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Home My WebLink About02-15-06 ~ 15056051047 REV-1500 EX (06-05) PA Department of Revenue . Bureau of Individual Taxes . PO BOX 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year File Number Date of Birth Decedent's Last Name Suffix Decedent's First Name MI (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW _ 1. Original Return C> 2. Supplemental Return C> 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required C> _ 4a. Future Interest Compromise (date of death after 12-12-82) C> 7. Decedent Maintained a Living Trust (Attach Copy ofTrust) C> 10. Spousal Poverty Credit (date of death C> 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes 4. Limited Estate C> -- C> Correspondent's e-mail address:jburke@mandtbank.com 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 ali information of which preparer has any knowiedge. ADORES Mann acturers and Traders Trust Company, One West High Street, Carlisle, PA 17013 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051047 15056051047 ~ ---.J REV-1500 EX Decedent's Name: RECAPITULATION 15056052048 1. Real estate (Schedule A). ............................................ 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3. 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. 6. Jointly Owned Property (Schedule F) c::> Separate Billing Requested. . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) c::> Separate Billing Requested. . . . . . .. 7. 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. 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)................................... 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14. TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 16. Amount of Line 14 taxable at lineal rate X.O_ 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. Decedent's Social Security Number 15. 16. 17. 18. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052048 Side 2 - 15056052048 ---.J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-05-0493 DECEDENTS NAME DENNIS E. HOOVER STREET ADDRESS 119 Walnut Street CITY I STATE I ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 44,041.53 55,000.00 Total Credits (A + B + C) (2) 55,000.00 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. Fill in oval on Page 2, Line 20 to request a refund. (4) 10,958.47 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5) (SA) (SB) A. Enter the interest on the tax due. Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;.......................................................................................... D I!J b. retain the right to designate who shall use the property transferred or its income; ............................................ D ~ c. retain a reversionary interest; or.......................................................................................................................... D U d. receive the promise for life of either payments, benefits or care? ...................................................................... D [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. D I[] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D I[] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ IX] D IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [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 zero (0) percent [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 zero (0) percent [72 P.S. ~9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, 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 twelve (12) percent [72 P.S. ~9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX+ (6-98) SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF DENNIS E. HOOVER FILE NUMBER 21-05-0493 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION 119 Walnut Street, Cumberland County, Carlisle, PA 17013 VALUE AT DATE OF DEATH 81,000.00 (Settlement Sheet attached) TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 81,000.00 REV-1503 EX+ (6-98) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF DENNIS E. HOOVER FILE NUMBER 21-05-0493 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1. 7.949276 shs. Corning, Inc. 2 shs. Delphi Corp. 3 shs. DirecTV Group, Inc. 4 52 shs. General Motors Corp. 5 Dividend on Item 4 5 510 shs. AMBAC Financial Group, Inc. Deb. 5.875% 6 510 shs. Morgan Stanley Cap Tr IV Ltd. Cap. 6.25% 4/1/33 7 Interest to ODD Item 6 9 4 shs. Raytheon Co. Class A 10 $88,150 par US Series EE Bonds 11 $5,425 par US Series E Bonds 12 $13,500 par US Series H Bonds 13 Interestto ODD Item 12 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH 118.13 129.42 58.54 1,604.98 26.00 12,836.70 12,906.02 199.22 100.67 92,470.92 26,999.00 13,500.00 60.00 161,009.60 REV-1508 EX+ (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF DENNIS E. HOOVER FILE NUMBER 21-05-0493 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Money Market Balance Trust utA Dennis E. Hoover 44,679.73 1,163.86 3.25 2 M&T Bank, Checking Accl. 1185586 3 Cash 4 Refund, Dickinson College, Medical insurance premium 56.58 5 Refund, State Farm Mutual, automobile insurance 154.92 6 Proceeds sale of Personal Property 1,650.70 8,801.00 2,641.35 365.27 7 Proceeds sale of 2003 Chevrolet Malibu 8 Refund, GE Capital Assurance, long term care premium 9 TIM, Traditional Account 10 TIM-CREF Variable Account 859.26 11 Refund, Master Trust Policy 248.00 12 Wacovia, balance Account 3000043999722 4,370.83 13 Wachovia Securities, Money Market 4061-1853 187.27 14 Refund, 2004 Federal Income Tax 372.00 15 Wachovia Securities, Money Market 3743-5828-1 116.06 16 Pro-rated Real Estate Taxes, 119 Walnut Street property 85.79 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 65,755.87 REV-1510 EX+ (6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF DENNIS E. HOOVER FILE NUMBER 21-05-0493 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. 1. AIG Annuity Insurance Co. Policy VP215490--Beneficiary, Estate of Dennis E. Hoover 100 2 AIG Annuity Insurance Co. Policy BX204788--Beneficiary, Estate of Dennis E. Hoover 100 3 Wachovia IRA 257410900438487 -Beneficiary, Estate of Dennis E. Hoover 100 4 Western-Southern Life Assurance Co. Contract W-0020472297-- Beneficiary, Estate of Dennis E. Hoover 13,712.62 100 TOTAL (Also enter on line 7 Recapitulation) $ (If more space is needed, insert additional sheets of the same size) EXCLUSION (IF APPLICABLE) TAXABLE VALUE 23,610.89 11,493.09 98,381.91 13,712.62 147,198.51 REV-1511 EX+ (12-99) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF DENNIS E. HOOVER FILE NUMBER 21-05-0493 ITEM NUMBER A. B. 1. Debts of decedent must be reported on Schedule I. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: Ewing Brothers Funeral Home, Inc. First Lutheran Church, funeral luncheon 2 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Manufacturers and Traders Trust Company Social Security Number(s)/EIN Number of Personal Representative(s) 16-0538020 Street Address One West High Street 17,923.74 City.. Carlisle Year(s) Commission Paid: 2006 _ State PA Zip 17013 2. Attorney Fees Saidis, Shuff, Flower & Lindsay 7,500.00 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 444.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Cumberland Law Journal, advertising Letters Testamentary Dept. of Vital Statistics, Death Certificates Diversified Appraisal Service, real estate appraisal The Sentinel, advertising Letters Testamentary Notary fee l\eserve for Closing and Filing Costs 75.00 180.00 275.00 129.77 5.00 1,500.00 8 9 10 11 12 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 28,557.15 REV-1512 EX+ (12-03) SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF DENNIS E. HOOVER FILE NUMBER 21-05-0493 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Clair S. Tritt, June garage rental 45.00 2. Borough of Carlisle, water and sewer service 64.72 3 UGI, service 73.96 4 PPL, service 69.73 5 Sprint, service 32.80 6 Marsh Advantage America, insurance premium on Walnut Street property 362.00 7 H&H Chevrolet, automobile repairs 36.04 8 Shevlin's Maintenance Service, cleaning Walnut Street property 195.81 9 Jim Stokes, plumbing repairs 119 Walnut Street property 42.95 10 Capital Tax Collection Bureau, local tax due 2.72 11 PA Dept. of Revenue, 2004 tax due PA 40 48.00 12 Smith Elliott Keanrs & Co., LLC preparation of 2004 personal tax returns 210.00 13 George L. Ebener & Assoc., realtor fee 2,455.00 2,405.00 810.00 14 ERA-NRT, Inc., realtor fee 15 1 % Real Estate Transfer Tax TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 6,853.73 REV-1513 EX+ (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF DENNIS E. HOOVER FILE NUMBER 21-05-0493 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 Manufacturers and Traders Trust Co. TUW Dennis E. Hoover FBO 411,553.10 Patricia M. Porr, 762 Hamilton Street, Carlisle, PA 17013 Cousin Sandra L. Hunter, 7635 E 600 S, Huntsville, UT 84317 Cousin Yvonne B. Karper, 322 N. College Street, Carlisle, PA 17013 Cousin Kenneth R. Miller, 1346 Eleventh St., Marion, IA 52302 Cousin Remainder Beneficiary--First Lutheran Church, Carlisle, PA 17013 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, 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 J. Herman Bosler Memorial Library, 158 West High Street, Carlisle, PA 17013 1,000.00 2 Cumberland-Goodwill Fire Co., 102 West Ridge Street, Carlisle, PA 17013 2,000.00 3 Keystone Area Council of Boy Scouts of America, P.O. Box 389, Mechanicsburg, PA 17055 5,000.00 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 8,000.00 (If more space is needed, insert additional sheets of the same size) REV-1514 EX+ (12-03) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN Check Box 4 on REV-1500 Cover Sheet ESTATE OF DENNIS E. HOOVER FILE NUMBER 21-05-0493 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 from 5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. I!I Will 0 Intervivos Deed of Trust 0 Other Patricia M. Porr 06/21/1954 10/02/1951 09/30/1945 11/19/1943 51 54 60 61 IX] Life or 0 Term of Years IX] Life or 0 Term of Years Sandra L. Hunter Yvonne B. Karper Kenneth R. Miller IiCI Life or 0 Term of Years IX] Life or 0 Term of Years o Life or 0 Term of Years 1. Value of fund from which life estate is payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 2. Actuarial factor per appropriate table ................................................. Interest table rate - 0 3 1/2% 0 6% 0 10% 0 Variable Rate 5.2 % 3. Value of life estate (Line 1 multiplied by Line 2) ......................................$ 411,553.10 0.71342 293,610.21 o Life or 0 Term of Years o Life or 0 Term of Years o Life or 0 Term of Years o Life or 0 Term 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 Bi-weekly (26) 0 Monthly (12) o Quarterly (4) 0 Semi-annually (2) 0 Annually (1) 0 Other ( ) 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% 0 10% 0 Variable Rate % 6. Adjustment Factor (see instructions) ....................... . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. ' Value of annuity - If using 31/2%, 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 and 15 through 18. (If more space is needed, insert additional sheets of the same size) FEB. 9.2006 7: 57AM DECEDENT: LIFE TENANT: RATES & FACTORS: M T TRUST ONE LIFE (Table S) -- PATRICIA M. PORR ****************** NO. 1293 P. 3 Date of Death........ ...[mm/dd/yyyy] 05/16/2005 Mortality Table. ..................F1 90 < Fl Help Date of Birth..... ......[mm/dd/yyyy] 06/21/1954 Age at Deed Dea~h (nearest birthday) 51 Sec. 7520 Table s: Table S: Table s: Rate. . . . . . . . . . . . . . . . . . . . Fl Remainder Factor....... Life Estate Factor.. ... Annuity Factor.... ..... 5.2% 0.28658 0.71342 13.7196 FEB. 9.2006 7:57AM '-- DECEDENT: LIFE TENANT: RATES & FACTORS: M T TRUST NO. 1293 P. 2 ONE LIFE (Table S) -- SANDRA L. HUNTER ****************** Da~e of Death... ... .....[mm/dd/yyyy] 05/16/2005 Morta1i~y Table......... ..........F1 90 < Fl Help Date of Bir~h,. .,.......[mm/dd/yyyy] 10/02/1951 Age ae Decd Death (nearest birthday) 54 Sec. 7520 Table S: Table s: Table S: Ra'te. . . . . . . . . . . . . . . . . . , ,Fl Remainder Fac~or....... Life Estate Fac'tor..... Annuity Fac'tor......... 5.2% 0.32031 0.67969 13.0710 FEB. 9.2006 7:57AM DECEDENT: LIFE TENANT: RATES & FACTORS: M T TRUST ONE LIFE (Table S) = YVONNE B. KARPER **********~******* NO. 1293 P. 4 Date of Death......... ..[mm/dd/yyyy] 05/16/2005 Mortality Table... ,... ........ ,...F1 90 <==Fl Help Date of Bi~th........ ...[mm/dd/yyyy] 09/30/1945 Age at Decd D~ath (neares~ birthday) 60 Sec. 7520 Ta.ble s: Table S: Ta.ble s: Ra'l:e. . . . . . . . . . . . . . . . . . . . F1 Remainder Fa.ctor, ,..... Life Esta'l:6 Factor...., Annui~y Factor. ........ 5.2% 0.39408 0.60592 11.6524 FEB. 9.2006 7:57AM DECEDENT: LIFE TENANT: RATES <5: FACTORS: M T TRUST ONE LIFE (Table S)-- KENNETH R. MILLER ****************** NO. 1293 P. 5 Date of Dea~h........ ...[mm/dd/yyyyJ 05/16/2005 Mor~ality Table...................F1 90 <--Fl Help Date of Birth...... ,... . [mm/dd/yyyyJ 11/19/1943 Age at Deed Death (nearest birthday) 61 Sec. 7520 Table S: Table S; Table S: Ra~e. . . . . . . . , . . . . . . . . . . . Fl Remainder Factor.. ..... Life Estate Factor..... Annuity Factor......... 5.2% 0.40699 0.59301 11.4040 ft.. Settlem:!nt Statement U.S. Department of Housing and Urban Development OMB Approval No. 2502-026~ B. Type of Loan 1. [ ] FHA 4.[ ]VA 2. [ ] FmHA 5. [ ] Conv.lns. 3. [ ] Conv.Unins. 6. File Number: 7. Loan Number: 8. Mortgage Insurance. Case Number: 400501254-CB C. NOTE: THIS NOTE IS FURNISHED TO GIVE YOU A STATEMENT OF ACTUAL SETTLEMENT COSTS. AMOUNTS PAID TO AND BY THE SETTLEMENT AGENT ARE SHOWN. ITEMS MARKED "(P.O. C.)" WERE PAID OUTSIDE THE CLOSING; THEY ARE SHOWN HERE FOR INFORMATIONAL PURPOSES AND NOT INCLUDED IN THE TOTALS. D. Name and Address of Borrower I E. Name and Address of Seller I F. Name and Address of Lender WAYNE L. BOOMER AND ROBERT E. OF MANUFACTURERS AND TRADERS OWENS TRUST COMPANY, EXECUTOR OF THE ESTATE OF DENNIS E. HOOVER 1226 HIGHLAND AVE. PORTSMOUTH, VA 23704 119 WALNUT STREET CARLISLE, PA 17013 G. PROPERTY LOCATION 119 WALNUT STREET, CARLISLE, PA 17013 COUNTY: CUMBERLAND PARCEL 10: 04-21-0320-466 H. Settlement Agent SECURED LAND TRANSFERS - MECHANICSBURG Place of Settlement 1068 HARRISBURG PIKE CARLISLE, PA I. Settlement Date / Disbursement Date. J. SUMMARY OF BORROWER'S TRANSACTIONS K. SUMMARY OF SELLER'S TRANSACTIONS 100. Gross Amount Due From Borrower 400. Gross Amount Due To Seller 101. Purchase Price .. $81,000.00 401. Purchase Price $81,000.00 102. Personal Property 402. Personal Property 103. Settlement Charges to Borrower $1,720.25 403. 104. 404. 105. 405. Adjustments For Items Paid By Seller In Advance Adjustments For Items Paid By Seller In Advance 106. CitylTown Taxes 406. CitylTown Taxes 107. County Taxes 414.3200/yr for 08/08/05 thru 01/01/06 $164.58 407. County Taxes 414.3200/yr for 08/08/05 thru 01/01/06 $164.58 108. Assessments 408. Assessments 109. School Taxes 999.1600/yr for 08/08/05 thru 07/01/06 $896.47 409. School Taxes 999.1600/yr for 08/08/05 thru 07/01/06 $896.47 110. 410. 111. 411. 112. 412. 8/8/2005 10:00:00 AM/8/8/2005 120. Gross Amount Due From Borrower I $83,781.30 420. Gross Amount DueTo Seller I $82,061.05 200. Amounts Paid By Or In Behalf Of Borrower 500. Reductions in Amount DueTo Seller 201. Eamest Money $1,000.00 501. Excess deposit 202. Principal Amount of New Loan(s) 502. Settlement Charges To Seller (line 1400) $6,666.44 203. Existing loan(s) taken SUbject to 503. Existing Loan(s) taken Subject To 204. 504. Payoff of First Mortgage Loan 205. 505. Payoff of Second Mortgage Loan 206. 506. 207. 507. 208. 508. " 209. ,~/l'. ; {;a.. ~.~....~ 'I. ~ ~ I" II . ... ;~.-' ,A.. -t ,. '~ ....... 509. I. .,"J Adjustments For Items Unpaid By Seller <, Adjustments For Items Unpaid By Seller 210. CitylTown Taxes 510. CitylTown Taxes 211. County Taxes 511. County Taxes 212. Assessments 512. Assessments 2"13. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. Total Paid By/For Borrower 300. Cash At Settlement FromlTo Borrower 301. Gross Amount Due From Borrower (line 120) 302. Less Amounts Paid By/For Borrower (line 220) I I I $1,000.00 520. Total Reduction Amount Due Seller 600. Cash At Settlement To/From Seller $83,781.30 601. Gross Amount Due To Seller (line 420) $1,000.00 602. Less Deductions In AmI. Due To Seller (line 520) I $6,666.44 I I $82,061.05 $6,666.44 $82,781.301603. Cash [X] To [ ] From Seller $75,394.61 303. Cash [ X ] From [ ] To Borrower 4cJ050i 254 - CB L. Settlement Statement ',.'" '\. .\;;..... '" 700..Total Sales Commission 81000.00 @ 6 % = 4860.00 " Division of Commission (line 700) As Follows: " Paid From Borrower's Paid From St:., 701. $2455.00 to George L. Ebener & Associates Funds At Settlement Funds At Settle'n" 702. $2405.00 to ERA-NRT, Inc. '" 703. COll)mission paid at settlement "-, $4,860.00 707. Transaction Fee to ERA-NRT, Inc. $125.00 " 800. Items Payable In Connection With Loan 801. Loan Origination Fee 802. Loan Discount 803. Appraisal Fee 804. Credit Report 805. Lender's Inspection Fee 900. Items Required By Lender To Be Paid In Advance 90'1. Interest From 902. Mortgage Insurance Premium for 903. Hazard Insurance Premium for 1000. Reserves Deposited With Lendel 1001. Hazard Insurance 1002. Mortgage Insurance 1003. City Property Taxes 1004. County Property Taxes 1100. Title Charges 1101. Settlement or Closing Fee 1102. Abstract or Tille Search 1103. Title Examination 1106. Notary Fees to Cash $2.00 $5.00 1107. Attorney's Fees 1108. Title insurance to Secured Land Transfers - Mechanicsburg $744,75 1109. Lender's Coverage $ ($) 1110. Owner's coverage $81000.00 ($744.75) 1200. Government Recording And Transfer Charges 1201. Recording Fees: Deed $ 38.50; Mortgage $ $38.50 1202. City/County Tax/Stamps 810.00 $810.00 1203. State Deed Tax $ 810.00 $810.00 1205. 1300. Additional Settlement Charges 1304.2005/06 School Taxes to Darlene L. Moyer, TC $975.26 1305. Final Water/Sewer to Carlisle Borough Office $16.18 1306. Home Inspection to South Central PA Home Inspection Co., Inc. (POC 0.00 by Buyer) 1400. Total Settlement Charges (Enter On Lines 103, Section J And 502, Section K) $1,720.25 $6,666.44 . . ,r I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief It IS true and accurate statement of all receipts and disbursements on my account or by me in this transaction. I further certify that I have received a copy of the HUD-1 Settlement Statement. SELLERS Manufacturers and Traders Trust Company, Executor of the Estate of E. Hoover , ~ ?'i1. ;tq.P; r-fls+ kef ~''4.f.e d.fr~ Robert E. Owen The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction. I have caused or will cause the funds to be disbursed in with this statement. . S.'".m..'Ag.., C. 2 ~1 . tJ.t ~ P () v/r:(.._.\. D 'Ii /'1f..f SECURED LAND TRANSFERS - MECHANICSBURG Date 8/8/200510:00:00 AM 105/~P/2005 13:27 302-934-2135 M AND T BANK RECORDS PAGE 01/01 499 MItchell Road MiIIsboro, 05 19966 Mall code DE-MB.12 Phone: 8138.502-4349 Fax; 302-934-2955 PI M&TBank Fax To: Jane F Burke M&T Investment Group From: Nancy Clagett Fax: 717-240-4559 Date: June 8, 2005 Re: Estate of: Dennis E Hoover Social Security: 186-34-4958 Date of Death: May 16, 2005 Pages: 1 DeB:{" Jane: Per your inquiry received June 06, 2005, please be advised that at the time of death" the above-named decedent had On deposit with this bank the following: l. Type of ACcount Checking Account Account Number 1185586 . Ownership (Names of) Dennis E Hoover '" Opening Date 08/09/93 Closed 06/03/05 Balance on Date of Death $1,163.86 Accrued Interest $ 0.00 Total $1,163.86 Please be advised, there wa.s no safe deposit box found for the above decedent. * For further account inf'ormation, regarding ciwners~,. closures tuUl/or reimbursement of funds, etc., pIeue caU the High Street Carlisle Office * 717-2404536. Sincerely, ~~~ Nancy Clagett Records Management . -~~ ~~ WACHOVIA Reference ill: 1278085 Wachovia Bank N.A. Balance ConfIrmation Services POBox 40028 Roanoke, VA 24022-73 13 July 5, 2005 M & T INVESTMENT GROUP 1 WEST HIGH ST CARLISLE, PA 17013 SUBJECT: Verification / Confirmation of Account and Balance Information provided for: Customer: DENNIS E HOOVER (SSN# 186-34':4958) Date of Death: May 16, 2005 Deposit Account Information Account Type Account Number Date of Death Balance Average Balance* Date Opened 6/23/2003 Maturity Interest Accrued YTD Date Date Rate Interest Interest Paid Closed SAVINGS 300004399722 $4,370.54 $0.29 $2.01 LEGAL TITLE: DENNIS E. HOOVER Your request has been forwarded to the Wachovia Correspondence Team to assist with address change and/or account closure. If you have any questions, please call 1-800- 922-4684. * Due to system limitations, we can only provide a twelve month average balance on depository accounts. Other Account Information Account Type Account Number Date of Balance Date Opened Date Closed Ledger Collected INSURANCE ANNUITY GES2PUCG4135379 4/26/2001 LEGAL TITLE: DENNIS E. HOOVER THIS IS A LONG TERM CARE INSURANCE FOR INFO. PLEASE CALL GE 888-456,-8240, OPTION 2 ~ ~ @ ~ 0 \TIj~ ~ lJU JUL '1 2005 ~ I By )000 000614 4mb Western-Southern Life$ Date: 08/25/2005 M&T Investment Group PO Box 220 One West High Street Carlisle, PA 17013 Re: Contract Number W0020472297 Dear Jane F Burke: Please accept our condolences on the death of Dennis Hoover. We are here to serve you during this difficult time. The Estate of Dennis Hoover is the designated beneficiary, therefore entitled to receive payment of $13,712.62 (date of death value) on the Western-Southern Life annuity referenced above. Payment of benefits under the contract is the obligation of, and is guaranteed by, Western-Southern Life Assurance Company, Cincinnati, Ohio. The following settlement option is available to you: · *Lump Sum. You can receive your settlement in one installment. Any earnings on this contract may be subject to tax. Western-Southern Life encourages you to seek tax or legal advice before selecting this option. If you choose this option, a check for the entire amount, including any interest, will be mailed directly to you. The enclosed claim form is for your use in selecting a settlement option. However, in order to process your request we will need the following: o Letter of Testamentary o Signature of the Executor o Estate Tax Identification Number Please return your completed form, along with a certified copy of the death certificate, using the postage-paid envelope provided. Our goal is to serve your needs and we will implement your selection as quickly as possible. ~=~""" ~ (!" ."~ ~ D IJJ Ii ffiAUG ~ 9 2005 ~ By Member Western & Southern Financial Group@ Annuity Operations Group. PO Box 2918 . Cincinnati, Ohio. 45201-2918 Phone (800) 926-1702. Fax (513) 629-1799