any of its provisions, any share or interest in my estate given to
that contesting beneficiary or remainderman under this Will is revoked and shall be disposed of
in the same manner provided herein as if that contesting beneficiary or remainderman had
predeceased me without issue.
LEGALITY OF ARTICLES
ARTICLE VII
If any provision of this Will or of any codicil thereto is held to be inoperative, invalid or
illegal, it is my intention that all of the remaining provisions thereof shall continue to be fully
operative and effective so far as it is possible and reasonable.
TAXES
ARTICLE VIII
All estate, inheritance and succession taxes, together with any interest and penalties
thereon, payable as a result of my death and imposed with respect to any property, whether or
not disposed of by this Will, shall be paid out of the residue of my estate.
Page 6 of 8 Pages
IN WITNESS WHEREOF, 1 have hereunto set my hand and seal and caused this my
Last Will and Testament, consisting of eight (8) typewritten pages, including this attestation
clause, to be executed, declared and published this day of
2011, at River Chase Office Center, 4431 North Front Street, Harrisburg, Pennsylvania.
(SEAL)
O INCO OVER
Signed, sealed, published and declared by the above named JOEL LINCOLN
HOOVER, Testator, as and for his Last Will, in the presence of us and each of us, who, at his
request and in his presence and in the presence of each other, have hereunto subscribed our
names as witnesses thereto the day and year last above written.
—� Residing at Hnig ek o i y �
2icl��coF; Pig I-7IIC
I j,ju- Residing at
Co-( IS A 0,3
Residing at
'J
Page 7 of 8 Pages
COMMONWEALTH OF PENNSYLVANIA SS.
COUNTY OF DAUPHIN
We. JOEL LINCOLN HOOVER, the Testator, and t I-
t l + �� and, \ :u .� ✓ '� "''' the witnesses, whose names are
T%ra •
signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the
undersigned authority that the Testator signed and executed the instrument as his Last Will; that
the Testator signed willingly and executed it as his free and voluntary act for the purposes therein
expressed; that each subscribing witness in the hearing and sight of the Testator signed the Will
as a witness and that to the best of his or her knowledge the Testator was at that time eighteen
(18 of age or old r, of sound and under no constraint or undue influence.
b, , rn.
N ER Witness
1 ness
Witness
Subscribed, sworn to and acknowledged before me by JOEL LINCOLN HOOVER, the
Testator, and
subscribed and sworn to before me b
)6-104 (l - _ and l i �" r ' : r witnesses, this
day of i
Notary Public
My Commission Expires:
gMMONWEr.L'Fi_!?i'rrgi tNPy!VA
NOTAi;' € .t.. s; -AL
Gwynne C. °ri c;l:'. r :ar; Public
Susquehanna�:�s., r,..,;;�':�County
Page 8 of 8 Pages MY COMMISS101i C :'G.:_;U.°25,2013
o EAU OF !N^u!Y:pl;a1, ia'[r5 inheritance - peens era
p0 LOX Z906�I Pennsylvania l ax an f' -
NARR7SBOR0 Pa ll1Z8-Oo91 information Notice CE"��7MEtiT OF'n°✓E,VU:
And Taxpayer Response ` °" "'
FILE NO. 2!13-04c9
ACN 13123810
DATE 06-13-2013
Type of Accourt
Estate of JOEL L HOOVER Savings
SSN 211-52-6078 X Checking
Date of Death 04-02-2013 Trust
CHRISTINE L GUTSHALL County CUMBERLAND Cerificate
164 BULLS HEAD RD
NEWVILLE PA 17241 -4613
c)
-C=
C.
METRO BANx provided the department with the information below indicating that at'tk e' death„of the
above-named decedent you were a joint owner or beneficiary of the account identified.
Account No.2840225847 Remit Payment and Forms to:,;
Date Established 02-14.2012 REGISTER OF WILLS
Account Balance $ 1,113.90 1 COURTHOUSE SQUARE
Percent Taxable X 50 CARLISLE PA 17013
Amount Subject to Tax $ 556.95
Tax Rate X 0.150
Tax Rate
Tax Due $ 015 NOTE`: If tax payments are made within three months of the
— decedent's date of death, deduct a 5 percent discount on the tax
With 5% Discount(Tax x MS) $ (see NOTE') _ due. Any inheritance tax due will become delinquent nine months
after the date of death.
E P'RT Step 1: Please check the appropriate boxes below.
A E]No tax is due. I am the spouse of the deceased or I am the parent of a decedent who was
21 years old or younger at date of death.
Proceed to Step 2 on reverse. Lao not check any other boxes and disregard the amount
shown above as Polenhat Tax Due.
Et r—'Y#w information is The above information is correct, no deductions are being taken, and payment will be sent
Tact. with my response.
Proceed to Step 2 on reverse. Do not check any ether boxes.
G The tax rate is incorrect. 4.5°,b 1 am a lineal beneficiary (parent, child:grandchild, etc.)of the deceased.
(Select correct tax rate at
right, and compiete Pa,1 12 1 am a sibling of the deceased.
3 on reverse.)
EJ 15`>6 All omer relationships (including none).
p Changes or deductions The information above is incorrect andbr debts and deductions were paid.
:eted. Complete Part 2 and part 3 as appropriate on the back of this form.
E Asset will be reported on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax
inheritance tax form Return filed by the estate representative.
Proceed to Step 2 on reverse. Do not check any other boxes.
PART Debts and Deductions
2
Allowable debts and deductions must meet both of the feotc wing cri estate is Insufficient to Pay
the deductible items.
A. The decedent was legally responsible for pay,. artment.
B. You paid the debt(I(aadditional cspac( is required.You and can
alt-chsa 11,2ox 1f 1F's.h sheets of Paper.)
by the der
D
Amount Paid
escrlpticn
Date Paid Payee
Total (Enter on Line 5 of Tax Calculation) $
PART Tax Calculation
3 If you are making a correction to the establishment date (Line 1) account balance(Line 2), or percent taxable(Line 3),
please obtain a written correction from the financial institution and attach it to this form.
1. Enter the date the account was established or titled as it existed at the date of death.
2. Enter the total balance of the account including any interest accrued at the date of death.
3. Enter the percentage of the account that is taxable to you
a. First,determine the percentage owned by the decedent. ivided
i. Accounts that are held "in trust for" another or others were 100°6 owned by the decedent.
ii. b rthe total accounts, established of more thz the decedent. r(Forhexamplef 2 ownerse P50%n3 owners-33.33%, 4downers
in one year= 25%, etc.)
viving owners or beneficiaries.
b. Next, divide the decedent's percentage owned by the number beneficiaries.
4. The amount subject to tax is determined by multiplying the account balance by the percent taxable.
ed from Part 2.
5. Enter the total of any debts and deductions claim
6. The amount taoxabatestax rate determined
from Step one oubre relationship tloothefde edenLmount subject to tax.ins
P Y
7. Enter the app P Official Use Only ❑ AAF
If indicating a different tax rate. please state PA Department of Revenue
your relationship to the decedent:�— - -
1. Date Established PAD -
2 $
2. Account Balance x
3. Percent Taxable 3 2
4. Amount Subject to Tax 4 $ 3
---
5 4
5. Debts and Deductions 5
6. Amount Taxable 6 $ 6
7. Tax Rate x
$ $
B. Tax Due 8 x
9. With 5% Discount (Tax x .95) 9
ow. you are TWO
c Checks must be made payable to Register of Wills,Agent." Do not send
ow. Return TWO c�ple'.ed and signed copies to the Register of wills listed on the front of this form,
Step 2: Sign and date bel
along with a check for any payment
payment directly to the Department of Revenue.
Under penalty of perjury. I declare that the facts I have repo,;cd above arc arc and complete to the best of my knowledge and
`'
�_t
belief. VVork —It -1
Home Date
c
F�,.. • ,'::- .': ••.. :- `r•c Telephone Number
Taxpayer Signature
IF YOU NEED FUR ORER THE ASSISTANCTANCONTAXTDIVIS ONLATN717-787-8327.EN SP VICESEFOR
DISTRICT OFFICE. PENN S
TAXPAYERS WITH SPECIAL HEARING AND.OR SPEAKING NEEDS ONLY: 1-800 447 3020