HomeMy WebLinkAbout01-0175
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
Estate of Hoover, Hilda S.
PETITION FOR GRANT OF LETTERS
~/-O} -/75
No.
also known as
, Deceased
Social Security No. 235183569
Rita S. BaloQh
Petitioner(s), who is/are 18 years of age or older, apply)ies) for:
(COMPLETE "A" OR "B" BELOW:)
@
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut rix
Decedent, dated 06/13/1989 and codicil(s) dated
named in the Last Will of the
State relevant circumstances, e.g., renunciation, death of executor, etc
Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered
for probate; was not the victim of a killing and was never adjudicated incapacitated:
o
B. Grant of Letters of Administration
(c.t.a., d.b.n.c.t.a.: pendente lite, durante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse
(if any) and heirs:
I
Name
Relationship
Residence
I
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal
residence at 1423 BridQe Street, New Cumberland, PA 17070
(list street, number and municipality)
Decedent, then 91 years of age, died January 19 , 2001 ,at Holy Spirit Hospital
(Location)
Decedent at death owned property with estimated values as follows:
(if domiciled in PA All personal property......................................... $
(if not domiciled in PA Personal property in Pennsylvania .................... $
(if not domiciled in PA Personal property in County.............................. $
Value of real estate in Pennsylvania ........................................................................................ $
Total ..................................................................................................................... $
2,167.08
2,167.08
Real Estate situated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in
the appropriate form to the undersigned:
I
Signature
Typed or printed name and residence
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RITA S. BALOGH
1423 BRIDGE STREET
NEW CUMBERLAND PA 17070
RW-1~'0 -c2~O = 4
~
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cumberland
The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true
and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the
Decedent, Petitioner(s) will well and truly administer the estate according to law.
Sworn to and affirmed and subscribed
13th
day of
~;-
~. /. p c~p~
Estate of Hoover Hilda S.
DECREE OF REGISTER
No.
also known as
Deceased
21-2001-175
Social Security No: 235183569
Date of Death: 01/19/2001
2001 , in consideration of the Petition on the
AND NOW, Februarv 14th
reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters ~ Testamentary 0 of Administration
are hereby granted to Rita S. Balo~h
((c.t.a., d.b.n.c.t.; pendente lite; durante absentia; durante minoriate)
in the above estate and that the instrument(s), if any, dated 06/13/89
described in the Petition be admitted to probate and filed of record as the Last Will of Decedent.
FEES
Letters ....................... .............
Short Certificates(s) ....~...._.
Renunciation ...... ....................
Extra Pages (8 ). .. .. .. '" .. ...
I. T. Roo........ _... _........................
JCP Fee.................................
Inventory... ......... .... ..... ...........
Other _. ._... ...............................
$ 25.00
$ 6.00
$
$ 24.00
$
$
$ 5.00
$
$
Signature
Attorney: Jan L. Brown, Esquire
I. D. No: 67993
Address: 845 Sir Thomas Court, Suite 9
HarrisburQ
PA 17109
TOTAL .............................$ 60.00
Telephone: (717) 541-5550
DATE FILED: FebTIlary 14,2001
MAILED LETTERS AND ORDER TO EXECUTRIX
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21-2001-175
e. 2187
COMMONWEALTH OF PENNSYLVANIA e OEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
I. Hilda S. Hoover
SEX
2, Female
STATE FilE NUMBER
SOCIAL SECURITY NUl.lBER
3. 235 18 _ 3569
00.0.0
g':=,ty) 0
NAME OF DECEDENT If "$I MldOle, L....'
AGE (LaSl BortNlay)
UNDER I YEAR
MOOIha Oaya
UNDER 1 DAY
Hours
PlACE OF DEATH ICt>ec. ""'V 0l'<I -< "'" ,ns"ucl.ono 00 _ _I
'. 90 VIS,
'.5.
. COUNTY OF OERH
'.
-'II
~.... Cumberland
'. DECEOENT'S USUAL OCCUPATION
(G,ve Iund 01.."". done duf.nq mosl
oC wocllin; IH; do no4 use le\Ved )
Ie.
WAS ~OENT OF HISPANIC ORIGIN?
No ~ "'" 0 "'f". 'PK"Y Cuban.
Me"lCan. Pueno Rlc;en. ele:
t.
RACE, Amenc:an Indian. Bleck. Wh~e, ele:
(Speedy)
White
17.. Slate
PA
MARITAL STATUS. M.......
Ne_ Maniecl. Widowed.
0N0<<:ad (Speedy)
14. Widowed
17C.o lW, dec:edent lived in
SURVIVING SPOUSE
\11 ..... g,.... ma.oen namel
Cumberland
Did
decedent
filM...
township? 17d.O ~i.:"'=~01
MOTHER'S NAME (F.sl. Moddle. M3Jden Sutnamel
Viola Butts
lWp,
New Cumberland
Ilb, Coon
CIlY~
PA 17070
lOCl(J'lON 'CilylTown. Slale. r", Code
Harrisburg,PA 17109
LICENSE NUMBER
DATE SIGNED
(MonlII. OaY. Yeatl
23b. 23c.
WAS CASE REFERRED TO MEDIC XAMINERlCORONER?
Ye8 rO
Nog.-
21.
WAS AN AUTOPSY
. PERfORMED?
I :
WERE AUTOPSY FINDINGS
A"'ILA81E PRIOR 10
COMPLETION OF CAUSE
OF DEATH?
It-s f IIZ A-7 hTN fJ /Il R.N'" ON III
DUE rotOR AS" CONSEOUENCE Of):
t=='P.5 , ~
DUE TO (OR AS A CONSEOUENCE Of)'
I Appfoxamale
: inlllNaa be""..n
I 0nse1 and dealh
I
I
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PART II:
OIlIer sognlllcanl condlliOns contributing 10 death. but
noI TlOSUhin; in 1he unOlH1y1ng cause QIIIen in PART I
.....EOlATE CAUSE (F.na1
dcsease or co~tlOO
'esuIInO on """Ih)__
Ct{1!
ODj71tI/cr'J~-
Pt1~"", ~~.!2'.L
~ h. condI1iona
~ any, -.g 10 _Ie
cause. Enl.. UNDERLYING
. CAUSE (Q.sease Of "'IUIY
. 1I\aI......a/ed events
'esuIInO'" <lealh) lAST
C ()~C-c-S?l"{;
k f?7I'r'rL'"1'
~ c..v.l1.C~~~~
h 2- /.( L:;;" w> c="rt-
D~~.nA
DUE TO (OR AS A CONSEQUENCE Of):
MANNER OF DEATH
DATE OF INJURV
tMonlh, Day. 'fear)
TIME OF INJURY
INJURY AT WORK?
DESCRIBE HOW INJURV OCCURRED,
Accidenl
Pending Investigation
o
o
o ~CE OF INJURV ' AI hom., tar~~;eel. laClOf't. office M.
bUIlding. elc ISpe"'M
3oe,
Yes 0
NoG
No
SUIcide
s-
O
o
Homoc:ide
Natural
3OC.
3Od.
lOCATION (Sll_ C.ty/lown. Slale)
..... 0
No IKl
Yes 0
Could not be delermlned
2... 21b,
CERTifiER IC~ecl< on,y onel
.CERTIFYING PHYSICIAN lPhySaCkln certifYing cause ~ dealh when anothe, pI'l\l'ilC,an has pronounced dealh ana completed Item 23)
To the beat 0' my knowledg., death occurred due 10 the cause(s) and manner.s slated.
29.
'PRONOUNCtNG AND CERTIFYING PHVSICIAN IPhys.coan both ~'onounc,ng Lleath an" c"""yon<;) 10 cause 01 deathl
To the beat of my knowl.dg~> death occurred ~t ttw time, date, I.nd p'a(;e, .od due \0 the cause(a) and manner.. stated.
Ja" 31b.
LICENSE NUMBER DATE SIGNEDiMonltl, Day. Yearl
o 31c, OS 60S "'{, 'i' - L 31d. I - 1'1 - 0 I
NAME AND ADDRESS Of PERSON WHO COMPLETED CAUSE OF DEATH
(Item 27) Type Of Pnnl G" E H Cr ~ '1' tv t:'-fl-/ 1) , (" .
8'10 Pc7l" Lr+-tl- C~~t(/nL'<' f1."I"1:t)
fA/,oll
o
'MEDICAL EXAMINER/CORONER
On Ihe bui. 01 eumin8lion and/or investigallon, in my OpinIOn, dealh occurred allhe lime. dale, and place, and due \0 Ihe cBuse(s) and
manner .. 3tated.. . . . . . . . . . " ...... ............ ........... - - . . - - . . - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
31.
REGISTR
SIGNATURE ~.!'t~t~'Y'.1B~~.-"
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31.
DATE FILED (Monlh Day, Yea"
33
34
22.
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LAST WILL AND TESTAMENT
OF
HILDA S. HOOVER
I, HILDA S. HOOVER, a resident of New Cumberland,
Pennsylvania, being of sound mind and memory, do make,
publish and declare this my Last Will and Testament,
hereby revoking all Wills by me heretofore made.
FIRST
IDENTITY OF TESTATRIX'S FAMILY
I declare that I am not married and that I have one
child now living whose name is Rita S. Balogh, who has
reached her majority. All references in this Will to
"my children" are references to her.
SECOND
DEBTS AND EXPENSES
I direct that all my just debts, funeral expenses
and expenses of administering my Estate be paid as soon
after my death as may be found convenient.
THIRD
TAXES
I direct my Executor to pay all inheritance, estate,
succession and legacy taxes to which my estate, or the
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~... ~ _ /VC-~.: v "'~L"
HILDA S. HOOVER
(Seal)
-,
Trustee, and said Trust shall be held, administered and
distributed in accordance with the following provisions:
A. PAYMENT AND DISTRIBUTION OF INCOME AND PRINCIPAL
The entire trust estate shall be administered
as one Trust until my granddaughter, Nancy Cheryl
Scully, is no longer living. Until that time the
Trustee shall apply the net income and principal of the
trust estate as follows:
(a) The net income of the Trust shall be paid
to or applied for the benefit of my granddaughter at
such times and in such amounts as my Trustee shall
in its discretion deem necessary for her support,
welfare, maintenance, and education. In the event
the income shall be insufficient to provide her with
adequate maintenance, support, welfare, or
education, the Trustee may invade the principal of
this Trust for that purpose.
(b) The Trustee in exercising its
discretionary authority with respect to the payment
of income or principal of the trust estate to the
beneficiary, shall take into consideration any
income or other resources available to such
beneficiary from sources outside of this Trust that
may be known to the Trustee. The Trustee may accept
as final and conclusive the written statement of the
rJ-:t4-- ~f~ J.I~- (Sea~ J
HILDA S. HOOVER
beneficiary receiving payment as to other
available income or resources. The
determination of the Trustee with respect to
the necessity of making payments out of income
or principal to any beneficiary shall be
conclusive on all persons howsoever interested
in the Trust.
(c) The Trustee shall accumulate and add to
principal any net income of the Trust not paid out
in accordance with the discretion hereinabove
conferred on the Trustee.
2. When my granddaughter, Nancy Cheryl Scully, is
no longer living, the Trust shall terminate and the
Trustee shall immediately distribute the balance of the
trust estate to my granddaughter, Karen Louise Balogh,
per stirpes.
3. No beneficiary of this Trust shall have any
right to alienate, encumber or hypothecate his or her
interest in the principal or income of the Trust in any
manner, nor shall any interest of any beneficiary be
subject to the claims of his or her creditors or liable
to attachment, execution or other process of law.
B. GENERAL ADMINISTRATION POWERS OF TRUSTEE
In order to carry out the purpose of this Trust
established by this Will, the Trustee, in addition to
;J44 J, 'll-JtHJv--~'1-' ( Seal)
HILDA S. HOOVER
transfer of the property hereunder may be subject, and
to charge such taxes as part of the expense of
administration.
FOURTH
DISPOSITION OF ESTATE
I hereby give, devise and bequeath my Estate, real,
personal and mixed, to my daughter, Rita S. Balogh,
provided she survives me.
Should my daughter, Rita S. Balogh, predecease me, I
then direct that all the rest, residue and remainder of
my estate, real, personal and mixed, shall be sold at
fair market value, at either public or private sale, and
the proceeds shall be joined with any amounts in any
savings accounts, checking accounts, certificates of
deposit, and/or retirement accounts, and shall be
divided as follows:
One-Half (1/2) to my granddaughter, Karen Louise
Balogh, per stirpes.
One-Half (1/2) to my granddaughter, Nancy Cheryl
Scully, in Trust, as hereinafter set forth.
FIFTH
RESIDUARY TRUST
The one-half share being given to my granddaughter,
Nancy Cheryl Scully, shall be placed into a Trust. I
hereby appoint my granddaughter, Karen Louise Balogh, as
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HILDA S.'HOOVER
(Seal)
all other powers granted by this Will or by law, shall
have the following powers over the trust estate, subject
to any limitations specified elsewhere in this Will:
1. To accept in kind and retain any property which
I may own at my death, without regard to any principle
of diversification and to invest in or purchase any form
of property.
2. To sell at public or private sale, exchange or
lease for any period of time any real or personal
property, and to give options for sales or leases.
3. To borrow money and to mortgage or pledge any
real or personal property.
4. To register property in the name of a nominee or
to hold property unregistered.
5. To compromise claims.
6. To distribute property in kind.
C. OPERATIONAL PROVISIONS
1. The Trustee shall determine what is income and
what is principal of the Trust established under this
Will, and what expenses, costs, taxes and charges of any
kind whatsoever shall be charged against income and what
shall be charged against principal in accordance with
the applicable laws of the Commonwealth of pennsylvania,
as they now exist and from time to time may be enacted,
amended or repealed.
'+i~ J~ Y/-#l~'
HILDA S. HOOVER
(Seal)
.1
2. No bond shall be required of any person
appointed in this Will as Trustee.
3. The validity and administration of the Trust
established under this Will and all questions relating
to the construction or interpretation of the Trust shall
be governed by the laws of the Commonwealth of
Pennsylvania.
SIXTH
EXECUTOR
I hereby nominate and appoint my daughter, Rita S.
Balogh, as the Executrix of this my Last Will and
Testament. Should she predecease me or be unable or
unwilling to serve, I appoint my granddaughter, Karen
Louise Balogh, as the Executrix of this my Last Will and
Testament. My said Executor/Executrix shall have full
power at his/her discretion to do any and all things
necessary for the complete administration of my estate,
including the power to sell at public or private sale,
and without Order of Court, any property belonging to my
Estate, to compound, compromise or otherwise settle or
adjust any and all claims, charges, debts and demands
whatever against or in favor of my estate, as fully as I
could do if living. No bond shall be required of anyone
appointed Executor under this Will.
;/Jet:<--t_ J!~-Z,w/L/ (Seal)
HILDA S. HOOVER
. .
SEVENTH
FUNERAL ARRANGEMENTS
I hereby direct that the funeral arrangements be
made at the discretion of my daughter, Rita S. Balogh or
my granddaughter, Karen Louise Balogh.
IN WITNESS WHEREOF, I have hereunto set my hand to
this my Last Will and Testament this' ').~ day of 'Tv\t"'"
1989, consisting of seven (7) pages.
1J;Jeit- i, f.I~v (Seal)
HILDA S. HOOVER
Subscribed and sealed by the Testatrix in the
presence of us and of each of us and at the same time
published, declared and acknowledged by her to us to be
her Last Will and Testament, and thereupon we, at her
request, in her presence and in the presence of each
other have hereunto subscribed our names as witnesses
this \:~ tl\ day of "T,,\\\.t
, 1989.
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COMMONWEALTH OF PENNSYLVANIA
COUNTY OF ~ ('li~"", b{J\r I l'\t'(..(
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) ss.
)
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We ,\)(.\ ~ L \ L\/ \ rv \')'\(.\1'1
and C ~ f'\ V t"i l<, U/ i> r:> 1,/
the witnesses whose names are signed to the attached
instrument, being duly qualified according to law, do
depose and say that we were present and saw Testatrix
sign and execute the instrument as her Last Will and
Testament; that HILDA S. HOOVER signed willingly; and
that she executed it as her free and voluntary act for
the purposes therein expressed; that each of us in
hearing and sight of the Testatrix signed the Will as
witnesses; and that to the best of our knowledge the
Testatrix was at that time eighteen (18) or more years
of age, of sound mind and under no constraint nor undue
influence.
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Sworn and subscribed to
before me this \ ~ 1\, day
of '"i. \O\,~ , 1989
).J~:,)) ?j-,
Notary Public
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"I:.i.U~~ f) :,iI>~:'Wlf.r:. ~iCfJt~r PUBLIC
;.,,-,p.'. ,;....:: f,l)f/\ C!,!'!~f)ERLMm co..
",."'\1~;.,.;':':t ~;':P!Rf.s SEPT, 15. 1992.
COMMONWEALTH OF PENNSYLVANIA
)
) ss.
)
COUNTY OF l~lUr C~,\\rdi{;" I(',,.,,l
I, HILDA S. HOOVER, whose name is subscribed to the
attached instrument, having been duly qualified
according to the law, do hereby acknowledge that I
signed and executed the instrument as my Last Will and
Testament; that I signed it willingly; and that I
signed it as my free and voluntary act for the purposes
therein expressed.
vL../:...taL0}'J ':J /
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HILDA S. HOOVER
Sworn and subscrihed to
before me this r) t~ day
of J\;\~ ' 1989
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Notary PUblic
r~~-~~"'''''' d ~'t<<)r^RYAf"'sifAr" ",' -".-In :,.;.:.- '~
! ~~'_L!~'tol.y... ~T~R.~~:'. NOTARY PUBUC. J
k~ ~,JIt',ljEiI..h"iJ r,,}~v. Cl.lMBERlANO OJ. 1
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........,... ..___~___......__ _.'T____.~r._~._.____.__,___
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
.--'
~
-
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Hoover. Hilda S.
Date of Death: o1/19/20Q1______
Estate No. 2001-00175
SSN: 235183569
File No.
21-01-0175
Date Letters Granted: 02/14/2001
Will or Administration No.
To the Register:
I certify that Notice of Estate Administration required by Rule 5.6(a) of the Orphans' Court Rules was served
on or mailed to the following beneficiaries of the above-captioned estate on 03/02/2001 ___~ __~_____
Name
Rita S. Balogh
Address
1423 Bridge Street
New Cumberland
PA 17070
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date: 03/02/2001
(--'r-,' (j,
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Signature " "
Jan L. Bllown. Esq.
Name (Please type or print)
Jan L. Brown & Associates
Address
845 Sir Thomas Court. Suite 9
Capacity:
Personal Representative
_X Counsel for Personal
Representative :
Harrisburg
__._m__________~_1? 109 _.
Telephone No. (11lL541-5550
(
PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE
STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE A 6.12 FORM YEARLY UNTIL
COMPLETION.
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Hilda S. Hoover
Date of Death: January 19.2001
Will No. 2001-00175
Admin. No.
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to
completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes~ No
2. If the answer is NO, state when the personal representative reasonably believes that the administration
will be complete:
3. If the answer to No.1 is YES, state the following:
a. Did the personal representative file a final account with the court? Yes
No-X
b. The separate Orphans' Court No. (if any) for the personal representative's account is:
c. Did the personal representative state an account informally to the parties in interest?
Yes No-X
d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed
with the Clerk of the Orphans' Court and may be attached to this report.
Date: i~r/o/ . ~ L, ~ ~
SIgnature
Rita S. Balogh
Name (Please type or print)
1423 Bridge Street. New Cumberland. P A 17070
Address
(717) 774-5505
Telephone Number
Capacity:
x
Personal Representative
Counsel for personal
representative
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
INVENTORY
Estate of Hoover, Hilda S.
No. 21
01
0175
, Deceased
Date of Death 01/19/2001
Social Security No. 235183569
also known as
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the
personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation
placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no
real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. l!We
verify that the statements made in this inventory are true and correct. l!We understand that false statements herein made are subject to the
penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Personal Representative:
Name of
Attorney: Jan L. Brown, Esquire
1.0. No.: 67993
Rita S. BaloQh
1423 BridQe St., New Cumberland, PA
Address: 845 Sir Thomas Court
Dated
HarrisburQ
Telephone: (717) 541-5550
PA 17109
Description
Value
Prudential Securities
Acct. #044-295075-73
2,167.08
Total
2,167.08
(Attach Additional Sheets if necessary)
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
include the value of each item, but such figures should not be extended into the total of the Inventory.
RW-4
REV-1S00 EX + (&-00)
'*
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Hoover Hilda S.
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
(8)
(11)
(12)
(13)
(14)
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OFFICIAL USE ONLY
FILE NUMBER
2 1 -0 1 0 1 7 5
COi:iNTYC06E ---VEAR- - - NmiBER--
SOCIAL SECURITY NUMBER
235-18-3569
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Return {date of dealh 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) I_h Soh 01
PA 17109
OFFICIAL USE ONLY
(1)
(2) 2,167.08
(3)
(4)
(5)
(6)
(7)
2,167.011.
1,518.00
17,229.66
18,747.66
-16,580,58
-16,580,58
0.00
0.00
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CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWERALLQUESTIONSON'REVERSE'SIDE AND RECHECK MATH. < <
01/19/2001 11/23/1910
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
00 1. Original Return
o 4. Limited Estate
[X] 6. Decedent Died Testate (Atlach copy of Win)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
D 4a. Future Interest Compromise (date of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copy olTrusQ
o 10, Spousal Poverty Credit (date of death between 12.31-91 and 1-1-95)
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llhBEdCOMl!1!
.DNa'!: GI!.-"DrGI:lE!IIi1'EN'l'l:J.1il1ii" 'DR
COMPLETE MAILING ADDRESS
845 Sir Thomas Court
I,
NAME
Jan L. Brown Es uire
FIRM NAME (If Applicable)
Jan L. Brown & Associates
TELEPHONE NUMBER
717 541-5550
Suite 9
Harrisbur
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Scheduie G or L)
8. Total Gross Assets (total lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debls of Decedent, Mortgage Liabilities. & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Une 8 minus Une 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Une 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
x _(15)
0.00 X 0.45 (16)
X .12 (17)
X .15 (16)
(19)
16. Amount of Une 14 taxable at lineal rate
17. Amount of Une 14 taxable at sibling rate
18. Amount of Une 14 taxable at collateral rate
19. Tax Due
Decedent's Comolete Address:
STREET ADDRESS
1423 Bridne Street
CITY I STATE I ZIP
New Cumberland PA 17070
Tax Payments and Credits:
1. Tax Due (Page 1 Line 1 g)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
0.00
Total Credits (A + B +C) (2)
3. InteresUPenalty if applicable
D. Interest
E. Penalty
TotallnteresUPenalty 10 + E) (3)
4. If Une 2 is greater than Une 1 + Une 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Une 20 to request a refund (4)
5. If Une 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Une 5 + 5A. This is the BALANCE DUE. (5B)
Make Check to: REGISTER OF AGENT
0.00
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; ........................................................................... 0 IRI
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 IRI
c. retain a reversionary interest; or ...............................................................................,...................... 0 00
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 IRI
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration?...... ........................................................................................ 0 IRI
3. Did decedent own an 'in trust fo~ or payable upon death bank account or security at his or her death? ................. 0 IRI
4. Did decedenf own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................... ........... 0 IRI
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. ~9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [/2 P.S. ~9116 (a) (1.1) (ii)].
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate Imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parenl,
or a stepparent of the child is 0% [/2 P.S. ~9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [/2 P.S. ~9116(a)(1)J.
The tax rale imposed on the net vaiue of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116Ia)(1.3)]. A sibiing is defined, under Section 9102, as an
individual who has alleast one parent in common with the decedent, whether by blood or adoption.
"'''''''''''''.
COMMONWEALTH OF PENNSYLVANIA
INHERJTANCE TAX RETURN
I
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
21 01
ESTATE OF
Hoover Hilda S
All property Jolntly-owned with right of survivorship must be disclosed on Schedule F.
0175
ITEM
NUMBER
1.
Prudential Securities
Ace\. #044-295075-73
DESCRIPTION
VALUE AT DATE
OF DEATH
2,167.08
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
2167.08
REV,"''''','''''.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
Hoover Hilda S
21
01
0175
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Zimmerman-Auer Funeral Home (Funeral expenses pre-paid)
2. Grave/Cemetery expenses 250.00
3. Grave Market 580.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s) Rita S. Baloqh 108.00
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address 1423 Bridqe Street
City New Cumberland State PA Zip 17070
Yea~s) Commission Paid: 2001
2. Attorney Fees Jan L. Brown & Associates 500.00
3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Register of Wills of Cumberland County 60.00
5. Accountanfs Fees
6. Tax Return Preparer's Fees
Register of Wills - Filing fee Inheritance Tax Return 20.00
TOTAL (Also enter on line g, Recapitulation) $ 1518.00
(If more space is needed, insert additional sheets of the same size)
REV'''''''.''''''.
COMMONWEALTH OF PENNSYLVANIA
'NHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Hoover Hilda S
SCHEDULEr
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
FILE NUMBER
21 01
0175
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
1.
Department of Public Welfare - Estate Recovery Program
(Class 3 claim - $17,167.93 and Class 6 claim - $57,076.92)
(Payment will be remaining available funds $1,167.35)
Nursing Home - West Health & Rehabilitation Center
2.
AMOUNT
17,167.93
61.73
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, 'Insert additional sheets of the same size)
17229.66
"".,"'".,'.,'.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
.. "",,_ c
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1,
Rita S. Balogh
1423 Bridge Street
New Cumberland, PA 17070
FILE NUMBER
?1 n1
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Daughter
()17~
AMOUNT OR SHARE
OF ESTATE
o
ENTER OOLLARAMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, 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
1,
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)