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Home My WebLink About07-10-06 ---I 15056041125 REV-1500 EX (06-05) PA Department of Revenue*, Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL U~,E ONLY County Code Year 2 1 0 6 File Number o 917 Date of Birth 143182759 1 0 122 0 0 6 05281919 HENSEL PHI LIP MI K Decedent's Last Name Suffix Decedent's First Name (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 00 1. Original Retum o 4. Limited Estate 00 o 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 0 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received o o o o 8. Total Number of Safe Deposit Boxes 2. Supplemental Return o o 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required DAVID W REAGER, E SQ. 717 763 138 3 Firm Name (If Applicable) City or Post Office State ZIP Code REGISTE~ WILLS USE!!L Y ....,.. 0 --.I ;'5 ;g c:.... :T1:r:O C :22 ):> r- r- :~zm .tcr5~ 0 " .~ ~ c>o 'JO., -0 <~ C :Jl: - :n --j y? jlTE FILED REAGER & A D L E R , P C First line of address 2 3 3 1 MARKET STREET Second line of address N C AMP H ILL P A 17011 Correspondent's e-mail address: Under penalties 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 pers I representative is based on II infonnation of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETU DATE ADDRESS 1 WINDING WAY SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS 2331 MARKET STREET CAMP HILL PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056041125 15056041125 ---I J,M -.J 15056042126 REV-1500 EX Decedent's Social Security Number 143182759 Decedent's Name: PHILIP K. HENSEL RECAPITULATION 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) D Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous N.2!!iProbate Property (Schedule G) U Separate Billing Requested. . . . . .. 7. 41423.19 11. Total Deductions (total Lines 9 & 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 4 1 4 2 3. 1 9 2 1 1 8 4. 4 6 2 1 9 4 7 . 5 0 4 3 1 3 1. 9 6 - 1 7 0 8 . 7 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. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . 13. 14. Net Value Subjectto Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . 14. - 1 7 0 8 . 7 7 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 _ o . 0 0 15. o . 0 0 16. Amount of Line 14 taxable o . 0 0 at lineal rate X .04..2.- 16. o . 0 0 17. Amount of Line 14 taxable o . 0 0 O. 0 0 at sibling rate X. 12 17. 18. Amount of Line 14 taxable o . 0 0 o . 0 0 at collateral rate X .15 18. 19. Tax Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. O. 0 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT D Side 2 L 15056042126 15056042126 ....J REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME PHILIP K. HENSEL STREET ADDRESS 545 C Brandt Avenue File Number 21 06 0917 CITY New Cumberland I STATE PA I ZIP 17070 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 + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty T otallnterest/Penalty ( 0 + 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. (5) 0.00 0.00 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (5B) 0.00 A. Enter the interest on the tax due. Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ...................................................................... 0 IXI b. retain the right to designate who shall use the property transferred or its income; ............................... 0 IXI c. retain a reversionary interest; or ................................................................................................ 0 00 d. receive the promise for life of either payments. benefits or care? ....................................................... 0 00 2. If death occurred after December 12, 1982. did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... 0 00 3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ......... 0 00 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. 0 00 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 exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. ~9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)). The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. ~9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-' "" EX .".... COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE ESTATE OF PHILIP K. HENSEL FILE NUMBER 21 06 0917 All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION All debt due under Article VI of the Last Will and Testament were paid prior to decedent's death. VALUE AT DATE OF DEATH TOTAL (Also enter on line 4, Recapitulation) $ (If more space is needed. insert additional sheets of the same size) REV-1508 EX + (6-98) '. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Philip K. Hensel SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21 06 0917 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PNC Bank 39,158.09 2. PNC Bank 2,063.50 3. Storage Unit Refund 30.00 4. PNC Interest 46.21 5. Cape Savings Interest 89.94 6. Corneast Refund 35.32 7. I.O.T. Refund 0.13 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheels of the same size) 41 423.19 REV-1~" EX:<'. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Philip K. Hensel SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMB R 21 06 0917 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Myers Harner Funeral Home 9,021.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attomey Fees Reager & Adler, PC 1,450.00 3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Cumberland County Register of Wills 105.00 5. Accountanfs Fees John Murphy & Schad & Schad, CPA 3,370.00 6. Tax Retum Preparer's Fees 7. Short Certificates 12.00 8. Advertisement - Cumberland Law Journal 75.00 9. Advertisement - The Sentinel 122.51 10. Courier Service to Cumberland County Courthouse 30.00 11. Cherie H. McLaughlin (Expenses for expenses for 10/17/06) 2,462.92 12. Cherie H. McLaughlin (Expenses for October 2006) 1,207.49 13. Cherie H. McLaughlin (Expenses for November 2006) 1 ,204.21 14. Cherie H. McLaughlin (Expenses for Dec. 2006 & January 2007) 507.98 15. Cherie H. McLaughlin (Correction for addition mistake) 332.61 16. Cherie H. McLaughlin (Expenses thru February 2007) 285.96 17. Cherie H. McLaughlin (Expenses for March 2007) 593.39 18. Cherie H. McLaughlin (Expenses for April 2007) 404.39 TOTAL (Also enter on line 9, Recapitulation) $ 21 184.46 (If more space is needed, insert additional sheets of the same size) REV-'51' EX ~ ('. SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF PHILIP K. HENSEL FILE NUMBER 21 06 0917 Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1. Bank of America, Account Number 4356023200804015 2. Bankcard Services (Bank of America), Account Number 4313084837465879 3. Citi AAdvantage Card, Account Number 4128004102506004 4. Interval International (Bank of America), Account Number 4264287062097601 5. JP Morgan Chase, Account Number 5466264000005841 6. lOT America (Telephone) 7. PPL Electric (Electric) 8. Comcast (TV) 9. Medical - Apria Healthcare (Oxygen, etc) 10. Medical- West Shore EMA (Ambulance) 11. Medical - Pinnacle Health Hospital (Med. Care) 12. Brandt Associates - (Rehab decedent's apartment) 13. Medical - The Foot Care Center 14. The Patriot News 15. VALUE AT DATE OF DEATH 4,078.56 4,867.28 4,987.21 3,972.22 1,218.22 72.11 112.66 64.35 122.66 712.06 32.84 1,684.22 19.91 3.20 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 21 947.50 ,"'-"" ""'* SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Philio K. Hense NUMBER I. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS pnclude outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Cherie MCLaughlin 1 Winding Way Cape May Courthouse, NJ 08210 FILE NUMBER 21 06 0917 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Lineal AMOUNT OR SHARE OF ESTATE ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET n. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) INVENTORY , Deceased No. 21 06 0917 Date of Death 10/12/2006 Social Security No. 143-18-2759 Estate of PHILIP K. HENSEL also known as PHILIP K. HENSEL, MD Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We verify that the statements made in this inventory are true and correct. I/We understand that false statements herein made are subject to the penalties of 18 Pa, C.S. Section 4904 relating to unsworn falsification to authorities. Name of Attorney: DAVID W. REAGER 1.0. No.: 20868 Address: 2331 MARKET STREET CAMP HILL PA 17011 Dated ?/ (P /0 7 l t Telephone: (717) 763-1383 Description Value PNC BANK 39,158.09 PNC BANK 2,063.50 STORAGE UNIT REFUND 30.00 PNCINTEREST 46.21 CAPE SAVINGS INTEREST 89.94 COM CAST REFUND 35.32 Total 41,423.19 (Attach Additional Sheets if necessary) NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW-4 Continuation of Inventory PHILIP K. HENSEL 21 06 0917 Page 1 Description of Inventory Description Value I.D.T. REFUND 0.13 Subtotal $ Grand Total $ 0.13 41,423.19 AFFIDAVIT I, Cherie H. McLaughlin, certify that I am the Executrix of the Estate of Philip K. Hensel. At the time of his death, my father had a storage unit in Camp Hill, Pennsylvania containing eighty-nine boxes of documents which I have reviewed, disposed of and/or archived. This review process required me to travel from my home in Camp May Courthouse, New Jersey to Camp Hill, Pennsylvania on numerous occasions. This traveli[al required overnight stays ~ch I am seeking reimbursemen' J /~ C ~ / M;tA'-~ Witn~ Cherie H. McLaughlin State of New Jersey SS. County of Cape May On this, the 6th day of July ,2007, before me, the undersigned officer, personally appeared Cherie H. McLaughlin, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that she executed the same for the purposes herein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. t,y~~" J ~ Notary pue ic E. Virginia Smith Notary Public New Jersey Commission Exp. 09/01/2011