The URL can be used to link to this page

Home My WebLink About06-22-07 ~ 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 USE ONLY County Code Year File Number 2 1 0 6 090 0 Date of Birth 17420 857 0 092 8 200 6 092 9 2 0 0 6 Decedent's Last Name Suffix Decedent's First Name MI HER SHE Y V I R GIN I A M (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 [Zl 1. Original Return o 4. Limited Estate 00 o 2. Supplemental Return o o o 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 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 J 0 H NeZ E P P I I I 71752 8 890 0 ......., Firm Name (If Applicable) City or Post Office State ZIP Code REGISTER _ WlLLS USE ~ Y ;;;-U .o.'D:;;- :0 C- , -0 '-11 ;;:r: 0 c= :';"1 !> r- Z -,.~~~ N Z(J);::>:::: N " ...~oo :.-)0." ()C :0 ~-o -l e1nE FILED :Do :x CO o +'" A T TOR N E Y A T LAW First line of address P 0 BOX 2 0 4 Second line of address YORKSPRINGS P A 17372 Correspondent's e-mail address: 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. SIGNA~ O_~RSON RESPONSIBLE FOR FILING RETURN DATE ~_ c.//7/~a')? ADDRESS 613 SUNSET DRIVE DILLSBURG PA 17019 R THAN REPRESENTATIVE DATE YORK SPRINGS PLEASE USE ORIGINAL FORM ONLY PA 17372 Side 1 L 15056041125 15056041125 ~ ~~ -I 15056042126 REV-1500 EX Decedent's Name: VIRGINIA M. HERSHEY 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) 0 Separate Billing Requested. . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) 0 Separate Billing Requested. . . . . .. 7. 8. Total Gross Assets (total Lines 1-7) ...........................8. 9. Funeral Expenses & Administrative Costs (Schedule H) . . . . . . . . . . . . . . .. 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . 10. 11. Total Deductions (total Lines 9 & 10) . . 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ..................14. TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X.O _ 0 0 0 15. 16. Amount of Line 14 taxable 4 at lineal rate X .01L 5 2 5 8 4 16. 17. Amount of Line 14 taxable 0 0 0 at sibling rate X .12 17. 18. Amount of Line 14 taxable 0 0 0 at collateral rate X .15 18. 19. Tax Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056042126 Decedent's Social Security Number 174208570 1533292 o 0 0 1533292 215021 665687 8 8 0 7 o 8 652584 200000 452584 o 0 0 20366 o 0 0 o 0 0 20366 o 15056042126 -I REV-1500 EX Page 3 Decede'nt's Complete Address: File Number 0900 DECEDENT'S NAME VIRGINIA M. HERSHEY STREET ADDRESS 100 MT. ALLEN DR. CITY I STATE I ZIP MECHANICSBURG PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 203.66 Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/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) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 203.66 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (5B) A. Enter the interest on the tax due. 203.66 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 ~ O qJ b. retain the right to designate who shall use the property transferred or its income; ............................... ~ c. retain a reversionary interest; or ................................................................................................ 0 ~ d. receive the promise for life of either payments, benefits or care? ....................................................... 0 ~ 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? ............ .............. ...................... ................................... .... 0 ~ 3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ......... 0 [!a 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................... ........ ..... ............................ .................................. Bj 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 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. REV-1508 EX + (6-98) '* SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 0900 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. ESTATE OF VIRGINIA M. HERSHEY DESCRIPTION VALUE AT DATE OF DEATH 7,448.92 ITEM NUMBER 1. Adams County National Bank Acct. #1965174 2. Savings Bond Redeemed at Adams County National Bank 3. Pa State Pension Program (remaining balance of husband persian benefit to which she was entitled 2,184.66 5,699.34 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 15,332.92 REV-1511 EX + (12-99) *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF VIRGINIA M. HERSHEY FILE NUMBER 0900 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Misc. Funeral Expenses 248.54 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Robert S. Hershey 0.00 Social Security Number(s)/EIN Number of Personal Representative(s) Street Address 613 Sunset Drive City DiIlsburg State P A Zip 17019 Year(s) Commission Paid: 2. Attorney Fees John C. Zepp, III 1,335.38 3. Family Exemption: (If decedenfs address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4, Probate Fees Cumberland County Register of Wills 252.00 5. Accountant's Fees 6. Tax Retum Preparer's Fees 7, The Sentinel 144.29 8. Cumberland Law Journal 75.00 9. Cumberland County Register of Wills (Inventory) 15.00 ]0. Cumberland County Register of Wills (Return) 24.00 11. Cumberland County Register of Wills (Family Agreement) 56.00 TOTAL (Also enter on line 9, Recapitulation) $ 2.150.21 (If more space is needed, insert additional sheets of the same size) I3EV~1512 F,X + (12-03) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF VIRGINIA M. HERSHEY FILE NUMBER 0900 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 VALUE AT DATE OF DEATH 1. Messiah Village 6,372.00 2. Albert Pharmacy 132.83 3. AXA Equitable 152.04 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 6 656.87 REV-1513 EX + (9-00) . v , . SCHEDULE J BENEFICIARIES . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF VIRGINIA M HERSHEY FILE NUMBER 0900 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Daniel Brunick Lineal 1,000.00 2. Jason Brunick Lineal 1,000.00 3. Amy Stauffer Lineal 1,000.00 4. Stephanie Ruhl Lineal 1,000.00 5. Lora Ruhl Lineal 1,000.00 6. Anna Marie Ruhl Lineal 0.00 7. Betsy Brunick Lineal 0.00 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. York Springs Lions Club 500.00 2. York Springs Fire Company 500.00 312 Main St. York Springs, PA 17372 3. Sunnyside Cemetery of York Springs 500.00 TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 2000.00 (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent . , . VIRGINIA M. HERSHEY Decedent's Name Page 1 21 06 0900 File Number Schedule J - Beneficiaries - 1 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS (include outright spousal distributions) 8. Robert Hershey Lineal 0.00 613 Sunset Drive Dillsburg, P A 17019 Continuation of REV-1500 Inheritance Tax Return Resident Decedent . ~ , . VIRGINIA M. HERSHEY Decedent's Name Page 2 21 06 0900 File Number Schedule J - Beneficiaries - 2B 4. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS Holy Trinity Luteran Church o[York Springs 216 Main St. York Springs, P A 17372 500.00 SUBTOTAL SCHEDULE J-2B 500.00 '>" , ). ~ ~ ~> :::,\:." ,J " ---., LAST WILL AND TESTAMENT OF VIRGINIA M. HERSHEY I, VIRGINIA M. HERSHEY, of Adams County, Pennsylvania, being of sound and disposing mind, memory, and understanding, do hereby publish and declare the following as and for my Last Will and Testament, hereby revoking any and all Wills by me at any time heretofore made. ITEM I I direct that all of my legal debts, the expenses of my last illness, and my funeral expenses be paid from my residuary estate, as soon as practicable after m6 deceas~as So c.'" part of the expenses of the administration of my estate. ~=-? 0 ~ :~ :=~' ---~~ r-':" j ,-- "'::~ n. :}~ (~-3 ~ w CJ C") () 9-T1 :D> ::a: ::0 ~ --I \f? I give and bequeath all of my jewelry, automobiles, clothing and otherpersoncfJ3 ITEM II effects, as well as all household goods and equipment which I may own, including any insurance thereon to my spouse, Jack B. Hershey, if he is living thirty (30) days after the date of my death. In the event my spouse should not be living thirty (30) days after the date of my death, then I give and bequeath the aforesaid items to my three children, Anna Marie Ruhl, Betsy Brunick, and Robert Hershey to be distributed among them as my Executor in his sole discretion, shall deem advisable, making such distribution in as nearly equal shares as possible. In the event that any of my children should predecease me, then the share to which that child would have been entitled I hereby give, devise, and bequeath to that child's :)~j ;"r-i '::-) G) C:) ~~~~ ~~? ~~~;~ , " children. Any of such effects distributed to a minor may be delivered to the person with whom the minor resides, or such other person as may have custody and control of the person of the minor, without the intervention of a guardian, and the receipt of any such person shall be a full acquittance of my Executor as to such distribution. ITEM III All of the rest, residue, and remainder of my estate, real, personal or mixed, of whatsoever kind and nature and wheresoever situate at the time of my decease, I give, devise, and bequeath to my spouse, Virginia M. Hershey, if she is living thirty (30) days after the date of my decease. ITEM IV In the event my spouse should not be living thirty (30) days after the date of my death, then I give, devise, and bequeath all the rest, residue and remainder of my estate, real, personal or mixed, of whatsoever kind and nature and wheresoever situate at the time of my decease, I give, devise, and bequeath as follows: A. Daniel Brunick, grandson.................................. .$1 0,000.00 8. Jason Brunick, grandson.................................... $1 0,000.00 C. Amy Stauffer, granddaughter............................ .$1 0,000.00 D. Stephanie Ruhl, granddaughter.........................$10,OOO.00 E. Lora Ruhl, granddaughter.................................. $10,000.00 F. York Springs Lions Club.....................................$ 5,000.00 G. York Springs Fire Company...............................$ 5,000.00 H. Sunnyside Cemetery of York Springs................$ 5,000.00 I. Holy Trinity Lutheran Church of York Springs....$ 5,000.00 All the rest, residue and remainder of my estate, real, personal or mixed, of whatsoever kind and nature and wheresoever situate at the time of my decease, I give, devise, and bequeath to my three children, Anna Marie Ruhl, Betsy Brunick, and Robert Hershey. In the event that any of my children should predecease me, then the share to which that child would have been entitled I hereby give, devise, and bequeath to that child's children, per stirpes. In default of issue of any child of mine, then the share to which that child would have been entitled I hereby give, devise, and bequeath to my then living children. Any of such effects distributed to a minor may be delivered to the person with whom the minor resides, or such other person as may have custody and control of the person of the minor, without the intervention of a guardian, but any distribution can only be expended for the minor's health, education, and welfare. ITEM V I nominate, constitute and appoint my spouse, Jack B. Hershey, to be the Executor of this my Last Will and Testament. In the event my spouse should predecease me, resign, renounce or be incapable of acting as the Executor of this my Last Will and Testament, then I nominate, constitute and appoint my son Robert Hershey, Executor of this my Last Will and Testament. \ " ITEM VI I direct that no bond shall be required of any fiduciary, trustee, executor or guardian, hereunder in any jurisdiction. IN WITNESS WHEREOF, I, VIRGINIA M. HERSHEY, named herein, have hereunto set my hand and seal to this my Last Will and Testament, consisting of three (3) typewritten pages, on this the ~ day of ::SA tU ' ,2000. . / .' U~"'~.......- fV1. ) ../.J.J1...-OJ!r..LA.A VIRGINIA M. HERSHEY l (S EAL) Signed, sealed, published, and declared by the above-named Testatrix as and for her Last Will and Testament, and we, in her presence and in the presence of each other, and at her reques>ha; SUbS..C.. r~be;,ur names as witnesses her.eto. r.' (rY (j;!J~ / () .! f\ jv , /. I) // ' /~. .~ -5 {)J....M_:J W _ C ((0/[. /t::!.f.A..Xj-, f Address \) ~ Ot' It.. .s~r I~t\.~ s- \,~ Address /1/'7 JJ i" /7'3. ?~ " ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA ) ) SS. COUNTY OF ADAMS ) I, VIRGINIA M. HERSHEY, Testatrix whose name is signed to the attached or foregoing instrument having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. / / <,Utc:1<.~'\.A..4'- fY1. ;'~n.4;4..t.v1 ( SEAL) VIRGINIA M. HERSHEY Sworn or affirmed to and acknowledged befOre&, by VIRGINIA M. HE~SHEY, this 'l day of ~ AiJL' M"j , 2000. /J 1 1 ~, ,', - .A'\r~{)l~_.mCt'L( tary Public NOTARIAL SEAL RICHARD E. STARE, Notary Public LatImore Township, Adams Courily 9mmlssioll Ex ires March 3, 2003 - AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA) ) 5S. COUNTY OF ADAMS ) We, #r!C-(! ~- and J..k Q... ~?p::;:;:\ , the witnesses whose names are signed"to th attached or foregoing instrument, being duly qualified according to law, do depose and sa~ that we were present and saw the Testatrix sign and execute the instrument as her Last Will and Testament; that VIRGINIA M. HERSHEY signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will asW 7:tnesses; and that to the best of our knowledge, the Testatrix was at that time 18 or more year of age, of sound mind and under no constraint or undue influence. . .., ". . C). (~ IY, /' vf2A1ft- C.' ,O~(SEAL) j / - 1 ~ (SEAL) , ~ \ \" I " Sworn and affirmed to and acknowledged b~fore me by ~~ f. ~[:... and ~Y~JC ,";~~pu) .' ., witnesses, this the ~ daYOf':;rADU~~1 ' /J I: 'l ~d '-- v / t!.J r-;.I" " .,'"~'I ,", ." · A' ~_-"( ;( _.bfi..,tA"}( ~c!!. _ {tj~..i 'Notary Public .~ \ NOTARIAL SEAL RICHARD E. STARE, Notary PUblic Latimore Township, Adams County My <i9lT1mlssioll Expires March 3, 2003