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Home My WebLink About09-22-06 --.J 15056041114 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 OFFICIAL USE ONLY County Code Year Fife Number INHERITANCE TAX RETURN RESIDENT DECEDENT P-I. O~ 072- Date of Birth 209-10-3299 Decedent's Last Name 03042006 Suffix 10221915 Decedent's First Name MI HOOVER MR. CLIFFORD (If Applicable) Enter Surviving Spouse's Information Below Spouse's last Name Suffix Spouse's First Name MI HOOVER Spouse's Social Security Number MRS. ELIZABETH FILL IN APPROPRIATE OVALS BELOW rn 1. Original Retum D D 4. Limited Estate CJ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Return CJ CJ o CJ 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required rn 6. Decedent Died Testate (Attach Copy of Will) D 9. Litigation Proceeds Received D CJ 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 between 12-31-91 and 1-1-95) 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number STEPHEN D. TILEY Firm Name (If Applicable) 717-243-5838 FREY & TILEY First line of address REGISTER OF WILLS USE <l:!!Y (") .~ C ,.- .,~ 0 0"'\ ::: :.0 (/) J -CJ 0 fT1 r-- -0 fTl N :D N 7=: -0 :0 ;.:~ ~;) ~:J C:J E9 5 SOUTH HANOVER STREET Second line of address City or Post Office State ZIP Code ED N W .z;::- c) --or. CARLISLE PA 17013 Correspondent's e-mail address: 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 repres ed on all information of which preparer has any knowledge. SIGNATUR OF PERSON RESPO SIBLE FOR FILING RETURN ATE a2-2. ST., CARLISLE, PA 5 SOUTH HANOVER STREET, CARLISLE, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056041114 15056041114 --.J ---I 15056042115 REV-1500 EX Decedent's Name: CLIFFORD HOOVER MR. RECAP ITU LA TION 1. Real estate (Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . . . 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . . . 6. Jointly Owned Property (Schedule F) DSeparate Billing Requested. . . . . . . . 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) DSeparate Billing Requested. . . . . . . . 8. Total Gross Assets (total Lines 1-7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Funeral Expenses & Administrative Costs (Schedule H) . . . . . . . . . . . . . . . . . . . . 209-10-3299 Decedent's Social Security Number 1. NONE 2. NONE 3. NONE 4. NONE 5. 6. NONE 7. 8. 9. NONE 10. Debts of Decedent. Mortgage liabilities, & Liens (Schedule I) . . . . . . . . . . . . . . . 10. NONE 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.O ~ 16. Amount of Line 14 taxable at lineal rate X .0 ii.- 17. Amount of line 14 taxable at sibling rate X . 12 18. Amount of Line 14 taxable at collateral rate X . 15 4 0 4 0 3 . 0 0 15. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056042115 16. 17. 18. Dt(}fh~ 0. u c6-J. jI\J APll --..:::. .If:J U.:J CI u , .... ... _ _ 14345.00 26058.00 40403.00 0.00 40403.00 0.00 40403.00 0.00 0.00 0.00 0.00 0.00 o ----' REV-1500 EX Page 3 209-10-3299 Decedent's Complete Address: DECEDENT'S NAME CLIFFORD HOOVER MR. STREET ADDRESS 21-2006-0392 File Number 770 SOUTH HANOVER STREET CITY CARLISLE STATE PA ZIP 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 ) 0.00 Total Credits (A + 8 + C ) (2) 0.00 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 avalon Page 2, Line 20 to request a refund. (4) 0.00 0.00 5. If line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 A. Enter the interest on the tax due. (5A) 0.00 B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58) 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 a. retain the use or income of the property transferred; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . 0 b. retain the right to designate who shall use the property transferred or its income; . . . . . . . . . . . . . . .. 0 c. retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D o D D d. receive the promise for life of either payments, benefits or care? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? . . No o o [~] o o o 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0 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 ofthe 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. 99116 (a) (1.1) (ii)l. 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. 99116(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. 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. 217 REV.1508 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hoover. Clifford Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned withriaht of survivorship must be disclosed on Schedule F. FILE NUMBER 21-2006-0392 ITEM NUMBER DESCRIPTION 1 PNC Account No.: 5004752819 (principal $881.0) Plus interest accrued to the date of death ($0.43) 2 PNC Account No.: 5004734311 (principal $13,439.47) Plus interest accrued to the date of death ($25.03) VALUE AT DATE . OF DEATH 881 13,439 25 TOTAL (Also enter on line 5. Recapitulation) $ (If more space is needed. insert additional sheets of the same size) 14.345 MAY-eB-2006 22:10 PNCBANK 412 1'68 3458 a PNCBAN< May 9, 2006 Stephen Tiley Attorney at Law 5 South Hanover St. Carlisle, PA 17013 scp RE: Estate of ClitTord Hoover (Deceased) SS~: 209.10-3299 000: 03-04-2006 Dear Mr. Tiley: In response to your request for Date of Death balances for the custOmer noted above, our records show the following: CheckiDg Account Account #5003902571 Established 06-28.2002 CLIFFORD HOOVER ELIZABETH HOOVER DOD balance: $0.00 + 50.00 accrued interest This account was at zero balance on the date of death. Account #5004752819 Established 06-2().200S CLIFFORD HOOVER 000 balance: 5881.00 + $0.43 accrued interest Slvlnas Ae~Qnc Account #5004734311 Established 06-20-2005 CLIFFORD HOOVER DOD balanoe: $13,439.47 + 525.03 accrued interest Page t of2 P.01 217 REV-1510 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATEOF Hoover. Clifford FILE NUMBER 21-2006-0392 DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO OECEOENT ANO THE OATE OF DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLlCABlEI VALUE 1. Transamerica Life Insurance Company Annuity #SC00457378 ($26.057.60) 26.058 100.00% 26.058 TOTAL (Also enter on line 7 RecaDitulation) $ 26.058 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. (If more space is needed. insert additional sheets of the same size) l.t~~. ~(Q)(P)'V Transamcrica Life Insurance Compan 4333 Edgcwood Road NE PO Box 3183 Cedar Rapids, Iowa 52406-3183 May 8, 2006 Elizabeth Hoover c/o Stephen Tiley 5 South Hanover Street Carlisle PA 17013 RE: Annuity Number(s) SC000457378 Dear Mrs. Hoover: We have received notification that, Clifford Hoover, the annuitant of the above listed policy is deceased. please accept our company's sincere condolences for your loss. Our records indicate the following annuity information: Annuitant: Owner: Primary Beneficiary: Policy Date: . Clifford Hoover, Deceased Clifford Hoover, Deceased Elizabeth Hoover July 11, 2005 As primary beneficiary of this annuity, you have two options for claim processing. The first option would be to continue receiving monthly payments in the amount of $562.43 in your name. The interest portion will be reported as taxable to you in the year in which it is received. The final guaranteed payment will be issued on or near July 11, 2010. In order to receive the maximum death benefit, our company encourages you to continue receivi~g the payments. The second option you have available would be to receive the annuity- commuted value in a lump sum. The commuted value is the present value of future annuity payments. ~s of May 5, 2006, the commuted value is ~ $26,057.60, of which nothing is taxable to you. Please note the commuted value may fluctuate and is subject to change. Member of the _EGON. Group To complete either option, we will need the following: · Certified Death Certificate indicating the cause of death · Payout Annuity Claimant Statement (Payout Annuity Claimant Statement must be completed in the name of the designated beneficiary listed above.) Please note that if Clifford Hoover has more than one policy with our company or if there are multiple beneficiaries, only one certified death certificate is required. If one death certificate is sent in for multiple policies please attach a statement to the death certificate indicating each policy number. You may elect to have the benefit payment(s) electronically transferred to a bank account. If you would like to take advantage of this service, please complete and sign the enclosed Direct Deposit Authorization Form. You will receive a Form 1099-R reporting these distributions the following January. This letter contains general tax information based on our company's interpretations and should not be relied upon for tax planning. If you have questions concerning the direct tax consequences when selecting an option, you may wish to consult a tax advisor. Transamerica Life Insurance Company is a member of the Insurance Marketplace Standards Association (IMSA), an organization committed to high ethical marketplace standards in the sale and service of individual life insurance and annuities. If you have additional questions concerning this annuity or the information contained in this letter, please contact our office or your personal representative. Sincerely, ~~ Robert Houk Income Payout Services 1-866-865-2935 Enclosure(s) : Payout Annuity Claimant Statement Direct Deposit Authorization Form Postage Paid Return Envelope ij ~ :. tXi&' ~~J ~m.i:; t, ". t,_; ~':. ~~l~ ....';, r~:5'. :~ ;.~, . ~ qv.'" ~". . I~:;;;~,~ ~;t\'f' , ;{~::~~ ~i~~ r.~'~t c;... :;,~.~'() I~:? l',"': ,: i":M ~.l"'~';'_' I;:;.. \. ..... rl ~ LAST WILL AND TEST AMENT OF CLIFFORD HOOVER I, CLIFFORD HOOVER, of 770 South Hanover Street, Apartment 3-A, Carlisle, Pennsylvania 17013, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all Wills by me at any time heretofore made. 1. I direct my hereinafter named personal representative to pay all of my just debts and funeral expenses as soon after my death as may be found convenient to do so. I direct that my funeral services be conducted by Cox Funeral Home at Warriors Mark, Pennsylvania, and that my body be interred on my burial lot located in Seven Stars Cemetery at Seven Stars, Franklin Township, Huntingdon County, Pennsylvania. 2. All of the rest, residue and remainder of my estate, real, personal and mixed, and wheresoever the same may be situate, I give, devise and bequeath to my wife, Elizabeth Hoover, her heirs and assigns, provided she shall survive me by a period of ninety (90) days. 3. Should my said wife, Elizabeth Hoover, predecease me or fail to survive me by the aforesaid period of ninety (90) days, then in such .event all of the rest, residue and remainder of my estate, real, personal and mixed, and wheresoever the same may be situate, I give, devise and bequeath as follows: a) The sum of Five Hundred ($500.00) Dollars to The Alliance Home, 770 South Hanover Street, Carlisle, Pennsylvania 17013, to be used for such purpose or purposes as the Board of Directors of said Home shall deem best; . .....__._-~l=All-uf tnfiwIS and-i.miiIUnltl'On:of5!g;us_oev.ef.lan..d:jl~lJype.l.give.and..bcifueath ~<to-~.tiine..frj~~~ry. Stinere~r;:w-arriors"'MlltK:-Pennsylvania 16877; c) All of my tangible personal property excepting any automobiles which I may own at the time of my death but including clothing, articles of personal use and adornment, household goods and furnishings, and all other tangible personal property, I give and bequeath to my friends, John Hoover and Dorothy Hoover, husband and wife, of Blain, Pennsylvania 17006; d) I direct that all automobiles which I may own at the time of my death1 if any, shall be converted into cash and included in the residue of my estate; and e) The balance thereof I give in twelve (12) equal shares to the following persons, their heirs, assigns, and successors, provided each of them shall survive me by a period of ninety (90) days, but should any of them fail to so survive me then the share such deceased person would have received shall be paid to the surviving spouse of such deceased person who shall survive me by a period of ninety (90) days, if any, and if there be no such surviving spouse then to the children of such deceased person who shall survive me by a period of ninety (90) days, but if there be no such surviving spouse or surviving children then the same shall lapse and be added to the remaining shares, per stirpes: Clarks Run Mennonite School c/o John Hoover Blain, Pennsylvania 17006 John Hoover R.D. Blain, Pennsylvania 17006 Jay Elton Hoover Blain, Pennsylvania 17006 . Keith Hoover Blain, Pennsylvania 17006 Mabel Jean Hoover Blain, Pennsylvania 17006 Linford Hoover Blain, Pennsylvania 17006 Curtis Hoover Blain, Pennsylvania 17006 Page 1 of 2 Pages / John Richard Hoover Blain, Pennsylvania 17006 Clifford Dean Hoover (born in August 1993 and the son of John and Dorothy Hoover) Blain, Pennsylvania 17006 Dorothy Hoover Blain, Pennsylvania 17006 Robert Bailey, Jr. 487 Meadows Road Newville, Pennsylvania 17241 Annette Bailey 487 Meadows Road Newville, Pennsylvania 17241 4. Should any person less than 21 years of age be entitled to distribution from my estate 1 direct the share to which such person may be entitled shall be paid to the parents of that person as Guardians of the estate of that person and authorize and direct such Guardians to receive and to invest the same and to pay the income arising therefrom together with so much of the principal thereof as in the opinion of the Guardians is necessary or desirable to be expended for the proper maintenance, support and education of such person, to or for the benefit of such person, and upon such person attaining 21 years of age to pay to him or her the then remaining principal together with any undistributed income. 5. I hereby nominate, constitute and appoint my wife, Elizabeth Hoover, as Executrix of this my Last Will and Testament but should she predecease me or fail to qualify or cease serving as such, then in such event I nominate, constitute and appoint my friend, Robert Bailey, Jr., of 487 Meadows Road, Newville, Pennsylvania 17241, as alternate or successor Executor, but should he fail to qualify or cease serving as such then in such event I nominate, constitute and appoint his wife, Annette Bailey, as second alternate or successor Executor. I further direct that no person serving as Executor or Executrix shall be required to post any bond to secure the faithful performance of his or her duties in the Commonwealth of Pennsylvania or in any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament written on two pages, this 10th day of December, 1993. ~~ Cliffo Hoover (SEAL) Signed, sealed, published and declared by CLIFFORD HOOVER, the Testator above-named, as and for his Last Will and Testament, in our presence, who, in his presence, at his r~uest, and in the presence of each other, have hereunto subscribed our names as attesting Wltnesses. ~-<1, ~. ~/-I~