HomeMy WebLinkAbout01-0466
Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of
Robert R. Hostetter
Estate No.
c':ll
.::3:(;..200 1- ~
Also known as Robert Russell Hostetter
Late of Middlesex Township
, Deceased
Social Security No.
164-28-3784
Eugene R. Hostetter
Name ofPetitioner(s), who is(are) 18 years of age or older, apply(ies) for:
(COMPLETE "A" OR "B" BELOW:)
D A. Probate and Grant of Letters and aver that Petitioner(s) is/are the executor/trix named in the Last Will of the
Decedent dated February 27,2001 and codicil(s) dated N/A
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:
D B. Grant of Letters of Administration
(c.t.a., d.b.n.c.t.a.)
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:
Name
Relationship
Residence
Attach additional sheets if necessary.
COMPLETE IN ALL CASES:
Decedent was domiciled at death in Lancaster County, Pennsylvania, with his/her last family or principal residence at:
375 Claremont Drive Carlisle PA 17013 Middlesex Township
Decedent, then
(Address)
68 years of age, died on
(City)
(Township or Borough)
4/21/01
at Claremont Nursing Home, Carlisle, P A
(Location)
(Date of Death)
Decedent at death owned property with estimated values as follows:
(if domiciled in P A) All personal property
Total
$ 100,000
$
$ 100,000
Value of real estate in Pennsylvania
Real Estate situated as follows
Wherefore, Petitio~er(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant ofletters in the appropriate
form to the underSIgned:
Signature Typed or Printed Name and Address
. I
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 ofPetttlOner(s) and that, as personal representative(s) oTthe Decedent, Petitioner(s)
will well and truly administer the estate according to law.
lJc:J7P~~
before me this
May 2001.
11th
day of
~~
Eugene t ostetter
Sworn to and affirmed and subscribed
For the Register
DECREE OF REGISTER
Deceased
.;(/ -0 J -ifl.e/P
Estate No. J J 11 _1
Estate of Robert R. Hostetter
also known as Robert Russell Hostetter
Social Security No.
164-28-3784
Date of Death April 21, 2001
AND NOW, MAY 11,2001 , in consideration of the Petition on the reverse side
hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters (X ) Testamentary ( ) of Administration
(c.t.a., d.b.n.c.t.a.)
are hereby granted to
Eugene I. Hostetter
in the above estate and that the instrument(s), if any, dated February 27,2001
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
Fees
Letters $
Short Certificate(s) 7 $
Renunciation $
Extra Pages ( ) $
Citation $
I.T.R. $
JCP Fee $
Inventory $
Other $
TOTAL $
200.00
21.00
YnO~~ <'...~, 1Le-P.8,Q"",
' t
Register of Wills
21.00
Attorney
I.D. #
Address
Roger S. Reist
06993
P.O. Box 1552
Lancaster PA 17608-1552
(717) 394-7247
5.00
Telephone
247.00
Date Filed:
MAY 11,2001
H105.905 REV.(09/00)
T~is is to certify that this is a true copy of the record which is on file in the Pennsylvanl'a D' . . f
h A 66 P L 4 IVlSlOn 0 Vital Records III accordance
Wit ct , ,,30, approved by the General Assembly, June 29, 1953,
~~S.~/~.
Robert S, cZimlerman, Jr" MPH
Secretary of Health
WARNING: It is illegal to duplicate this copy by photostat or photograph.
21-01-466
No,
~)(~
Charles Hardester
State Registrar
1804840
lAY 0 3 2001
Date
CORRECTED ITEMS: 5.6
Hl05.''''ROY.2117 PER: FD DATE: 5- 3-o1bas COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
TYPE/PRtNT
IN
PERMANENT
IILACK _
NAME OF oeCEOENl(FIfSf. MiddIe.l_'
SEX
STATE FilE NUM8EA
SOCIAL SECUfUT\" NUMBER
t. Robert Russell Hostetter
Male
164-
68 v...
UNDER 1 OM
MouN ! MIftut_
BIRTHPlACE (C"V aNt
Stare 01 F cre.gt' CountrYI
AGE (last Birthday) UNOER 1 YEAR
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COUNTY OF oe.crH
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Ctmberland
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WERE AlITOPSY FINDINGS MANNER OF DEATH
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DATI: OF INJURY
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TIMe OF INJuRY
INJURY II.J 'M>RK1 DESCRIBE HOW INJURY OCCURRED.
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To... bes1 of my knowtedgft, deslft occur"" at"" .......lMl., and pfan. and due 10 IfM caUM(.) and ",_niter.. ...,ed.. ... - . " . . . . . . . . . . " . . . .
:M.
LAST WILL AND TESTAMENT
OF
ROBERT R. HOSTETTER
I, Robert R. Hostetter, of Carlisle, Cumberland County, Pennsylvania, being of sound and
disposing mind, memory, and understanding, so make, publish and declare this to be my Last
Will and Testament, hereby revoking and making void all previous Wills and Codicils heretofore
made by me.
First
I order and direct my personal representative hereinafter named to pay all of my just
debts, funeral expenses, and expenses involved or connected with the administration of my
estate as soon after my death as is reasonably possible. However, my personal representative
need not accelerate and pay those unmatured obligations which, in his, her, or its opinion, it
might be proper and more advantageous to retain or renew and pay as they become due and
payable. If! do not own a burial plot or a grave marker at the time of my death, I authorize my
personal representative, in his, her, or its sole discretion, to purchase a burial plot and to erect a
suitable grave marker at my grave, and to expend sums from my estate for this purpose.
Second
I give, devise, and bequeath the following property with all insurance proceeds thereon as
follows:
To my daughter, Ellen Martin of Fontana, California, I leave my grandfather's
watch.
Page 10f8
Third
I give, devise, and bequeath the rest and remainder of my estate, together with all
insurance proceeds thereon of whatever nature and wheresoever situate in four equal shares as
follows:
25% to my daughter Sharon Dickerson, provided that she survives me by sixty
(60) days, per stirpes;
25% to my daughter Ellen Martin, provided that she survive me by sixty (60)
days, per stirpes;
25% to my brother Eugene R. Hostetter, provided that he survive me by sixty (60)
days, per stirpes;
25% to my church, Harrisburg Church of God Seventh Day, 5122 Earl Drive,
Harrisburg, Pennsylvania.
Fourth
It is further my desire that my personal representative, after consultation with any heir or
heirs of mine who survive me, and in his, her, or its own discretion, choose such articles from
my tangible personal property (exclusive of cash, stock certificates, bonds, and all other tangible
evidences of intangible personal property) as he, she, or it believes will be useful to such heir or
heirs or desirable for him or her or them to have, either from a sentimental point of view or
otherwise, and to deliver such articles to such heir or heirs or among such heirs in equal or
unequal shares as determined by the further exercise of his, her, or its discretion, provided no
other heir objects to the distribution. All tangible personal property not so distributed is to be
Page 2 of8
sold, either publicly or privately, by my personal representative, adding the proceeds of such sale
or sales to my residuary estate and to be disposed of in equal shares among my surviving heirs
after payment of my estate debts, taking into account the tangible personal property otherwise
provided to them.
Fifth
Any devise or distribution under this Last Will and Testament which is payable to any
beneficiary who may be under twenty one (21) years of age or, in the judgment of my personal
representative, mentally disabled, shall be held in a separate trust by my personal representative
as trustee until such beneficiary reaches twenty one (21) years of age or during such period of
disability. In the case ofa beneficiary under twenty one (21) years of age, the trustee may
distribute the entire remaining principal and the accumulated interest at or after the beneficiary's
twenty first (21) birthday. During the term of any trust created pursuant to this Paragraph, the
Trustee is authorized to expend and apply so much of the net income and principal of each such
trust as the trustee shall consider advisable for the health, maintenance, support, and education
(including college education, undergraduate and graduate) of each such beneficiary until he or
she attains twenty one (21) years of age, or until all such amounts are paid out of trust. I direct
that no Guardian shall be required to give or post bond for the faithful performance of the
Guardian's duties in this or any other jurisdiction.
~
I grant my personal representative the following powers in addition to and not in
limitation of such powers as my personal representative shall hold by law.
a.) To retain all property received including the stock of any corporate fiduciary
acting hereunder, provided such property remains productive.
Page 3 of8
b.) To join in any corporation, partnership, recapitalization, merger, reorganization or
voting trust plan; to delegate authority with respect thereto; to deposit investments
under agreements and pay assessments; and generally to exercise all rights of
investors, including but not limited to the voting of shares.
c.) To manage, operate, repair, improve, mortgage or lease on any terms any real
estate held or owned by my estate.
d.) To operate any business that I may own at my death.
e.) To invest any funds of my estate in stocks, bonds, notes, or other securities or
property, real or personal, without regard to the principle of diversification or any
other statute or general rule of law in this, her, or its absolute discretion, it being
my intention to give my personal representative the broadest investment powers
possible, providing such investments do not unnecessarily prevent the prompt
settlement of my estate.
f.) To sell or otherwise dispose of any property, real or personal, tangible or
intangible, at any time forming a part of my estate in any manner and on such
terms and conditions as my personal representative shall see fit in his, her, or its
absolute discretion.
g.) To borrow money for the payment of taxes or for any other proper purposes in the
administration of my estate, and to mortgage or pledge estate assets as security.
h.) To compromise claims without court approval including, but not limited to, any
controversies with the United States of America or the Commonwealth of
Pennsylvania concerning estate and inheritance taxes on any interests that may
pass under this my Last Will and Testament.
Page 4 of8
i. ) To distribute in cash of in kind upon any division or distribution of my estate.
j.) To undertake any and all acts deemed necessary and proper by my personal
representative for the proper, advantageous, and prompt management of the
settlement of my estate.
k.) In general, to exercise all powers in the management of my estate which any
individual could exercise in the management of similar property owned in his
own right, upon such terms and conditions as to hi~ her, or it may seem best and
to execute and deliver all instruments and to do all acts which he, she, or it deems
necessary or proper to carry out the purposes of this, my Last Will and Testament.
Seventh
No interest of any beneficiary of my estate, either in income or in principal, shall be
subject to anticipation or pledge, assignment, sale, or transfer in any manner, nor shall any
beneficiary have the power in any manner to charge or encumber his interest either in income or
principal, nor shall the interest of any beneficiary be liable or subject in any manner while in the
possession of my personal representative for the liability of such beneficiary.
Ei2hth
I nominate, constitute, and appoint my brother, Eugene Hostetter, as Executor of this, my
Last Will and Testament. In the event my brother is deceased, unable, or unwilling to serve or
shall cease to serve for any reason whatsoever, then I nominate, constitute, and appoint my
daughter, Ellen Martin, as personal representative of this, my Last Will and Testament. I direct
that my personal representative shall not be required to give or post bond for the faithful
performance of his, her, or its duties in this or any other jurisdiction.
Page 5 of8
Ninth
I hereby declare it to be my expressed desire that my personal representative employ the
law:fIrm of Stephanie E. Chertok, Esquire, of Cumberland County, Pennsylvania, for the legal
advice and assistance regarding this, my Last Will and Testament, they having considerable
knowledge of my affairs, views, and wishes respecting any matters that may arise at the probate
of this instrument, the administration of my estate, and the execution of the powers herein
mentioned.
IN WITNESS WHEREOF, I have set my hand to his my Last Will and Testament this
;l1~
daYOf~br-vGtl
,2001.
9.(.~~-"'l
WITNESS
~~
NESS
(~~/u
Page 6 of8
LAST WILL AND TESTAMENT OF ROBERT R. HOSTETTER
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND
I, Robert R, Hostetter, the testator whose name is signed to the attached or foregoing
instrument, having been duly qualified according to 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.
\1
\
ROBERT R. HOSTETTE
Sworn or affirmed and acknowledged before me by Robert R. Hostetter, the testator,
1'\, .
this ~ day of~b~^^""
\
'2:/~
vNOTARY PUBLIC
......1EiAL
...c.8PI'IZ, NOrARY PUIJUC
~..~cam&lUNDco PA
IIY~ ..
_'" .... '" EXPIREs MAY 25, 200"-
Page 70f8
LAST WILL AND TESTAMENT OF ROBERT R. HOSTETTER
AFFIDAVIT
COMMONWEALTH OF PENNSYL VANIA
SS
COUNTY OF CUMBERLAND
WE, S'i{ 5' a N
(:\-<ctQr
and ~e~. C1~iol
the witnesses whose names are attached to the foregoing document, being duly qualified
according to law, do depose and say that we were present and saw testator sign and execute the
instrument as his Last Will and Testament; that he signed willingly and that he 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 Last Will and Testament as witnesses; and that to the
best of our knowledge the testator was at the time 18 or more years of age, of sound mind and
under no constraint or undue influence,
/01'. SCLl~ h iVIClrke-&51 S; &~ '1/ /j11/0)
.:2 ~ 3- F" I. 11 pi ' ~<Jh-./l -\J cL- ~ '/ .
?->fee he.. IV ;cS b.rj, S. ~~ .:2/;J.l/ClI
} '10 5s-L 3.22 /
and
Sworn or affirmed and subscribed before me by .3uS0..n Q..,y.\~.e.r"
~",,'e E:. C.~.1o L this :J.1-t'- _ ~~ 2666.
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_COIf 1I1DII......IlAYIS, -
Page 80f8
~
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
Robert R. Hostetter
April2l,2001
Estate No.
21-2001-0466
Date of Death:
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 May 15, 2001
Name
Address
Sharon Dickinson, 3209 North Arrowhead Avenue, San Bernardino CA 92405
Ellen Martin, 17797 San Bernardino Avenue, Apt. 25, Fontana CA 92335
Eugene R. Hostetter, 2041 Harrogate Road, Lancaster P A 17601
Harrisburg Church of God, Seventh Day, 5122 Earl Drive, Harrisburg P A 17112
Mark A. Pacella, Chief Deputy Attorney General, Charitable Trusts and Organizations Section, 14th Floor,
Strawberry Square, Harrisburg P A 17120
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except:
Notice has been given to all parties
Date: 6/4/ o;i Signature
Capacity: Personal Representative Name (Print)
X Counsel for Personal
Address
P.O. Box 1552
Representative
Lancaster P A 17608-1552
Telephone
(717) 394-7247
SHIRK" REIST" WAGENSELLER AND MECUM
II. GEiiHT PI?I?H
OF COUNSEL
KATHIE SHIRK GONICK
January 10,2002
1<' L. SHIRK, SR. (1915-1956)
PRINCIPAL OFFICE
132 E. CHESTNUT STREET
AREA CODE 717
LANCASTER-394-7247
FAX (717) 394-1080
E-MAIL.law@srwm.com
AKRON-859-1742
KEN ELM L. SHIRK, JR.
ROGER S. REIST
DAVID WAGENSELLER, III
SAMUEL M. MECUM
BARBARA REIST DILLON
RICHARD K. DIETERLE, JR.
ATTORNEYS AT LAW
P. O. BOX 1552
LANCASTER., PENNSYLVANIA 17608-1552
IN REPLY REFER TO,
Hll14 E01RR HOST
Cumberland County - Register of Wills
Hanover and High Street
Carlisle PA 17013
RE: Estate of Robert R. Hostetter
File No. 21-01-0466
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Dear Sir/Madam:
u
Enclosed is the original and two copies of the Inheritance Tax Return iithe abo~ referenced estate.
The original and one copy is for your files. Please file stamp the remaining copy and return it to me in the
enclosed envelope.
Also enclosed is a check in the amount of$8,437.83 payable to the Register of Wills, Agent to pay
the inheritance tax due.
Finally, enclosed is the original and one copy of an Inventory for this estate. Please keep the original
for your files and return the file stamped copy to me in the enclosed envelope.
Thank you for your assistance. Do not hesitate to contact me if you have any questions.
Very truly yours,
Enclosures
cc: Eugene R. Hostetter
OTHER OFFICES
107 WEST MAIN STREET
EPHRATA.. PENNSYLVANIA 17522-2014
717-733-2588 717-626-2404
TELECOPIER (717) 733-2230
402 SOUTH BROAD STREET
L1T1TZ, PENNSYLVANIA 17543-2602
717 -626-2775
TELECOPIER (717) 626-5587
16 SOUTH HESS STREET
QUARRYVILLE,. PENNSYLVANIA 17566-J224
717-786-1123
TELECOPIER (7J7) 786-2742
(~
Register of Wills of
CUMBERLAND
County, Pennsylvania
INVENTORY
Estate of Robert R. Hostetter
No. 2101-0466
also known as Robert Russell Hostetter
Date of Death 04/21/2001
Late of Middlesex Township
,Deceased Social Security No. 164 - 28 - 3784
Eugene R. Hostetter,
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 of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this
Inventory. I me verify that the statements made in this Inventory are true and correct. Ime understand that false statements herein
are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Name of
Attorney:
Roger S. Reist
Personal Representative
Signature: f"': "A-J . - . - -~
E~stetter
1.0. No.:
06993
Signature:
Address:
P. O. Box 1552
Address: 2041 Harrogate Road
Lancaster, PA 17608-1552
Lancaster, PA 17601
Telephone: 717/394 - 7247
Telephone: 717/299-2871
Dated: L / f P / 2- t:Jp ~
, .
Description
Value
(See continuation page(s) attached)
(Attach additional sheets if necessary)
Total:
181,668.48
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.
Prepared by the Pennsylvania Bar Association
Copyright (c) 1996 form software only CPSystems, Inc.
Form IIRW-7 (1992)
Estate of:
Date of Death:
County:
INVENTORY
Robert R. Hostetter
04/21/2001
Cumberland
CASH:
Cash - found in wallet of
decedent
33.00
Claremont Nursing and
Rehabilitation Center -
refund
147.24
Polyclinic Hospital tdba
Pinnacle Health Hospital,
Bedford F. Boylston MO, FACS
and Shaffer Cardiovascular
Asssociates, LTD -
litigation settlement
181,218.24
PERSONAL PROPERTY:
Jewelry - value per appraisal
by Brent L. Miller
270.00
TOTAL RECEIPTS OF PRINCIPAL............ ...
-1-
181,398.48
270.00
181,668.48
SHIRK... REIST... WAGENSELLER AND MECUM
KEN ELM L. SHIRK, JR.
ROGER S. REIST
DAVID WAGENSELLER, III
SAMUEL M. MECUM
BARBARA REIST DILLON
RICHARD K. DIETERLE, JR.
K. L. SHIRK, SR. (1915-1956)
ATTORNEYS AT LAW
P. O. BOX 1552
LANCASTER, PENNSYLVANIA 17608-1552
OF COUNSEL
KATHIE SHIRK GONICK
January 15,2002
PRINCIPAL OFFICE
132 E. CHESTNUT STREET
AREA CODE 717
LANCASTER-394-7247
FAX (717) 394-1080
E-MAIL.law@srwm.com
AKRON-859-1742
II iCQTT POQ1.E--
IN REPLY REFER TO,
Hll14 EOlRR HOST
Register of Wills
Attn: Cheryl
Cumberland County Courthouse
Room 102
One Courthouse Square
Carlisle P A 17013
RE: Estate of Robert R. Hostetter
File No. 21-01-0466
Dear Cheryl:
As we discussed, in reference to the above captioned estate, enclosed is a check in the amount of
$63.00 payable to the Register of Wills to cover the following filing fees: $15.00 for the Inheritance Tax
Return, $13.00 for the Inventory and $35.00 for the additional cost of probate.
Thank you for your assistance with this matter. Please do not hesitate to contact me if you have any
questions.
Very truly yours,
SHIRK, REIST, W AGENSELLER AND MECUM
By:
~
Wendy E. alle
Legal Coordinator
Enclosures
cc: Eugene R. Hostetter
OTHER OFFICES
107 WEST MAIN STREET
EPHRATA- PENNSYLVANIA 17522-2014
717-733-2588 717-626-2404
TELECOPIER (717) 733-2230
402 SOUTH BROAD STREET
LlTlTZ, PENNSYLVANIA 17543-2602
717-626-2775
TELECOPIER (717) 626-5587
16 SOUTH HESS STREET
QUARRYVILLE. PENNSYLVANIA 17566-1224
717 -786-1123
TELECOPIER (717) 786-2742
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ROGER S REIST ESQUIRE
POBOX 1552
LANCASTER, PA 17608-1552
___n___ fold
ESTATE INFORMATION: SSN: 164-28-3784
FILE NUMBER: 21-2001- 0466
DECEDENT NAME: HOSTETTER ROBERT R
DATE OF PAYMENT: 01/14/2002
POSTMARK DATE: 01/10/2002
COUNTY: CUMBERLAND
DATE OF DEATH: 04/21/2001
NO. CD 000743
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $8,437.83
I
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I
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I
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I
I
TOTAL AMOUNT PAID:
$8,437.83
REMARKS: EUGENE R HOSTETTER ESQUIRE
C/O ROGER S REIST ESQUIRE
CHECK#1008
SEAL
INITIALS: CW
RECEIVED BY:
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
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OFFICIAL USE ONLY
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
It- -~3()- i.j
AEV-1500 EX + (6-00)
CAPS
HpRL
EplO
CRAC
KOTK
ES
FILE NUMBER
D
E
C
E
D
E
N
T
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF AEVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Hostetter Robert R. a/k/a Robert Russell
DATE OF DEATH{MM-OD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
Hostetter
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
164-28-3784
THIS RETURN MUST BE FilED IN DUPLICATE WITH THE
2101-0466
NUMBER
REGISTER OF WILLS
SOCIALS CURITYN MBER
X 1. OrigInal Return
4. limited Estate
X 6. Decedent DIed Testate
3 'date of death
. Aema nder Return pr[orta 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Sate Deposit Boxes
2. Supplemental Return
4a. Future Interest CompromIse (date of death after 12-12-82)
7. Decedent Maintained a living Trust
o
(Attach copy of WIIO
D 9. litigation Proceeds Received 010.
C P
o 0
R N
R D
E E
S N
T
o
11. ElectIon to tax under Sec, 9113(A)
(Attach Sch 0)
lltN}lflQYl~ 8E:QrR~~Mi:t:Qili ;
Ro er S. Reist
FIRM NAME Of Applicable)
Shirk, Reist, Wa ense11er and Mecum
TELEPHONE NUMBER
P. O. Box 1552
Lancaster, PA 17608-1552
R
E
C
A
P
I
T
U
L
A
T
I
o
N
394- 24
Real Estate (Schedule A)
Stocks and Bonds (Schedule B)
Closely Held Corporation, Partnership or
Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
S. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage liabilities, & Liens (Schedule il (10)
11. Tolal Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Sub'eet to Tax (Line 12 minus Line 13)
(8) 182,349.34
(11) 21. 628.74
(12) 160,720.60
(13) 40.180.15
(14) 120,540.45
(1)
(2)
(3)
OFF''31
('J c:
"~ ,~~,
EONLY
:<3
lim;1e
bton~
<....
:::P
:z
(4)
(5)
None
181,668.48
-
.,.
-0
680.86
-.
(6)
(~
U1
'1":. '""
None
21,628.74
None
C
o
M
T C
A T
X A
T
I
o
N
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
x .0 0 (15) 0.00
80,360.30 X .045 (16) 3,616.21
40,180.15 X .12 (17) 4,821.62
X .15 (18) 0.00
(19) 8,437.83
Copyright (c) 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev, 6-00)
Decedent's Complete Address:
STREET ADDRESS
375 Claremont Drive
CITY I STATE I ZIP
Carlisle PA 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
8,437.83
Total Credits ( A + B + C) (2)
0.00
3. InteresVPenalty if applicable
D. Interest
E. penaity
Total Interest/Penalty ( D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (SA)
B. Enter the totai of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WillS, AGENT
i!liiliJlWiilii!!i:;;",' ,:':::!!;!:':;::::~a:;;;;!~:::;ll::;':%:' :::::1':::",I:;:;':11:1i::'1:;' ::::',!!::!:;:111!i1:::!i:i:!~~l::::::::::i:];;':: ,::;;:: I,:" '" ",:::::1:::1::11:
:~,': 1,,:: !::il::I:ili::;:j;,:':::::::!~:,:;::H, "::;i:j:;:::Hi:':: II) ,: :l::::i::nl!I:: :::, "..::::j::~::: ::jl:, ,~:: ':;,:!I:': ::!(:j:j::::: :,~::,f 1:
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1.
0.00
0.00
8,437.83
0.00
8,437.83
Did decedent make a transfer and:
a. retain the use or income of the property transferred; . . . .
b. retain the right to designate who shall use the property transferred or its income; .
c. retain a reversionary interest; or. . . . . . . . . . . . . . . . . . .
d. receive the promise tor lite of either payments, benefits or care? .
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? . . . . . . . . . .
3. Did decedent own an "in trust for" or payable 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.
Yes No
~~
o
o
o
[!]
[!]
[!]
Under penaltIes of perjury, I declare that I have examined this return, IncludIng accompanying schedules and statements, and to the best of my knowledge and belief. It Is true,
correct and complete. Declaration of preparer other than the personal representatIve Is based on all Information of whIch preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FlUNG RETURN Eugene R. Hostetter DATE
- . ~--i~~~-a~t~~;8~1~-~-n~r------------------------- I/'Cb_I?O ~
EPAREROTHERTHAN REPRES TATIVE Shirk, Reist, Wagenseller and Mecum DATE
P. O. Box 1552
- - Lan~;a~t~r - - PA - - Ii60fi--iss-i - - - - - - - - -- - - - - - - ---
For dates of death on or atter 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) (ilJ.
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%
{72 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 retum are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural
parent, an adoptive parent, or a stepparent of the child is 0% [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%, 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% [72 P.S. 9116(aX1.3)]. 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.
Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6.00)
REV-1508 EX +(1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Robert R. Hostetter SS# 164-28-3784 04/21/2001 2101-0466
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.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ITEM
NUMBER
1
DESCRIPTION
Cash - found in wallet of decedent
VALUE AT DATE
OF DEATH
33.00
2
Polyclinic Hospital tdba Pinnacle Health Hospital, Bedford F.
Boylston MD, FACS and Shaffer Cardiovascular Asssociates, LTD
litigation settlement
181,218.24
3
Claremont Nursing and Rehabilitation Center - refund
147.24
4
Jewelry - value per appraisal by Brent L. Miller
270.00
TOTAL (Also enter on line 5, Recapitulation) $ 181,668.48
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97)
Wednesday, December 26, 2001 12:38
To: Roger Reist
From: Eugene R. Hostetter.
Page: 3 of 7
DEC-25-2001 09:24
P.02/05
Th_WHill,_ ~~'ft>~
Edward R. Kennett, EsCJ.llire
ATLEE, HALL & BROOKHART. LLP
8 North Queen Street
P. O. Box 449
L~~, p). 17608~9
am 393.9596
ID No. 33092 &69072
).ttorneyfor Plaintiff
<
..
ATLEE. HALL & BROOKHART
717 393 2138
'-Ni a
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,'. -:'.-.
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",', :'
ROBERT HOSTBrn~K.
Plalntiff.
vs.
POLYCLINIC HOSPITAL tIdlb/a
PINNACLE HEALTH HOSPITALS,
BEDFORD F. BOYLSTON, M.D., F.A.C.S.,
and SHAFFER CARDIOVASCULAR
ASSOCIATES. LTD. -
Defendants.
.
: JURY TRIAL DEMANDED
ORDER
AND NOW, this lli day of -De c.. , 2001. upon Petition of
PlaIntiff for Approval of a Settlement and Distribution in a Survival Action, the Court orders
as follows:
,4.
1.
'FLib ~..................ll11n1. 1.:. Jl.....J...d ~J w.v~ ~~ }oI"'I::~lL ~U'J... _~...._ k... ~..! iSrael r>f
-tiIi:l Or....Li .:S 'Ac::,<::tJe.t" "d,-\"2,-C\
. Settlement of this case in the amount of $450,000 is approved;
Attomeys' fees in the amount of $150,000, payable to the Law Fi.t:m of Atlee.
Hall & Brookhart, ILP, is llpproved.i.. " ,\........ .
~ ~'i!, lP55.\.>>-' -:s- "'=\1......
:&pel'lSCS hi the ammmt-of !'i++,Bd3.3B.-matte-payable-~ the LawFiml:ej!.A&e,. .
Hall Be Brookhart. LLP. is approvC:dj
Payment of $76. 303.85, made p~able to the Commonwealth of PeDIlSj'lvania.
Department of Public Welfare, in full satisfaction of said lien held by the
Department of Public Welfare concerning Robert Hostetter, is approvedj
Z.
3.
s.
l:\U~-lD9\M.BA1:lING)fmTID~S\Apj>lO'lilI.D.t J \,.,..r-
Wednesday, December 26, 2001 12:38
To: Roger ReIst
From: Eugene R. Hostetter,
Page: 4 of 7
DEC-26-2001 09:24
ATLEE. HALL & BROOKHART
717 393 2138 P.03/06
t
6. Payment of $ 3.8~~.~7 made payable to Medicare in full satisfaction of its liens
held agaiDllt Robert Hostetter. is approved; _ ,1
"lo 15"1,2..11'.';1.,/ .J noo"er
7. Net settlement proceeds of $174 ,98,,00 are approved and shall be paid to
Eugene Hostetter in his capacity as Executor of the Estate of Robert Hostetter,
for further distribution, in accordance with the law aXJd provisiOns of.the .Last
Will and Testament of Robert Hostetter.
BY THE COURT
.h:c,\ \~M ~. ~\Jex
, e Honorable A. oover. ge
OEe 1 9 200'1
I her,,; ~",iiry that h18 foregoing is a
... on' ""'" 1"" <<. iginal
filed.
JpkrlJ 2!.. ~.
ProthllnOlary , -
1:\TJSE\lS\CASllS\9'7.11l9\PUlADlNG\Pl!'mlOllN!oPNVOIl.ku
~~-. L. ~'((
~ ~i-,
~ f3..-aduate 'V
f3em()I()Uist
'v
AVVVAISAL
13[)1:~ L MILLI:[)
Jewelen W()rlUh()p
1818 Columbia Avenue
Lancaster, PA 17603
717-293-3333
TO WHOM IT MAY CONCERN
Thiele to certifylhat we are BI'lgIlQ9d In Ih'lewelrybuslness, appr.-lslng diamonds, watches, jewelryand precious stonlG of all descrlptlons, We herewtth certify thai we tlevelhls day
carefully examined tM,followlng listed Bnd dS6Cribed artlolea We
esUmate the value as ~slltd for Insurance or other purposes at Ihe current retail value. excludlrlQ Federal and Olnilr taxes. In making this Appraisal, we DO NOT agree to purchase or
raplece the articles. '
DESCRIPTION
06-07-2001
The Estate of Robert R. Hostetter
2041 Harrogate Road
Lancaster,Pa.17601
1. 1 Ok Yellow gold gents onyx initial ring rivet set with a white gold plate set with a 0.01
carat round melee diamond bead set into the center and installed with a yellow gold screw
in gold R initial. The inside of the shank is stamped "IANY, 1OK." Weight 5.08 grams.
Value $30.00.
See photograph.
2. 14k Yellow gold gents wedding band that is engraved inside the shank "Devotedly
United 7-7-74." The inside of the shank is stamped "lC.S. 141." Weight 7.38 grams.
Value $40.00.
3. Gold filled Elgin pocket watch eighteen size with an exceptional porcelain face and
beautiful case (dented on the bottom). The case number is 1192667 CWC (Planet). The
full plate seven jewel movement is number 8,585,895 for an estimated production date of
1899. Value $200.00.
,
This is not an insurance replacement appraisal. These prices are what I think might be
offered by a jeweler or what price might be attained if these items were offered at a public
sale. This is not a offer to buy these items.
Dear Insurance Company. Please scbodulc thisjewebyonmy homeowners orxmteIB insumnce poli~. Ploaso make sme that the above itcm(s) will be covered
against Joss or damaae without any dcducbblc and against all perils. AD or some ofthc following cquipnell1 was used aI: the time of examinal:ion. American
Optical stereo star microsoopc. GIA Duplex II refractomder, GIA Gem Set. illuminator p:>1arisoope, Mettler CM200 c1ed:ronic caratfgram sca1e, 0Ila1B sCout
scale, Tri Electronics GXJ....18 clectrooic gold tester Master oolor diamonds, GlA gem diamoDd lite and gem fiber lite. Ceres Reliance AC and CcIes Secure
~ lV\~
Thc foregoing Appraisal is madc with Ihc understanding thaI thc Appraiscr assumes no liability with respect 10 any action Ihat may bc taken on thc basis of this Appraisal.
REV-1509 EX +(1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Robert R. Hostetter
SCHEDULE F
JOINTLY-OWNED PROPERTY
55ft 164-28-3784
04/21/2001
FILE NUMBER
2101-0466
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
A.
Eugene R. Hostetter
ADDRESS
2041 Harrogate Road
Lancaster, PA 17601
RELATIONSHIP TO DECEDENT
Brother
B.
c.
JOINTLY -OWNED PROPERTY,
LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial Institution and bank DATE OF DEATH DECD'S VALUE OF
account number or similar IdentifyIng number.
NUMBER TENANT JOINT Attach deed for Jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1 A 1M & T Bank - checking 1,361. 72 50.00% 680.86
account #3741612299, held
jointly with brother,
Eugene R. Hostetter.
Balance to date of death
TOTAL (Also enter on line 6. Recapitulation) $ 680.86
(If more space is needed insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc.
Form REV-1509 EX (Rev. 1-97)
v
m1M&rBank
July 18,2001
RE:
Estate Search
The Estate of:
Date of Death (D.O.D.)
Robert R. Hostetter
4-21-2001
To Whom It May Concern:
Identified below is the account information requested.
1. M&T Bank accounts in which the decedent's name appears:
Account
Type
Account Number
Account Title
Opening Branch
D.O.D. Accrued Interest
Balances
(Includes Accr.
Int.)
$1,361.72 $.00
CHK
3741612299
Robert R. Hostetter
Eugene R. Hostetter
4345
2. Loans, Mortgages, or other obligations titled in the decedent's name
Account Number
Amount Owed
Account Description
NO Safe Deposit Box titled in the Decedent's name existed at our office.
If yon have any questions about the information provided, please contact our Records Departtnent at (716) 635-4010 or 1-800-724-
2440 outside of the Buffalo, NY calling area. Thank you.
Sincerely,
M&T BANK CORPORA nON
~~J-z-
Authorize Signature ~
BY:
DATE:
j- r j'-d/
Manufacturers and Traders Trust Company. 1100 Wehrle Drive, Po. Box 701, Buffalo, NY 14240-0701
REV-1S11 EX +(1-97)
ESTATE OF
Robert R. Hostetter
COMMONWEALTH OF PENNSYLVANIA
INHER1TANCETIiX RETURN
RESIDENT OECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
SSjF 164-28-3784
04/21/2001
FILE NUMBER
2101-0466
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1 Hoffman-Roth Funeral Home - funeral bill 4,330.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions 8,266.74
Name of Personal Representative(s) Eugene R. Hostetter
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address 2041 Harrogate Road
City Lancaster State PA Zip 17601
-
Year(s) Commission Paid: 2002
2. Attorney's Fees Shirk, Reist, Wagense11er and Mecum 8,121.19
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
-
Relationship of Claimant to Decedent
4. Probate Fees Register of Wills 247.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1 Bank of Lancaster County - checkbook fee 22.00
2 Brent L. Miller - jewelry appraisal fee 100.70
3 Cumberland County Register of Wills - short certificates 15.00
4 Cumberland Law Journal - estate notice publication 75.00
5 Postmaster - stamps 34.00
6 Shirk, Reist, Wagense11er and Mecum - reimbursement of costs 33.00
advanced as follows: Reg i ster of Wills, short certificates
Total of Continuation Schedu1e(s) 384.11
TOTAL (Also enter on line 9, Recapitulation) $ 21,628.74
(If more space is needed, insert additional sheets of the same size)
Copyright (e) 1996form software only CPSystems, Inc.
Form REV-1511 EX (Rev. 1-97)
Estate of: Robert R. Hostetter
Soc Sec #: 164-28-3784
Date of Death: 04/21/2001
Item
41
Continuation of Schedule H-Bl
(Personal Representative's Commissions)
Description
Amount
1
Eugene R. Hostetter - executor fee (5% of $100,000.00
+ 4% of $81,668.48 - $3,266.74)
$5,000.00
8,266.74
8,266.74
Estate of: Robert R. Hostetter
Soc Sec #: 164-28-3784
Date of Death: 04/21/2001
Continuation of Schedule H-B2
(Attorney's Fees)
Item
#
Description
Amount
1
Shirk, Reist, Wagense11er and Mecum - attorney fee (7% of
$25,000.00 = $1,750.00 + 6% of $25,000.00 - $1,500.00 + 5% of
$50,000.00 - $2,500.00 + 4% of $81,668.48 - $3,266.74 + 1% of
$680.86 - $6.81 for a total of $9,023.55 less 10% or $902.36)
8,121.19
8,121.19
Estate of: Robert R. Hostetter
Soc Sec #: 164-28-3784
Date of Death: 04/21/2001
Continuation of Schedule H-B7
(Other Administrative Costs)
Item
1f
Description
Amount
$20.00, photcopies $1.00, notary fees $2.00 and fax transmission
$10.00
7
Shirk, Reist, Wagense11er and Mecum - Client's Fund RESERVED for
acknowledgments and affirmations to, and filing of releases,
affidavits, etc.; notary fees (if any) and other misce11anoues
expenses necessary to close out estate
300.00
8
The Sentinel - estate notice publication
84.11
384.11
REV-1513 EX + (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCETAA RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
Robert R. Hostetter
SSfl 164-28-3784
04/21/2001
NUMBER NAME AND ADDRESS OF PERSON(Sj RECEIVING PROPERTY
I. TAXABLE DISTRIBUTIONS [Include outright spousal distributions, and
transfers under Sec. 9116(aX1.2)]
1 Sharon Dickinson
3209 North Arrowhead Avenue
San Bernardino, CA 92405
2
Eugene R. Hostetter
2041 Harrogate Road
Lancaster, PA 17601
3
Ellen Martin
17797 San Bernardino Avenue, Apt 25
Fontana, CA 92335
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Daughter
Brother
Daughter
FILE NUMBER
2101-0466
AMOUNT OR SHARE
OF ESTATE
1/4 residue
1/4 residue
1/4 residue
and
grandfather's
watch
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS,
A. SPOUSAL DISTRIBUTIONS UNDER SEC, 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
Harrisburg Church of God Seventh Day
5122 Earl Drive
Harrisburg PA 17112
40,180.15
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)
Copyright (c) 2000 form software only The Lackner Group, Inc.
40,180.15
Form REV-1513 EX (Rev. 9-00)
. " ~!,' , -'," \ " " j v \ _,) \ I .. A l~ ". , ,', " ,
" f ~ I 1 ,) '. " 1,ri/O"'~ "l..,.r<. ' . ~ ~~'r! I' I ". (,' ,. " ''i' "J'~," ,'iL.L<.oiw-..>",~, . 91"
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~...' - "~~~~..". .. ~~ .'J - . ~ ,'",->: -,-_: ., " ~ ", . '. ,:' ~~", ""r::':~ "~"'~.".;'/"< ~,~.,~J"~g, ,','1'.:'
,
II! . ~.. '." .:." I .. .:''''f ,,'"'
OF
ROBERT R. HOSTETTER
I, Robert R Hostetter, of Carlisle, Cumberland County, Pennsylvania, being of sound and
disposing mind, memory, and understanding, so make, publish and declare this to be my Last
Will and Testament, hereby revoking and making void all previous Wills and Codicils heretofore
made by me,
Ii!:!!
I order and direct my personal representative hereinafter named to pay all of my just
debts, funeral expenses, and expenses involved or connected with the administration of my
estate as soon after my death as is reasonably possible. However, my personal representative
need not accelerate and pay those unmatured obligations which, in his, her, or its opinion, it
might be proper and more advantageous to retain or renew and pay as they become due and
payable. If I do not own a burial plot or a grave marker at the time of my death, I authorize my
personal representative, in his, her, or its sole discretion, to purchase a burial plot and to erect a ,
suitable grave marker at my grave, and to expend sums from my estate for this purpose,
Second
I give, devise, and bequeath the following property with all insurance proceeds thereon as
follows:
To my daughter, Ellen Martin of Fontana, California, I leave my grandfather's
watch.
Page 1 of8
. ~ . -- - . -,- - -. - . -.- -~ . - - . -, -,.," "_' .".-.- "'".-'-_'_'__' .~.'_ 'h~'.';.." ....,-_..o.....,....p.....~,.,._."'_.,-;..-..o.,.".,.....',". .'.".'
,','
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'0. ....
i'_ :.:,~_:..: I!!!!:d + ' ".:...'., :)':..~"'::~' ,'4'':.'"~ng my $,,(0....'""
, ,,,
,~'. , ~ '
I give, devise, and bequeath the rest and rem,,;nrlerofmy estate, together with all
insurance proceeds thereon of whatever nature and wheresoever situate in four equal shares as
follows:
25% to my daughter Sharon Dickerson, provided that she survives me by sixty
(60) days, per stirpes;
25% to my daughter Ellen Martin, provided that she survive me by sixty (60)
days, per stirpes;
25% to my brother Eugene R. Hostetter, provided that he survive me by sixty (60)
days, per stirpes;
25% to my church, Harrisburg Church of God Seventh Day, 5122 Earl Drive,
Harrisburg, Pennsylvania.
Fourth
It is further my desire that my personal representative, after consultation with any heir or
,heirs of mine who survive me, and in his, her, or its own discretion, choose such articles from
my tangible personal property (exclusive of cash, stock certificates, bonds, and all other tangible
evidences of intangible personal property) as he, she, or it believes will be useful to such heir or
heirs or desirable for him or her or them to have, either from a sentimental point of view or
otherwise, and to deliver such articles to such heir or heirs or among such heirs in equal or
unequal shares as determined by the further exercise of his, her, or its discretion, provided no
other heir objects to the distnbution All tanglble personal property not so distributed is to be
Page 2 of8
__ _ __ . .. _~_. ..~~ ' ~~_""-""'~,_"",,,,,,._~,,,,,,,,_~''''''''''_''-.'.'''''_'_''_ . ,...... ';-- '.~', ~.. ,.,'9~~~: .,--:"~::- '_;. ;:~.:'=':'~'~::~'.;.:::~:::i;:.~~;:;;~'-;~-'''~'
,~_: -':':. ~~ " :: ::.:_~,:~,.:~:~ ;:~~:: ::::~~:::::::::.:;:_:.::.:,.::::"",;:;:-::
. ;,...i
"'-Sola,'^elmei'"ptil5li.cly or'pn.vate'lY~~ym:y personal representa1J.ve, aamng the proceeds of sUcn-saIe
or sales to my residuary.estate:and.to':be:disposed of in, equal shares among my surviving heirs '
after payment of my estate debts, taking into account the tangible personal property otherwise
provided to them.
--- .~.,.~,~-.
Fifth
Any devise or distribution under this Last Will and Testament which is payable to any
beneficiary who may be under twenty one (21) years of age or, in the judgment of my personal
representative, mentally disabled, shall be held in a separate trust by my personal representative
as trustee until such beneficiary reaches twenty one (21) years of age or during such period of
disability, In the case ofa beneficiary under twenty one (21) years of age, the trustee may
distribute the entire remaining principal and the accumulated interest at or after the beneficiary's
twenty first (21) birthday. During the term of any trust created pursuantto this Paragraph, the
Trustee is authorized to expend and apply so much of the net income and principal of each such
trust as the trustee shall consider advisable for the health, maintenance, support, and education
(including college education, undergraduate and graduate) of each such beneficiary until he or
she attains twenty one (21) years of age, or until all such amounts are paid out of trust I direct
that no Guardian shall be required to give or post bond for the faithful performance of the
,
Guardian's duties in this or any other jurisdiction.
~
I grant my personal representative the following powers in addition to and not in
limitation of such powers as my personal representative shall hold by law.
a.) To retain all property received including the stock of any corporate fiduciary
acting hereunder, provided such property remains productive.
Page 3 of8
___~_.. - -- -. .._.- _.-'.-' ....,..,.._.....',:.,<:.....;-,.,.:-:.;-:.;,~.~.;.:-:.-.;.:';'o'"..:...-,~: :'~...-_._.,.. ;.':...'"":':"...,,;.1~~.-~..."..M.: ';:~::.:;..:.::~..:;--":::::::'.~:;:::;;.
-::.:,.:~c-,..""
'.'-.".-'
., ..-~-~..;:~-:::.:...~:: :': ::~-.:.;.::{:::.:..::.~::::~~:';:: :-:-.: ;:-~:-: . "~: :~'::" .
.,.
,',.
'."d:
. ,', , ," .,.:"" t:. .r' I. r. ~ . ;~... : ' . \: ',"
on; 'merger; eorgan17l' on or
voting trust plan; 10 delegate authority with respect.thereto; to deposit investments
under agreements and pay assessments; and generally to exercise all rights of
investors, including but not limited to the voting of shares.
c.) To manage, operate, repair, improve, mortgage or lease on any terms any real
estate held or owned by my estate.
d.) To operate any business that I may own at my death.
e.) To invest any funds of my estate in stocks, bonds, notes, or other securities or
property, real or personal, without regard to the principle of diversification or.any
other statute or general rule of law in this, her, or its absolute discretion, it being
my intention to. give my personal representative the broadest investment powers
possible, providing such investments do not unnecessarily prevent the prompt
settlement of my estate.
f.) To sell or otherwise dispose of any property, real or personal, tangible or
intangible, at any time forming a part of my estate in any manner and on such
terms and conditions as my personal representative shall see fit in his, her, or its .
absolute discretion.
g.) To borrow money for the payment of taxes or for any other proper purposes in the
administration of my estate, and to mortgage or pledge estate assets as security.
h.) To compromise claims without court approval including, but not limited to, any
controversies with the United States of America or the Commonwealth of
Pennsylvania concerning estate and inheritance taxes on any interests that may
pass under this my Last Will and Testament.
Page 4 of8
. . _ _.. .. -,".',', _...."......".....__ - -. ..--._._~-,-.J'...,-...-.~.. ,,, '_4" . _',' "._._."."'",'..
. -. :.:.:....:.._.._~...-.........:.:.7...:.;...':.:.:.:.-,:-...;0.:,,:,:,:--:,:,-,,-:."-:-, . " .,....;
J>-- __._.....
~ " ' .\ ' . " " .-,
8-'-"'1.~aiStdg~~m~C'8Sl(;~t;n:~a:~~'~yfu'V1s~~no;ctiStn:butl~n of my esta~e~";';
,.;..-,~
j.) . . Tou.ndertlike anyandalLacts de"eniednecessary and proper by my personal
representative for the proper, advantageous, and prompt management of the
settlement of my estate.
k) In general, to exercise all powers in the mAnAgement of my estate which any
individual could exercise in the management of similar property owned in his
own right, upon such terms and conditions as to him, her, or it may seem best and
to execute and deliver all instruments and to do all acts which he, she, or it deems
necessary or proper to carry out the purposes of this, my Last Will and Testament
Seventh
No interest of any beneficiary of my estate, either in income or in principal, shall be
subject to anticipation or pledge, assignment, sale, or transfer in any manner, nor shall any
beneficiary have the power in any manner to charge or encumber his interest either in income or
principal, nor shall the interest of any beneficiary be liable or subject in any manner while in the
possession of my personal representative for the liability of such beneficiary.
Eil!hth
I nominate, constitute, and appoint my brother, Eugene Hostetter, as Executor of this, my
Last Will and Testament. In the event my brother is deceased.. unable, or unwilling to serve or
shall cease to serve for any reason whatsoever, then I nominate, constitute, and appoint my
daughter, Ellen Martin, as personal representative of this, my Last Will and Testament. I direct
that my personal representative shall not be required to ~ve or post bond for the faithful
performance of his, her, or its duties in this or any other jurisdiction.
Page 5 of8
" "
. .'
. ,
-
.'~ C.('l:;,t~lr\nrJ:,[]T.L:'!:l.":;"H ill-U~ ~/.~~ n"";'.{~lt tp, ;~'\"~~Uj'\:l'.'
. ; ~., ,," h,
-----~.~..
" ":',.:',',...~~,!,"'.::',~. ,1<,:'::~:_!_,~""__r""''''' ,"'.. "~',.~":'~~r*;'_r"" :" 'ii' .
I hereby declare it to be my expressed desire that my personal representative employ the
,
law fum of Stephanie E. Chertok, Esquire, of Cumberland County, Pennsylvania., for the legal
advice and assistance regarding this, my Last Will and Testament, they having considerable
knowledge of my affairs, views, and wishes respecting any matters that may arise at the probate
of this instrument, the administration of my estate, and the execution of the powers herein
mentioned.
IN WITNESS WHEREOF, I have set my hand to his my Last Will and Testament this
&,11-
day of -RbY'VO-lrl
, 2001.
C;;i/~4f."4. (~A~"L
7=~
~S
\
Page 6 of8
t:.A"
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,.........
-LAST WILL AND TESTAMENT,OF ROBERT R. HOSTETTER
ACKNOWL'EDGMENIf,~;","",(!,>,,,, .
COMMONWEALTH OF PENNSYLVANIA -.
: SS
'COUNTYOFCUMBERLAND
:
1, Robert R, Hostetter, the testator whose name is signed to the attached or foregoing
instrument, having been duly qualified according to 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.
ROBERT R. HOSTE~"-----
Sworn or affirmed and acknowledged before me by Robert R. Hostetter, the tesWor,
1-t\,
a-.
day of _k..-bh-rtl ^""
\
'2j~_
.1'NOTARY PUBLIC
this
_IUL
_c.IPIl%,IlOl'MYPUBLIC
,......a.hJ 11I\ v nioANDCO PA
1rf':O"- It t..1!llIlIMlI MAY2S 2tli;.
--" ..~.... ".-.. ,-.. '- '-""'-.''' ~.
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Page 7 of8
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lilJiiinnlJH'II11llLlf,l11t--r "_._,. ..'-~I'''''l.-'rr--'''~r,"' ._-
<f;'~'" UsrWIIlt 'i\Nn TESTAMENT OF ROBERT R. HOSTETTER
AFFIDAVIT "
. ",I.' ,.
r TTr
COMMONWEALTH OFPENNSYLV ANJA'
SS
COUNTY OF CUMBERLAND
.
.
WE, .5'i< sa l\j
(~ y-'.A p 'r
and ~e E". c.h~~k
the witnesses whose names are attached to the foregoing document, being duly qualified
according to law, do depose and say that we were present and saw testator sign and execute the
instrument as his Last Will and Testament; that he signed willingly l!!1d that he 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 Last Will and Testament as witnesses; and that to the
best of our knowledge the testator was at the time 18 or more years of age, of sound mind and
under no constraint or undue influence.
/0 q S"u.-t ~ -MD.rke1S. 5] ~ 10 /" "' I )
.:::; -x.::L- n. 1/ pi - / ./1...._""" /'\ A AJ ;;2;J fJ 0
-:rtec..hc..ru;c.S bUV-j{fi. " ~df~ ..11~11()1
I" 0 5"5'-1.3:8 /
and
Sworn or affirmed and subscribed before me by 3us.0..Y"\ Q.x.\~.e.\'"
~"'l"E:r~;toLtrus9.1~ ~:a,.,I,""
TAR UBLIC
.
'r;, ~'" ~/l'~",
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Page 80f8
/1.,- c2 3 0- Y
OFFICIAL USE aNL Y
REV~ 1500 EX + (6-00)
CAPB
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CRAC
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ES
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
D
E
C
E
D
E
N
T
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Hostetter Robert R.
DATE OF DEATH (MM-DD- YEAR)
2101.0466
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
164.28.3784
THIS RETURN MUST BE ALEC IN DUPUCATEWlTH THE
NUMBER
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
1. OrIginal Return
4. LImited Estate
X 6. Decedent Died Testate
X 2.
4a.
7.
3 date of death
. Rema!nder Return prior to 12.13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
(Attach copy of WflQ
o 9. litIgation Proceeds ReceIved
Supplemental Return
Future Interest CompromIse (date of death after 12-12-82)
Decedent Maintained a LIving Trust
(Attach copy of Trust)
o
010. Spousal Poverty Credit D 11. Electfonto tax under Sec, 9113(A)
(date of death between 12-31.91 and 1-1-95) (Attach Sch 0)
iWl~;lil~~MI\!iet:Ell'.j~. .~OJifIl,ESPONDEN!lE'&~QN")QE;*i'jAllitAX1NFORM'~1IQl($f1Ql,IQ:Bebfli(EeTEI1TO,' ,.
COMPLETE MAILING ADDRESS
Ro er S. Reist
FIRM NAME (If Applicable)
Shirk, Reist, Wa enseller and Mecum
TELEPHONE NUMBER
P. O. Box 1552
Lancaster, PA 17608.1552
394.724
Real Estate (Schedule A) (1) None OFFICIAL USE ONLY
Stocks and Bonds (Schedule B) (2) rltl~e
Closely Held Corporation, Partnership or (3) SNOhe 8
~ "1'
Sole-Proprietorship rr .
. '
4. Mortgages & Notes Receivable (Schedule D) (4) ltNone ::>:
R S. Cash, Bank Deposits & Miscellaneous Personal Property (5) 11 , 6~1. 41 ~
E (Schedule E) '"j I
C Ul
A 6. Jointly Owned Property (Schedule F) (6) CNone
P 0 ,:. "
I Separate Billing Requested
T N
U 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) -iNane (",
L (Schedule G or L) ).- ..1 W
A
T 8. Total Gross Assets (total Lines 1-7) (8) 11,671.41
I 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 2,545.55
0
N 10. Debts of Decedent, Mortgage liabilities, & Liens (SchedUle I) (10) None
11. Tolal Deductions (total Lines 9 & 10) (11) 2.545.55
12. Net Value of Estate (Line a minus Line 11) (12) 9,125.86
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) 2 .281.47
made (Schedule J)
14. Net Value Sub'eel to Tax (Line 12 minus Line 13) (14) 6,844.39
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116(aX1.2)
16. Amount of line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20.
(15)
(16)
(17)
(18)
(19)
.0 0
.0 45
.12
.15
0.00
205.33
273.78
0.00
479.11
4,562.93
2,281. 46
x
X
X
X
CopyrIght (c) lOOO form software only The Lackner Group, Inc,
FormREV-1500 EX (Rev, 6.00)
Decedent's Complete Address:
STREET ADDRESS
375 Claremont Drive
CITY I STATE \ ZIP
Carlisle PA 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
479.11
Total Credits ( A + B + C) (2)
0.00
3. InteresVPenalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E) (3)
4. If Une 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Une 1 + Line 3 is greater than Line 2, enter the d'ltference. This IS the TAX DUE. (5)
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line S + SA. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
qpLEi>SE 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; ~ ~~x
b. retain the right to designate who shall use the property transferred or its income; .
c. retain a reversionary interest; or.
d. receive the promise for life of either payments, benefits or care? . .
2. If death occurred after December 12, 1982, did decedent transfer property within one year of dea,th
without receiving adequate consideration? .
3. Did decedent own an ~in trust forft or payable 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.
0.00
0.00
479.11
0.00
479.11
o
o
o
[!]
[!]
[!]
Under penalttes of perJury, I declare that I have examined this return, Including accompanying schedules and statements, and to the best of my knowledge OInd belief, It Is true,
correct and complete. DeclaratIon of preparer other than the personal representative Is based on all Information of which preparer has any knowledge.
SIGNATURE OF PERSON RESpoNSIBLE FOR FILING RETURN Eugene R. Hostetter
_ _ ?:Q~}-_ _~~!_:r:C1g!,-_t." _ !<_CO..<:l_ _ - - - - - - - - - - - - - - - - - - - - - - - --
Lancaster, PA 17601
Shirk, Reist, Wagenseller and Mecum
P. O. Box 1552
-- -r.:~n(;a:st;;r - - piC - i"i60ii: iss-i - - - - - - - - - - - - - -- - - --
DATE
-51").. ( D.3
DATE
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed 011 the net value of transfers to or for the use of the
surviving spouse Is 3% [72 P.S. 9;16 (a) (1.1) (;)].
For dates of death on or after January " 1995, the tax rate imposed on the net value of transfers to or for the use at the surviving spouse is 0%
[72 P.S. 9116 (a) (1.1) (in], The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets
and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural
parent, an adoptive parent, or a stepparent of the child is 0% [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%, 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% [72 P.S. 9116(a)(1.3n A sibling is defined, under
Section 9102., as an individual who has at least one parent in common with the decedent, whether by blood Of adoption.
Copyrlght{c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00)
,
REV"-1508 EX + (1~97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Robert R. Hostetter
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
SSfI 164-28-3784
04/21/2001
FILE NUMBER
2101-0466
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
NUMBER
1
DESCRIPTION
Hostetter VS. Marston - litigation settlement
VALUE AT DATE
OF DEATH
11,671.41
TOTAL (Also enter on line 5. Recapitulation) S 11,671.41
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 199610rm soHwareonly CPSystems.lnc. Form REV-150B EX (Rev. 1.97)
Tuesday, April 15, 2003 9:43 AM
To: Roger Reist
From: Eugene R. Hostetler,
Page: 1 of 2
....
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~ ~ .- --~"="""==rt -~~"':'~DOLLARS Iil ":7'..:'1
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,Tuesday, April 15, 2003 9:43 AM
To: Roger ReIst
EUGENE R. HOSTETIER, Individually
and as ADMINISTRATOR OF THE
ESTATE OF ROBERT R. HOSTETTER,
Deceased,
Plaintiff
v.
From: Eugene R. Hostetter,
: IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PA.
CIVIL ACTION - LAW
NO. 99-1058
HEATHER E. MARSTON and MASTER
MANUFACTURERS INC.,
Defendants JURY TRIAL DEMANDED
TO THE PROTHONOTARY:
PRAECiPE
discontinued with prejudice.
Please mark the docket in the above-caplioned matter as settled and
II ERIE INSURANCe EXCHANGE
~ HomclOtb.100ErW.....PL.ErIl.PA16s3o
ERIF"
PAY TWENTY THOUSAND AND ODfl00
TO
rHE
ORDER
OF
EUGENE R. HOSTETTER, ADMlNS,
OF ESTATE OF ROBERT HOSTETTER
AND R. MARK THOMAS, ESO
HIS ATTORNEY
FOR ANAL PAYMENT
BODILV INJURY LIABILITY
.
1ri.........ClIl~1on lU-12T' ~
=~.GeoIvI. --rn- ~
CHeCK NO.: 0I2OS80 j
DATE!1SSUED: 03-21-20(13 . ~
~
>
OF'EAATOI'l 2e5HOlMES )0
-Ii
~
~
,.,.".,,--. i
wmm..- j;5
J!?/tA7~
R. Mark Thomas, Esquire
101 South Market Street
Mechanicsburg, PA 17055
Stephanie E. Chertok, Esquire
61 West Louther Street
Carlisle, PA 17013-2935
ClAIM HO..: 010170397686
DATI!OI"LOSS: 11-13-1998
eMS NO.: F228B80
TAX 10 HO.
251766036
~.,._-~~.
. Alnli TUE
I!!HCI.
"O~ 2 28~801l' I:D~ H. nBB': :I i!'l'l'l'l'l1,'l2I1'
Page: 2 of 2
REV~1S11 EX +(1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCETAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Robert R. Hostetter
SSff 164-28-3784
04/21/2001
FILE NUMBER
2101-0466
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES,
B. ADMINISTRATIVE COSTS,
,. Personal Representative's Commissions 583.57
Name of Personal Representative(s} Eugene R. Hostetter
Social Security Number(s) / EIN Number of Personal Representative(s)
Street Address 2041 Harrogate Road
City Lancaster State PA Zip 17601
-
Year(s} Commission Paid:
2. Attorney's Fees Shirk, Reist, Wagense11er and Mecum 1,750.00
3. Family Exemption: (If decedent's address is not the same as claimant's. attach explanation)
Claimant
Street Address
City State Zip
-
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1 Shirk, Reist, Wagense11er and Mecum - reserve 200.00
2 Shirk, Reist I Wagense11er and Mecum - reimbursement of costs 11.98
advanced as follows: postage $3.98; Notary fees $2.00 and fax
transmission $6.00
TOTAL (Also enter on line 9. Recapitulation) $ 2,545.55
(If more space is needed, insert additional sheets of the same size)
CopyrIght (c) 1996 form software only CPSystems, Inc.
Form REV-1511 EX (Rev. 1~97)
Estate of: Robert R. Hostetter
Soc Sec #: 164-28-3784
Date of Death: 04/21/2001
Continuation of Schedule H-B1
(Personal Representative's Commissions)
Item
1f
Description
Amount
1
Eugene R. Hostetter ~ executor fee
583.57
583.57
Estate of: Robert R. Hostetter
Soc Sec #: 164-28-3784
Date of Death: 04/21/2001
Continuation of Schedule H-B2
(Attorney's Fees)
Item
If
Description
Amount
1
Shirk, Reist, Wagense11er and Mecum - attorney fee
1,750.00
1,750.00
REV-15~3 EX + (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
Robert R. Hostetter
SSf; 164-28-3784
04/21/2001
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I. TAXABLE DISTRIBUTIONS [Include outright spousal dIstributions, and
transfers under Sec. 9116(aX1.2)]
1 Sharon Dickinson
3209 North Arrowhead Avenue
San Bernardino. CA 92405
2
Eugene R. Hostetter
2041 Harrogate Road
Lancaster. PA 17601
3
Ellen Martin
17797 San Bernardino Avenue. Apt 25
Fontana. CA 92335
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Daughter
Brother
Daughter
FILE NUMBER
2101-0466
AMOUNT OR SHARE
OF ESTATE
1/4 res idue
1/4 residue
1/4 res idue
and
grandfather's
watch
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18. AS APPROPRIATE. ON REV 1500 COVER SHEET
II. NON. TAXABLE DISTRIBUTIONS,
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1
S. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
Harrisburg Church of God Seventh Day
5122 Earl Drive
Harrisburg PA 17112
2.281.47
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)
CopyrIght (c) 2000 form software only The Lackner Group, Inc.
2.281.47
Form REV-1513 EX (Rev. 9-00)
"
,
REV'-1500 EX + (6-dp)
CAPB
HpRL
EplO
CRAC
KOTK
ES
C P
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R N
R D
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C
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P
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X A
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OFFICIAL USE ONLY
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
/I, ~ ~30-V
FILE NUMBER
D
E
C
E
D
E
N
T
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT's NAME (LAST, FIRST,AND MIDDLE INITIAL)
Hostetter Robert R, a/k/ a Robert Russell
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
Hoste ter 164-28-3784
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
2101-0466
NUMBER
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
1. Original Return
4. limited Estate
X 6. Decedent Died Testate
(Attach copy of Will)
D 9. LItigation Proceeds Received
X 2. Supplemental Return
4a. Future Interest CompromIse (date of death after 12-12-82)
7. Decedent Maintained a Living Trust 0
(Attach copy of Trust)
3. date of death
. Remarnder Return prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
11. Election to tax under Sec. 9113(A)
(Attach Sch 0)
" rJ~":S~OllLDSE:Qll!ll!drI!l))T~,:!i
Ro er S. Reist
FIRM NAME (If Applicable)
Shirk, Reist, Wa enseller and Mecum
TELEPHONE NUMBER
P. 0, Box 1552
Lancaster, PA 17608-1552
Copyright (c) 2000 form software only The Lackner Group, Inc.
D 10. Spousal Poverty Credit
(date of death between 12-31-91 and 1-1-95)
ili!N;L;~llRIISJ!O If ~.. ~NFllDEN Al:i'l'~!NFO
COMPLETE MAILING ADDRESS
o
s,?:!llnl,~,
NAME
{l '~.i::OM .
R
E
C
A
P
I
T
U
L
A
T
I
o
N
1 394-7247
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)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 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)
OFFICIAL USE ONLY
(a) 14,126.30
(11) 1.063.00
(12) 13 , 063 . 30
(13) 3,265,82
(14) 9,797.48
(15)
(16)
(17)
(la)
(19)
0.00
293.92
391. 90
0.00
685.82
(1)
(2)
(3)
None
None
None
(4)
(5)
None
14,126.30
(6)
None
None
1,063.00
None
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116(a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20.
6,531.66
3,265.82
X
X
X
X
.0 0
.0 45
.12
.15
FormREV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
375 Claremont Drive
CITY I STATE I ZIP
Carlisle PA 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
685.82
Total Credits ( A + B + C) (2)
0.00
3. Interest/Penalty jf applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58)
Make .Check Payable to: . REGISTER OF WILLS, AGENT
":;;;<i:::C
. . ....PLEASE..ANSWEFrrHfFOLLOWIN<fGUESTIONSBY PLAClNGAN..,ix;;iN.fHEAPPROPR1ATEBLocKs.......
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 property transferred or its income; .
c. retain a reversionary interest; or. .
d. receive the promise for life of either payments, benefits or care?
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? . 0 [!]
3. Did decedent own an "in trust for" or payable upon death bank account or security at his
orherde~h? c=J [1D
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property
which contains a beneficiary designation? 0 [!J
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
0.00
0.00
685.82
0.00
685.82
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true,
correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIB E FOR FILING ETURN
Eugene R. Hostetter
.. .2QL,-].. .1i~y.r()g~1;~. ~.o'O?-...........................
Lancaster, PA 17601
Shirk, Reist, Wagense11er and Mecum
P. O. Box 1552
DAlE
'1..3/1 ':I-bO:2.--
o TE 1
/tJ- " ~- v-z.
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% [7Z 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%
[72 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 twenty-one years of age or younger at death to or for the use of a natural
parent, an adoptive parent, or a stepparent of the child is 0"10 [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%, 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% [72 P.S. 9116(aX1.3)]. A sibling is defined, under
Section 9102, as an individual who has at least one parent in cornman with the decedent, whether by blood or adoption.
copyright (c) 2000 form software only The Lackner Group, Inc. Form REY-1500 EX (Rev. 6~OO)
REV:-'1508 EX +(1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Robert R. Hostetter
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
SSff 164-28-3784
04/21/2001
FILE NUMBER
2101-0466
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
NUMBER
1 Cash - found in home
DESCRIPTION
VALUE AT DATE
OF DEATH
9,120.00
2
Hostetter vs. Hershey - litigation settlement
3,136.14
3
Medicare - reimbursement of overpayment
1,870.16
TOTAL (Also enter on line 5, Recapitulation) S 14,126.30
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97)
R. MARK THOMAS
Attorney at Law
101 South Market Street
Mechanicsburg, Pennsylvania 17055-3851
Telefax: (717) 796-3600
Telephone: (717) 796-2100
October 1, 2002
Roger S. Reist, Esq.
PO Box 1552
Lancaster, PA 17608-1552
RE: Hostetter v. Hershey, No. 01-1377
Dear Mr. Reist:
Enclosed please find the check in the amount of $5,000.00 which will need to be
endorsed by Mr. Hostetter and returned to me. According to the fee agreement, a copy of
which is enclosed, the amount of the claim is to be reduced by the expenses. In this case
the expenses totaled $298.14. This left a balance of $4,70 1.86, which represents the "net
proceeds". One-third of the net proceeds is to go to the attorney for attorneys fees.
Therefore, the fee is $1,565.72. The client's share is $3,136.14.
Would you kindly have Mr. Hostetter endorse the check which has been made
payable to the estate and to me as counsel. Please return the endorsed check to me so that
1 can deposit it into my trust account and disburse the monies according to this letter. If
you have any questions please contact me.
Very truly yours,
m~
R. Mark Thomas
RMT/ac
cc: Stephanie Chertok
R. MARK THOMAS
Attorney at Law
101 South Market Street
Mechanicsburg, Pennsylvania 17055-3851
Telefax: (717) 796-3600
Telephone: (717) 796-2100
October 10, 2002
Roger S. Reist, Esquire
P.O. Box 1552
Lancaster, PA 17608-1552
Re: Hostetter v. Hershey, No. 01 - 1377
Dear Mr. Reist:
Thank you for the prompt response with the endorsed check. Enclosed please
find a check in the amount of$3,136.14 made payable to the Estate of Robert R.
Hostetter.
s,
R. Mark Thomas
cc: Stephanie Chertok, Esq.
"~~~=",,,I\,_.l>.':_-! '" 'rnS~c"rjr~ ""ltn'lced doc"",",,!. See j'"ck {or d"'oil,"m_,.~"~"""",,-."1IIIIIliiOr'"~_~~'~!ft.o-'"
1:1.'1- R. MARK THOMAS ATTO RNEY AT LAW
, IOLTA CLIENT TRUST FUND
, 101 S. MARKET ST.
, " MECHANICSBURG, PA 17055
" (717) 796-2100 DATE
i;~~~~~~
0: 0~PNCBAN<
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'-
t.l'onday, February 25, 2002 1:11 PM
To: Wendy Vale
From: Eugene R. Hostetter,
"-- ~
~
MEDICARE
'llt1AIaW~
'1Ioae 1-177-647-65%8
ROBERT HOSTETTER
375 CLAREMONT DR
CARLISLE PA 17013-8820
THIS COPY IS PROVIDED TO YOU FOR YOUR RECORDS. ACTUAL LETTER SENT
TO:
February 7, 2002
ATLEE, HALL, &. BROOKHART, LLP
Attn: LAURIE RUSSELL
8 NORTH QUEEN STREET
POBOX449
LANCASTER PA 17608-0449
Re: Robert Hostetter
HlC No.: 164-28-3784A
Date of Accident: 10-25-1996
Dear Ms. Russell:
We bave received your check in the amount of $3,822.27 for payment of services Robert
Hostetter received. In reviewing the records, I find that Medicare payment was made for a total
ofSI,952.11.
Therefore, I bave enclosed a check in the amount ofSl,870.16. This is the difference of your
payment and Medicare's reimbursement amount.
Thank you for your courtesy and cooperation in this matter.
Sincerely,
~~
Juanita Johnson
SubrolUltion Analvst
o MutqdorOmualanallDC8 eompauY_Medicarel\nu. - p.o. BoJllG02,OIMM,.NF. 61101_ AHCFACClNTRACTJIDNTER..\iEDlAAY
JID64.nl..H
Page: 2 of 5
M?nday, February 25, 2002 1:11 PM
To: Wendy Valle
From: Eugene R. Hostetter,
Page: 3 of 5
ATLEE, HALL
& BROOKHART, LLP
717.393.9.596
800.924.2309
117.3<}3.2UaFAX
hlldil1lech;.l1.com
WlUl.lm A Atll:!':, Jr
~sWHaIJ
DlInM Brookhiut
Edward R ~rU1ett
JairrH:D)ild::son
ilobinA)./)Q<,lr
A.TTOkNI:::YS AT lA.VII
February 22, 2002
Mr, Eugene Hostetter
2041 Harrow Gate Road
Lancaster, PA 17601-2423
Re: Estate of Robert Hostetter
Reimbursemem of overpayment to Medicare
Dear Mr. Hostetter:
Enclosed is a check from Mutual of Omaha in the amount of $1,870.16 which represents
reimbursement for an overpayment made to them for payments made on behalf of Robert
Hostetter, I have also enclosed a copy of their letter dated February 7. 2002. for your
reference.
Please nole thaI the check is made payable to Allee, Hall & Brookhart, LLP and Robert
Hostetter. We have endorsed the check on behalf of the fmu. If you should have aoy
difficulty depositing this check, please contact Ken Miller, our CFO. He can provide aoy
additional information required by your bank regarding our endorsement.
Thank you.
Very truly yours,
ATLEE, HALL & BROOKHART, L.L.P.
By:
(L1lJ2UJ;'f-~
Carmela R. Witmer
Paralegal
CRW/clc
Enclosures
ElRiar North QlK"('n StRel
uncasterPA 17603
1:\USlJRS\Ct\SesW7.IOO\LT~-SeIlI.ek:{r<mMcilic&n.>
MaiID.J Mims
1'0 Box 449
uncastt'rPA 17608-()449
M.ooday, February 25, 2002 1 :11 PM
To: Wendy Vale
From: Eugene R. Hostetter,
Page: 5 of 5
-*VOID IF BACKGROUND NOT BLUE *VQfD IF BACKGROUND NOT BLUE *VQIC l~fD.Itjp~T BLUE *VOID IF BA8KGROU'llD NOT BLUE *110'D IF BACKdROU\iONOTBt
Ml70009-gs 0 ~- CHECK NUI.'IlER
............. 001035540 flfo
. ~~,;::~~
~~ MEDICARE PAYMENT
.: -. 'For Heaith~ ~surance - SOclaJ Security At:t
ONE THOUSAND EIGHT HUNDRED SEV~NTY roo U.'.BANK
AND 16/100 DOLLAltS OMAHA,NESAASKA
00000
164283784
Pay Ie the Order of:
FEDERAL HEALTH INSURANCE BENEFITS ACCOUNT
PART "N
AMOUNT OF CHECK
DOLLARS I CENTS
DATE. Of CHECK
MO. CAY YEAR
ALLEE. HALL & BROOKHART LLP
AND ROBERT HOSTEITER
PO 80X 449
LANCASTER PA 176D8
*VOID IF BACKGROUr~D NOT OLUE *VOif) IF BACKGFl.OUND 'IIOT Bll
11'00 ~O 3551,011' .: ~01,0000 ~'ll: ~ 1,8? ~O 'I? 5 5 ~ I,n'
REY~1511 EX+(1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Robert R. Hostetter
SSif 164-28-3784
04/21/2001
FILE NUMBER
2101-0466
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
FUNERAL EXPENSES,
B.
1.
ADMINISTRATIVE COSTS,
Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s) / EIN Number of Personal Representative(s)
Street Address
City
State
Zip
Year(s) Commission Paid:
2.
3.
Attorney's Fees
Family Exemption:
Claimant
Street Address
Shirk, Reist, Wagenseller and Mecum
(If decedent's address is not the same as claimant's, attach explanation)
1,000.00
City
Relationship of Claimant to Decedent
State
Zip
4. Probate Fees
5. Accountant's Fees
6. Tax Return Pre parer's Fees
7.
1
Other Administrative Costs
Bank of Lancaster County - checkbook fee
22.00
2
Shirk, Reist, Wagenseller and Mecum - reimbursement of costs
advanced as follows: Notary fee $2.00 and filing fees $39.00
41.00
TOTAL (Also enter on line 9, Recapitulation) S 1,063.00
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97)
Estate of: Robert R. Hostetter
Soc See #: 164-28-3784
Date of Death: 04/21/2001
Continuation of Schedule H-B2
(Attorney's Fees)
Item
II
Description
Amount
1
Shirk, Reist, Wagenseller and Mecum - attorney fee
1,000.00
1,000.00
Rt::Y-1513 EX + (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
SS1I 164-28-3784
04/21/2001
FILE NUMBER
2101-0466
AMOUNT OR SHARE
OF ESTATE
ESTATE OF
Robert R. Hostetter
NUMBER
I.
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
1
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and
transfers under Sec. 9116(a)(1.2)]
Sharon Dickinson
3209 North Arrowhead Avenue
San Bernardino, CA 92405
Daughter
1/4 residue
2
Brother
1/4 residue
Eugene R. Hostetter
2041 Harrogate Road
Lancaster, PA 17601
3
Ellen Martin
17797 San Bernardino Avenue, Apt 25
Fontana, CA 92335
Daughter
1/4 residue
and
grandfather's
watch
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS,
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
Harrisburg Church of God Seventh Day
5122 Earl Drive
Harrisburg PA 17112
3,265.82
TOTAL OF PART II - 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)
Copyright (c) 2000 form software only The Lackner Group, Inc.
3,265.82
Form REV-1513 EX (Rev. 9-00)
/&-d30~4
BUREAU OF INDIVI6uAL TAXES /
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
Rec:Otc,
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
02-26-2002
HOSTETTER
04-21-2001
21 01- 0466
CUMBERLAND
101
'02 MAR-1
A11 ''13
-II./-
ROGER S REIST
SHIRK ETAL
PO BOX 1552
LANCASTER
(;:E'{L
PA i);%U8cY
c/*
REY-15~7 EX AFP 101-021
ROBERT
R
Allount Rellitted
U)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
181.668.48
680.86
.00
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REv=iS4-j-Ex-AFP-COY=02Y-NOYIcE--oF-YNHEifITANCE-YAirA'PPRA'IsEMENT~--AiLOWANCE-oi-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF HOSTETTER ROBERT R FILE NO. 21 01-0466 ACN 101 DATE 02-26-2002
TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule f)
7. Transfers (Schedule G)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
UO)
21. 628.74
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
(8)
182,349.34
.00
Ul)
(2)
(3)
(4)
21.628.74
160,720.60
39,942.44
120,778.16
NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ Abk returns assessed to date.
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate
16. Amount of Line 14 taxable at Lineal/Class A rate
17. Allount of Line 14 at Sibling rate
18. Allount of Line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
(5) .00 X 00 = .00
(6) 80,835.72 X 045 = 3,637.61
(7) 39,942.44 X 12 = 4,793.09
(8) .00 X 15 = .00
(9)= 8,430.70
7'AX CREDITS:
~ .. .-... (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
INTEREST IS CHARGED THROUGH 03-13-2002 TOTAL TAX CREDIT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 8,430.70
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 70.51
TOTAL DUE 8,501.21
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE
A D~~IINn_ SI'I' RI'VERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
REV-1470 EX (6-S8)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENTS NAME
HOSTETTER,ROBERT
REVIEWED BY
LARRY SZOLLOSY
ITEM
SCHEDULE NO.
INHERITANCE TAX
EXPLANATION
OF CHANGES
FILE NUMBER
ACN
EXPLANATION OF CHANGES
2101-0466
101
F-J
Jointly-owned property and specific bequest are taxable outright before residue.
ROW
Page 1
1 ~~3{) J t/
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
ROSER S REIST
SHIRK ETAL
PO BOX 1552
LANCASTER
ReC()i DATEA
ESTATE OF
DATE OF DEATH
FILE NUMBER
'02 MAR -1 cbUN:tYl
ACN
PA 17608
CI<E'{ \
Cumbe"
c..-/
'*
REY-li01 EX AFP 181-D21
02-25-2002
HOSTETTER
04-21-2001
21 01-0466
CUMBERLAND
101
Allount Reid tted
ROBERT
R
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
RESISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, subllit the upper portion of this fOri! with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV:i61jj-ix--AFP--foY:02Y------...--iNHERiTANCE-TAX--STAfEMENi-ifF"-Accouiif--...---------------------
ESTATE OF HOSTETTER ROBERT R FILE NO. 21 01-0466 ACN 101 DATE 02-25-2002
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 02-26-2002
P R I NCI PAL TAX DUE: ...........................................................................................................................................................................................................................
PAYMENTS (TAX CREDITS):
8,430.70
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
01-10-2002 CDOO0743 .00 8,437.83
TOTAL TAX CREDIT 8,437.83
BALANCE OF TAX DUE 7.13CR
INTEREST AND PEN. .00
IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 7.13CR
.
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRl,
- -.-- . ---...... '"cc D~U~RS.E SIDE OF THIS FORM FOR INSTRUCTIONS. l
E
---
COMMONWEALTH OF PENNSYL VANIA
COURT OF COMMON PLEAS OF CUMBERLAND COUNTY
ORPHANS' COURT DIVISION
IN THE ESTATE OF
ROBERT R. HOSTETTER
)
)
)
)
)
)
No. 21-2001-0466
Late of Middlesex Township
Deceased
RELEASE
KNOW ALL MEN BY THESE PRESENTS that the undersigned does hereby acknowledge that she this
day has and received of and from Eugene R. Hostetter, personal representative of the above named decedent, the
following items and/or sums set opposite his name, to wit:
TO: Ellen Martin, specific bequest
Grandfather's watch
$200.00
said distribution being in full satisfaction of the terms of second paragraph ofthe Last Will and Testament of Robert
R. Hostetter dated February 27,2001.
THEREFORE, the undersigned hereby releases the personal representative of the above Estate, their
representatives and successors and the Estate itself with respect to the distribution of the stated specific bequest.
I
EXECUTED this 50~ day of 1)e(t~ , 200~.
~~~
...- .,>"".
..,';0..'
"..
~
'-'
r-'-.l
--
~i'<\~Q~
Ellen Martin
;::r;-'
~~
I
N
~-~)
-i.,-;~'
)
) SS:
)
. j -<<-A.....
On this 30 TIt day of Decek, 2006.., before me, a Notary Public in and for said County and State,
personally appeared ELLEN MARTIN and acknowledged the foregoing RELEASE to be her act and deed and
desired the same to be recorded as such.
STATE OF CALIFORNIA
COUNTY OF Safl f1tnwcL<.rw
WITNESS my hand and Notarial Seal the day and year aforesaid.
~ e of~
J- . Notary Pubhc 0
My commission expires: . NANCY E. LONGO (
- Comm. # 1320301
U) NOTARY PUBLIC. CALIFORNIA (J)
San Bernardino County -
My Comm. Expires Sept. 8, 2005-
COMMONWEAL TH OF PENNSYLVANIA
COURT OF COMMON PLEAS OF CUMBERLAND COUNTY
ORPHANS' COURT DIVISION
IN THE ESTATE OF
ROBERT R. HOSTETTER
)
)
)
)
)
)
No. 21-2001-0466
Late of Middlesex Township
Deceased
RELEASE
KNOW ALL MEN BY THESE PRESENTS that the undersigned does hereby acknowledge that she this
day has and received of and from Eugene R. Hostetter, personal representative of the above named decedent, the
following items and/or sums set opposite his name, to wit:
TO: Sharon Dickinson
jewelry as per appraisal
$70.00
said distribution at the discretion of the executor in satisfaction of the terms of fourth and sixth paragraphs of the
Last Will and Testament of Robert R. Hostetter dated February 27,2001.
THEREFORE, the undersigned hereby releases the personal representative of the above Estate, their
representatives and successors and the Estate itself with respect to the distribution.
EXECUTED this 30+~ day of ~
I
, 200~.
~~.4.cA:~
Sharon Dickinson
STATE OF CALIFORNIA )
) SS:
COUNTY OF S~l n )1= (nO- reL<. no)
. 0 I ulU,
On this 3J TH day of ce (! , 200~, before me, a Notary Public in and for said County and State,
personally appeared SHARON DICKINSON and acknowledged the foregoing RELEASE to be her act and deed
and desired the same to be recorded as such.
COMMONWEALTH OF PENNSYLVANIA
COURT OF COMMON PLEAS OF CUMBERLAND COUNTY
ORPHANS' COURT DIVISION
--
}::::
;,.....-
ROBERT R. HOSTETTER
)
)
)
)
)
)
No. 21-01-0466
In the Estate of:
Late of Middlesex Township
Deceased
OUT -OF-COURT DISTRIBUTION AGREEMENT
In this document, these words mean:
DECEDENT refers to
ROBERT R. HOSTETTER
FIDUCIARY refers to
EUGENE R. HOSTETTER
BENEFICIARY refers to
SHARON DICKINSON
ELLEN MARTIN
HARRISBURG CHURCH OF GOD
EUGENE R. HOSTETTER
BENEFICIARY assumes certain risks by executing this document. These risks have
been explained by Shirk, Reist, Wagenseller and Mecum, or BENEFICIARY has decided no
explanation is necessary.
This document is intended to save money by avoiding normal court proceedings, but yet
to protect FIDUCIARY.
BENEFICIARY, intending to be legally bound, agrees to all of the following, and claims
all statements to be fully correct:
1. Only BENEFICIARY is entitled to the entire residue of the Estate of Robert R.
Hostetter. All parties who are listed above as BENEFICIARY will be bound individually and
together to all matters in this document.
2.
A.
FIDUCIARY has not asked for any audits from the Internal Revenue
Service, Commonwealth of Pennsylvania or any other income taxing body, nor has FIDUCIARY
given notice as may be required under the Internal Revenue Code and other laws to taxing
authorities of the death of DECEDENT or of the FIDUCIARY'S qualification.
B. Since FIDUCIARY for the benefit of BENEFICIARY will be personally
liable for such taxes, etc. and is assuming the risk that no such taxes are due, at FIDUCIARY'S
request, BENEFICIARY will reimburse FIDUCIARY fully, if any taxes, etc. are found due.
3. A. BENEFICIARY desires to have this estate settled as soon as possible and
with the least amount of cost.
B. For this reason, FIDUCIARY and Shirk, Reist, Wagenseller and Mecum
are hereby instructed to proceed accordingly without going through court audit proceedings.
C. BENEFICIARY releases, remises, quitclaims and discharges
FIDUCIARY and Shirk, Reist, Wagenseller and Mecum of and from any liability of any nature
whatsoever by virtue of this estate not having been settled through court audit proceedings and
agrees to reimburse them fully as to any such liability.
4. A. Should additional creditors appear after the inheritance tax is paid, the
expenses of securing a refund of the inheritance tax may well exceed the excess tax which would
have been paid (because the deduction for that additional expense was not taken at the original
time of payment of the tax).
B. BENEFICIARY agrees to waive any such refund.
5. A. Any creditor of DECEDENT or of this estate who has not been paid can
require a formal accounting be filed with the court.
2
B. FIDUCIARY has stated that FIDUCIARY does not know of any such
creditor at this time. If any such unexpected creditor makes a claim, this will involve additional
expenses, costs, filing fees and attorney fees.
C. Rather than incur the delay and expense of a formal court accounting,
BENEFICIARY agrees to be personally liable for any such sums which have not been paid and
for all expenses relating thereto.
6. A. A normal fee due and owing in Lancaster County for the settlement of this
estate would be $9,023.55.
B. Shirk, Reist, Wagenseller and Mecum are satisfied to accept a lesser fee of
$8,121.19; because less responsibility and work is required, since no formal accounting is to be
filed with the Orphans' Court Division.
C. However, BENEFICIARY agrees that the balance will be due, plus
additional charges, should a formal court accounting be required at some future time.
7. A. BENEFICIARY hereby acknowledges that all facts in connection
with the administration of the above named estate have been made available to BENEFICIARY,
that BENEFICIARY has had the opportunity to consult counsel, and that BENEFICIARY has
made or caused to have been made such inquires and has examined or caused to be examined
such books or records of FIDUCIARY as in BENEFICIARY'S opinion or in the opinion of
BENEFICIARY'S counsel were necessary or advisable to acquaint BENEFICIARY fully with
all of the facts relative to the operation of the above named estate.
B. The accounting set forth on the pages attached to this document
has been read in detail by BENEFICIARY and is fully understood by BENEFICIARY.
3
C. BENEFICIARY has received, or will receive upon the execution of this
Agreement, the balance shown thereon due to BENEFICIARY.
.
D. BENEFICIARY, therefore, hereby releases, quitclaims and forever
discharges FIDUCIARY, Shirk, Reist, Wagenseller and Mecum and the estate of DECEDENT of
and from any liability to BENEFICIARY of any nature whatsoever pertaining to the estate of
DECEDENT.
8. A.
The provisions of this Paragraph shall not be limited by anything else in
this document in any way.
B. Should the distribution made hereunder in any way be improper or
incorrect, BENEFICIARY agrees to indemnify and save harmless FIDUCIARY fully.
C. An improper or incorrect distribution shall include, but is not limited to:
1. Additional debts being incurred;
2. Additional claims being made against the estate;
3. Taxes not known to be due but being found to be due; and
4. Other persons making claims for a share of the estate.
D. Payment by BENEFICIARY to FIDUCIARY shall be made immediately
upon demand.
E. Payment shall include any costs incurred by FIDUCIARY, including, but
not limited to: accountant fees, lawyer fees, taxes, penalties, interest, costs (court and otherwise),
expenses of collection (including all of the foregoing), and any other expenditures relating to the
protection of FIDUCIARY and/or the estate of DECEDENT.
F. All who sign this document warrant that they know of no claimant against
4
the decedent who has not been paid and that they know of no beneficiary, heir or next of kin who
claims to be entitled to share in the residue of this estate who is not listed as a BENEFICIARY
above.
G. No paYment required of BENEFICIARY shall exceed the total distribution
to BENEFICIARY, except in the case of fraud or misrepresentation by that BENEFICIARY.
9..
BENEFICIARY is bound hereby personally and binds the
respective heirs, legal representatives, successors and assigns of BENEFICIARY.
10.
This document and any attachments have been read in full.
/ I M day of
" !
11121'L
,2002.
EXECUTED this
WITNESSES:
O-i1l1~ ?-;J~
~(X 3~'vu
~L~/L X~' ~
SHARON DICKINSON
ELLEN MARTIN
HARRISBURG CHURCH OF GOD
EUGENE R. HOSTETTER
5
the decedent who has not been paid and that they know of no beneficiary, heir or next of kin who
claims to be entitled to share in the residue ofthis estate who is not listed as a BENEFICIARY
above.
G. No payment required of BENEFICIARY shall exceed the total distribution
to BENEFICIARY, except in the case of fraud or misrepresentation by that BENEFICIARY.
9..
BENEFICIARY is bound hereby personally and binds the
respective heirs, legal representatives, successors and assigns of BENEFICIARY.
10.
This document and any attachments have been read in full.
I~ pf\~ J
II
day of
,2002.
EXECUTED this
WITNESSES:
t:1<~~,
SHARON DICKINSON
(QQ Ov~ fYla.t-{:-
ELLEN MARTIN
HARRISBURG CHURCH OF GOD
EUGENE R. HOSTETTER
5
the decedent who has not been paid and that they know of no beneficiary, heir or next of kin who
claims to be entitled to share in the residue of this estate who is not listed as a BENEFICIARY
above.
G. No payment required of BENEFICIARY shall exceed the total distribution
to BENEFICIARY, except in the case of fraud or misrepresentation by that BENEFICIARY.
9..
BENEFICIARY is bound hereby personally and binds the
respective heirs, legal representatives, successors and assigns of BENEFICIARY.
10. This document and any attachments have been read in full.
EXECUTED this
1ti
day of /f." tf4 L
,2002.
WITNESSES:
SHARON DICKINSON
ELLEN MARTIN
~ ofj
~GC C~
EUGENE R. HOSTETTER
5
the decedent who has not been paid and that they know of no beneficiary, heir or next of kin who
claims to be entitled to share in the residue of this estate who is not listed as a BENEFICIARY
above.
G. No payment required of BENEFICIARY shall exceed the total distribution
to BENEFICIARY, except in the case of fraud or misrepresentation by that BENEFICIARY.
9..
BENEFICIARY is bound hereby personally and binds the
respective heirs, legal representatives, successors and assigns of BENEFICIARY.
10. This document and any attachments have been read in full.
EXECUTED this I ~-t "-
WITNESSES:
day of
April
,2002.
SHARON DICKINSON
ELLEN MARTIN
HARRlSBURG CHURCH OF GOD
~STETTER
5
SCHEDULE A
RECEIPTS OF PRINCIPAL
CASH:
04/21/01
Cash - found in wallet of
decedent
11/29/01
Claremont Nursing and
Rehabilitation Center - refund
03/20/02
Pennsylvania Department of
Revenue - refund of
inheritance tax
04/21/01
Polyclinic Hospital tdba
pinnacle Health Hospital,
Bedford F. Boylston MO, FACS
and Shaffer Cardiovascular
Associates, LTD - litigation
settlement
PERSONAL PROPERTY:
04/21/01
Jewelry - value per appraisal
by Brent L. Miller
33.00
147.24
7.13
181,218.24
270.00
TOTAL RECEIPTS OF PRINCIPAL...............
6
Fiduciary
Acquisition
Value
181,405.61
270.00
181,675.61
--------------
--------------
06/08/01
06/05/01
06/07/01
06/13/01
07/14/01
01/03/02
SCHEDULE C
DISBURSEMENTS OF PRINCIPAL
SCHEDULE C-2
FUNERAL EXPENSES
Hoffman-Roth Funeral Home -
funeral bill
4,330.00
TOTAL FUNERAL EXPENSES..............................
SCHEDULE C-3
ADMINISTRATION EXPENSES
Bank of Lancaster County -
checkbook fee
22.00
Brent L. Miller - jewelry
appraisal fee
100.70
The Sentinel - estate notice
publication
84.11
Postmaster - stamps
34.00
Register of wills - probate
fee
247.00
Cumberland Law Journal -
estate notice publication
75.00
Shirk, Reist, Wagenseller and
Mecum - reimbursement of
costs advanced as follows:
Register of wills, short
certificates $20.00,
photocopies $1.00, notary fees
$2.00, fax transmission
$10.00 and inheritance tax
filing fee $63.00
96.00
Shirk, Reist, Wagenseller and
Mecum - Client's Fund
RESERVED for acknowledgments
and affirmations to, and
filing of releases,
affidavits, etc.; notary fees
(if any) and other
miscellaneous expenses
necessary to close out estate
300.00
TOTAL ADMINISTRATION EXPENSES.......................
7
4,330.00
958.81
01/10/02
SCHEDULE C-4
FEDERAL AND STATE TAXES
Register of Wills - payment
of inheritance tax
8,437.83
TOTAL FEDERAL AND STATE TAXES.......................
SCHEDULE C-5
FEES AND COMMISSIONS
Eugene R. Hostetter -
executor fee (5% of
$100,000.00 = $5,000.00 + 4%
of $81,668.48 = $3,266.74)
8,266.74
Shirk, Reist, Wagenseller and
Mecum - attorney fee (7% of
$25,000.00 = $1,750.00 + 6%
of $25,000.00 = $1,500.00 +
5% of $50,000.00 = $2,500.00
+ 4% of $81,668.48 =
$3,266.74 + 1% of $680.86
$6.81 for a total of
$9,023.55 less 10% or
$902.36)
8,121.19
TOTAL FEES AND COMMISSIONS..........................
TOTAL DISBURSEMENTS OF PRINCIPAL............. .......
8
8,437.83
16,387.93
30,114.57
Sharon Dickinson
02/05/02
SCHEDULE D
DISTRIBUTIONS OF PRINCIPAL TO BENEFICIARIES
advance distribution
01/28/02
Harrisburg Church of God Seventh Day
advance distribution
Eugene R. Hostetter
01/16/02
Ellen Martin
01/28/02
advance distribution
advance distribution
TOTAL DISTRIBUTIONS TO BENEFICIARIES......
9
10,000.00
10,000.00
10,000.00
10,000.00
40,000.00
--------------
--------------
SCHEDULE G
RECEIPTS OF INCOME
SCHEDULE G-2
INTEREST
Bank of Lancaster County
06/11/01 interest on estate account 0.33
07/11/01 interest on estate account 0.11
01/10/02 interest on estate account 10.13
02/11/02 interest on estate account 61.62
03/11/02 interest on estate account 59.96
--------------
TOTAL INTEREST INCOME.. ...... .............
TOTAL RECEIPTS OF INCOME.. ................
10
132.15
132.15
132.15
SUMMARY OF ACCOUNT
Estate of Robert R. Hostetter, Deceased
For Period of 04/21/2001 through 03/26/2002
Page
Proposed Distributions
to Beneficiaries
PRINCIPAL
Receipts:
Per Inventory Filed
This Account
Net Gain (or Loss) on Sales
or Other Disposition
Less Disbursements:
Debts of Decedent
Funeral Expenses
Administration Expenses
Federal and State Taxes
Fees and Commissions
Family Exemption
Balance before Distributions
Distributions to Beneficiaries
Principal Balance on Hand
For Information:
Investments Made
Changes in Investment Holdings
INCOME
Receipts:
This Account
Net Gain (or Loss) on Sales
Less Disbursements
Balance Before Distribution
Distributions to Beneficiaries
Income Balance on Hand
Investments Made
Changes in Investment Holdings
COMBINED BALANCE ON HAND
Current
Value
0.00
---------------
---------------
0.00
4,330.00
958.81
8,437.83
16,387.93
0.00
11
Fiduciary
Acquisition
Value
0.00
---------------
---------------
181,675.61
0.00
181,675.61
30,114.57
151,561.04
40,000.00
111,561.04
132.15
0.00
132.15
0.00
132.15
0.00
132.15
111,693.19
---------------
---------------
RECAPITULATION
Estate account
$128,282.12
In Kind -
Jewelry
270.00
Less Not Yet Paid
(16,858.93)
BALANCE AVAILABLE FOR DISTRIBUTION
$111,693.19
SCHEDULE OF DISTRIBUTION
TO: Sharon Dickinson, daughter, personal property per Paragraph
Fourth and 25% of residue per Paragraph Third of Last Will and
Testament dated February 27,2001
Cash
Personal property
$27,855.79
70.00
$ 27,925.79
TO: Ellen Martin, daughter, grandfather watch per Paragraph Second
and 25% of residue per Paragraph Third of Last Will and Testament
dated February 27,2001
Cash
Grandfather watch
$27,855.80
200.00
28,055.80
TO: Eugene R. Hostetter, brother, 25% of residue per Paragraph Third
of Last Will and Testament dated February 27, 2001 27,855.80
TO: Harrisburg Church of God Seventh Day, 25% of residue Paragraph
Third of Last Will and Testament dated February 27, 2001 27,855.80
$111,693.19
* This Schedule of Distribution represents
assets received to date. Any additional assets
received as a result of additional litigation
settlements will be reported to all beneficiaries
on a supplemental account and supplemental schedule
of distribution
12
COUNTY OF LANCASTER
)
)
)
SS:
COMMONWEAL TH OF PENNSYLVANIA
EUGENE R. HOSTETTER, being duly affirmed according to law, declares and says that
she is the Executor of the estate of ROBERT R HOSTETTER, deceased and that the foregoing
ACCOUNT is true and correct, to the best of his knowledge, information and belief.
~~
Eugene Hostetter
Mfirmed and subscribed to
of
/~
before me this day
,
, 2002.
My commission expires:
t "-""~'-"- "'-~'
,
I' '. . Notarial Seal
Elizabeth C. Neuer, Notary Public
. Lanc~st.er, Lancaster County
.. !!-Y 9..0mmISSlon Expires Sept. 10, 2002
STATE OF CALIFORNIA
COUNTY OF San ~Q.n~ ~
)
)
)
SS:
On this J I TI+ day of A P n 2002, before me, the undersigned
officer, personally appeared SHARON DICKINSON, known to me (or satisfactorily proven) to
be the person whose name is subscribed to the within OUT-OF-COURT DISTRIBUTION
AGREEMENT, and acknowledges the same to be his/her act and deed and further affirms that
the facts set forth in said document are true and correct to the best of his /her knowledge,
information and belief, .
JOe" & '~~g~ JR~l, h.?!d and notarial seal the day and year aforesaid.
rfANCY E. LONGO
I/J- Comm #1320301 ':!J (Jd
NOT ~RY PU8LiC. CAlIFOIINIA (J)~ ~ .
San lIfrnlldino County _ - .. - - ( . ~ 91;
My Comm ExplIes Sept. a, 200S"" (j (SEAL)
tary Public
STATE OF CALIFORNIA
COUNTY OF s:a fL 8e.rY\ CVY ulA. i'~
)
)
)
SS:
On this J I TH day of /1 P n I 2002, before me, the undersigned
officer, personally appeared ELLEN MARTIN, known to me (or satisfactorily proven) to be the
person whose name is subscribed to the within OUT -OF-COURT DISTRIBUTION
AGREEMENT, and acknowledges the same to be his/her act and deed and further affirms that
the facts set forth in said document are true and correct to the best of his /her knowledge,
information and belief.
WITNESS my hand and notarial seal the day and year aforesaid.
Xe N~NCY E.. LONGO &1:. ~. (I fl
Comm. # 13203Ql ( .c;f rh.
.... ......, "'1I,.."1I"''''' ~ ~ 118'" (SEAL)
,,~ San Ber~itdifio County ..... P bl'
~ My Comm. Expi~e~ Sept. ~,.2~~~ otary u IC
r--.... y
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF Yo.lU{
)
)
)
SS:
On this Vrr day of A .,o~/' / ,2002, before me, the undersigned
officer, personally appeared l3 fi. q ceE 2:>.. C"I C.5.AJ €y , who acknowledged
~erselfto be the ?45ro/1.. of THE HARRISBURG CHURCH
~GOD and that he/she as such officer, being authorized to do so, executed the foregoing OUT-
OF-COURT DISTRIBUTION AGREEMENT for the purpose therein contained by signing the
name of 7!>Il..U C-C .1) C HiJ N t2.y as r:'AJlo/t.
,
IN WITNESS WHEREOF, I have hereunto set my hand and Notarial Seal.
My Commission expires: 7 -3/~)/
~~-~~
I Notary Public
Notarial Seal
Patricia A. Gordon. NotaIY Public
Fairview Twp., York County
My Commission Expires July 31. 2005
Member, Pennsylvania Association of Notartes
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF LANCASTER
)
)
)
SS:
On this day of 2002, before me, the undersigned
officer, personally appeared EUGENE R. HOSTETTER, known to me (or satisfactorily proven)
to be the person whose name is subscribed to the within OUT -OF-COURT DISTRIBUTION
AGREEMENT, and acknowledges the same to be his/her act and deed and further affirms that
the facts set forth in said document are true and correct to the best of his /her knowledge,
information and belief.
WITNESS my hand and notarial seal the day and year aforesaid.
(SEAL)
Notary Public
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX{11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REIST ROGER S ESQUIRE
POBOX 1552
LANCASTER, PA 17608-1552
-------- fold
ESTATE INFORMATION: SSN: 164-28-3784
FILE NUMBER: 2101-0466
DECEDENT NAME: HOSTETTER ROBERT R
DATE OF PAYMENT: 11/05/2002
POSTMARK DATE: 11/04/2002
COUNTY: CUMBERLAND
DATE OF DEATH: 04/21/2001
NO. CD 001812
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $685.82
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: EUGENE R HOSTETTER
C/O ROGER S REIST ESQUIRE
CHECK#1023
SEAL
INITIALS: CW
RECEIVED BY:
REGISTER OF WILLS
$685.82
MARY C. LEWIS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT,280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REIST ROGER S ESQUIRE
POBOX 1552
LANCASTER, PA 17608-1552
n___n_ fold
ESTATE INFORMATION: SSN: 164-28-3784
FILE NUMBER: 2101-0466
DECEDENT NAME: HOSTETTER ROBERT R
DATE OF PAYMENT: 12/23/2002
POSTMARK DATE: 12/20/2002
COUNTY: CUMBERLAND
DATE OF DEATH: 04/21/2001
NO. CD 001976
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
501 I $2.92
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$2.92
REMARKS: ROGER S REIST ESQUIRE
CHECK# 046145
SEAL
INITIALS: CW
RECEIVED BY:
REGISTER OF WILLS
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
STATUS REPORT UNDER RULE 6.12
/
""
(/./
Ot)
Name of Decedent :
Robert R. Hostetter
Date of Death :
April 21, 2001
21-01-0466
Estate Number:
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 X
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete: July 1,2003
3. If the answer to No.1 is Yes, state the following:
A. Did the personal representative file a formal final account with the court?
Yes No
B. Did the personal representative state an account informally to the parties
in interest? Yes No
C. Did the personal representative file approvals of the account, receipts,
joinders and releases with the Clerk of Orphans' Court?
Yes No
D. Did the personal representative complete final distribution?
Yes No
Date: ?~/7-f!J Signature ~~ 1_ /f'f
Capacity: Personal Representative Name Roger S. Reist
X Counsel for Personal
Address P.O. Box 1552
Representative Lancaster P A 17608-1552
Telephone 717-394-7247
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 3/10/2003
EUGENE HOSTETTER
2041 HARROGATE ROAD
LANCASTER, PA 17601
RE: Estate of HOSTETTER ROBERT R
File Number: 2001-00466
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after
July I, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing will become delinquent on: 4/21/2003
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
cc:V File
Counsel
Judge
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 002525
DUPLICA TE
REIST ROGER S ESQUIRE
POBOX 1552
LANCASTER, PA 17608-1552
-------- fold
ESTATE INFORMATION: SSN: 164-28-3784
FILE NUMBER: 2101-0466
DECEDENT NAME: HOSTETTER ROBERT R
DATE OF PAYMENT: 05/05/2003
POSTMARK DATE: 05/02/2003
COUNTY: CUMBERLAND
DATE OF DEATH: 04/21/2001
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $479.11
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: ROGER S REIST ESQUIRE
CHECK# 046514
SEAL
INITIALS: CW
RECEIVED BY:
REGISTER OF WILLS
$479.11
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REIST ROGER S ESQUIRE
POBOX 1552
LANCASTER, PA 17608-1552
---~---- told
ESTATE INFORMATION: SSN: 164-28-3784
FILE NUMBER: 2101-0466
DECEDENT NAME: HOSTETTER ROBERT R
DATE OF PAYMENT: 06/17/2003
POSTMARK DATE: 06/16/2003
COUNTY: CUMBERLAND
DATE OF DEATH: 04/21/2001
NO. CD 002687
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
502 I $1.38
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: ROGER S REIST ESQUIRE
CHECK# 048258
SEAL
INITIALS: VZ
RECEIVED BY:
REGISTER OF WILLS
$1.38
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
\
/6 '"' OU)o .. y
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG. PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*
REY-16D7 EX UP 101-021
ROGER S REIST
SHIRK ETAL
PO BOX 1552
LANCASTER
DATE
ESTATE OF
DATE OF DEATH
'02 flrJD 12 p 1 'r; I'ILE NUMBER
I. 1\ ,'-- '-bOUNTY
ACN
03-18-2002
HOSTETTER
04-21-2001
21 01-0466
CUMBERLAND
101
ROBERT
R
.... .
t..l~ ',:;:;
PA 176dipnL;,
Allount Rellitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV=i60j-EX--AFP--foY=02Y------...--iNiiiiiTANCE-TAX-STATEMENT-OF'-Accouiff--.-..------------------ ---
ESTATE OF HOSTETTER ROBERT R FILE NO. 21 01-0466 AtN 101 DATE 03-18-2002
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND. IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 02-26-2002
P R I NCI PAL T AX DUE: ..............................................................................................................._.....................................................................................................
8.430.70
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
01-10-2002 CDOO0743 .00 8.437.83
03-04-2002 REFUND .00 7.13-
TOTAL TAX CREDIT 8,430.70
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
!Ii
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRl,
-- -- . --~...... c,,,::c D~U~RS" SIDE OF THIS FORM FOR INSTRUCTIONS. l
/6-,;2.$D -,y
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
'*
REV-16D7 EX AFP (0I-D2)
ROGER S REIST
SHIRK ETAL
PO BOX 1552
LANCASTER
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
12-09-2002
HOSTETTER
04-21-2001
21 01-0466
CUMBERLAND
501
ROBERT
R
Allount Rellitted
r~. 17608
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV=i6o-,-Ex--AFP-foY=o2Y------..i'-iNHERITANCE--TAx-si'jrfEMENT-OF'-ACCoUiff--...---------------- -----
ESTATE OF HOSTETTER ROBERT R FILE NO.21 01-0466 ACN 501 DATE 12-09-2002
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 12-10-2002
P R I N C I PAL TAX DUE: ........................................................................................................................................................."................................................................
685.82
PAYMENTS (TAX CREDITS):
BAL
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
1l-04-2002 CDOO1812 .00 685.82
ANCE OF UNPAID INTEREST/PENALTY AS OF 11-05-2002 TOTAL TAX CREDIT 685.82
BALANCE OF TAX DUE .00
INTEREST AND PEN. 2.92
IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 2.92
.
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR),
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
/~-026'o-y
~ BUREAU .~ INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
ROGER S REIST
SHIRK ETAL
PO BOX 1552
LANCASTER
\:
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
f::OUM'rV :i I
ACN
12-10-2002
HOSTETTER
04-21-2001
21 01-0466
CUMBERLAND
501
*'
REY-1S47 EX AFP (01-02>
ROBERT
R
Allount Rellitted
PA 17608
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV =is4j-Ex--AFP-foY=o2Y-NoYicE--oF-YNHEifiTAifcE-YA"irA-ppfiA-isEMENT~--ALi-oWAifcE-C'-R-------------- ---
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF HOSTETTER ROBERT R FILE NO. 21 01-0466 ACN 501 DATE 12-10-2002
TAX RETURN WAS: ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: LITIGATION RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
4. Mortgages/Notes Receivable (Schedule D) (4)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
.00
.00
.00
.00
14.126.30
.00
.00
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
(10)
1,063.00
.00
(11)
(12)
(13)
(14)
NOTE: I~ an assessment was issued previously, lines
re~lect ~igures that include the total o~ ALL
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate (15)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate (17)
18. Allount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
(8)
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
14,126.30
1.063 00
13,063.30
3,265.82
9,797.48
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
.00 X 00 =
6,531.66 X 045=
3,265.82 X 12 =
.00 X 15 =
(19)=
.00
293.92
391. 90
.00
685.82
r",uncn NC\.C.Lr"' l+J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
11-05-2002 CDOO1812 .00 685.82
BALANCE OF UNPAID INTEREST/PENALTY AS OF 11-06-2002 TOTAL TAX CREDIT 685.82
BALANCE OF TAX DUE .00
INTEREST AND PEN. 3.04
TOTAL DUE 3.04
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A RI"FUND_ SI"I" RI"UFRSF STn~ n~ TWTS ~nDM ~nD T..C::TDllrTTn..c:: ~
REV-1470 EX (6-88)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENTS NAME
HOSTETTER,ROBERT
REVIEWED BY
LARRY SZOLLOSY
ITEM
SCHEDULE NO.
INHERITANCE TAX
EXPLANATION
OF CHANGES
E 1
Interest is effective 10-10-2002.
EXPLANATION OF CHANGES
ROW
FILE NUMBER
ACN
2101-0466
501
Page 1
/6-d8o - ~
BUREAU OF INDIVIDUAL TAXES
~INHERITANCE TAX DIVISION
"6EPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
1'1
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
06-16-2003
HOSTETTER
04-21-2001
21 01-0466
CUMBERLAND
502
'03
JUN 20
j!11 8
/;1 i :3
ROGER S REIST
SHIRK ETAL
PO BOX 1552
LANCASTER
'*
REV-1S47 EX AFP (01-03'
ROBERT
R
Amount Remitted
C.:,
P A f-ti6U8 ~
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV=is4-j-Ex-AFP--coY=03Y-NoYIcE-oF-YNHEifITAN-cE-Yix-APPRAISEMENT-,--iLi-oWAN-cE-o-i-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF HOSTETTER ROBERT R FILE NO. 21 01-0466 ACN 502 DATE 06-16-2003
TAX RETURN WAS: ( ) ACCEPTED AS FILED
( X) CHANGED
SEE ATTACHED NOTICE
If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of !hh returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate
16. Amount of Line 14 taxable at Lineal/Class A rate
17. Amount of Line 14 at Sibling rate
lB. Amount of Line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS'
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: LITIGATION RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
4. Mortgages/Notes Receivable (Schedule D) (4)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
.00
.00
.00
.00
11,671.41
.00
.00
(B)
B.
Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
(9)
(10)
2,545.55
.00
Cl1)
Cl2)
Cl3)
Cl4)
12.
13.
14.
Net Value of Tax Return
Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
Net Value of Estate SUbject to Tax
NOTE:
Cl5)
Cl6)
(17)
(18)
.00 X
4,562.93 X
2,281.46 X
.00 X
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
11,671.41
?1i41i.1i1i
9,125.86
2,281.47
6,844.39
00
045 =
12 =
15
.00
205.33
273.78
.00
479.11
Cl9)=
.
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
05-05-2003 CD002525 .00 479.11
BALANCE OF UNPAID INTEREST/PENALTY AS OF 05-06-2003 TOTAL TAX CREDIT 479.11
BALANCE OF TAX DUE .00
INTEREST AND PEN. 1. 38
TOTAL DUE 1. 38
* IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN *1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
REV-1470 EX (5-88)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENTS NAME
HOSTETTER, ROBERT
REVIEWED BY
LARRY SZOLLOSY
INHERITANCE TAX
EXPLANATION
OF CHANGES
ITEM
SCHEDULE NO. EXPLANATION OF CHANGES
E 1 Interest is effective 04-15-2003.
ROW
FILE NUMBER
ACN
2101-0466
502
Page 1
/,~. Q,,"qCJ. Y
,,/ BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z8060l
HARRISBURG, PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*'
REY-16D7 EX AFP 101-031
'03 JUL 11
[1.11 :28
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
07-07-2003
HOSTETTER
04-21-2001
21 01-0466
CUMBERLAND
502
ROBERT
R
ROGER S REIST
SHIRK ETAL
PO BOX 1552
LANCASTER
Allount Rellitted
l. -.
PA 1 ttd~,t:
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE~ PA 17013
NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV:i60-j-EiCAFP-foY:03Y------...--iNifERifANCE-TAX-STiffEHENT-OF-ACCouiif--i'..------------------ ---
ESTATE OF HOSTETTER ROBERT R FILE NO. 21 01-0466 ACN 502 DATE 07-07-2003
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE~ APPLICATION OF ALL PAYHENTS~ THE CURRENT BALANCE, AND~ IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 06-16-2003
P R I NC I PAL TAX DU E : m..................m.................m..m..m...m................m..........m.......m............m.................m..m...m.......................................................................
479.11
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
05-05-2003 CD002525 .00 479.11
06-16-2003 CD002687 1.38- 1.38
TOTAL TAX CREDIT 479.11
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
IF PAID AFTER THIS DATE~ SEE REVERSE TOTAL DUE .00
II
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A '"CREDIT'" (CR),
vnll lOA V RS: nllS: " REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
~/
oK-
STATUS REPORT UNDER RULE 6.12
Name of Decedent : Robert R. Hostetter
Date of Death : April 21, 2001
Estate Number: 21-01-0466
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 t/ I 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 formal final account with the
court?
I.NO 0
Yes
B. Did the personal representative state an account informally to the
parties in interest?
Yes I t/ l No D
C. Did the personal representative file approvals of the account, receipts,
joinders and releases with the Clerk of Orphans' Court?
Yes I t/ l No D
D. Did the personal representative complete final distribution?
Yes I t/ l No D
Date :
" /0/'1>/"1
Capacity: D Personal Representative
,0 Counsel for Personal
I
Representative
Signature
Name
,!/.7.,-f, ~~
Roger S. Reist
Address PO Box 1552
Lancaster P A 17608-1552
Telephone (717) 394-7247