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Home My WebLink About01-0977 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 MULLIN DONNA M 134 SIPE AVENUE HUMMELSTOWN, PA 17036 -------- fold ESTATE INFORMATION: SSN: 172-24-8686 FILE NUMBER: 21-2001- 0977 DECEDENT NAME: HOOVER HAROLD C DATE OF PAYMENT: 10/24/2001 POSTMARK DATE: 10/22/2001 COUNTY: CUMBERLAND DA TE OF DEATH: 07/28/2001 NO. CD 000430 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $3,805.86 I I I I I I I I TOTAL AMOUNT PAID: $3,805.86 REMARKS: ANNA B HOOVER C/O DONNA M MULLIN ESQUIRE CHECK# 3823 SEAL INITIALS: PB RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS f..ooo4 ~ ~ ~ ~ ~ 'Or' ~ C ~ 9 ~ 0 0' "r\ . ~ Z ~ :. ~ ~ t:!1 ~ (l :j 9 s ~ b Z r:7' ~ ~ l ~ b ~ ." - ~ ~ g VA g ~ r A.& /...--.....,"'-- (" );~~\ ( ''''0 (:i ; .l::f (',,.., ~; \ V ',_ \ -'''... - ~-~~~~. .~ \'~ ~\.~) ~ ~''''-~('''-' r", W \~ ;:n .-, \) '1.) C--' 0 <.:" v-...j 'c; ':!) ~ . c. ~, t,,- ... - ~~l ~t ':~ ~-: <A ~::..~l. ~:;:;-- jl\II'''\11111 Dl 11,1,\ l\: ("'\'\1111 Ill' I III ()IIIII, J'~')'( October 22,2001 Mary C. Lewis, Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, P A 17013-3387 THE ESTATE SECURITY FOlThlliL RE: ESTATE OF HAROLD C. HOOVER, DECEASED Dear Ms. Lewis: Stephanie L. Gaffey Paralegal slg@jsdlegal.com I am enclosing herewith the Pennsylvania Inheritance Tax return for the above-referenced decedent, which is in triplicate. There was no estate opened for the decedent as there were no probate assets. I am enclosing a check in the amount of $10.00 representing the filing fee for the inheritance tax return. I am also enclosing a check in the amount of $3,805.86 representing the amount of Pennsylvania Inheritance Tax owing on the return. Please file the inheritance tax return and return a stamped copy to me in the enclosed, self-addressed, stamped envelope. Thank you for your attention in this matter. ~~~~~JL ~~e L Gaffey v~ , I Paralegal :slg Enclosures 134 SIPE AVENUE HUMMELSTOWN, PA 17036 MAILING ADDRESS po. BOX 650 HERSHEY, PA 17033 TOLL FREE 1.800.942.3660 TEL 717533.3280 FAX 717.533.7771 www.jamesestateplan.com REV-1500 EX +(6-00) OFFICIAL USE ONLY C P o 0 R N R 0 E E S N T REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DATE OF BIRTH (MM-DD-YEAR) FilE NUMBER c2./ 0 j COUNTY CODE YEAR SOCIAL SECURITY NUMBER 172-24-8686 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE (i l '7 NUMBER o E C E o E N T COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG. PA 17128-0601 D CEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Hoover Harold C. DATE OF DEATH (MM-DD-YEAR) REGISTER OF WILLS SOCIAL SECURITY NUMBER B. 3. date of death . Remainder Return prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes Original Return 4. Limited Estate 6. Decedent Died Testate 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) X 7. Decedent Maintained a Living Trust 0 (Attach copy of Trust) 010. Spousal Poverty Credit (date o~ death between 12-31-91 and 1 -1-95) 0[1 11. Election to tax under Sec. 91 13(A) (Attach Sch 0) NAME Donna M. Mullin Es . FIRM NAME (If Applicable) JAMES, SMITH, DURKIN & CONNELLY, LLP TELEPHONE NUMBER COMPLETE MAILING ADDRESS 134 Sipe Avenue Hurnmelstown, PA 17036 R E C A P I T U l A T I o N 533-3280 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (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) (8) 189,937.58 (11) 12,318.20 (12) 177 ,619.38 (13) (14) 177 ,619.38 (1 ) (2) (3) None None None OFFICIAL USE ONLY (4) (5) None 3,000.00 (6) None 186,937.58 12,318.20 None C o M P T U A T X A T I o N 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. (15) (16) (17) (18) (19) .0 0 .0 45 .12 .15 88,593.36 89,026.02 x X X X 4,006.17 4,006.17 Copyright (c) 2000 form software only The Lackner Group,lnc. Form REV-15DD EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 49 Colgate Drive CITY I STATE T ZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 4,006.17 200.31 Total Credits ( A + B + C) (2) 200.31 3. Interest/Penalty if 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 L.ine 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. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT . . . pLEASE . ANS~~~"~'A~'::~:b:CEBWI'~'~:::~j~~~jb'~~:::~9 ~~~2!i~:~::~~":"\~W '1~:::~~:~:'~!~~~:~~'~'I~i~:::~t82:~~"i!im:'::: 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 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . [KI 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. 3,805.86 3,805.86 o o [R] [R] 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. ~ A. /J.~~. L~/ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ~~!n/~ Anne B. Hoover _ _ _~~ _ ~_~~g~_t:e: _ p_r.:~ '!~_ _ - - _ -. - - - -. - - - -' - - - - - - - - - - - - -- Camp Hill, PA 17011 JAMES, SMITH, DURKIN & CONNELLY, LLP _ _ _:I;.~~_ _~~p~_ A'!~?.~~_.. - - - - - - - - - - - - - - - -.- - - - - - - - - - -- Humme1stown, PA 17036 DATE SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN /d./'l-Clr DATE lo} /S:-jol For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. 9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 9116 (a) (1.1) Oi)]. 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. ::':':";:::; j;jmn ,:;:':::: U]\))))j) nnm~ '::,:l::::;::::::::::::': :::~ inn!!! !Hnn~n~~nj;~;n;:; in; n n i !jjn~H1;~~;11;1;;U;; ,.,.,.;.::;:::. :":ii::'-:'" iHHi!!:~~ jH~Hn:1Hij :,:;:;;:;:nn,niji;ji;;;;;;:;i,;:,;:i::;: ;:,;;,g!i;ii:,i:, jHu!~!nH~nn! ..:.;.;:~: ,:, :,:i; :;::\:\:;~;U;H )jj ni)j \\HnnnnT nnH hi<\j)ji ;.:.,::::::......... . ..:.,:::,::::.::.:..:......... . j;:!!jH[nnljiijij1[lji[ij~11m 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)(1.3)]. 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-150B EX +(1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Harold C. Hoover SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER SSif 172-24-8686 07/28/2001 Include the proceeds of litigation and the date the proceeds were received by the estate. All propert'1 jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1 DESCRIPTION 1989 Buick - in decedent's sole name Allocated to Family Exemption VALUE AT DATE OF DEATH 3,000.00 TOTAL (Also enter on line 5, Recapitulation) $ 3,000.00 (If more space is needed, insert additional sheets of the same size) Copyright (cl 1996 form software only CPSystems, Inc. Form REV-150B EX (Rev. 1-97) REV -1510 EX + (1-97) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Harold C. Hoover 07/28/2001 FILE NUMBER SS!! 172 - 24 - 8686 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. ITEM NUMBER 1 DESCRIPTION OF PROPERTY RELAW8~M~I~ t~1,~~~B~~l~J.rJ~~~1fA1'tEJF t~~~RSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE. 1,268.807 Franklin U.S. Government Securities Fund - Class A - IRA #110-10158001080; Beneficiary is spouse, Anna B. Hoover DATE OF DEATH VALUE OF ASSET 8,653.26 % OF DECO'S INTEREST EXCLUSION (IF APPLICABLE) 2 Sun America - Annuity #A634050779D; Beneficiary is spouse, Anne B. Hoover 8,094.74 3 231.106 The Vanguard Group - IRA #009029157; beneficiary is spouse, Anna B. Hoover 6,323.06 4 All First - Checking Account #0043922058; held in the name of the Harold C. Hoover and Anna B. Hoover Living Trust dated 4/29/1996; opened 11/28/1967; title changed on 4/29/1996; 1/2 value 11,538.18 ALL ASSETS HELD IN THE LIVING TRUST ARE HELD JOINTLY AS "TENANTS IN COMMON" BY EACH SPOUSE'S SUB-TRUST WITHIN THE JOINT TRUST 6 Edward Jones - Mutual funds account; held in the name of the Harold C. Hoover and Anna B. Hoover Living Trust dated 4/29/1996; 1/2 value; total value is $19,901.02 9,950.51 7 800 shares Fortune Brands Inc, CUSIP #349631101 - held in the name of the Harold C. Hoover and Anne B. Hoover Living Trust dated 4/29/1996; 1/2 value; 29,224.00 Total of Continuation Schedule(s) TOTAL (Also enter on line 7, Recapitulation) $ (If more space is needed, insert additional sheets of the same sjze) Copyright (cl 1996 form software only CPSystems, Inc. TAXABLE VALUE 8,653.26 8,094.74 6,323.06 11,538.18 9,950.51 29,224.00 113,153.83 186,937.58 Form REV-1510 EX (Rev. 1-97) Estate of: Harold C. Hoover Sac See #: 172-24-8686 Date of Death: 07/28/2001 Continuation of Schedule G (Inter-Vivos Transfers & Misc. Non-Probate Property) Item Description of Property if Date of Death % Deed Exclusion Taxable Value Value of Asset Intrst total shares = 1600 8 800 shares Gallagher Group PLC, CUSIP #363595109 - held in the name of the Harold C. Hoover and Anne B. Hoover Living Trust dated 4/29/1996; 1/2 value; total shares = 1600 20,848.00 20,848.00 9 167 shares GPU Inc, CUSIP #36225X100 - held in the name of the Harold C. Hoover and Anne B. Hoover Living Trust dated 4/29/1996; 1/2 value; total shares = 334 5,993.63 5,993.63 10 Personalty - 1/2 value of personalty as held as tenants in common in the Harold C. Hoover and Anne B. Hoover Living Trust dated 4/29/1996 12,500.00 12,500.00 11 160 shares PPL Resources Inc Hldg Co, CUSIP #693499105 - held in the name of the Harold C. Hoover and Anne B. Hoover Living Trust dated 4/29/1996; 1/2 value; total shares = 320 7,160.00 7,160.00 12 6 shares PPL Co, CUSIP #693499105 - Preferred 4 1/2 % stock; held in the name of the Harold C. Hoover and Anne B. Hoover Living Trust dated 4/29/1996; 1/2 value; total shares = 320 402.00 402.00 13 PSECU - Regular Share 2,445.58 2,445.58 Estate of: HaroldC. Hoover Sac Sec #: 172-24-8686 Date of Death: 07/28/2001 Continuation of Schedule G (Inter-Vivos Transfers & Misc. Non-Probate Property) Item Description of Property # Date of Death % Decd Exclusion Taxable Value Value of Asset Intrst Account held in the name of the Harold C. and Anne B. Hoover Living Trust dated 4//29/1996; opened 05/12/1983; Changed to trust name on 4/30/1996; 1/2 value 14 Real Estate situate at 49 Colgate Drive, Camp Hill, Cumberland County, Pennsylvania - 1/2 value of real estate as held as tenants in common in the Harold C. Hoover and Anne B. Hoover Living Trust dated 4/29/1996 62,500.00 62,500.00 15 Waypoint Bank - Savings Account #502123748; In Trust for son, Todd Hoover; Opened 11/01/1991 1,304.62 1,304.62 113,153.83 REV-1S11 EX +(1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Harold C. Hoover FILE NUMBER SSfl 172 - 24 - 8686 07/28/2001 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT 1 FUNERAL EXPENSES: Parthemore Funeral Home - funeral services 5,793.20 2 Parthemore Funeral Home - grave opening charge 525.00 B. ADMINISTRATIVE COSTS: 1. 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 JAMES, SMITH, DURKIN & CONNELLY, LLP Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Anna B. Hoover Street Address 49 Colgate Drive City Camp Hill State PA Zip 17011 Relationship of Claimant to Decedent Spouse 2,500.00 3,500.00 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs TOTAL (Also enter on line 9, Recapitulation) $ 12,318.20 (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) REV-1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIAR IES ESTATE OF Harold C. Hoover FILE NUMBER SS1f 172-24-8686 07/28/2001 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] 1 Anna B. Hoover Franklin U.S. Government IRA Sun America Annuity Vanguard IRA Life estate in Harold C. Hoover Family Trust RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE Spouse 8,653.26 8,094.74 6,323.06 65,522.41 2 Harold C. Hoover, Jr. Todd Hoover 1/2 remainder interest to each in Harold C. Hoover Family Trust Son Son 87,721. 29 3 Todd Hoover Waypoint Savings Account in Trust Son 1,304.62 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 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. Form REV-1513 EX (Rev. 9-00) REV-1514 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN Check Box 4 on Rev-1500 Cover Sheet Copy 1frl ESTATE OF FILE NUMBER Harold C. Hoover SS# 172-24-8686 07/28/2001 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 [K] Intervivos Deed of Trust D Other DATE OF BIRTH Anna B. Hoover 12/04/25 76 Term of Years Term of Years 1. Value of fund from which life estate is payable 2. Actuarial factor per appropriate table Interest table rate - 031/2% 06% 0 10% 3. Value of life estate {Line 1 multiplied by Line 2} $ 153,243.70 0.42757 [] Variable Rate 6.2 % $ 65,522.41 DATE OF BIRTH Term of Years 1. Value of fund from which annuity is payable 2. Check appropriate block below and enter corresponding (number) Frequency of payout - D Weekly (52) D Bi-weekly (26) o Quarterly (4) 0 Semi-annually (2) D 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 - D 3 1/2% 06% 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 D Monthly (12) D Other ( ) 0.0 % 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, 17 and 18. (If more space is needed, insert additional sheets of the same size) Copyright (c) 2000 farm software only The Lackner Group,lnc. Form REV-1514 EX (Rev. 9-00) REV-1649 EX + (1197) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 0 ELECTION UNDER SEC. 9113(A) (SPOUSAL DISTRIBUTIONS) ESTATE OF FILE NUMBER Harold C. Hoover SS# 172-24-8686 07/28/2001 Do not complete this schedule unless the estate is making the election to tax assets under Section 9113(A) of the Inheritance & Estate Tax Act. If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust. This election applies to the Family Trust Trust (marital, residual A, B, By-pass, Unified Credit, etc.). If a trust or similar arrangement meets the requirement of Section 9113(A), and: a. The trust or similar arrangement is listed on Schedule 0, and b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0, then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule 0, the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar arrangement included as a taxable asset on Schedule O. The denominator is equal to the total value of the trust or similar arrangement. PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's surviving spouse under a Section 9113 (Al trust or similar arrangement. DESCRIPTION VALUE 1 The Assets which comprise the Harold C. Hoover Family Trust 153,243.70 2 Franklin U.S. Government Securities IRA 8,653.26 3 Sun America Annuity 8,094.74 4 Vanguard IRA 6,323.06 Part A Total 176 314.76 PART B: Enter the description and value of all interests included in Part A for which the Section 9113 (Al election to tax is being made. DESCRIPTION VALUE 1 The Assets which comprise the Harold C. Hoover Family Trust 153,243.70 Part B Total 153,243.70 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems.lnc. Form REV-1649 EX (Rev. 1-97) PA INHERITANCE TAX: SCHEDULE O/9113(A) ANALYSIS ************************************************ DECEDENT: Date of Death...... .....[mm/dd/yyyy]07/28/2001 Mortality Table.... .......... .....F1 90 <==F1 Help SURVIVING SPOUSE: Date of Birth...... .....[mm/dd/yyyy]12/04/1925 Age at Decd Death (nearest birthday) 76 RATES & FACTORS: Sec. 7520 Rate... ............ .....F1 Table S: Life Estate Factor. ....... PA Rate (4.5%-6%-12%-15% or mixed).. TRUST: Life Insurance...................... Other As sets. . . . . . . . . . . . . . . . . . . . . . . . Total. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Life Estate......................... Remainder Interest.................. Press <Enter> for results... 6.2% 0.42757 4.5% 82,161 153,244 235,405 100,652 134,753 Tax on Life Insurance..... ........ ....... OPTION #1: Tax REMAINDER int on 1st estate [MAKE 9113(A) ELECTION] Tax on Other Assets: Life Estate........ ..... Remainder Interest...... 65,522 87,721 Tax on Remainder Interest @ 4.5% .. OPTION #2: Tax ENTIRE trust on 2nd estate [NO ELECT].. Exempt 3,947 10,593 Tax paid unnecessarily [Life Insur x 4.5%] 3,697 Appropriate tax on 2nd estate @ 4.5% ..... ...;.......A Tax under OPTION #1 @ 4.5% # Years Spouse Survives.. Assumed Interest Rate.... FUTURE Value (compare this 6,896 3,947 8 10.00% amt with A above)...C 8,462 Last Will of HAROLD C. HOOVER I, HAROLD C. HOOVER, a resident of Pennsylvania County, Pennsylvania, declare that this is my will. I hereby revoke all, my previous wills and codicils. Article One Introductory Provisions Section 1. Marital Status I am currently married to ANNE B. HOOVER A/KJA ANNA B. HOOVER, and all references to my spouse in this will are to her. Section 2. Children a. The name(s) and birth date(s) of my children: Name Birth date HAROLD C. HOOVER, JR. TODD E. HOOVER September 18, 1952 March 21, 1957 All references to my children in this instrument are to these children and any children subsequently born to or adopted by me. 1 Article Two Appointment of My Personal Representatives Section 1. Nomination of My Personal Representatives I appoint the following to be my Personal Representative: ANNE B. HOOVER AlKJA ANNA B. HOOVER If, for any reason, the Personal Representative(s) named above are unable or unwilling to serve, the following successor Personal Representative(s) shall serve until the successor Personal Representative(s) on the list have been exhausted. Unless otherwise specified, if Co-Personal Representatives are serving, the next following named successor Personal Representative shall serve only after all of the Co-Personal Representatives cease to act as Personal Representatives. (1) HAROLD C. HOOVER, JR. AND (2) TODD E. HOOVER, OR THE SURVIVOR OF THEM Section 2. Waiver of Bond No bond or undertaking shall be required of any Personal Representative nominated in my will. Section 3. General Powers My Personal Representative shall have full authority to administer my estate under the laws of the State of Pennsylvania relating to the powers of fiduciaries. My Personal Representative shall have the power to administer my estate under the Pennsylvania Probate, Estates and Fiduciaries Code. 2 Article Three Disposition of My Property Section 1. Distribution to My Revocable Living Trust I give all of my property of whatever nature and kind and wherever located to my revocable living trust of which I am a Trustor known as: HAROLD C. HOOVER and ANNE B. HOOVER A/KJA ANNA B. HOOVER, Trustees, or their successors in trust, under the HAROLD C. HOOVER AND ANNE B. HOOVER A/KJA ANNA B. HOOVER LIVING TRUST dated APR 2 9 1996 and any amendments thereto Section 2. Alternate Disposition If my revocable living trust is not in effect for any reason, I give all of my property to my Personal Representative under this will as Trustee who shall hold, administer and distribute my property as a testamentary trust the provisions of which are identical to those of my revocable living trust on the date of execution of my will. Article Four Death Taxes Section 1. Definition of Death Taxes The term "death taxes," as used in my will, shall mean all inheritance, estate, succession, and other similar taxes that are payable by any person on account of that pe!son's interest in the estate of the decedent or by reason of the decedent's death, including penalties and interest, but excluding the following: a. Any addition to the federal estate tax for any "excess retirement accumulation" under Internal Revenue Code Section 4980A. 3 b. Any additional tax that may be assessed under Internal Revenue Code Section 2032A. c. Any federal or state tax imposed on a generation-skipping transfer, as that term is defined in the federal tax laws, unless the applicable tax statutes provide that the generation-skipping transfer tax is payable directly out of the assets of my gross estate. Section 2. Payment of Death Taxes Pursuant to the terms of my revocable'living trust, all death taxes whether or not attributable to property inventoried in my probate estate shall be paid by the Trustee from that trust. However, if that trust does not exist at the time of my death or if the assets of that trust are insufficient to pay the death taxes in full, I direct my personal representative to pay any death taxes that cannot be paid by the trustee from the assets of my probate estate by prorating and apportioning those taxes among the beneficiaries of this will. Notwithstanding any other provision in my trust, all death taxes incurred by reason of assets transferred outside of my trust or probate estate shall be assessed against those persons receiving such property. Article Five General Provisions Section 1. No Contest Clause If any person or entity other than me singularly or in conjunction with any other person or entity directly or indirectly contests in any court the validity of this will including any codicils thereto, then the right of that person or entity to take any interest in my estate shall cease and that person or entity shall be deemed to have predeceased me. Section 2. Captions The captions of Articles, Sections and Paragraphs used in this will are for convenience of reference only and shall have no significance in the construction or interpretation of this will. 4 Section 3. Severability Should any of the provisions of my will be for any reason declared invalid, such invalidity shall not affect any of the other provisions of this wiil and ali invalid provisions shali be whoiiy disregarded in interpreting this will. Section 4. Governing Law This will shall be construed, regulated and governed by and in accordance with the laws of the State of Pennsylvania. I signed this, my last will, on APR 2 9 1996 ~~~~ 5 The foregoing Will was, on the day and year written above, published and declared by HAROLD C. HOOVER in our presence to be his WilL We, in his presence and at his request, and in the . presence of each other, have attested the same and have signed our names as attesting witnesses. We declare that at the time of our attestation of this Will, HAROLD C. HOOVER was, according to our best knowledge and belief, of sound mind and memory and under no undue duress or constraint. ~~ Address: 02'5'" ~vJ/.)db ~ {:..-e / du..r M-r f7J Cd y q,~~~/ WITNESS Address: o f / /9f /7?U3 6 ~ STATE OF PENNSYLVANIA : SS: COUNTY OF DAUPHIN We, HAROLD C. HOOVER, 1<::>",- -K'UZo..Lv- , and - ~ ~ L , the Testator and the witnesses, respectively, whose names are signed to the fore ing ill, having been sworn, declared to the undersigned officer that the Testator, in the presence of witnesses, signed the instrument as his last Will, that he signed, and that each of the witnesses, in the presence of the Testator and in the presence of each other, signed the Will as a witness. ~ep 'HAROLD c. HOIT ER ...~~r- ~ ESS C~,7 o/7!/eA/ ~TNESS ' Subscribed and sworn before me and by ~OLD C. HOOVER, the Testator, and by /;:/wI, A( 7 k ,., Y'" the witnesses on 't. ~ I"; ~,I.'.. '\ , , \. ;' I; 1 " 1 .. '. i., ary Public ," ~:~t. /.< t/ 1('" My corrimission expires: .) , i , I' \.. '" ',' ,; \ ' ) "" ,,," '( -' - ~..,-- MO:TP,RIAl SE:\l "ub1il" ':, , I~ E"E f\lot3J'J ' ' ... \ \ CONNIE L ~[ oauphin COllntv10('!9 \ \-\el'Sn~J.. Expires Ma'j 10, vv' , ': t..~ comtlllSSIOO 7 ~ iii allftrst September 24, 2001 James Smith Durkin & Connelly LLP Art. Stephanie L. Gaffey P.O. Box 650 Hershey, PA 17033 Allfirst Financial Center N.A. P.O. Box 900 Millsboro, DE 19966 RE: Estate of Harold C. Hoover Date of De.ath: July 28,2001 Social Security Number: 172-24-8686 Dear Ms. Gaffey: In response to your request, please be advised that at the time of death, the above- named decedent had on deposit with this bank the following account. Account Type. .... ... .... .. .. . .... .. . ... Relationship w / Int. Checking Account Account Number.. ..................... 0043922058 Ownership (Names of)............... Hoover Harold C. & Anna B Liuing Trust Dtd 4/29/96)' HaroldC. Hoover & Anna B. Hoover Co-Trustees Opening Date. ......... ................. 11/28/67 Balance on Date of Dea(h.. ........$ 23,073.19 Accrued Interest $ 3.17 Total.......................................$ 23,076.36 f:TIris respoh5~ dues not apply to c2.a.J.y &3~et.s h..(;l..il-.;~i".:h :!JJ.f...~L B:"Gl~~~: .,"'.;"here ~JJ..:fu-~~ .:!c.:--...k.. is ~.!"'.'i.~g 2..:? 8. ~.:.~~e. nor to ally credit cards owned by Bank of America beariIl.g'Allfirst Bank's name." If you have any further questions on these accounts, please contact the branch of record: 344 South 10th Street, Lemoyne, PA 17043, telephone 717-737-3322. Sincerely, .~,d.~ Mary Anne Macielag Associate IIClS (302) 934-2240 Edward Jones 1300 Market Street Lemoyne, PA 17043 (717) 731-5432 Sean Ferguson Investment Representative I- '::l,--- EdwardJones September 17, 2001 Stephanie L James Smith PO Box 650 Hershey, PA Gaffey Durkin & Connelly LLP 17033 Dear Stephanie: Sorry for the delay in getting this information to you, the request was mailed to the wrong Edward Jones office. We finally got it and here is the information you requested: 1. Title: Harold C Hoover, TTEE & Anna B Hoover, TTEE V/A DTD 4/29/96 Harold C & Anna B Hoover Trust 2. Account established 9/12/2000 3. Change of ownership - none 4. Date of death balance - $19,901.02 5. Interest earned from 1/1/01-7/28/01 - Interest earned: $.34 Dividends earned and reinvested back into mutual funds: $242.90 If there is anything else we can do for you, please let us know. ~ely, ,/! ---/' , ~0 ',rJ;. Terri Jackson Branch Office Administrator PSECIt; ,-~ '''"- the financiallinkTM September 19,2001 Account # 0172248686 STEPHANIE L. GAFFEY CIO JAMES SMITH DURKIN& CONNELLY LLP PO BOX 650 HERSHEY, PA 17033 Dear MS. GAFFEY: The following is the status of HAROLD C. HOOVER's account with PSECU as of the date of death. Joint Owner's Name 04.30.1996 CHANGED TITLE TO HC & AB HOOVER R1L1T DATED 04.29.1996 05.12.1983 07.28.2001 01.03.1926 Date Established Date of Death Date of Birth Share(s) Regular Shares (S 1) MoneyHand1er Shares (S4) Balance $4,880.59 0.00 Accrued Dividend $10.57 0.00 The dividend earned from January 1,2001 through the date of death was $80.36 The decedent had no loans with us. We do not have safe deposit boxes for our members. If you have any questions, please call 234- 8484 in Harrisburg or our toll-free number, (800) 237-7328. At the menu prompt, enter 6 and then extension 2227, Sincerely, 1/-4, \/i ,/ ~ ~./: /,1/1' . . &vfL-0 V' I" r (/V'" 77. I I 1',-, It Meacie Fairfcb{ . Member Service Representative Finance Support Unit PENNSYLVANIA STATE EMPLOYEES CREDIT UNION Main Address: 1 Credit Union Place, Harrisburg, PA 17110-2990' (717) 234-8484' (800) 237-7328 Mailing Address: P.O. Box 67013, Harrisburg, PA 17106-7013 . (717) 777-2100 (TDD) . (800) 472-1967 (TDD) Web Address: www.psecu.com Savings federally insured up to $100,000 by the National Credit Union Administration. ~IWayRRi!lJ C- lOOK FOR US. WE'll GET YOU THERE. 09/14/2001 JAMES SMITH DURKIN & CONNELLY POBOX 650 HERSHEY P A 17033 The information which you requested on the account(s) of HAROLD HOOVER DECEASED (Social Security Number 172-24-8686) is/are as follows: Account Number 502123748 502132559 Class of Account SA VINGS SA VINGS Date Opened 11/01/9] 07/02/96 Principal Balance 1303.13 ] 183.53 Accrued Interest 1.49 1.35 Balance at Date of 1304.62 1184.88 Death Account Ownership TRUST JTO Name of Joint TODD - aNI. ANNE Owner, if any HOOVER HOOVER Date Ownership 11/01/91 07/02/96 Was Established Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership Name of .Toint Owner, if any Date Ownership Was Established Additional Information Requested PLEASE COMPLETE W-9 S41cerely, J)~. I) {l.iJ'fJ., 0<.. . . i KATHwYO 0 SENIOR SERVICES REP. P.o.. Box 1711. HARRISBURG. PENNSYLVANIA 17105-1711 Toll FrEE 1-865-WAYPOINT 0-866-925-7646) . www.waypointbanlccom ior~~ B'Jtcr' Hoc'/er Fax +1(-:'17';77':'.3434 To: Stephahle Gaff)' ~a.; (;'17'/ 533~7771 Page :2 of,: VVednesday, October 17 ~G:Jl 4'5~ q~./ Di.::ur .E:Ii;cl:Ul()f: . .' '1.'."l,......,.ll^q!". 'LIP" [TOrr "Stej"]ha11ire"G';Jfl;:~v t(,"~Mi({'vT'li.t1V; 'VBltlt'~ (Iflhl' '~J"('nF,"j~ \ "'~"~~'" ~':Y ~'. ~,J' ,,:~":I.-.,',' ,..' L, ',' :4e "':,"' " 'J' ":. " ' " .'~. '. ,',\ '. ,... ,~;: ":,!,'-:lJ.".,t'. ": '~.:...r r-,' ....; "': ~:, ,',' "'C', ' jI...,~.!' 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