HomeMy WebLinkAbout01-0539
REV-15llOEX+(&-OO)
'~.ffl
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT, 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I-
Z
W
a
w
(..)
w
a
DECEDENfS NAME (LAST, FIRST, AND MIDDLE INITIAL)
Hovetter, J. Earl a1k1a Jose h Earl
DATE OF DEATH (MMDD-Yea)
DATE OF BIRTH (MMDD-Yearl
04/12/2001 08/08/1918
(IF APPUCABl.E) SVRVMNG SPOUSE"S NAME (LAST, FIRST. ANO MIDDLE INITlAl)
Aida D. Hovetter
w
....
..
"ii!r:!
0"0
~~g
0....
~
00 1. Original Retum
o 4. Limited Estate
00 6. Oecedent Died Testate __dWWI
o 9. Litigation Proceeds Received
o 2. Supplemental Return
00 4a. Future Interest Compromise (daDt of death alter 12-12-82)
o 7. Decedenl Maintained a LiVing Trust_h""dT""'l
o 10. Spousal Poverty Credit (dNrAcIe8lhbllween 1l-31-91 and 1-1-951
OfFICIAl USE ONLY
G
/ 6-c2,so- - ~
FilE NUMBER
2 1 -0 1 0 5 3 9
CO\JNTYCOOE -YEAA- - - NUMBER- -
SOCIAL SECURITY NUMBER
2 04- 0 1 - 5 3 0 7
THIS RETURN MUST BE fILED IN DUPllCAl'E W\TH THE
REGISTER OF WILLS
SOCiAl SECURITY NUMBER
o 3. Remainder Retum (dateofdeatflpr101'to12-t3-82)
o 5. Federal Estate Tax Return Required
_ 8. Total Number of Safe DeposRBoxes
o 11. ElecIion IDtax under Sec. 9113(A)_"'hO)
....
z
w
Q
~
..
II)
w
'"
'"
o
o
COMPLETE MAILING ADDRESS
1 Irvine Row, Carlisle, PA 17013
NAME
Susan J. Hartman, Es uire
FIRM NAME PfApplicable)
Duncan & Hartman, P.C.
TELEPHONE NUMBER
717-249-7780
(1)
(2)
(3)
(4)
(5)
z
o
5
;:)
l-
ii:
<(
(..)
w
I:t::
1. Real Eslate (Schedule A)
2. Slocl<s and Bonds (Schedule B)
3. Close~ He~ Corporation. Partnership Of Sole-Proplietorship
4. Mortgages & Notes Rece"able (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly OWned Property (Schedule F)
o Separate Billing Requestad
7. lnterNivos Transfers & Miscellaneous Non-Probate Property
(Schedule G Of L)
8. Total Gross Assets (IDtal Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10, Debts ofOocedenl Mortgage Liabilities, & Lions (Schedule I)
11. Tot.1 Deductions (IDtal Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Chamable and GO\lemmental BequestslSec 9113 Trusts for whictl an election to tax has not been
made (Schedule J)
(6)
(7)
(9)
(10)
14. Net Value SUbject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
z
o
~
:J
a.
~
o
(..)
E
15. Amount of Line 14 taxable at the spousal tax
rate. Of transfers under Sec. 9116 (a)(1.2)
218,427.70
106,400.93
16. Amount ofUne 14 taxable at lineal rate
17. Amount olUne 14 taxable atsibliog rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
6,872.67
(8)
15,037.85
1,788.33
(11)
(12)
(13)
(14)
X ~(15)
X .045 (16)
X .12 (17)
X .15 (18)
(19)
20 0
CHECK HERE IF YOU ARE REOUESTING A REFUND OF AN OVERPAYMENT
27,860.00 I
315,~8..g7 f'3
OFFICIAL USE ONLY
:;:,'1,
r"'" ~
:0
:oro
Ci 0
"'i ~~
'-
"'"
z
9,185.00
I
\0
-:l
\..J
0\
I
"
359,636.64
16,826.18
342,810.46
17,981.83
324,828.63
4,788.04
4,788.04
Decedent's ComDlete Address:
STREET'ADORESS 36 W M . S t
. aln tree
CITY I STATE PA I ZIP
Walnut Bottom 17266
Tax Payments and Credits:
1. Tax Due (Page 1 Une 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
4,788.04
7,000.00
239.40
Total Credits (A +8 +C)
(2)
7,239.40
3. InteresVPooal!y ~ applicable
D. Interest
E. Penalty
T otallnteresVPenalty ( D + E )
4. li Une2 is grealerthan Une 1 + Une 3, oolerthe difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Une 1 + Une 3 is greater than Une 2, enter the diffenence. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
J,1~!JliL:)I;IIiI!:I.lrflll~""1ll1r nrr T- 1111 1!1Fln'JaRlllll!lllKillliW!lI'II'!>'
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN .X" IN THE APPROPRIATE BLOCKS
(3)
2,451.36
0.00
0.00
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ........................................................................... 0 ug
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 ug
c. retain a reversionary interest; or ...................................................................................................... 0 ug
d. receive the promise forlffe of either payments, benefrts or care? ............................................................. 0 ug
2. ~ death occurred after December 12, 1982, did decedent transfer properly within one year of death
without receiving adequate consideration?............................................................................................... 0 ug
3. Did decedent own an 'In trust fot" or payable upon death bank actOUnt or security at his or her death? ................. 0 ug
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................................. ........................... .......... ug 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Uodef penallits of pe~ury, I decIa<e thai I have exanined!his return, includ~ accomp<Il.ying sOOedules. aAd sl.a\elllelltS, and \D \he best of rT'r1 ~ CJlO belief, it is true. correct
and ~le.
Declaration 01 preparer other tIlCIl the personal r8pteSefllative is based on allmformallon of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN OA TE
/(t.A.c. IY, ~A....I i4..;. 1/8/02
ADORE S 36 W. Main Street
Walnut Bottom, PA 17266
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
_llid m millUi ~ IV - 1-~IIl~~llli..I._i!IIIlIlim\i1!!!.i~~~ii"ii~0!0ii~!!'!i
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 orlor the use of the surviving spouse is 3%
[72 P.S. ~9116 (a)(1.1) (ill.
For dates of death on or after January 1, 1995, the tax rate imposed on the net value oftransfers to or for the use of the surviving spouse is 0% 172 P.S. ~9116 (a)(l.l) (ii)].
The statute does not exemot a transfer to a surviving spouse from tax, and the stalulory requirements for disclosure of assets and ming a tax return are stili appticabie even if
the survivin9 spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rale 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 oHhe child is 0% [72 P.S. ~9116(a)(1.2)J.
The lax rate imposed on the net value of transfers to ar for the use 01 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 oftransf.... to or for the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)]. A sibling is defined, under Seelion 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV.1502EX"11~7}
SCHEDULE A
REAL ESTATE
COMMONWEALTH O~ PENNSYLVANIA
INHERITANCE TAX RETURN
E
ESTATE OF FILE NUMBER
Hovetter .J Earl a/kla .Joseoh Earl 21 01 0539
All real property owned S41e1y or as a tenant In common mUlt be reported at lair marl<et ....lue. Fair mal1\et value is <letined as the price at which property would be exchanged
between a willing buyer and a willing seller, n,,;ther being IXlmpelled to buy or sell, both having reasonable knowledge of the relevant facls. Real property which is jointly.owned with
right of
survivorshin must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
13.550 acres, High Mountain Road, South Newton Township, Cumberland County
Deed Book 29-"H"-993 assessed value 27,860
VALUE AT DATE
OF DEATH
27,860.00
TOTAL (Also enteron line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
27,860.00
REL426D
CUMBERLAND COUNTY
Public Inquiry
Cntl Number 41 325
Map Number 41-13-0110-017
Old Ref
Grantor
Grantee(1)
(2)
Address
HOVETTER, J EARL
BOX 41
WALNUT BOTTOM PA 17266
SITUS:
R HIGH MOUNTAIN ROAD
R HIGH MOUNTAIN ROAD
T-334
Desc. (1)
(2)
Property Desc. (1)
(2)
(3)
Preferred land Val
land Val
Improvement Val
Mineral Val
F12=Cancel F10=Sales
Vacant Land
1980
27860
Total Value
1980
F5=Taxes
Acreage
SOUTH NEWTON TOWNSHIP
BIG SPRING S.D.
land Use Code
Consideration
Sale Date
Deed Bk/Pg
Taxable/Exmpt
Clean&Green?
Sqft
Bldg Area
Gross Area
Dimensions
Year Built
Initial Struct
Mob ile Home Code
Mobile Home Park
Mobile Home Mfg.
Mobile Home Year
Mobile Home Unit
13.550
V
1870
2/27/1981
0029H 00993
TAXABLE
Y
'"
"\
'\
~!~~H;'i;~J:..~~J=..mp~ J'ona. Ae\.1 not. Blnale Sh-..
h,~n: '
@L,ijU%
20*
L . ."'1\, ". ~
~1'8. :~f1)rnf
~~~L:;j)9
ftC.OROEe-ft" I:! OF THE
REtORCER OF DEEDS
CUMBER,AND COUNTY
PF.NNSYLVANIA
fEU 27 1115 AM '81
doy 01 Ft ~('^ ov.!
In the year
L
MADE THE
of our Lord on. thousand nine hundred
BElWEEN CECIL R. GOODHART, KENNETR McBETH, WILLIAM r. ROVETTER, JR. and
J. EARL ROVETTER, all of South Newton Township, Cumberland County,
Pennsylvania, Granla" ,
and J. EARL ROVETTER, of Walnut Bottom, Pennaylvania
"
Crant..
WITNESSETH. that 1ft can.idoratlon of One ------- --------------
________________________________________($1.00) Dollars,
1n hand paid, the r.~eipt wt,ereof ,. hereby o(!c.nowledg.d, the laid grantor 8 do her.by grant and
convey to the said grant.. , his heirs and assigns t ALL that certain tract of
land aituate in South Newton Townahip, Cumberland County, Pennsylvania,
bounded and described as follows:
-
111111111111111
'. I N I
~ I ~ ,
i; L;J
'>JU.l
~- z;
,i. /.
o~~
~-...
~". .~
~u..
~jO
~~L
....,0
... -.. ~~.
-:",:
:'~ ~~(
();,.;
vo
1\ E
I N
I ~
!li
;~
0\-..)(
""~ ...:.:
~--
:S1t,Q
(
~ /
BEGINNING at an iron pin on the South Newton ani Penn Township Line
which is also the dividing line between Lots 3 and 4; thence along
Lot 3 about to be conveyed to Cecil R. Goodhart, South seventy (70)
degrees twenty (20) einutes ten (10) aeconds West, a distance of four
hundred eighty-six and eighty hundredths (486.80) feet to an iron pin
at,lands now or fonnerly of Abram Sea...ers; thence along lands now or
fonnerly of Abrse Seavers, North sixteen (16) degrees forty-three
(43) minutes zero (00) seconds West, a distance of twelve hundred
twelve and fifty hundredths (1212.50) feet to an existing stone pile;
thence along lands now o~ forme~ly of Edwa~d St~ekt North sixty-n1ne
(69) degrees fifty (50) minutes ten (10) seconds East, a distance
of four hundred eighty-six and eighty hundredths (486.80) feet to
an existing stone pile on the South Newton and Penn TOl~ship Line;
thence along the South Newton and Penn Township Line and lands of
The Commonweslth of Pennsylvsnia, South sixteen (16) degrees forty-
three (43) minutes thirty (30) seconds East, a diatance of twelve
hundred sixteen and seventy-five hundredths (1216.75) feet to an
iron pin, the point and place of BEGINNING. CONTAINING l3.552 acrea.
BEING all of Lot No. 4 on survey prepared by Wilbur R. Clifton dated
January 31, 1981.
BEING part of that ssee parcel of land granted and conveyed by Edith
Seavers by deed dated February 14, 1949, recorded in the Office of the
Recorder of Deeds in and for'Cumberland County in Deed Book "J", Volume
l4, Page 97, unto Cecil R. Goodhart, Kenneth HcBeth, William F. Rovetter,
Jr. and J. Esrl Hovetter.
TOGETHER with a right-of-way for ingress and egreas in common nevertheless
with the Grantors, their heirs and assigns, over a mountain road from the
within conveyed premises to the mountain rosd lesding from the High Mountain
Road.
UNDER AND SVBJECT to any rights-of-way for ingress and egress over and along
said mountain road.
EX~EPTING AND RESERVING unto the Grantors, their heirs and assigna, a right-of-
way for ingress snd egreas over and along said mountain road where the same
traverses the within described premises.
AND the laId grantordlereby covenant and agree that they and each of them wiJI.wa"ant
generally the property hereby conveyed.
Boo~~'29
~.\ ",-
i-,,,,,\.
593
\
,
I
i
l
I
I
I
IN WITNESS WHEREOF, laid 9ronlor 8 ha ve
the day and year firsr oboy. written.
JiiSlh''-. ..,.lell! 'n~ Jjldhtcrt)
in 14' frese,," Ill'
hereunto Ie' their hand 8
_~,,,.liA~&vt:
. C!leU R. Got~ ~
'~~~~~eW ~ It.
.J~.J.dL~
Willia)l' F" ~~etter, Jr_
/I . ~-.,~~..,.....,z' ,.'-'
~_. ~arL ~oviEEer
~
e
~
..~~
and .eal 8
State of Pennsylvania
}...
day af F-ek...D" 7
, 1981 , before m.,
Caun~ af Cumberland
On .his, the
~"tf:
the undenigned officer, personally appeared Cecil R.. Goodhart, Kenneth McBeth, William F.
Hovetter, Jr. and J. Earl Hovetter
known to me 'or satisfactorily proven J to be the penon S who.o name 8 are subscribed to the with..
in in.trument, and acknowledged thol they e",ecured lome for the purpol.' ther.11I con~Qirutd;'""
IN WJTNESS WHEREOF, I hereunto set m~hand and offic:ia,1 sylo I) .~~'~:\.~:."".\":l":>:<:,
,-'.1VL.. {I -...~..~ !,1'.~:'. e ').'" i-,
. .- . I _ _....u:;JI ..AL ',. ~ .
'r '.' .
HAMILTONC. DAVIS. NotiryPubliG .' 11 :"<'!'." ~ .. ~;....
Newviil., Cumtwlln'll O:t. " ..~ .... I;
Mt Comm1nIon bplr.. bptombor 22, 1984 TIll. 'of .ollie... ",' .
. :',,' (,~".,' " ';. ,"
~ '".,..,. ,.,\ ..'
.... :J. do hereby certify that the precise residence and complete PO$t ofRc..,add;~"'of
th. within nam.d grant.. i. 6o~ 4 J I CJ~h.J- ~~ .) pt::.. J1Z66 .
~~hLA/~ ~~
Attorney f.r G-Y-~-4I1e
nb.701
19'1
,
. (j- ~
is
., . Schoa;;;tt. Cumb. Co.. p..
'" ::l .
u .,
::c'O 0 '" ,).... ft..r Elt". Tr...f., T..
c: ... ...
i:'" ~ ~ ;>-c 1.. 2 -.)7-8.( '? of.
., . D... ........... '0 M..tJO.....
~e; " ~ c.. Lt." Cl ,~~
&J
"- !:l . Z (/ .'tA'~..... .
,l;}. <W .ffi COMIt. c.. Oi... CoL U.
'" <
~ ~ ., H!:: . ~ . ._..... of~S.d:~
'" ~~~ '" 0=:
~ .,
fla >... !:: 0=:
., "'0'"
'" 0='" ., Cumbo Ca., P..
o > g <
" . 0
"'= ~ ..-+'J\. R..I E.'.t. TreMl., T..
..i?i3 ~ v).. ~7-!r/ Mot. 7. .~~. .
.......
....... Dat. ............
U... p::::J ~ H 'l/~
"'.... .
U;..., .., c..... c.. Dl". c:.l. A')1:7
COMMONWEALTH OF PENNSYLVANIA
Caun~ af ~~/tc/
}.~
"
.
RECORDED on thi. - .,,(/'Y.1
A. D. 19 'II
,;)1'
,
in the Recorder'J office of the
., .
Vol.
9f!3
"':' .
."
, page
Giv.n under my
hand ~ .eal af th. .oid ollie., th. dot~ aboy. written.
'\., ') ~ ~ ,--I . ...OId.,.
~ooKt{ 29 i'""t 534
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RE IDEN"< NT
ESTATE OF
Hovetter J Earl a1k!a .Josl\ph Earl
An property joinlly-<>wned willi right 01 SUNNOrsbip must be disclosed on Scbedule F.
REV-1503 EXt (H1}
SCHEDULE B
STOCKS & BONDS
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
7.
FILE NUMBER
21 01
0539
VALUE AT DATE
OF DEATH
7,678.65
330 AD
87,463.28
101,626.20
116,926.96
564.68
1,128.80
DESCRIPTION
AT&T 355 shares @ 21.63
Avaya 28 shares @ 11.80
Bell South 2,104 shares@41.57
PP&L 2,020 shares@50.31
Kemper Fund 8,844.702 shares @ 13.22
Lucent 76 shares @ 7.43
Television-Electronics Fund, Inc. (now Scudder Technology Fund) 80 shares @14.11
TOTAL (Also enter on line 2, Recapitulation) $
(If more space Is needed, insert additional sheets of the same size)
315,718.97
REV.l508 EX4 (1.97)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RE1URN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hovetter J Earl a/k/a .Joseph Earl 21 01 0539
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
VALUE AT DATE
OF DEATH
9,185.00
1997 Chevrolet 8-10 Pick-up truck
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additionai sheets of the same size)
9,185.00
'Kelley Blue Book Used Car Values
Page 1 of 2
-..........
. kbb.com- guiding the car blJyer
New Car Pridng
II1lild l' tar
l~.ti_
...., Oir'$ "'al\lll.
Ihed tar __il
EIUy . lie., c:.
Buy. UledCiw
WI v_o..
MotlIrcyds
Flnand.,.
In__
Leoiltft CNlCk
w....~
~..
CB< Re~
0... Prev'-"
DadsiOlt Gui....
AiMee
,""""".~",....~..~~-",,.
_uc _
IIO/lIe
..-
Want to know if you're
buying a bad car1
Click on the image above to visit this advertiser
Blue Book Private Party Report
Pennsylvania. January 9, 2002
1997 Chevrolet 510 Pickup Extended Cab
Buy a New Car
Buy a Used Car
List Your Car For Sale Online
Financing Quote
Insurance Quote
Warranty Quote
Payment Calculator
Engine: 4-Cyl. 2.2 Liter
Trans: 5 Speed Manual
Drive: 4 Wheel Drive
Mileage: 36,000
Equipment
Third Door
LS
Power Steering
AM/FM Stereo
Cassette
ABS (4-Wheel)
Suggested Value: $9.185.00
Consumer Rated Condition:
Good
"Good" condition means that the vehicle is free of any major defects. The
paint, body and interior have only minor (if any) blemishes, and there are no
major mechanical problems. In states where rust is a problem, this should be
very minimal, and a deduction should be made to correct it. The tires match
and have substantial tread wear left.. A clean title history is assumed. A
"good" vehicle will need some reconditioning to be sold at retail; however
major reconditioning should be deducted from the value. Most recent model
cars owned by consumers fall into this category.
REV-1510E.X+11-97)
~I(f
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT OECEDENT
SCHEDULE G
INTER.VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
Hovetter J. Earl a/k/a Joseoh Earl
FILE NUMBER
21 01
0539
This schedule must be completed and filed jf the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERlY %OF
ITEM INCLUDEMtW.IEOFTHETRANSFEflEE,THEIRRBATlONSHIPTOllECEllENTANDTHEDATEOFfRANSfER. DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE
NUMBER ATIACH ArM"fOFTHEDEED FORREAlESJATE. VALUE OF ASSET INTEREST OFAPf'UCABLE)
1. American General Life Insurance Company 6,872.67 100. 6,872.67
Annuity Contract #A10088334F
TOTAL (Also enter on line 7, Recapitulation) $ 6,872.67
(If more space is needed, insert additional sheets of the same size)
--
AMERICAN
I GENERAL
FINANCIAL GROUP
Amaican General Life
Insur.mce Company
June 25, 2001
AIDA D HOVETTER
PO BOX 41
WALNUT BOTTOM PA 17266
Contract Number: A 1 0088334F
Contract Owner: J Earl Hovetter
Dear Mrs. Hovetter:
American General Financial Group wishes to extend our sincere condolences to the family of J.
Earl Hovetter. Please find enclosed a check in the amount of $6,185.40, which represents the
proceeds from the above referenced annuity contract.
Mrs. Hovetter, should you have questions or need additional assistance, please contact the
Annuity Administration Department at 1-800-247-6584.
American General Life Insurance Company
Memhr Ame>i= General FinttnWJ G-tr:Mp
Administrative Offices. P.O. Box 1401 . Houston, 'IX n251-1401 . Fax 7U-831.3701
American General Life Insurance Company
MO. DAY YEAR CHECK NO.
06 26 2001
0010243260
EXPLANATION AMOUNT
40024451 CL263
A10088334F FACE AMOUNT 6,872.67
A1oo88334F FEDERAL TAX WITHHEW 687.27-
INSURED POUCY NtIMBER CHECK AMOUNT
HOYETfER, J EARL A10088334F $6,185.40
PlJWlE DETACH ... KEEP FOR YOUR RECORDS
.
REV-1511EX+(1-97)
:.J I '" ?f
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Hovetter. J Earl alkJa Joseoh Earl
FilE NUMBER
21 01
0539
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Bricker Funeral Home 7,122.50
2. Shull & Koontz - memorial stone 3,213.00
B. ADMINiSTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Numbe~s) I EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) 3,500.00
Claimant Aida D. Hovetter
Street Address 36 W. Main Street
City Walnut Bottom State PA z~ 17266
Relationship of Claimant to Decedent spouse
4. Probate Fees 340.00
5. Accountanfs Fees - Preparation of finallieflime income tax return 200.00
6. Tax Return Preparer's Fees
7. Cumberland Law Journal - Advertising 75.00
8. Sentinel - Advertising 87.35
9. Estimated final closing costs of estate 500.00
TOTAL (Also enter on line 9, Recapitulation) $ 15,037.85
(If more space is needed, insert additional sheets of the same size)
REV.1512 EX-+(1-ll71
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE T>:x RETURN
RESIDENT DECEDENT
ESTATE OF
Hovetter. J. Earl alkla Joseoh Earl
Include unrelmbuI1Ied medical expens...
ITEM
NUMBER
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
FILE NUMBER
21
01
0539
1.
Un reimbursed medical expenses (copies of invoices attached)
DESCRIPTION
AMOUNT
1,788.33
TOTAl (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
1,788.33
03/14/01
03/14/01
03/14/01
04/18/01
04/18/01
EVE lASSR . VAG
lASER KIT VR. STO~e"'$
PRO.PARAt.AJ~ DPHTa $.11.14 t$"1.
Ml!:1I1CAR.. INS\JR""~ ,. YMEfff
MEIIICARE O/P ~RITt.O .~
w
Ii
c
w
u
~
"
a:
c
UJ
Ii
c
'"
~
o
i
J
~
m
i'l
./1..- ~I"l
(pI' f
eI4 ;Jt....'"
We have billed your insurance company,for
your services at the Hospital. However to
date we have not received payment. The
Hospital now expects payment from the
patient.If the carrier fails to pay.Please
contact your insurance company and call
717-218-8822 regarding payment. Thank you.
Vou may reach Patient Financial Svcs
at 419 Stunehedge Dr Carlisle Pa. Our
hone number is 717-218-8820.
~~~~~~TE 03/14/01
AGREEMENT
AMoUNT . 00
RETAIN THtS pORnON
PA.'iMENTS RECElVED AFTER BIWNG DATE WILL APPEAR ON NEXT STATEMENT
1
1
1
1
1
604.00
46.00
11.00
124. 89CR
424.41CR
~~~s
NEW
CHARGES
~~NTSI
APJUSTMENTS
.00
658.00
549.30CR
108.70
07l0Zl01
108.70
I :::I ..: . _ J: ; .. ; ;..1 I. _ . : II I;. _ =~ I ~ ,\, - ;. ..... . ;.. . ,. " ... .
.tnu'
006-21
Your account is PAST DUE. Please remit
payment to prevent further action from our
collection department. Thank you for your
immediate attention to this matter. If you
have any questions please call
717-218-8833 between the hours of lam and
4pm. Thank You.
Vou may reach Patient Financial Svcs
at 419 Stoneh~dge Dr Carlisle Pa. Our
6a
1
I
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
802.00
522.00
3.00
3.00
315.00
3.00
B.OO
20.00
45.00
178.00
120.00
90.00
'16.00
124.00
150. 00
..00
"'.011
7..00
174.00
!J.O'
29.00
18. it II
26.00
11.00
3.00
3.00
18.00
'$71 .1BI;R
2.328.BeeR
l~t oJ
~l .Ifl~
Of.ll
553.20
377 .18CR
~=og~TE 06/28/00
176.02
07102/01
176.02
PAYMENTS RECEIVED AFTER BtlUNG DATE WilL APPEAR ON NEXT STAtEMENT
AGREEMeIT
AMOUNT . 00
RETAIN THIS PORTION
:::**~~I~~I*~~*i~~I*t2~*~22l**lt*I~~*~X!*tl&&lf~*~~!rI2f~*~~~*~~~;~~~Z*****:::
Insurance Charges pending to Dr: 85.00 85.00
1 1 E REMOVE SECONDARY CATARACT 66821 366.53 1000.00
Medicare Payment
Accept Assign Adj.
AETNA Payment
03/14/01
04/05/01
04/05/01
07/05/01
'llr->tol
Ii. /.
,j. "I1!J 1
v<,(Y
108.39
-798.80
52.57
40.24*
E-Thh !:till a.tUe4 against YQur d.~..ti!tl., 't,,~~P. #,!,~~ibl\1!i~.,pay u_,
STOKEN OPHTHALMOLOGY
338 ALEXANDER SPRING RD.
CARLISLE, PA 17013
PATH 1-J EARL HOVETTER DR# 1-STOKEN, DREW J., M.D.
~
40.24*
Ph: (717)-249-6337
Acct/J: 7682
Date: 07/06/01
Page 1 of 1
-
PLEASE DETACH AT PERF AND RETURN TOP PORTION WITH YOUR PAYMfNT
STATEMENT
I......................
Ins.
Date 8illed Code , Description Oiag. Charge Ins. Pmt. Pat. Pmt. Adjust. Amount Ins
04/02/01 05/18/01 93307 ECHO REAL TIME COMP W OR W/O M-HOOE 785.Z 150.00 44.n 94.10 11.18
Deductible Appl ied
04/02/01 05/18/01 933Z0 ECHO DOPPLER 785.Z 75.00 18.55 51.81 4_64
Deductible Appl ied
04/DZ/Ol 05/18/01 933Z5 DOPPLER COLOR FLOW VELOCITY MAPPING 785.Z 10.00 3.19 6.01 0.80
Deductible Appl ied
04/05/01 05/18/01 93018 IV PERSANTINE TESTING 410.41 100.00 14.4Z 61.97 3.61
Oeductible Applied
04/05/01 05/18/01 93016 STRESS TEST SUPERVISION ONLY 410.41 50.00 ZO.9S Z3.81 5.Z4
Deductible Applied *
04/01/01 06/13/01 99ZZ3 HOSPITAL ADMISSION-COMPLEX 410.41 190.00 lZ4.Z6 34.68 31.06
04/0Z/01 06/13/01 99Z33 HOSPITAL VISIT, DETAILEO 410.41 9S.0D 63.01 16.Z4 15.75 *
04/03/01 06/13/01 99Z3Z HOSPITAL VISIT, EXTENDED 410.41 80.00 44.40 Z4.50 11.10 *
04/04/01 06/13/01 99Z3Z HOSPITAL VISIT, EXTENOEO 410.41 SO.OO 44.40 Z4.50 11.10 *
04/05/01 06/13/01 99Z3Z HOSPITAL VISIT, EXTENDEO 410.41 80.00 44.40 Z4.50 11.10 *
04/06/01 06/13/01 93510 LEFT HEART CATH, PERCUTANEOUS 410.41 600.00 199.58 350.53 49.89 *
04/06/01 06/13101 93543 ANGIOGRAPHY, LEFT VENT OR ATR 410.41 100.00 14.40 HZ.OO 3.60 *
04/06/01 06/13/01 93545 SELECTIVE CORONARY ANGIOGRAPHY 410.41 150.00 19.44 1Z5.70 4.86 .
04/06/01 06/1.3/01 93555 IMAGING SUPERVISION/VENT/ATR ANGIOG 410.41 100.00 34.84 56.45 8.71 *
04/06/01 06/13/01 93556 IMAGING SUPERVISION/PUL" ANGIOGRAPH 410.41 100.00 36.87 53.91 9.ZZ .
.. paJlme.at Due Upo.a Recei.pt of Statement . Thul< You ..
Current 30 Days 60 Days 90 Days 120 Days Total Balance . Ins. Pending Now Due
25.47 0.00 0.00 0.00 0.00 181. 86 156.39 $25.47
7 Jcr/ fj(
II
Account Number
Message
fJ.., c!C:#LfI5;J...
26380
Statement Date
Make Checks Payable To:
CARDIOVASCULAR ASSOCIATES
601 NORLAND AVENUE
CHAMBERSBURG PA 17201
06/28/01
Billing Questions
(717) 264-6050
~ DETACH HERE TO ASSUAE PAOPEA CREDIT PLEASE WRITE YOUR ACCOUNT NUMBEA ON YOUA CHECK ANO RETUAN UPPER POATION WITH AEMITTANCE.'"
KEEP THIS PORTION FOR YOUR RECORDS
PAYMENT HAD NOT BEeN REGEIVED ON YOUR AGCOUNT.
YOUR PAYMENT PROMPTLY.
THANI< YOU
PLEADE REMIT
Il/)l
f)..' bt~l~s{
vI if ~'1,
CHAMBERSBURG IMAGING ASSOCIATES, P.C.
25 PENNCRAFT AVE.
CHAMBERSBURG, PA 17201-1686
..1 E HOVETTER
ACCT NO, C323616-01
IRS # 23-2192005
......"1.).:::-1 ;;::_....~.-l;,.::;.."";.t.:::..~'l.: ~[.:I.:::N....:l.:.~.I.::;I.~i:}":.:.... [..~l...).;;::.~......... ................ ........;".;;:,,;;::,.:,.:,.: I'; :'1':''''[
(..:).(-:';........-"... .... ........... ........ ..;.....D......]..:~.:.:.........~.~ .;.M.....::l:(..';:-;~r:.....-
. H 1;.. I J~", (;"1 .... I '\..L , 1;..1 U......H.. \.. .. '( f ..1"1(" I I" t..Tt~
...--.........-..--...----.........-."--."--...--.........--....-.-......--.............--.-...----.------.--...-......------...----...-.
04/01./0;1. I c:W, I Eo"':!.
04/01/01IcvetFarl
04/01/01fcveIEarl
04/:'l()/O II
04/:30/0:l.t
: A()..'t~:~'7
t AO:3'?O
I A04 2~':~
: ALHl Etr'~1"'~.:J(.;~ncy : /'HI.:... f,)()
tAtS 11il'''''91'' (p';)J' 11:i.1 1'7l:lt.,,~:';O
~Oxygen :786~50
IPlal) Pay~~rlt~10~80064Hedicat'et
lAdj~Medicare WritecffMedi(:arel
,
.
6~~~:; .. ()()
:to 1. ~:~ " ~~()
~';O . O()
3~:~4,,;;\7...
:?a:~;:~ .. ()4 ...
\'\\
~B-.; ~\1-' If 10 ct'
VL-- ~
PAY THH, AI-lOUNT ...... >
B:I..()';>
Eel) iji~:i:""i~i) "i' (;i:ji~i;iF.j'~:i ....-..... ....:;;'i:.:;!;()....... ...........6i:::~;(;......._..... ....;; i ':::'1 ;~;(;......i....ijvf.:i:i.... i ~;() :
_._._...__.__.__..~.N._._____.__.M.________._.__.___..___._.________.._______:
:":1.004":1.:1. I
n:l.,,()9~
o"()() I
0,,001
0.. O() :
0..00:
.-..,......
04106/0~
04/06/01
04/06/01
04/06/01
.04/06/01
~...~".t~,..""'-j"
14$
we
ws
"'$
W$
LlEl"T HEART CATH, RETRO,it
coRONARY ANGIOGRAPHY O~
lNTiRPRET CORONARY,SVG,;I
rtiAN$CA.PLACEMNT INTRAilf
INTRAVASCULAR ULTRASOU~.
809.07
322.43
298.18
.H61.66
86.72
112.74
22.06
41.46
830.67
90.68
28.11,
5.5:
10.3E
207.6i
22. erE
960. 001''''
350. 0~:"
350.012(' '"
3200. 00' ..
20121. 0121' ...
t
F\\r~\\)\
;})i-\ ~J~O
(JV-'~ q 'Y
~ 'iJ'1''\
~.
$097.
Please provide additional Insurance Information on back of form.
If you have a question about your account, please call (202) 877-2700 or (888) 239-4431
- indicates that your insurance has been billed
on Cardiology Center
)(~
RE, MP 21203-4265
. .
214.39
LOWEll F. SATLER, M.D.
JOHN M. SHARREITS. M.D.
WILLlAMO. SUDDATH, M.D.
RON WAKSMAN, M.D.
04/01/0 193000
04/18/0
04/18/0 I
05/18/0
04/01/0 199203
04/18/0
04/18/0 I
Patient Name;
J carl E
Patient Balance
0.00
22.90
22.90
." .
Ekg Inter,,,,,r!lt:.'lli~Slr.LAli4jl1~port 410.90
P Ian PaYrli~ntt'l'.~'lH$:8
COINSURANCE U~.9. :
Adj:/llQI' Wr.tt~(Jff f.lG$ Adminisltr
Plan pa,Yl1l!mt:tl.0~,' I
PT RESPONSIllltLITV/DEIlUCTIBLEj
Office VisH, J.t\r:llJ"J;::fi. New :410.90
Plan PotJ/lilllt'1.:d'tlll>1B8 i
Adj:l'lcr Wr1t;li!of'f litiS Admini~tr
I
!
~tl t)
',fit. _,.:>.> :":"- .,
~.:lt,; .'
'A " \..,
(!.. ( ... I I'
,::;j'"
A: \~t
~*4'
er
PLEASE RETAIN THIS PORTION OF
STATEMENT FOR YOUR RECORDS
'~1-60 . :;-J. I "i90,. '\
'. ': -. .," '" - ~.: '.,:,_: ','i..c... . . :". ,.t;
e... I ..110 I'
0. 08 H~__~~0~ j
0.00
0.00
t:
0.00
22.90
-~-----._------------
------------------------------------------
.
57.00
21. 74-
5.43
29.83-
0.00
97.00
69.90-
9.63-
17.47
,
I
I
I
I
22.90
0.00
0.00
1_-
Date of Date Ins Insuranc Patient
Ser\(ice Piltient Billed Code 0 Description O;ag. Charge Receipts ~lIjpt. AdiU$t. Bal sliCe
04/~/01 EAAL 05/11/01 99254 6 INITIAL HOSP CONsULTATIQN. cOIWRli'tII; 431 24$.01 84.i' n.o
04/07/01 EAAl lIS/ll/0l 61$13 6 GlWllfCTQlY /CIWIlOTOIlY INTRACSlll!BU 431 5500.01 3514.1 193.1
04/07/01 EARL 05111/01 61618 6 P!RICRANIAL GIlAFT 431 40011.01 3349.1 1~.1
04/07/01 EARL 05/11/01 69990 6 MICROSuRGERY OF BRAIN/SPINE 431 1000.CC 756.9 48.<Il
** Stat8llleZ1t Dl>e 0'pc>:D Receipt * 2'1lank You **
Curreut 3~ Days 60-'.10 Days 90-120 Days 110 DAYS + Total Balance Ins. Pending PATIENT DUE
604 _ 02 0.00 0.00 0.00 0.00 604 _ 02 0.00 ( $604.Q~
Doctor Codes:
Message
2-Barrett,M.D.,John W.
If. ,,{, '110 ~~ If, ')-
3-Cooney,M.D.,F.Donald
4-Jacobson M.D., Jeff
5-Powers,M.D.,Alexandros
Make Checks Payable To:
Billing Questious
(202) 223-1394
6-Aulisi,M.D.,Edward F.
WASHINGTON BRAIN & SPINE INSTITUTE
3 WASHINGTON CR. NW #306
WASHINGTON oc 20037-2381
7-Levine,M.D.,Zachary T.
Federal Tax Id
520954376
~
ACCQUII't #
li?0&544
PATliNT l/AME
l\O\I\!TtIill ,llI\Itl
SERVICE STARt
01,/%/01
UIlVlCf fNO
Il4( "lll1
!lTAtl!ll$ft lIATE
O&Ifl/Ol
lA$'t StAttM$lfT llAtll
lWf~
TRANS DATE
DESCRIPTION AMOUNT
05/02/01
OS/22/01
OS/22/01
OS/22/01
PR!lVIOUS BAI..ANCE
MEDlCARE-A ALLOW I/P M21 MEDICARE 'A'
MEDICARE-A ALLOW I/P M21 MEDICARE 'A'
MEDICARE-A ALLOW I/P M21 MEDICARE 'A'
MEDICARE 'A' PMT (aC M21 MEDICARE 'A'
85191. 61
-70415.34
70415.34
-69213.61
-15840.00
't I qf,.
-fit c../(',t4"
tjtr'J/ot
This is your bi11'fqr ~epit.l oharges. P1e.se see the back of this statement for all
payment options at.Ug).t to yo~.
\.;....',;,
ALL BILLS ARE DUE ON PRESENTATION. PLEASE PAY THE AMOUNT DUE FROM
PATIENT. YOU HAVE 24 HOUR ACCESS TO CERTAlH ACCOUNT INFORMATION VIA
OUR AUTOMATED TELEPHONE SYSTEM. CALL (202) B77-6171 AHD HAVE YOUR
ACCOUNT NUMBER AND DATE OF BIRTH READY. CUSTOMER SERVICE PERSONNEL
ARE AVAILABLE FROM 9AM-4PM A $20.DO FEE WILL BE CHARGED FOR
RETURNED CHECKS.
~~tMitit. 138.00
0.00
PAY THIS AMOUNT
$13'8.00
MedStar Health
Washington 110 IRVING ST., N.W.
Hospital Center WASHINGTON, D.c. 20010.2975
.'
ACCOUNT NO.
23383912
STATEMENT DATE
LAST STATEMENT DATE
PAGE NO.
09/23/01
1
PATIENT:EARL J HOVETTER 23383912
13508544
ADMIT 04/06/01 DSCH 04/12/01
PERFORMED BY EDWARD MD PLATIA
04/06/01 1 EKG, INTERPRETATION
93010 01 lip aOSPITA
· 06/21/01 MANUAL T~S~~R
. 09/21/01 HCARE TA~E.~
* 09/21/01 MCARE TAi'1t ..~
* 09/21/01 HCARE TAi't ~
04/07/01 1 E~.
93010
. 06/21/01 MANUAL T
* 09/21/01 MeARa
* 09/21/01 ~
* 09/21/01 MeARS
* I.NDICATES NEW 1f
FEDERAL TAX 10 jI
WE PREVIOUSLY NOTtgt
PLEASE REMIT YOUR PA
RECEIVED WITHIN TH*
ACCOUNl' TO A CQ~1
50.00
50.00
9.Jl2-
38.3&-
2.33
$0.00
TOTAL ACCOUNT BALANCB
4.66
EST. :tNStlRJUfCE Rlt$PONSIlilILITY
0.00
PLEASE PAY THIS AMOUNT
.~~.~~.. $4.66
TRAILBLAZER PART B
{J J.. AJ p,
f 0 ~tf '1'1.:7 cr
PAYMENT DUE: 10113/01
MedStar Health
Washington no IRVING ST., N.W.
Hospital Center WASHINGTON, D.C. 20010-2975
to
*** Referred By EDWARD F AULISI, MD ***
DATE RANGE
DESCRIPTION
AMOUNT
04/07/01
04/07/01
06/29/01
06/29/01
Diagnostic X-RAY Service
CT Scan Service
Adjustment
Insurance Payment
270.00
765.00
-544.20
-238.25
0.00 0.00
~t online
iII.ve our logo
Visit our
To Contact us, provide i
w@$:i.l:J"
CURRENT 31- 6 0 :!lAYS
..
PLl!lASE PAY THIS AMOUNT
~~.......~. $252.55
IRS# 52-2196600 CTR632639
PLACE OF SERVICE WAS. It~R(l1t1f!' 1:it
PROVIDER OJ!' SERVICE, CENT~ ~:rQt.tx:!IY, PC
LOCAL PHONE NOMBER , 301-562-79U
MESSAGE:
WE ARE UNABLE TO COLLECT FROM YOUR INSURANCE BECAUSE. YOUR INSURANCE NEEDS ADDITIONAL
INFO FROM THE INSURED.
TO PROVIDE INSURANCE INFORMATION. PLeASE SEE REVERSE SIDE
.
;
*** Referred By EDWARD I' AULISI. MD ***
DATE RANGE
04/07/01
07/10/01
07/10/01
DESCRIPTION
AMOUNT
Surgical Pathology Service
Adjustment
Insurance Payment
195.00
-131. 32
-50.94
0.00
31-60 DA1tS
0.00
f);-' I
~ \\10 \ 01 I{~
,b vt~
To Contact us. provide . . .,.
websd.lIlt iI'
Visit our
CtIl!REN'1'
PLPlASE PAY THIS AMOUNT
........... $12.74
1R8# 52-1106113 MEl\:69WO,. '.\ . .... ce,
PLACE OF SERVICE ,l( . !lOll' ~,..~
PROVIDER OF SERVICE: MAAY ",. lC:A$'$, Iil. P., P. C .
LOCAL PHONE NOMBBR , 301.562-7993
MESSAGE:
The balance on your account is now due.
TO PROVIDE INSOllANCE IJlPORMAT ON. ..PLPlASE SEE REVERSE SIDE
REV.1513EX+{1-91)
,
~ I tz
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
I 11=",1 71 n1 n<;'lQ
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
1. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1. Aida D. Hovetter Spouse 163,570.47
36 W. Main Street life interest in trust 47,984.55
Walnut Bottom, PA 17266 annuity 6,872.67
2. Joseph E. Hovetter, Jr. Son
P.O. Box 62 remainder int. in trust 35,466.98
Walnut Bottom, PA 17266
3. Susan J. Hartman Daughter
435 W. Main Street remainder int. in trust 35,466.97
Walnut Bottom, PA 17266
4. Judith A. Hovetter Daughter 35,466.98
P.O. Box 695 remainder int. in trust
EI Prado, NM 67529
ENTER OOLLARAMOUNTS FOR DISTRIBUTIONS SHOWN A60VE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON.TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1. Hays Grove United Methodist Church 17,981.83
2160 Pine Road
Newville, PA 17241
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 17,961.63
(If more space is needed, Insert additional sheets of the same size)
REV-15H EX" ~1-911
SCHEDULE K
LIFE ESTATE, ANNUITY
& TERM CERTAIN
Check Box 4 on Rev-150ll Cover Sheet
FILE NUMBER
COMMONWEALTH Of PENNSYLVANIA
INHE~TANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Hovetter J Earl alk!a Joseoh Earl 21 01 0539
This schedule is to be used for all single life, joint or successive life estate and term certain calculations, For dates of death
prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit.
Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death on or after 5-1-89,
Indicate the type of instrument which created the future interest below and attach a copy to the tax return,
o Will 0 Intervivos Deed ofTrust 0 Other
NAME(S) OF
LIFE TENANT S
NEAREST AGE AT
DATE OF BIRTH DATE OF DEATH
12/21/18 83
TERM OF YEARS LIFE ESTATE IS
PAYABLE
[2gufeorDTermofYears _
DUfeorDTermofYears _
DUfeorDTermofYears _
DUfeorDTermofYears _
Aida D. Hovetter
1, Value of fund from which life estate is payable
2, Actuarial factor per appropriate table
Interest table rate - 0 3 1/2% D 6% D 10% Q9 Variable Rate
3. Value of life estate (Line 1 multiplied by Line 2)
$
,31081
154,385.48
%
$
47,984,55
NAME(S) OF
ANNUITANT S
DATE OF BIRTH
NEAREST AGE AT TERM OF YEARS
DATE OF DEATH ANNUITY IS PAYABLE
DUfeorDTermofYears _
DUfeorDTermofYears _
DUfeorDTermofYears _
DUfe or DTerm of Years _
1, Value of fund from which annuity is payable
2, Check appropriate block below and enter corresponding (number)
Frequency of payout - 0 Weekly (52) 0 Si-weekly (26)
o Quarterly (4) 0 Semi-annually (2) 0 Annually (1)
3, Amount of payout per period
4, Aggregate annual payment, Line 2 multiplied by Line 3
5, Annuity Factor (see instructions)
interest table rate 0 3 1/2% 0 6% 010% 0 Variable Rate
6, Adjustment Factor (see instructions)
7, Value of annuity -If using 3 1/2%, 6%, 10%, or if variable rate and period payout is at end of period,
calculation is : Line 4 x Line 5 x Line 6
if using variable rate and period payout is at beginning of period, calculation is :
(Line 4 x Line 5 x Line 6) + Line 3 $
NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on
Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on
Lines 13, 15. 16 and 17,
$
o Monthly (12)
DOther( )
$
%
$
(If more space is needed, insert additional sheels 01 the same size)
~
\
"
LAST WILL AND TESTAMENT
OF
J. EARL HOVETTER
I, J. EARL HOVETTER, of the Village of Walnut Bottom, County of Cumberland,
and Commonwealth of Pennsylvania, being of sound and disposing mind, memory and
understanding, do make, publish and declare this to be my Last Will and Testament,
hereby revoking and making void any and all Wills or testamentary writings by me at any
time heretofore made.
FIRST:
I direct that all my debts, funeral expenses, and inheritance taxes be
paid by my personal representative, hereinafter named, as soon after my death as may
be practicable.
SECOND: I give, and bequeath all my household furniture and furnishings,
books, pictures, jewelry, silverware, automobiles, wearing apparel, and all other articles
of household or personal use or adornment to my wife Aida D. Hovetter, providing she
is living on the 61st day following my death.
THIRD:
If my wife, Aida D. Hovetter, is not living on the 61 st day following my
death, I give and bequeath all my household furniture and furnishings, books, pictures,
jewelry, silverware, automobiles, wearing apparel, and all other articles of ho.usehold or
personal use or adornment to my children, Joseph E. Hovetter, Jr. who presently resides
in Walnut Bottom, Pennsylvania, Judith A. Hovetter who presently resides in Taos, New
Mexico, and Susan J. Otto who presently resides in Carlisle, Pennsylvania, in equal
shares per capita and not per stirpes.
FOURTH: I give and bequeath a sum of money equal to five percent (5%) of
my gross Estate to my Church, Hays Grove United Methodist Church of Newville,
Pennsylvania.
FIFTH:
I give, devise and bequeath one-half (1/2) of the remaining rest,
residue and remainder of my Estate, be it real, personal and mixed, of whatever nature
and wheresoever the same may be situate, to my wife, Aida D. Hovetter, providing she
is living on the 61st day following my death. Should my wife, Aida C. Hovetter,
predecease me or not be living on the 61st day following my death, I give, devise and
bequeath the share described herein as follows:
~
"
A. One-third (1/3) thereof to Joseph E. Hovetter, Jr. per stirpes and not per
capita.
B. One-third (1/3) thereof to Judith A. Hovetter per stirpes and not per capita.
C. One-third (1/3) thereof to Susan J. Otto per stirpes and not per capita.
D. If any of my children referred to above predecease me or are not living at
my death and none of their issue are living. I give, devise and bequeath the share
or shares bequeathed to said child or children who may have predeceased me
leaving no issue, to my living child or children, per stirpes and not per capita.
SIXTH: Should my wife, Aida D. Hovetter, be living on the 61 st day following
my death, I give, devise and bequeath the remaining one-half (1/2) of all the rest, residue
and remainder of my Estate, be it real, personal and mixed of whatever nature and
wheresoever the same may be situate, to Joseph E. Hovetter, Jr., Judith A. Hovetter and
Susan J. Otto, in trust nevertheless for the following uses and purposes:
A. To retain any property or investments herein transferred and devised in
trust, as long as the Trustee may deem it advisable to do so, and to distribute the
income therefrom to my wife, Aida D. Hovetter, in quarter-annual installments, or
more frequently if she so desires, for and during the term of her natural life.
B. To vary investments when deemed desirable by the Trustee, and to invest
in such bonds, stocks, notes, real estate, mortgages or other securities. or in such
other property, real or personal, as said Trustee may deem wise, being restricted
to so-called "legal investments."
C. Until any distribution is actually made or paid over to any beneficiary, all
principal and income passing in accordance with the terms of this Trust shall be
free of any debts, contracts, alienations, assignments, encumbrances or
anticipations of any beneficiary and the same shall not be subject or liable to any
levy, attachment, execution or sequestration while in the possession of the Trustee.
D. Upon the death of my wife, Aida D. Hovetter, this Trust shall cease and
terminate and all principal and accumulated income shall be distributed as follows:
1. One-third (1/3) thereof to Joseph E. Hovetter, Jr. per stirpes and not
per capita.
2
'\
, ,
2. One-third (1/3) thereof to Judith A. Hovetter per stirpes and not per
capita.
3. One-third (1/3) thereof to Susan J. Otto per stirpes and not per capita.
4. If any of my children referred to above predecease me or are not
living at my death and none of their issue are living, I give, devise and
bequeath the share or shares bequeathed to said child or children who may
have predeceased me leaving no issue, to my living child or children, per
stirpes and not per capita.
SEVENTH: Should my wife, Aida D. Hovetter, predecease me or not be living on
the 61 st day following my death, I give, devise and bequeath the remaining ona-half (1/2)
of all the rest, residue and remainder of my Estate, be it real, personal and mixed of
whatever nature and wheresoever the same may be situate, as follows:
A. One-third (1/3) thereof to Joseph E. Hovetter, Jr., per stirpes and not per
capita.
B. One-third (1/3) thereof to Judith A. Hovetter per stirpes and not per capita.
C. One-third (1/3) thereof to Susan J. Otto per stirpes and not per capita.
D. If any of my children referred to above predecease me or are not living at
my death and none of their issue are living, I give, devise and bequeath the share
or shares bequeathed to said child or children who may have predeceased me
leaving no issue, to my living child or children, per stirpes and not per capita.
EIGHTH: I hereby nominate, constitute and appoint my wife, Aida D. Hovetter,
as executrix of this my Last Will and Testament. Should my wife, Aida D. Hovetter, fail
to qualify or cease to act as executrix of this my Last Will and Testament, I hereby
nominate, constitute and appoint Joseph E. Hovetter, Jr., Judith A. Hovetter and Susan
J. Otto to serve as executors of this my Last Will and Testament. Further, I direct that
my personal representatives shall serve without bond. Said personal representatives
shall have the power to discharge all the debts, liens and encumbrances upon my Estate,
as well as any taxes thereon, to pay for the cost of the final disposition of my remains
and final illness, if any, to receive any and all commissions and other compensation for
services rendered by me during my lifetime and to perform any and all fiduciary duties
authorized by statute. Further, I direct my personal representative to preserve my Estate
and any instructions pertaining to the distribution of the same from any attachment or
3
J
'\
.
"
anticipation while in the hands of my personal representatives, it being my express intent
that all legacies shall be free from any attachment or anticipation while in the hands of
the accountant for my Estate.
IN WITNESS WHEREOF, I, J. EARL HOVETTER, have signed, sealed. published and
declared this to be my Last Will and Testament, consisting of this and five (5) additional
pages in the margin of each of which I have also set my hand for greater security and
better identification this /(, ~ day of Jl~ .~ ' 1997
1
o ~~~J
{Yarl Hovetter
(SEAL)
4
\
. ,
The preceding instrument, consisting of this and five (5) other typewritten pages,
each identified by the signature of the Testator, was on the day and date hereof signed,
sealed, published and declared by J. EARL HOVETTER, Testator herein named as and
for his Last Will, in the presence of us, who at his request, in his presence and in the
presence of each other have hereunto subscribed our names as witnesses hereto. We
further certify that at the time of the execution hereof, the said J. EARL HOVETTER was
of sound and disposing mind, memory and understanding.
~,,, rutJA- r. da h...o~9.
~.-:--~~,.,;.?~~.--=---<--
..0'" ~
~ c.-.........----.
~
-~
of Ub~ \..J ~~-\- t";-\-.
J..\.Od'-'-" <!!>.I""orj, '"1>/4. \""'1-\ 0 \
of a..JLV\.~~~
~~~~~ll~OL
of t"C?'YJ. do q z% d
(
I-J ali../t.v,LJU<A/ ' :J,4.1 ),/,c?q
I' I
(
5
~
.
. .
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF DAUPHIN
I, J. EARL HOVETTER, 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.
Sworn or affirmed to and ack wledQed before me by J. EARL HOVETTER, the
Testator, this 1(.,. ay day of / .I /' ,1997.
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF DAUPHIN
/(
( ,
. .;
c. ..1
.C.C "v~'
Not~ Public ~ j,. . /. c/
My is mmission expires: tf/ / '1/ 'f '"
(SEAL)
Notarial Seal
Acnes G. Nlchlcl, Notary Public
fiarrlsburg, Oauphin County
My Commission Expires June 19, 1988
Member, PennsylvantaAsGOCla1lon of Notaries
5S:
. We., ON' n 'it ~ (' _rl. bt>-Prl and--o- ' ~. '-"'-.
the witnes~ who names are signed to the attac~ instrument, bei
duly qualified according to law, do depose and say that we were present and saw
J. EARL HOVETTER, Testator, sign and execute the instrument as his Last Will and
Testament; that J. EARL HOVETTER signed willingly, and that he executed it as his free
and voluntary act for the purposes therein expressed; that each of us in the hearing and
sight of the Testator signed the Will as witnesses; and that to the best of our knowledge,
the Testator was at that time 18 or more years of age, of sound mind, and under no
constraint or undue influence.
Sworn to and subscribed before me
i. (),:
this .' t"tlL- day of 'r-i..ec l/ ~
l~ l
~~~
,........ " w
C -
1997.
.'
/"
/
iii ) '. ~
_/ " 1. ','
0::;/. /I-.C.':!N (..C-u
ilr/9f/
,
No:"
Aaoas G. Nichl<v . r;'Jl~UQ
'Fiarrisburg, Oaup'l i... -,'.
My Oommission Expires June i '.';"" I
tJIerTbef, PennsylvaniaAooodation Al'~io,.~ .'. :,: