HomeMy WebLinkAbout09-20-06
Glenda Farner Strasbaugh
Register of Wills
and
Clerk of Orphans' Court
Marjorie A. Wevodau
First Deputy
Kirk S. Sohonage, Esq
Solicitor
Register of Wills and Clerk of the Orphans' Court
County of Cumberland
One Courthouse Square
Carlisle, PA 17013
(717) 240-6345
FAX (717)240-7797
INVOICE
Bill To:
InvoiceNo:
Invoice Date:
Estate of:
Estate No:
1056
9/20/2006
HOOVER. KAY F.
21-2005-0818
WOLF & WOLF
10 WEST HIGH S1REET
wz
CARLISLE, P A 17013
Qty
1
Fee Description
Additional Probate
Fee Total
50.00 $50.00
Total:
$50.00
C\\JO O~
~~~ v5l
Checks should be made payable to the Register of Wills. Tenns: Net 30.
Please return one copy of this invoice with your payment. Thank you.
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15056051058
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 Number Date of Death
OFFICIAL USE ONLY
~ou~'X ~ode Year
INHERITANCE TAX RETURN
RESIDENT DECEDENT
File Number
21
05
0818
Date of Birth
08/12/2005
09/14/1942
Decedent's Last Name
Suffix
Decedent's First Name
MI
Hoover
Kay
F
(It Applicable) Enter Surviving Spouse's Intonnation Below
Last Name Suffix
First Name
MI
~p<Jusl:!'~S()cil:ll~eclJ~tyl\llJrrl~e~ .
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:::iI
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
C::;:)
4. Limited Estate
c:::iI
C:::J
C::l 4a. Future Interest Compromise (date of
death after 12-12-82)
<::::::;} 7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
CY 10. Spousal Poverty Credit (date of death <::::::;} 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 [)aytirrle"Tell:!p~oneNurrl~er.
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
8. Total Number of Safe Deposit Boxes
Ct
Nathan C. Wolf
(717) 241-4436
Firm Name
PA
17013-2922
...................m..........................m........~.m......
REGISTER OF WILLS USE~tlLy
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Wolf & Wolf
First line of address
10 West High Street
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Second line of address
City or Post Office
Carlisle
State
ZIP Code
-)
Correspondent's e-mail address:nathancwolf@earthlink.net
Under penalties of pe~ury, I declare that I have examined this retum, including accompanyin9 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.
ADDRESS
10 West Hi
DATE
FILING RETURN
DATE
-2.bo/2o{,'('
I I
, PA 17013-2922
PLEASE USE ORIGINAL FORM ONLY
L
15056051058
Side 1
15056051058
--1
'.,
~
15056052059
REV-1500 EX
Decedent's Social
Number
Name:
RECAPITULATION
Kay
F Hoover
195-32-1773
1. Real estate (Schedule A). ............................................ 1.
104,000.00
0.00
2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3.
0.00
4. Mortgages & Notes Receivable (Schedule D). . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4.
0.00
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5.
8,132.20
996.34
6. Jointly Owned Property (Schedule F) c:::J 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.
113,128.54
9,449.37
103,353.05
112,802.42
-326.12
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 BequestslSec 9113 Trusts for which
an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13.
14. Net Value
to Tax (Line 12 minus Line
. . . . . . . . . . . . . . . . . . . . . . . . 14.
0.00
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 45
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
0.00
15.
0.00
0.00
16.
0.00
0.00
17.
0.00
0.00
18.
0.00
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.
0.00
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
.~
L
15056052059
Side 2
15056052059
-I
~EV-1500 E~ Page 3
Deced~nt's Complete Address:
DECEDENT'S NAME
Kay F Hoover
STREET ADDRESS
11 East Keller Street
File Number
! 21 ! I 05 I r0818"-"'~""~~~""ww~
DECEDENT'S SOCiAl SECURITY NUMBER
195-32-1773
CITY
Mechanicsburg
I STATE
PA
I ZIP
17055
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
0.00
44.84
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits (A + 8 + C ) (2)
44.84
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)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
(5)
(5A)
(58)
-44.84
8. Enter the total of Line 5 + 5A. This is the BALANCE 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;.......................................................................................... 0 [i]
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 [i]
c. retain a reversionary interest or.......................................................................................................................... 0 [KJ
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [i]
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0 [i]
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 [i]
4. Did decedent own an Individual RetirementAccount, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ [KJ 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.
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 retum are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an
adoptive parent, or a stepparent of the child is 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 ofthe 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-1S02 EX+ (6-98)
'.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
Kay F. Hoover
FILE NUMBER
2105-0818
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 jolntly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
11 East Keller Street
104,000.00
(Value per appraisal on December 22, 2005 - Attached)
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
104,000.00
REV-1:08 EX+ (6-98) '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Kay F. Hoover
FILE NUMBER
2105-0818
ITEM
NUMBER
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.
DESCRIPTION
VALUE AT DATE
OF DEATH
1 2002 Mercury Sable (Kelley Blue Book Estimated Value Attached)
5,180.00
812.00
2 Value of Personal Property sold
3 Miscellaneous Amounts received by Estate
736.20
4 2005 IRS Tax refund
1,404.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
8,132.20
.. REV-:S09 EX+ (6-98.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINR V-OWNED PROPERTY
ESTATE OF
Kay F. Hoover
FILE NUMBER
2105-0818
If an asset was made joint within one year of the decedent's date of death, It must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. William P. Irvin
512 EI Dorado Drive
Red Lion, PA 17356
Son (Child)
B.
C.
JOINTLY.OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INS1lTUTlON AND BANK ACCOUNT NUMBER OR SIMIlAR DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINllY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENrs INTEREST
1. A. 09106/88 Citizens Bank Checking Account 1,992.68 50 996.34
TOTAL (Also enter on line 6, Recapitulation) $ 996.34
(If more space is needed, insert additional sheets of the same size)
REV-1I510 EX+ (6-98)
.
COMMON\NEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kay F. Hoover
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
2105-0818
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.
DESCRIPTION OF PROPERTY
ITEM INClUOE THE NAME OF THE TRANSFEREE. THEIR RELATI~SHIP TO OECEOENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER THE OATE OF TRANSFER. ATTACH A CCf'Y OF THE DEED FOR REAl ESTATE. VALUE OF ASSET INTEREST (IF APPllCABLEl VALUE
1. Empire Blue Cross Retirement Plan 12,005.28 100 12,005.28 0.00
TOTAL (Also enter on line 7 Recapitulation) $ 0.00
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99)
'W
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Kay F. Hoover
FILE NUMBER
2105-0818
Debts of decedent must be reported on Schedule L
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
Myers Funeral Home, Mechanicsburg, PA 17055
(including fees for cremation to Con-O-Lite - arranged through Myers Funeral Home)
5,511.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s) William P. Irvin
Social Security Number(s)/EIN Number of Personal Representative(s) 187-52-0917
Street Address 512 EI Dorado Drive
City Red Lion
Stale PA Zip 17356
Year(s) Commission Paid:
2.
Attomey Fees
1,500.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City . Stale . Zip
Relationship of Claimant 10 Decedent
4. Probale Fees
5. Accountant's Fees
6. Tax Retum Preparer's Fees
7. Baren Limppo (Trash Hauling)
8 Safeco Car Insurance (Premium paid until auto sold)
9 The Sentinel - Legal Advertising
10 Cumberland Law Joumal- Legal Advertising
11 Misc expenses related to sale of residence
254.00
75.00
75.00
213.81
173.33
75.00
1,572.23
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
9,449.37
REV-1512 EX+ (12-03)
,'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
Kay F. Hoover
FILE NUMBER
2105-0818
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.
AMC Mortgage Services - Account 0084993765
102,427.77
167.23
2
United Water of Pennsylvania
3
Pennsylvania Power & Light
78.03
4
Borough of Mechanicsburg (Sewer & Refuse)
175.64
5
UGI Utilities
249.84
6
Westfield Group - Homeowner's Insurance
196.75
7
Mechanicsburg Borough/Cumberland County Personal Tax
11.00
8
Mechanicsburg School District Personal Tax
11.00
9
West Shore Tax Bureau 2004 Personal Tax Payment
21.64
10
West Shore Tax Bureau 2005 Earned Income Tax
14.15
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
103,353.05
Jo
r
I
i
Ii
1. ~
12/2912005
tarry
Statewide ~ Associates. Inc.
1271 Eisenhower Boulevard
Harrisburg. PA 17111
FUe Number. B0512214
In accordance with your request, I have personally inspected and appraised the real property at:
11 Keller Stleet East
Mechanlc:sbufg, PA 17055
The purpose of this apprais.al is to estimate the market value ot the subject property, as improved.
The property rights appraised are the fee simple interest in the site and Improvements.
In my opinion. the estimated market value of the property as of 0ilCembei' 22. 2005 is:
$104,000
One Hundred Four Thousand Dollats
The attached report contains the description, analysis and supportive data for the conclusions,
final estimate of value, descriptive photographs, limiting conditions and appropriate certifications.
Respectfully Submitted,
Leon D. Gerlach, MSA, MfLA. GAA. CCRA
Pa Certified General Real Estate Appraiser
Certification Number GA-0003SB-t
305 West Shady lane, Enola, PA 17025-2240
Phone 717-732-5052 Fax 717-132.6646 email: gerlachl@verlzon.net
I
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Kelley Blue Book - Private Party Pricing Report - Mercury, Sable
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"'.' . ~':, Ketley Blue Book
" THETRUSTEO RESOURCE
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Close Window X
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Find Out Now!
Enter d YIN to get started:
I Enter a VIN q..Dfl!fl
2002 Mercury Sable GS Sedan 40
BLUE BOOK'~: PRIVATE PARTY VALUE
Condition
advertisement
Value
.Find OUI
Nowl
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"0.
Excellent
$5,745
Good $5,180
P~'id 6.- 61"'-D6)
.t Fair $4,510
(Selected)
Vehicle Details
Engine:
Transmission:
Drivetrain:
Mileage:
V6 3.0 Uter
Automatic
FWD
89,500
Selected Standard Equipment
Air Conditioning Power Door Locks
Power Steering Tilt Wheel
Power Windows Cruise Control
AM/FM Stereo
Dual Front Air Bags
Selected Optional Equipment
Single Compact Disc ABS (4-Wheel)
Blue Book Private Party Value
Private Party Value is what a buyer can expect to pay when buying a used
car from a private party. The Private Party Value assumes the vehicle Is sold
"As Is" and carries no warranty (other than the continuing factory
warranty). The final sale price may vary depending on the vehicle's actual
condition and local market conditions. This value may also be used to derive
Fair Market Value for insurance and vehicle donation purposes.
Enter a VIN Below
to Get Started!
I Enter a VIN
O.Jillll,
$5,745
The most trusted
source of
vehicle history
information.
Vehicle Condition Ratings
Excellent
"~,, ,'" .f,',,",, M..", ,-,., ...,-~"
"Excellent" condition means tilat the vehicle looks new, is in exce!lent
mechanical condition and needs no reconditioning. This vehicle has
never had any paint or body work and is free of rust. The vehicle ilas ,]
clean title history and will pass a smog and safety inspection, Tile
engine compartment is clean, witll no fluid leaks and is free of any wear
or visible defects, Tile vehicle also has complete and verifiable service
CLlCI- HEFE TI-I LEHRI~ f'10F E
http://www.kbb.com/kb/ki.dll/kw.kc.ucp?kbb.PA;;PAI33;& 17356&pop;702391 &;;ucp;&5;ME;L 1
1/27/2006
DECEASED
TAXPAYER'S COpy
E 1040 2005/199\
<:; u.s. Individual Income Tax Return IRS Use Only - Do not write or staple in this space.
u..
Label For the year Jan. 1-Dec. 31, 2005, or other tax year beginning , 2005, ending .20 OMB No. 1545-0074
L Your first name and initial Last name (DEC. 08/12/05) Your social security number
(See
instructions A KAY F II-WOVER 195 i 32 ! 1773
on page 16.) B If a joint return, spouse's first name and initial Last name Spouse's social security number
E
Use the IRS L
label. H Home address (number and street). If you have a P.O. box, see page 16. I Apt. no. You must enter
otherwise, E 512 EL DORADO DR %WILLIAM P IRVIN A your SSN(s) above.A
please print R City, lown or post office, state, and ZIP code. If you have a foreign address, see page 16.
or type. E Checking a box below will not
Presidential RED LION , PA 17356 change your lax or refund.
Check only
one box.
Election Campaign" Check here if you, or your spouse if filing jointly, want $3 to go to this fund (see page 16) ... .. D You D Souse
Filing Status 1 D Single 4 X Head of household (with Qualifying person). If the Qualifying
2 D Married filing jointly (even if only one had income) person is a child but not your dependent, enter this child's
3 D Married filing separately. Enter spouse's SSN above name here. ..
and full name here. .. 5 D Quali in widower with de endent child see a e 17
6a 00 Yourself. If someone can claim you as a dependent, do not check box 6a ................ ~~~~sa~~'6~ed
b D Spouse ................... .................................................... No. of children
(3) Dependent's on 6c who:
C Dependents: (2) Dependent's social relationship to . lived with you
(1) First name Last name security number you . did noll/ve with
you due to divorce
or separation
(see page 20)
Exemptions
1
ANNA HENNINGER
207.03.7946
OTHER
If more than four
dependents
~~f:~l~:: a~~~; 1
see page 19'. Add numbers Q
d Total number of exemDtions claimed ..................... ......... ...... ........... ........ ........ .... ............................. ~g~~"ees~
Income 7 Wages, salaries, tips, etc. Attach Form(s) W-2 ................ .......................... ................ ....... ....... 7 14,148.
Attach Form(s) 8a Taxable interest. Attach Schedule B if required .......... .......... 8a
W-2 here. Also b Tax-exempt interest. Do not include on line 8a .:::.::::.::::::.::::::::::::::::..j'.Sb.'j'.........
attach Forms 9a Ordinary dividends. Attach Schedule B if required ...................................................... ........... ....... 9a
W-2G and b Qualified dividends (see page 23) lmLl
1099-R iftax ................................................... ,._,. ~-.. -"-~-~.~.. --_.--~ - .--..-
was withheld. 10 Taxable refunds, credits, or offsets of state and local income taxes.. .._..... ......... ..... ......................... .... 10
11 Alimony received ................................ . ............................................... ............................ . ..... 11
12 Business income or (loss). Attach Schedule C or C-EZ ......... ................................ .................. 12
If you did not 13 Capital gain or (loss). Attach Schedule D if required. If not required, check here .. D 13
get a W-2, .....................
see page 22. 14 other gains or (losses). Attach Form 4797 .................... ............................................................ 14
15a IRA distributions ..................... lli:J I b Taxable amount (see page 25) 15b
Enclose, but do 16a Pensions and annuities b Taxable amount (see page 25) 16b 2,414.
not attach, any ............ 16a
payment. Also, 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E ........................ 17
please use 18 Farm income or (loss). Attach Schedule F .......... ................ .......................... ......... ............ ...... 18
Form 1 040-V. 19 Unemployment compensation 19
............ .......... ................. ......................................... ...... .........
20a Social security benefits .......... , 20a I I b Taxable amount (see page 27) 20b
21 other income. List type and amount (see page 29)
SEE STATEMENT 1 21 o.
22 Add the amounts in the far rioht column for lines 7 throunh 21. This is vour total income ....... .. 22 16,562.
23 Educator expenses (see page 29) 23
Adjusted 24 CertaIn business expenses of reservists, .perlom;i~g' artists; 'and 'fee-'basis go\;e';lme'nt 24
officials. Attach Form 2106 or 210S-EZ ........ .............. ..... .............. .... .....
Gross 25 Health savings account deduction. Attach Form 8889 ........ .. ....... 25
Income 26 Moving expenses. Attach Form 3903 .......... ......... ....... .......... ..... 26
27 One-half of self-employment tax. Attach Schedule SE ... ......... .. ..... 27
28 Self-employed SEP, SIMPLE, and Qualified plans ............. ...... .... .... 28
29 Self-employed health insurance deduction (see page 30) . .... ...... 29
30 Penalty on early withdrawal of savings ........................... ....... 30
31a Alimony paid b Recipient's SSN .. 31a
32 IRA deduction (see page 31) ..... ..... ...................... . .. ....... 32
33 Student loan interest deduction (see page 33) 33
34 Tuition and fees deduction (see page 34).. ............... ............... ...... 34
35 Domestic production activities deduction. Attach Form 8903 35
36 Add lines 23 through 31a and 32 through 35 ........ ......... . . . . . . . . .. .. .... ................... ..... .......... 36
510001 16,562
11-OS-05 37 Subtract line 36 from line 22. This is vour adiusted oross income ..... .. 37 .
LHA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see page 78.
Form 1040 (2005)
Form~040(2005) KAY F HOOVER
Ta>> and 38 Amount from line 37 (adjusted gross income) ................................................ .............. .. . ...... ......
Credits 39a Check {D You were born before January 2,1941, D Blind.} Total boxes I
~:~c~r~n lor -l if: D Spouse was born before January 2, 1941, D Blind. checked ... ... 39a
. People who b If your spouse Itemizes on a separate retum or you were a dual-status alien, see page 35 and check here ..... ... 39b D
~~~~~na:~ga 40 Itemized deductions (from Schedule A) or your standard deduction (see left margin) ............... ........... .....
~~~~ ~ra~~ 41 Subtract line 40 from line 38 ........ ..... ..... ............. .......... ..... .................... .................. .. ...... .......
as a dependent 42 If line 38 is over $109.475, or you provided housing to a person displaced by Hurricane Katrina,
see page 37. Otherwise, multiply $3,200 by the total number of exemptions claimed on line 6d ...... ...............
43 Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter-O-
44 Tax. Check if any tax is from: a 0 Form(s) 8814 b D Form 4972............. .....:::::::::::::::::::::::::::::::::
45 Alternative minimum tax. Attach Form 6251 .............................................. .................. " .......... .......
46 Add lines 44 and 45............. ................. .............................. ................................................. ...
47 Foreign tax credit. Attach Form 1116 if required... ....... ............ ....... ......... 47
48 Credit for child and dependent care expenses. Attach Form 2441 ....... .... ....... 48
49 Credit for the elderly or the disabled. Attach Schedule R .... ....... ......... .......... 49
50 Education credits. Attach Form 8863 ...................................................... 50
51 Retirement savings contributions credit. Attach Form 8880 ........................ 51
52 Child tax credit (see page 41). Attach Form 8901 if required ............d.......... 52
53 Adoption credit. Attach Form 8839............... ....................................... 53
54 Credits from: a D Form 8396 b D Form 8859............... 54
55 Other credits. Check applicable box(es): a D Form 3800
b DForm 8801 c 0 Form ...... 55
56 Add lines 47 through 55. These are your total credits ............................................ .................................
57 Subtract line 56 from line 46. If line 56 is more than line 46 enter-O- ........ ............ ............................. ...
58 Self-employment tax. Attach Schedule SE . ........... ..... ............... '" .............. .......... .... ... .......... .............
59 Social security and Medicare tax on tip income not reported to employer. Attach Form 4137 ..........................
60 Additional tax on IRAs, other Qualified retirement plans, etc. Attach Form 5329 if required ... ........... ......... .....
61 Advance earned income credit payments from Form(s) W-2 . .................. ............. ..... ........ .... ..... .......
62 Household employment taxes. Attach Schedule H............ ........................ ....... ........
63 Add lines 57 through 62, This is your total tax ........ .................. ................. ........ ..... ........
Payments 64 Federal income tax withheld from Forms W-2 and 1099 .......................... 64
65 2005 estimated tax payments and amount applied from 2004 return .. ........ 65
66: ~~~~::a::::~~:~~j~:~:~~t;~~"::::::' .... .~.. i"~~~' j..... .... '" ......... ......... .. 66a
67 Excess social security and lier 1 RRT A tax withheld (see page 59) ........... 67
68 Additional child tax credit. Attach Form 8812...... ............................. ... .... 68
69 Amount paid with request for extension to file (see page 59) ....... .... .........,.. 69
70 Payments from: aDForm2439 bDForm4136 cDForm8885 70
71 Add lines 64 65 66a, and 67throuoh 70. These are vourtotaf payments ........................................ ...
72 If line 71 is more than line 63, subtract line 63 from line 71, This is the amount you overpaid................. ..
73a Amount of line 72 you want refunded to you ........ ................. ...... ..................... ........................ ...
... b ~~~~ I ,... C Type: D ~kJng DSa~ngs ... d ~:;t I
74 Amount of line 72 YOU want applied to YOUr 2006 estimated tax ........ ... 74
Amount 75 Amount you owe. Subtract line 71 from line 63. For details on how to pay, see page 60 "'.. ............
You Owe 76 Estimated tax Denaltv (see Dace 60\............................................... T 76
. All others:
Single or
Married filing
separately.
$5,000
Married filing
jointly or
Qualifying
widow(er),
$10,000
Head of
hOllsehold,
$7,300
Other
Taxes
If you have
a qualifying
child, attach
Schedule EIG.
Refund
Direct
deposit?
See page 59
and fill in 73b,
73c, and 73d.
195-32-1773
...... ....... ...
1,690.
36
Page 2
16,562.
40 7,300.
41 9,262.
42 6,400.
43 2,862.
44 286.
45
46 286.
56
57
58
59
60
61
62
63
286.
286.
71
72
73a
1,690.
1,404.
1,404.
...
75
Third Party Do you want to allow another person to discuss this return with the IRS (see page 61)? [}[] Yes. Complete the following. D No
Designee Designee'S", PRE PARER Phone... Personal identification ...
name no, number (PINl
Sign Under penalties of pe~ury, I deciare that I have examined this retum and accompanying schedllles and statements, and to the best of my knowledge and belief, they are true, correct,
and complete. Declaration of preparer (other than taxpayer) is based on all infonnation of which preparer has any knowledge,
Here Your signature Date YOllr occupation Daytime phone number
Joint retum? ~
See page 17.
Keep a copy Spouse's signature, If a joint retum, both mllst sign. Date
for your
records.
Paid Preparer's ... /~ / ,r '-"~ U
Preparer'ssignature ~/ /~t:.<..15 .c"
Use Only Firm'Sname(or.'~' KUHN & DOVIAK PC
yourslfself-ern.;.../' 1402 MT ROSE AVE
510002 played), address,
11-05-05 and ZIP code YORK PA 17403-2908
Preparer's SSN or PTIN
P00173765
20,0533459
Phone n07 1 7 - 8 4 6 - 4 5 0 2
Myers Funeral Home, Inc.
Boyd L. Myers Jr., Supervisor
37 East Main Street
Mechanicsburg, Pennsylvania 17055
(717) 766-3421
Fax (717) 795-7291
A standard of excellence in Central Pennsylvania since 1910
Saturday, September 3, 2005
Mr. William Paul Irvin
512 Eldorado Drive
Red Lion, PA 17356
Dear Mr. Irvin,
Thank you for selecting our funeral home to provide services for your family during your bereavement.
I hope that you found our services to be of the highest standards and that they met your needs and those
of your family and friends. The following is a summary of the service charges as previously explained and
provided in written form on the services for:
Kav F. Hoover
SUMMARY OF EXPENSES
TOTAL OF SERVICE RENDERED $7,156.00
LESS: Credits granted 1,645.00
LESS: Total Payments 1,000.00
CURRENT BALANCE $4,511.00 c:
Credits Granted: $1,645.0 Package Price Discount /?t:- tv", -...;r J ,5;~-11 .Lv..,
Int.,.,t at the mt. of 1.5 % p.' month ( 16 % p.' annom) wUl be added to balance 'taD d:~..
If there are any questions or concerns that remain unanswered, please call me.
h/'~
r
. WaIt & Wolf, Attorneys At Law
10 West High Street
Carlisle, P A 17013
Date: 9/20/2006
W. Paul Irvin
512 EI Dorado Drive
Red Lion, P A 17356
Regarding:
Invoice No:
Hoover, Kay F. (Estate of)
1036
Fee Subtotal
Adjustments to Fees
$1,512.00
$-12.00
Total Fees
$1,500.00
RECEIPT FOR PAYMENT
-------------------
-------------------
* DUPLICATE *
GLENDA FARNER STRASBAUGH
CUmberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17G13
Rece~pt Date:
Rece~pt Time:
Recelpt No.:
9/14/2005
08:27:12
1041905
HOOVER KAY F
Estate File No. :
Paid By Remarks:
2005-00818
WILLIAM P IRVIN
RSK
------------------------ Receipt Distribution ----------______________
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS ADM
RENUNCIATION
SHORT CERTIFICATE
JCP FEE
AUTOMATION FEE
Check# 7353
Total Received.........
210.00
5.00
24.00
10.00
5.00
----------------
$254.00
$254.00
CUMBERLAND COUNTY GENERAL FU
CUMBERLAND COUNTY GENERAL FU
CUMBERLAND COUNTY GENERAL FU
BUREAU OF RECEIPTS & CNTR M.
CUMBERLAND COUNTY GENERAL FU
KAY F HOOVER (ESTATE)
C/O WILLIAM P IRVIN
512 EL DORADO DR
RED LION PA 17356
KUHN & DOVIAK, PC
1402 MT ROSE AVE
YORK PA 17403-2908
Phone (717) 846-4502
PROFESSIONAL SERVICES
2005 ESTATE TAX RETURNS - IRS & PA
Total
INVOICE
DATE NUMBER
8/9/2006
2009247
AMOUNT
75.00
$75.00
pet crs';/-06
C:\--< rJ :3 7'7 3
C".-yv,
DETACH AND RETURN THIS PORTION WITH YOUR PAYMENT
THE SENTINEL - LEGAL E t K H r
POBOX 130 CARLISLE PA 17013 s . . oove
. .
AD NUMBER CLASSO START DATE STOP DATE
293966 PUBLIC NOTICES 09/16/05 09/30/05
AD DESCRIPTION BILLING DATE TELEPHONE NUMBER
ADMINISTRATOR'S NOTICE LETTERS OF 09/30/05 717-241-4436
GROSS AMOUNT OF
208.00
DUE AFTER 10/30105
TOTAL AMOUNT DUE
ATTORNEY AT LAW NATHAN C. WOLF
37 S. HANOVER ST.
SUITE 201
CARLISLE, PA 17013
1...11I11.111......11..11.1..1.1
173.33
ENTER AMOUNT ENCLOSED
/7?,?i3>
20200000002939660000000000000002080000000173339
CUMBERLAND LA'V JOURNAL
32 SOUTH BEDFORD STREET
CARLISLE, PA 17013
OCTOBER 7, 2005
Cumberland Law Journal is published every Friday by the Cumberland County Bar
Association and is designated by the Court of Common Pleas as the official legal publication for
Cumberland County and the legal newspaper for publication of legal notices.
TO:
Nathan C. Wolf, ESQUIRE
RE:
Kay F. Hoover, ESTATE
Legal advertisements must be received by Friday Noon. All legal advertising must be
paid in advance. Make all checks payable to: Cumberland Law Journal.
---------------------------------------------------------------------
---------------------------------------------------------------------
Advertisement inserted on following dates:
September 23,30, October 7, 2005
Advertising Cost
75.00
$ 0.00
$ 0.00
$ 0.00
-------------
Proof of Publication
Second Proof Request
Payment received
Total Amount Due
$ 75.00
---------
---------
Payment received by
, \/;,
,\
. \
" 1).'\
, .Il.l
, ;-
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"'-1 \.
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l ) I
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fill lAMe
MORTGAGE SERVICES
MORTGAGE LOAN STATEMENT
RETAIN THIS PORTION FOR YOUR RECORDS
STATEMENT DATE
LOAN NUMBER
08/16/05
0084993765
PROPERTY
ADDRESS
11 KELLER STREET
MECHANICS BURG PA 17055
KAY F HODVER
11 EAST KELLER STREET
MECHANICSBURG PA 17055-3827
'11111I11111I111I'1'11'1'11.".111111.'." 111'.111111. 111111I'
20H5
Thinking About
Refinancing?
For information.
please call toll-free
(800) 325-1493
~,.._.::'ft\~-,';r.:<imIIID," ~ II ""f;-~"'"I~5f,~""'-"''"'.h''Il'""'"''''''-''''':;1'I''' ~~.;@iIlY.""." """'~~~.';"~>f''';{''';;'''~''f'~>;::i~.''. ""~,~.,, (I".'tl")'''''I;;';;(
. ..' . '~ui.,. :~\ I'!~'" -'-~. i .'''iIii'fH'','. ......f " ft;~ ,~dl,jt:~-:- ;€~J. '~i,vj i::;,' ~ ~-;;,;.~~, i fif~ ~:~.~'" ~.'.".~.?"_.'.'..... ;.'~."... ..,.....,.......i'J.t:I:...";;...~..,.::,.'.".'.:..~.).' ;,;..~.ill.~\i.r,.~.....,...-- ..:......,.......... '." ...~ '..".... i~{:.>..
'.. . ~ _........~. ". -. ,.. .'" :il..l,;"."'....",,1I.4... .>l,\jcoll''''''.''_'';;~~,likd'''''",oj',!\,o,,,,,.....,..:Jt, =."., '.,'." ~.. _,~,_~,''''_ ,,"_, _.. .,,'0
(For Payment Due; 09/01/05)
Suspense Balance:
Total Amount Past Due;
Payment Due on 09/01/05
Expenses Paid by AMC:
Unpaid Late Charges;
Other Fees & Charges:
Total ExpenseslFees Due:
Total Amount Due:
$.00
$.00
$681.66
Interest Rate:
Monthly Payment
Escrow;
Insurance Products/Misc:
Monthly Total;
6.90000\
$681. 66
$.00
$.00
$681. 66
Principal Balance:
Escrow Balance:
$102,427.77
$.00
$.00
$.00
$.00
$.00
Next Monthly Payment
Change Date;
Amounts Paid Year-To-Date
Principal:
Interest:
Late Charges:
Hazard Insurance:
Taxes/Liens;
$723.10
$4,730.52
$.00
$.00
$.00
$681.66
09/01/06
To avoid late charges of $40.90 we must receive
your payment by 09/16/05 during business hours.
Visit www.mvamcloan.com.
; "1';~.G:;n!(;g:~Zg1!!nt!;~:~::t)!iiJZ:].~~:li.fl.,:rfJI::~l~\1:!ti~.f4..I_'Ii..Iif~~rf.
DATE DESCRIPTION AMOUNT PRINCIPAL INTEREST ESCROW INSURANCE LATE CHARGES/ SUSPENSE
PRODUCTS/MISC CORP ADVIFEES
08-15 PMT 08/01/05 $681.66 $92.17 $589.49
rId\{
005-06 PERSONAL TAX NOTICE ** SCHOOL ** JULY 1 2005
MECHANICSBURG AREA SCHOOL DISTRI
:~t"_ C:ri::-'.i::.'_~ ""''-f;';'~,'' "'.
;:lLL Cl
2317
BARRY L HECKARD SR
605 SOMERSET DR
MECHANICSBURG PA 17055
PHONE: 717-766-6205
CLOSED NOV 8 DEC 31 SEPT 12-16
JULY-AUG TUES&THURS 10-4PM WED 5-7
SEPT-DEC TUES 10-4PM WED 5-7PM
S.CH pic
10
4.90:
5.00:
5.50:
SCH RES
10 .<1
4.90:
5.00;
5.5d
.",r '.;,;,
'DISCOUNT
,FACE
PENALTY
I
I
.':'i::! ,;~.: j[)
i.; 4.Vrf; ;~S
AUG
OCT
DEC
9.80
10.00
11.00
HOOVER, KAY F.
11 E. KELLER ST.
MECHANICSBURG PA 17055
IF UNPAID BY 12/15/05 TAXES
WILL BE TURNED OVER TO
DELINQUENT COLLECTOR.
ACCT # 016-0012677
SS# 195-32-1773
~rJ~\l~}~i:~Cl;J-~i;;:'!:;Jti:~~:"'i:,"::--,))~,f;~:iWi:,iif:_~;\':;j:~(r;it~'.~f:jfj';li'l.'~~;~W,~iN--l'~;'i~''1;'):~{Jf;;j:)~'!--~:~)~1~~~\ii?:,rj\;TW~j},'~~~~
Dl!: A:tiL"I'NE"'T 0""cO R'REcT'CI'6 R"I"API' 'E'AL"' 'J 0 B TIT LEI S 90 DAY S FRO M D ATE 0 FBI L L
~LL 240-6365 OR 697~0371 EXT 6365 OR 532-7286 EXT 6365.
AX\;"~C.!::"H
Dft~TE
';J,~Lt
C2
J05-06 PERSONAL TAX NOTICE ** SCHOOL ** JULY 1 2005
MECHANICSBURG AREA SCHOOL DISTRI
i.; U-!~~Ct<~,', ~-'!j,'::'.',,~',;J~J."
2317
BARRY L HECKARD SR
605 SOMERSET DR
MECHANICSBURG PA 17055
PHONE: 717-766-6205
rg',~,,,J?IC ;11;' r~~p'RES',~.I..$G.~:1
4.901 ..... 4.9b!
5.00! 5.001
5.50; 5.50:
CLOSED NOV 8 DEC 31 SEPT 12-16
JULY-AUG TUES&THURS 10-4PM WED 5-7
SEPT-DEC TUES 10-4PM WED 5-7PM
P;.;,{ T!-HS J~,M,[)~IH'r
U9.80
10.00
11.00
IF UNPAID BY 12/15/05 TAXES
WILL BE TURNED OVER TO
DELINQUENT COLLECTOR.
ACCT # 016-0012677
SS# 195-32-1773
/'jr~\\tff(r~~~j~'\~lV!1~B~i~l~~i4:!~;~~~~~{~j~~!'f~;~ 0 B TIT LEI S 90 DAY S FRO M D ATE 0 FBI L L
ILL 240-6365 OR 697-0371 EXT 6365 OR 532-7286 EXT 6365.
HOOVER, KAY F.
11 E. KELLER ST.
MECHANICSBURG PA 17055
l
.
2349
** TAXPAYER COPY **
BARRY L HECKARD SR TAX COLLECTOR
605 SOMERSET DRIVE *766-6205*
MECHANICSBURG. PA 17055
CTL 16 12677
SSN 195-32-1773
HOOVER. KAY F.
11 E. KELLER ST.
MECHANICSBURG PA 17055
MAR-APR. TUES & THURS 10AM-4PM
WED 5PM-7PM MAY-JUNE TUES 10-4PM
WED 5PM-7PM OR CALL FOR APPT
CLSD 3/10 AND ALL ELECTION DAY
1('1
",,:
** TAX COLLECTOR COPY **
BARRY L HECKARD SR TAX COLLECTOR
605 SOMERSET DRIVE *766-6205*
MECHANICSBURG. PA 17055
CTL 16 12677
SSN 195-32-1773
HOOVER. KAY F.
11 E. KELLER ST.
MECHANICSBURG PA 17055
MAR-APR. TUES & THURS 10AM-4PM
WED 5PM-7PM MAY-JUNE TUES 10-4PM
WED 5PM-7PM OR CALL FOR APPT
CLSD 3/10 AND ALL ELECTION DAY
BILL DATE
3/01/2005
BILL NO
2349
2005 PERSONAL TAX NOTICE
COUNTY OF CUMBERLAND
BOROUGH OF MECHANICSBURG
UNPAID TAXES SUBMITTED TO DELINQUENT COlL 12/15/05
CNTY pic
MOO pic
9.80
2.0% 10.0% DISCOUNT
2.0% 10.0% 3/0112005
TO
4/30/2005
BILL DATE
3/01/2005
5.00
5.00
10.00
FACE
5/01/2005
TO
6/30/2005
BILL NO
5.50
5.50
11.00
PENALTY
AFTER
6/30/2005
2349
2005 PERSONAL TAX NOTICE
COUNTY OF CUMBERLAND
BOROUGH OF MECHANICSBURG
UNPAID TAXES SUBMITTED TO DELINQUENT COLL 12/15/05
5.00000
5.00000
CNTY pic
MUN pic
9.00
2.0% 10.0% DI$COllNr
2.0% 10.0% 3/01/2005
TO
4/30/2005
5.00
5.00
1
rACE
5/01/2005
TO
6/30/2005
5 50
5.50
11.{)l)
N:NA[TY
AFTER
6/30/2005
l,
.
WEST SHORE TAX BUREAU
PHONE: 717-761-4900 WEB SITE: ~~WJ:'L\o;Y~~S'mB/JJ1G
-.-
rC{11rn enveiope and the
appropriate mailing labels
to file this Retum
FINAL EARNED INCOME TAX RETURN
CALENDAR YEAR I
2005
PLEASE FILE THIS RETURN In' APmL15TH EVEN IF NO TAX IS DUE OR IF IT HAS ALL BEEN WlTHHEto
**********AIJTO**3-DIGIT ]73
,"".",...,.."..,.,.."".,..,.,.. .",.. .".. III .1'. .,.",. III
HOOVER KAY F
512 EL DORADO DR
RED LION, PA ] 7356-8700
YQUMUST
COMPLETE
r=:>
1. Gross Eamings Enclose W-2
2. Allowable Non-Reimbursed E
Statement of expenses (PA Form
3. Taxable Earnings (Line] m
1099's and supporting docume
4. Net Loss (Use Line 8 for any
NRK-l NOTE: PA Schedule
5. Subtotal (Line 3 minus Line
6. Net Profits (Use Line 4 for N
and/or NRK-]
7. TOTAL EARNED INCOME
8. Tax Liability Line 7 multipli
9. Quarterly Estimated Paymen
10. Eamed Income Tax Withheld
II. Credit from last year
12. Miscellaneous Credits Please
Tax Credit or Credit for Philade
13. TOTAL of 9 + IO + II + 12
14. REFUND/CREDIT Subtract
riO REFUNDS OR CREDITS L
15. TAX DUE If Line 8 is greater
j-\.1VIClUNTS LESS TH/\ N $1,01
16. Interest + Penalty (1 % per m
17. TOTAL AMOUNT DUE (Lin
RefCl-ence #T/P A: 377419
Reference # TIP B:
MUNICIPALITY: MECIIANICSlHrnG BORO 061
FULL YEAR RESIDENT YES () NO ( )
~0>:S" A husdand anqwifemayboth fileonthis form"howeve~',
:PdGWSrl tax calcul'\tions mustbe repor,ted mseparatecol~ns.Joiilt
filing (combining income or expenses) is not permitted.
. .., " .,.... .., ,
Taxpayer A SS# /fJ5"- 3.2 - 1773 Taxpayer A c Name TaxpayerB -Name
Taxpayer B SS# KAYF
's, 1099's, or explain other income I. /1// &/ff. (9
mployee Business Expenses Include detailed 2.
sUE-I, UE-2 and all supporting documents)
intiS Line 2) Audit may be required if all W-2's. 3.
nts are not attached or other income is not explained
Net Profits) Attach PA Schedules C, F, RK-I and/or 4.
. C-F Reconciliation is not acceptable.
4) IF LESS THAN ZERO - ENTER ZEJ<U 5.
et Losses) Include PA Schedules C, F, RK-I 6. .
SUBJECT TO THIS TAX (Line 5 plus Line 6) 7. /L//4,k",;9
ed by tax rate / '7 (See back of Return for tax rates) 8. ..2. t../ CI' '~J-.2...
ts 9.
as per attached W-2's 10. ..:l..1. t... 3 I
II.
see Instructions for calculating Out-Of-State 12.
Iphia Tax Withheld, ,,1- J.. f" 3 7
13.
Line 8 from Line 13 14.
ESS THAN $1,00 ( ) Credit to next year l ) Refund I 4, I ~-
than Line 13 - subtract Line 13 from Line 8 IS.
) NEED NOT BE PAlO
onth after April 15th) 16.
e 15 + Line 16) ]7.
ATTACH APPROPRIATE COPIES OF STATE SCHEDULES AND/OR ALL W-2'S
Signature Taxpayer A
.! ,i.} , n::c'~<;; !,\',',BL.F TO \','1::S1' ~;l-lD;:ET-~\ Br'nl',\L, .\ FEE i.I ,;-,'\.i'{ ',,' ~:T ;;r; : f\,;(,F,L' Fr;p ;~F. (l:P\i),; ['.~J;;' I.',
I declare uuder penalties of perjury that I have examined this return and to the best of my knowledge and helief, it is a true, aeeurate and complete return.
Signature Taxpayer n
Date
Occupation
E-Mail
Daytime Telephone
Date
Occupation
E-Mail
Daytime Telephone
~
.
WOLF & WOLF
PHONE
717-241-4436
ATTORNEYS AT LAw
10 WEST HIGH STREET
CARuSLE, PENNSYLVANIA 17013
wolfandwolf@earthlink.net
STACY B. WOLF
NATHAN C. WOLF
FACSIMILE
717-241-4437
September 20, 2006
Pa Department Of Revenue
Bureau of Individual Taxes
Inheritance Tax Division
P.O. Box 280601
lIarrisburg,Pll 17128-0601
Re: Estate of Kay F. lIoover
Docket No.: 21-05-0818
Date of Death: 8/12/2005
Dear Sir or Madam:
I represent the Executor, W. Paul Irvin, in the settlement of the above-referenced estate.
Letters of Administration were granted on September 14, 2006, by the Register of Wills of
Gnnberland Q:mnty. We are aware that the inheritance tax return was due on April 12, 2006, but
we have just completed the inheritance tax return.
Attached is the return filed with the Register of Wills, for which we believe no tax is due.
Included with the return is supporting documentation of assets and liabilities of the estate. Should
you require any further information, please do not hesitate to contact this office.
Thank you in advance for your assistance in this regard.
cc: W. Paul Irvin (w/enc.)
'-.J
15056051058
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 Number Date of Death
OFFICIAL USE ONLY
(;()u.~'X Code Year
INHERITANCE TAX RETURN
RESIDENT DECEDENT
File Number
21
05
0818
Date of Birth
08/12/2005
09/14/1942
Decedent's Last Name
Hoover
Decedent's First Name
MI
Kay
F
(If Applicable) Enter Surviving Spouse's Infonnation Below
Last Name
~p<JU~I:!'~~cil:ll~eclJ~ityf'JlJrrl~er
First Name
MI
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:::iI
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
C::;:)
4. Limited Estate
c:::iI
C::;:)
c:::iI 4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
<::::::;} 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 [)aytirrle"Tell:!p~()nel\lurrl~l:!r ..
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
8. Total Number of Safe Deposit Boxes
C::;:)
Nathan C. Wolf
(717) 241-4436
Wolf & Wolf
Firm Name
REGISTER OF WILLS USE ONLY
First line of address
10 West High Street
Second line of address
City or Post Office
Carlisle
State
ZIP Code
DATE FILED
PA
17013-2922
Correspondent's e-mail address:nathancwolf@earthlink.net
Under penalties of perjury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PER FILING RETURN
ADDRESS
10 West Hi
, PA 17013-2922
PLEASE USE ORIGINAL FORM ONLY
L
15056051058
Side 1
15056051058
~
'-.J
15056052059
REV-1500 EX
Decedent's Name:
RECAPITULATION
Kay
F Hoover
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/Sec 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
. . . . . . . . . . . . . . . . . . . . . . . . 14.
TAX 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 45
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X. 15
0.00
15.
0.00
16.
0.00
17.
0.00
18.
19. TAX DUE. . . . . . . . . . .. . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . .. . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
L
15056052059
Side 2
Decedent's Social
195-32-1773
15056052059
Number
104,000.00
0.00
0.00
0.00
8,132.20
996.34
113,128.54
9,449.37
103,353.05
112,802.42
-326.12
0.00
0.00
0.00
0.00
0.00
0.00
.>
.-J
REV-1500 EX Page 3
.
fill' Num!?!c "".""'_,_, ''''''''''''
:0818
Decedent's Complete Address:
DECEDENT'S NAME
Kay F Hoover
STREET ADDRESS
11 East Keller Street
DECEDENT'S SOCIAL SECURITY NUMBER
195-32-1773
CITY
Mechanicsburg
STATE
PA
ZIP
17055
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
0.00
44.84
3. InteresUPenalty if applicable
D. Interest
E. Penalty
Total Credits (A + B + C ) (2)
44.84
TotallnteresUPenalty ( 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)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
(5)
(5A)
(5B)
-44.84
B. Enter the total of Line 5 + 5A. This is the BALANCE 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;.......................................................................................... 0 !iI
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 !iI
c. retain a reversionary interes~ or.......................................................................................................................... 0 [iJ
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 Ii]
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0 !iI
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 !iI
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ !iI 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.
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. 99116 (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. 99116 (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. 99116(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. 99116(1.2) [72 P.S. 99116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use ofthe decedent's siblings is twelve (12) percent [72 P.S. 99116(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.
.
RE~-1502 EX+ (6-9.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
Kay F. Hoover
FILE NUMBER
2105-0818
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 joinUy-owned wIth right of survivorshIp must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
11 East Keller Street
104,000.00
(Value per appraisal on December 22, 2005 - Attached)
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert addnional sheets of the same size)
104,000.00
RE~-1508 EX+ (6-98) *'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Kay F. Hoover
FILE NUMBER
2105-0818
ITEM
NUMBER
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.
DESCRIPTION
VALUE AT DATE
OF DEATH
1 2002 Mercury Sable (Kelley Blue Book Estimated Value Attached)
5,180.00
812.00
2 Value of Personal Property sold
3 Miscellaneous Amounts received by Estate
736.20
4 2005 IRS Tax refund
1,404.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
8,132.20
RE;'-15D9 EX+ (6-98*
COMMONV\lEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kay F. Hoover
SCHEDULE F
JOINTlY-OWNED PROPERTY
FILE NUMBER
2105-0818
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
A. William P. Irvin
B.
c.
JOINTLY-OWNED PROPERTY:
ADDRESS
512 EI Dorado Drive
Red Lion, PA 17356
RELATIONSHIP TO DECEDENT
Son (Child)
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-liELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST
1. A. 09106/88 Citizens Bank Checking Account 1,992.68 996.34
50
TOTAL (Also enter on line 6, Recapitulation) $ 996.34
(If more space is needed, insert additional sheets of the same size)
RE~-1510 EX+ (6-98*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
Kay F. Hoover
FILE NUMBER
2105-0818
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.
DESCRIPTION OF PROPERTY
ITEM INClUOE THE NAME OF THE TRANSfEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER THE CATE OF TRANSfER. ATTACH A COPY OF THE DEED FOR REAl ESTATE. VALUE OF ASSET INTEREST (IF APPLICABlE) VALUE
1. Empire Blue Cross Retirement Plan 12,005.28 100 12,005.28 0.00
TOTAL (Also enter on line 7 Recapitulation) $ 0.00
(If more space is needed, insert additional sheets of the same size)
R~V-1511 EX+ (12-99*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Kay F. Hoover
FILE NUMBER
2105-0818
Debts of decedent must be reported on Schedule L
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
Myers Funeral Home, Mechanicsburg, PA 17055
(including fees for cremation to Con-O-Lite - arranged through Myers Funeral Home)
5,511.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s) William P. Irvin
Social Security Number(s)/EIN Number of Personal Representative(s) 187-52-0917
Street Address 512 EI Dorado Drive
City Red Lion
State PA Zip 17356
Year(s) Commission Paid:
2.
Attomey Fees
1,500.00
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
5. Accountant's Fees
6. Tax Retum Preparer's Fees
7. Baren Limppo (Trash Hauling)
8 Safeco Car Insurance (Premium paid until auto sold)
9 The Sentinel - Legal Advertising
10 Cumberland Law Joumal- Legal Advertising
11 Misc expenses related to sale of residence
254.00
75.00
75.00
213.81
173.33
75.00
1,572.23
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
9,449.37
RE:-1512 EX+ (12-03) '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
Kay F. Hoover
FILE NUMBER
2105-0818
Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death, including unrelmbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
AMC Mortgage Services - Account 0084993765
102,427.77
167.23
2
United Water of Pennsylvania
3
Pennsylvania Power & Light
78.03
4
Borough of Mechanicsburg (Sewer & Refuse)
175.64
5
UGI Utilities
249.84
6
Westfield Group - Homeowner's Insurance
196.75
7
Mechanicsburg Borough/Cumberland County Personal Tax
11.00
8
Mechanicsburg School District Personal Tax
11.00
9
West Shore Tax Bureau 2004 Personal Tax Payment
21.64
10
West Shore Tax Bureau 2005 Earned Income Tax
14.15
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
103,353.05
~
J
I
I
11
'1
j
,
I
I
I
f
~ ~
I'
12/2912005
Larry
Statewide Mortgage Associates. lne.
1271 Eisenhower Soufevard
Harrisburg. PA 17111
FIe Number: BOS12214
In accordance with your request. I have personally inspected and appraised the real property at:
11 Keller SlIeet East
Mechanlcsburg. PA 17055
The purpal.e of this appraisal is to estimate the market vatue of the subject property, as improved.
The property rights appraised are the fee simple interest in the site .and Improvements.
11'1 my opinion, the estimated market value of the property as of December 22, 200S is:
$104,000
One Hundred Four Thousand Dul.lats
The attached report contains the description. analysis and supportive data for the conclusions,
flna.l estimate of value, descriptive photographs, limiting conditions and appropriate certifications.
Respectfully Submitted.
Leon D. Gerlach, MSA, MFLA. GM CeRA
Pa Cenlfied General Real Estate Appraiser
CerlJficalion Number GA.OOO368.L
305 West Shady lane, Enola. PA 17025.2240
Phone 717~132.5052 Fax 717.732.6646 email: gerlachl@verizon,Mel
,"~~lley Blue Book - Private Party Pricing Report - Mercury, Sable
.~
"" Kelley Ilue Book
: THETRumo RESOURCE
.....-.-....-...-....'"--..---- - - kbD.clI"
2002 Mercury Sable GS Sedan 4D
BLUE BOOKi' PRIVATE PARTY VALUE
Condition
Value
----. ."......~......~................. .'.."".
::::::'7..;r~~
. '~.,,-:.~
Excellent
$5,745
Good $5,180
r~'id U-l,tJ'-Db)
.,f Fair $4,510
(Selected)
Vehicle Details
Engine:
Transmission:
Drivetrain:
Mileage:
V6 3.0 Liter
Automatic
FWD
89,500
Selected Standard Equipment
Air Conditioning Power Door Locks
Power Steering Tilt Wheel
Power Windows Cruise Control
AM/FM Stereo
Dual Front Air Bags
Selected Optional Equipment
Single Compact Disc ABS (4-Wheel)
Blue Book Private Party Value
Private Party Value is what a buyer can expect to pay when buying a used
car from a private party. The Private Party Value assumes the vehicle Is sold
"As Is" and carries no warranty (other than the continuing factory
warranty). The final sale price may vary depending on the vehicle's actual
condition and local market conditions. This value may also be used to derive
Fair Market Value for insurance and vehicle donation purposes.
Vehicle Condition Ratings
Excellent
$5,745
"Excellent" condition means that the vehicle looks new, is in excellent
mechanical condition and needs no reconditioning. This vehicle has
never had any paint or body 'Nork and is free of rust. The vehicle has J
clean title history and will pass a smog and safety inspection. The
engine compartment is clean, with no fluid leaks and is free of any wear
or viSible defects. The vehicle also has complete and verifiable service
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1/27/2006
DECEASED
TAXPAYER'S COpy
j .1 040 u.s. Individual Income Tax Return 2005/199\ IRS Use Only - Do not write or staple in this space.
Label For the year Jan. 1-Dec. 31, 2005, or other tax year beginning , 2005, ending .20 OMB No. 1545-0074
L Your first name and initial Last name (DEC. 08/12/05) Your social security number
(See
instructions A KAY F lHOOVER 195 : 32 ! 1773
on page 16.) B If a joint return, spouse's first name and initial Last name Spouse's social security number
E
L :
Use the IRS
label. H Home address (number and street). If you have a P.O. box, see page 16. I Apt. no. You must enter
Othe rwise, E 512 EL DORADO DR %WILLIAM P IRVIN A your SSN(s) above.A
please print R City, town or post office, state, and ZIP code. II you have a loreign address, see page 16.
Or type. E Checking a box below will not
Presidential RED LION , PA 17356 change your tax or refund.
Check only
one box.
Election Campaign ~ Check here if you, or your spouse if filing jointly, want $3 to go to this fund (see page 16) ... ~ D You D Souse
Filing Status 1 D Single 4 X Head of household (with Qualifying person). If the Qualifying
2 D Married filing jointly (even if only one had income) person is a child but not your dependent, enter this child's
3 D Married filing separately. Enter spouse's SSN above name here. ~
and full name here. ... 5 D Quali in widower with de endent child see a e 17
6a 00 Yourself. If someone can claim you as a dependent, do not check box 6a ... ................... ....................... ~~~~Sa~~~~ed
b D Spouse .................... --....................................................... ................. No. 01 children
on Be who:
C Dependents: (2) Dependent's social (3) Dependent's . lived with you
relationship to
(1) First name Last name security number you . did not live with
you due to divorce
or separation
(see page 20)
Exemptions
1
ANNA HENNINGER
207.03.7946
OTHER
If more than four
dependents
~~f:~t~~~~S a~~~~ 1
see page 19'. . Add numbers Q
d Total number of exemotions claimed ........ ..... ....... .....n.. ...... ....n.... ......... ............ . . . . . . . . . . . . . . . . . ........... ~~~~nees~
Income 7 Wages, salaries, tips, etc. Attach Form(s) W-2 ......... ...... ...... ................... ...... ...... ........ ........... 7 14,148.
Attach Form(s) Ba Taxable interest. Attach Schedule B if required ......... 8a
W-2 here. Also b Tax-exempt interest. Do not include on line 8a :::::::::::::::::::::..:::::::::::..j..8b..j......................
attach Forms ga Ordinary dividends. Attach Schedule B if required .......................................... ............................... 9a
W-2G and b Qualified dividends (see page 23) L9bJ
1099-R if tax ................................................... - __. w..~.__r.~_..._.___
was withheld. 10 Taxable refunds, credits, or offsets of state and local income taxes... .............. ......................... . ......... 10
11 Alimony received . . . . . . . . . . . . . . . . . . . . . . ....................... ................................. .................... ..... ...... .... 11
12 Business income or (loss). Attach Schedule C or C-EZ ........... ................... ..... ............ . .............. 12
If you did not 13 Capital gain or (loss). Attach Schedule D if required. If not required, check here ~ D 13
get a W-2, .....................
see page 22. 14 Other gains or (losses). Attach Form 4797 .... ........... ............. ..................................................... 14
15a IRA distributions ..................... ti:J I b Taxable amount (see page 25) 15b
Enclose, but do 16a Pensions and annuities b Taxable amount (see page 25) 16b 2,414.
not attach, any ............ 16a
payment. Also, 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E ........................ 17
please use 18 Farm income or (Joss). Attach Schedule F ..................................................... . ............... ............. 18
Form 1040-V. 19 Unemployment compensation 19
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......... ......................... .. ............. ............
20a Social security benefits ............ I 20a , I b Taxable amount (see page 27) 20b
21 Other income. List type and amount (see page 29)
SEE STATEMENT 1 21 o.
22 Add the amounts in the far rinht column for lines 7throuoh 21. This is vour total income ....... ... 22 16,562.
23 Educator expenses (see page 29) ............................................. 23
Adjusted 24 Certain business expenses of reservists, perfonning artists, and fee-basis govemment 24
officials. Attach Form 2106 or 2106-EZ .... ............... ................... .... ......
Gross 25 Health savings account deduction. Attach Form BBB9 ...... .. ........ .... 25
Income 26 Moving expenses. Attach Form 3903 . . . . . . . . . . . . . . .............. ........ ...... 26
27 One-half of self-employment tax. Attach Schedule SE ..... ...... ..... ..... 27
28 Self-employed SEP, SIMPLE, and Qualified plans .. .. ............ ........ 28
29 Self-employed health insurance deduction (see page 30) .............. 29
30 Penalty on early withdrawal of savings ... ........... ... ... ........ . . . . . . . . . . . 30
31a Alimony paid b Recipient's SSN .. 31a
32 IRA deduction (see page 31) ........... ......................... . ....... ....... 32
33 Student loan interest deduction (see page 33) 33
34 Tuition and fees deduction (see page 34) ......................................... 34
35 Domestic prOduction activities deduction. Attach Form B903 ....... 35
36 Add lines 23 th rough 31 a and 32 lh rough 35 ........ ............................ ......... ........ ..... ............ 36
510001 16,562
11-05.05 37 Subtract line 36 from line 22. This is vour adiusted nross income .... ... 37 .
LHA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see page 78.
Form 1 040 (2005)
Form 1040(2005) KAY F HOOVER
195-32-1773
Page 2
Tex and 38 Amount from line 37 (adjusted gross income) .................................................... ............. ...... o . . . . . . . . . . . 38 16,562.
Credits 39a Check {D You were born before January 2,1941, D Blind.} Total boxes I
Standard l if: D Spouse was born before January 2,1941, D Blind. checked ... ... 39a
Deduction for -
. People who b If your spouse Itemizes on a separate retum or you were a dual-status alien, see page 35 and check here .... ... 39b D
checked any 40 Itemized deductions (from Schedule A) or your standard deduction (see left margin) 40 7,300.
box on line 39a ................. ......... .....
or 39b or who 41 Subtract line 40 from line 38 41 9,262.
can be claimed .......................................................................................... ..... ...........
as a dependent. 42 If line 38 is over $109.475, or you provided housing to a person displaced by Hurricane Katrina,
see page 37. Otherwise, multiply $3,200 by the total number of exemptions claimed on line 6d ...... ................. 42 6,400.
43 Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -D- ................................. 43 2,862.
. All others: 44 Tax. Check if any tax is from: a D Form(s) 8814 b D Form 4972.............. ..................................... 44 286.
Single or 45 Alternative minimum tax. Attach Form 6251 45
Married filing ................................................................................ ......
separately t 46 Add lines 44 and 45.............................................................. ... 46 286.
$5,000 ......................................... .......
Married filing 47 Foreign tax credit. Attach Form 1116 if required ...................... .... ........... 47
join~y or 48 Credit for child and dependent care expenses. Attach Form 2441 ..,............... 48
Qualifying
widow(er), 49 Credit for the elderly or the disabled. Attach Schedule R ........... ......... .......... 49
$10,000 50 Education credits. Attach Form 8863 50
......................................................
Head of 51 Retirement savings contributions credit. Attach Form 8880 51
hOllsehold, ........................
$7,300 52 Child tax credit (see page 41). Attach Form 8901 if required 52
.........................
53 Adoption credit. Attach Form 8839 ..................................................... 53
54 Credits from: a D Form 8396 b D Form 8859.............. 54
55 Other credits. Check applicable box(es): a D Form 3800
b o Form 8801 c DForm ...... 55
56 Add lines 47 through 55. These are yourtotaf credits .......................................................................... .. 56
57 Subtract line 56 from line 46. If line 56 is more than line 46 enter -0- .............. ................................ .... ... 57 286.
Other 5B Self-employment tax. Attach Schedule SE ...................................................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Taxes 59 Social security and Medicare tax on tip income not reported to employer. Attach Form 4137 ........................... 59
60 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required .............. ............... 60
61 Advance earned income credit payments from Form(s) W-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... .............. ......... ..... 61
62 Household employment taxes. Attach Schedule H ............ ............................... ...... ....... 62
63 Add lines 57 through 62. This is yourtotaf lax ...................................... .............. . . . . . . . . . . . . . . . . . . ....... ~ 63 286.
Payments 64 Federal income lax withheld from Forms W-2 and 1099 ............................ 64 1,690.
65 2005 estimated tax payments and amount applied from 2004 return .. ......... 65
If you have 66: ~~~~::a:':::~~:~~i~:~:~~t;~~":'.:.: ......~.. i ..~~~. i........ -........................ 66a
a qualifying
child, attach
Schedule EIC. 67 Excess social security and tier 1 RRTA tax withheld (see page 59) 67
...........
68 Additional child tax credit. Attach Form 8812 .. . .. .. ...... ..... ... .. . ..... 68
69 Amount paid with request for extension to file (see page 59) ........................ 69
70 Payments from: a DForm 2439 b DForm4136 c 0 Form 8885 70
71 Add lines 64. 65, 66a and 67 throuoh 70. These are vour Iota I oavments ....... ..................... ...... "".. ~ 71 1,690.
Refund 72 If line 71 is more than line 63, subtract line 63 from line 71. This is the amount you overpaid................... 72 1,404.
Direct 73a Amount of line 72 YOU want refunded 10 you .................................................... ~ 73a 1,404.
deposit? ............ ........... ....
See page 59 ... Routing I ,... 0 D Accoun,t r
and fill in 73b, b number C Type: Checldng &1.,;ngs ... d number
73c, and 73d. 74 Amount of line 72 you want aoolied to your 2006 estimated lax ........ ... 74
Amount 75 Amounl you owe. Subtract line 71 from line 63. For details on how to pay, see Pjge 60 r'" . . . . . . . . . . . . . . . . ..... ... 75
You Owe 76 Estimated tax nenaltv (see oaoe 60\ ....................... ............................ 76
Third Party Do you want to allow another person to discuss this return wilh the IRS (see page 61)? [X] Yes. Complete the following. D No
Designee ~~ee's", PRE PARER ~hone... ~~;;;~~~'~?~ntification ~
Sign Under penalties of pe~ury, I declare that I have examined this retum and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct,
and complete. Declaration of preparer (other than taxpayer) is baSed on all Information of which preparer has any knowledge.
Here Your signature Date Your occupation Daytime phone number
Joint retum? ~
See page 17.
Keep a copy Spouse's signature. If a joint retum, both must sign. Date
for your
records.
Preparer's SSN or PTiN
Paid Preparer's ..... . " ~ --A /': / ~.
Preparer' s signature ~/?<---:ec-.~~ (..c' Y'Z.a:.-L.-. c;/ 'Af!
Use Only Firm's name(or,,~'.. KUHN & DOVIAK PC
yoursifself-e'1l:..--_/ 1402 MT ROSE AVE
510002 ployed), address,
11-05-05 and ZIP code YORK PA 17403-2908
P00173765
20:0533459
Phone n07 1 7 - 8 4 6 - 4 5 0 2
Myers Funeral Home, Inc.
Boyd L. Myers Jr., Supervisor
37 East Main Street
Mechanicsburg, Pennsylvania 17055
(717) 766-3421
Fax (717) 795-7291
A standard of excellence in Central Pennsylvania since 1910
Saturday, September 3, 2005
..
Mr. William Paul Irvin
512 Eldorado Drive
Red Lion, PA 17356
Dear Mr. Irvin,
Thank you for selecting our funeral home to provide services for your family during your bereavement.
I hope that you found our services to be of the highest standards and that they met your needs and those
of your family and friends. The following is a summary of the service charges as previously explained and
provided in written form on the services for:
Kav F. Hoover
r
$7,156.00
1,645.00
1,000.00
$4,511.00 c::
fJ. -
Credits Granted: $1,645.0 Package Price Discount f-l'-- ,,'V'\ --.}- J .5"11/ ;(..v..1
Inlere,' allhe ra'e 011.5 % per monlh (18 % per annum) w;JJ be added 'A balance ato d:..
If there are any questions or concerns that remain unanswered, please call me.
h/~
SUMMARY OF EXPENSES
TOTAL OF SERVICE RENDERED
LESS: Credits granted
LESS: Total Payments
CURRENT BALANCE
.
WoIf & WoIf, Attorneys At Law
10 West High Street
Carlisle, P A 17013
Date: 9/20/2006
W. Paul Irvin
512 El Dorado Drive
Red Lion, P A 17356
Regarding:
Invoice No:
Hoover, Kay F. (Estate of)
1036
Services Rendered
Date Staff Description Hours Rate Charges
9/09/2005 NCW Draft ~te documents and open estate, including 1.20 $140.00 $168.00
renunc.IatJ.ons
9/20/2005 NCW Conference with Paul re: estate matters 1.00 $140.00 $140.00
1/09/2006 NCW Draft deed and communicate with lender re:short salel.50 $140.00 $210.00
along with buyer's agent for sale
4/09/2006 NCW Review docs from levins - e-mail to Paul 0.50 $140.00 $70.00
7/30/2006 NCW Prepare inheritance tax return 3.50 $140.00 $490.00
8/07/2006 NCW Conference with Paul re: Inheritance Tax Return 2.30 $140.00 $322.00
8/15/2006 NCW Review docs from Paul- edit and finalize inheritance 0.80 $140.00 $112.00
tax return
Fee Subtotal
Adjustments to Fees
$1,512.00
$-12.00
Total Fees
$1,500.00
RECEIPT FOR PAYMENT
-------------------
-------------------
* DUPLICATE *
GLENDA FARNER STRASBAUGH
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17G13
Receipt Date:
Receipt Time:
Receipt No.:
9/14/2005
08:27:12
1041905
HOOVER KAY F
2005-00818
WILLIAM P IRVIN
RSK
------------------------ Receipt Distribution -------------___________
Fee/Tax Description Payment Amount Payee Name
Estate File No. :
Paid By Remarks:
PETITION LTRS ADM
RENUNCIATION
SHORT CERTIFICATE
JCP FEE
AUTOMATION FEE
Check# 7353
Total Received.........
210.00
5.00
24.00
10.00
5.00
----------------
$254.00
$254.00
CUMBERLAND COUNTY GENERAL FU
CUMBERLAND COUNTY GENERAL FU
CUMBERLAND COUNTY GENERAL FU
BUREAU OF RECEIPTS & CNTR M.
CUMBERLAND COUNTY GENERAL FU
KAY F HOOVER (ESTATE)
C/O WILLIAM P IRVIN
512 EL DORADO DR
RED LION PA 17356
KUHN & DOVIAK, PC
1402 MT ROSE AVE
YORK PA 17403-2908
Phone (717) 846-4502
PROFESSIONAL SERVICES
2005 ESTATE TAX RETURNS -IRS & PA
Total
INVOICE
DATE NUMBER
8/9/2006
2009247
AMOUNT
75.00
$75.00
pel ~-//-06
c::~ rJ :3 7'7 3
C'?-v1
. .
DETACH AND RETURN THIS PORTION WITH YOUR PAYMENT
THE SENTINEL - LEGAL Est K Hoover
P.O. BOX 130. CARLISLE PA 17013 . .
AD NUMBER CLASSO START DATE STOP DATE
293966 PUBLIC NOTICES 09/16/05 09/30/05
AD DESCRIPTION BILLING DATE TELEPHONE NUMBER
ADMINISTRATOR'S NOTICE LETTERS OF 09/30/05 717-241-4436
ATTORNEY AT LAW NATHAN C. WOLF
37 S. HANOVER ST.
SUITE 201
CARLISLE, PA 17013
1...11I.1111I......111111.1..1.1
20200000002939660000000000000002080000000173339
GROSS AMOUNT OF
208.00
DUE AFTER 10/30/05
TOTAL AMOUNT DUE
173.33
ENTER AMOUNT ENCLOSED
/7 ?."5!.>
CUMBERLAND LA ~V JOURNAL
32 SOUTH BEDFORD STREET
CARLISLE, PA 17013
OCTOBER 7, 2005
Cumberland Law Journal is published every Friday by the Cumberland County Bar
Association and is designated by the Court of Common Pleas as the official legal publication for
Cumberland County and the legal newspaper for publication of legal notices.
TO:
Nathan C. Wolf, ESQUIRE
RE:
Kay F. Hoover, ESTATE
Legal advertisements must be received by Friday Noon. All legal advertising must be
paid in advance. Make all checks payable to: Cumberland Law Journal.
---------------------------------------------------------------------
---------------------------------------------------------------------
Advertisement inserted on following dates:
September 23, 30, October 7, 2005
Advertising Cost
75.00
$ 0.00
$ 0.00
$ 0.00
-------------
Proof of Publication
Second Proof Request
Payment received
Total Amount Due
$ 75.00
---------
--------
Payment received by
; .r.,
, I"
. 1\
.. itl
., ./ {, "
\ ,~
/j).-.
1\
/ J(',r:(
/; I"
'_} \..i
MORTGAGE LOAN STATEMENT
RETAIN THIS PORTION FOR YOUR RECORDS
STATEMENT DATE
LOAN NUMBER
08/16/05
0084993765
PROPERTY
ADDRESS
11 KELLER STREET
MECHANICS BURG PA 17055
KAY F HOOVER
11 EAST KELLER STREET
MECHANICSBURG PA 17055-3827
111111I11111I111I1111111111111.11111111.1111111111111111111111
20...
Thinking About
Refinancing?
For information,
please call toU-free
(800) 325-1493
~Wi~;~-.~''''\'.,,::;m'f~~: ~,i;i\r'~"'7fft\i:;ii"--T-a'''''';;''''''!1''''-'''-r~''''~i.fJi ~:.~_.<'.."....'..'.t~..:;;'..~"'.'.".. '~"."it.".:c''''''':'"::'l~~~%\~t"",,,JG,;!iI.l!l'.'''.
e~.J:j~~~W~.4~,~~~al m~J.!;,L~,M.t.~i:lit~~~'~i~..r';Ui.:~~.;J:;J,;:;,~;,%~ ~~~ffi!;f~~'i~i~~,\{~l~~:,;,.\~.!~~~~;,~~)~;;
(For Payment Due: 09/01/05)
Suspense Balance:
Total Amount Past Due:
Payment Due on 09/01/05
Expenses Paid by AMC:
Unpaid Late Charges:
Other Fees & Charges:
Total ExpenseslFees Due:
$.00
$.00
$681.66
Interest Rate:
Monthly Payment
Escrow:
Insurance Products/Misc:
Monthly Total:
6.90000\
$681. 66
$.00
$.00
$681. 66
Principal Balance:
Escrow Balance:
$102,427.77
$.00
$.00
$.00
$.00
$.00
Next Monthly Payment
Change Date:
Amounts Paid Year-To-Date
Principal:
Interest:
Late Charges:
Hazard Insurance:
Taxes/Liens:
$723.10
$4,730.52
$.00
$.00
$.00
Total Amount Due:
$681.66
09/01/06
To avoid late charges of $40.90 we must receive
your payment by 09/16/05 during business hours.
Visit www.mllamcloan.com.
~""""~l""''''':~''I-'''.I!''f''''''mu'''''.'''","''4:.'''''''_'''''''.''''''.'''I'..'-. ".'''. :.';t ~"..';#,'F...,,.,.,,.tI\.~"~~.'j)i;!~.~ ~I!..I1~~~< .~i~;~j'1lt~'3;r0":rrj'
;~l:ii;i!~~J~;i~~~U~~~f~~~~iJ'~~,:~~tJ.~,~,{t~l:~J):J'~':_:~,~~~it:';:~~:?~!i~~~tl~~~ll;iIi~.~~~i~:~f~~~,:~
DATE
DESCRIPTION
AMOUNT
PRINCIPAL
INTEREST
ESCROW
INSURANCE LATE CHARGES/
PRODUCTS/MISC CORP ADVIFEES
SUSPENSE
08-15 PMT 08/01/05
$681. 66
$92.17
$589.49
rf\X
005-06 PERSONAL TAX NOTICE ** SCHOOL ** JULY 1 2005
MECHANICSBURG AREA SCHOOL DISTRI
~f:'_ c'!'-r:'~.';-.- ""l";~"" ",.,
Cl
2317
BARRY L HECKARD SR
605 SOMERSET DR
MECHANICSBURG PA 17055
PHONE: 717-766-6205
CLOSED NOV 8 DEC 31 SEPT 12-16
JULY-AUG TUES&THURS 10-4PM WED 5-7
SEPT-DEC TUES 10-4PM WED 5-7PM
S CH P / C
10
SCH RES
10
SCH OCC
~).'~r <c{. t'J
""r
DISCOUNT
FACE
PENALTY
I
I
Pi1.'{ nll:,S
'd
4. gO!
5.00i
5.50!
",
4.90:
5.00,
5.50'
.AlJG
& OCT
& DEC
IF UNPAID BY 12/15/05 TAXES
WILL BE TURNED OVER TO
DELINQUENT COLLECTOR.
ACCT # 016-0012677
SS# 195-32-1773
D'i~rrW~~'~~~~~~'~'u~WE~~"tf~~JOB TITLE IS 90 DAYS FROM DATE OF BILL
~LL 240-6365 OR 697~0371 EXT 6365 OR 532-7286 EXT 6365.
HOOVER, KAY F.
11 E. KELLER ST.
MECHANICSBURG PA 17055
tUCt" r:.!'l.n
D:iffE
;\1RJ.-,~
C2
J05-06 PERSONAL TAX NOTICE ** SCHOOL ** JULY 1 2005
MECHANICSBURG AREA SCHOOL DISTRI
.r :~!.W~Ct-;:::,; f'p,'f,',/-';U: -~-(!-
2317
BARRY L HECKARD SR
605 SOMERSET DR
MECHANICSBURG PA 17055
PHONE: 717-766-6205
3cH-p!c" r
L 0 ,;~,{. \'i<J]
CLOSED NOV 8 DEC 31 SEPT 12-16
JULY-AUG TUES&THURS 10-4PM WED 5-7
SEPT-DEC TUES 10-4PM WED 5-7PM
4.90!
5.00'
5.50!
i:icH; RE$:;~_li
10,,,,, '"
"...".- 4.~ go!
5.00i
5.501
~qfl Q~G
";.;,.p
I
""!;~~-
!
'%P
.
10.00
11.00
!
. I
IF UNPAID BY 12/15/05 TAXES
WILL BE TURNED OVER TO
DELINQUENT COLLECTOR.
ACCT # 016-0012677
SS# 195-32-1773
J\i~'B;"t?f:r~,,,);i~a~~@'3W:~I:~J~i4;~;~W[ji'I'~ilr~~i~ 0 B TIT LEI S 90 DAY S FRO M D ATE 0 FBI L L
ILL 240-6365 OR 697-0371 EXT 6365 OR 532-7286 EXT 6365.
HOOVER, KAY F.
11 E. KELLER ST.
MECHANICSBURG PA 17055
.
2349
** TAXPAYER COPY **
BARRY L HECKARD SR TAX COLLECTOR
605 SOMERSET DRIVE *766-6205*
MECHANICSBURG, PA 17055
CTL
SSN
16 12677
195-32-1773
HOOVER. KAY F.
11 E _ KELLER ST.
MECHANICSBURG PA
17055
MAR-APR. TUES & THURS 10AM-4PM
WED 5PM-7PM MAY-JUNE TUES 10-4PM
WED 5PM-7PM OR CALL FOR APPT
CLSD 3/10 AND ALL ELECTION DAY
;i
, ~,~. (I .
, I
** TAX COLLECTOR COpy **
BARRY L HECKARD SR TAX COLLECTOR
605 SOMERSET DRIVE *766-6205*
MECHANICSBURG, PA 17055
cn
SSN
16 12677
195-32-1773
HOOVER. KAY F.
11 E. KELLER ST.
MECHANICSBURG PA 17055
MAR-APR. TUES & THURS 10AM-4PM
WED 5PM-7PM MAY-JUNE TUES 10-4PM
WED 5PM-7PM OR CALL FOR APPT
CLSD 3/10 AND ALL ELECTION DAY
BILL DATE
3/01/2005
BILL NO
2349
2005 PERSONAL TAX NOTICE
COUNTY OF CUMBERLAND
BOROUGH OF MECHANICSBURG
UNPAID TAXES SUBMITTED TO DELINQUENT COLl 12/15/05
CNTY P /C
MUN PIC
CNTY pic
MUN pic
9.80
2.0%- lO.O%-. DISCOUNT
2.0%- lO.O%-: 3/01/2005
TO
4/30/2005
BILL DATE
3/01/2005
5.00
5.00
FACE
5/0l/2005
TO
6/30/2005
BILL NO
5.50
5.50
11.00
PENALTY
AFTER
6/30/2005
2349
2005 PERSONAL TAX NOTICE
COUNTY OF CUMBERLAND
BOROUGH OF MECHANICSBURG
UNPAID TAXES SUBMITTED TO DELINQUENT COLL 12/15/05
4.90
4.90
9.~
DISCOUNT ..
3/01/2005
TO
4/30/2005
F Act-'r . PENALTY
5/01/2005 AFTER
TO
6/30/2005 6/30/2005;
CNTY pic
MUN pic
5.00
5.00
1
5.50 :
5. :,0
11.M 'J
.:. - .. ... .. j
.
WEST SHORE TAX BUREAU
PHONE: 717-761-4900 \\lER SITE: lVVvJ,y,V'/ES'fM151RG
DC 0
retllftl enveiope and the
appropriate mailing labels
to file this Return
FINAL EARNED INCOME TAX RETURN
CALENDAR YEAR I
2005
PLEASE FJLE THIS RETURN BY APRiL 15T.H EVEN [iF NO TAX IS [JUE OR IF rr HAS ALL BEEN WiTHHELD
**********AlJTO**3-DIGIT 173
I... I I I.. .1.. I I. .1.1.. I I.. I. .1. I.. .111.. .11......1 I. .1. I I I... I
HOOVER KAY F
512 EL DORADO DR
RED LION, PA ] 7356-8700
YQUMUST
COMPLETE
~
1. Gross Eamings Enclose W-2
2. Allowable Non-Reimbursed E
Statement of expenses (PA Form
3. Taxable Earnings (Line 1 m
1099's and supporting docume
4. Net Loss (Use Line 8 for any
NRK-l NOTE: PA Schedule
5. Subtotal (Line 3 minus Line
6. Net Profits (Use Line 4 for N
and/or NRK-I
7. TOTAL EARNED INCOME
8. Tax Liability Line 7 multipli
9. Quarterly Estimated Paymen
10. Earned Income Tax Withheld
11. Credit from last year
12. Miscellaneous Credits Please
Tax Credit or Credit for Philade
13. TOTAL of 9 + 10 + 11 + 12
14. REFUND/CREDIT Subtract
NO REFUNDS OR CREDITS L
15. TAX DUE If Line 8 is greater
/~.MOUNTS LESS THAN $1.0(
16. Interest + Penalty (1 % per mo
17. TOTAL AMOUNT DUE (Lin
Reference #T/P A: 377419
Reference # T/P B:
MUNICIPALITY: MECIlANICsnlfUC BORO 06]
FULL YEAR RESIDENT YES () NO ( )
r)t/o-s A husdand anclwifem,iy both fileon this form, ho'Veve~., .
.;J?e(1GWSe-/) tax calcuI'!tions mustbe repolied ~.~eparate cOIWJ.11lS' Joint
filing (c01l1bining. income or. expenses). fs notpennitted.
....
Taxpayer ASS# /9~-3.2 - /773 Taxpayer A " Name TaxpayerB "Name
Taxpayer B SS# KAYF
's, 1099's, or explain other income 1. /1//4g. (9
mployee Business Expenses [nclude detailed 2.
sUE-I, UE-2 and all supporting documents)
in liS Line 2) Audit may be required if all W-2's, 3.
nts are not attached or other income is not explained
Net Profits) Attach PA Schedules C, F, RK-I and/or 4.
C-F Reconciliation is not acceptable.
4) IF LESS THAN ZERO - ENTER ZEIIU 5.
et Losses) Include PA Schedules C, F, RK-I 6. -
SUBJECT TO THIS TAX (Line 5 plus Line 6) 7. /L/ /'-lx, i 9
ed by tax rate I '7 (See back of Return for tax rates) 8. ~ t./ Col' {; 2-
ts 9.
as per attached W-25 10. ~ {... 3 I
11.
see Instructions for calculating Out-Of-State 12.
Iphia Tax Withheld. ,.1- .2.. 6. 3 '1
13.
Line 8 from Line 13 14.
ESS THAN $100 ( ) Credit to next year l ) Refund I t..j, I ~-
than Line 13 - subtract Line 13 from Line 8 15.
J NEED NOT DE PAID
nth after April 15th) 16.
e 15 + Line 16) 17.
ATTACH APPROPRIATE COPIES OF STATE SCHEDULESAND/ORALL W-2'S
Signature TaxpaYI>r A
i ';'1' ' !l::C'h:': F\Y,BtF TO \YEST ;;BO;:[ .n7.. rn RL:L. .\ FEE (>F .0>'.;": '. ;,.1 '.:. :f\:;,;Vf. Fein ;':FfUE\i j'; ,'~pc, i..
I declare under penalties of perjury that J hare examined this return and to the best of my knowledge and helier, it is a true, accurate and complete return.
Signature Taxpayer n
Date
Occupation
E-Mail
Daytime Telephone
Date
Occupation
Daytime Telephone
E-Mail
~