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Home My WebLink About06-21-06 REV-1500 EX + (6-00) OFFICIAL USE ONLY REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVEN,UE DEPT. 280601 HARRISBURG, PA 17128-0601 *' FILE NUMBER II 06 COUNTY CODE . YEAR SOCIAL SECURITY NUMBER 0157 NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Shughart, Emma P. DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) 11-02-2005 04-05-1920 (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) 183-12-2104 I- Z W Q W o W Q THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER I o o o o o o [!] 1. Original Return 04. Limited Estate [!] 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received 2. Supplemental Return 3. Remainder Retum (date of death prtor to 12-13-82) W I- :.::$11) ull::': w...u ",00 ull:.... ...1lI ... 4: 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (AIlach copy of Trust) 10 SpOusal PovertY Credit (date of death between . 12-31-91 and 1-1-95) 5. Federal Estate Tax Retum Required 8. Total Number of Safe Deposit Boxes o 11.Eleclion to tax under Sec. 9113(A) (Attach Sch O) I- Z W C z l? II) w II: II: o U I COMPLETE MAILING ADDRESS NAME Patricia R. Brown, Esq. FIRM NAME (If applicable) SALZMANN HUGHES PC 354 Alexander Spring Road, Suite 1 Carlisle, PA 17013 TELEPHONE NUMBER 7.17 -249-6333 1. Real Estate (Schedule A) (1) None OFFICIAL USE ONL Y (2) None '" (-) = '-:-:".:) ::I.J ;..:...,--, (3) None fT"l C) l c___) (4) None ..J :"~,) ~-J .~_.:-- (5) 14,587.68 cj :-' c.) (6) None ' , ...., .. -'..J ", C) C-) (7) None fT1 N (8) 14,587.68 (9) 6,434.14 (10) 15,126.44 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 0 Separate Billing Requested 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) z o i= :5 ::l l- ii: <C o W It: 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) (11 ) 21,560.58 12. Net Value of Estate (Line 8 minus Line 11) (12) insolvent 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (13) 0.00 (14) 0.00 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15.Amount of Line 14 taxable at the spousal tax rate, 0.00 x .00 (15) z or transfers under Sec. 9116(a)(1.2) 0 (16) i= 16.Amount of Line 14 taxable at lineal rate 0.00 x .045 ~ ::l Q. 17. Amount of Line 14 taxable at sibling rate 0.00 x .12 (17) :E 0 0 18. Amount of Line 14 taxable at collateral rate 0.00 x .15 (18) >< ~ 19. Tax Due (19) 0.00 0.00 0.00 0.00 0.00 20.0 ". ;~;\?' .. ~bi;:;:' :;::;;;};~, :'L;;jiC::; ~,~;{~~~'>>:Be $,uRe,:ro ~NSiNER Ail::{QUESTIONSbN'REYERSE;SIDEA-NP~ECHECk'MATJil.;(<,r CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ~{~;.:r;'f-~~!0~~':~%ti~Wf;~ ~;),~~;~'~;,{,~~\~~~;;r; ;i< ::':"::;; Copyright 2002 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00: /...../ Decedent's Complete Address: STREET ADDRESS 1921 Reservoir Drive CITY Carlisle I STATE PA I ZIP 1 701 3 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 0.00 0.00 Total Credits (A + B + C) (2) 0.00 3. InteresUPenalty if applicable D. Interest E. Penalty TotallnteresUPenalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund 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. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) (4) (5) 0.00 (5A) (5B) 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS No D ~ D ~ D ~ D ~ D ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?........ D ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ............ ......................... .................. ...................... ........................ ................. 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. Under penatties of pe~ury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS Ralph . Hocker 1. Did decedent make a transfer and: a. retain the use or income of the property transferred;.................................................................................. b. retain the right to designate who shall use the property transferred or its income;.................................... c. retain a reversionary interest; or.................................................................................................................. d. receive the promise for life of either payments, benefits or care?.............................................................. 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?...........................................................................................:................... ....... Yes DATE 1274 Alma Lane Mechanicsburg, PA 17055 q/;~~~ OAT ADDRESS SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ",~w~~s~ ADDRESS DATE 354 Alexander Spring Road, Suite 1 Carlisle, PA 17013 c,/tc,,!i:J'- For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. 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 0% [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 0% [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 4.5%, 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 of the decedent's siblings is 12% [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. Rev-1508 EX+ (6.98) *' SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Shughart, Emma P. FILE NUMBER 21-06-0157 ESTATE OF Include the proceeds of I~igation and the date the proceeds were received by the estate. All property Jolntly-<)wned with the rtght of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION 1 Cash VALUE AT DATE OF DEATH 5.226.00 2 Members 1st Federal Credit Union - savings account #202652-00 25.00 3 Members 1st Federal Credit Union - savings account #207948-00 25.00 4 Members 1st Federal Credit Union - checking account #207948-11 8.851.93 5 Members 1st Federal Credit Union - money management account 459.75 ) ~O;P~o/ ~~ .."..- ~ IrOn TOTAL (Also enter on Line 5, Recapitulation) 14.587.68 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) REV.1151 EX+ (12.99) . SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Shughart, Emma P. Debts of decedent must be reported on Schedule I. FILE NUMBER 21-06-0157 ESTATE OF ITEM NUMBER A. FUNERAL EXPENSES: Hoffman Roth Funeral Home DESCRIPTION AMOUNT 4,111.85 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions B. Ralph W. Hocker Jr. Social Security Number(s) I EIN Number of Personal Representative(s): Street Address 1274 Alma Lane City Mechanicsburg State PA Zip - Year(s) Commission paid 2006 17055 1,000.00 2. Attorney's Fees SALZMANN HUGHES PC 1,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent State Zip 4. Probate Fees 103.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs See continuation schedule(s) attached 219.29 TOTAL (Also enter on line 9, Recapitulation) 6,434.14 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1502 EX+ (8-98) *' SCHEDULE H-87 OTHER ADMINISTRATIVE COSTS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Shughart, Emma P. FILE NUMBER 21-06-0157 ESTATE OF ITEM NUMBER DESCRIPTION AMOUNT 1 Cumberland Law Journal - estate notice publication 75.00 2 The Sentinel - Legal - estate notice publication 144.29 Subtotal 219.29 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) Rev.1512 EX+ (5.98) . SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT . Shughart, Emma P. FILE NUMBER 21-06-0157 ESTATE OF Include unrelmbursed medical expenses. ITEM NUMBER DESCRIPTION 1 HeR Manorcare - nursing home fees VALUE AT DATE OF DEATH 13.775.70 2 NeighborCare - pharmacy fees 1.350.74 TOTAL (Also enter on Line 10, Recapitulation) 15,126.44 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV 1513 EX+ (9-00) *' SCHEDULE .. BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT NUMBER Shughart, Emma P. NAME AND ADDRESS OF PERSON{S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal aistributions, and transfers under Sec. 9116{a){1.2)] RELATIONSHIP TO DECEDENT Do Not UsI Truslee/sl FILE NUMBER 21-06-0157 SHARE OF ESTATE AMOUNT OF ESTATE (Words) ($$$) ESTATE OF I. Stephen C. Adams 816 Golden Eagle Drive Conway, SC 29527 Ralph W. Hocker Jr. 1274 Alma Lane Mechanicsburg, PA 17055 Son Son Total Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) LAST WILL AND TESTAMENT OF EMMA P. SHUGHART 1, EMMA P. SHUGHART, a resident of Carlisle, West Pennsboro Township, Cumberland County, Pennsylvania, being of sound mind and disposing intent, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils at anytime heretofore made by me. FIRST I order and direct my Executors, hereinafter named, to pay all of my debts, funeral expenses and expenses involved or connected with the administration of my estate as soon after my death as is reasonably possible. However, my Executors need not accelerate and pay those unmatured obligations which, in their opinion, might be proper and more advantageous to retain or renew and pay as they become due and payable. SECOND I own a prepaid funeral at Hoffman Roth Funeral Home and following my funeral, wish to be buried in my plot in Westminster Cemetery. THIRD I give, devise and bequeath all the remainder of my property, of every kind and description (including lapsed legacies and devises) wherever situate and whether acquired before or after the execution of this Will, to my sons, RALPH WILLIAM HOCKER, JR., and STEPHAN CHARLES ADAMS, equally, and to their issue, then living, per stirpes. .c: Q. " .t.,rI..J Page 1 of 3 FOURTH I hereby nominate, constitute and appoint as Co-Executors of this my Last Will and Testament, my sons, RALPH WILLIAM HOCKER, JR., and STEPHAN CHARLES ADAMS. FIFTH I direct that no executor, trustee or any fiduciary under this instrument shall be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and affixed my seal this / 'S I day of ~ {/ , 2001. ? ~ E~~HART ( ; SIGNED, SEALED, PUBLISHED and DECIARED by the above Testatrix as and for her Last Will, in the presence of us, who thereupon at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses. UctMl'u-f ~ly\DQ LilD lAC] /{\ Witness Address \....RI~ ~ ~~~-'-/ Witness G._..'LL~-1 Address . J:Jc,,-, I . Page 2 of 3 STATE OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND We, EMMA P. SHUGHART, VICKIE J. GROUP and PATRICIA R. BROWN. the Testatrix and the witnesses, respectively, whose names are signed to the foregoing instrument, being first duly swom, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witnesses and that to the best of each witness' knowledge and belief the Testatrix was at that time eighteen years of age or older, of sound mind and under no undue constr;:tint or influence. ;t~~ r. ~ Testatrix . ( Vl~ itness "-P~ '-R .~ Witness Subscribed. swom to and acknowledged before me by EMMA P. SHUGHART, the Testatrix, and subscribed and swom to before me by VICKIE J. GROUP and PATRICIA R. BROWN. witnesses. this / :oJ- day of __J I..JA-~ . 2001. r\ ~/\)j~ I.(i^-OJKJ\~\ "~lic Page 3 of 3 fvl~ MEMBERS 1st FEDERAL CREDIT UNION SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued I nterest to Date of Death Total Principal and Accrued Interest Name of Joint Owner 202652 -00 03/07/2001 $25.00 $.00 $25.00 None 207948 -00 08/02/2001 $25.00 $.00 $25.00 None CHECKING ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner 207948 -11 08/0212001 $8,851.93 $.06 8,851.00 None MONEY MANAGEMENT ACCOUNT: Account Number/Suffix Date' Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner 207948 -05 08/02/2001 $459.75 $.00 $459.75 None .rfrB.ERS ;J FE~~L CREDIT UNION ;;'V;rIV( ?/mf<.- ; Denise A. Wolfe f' Insurance Services Supervisor February 16, 2006 Estate of: EMMA P. SHUGHART Date of Death: 11/02/2005 Social Security Number: 183-12-2104 5000 Louise Drive · P.o. Box 40 · Mechanicsburg, Pennsylvania 17055 . (717) 697-1161 . www.members1st.org