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Home My WebLink About10-05-07 (3) ...J 15056051047 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 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year File Number 2 1 o 6 00927 Date of Birth 207 2 2 1 662 1 004 2 006 Suffix 073 1 193 2 Decedent's Last Name Decedent's First Name MI H 0 R N J A NET c (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI H 0 R N D A V I D R Spouse's Social Security Number 201 1 6 6 5 6 9 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW i*~ 1. Original Return C) 2. Supplemental Return C) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required ~ C) 4a. Future Interest Compromise (date of death after 12-12-82) C) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) C) 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) ?v_~_~'~_'~'~,^_~'____~~_'~~~_~ ____'__._.m_'~mm'~'~'~~'".," 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 ---0 8. Total Number of Safe Deposit Boxes 4. Limited Estate K E I THO Firm Name (If Applicable) B R E N N E MAN S N E L B A K E R & B R E N N E MAN First line of address 4 4 W EST M A I N S T R E E T Second line of address City or Post Office State ZIP Code i>A.'~::: N M E C H A N I C S BUR G P A 17055 Correspondent's e-mail address: Under penalUes 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. , ,n nnm'm>>m'm~_"_u"~ ""mm,.,~,_~,___~,,~,_~,~,~*,,_______>>______~___.-____'~'>>m __'___'''@,~_@m_>>_ ,'.~,_,,~,,~>, _,"' ,_,., m~__~__~___,__"" "'_""""""'_"""'.'.,.~m_m,~~"o~,'., ,., 'w ,."..",.,...,.....,.~....,.., ,.,.'., ".",moo"".", AD E S ~~ ~E;;~::::lli~~~;Z:;_:.~~~RN. ' ExecutriXm.!~I[L~Z _..Z.9QQ ~~Etzville Road, Mechanic~buI~__ 1705_Q_._n / nwn_n_w....__w SIGNATUR~THER THAN REPRESENTATIVE DATE ADDREJ_n.wwwwwnw_ww~nwww~w~w_Jg.l~Lel.. w'w'" now ..w~~w..}i~~!w..~~..~wl!ww;; t r~.~J~..Lt1echani CS bu ~J? A __J2 0 5 5__....w_......_..__.....________w__....~.. PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051047 15056051047 ---I , . ~ 15056052048 REV-1500 EX Decedent's Name: Janet C. Horn RECAPITULATION 1. Real estate (Schedule A). . . . . . . . . .. 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) 6 Jointly Owned Property (Schedule F) c::::J Separate Billing Requested 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) c::::J Separate Billing Requested.. 7. 8. Total Gross Assets (total Lines 1-7). 207 Decedent's Social Security Number 221662 2. 5. 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 .0_ 16. Amount of Line 14 tClxable at lineal rate X.O ~ 3 2, 2 2 3 .6 9 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 15. 16. 17. 18. 19. TAX DUE. . .. 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056052048 4 5, 8 9 8. 0 0 6, 9 5 5.0 0 5 2, 8 5 3. o 0 2 0, 2 1 9 . 7 6 4 0 9. 5 5 2 0, 6 2 9. 3 1 3 2, 2 2 3. 6 9 3 2, 2 2 3. 6 9 . 1,450.07 1,450.07 15056052048 --.J REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME Janet C. Horn STREET ADDRESS 609 Robert Street File Number 21-07-00927 CITY STATE PA ZIP 17055 Mechanicsburg Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2 Credits/Payments A Spousal Poverty Credit B Prior Payments C. Discount (1) 1,450.07 Total Credits (A + B + C ) (2) 1,450.07 3. Interest/Penalty if applicable D. Interest E. Penalty 29.12 --- 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) 29.12 5 If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 1,479.19 A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (5B) 1,479.19 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;........................ .................................................... ........... D IX] b. retain the right to designate who shall use the property transferred or its income; ............................................ D IX] c. retain a reversionary interest; or.......................................................................................................................... D IX] d. receive the promise for life of either payments, benefits or care? ...................................................................... D OCJ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................................................................................ ....... D OCJ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?.. ........... D IX] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................................. ....................................................... ..... 0 IX] 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 PS. 99116 (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. 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 PS. 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-1503 EX+ (6-98) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Janet C. Horn FILE NUMBER 21-06-00927 ESTATE OF All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION Citigroup Smith Barney Investment Account, account No. 724-10196-16 205: VALUE AT DATE OF DEATH $45,898.00 TOTAL (Also enter on line 2, Recapitulation) $45,898.00 (If more space is needed, insert additional sheets of the same size) REV-15G8 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Janet C. Horn FILE NUMBER 21-06-00927 ESTATE OF 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 NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. 2006 Individual tax refund - Pennsylvania Department of Revenue 100.00 2. 2002 Chevrolet Impala Sedan 6,855.00 TOTAL (Also enter on line 5, Recapitulation) $ 6,955.00 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (10-06)W COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Janet C. Horn FILE NUMBER 21-06-00927 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT FUNERAL EXPENSES: Malpezzi Funeral Home $10 , 248 .40 2. Garden Boutique - flowers 52.12 3. Gingrich Memorial - headstone/engraving 2,870.00 4. Mechanicsburg Cemetery Association - burial lot 1,535.00 B. ADMINISTRATIVE COSTS: 1 . Personal Representative's Commissions WAIVED Name of Personal Representative(s) Street Address City State ~ Zip _________ Year(s) Commission Paid: 2. Attorney Fees to Snel baker & Brenneman, P. C. 4,000.00 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 5. Probate Fees to Register of Wills ($118.00; additional pro ba te fee of $75.00) Accountant's Fees, miscellaneous filing and administrative fees, reserve T~f/!l\l[rx~ft\1['x ~~ 193.00 4. 1,000.00 6. 7. Avertise grant of Letters Testamentary: a. Cumberland Law Journal: b. The Patriot News: $ 75.00 246.24 Total: 321.24 TOTAL (Also enter on line 9, Recapitulation) $ 20, 219 .76 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Janet C. Horn FILE NUMBER 21-06-00927 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 Capital One - payment on account of credit card balance VALUE AT DATE OF DEATH $331.03 2. Dr. Turnpaugh - payment on account of medical expense 78.52 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 409.'1'1 REV-1513 EX+ 19-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Janet C. Horn FILE NUMBER 21-06-00927 ESTATE OF 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 (al (1.2)] Kelly F. Stanley Daughter 50,000.00 7000 Wertzville Road Mechanicsburg, PA 17050 2. Carol A. Horn Daughter 50,000.00 8 Texaco Road Mechanicsburg, PA 17050 3. Morris Stanley, III Grandson 10,000.00 12 White Birch Avenue Mechanicsburg, PA 17050 4. Morris Stanley, IV Great-grandson 10,000.00 12 White Birch Avenue Mechanicsburg, PA 17050 5. Christian Stanley Great-grandson 10,000.00 12 White Birch Avenue Mechanicsburg, PA 17050 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 $ (If more space is needed, insert additional sheets of the same size) SCHEDULE J (CONTINUED) Estate of Janet C. Horn File No. 21-06-00927 Name and Address of Relationship Amount or No. Person Receiving Property to Decedent Share of Estate 5. David R. Horn Surviving Spouse residue of estate 609 Robert Street Mechanicsburg, P A 17055 6. Joseph Stanley Grandson $10,000.00 7000 Wertzville Road Mechanicsburg, P A 17050 7. Matthew Stanley Grandson $10,000.00 7000 Wertzville Road Mechanicsburg, P A 17050 8. Mark Stanley Grandson $10,000.00 7000 Wertzville Road Mechanicsburg, P A 17050 9. Timothy Stanley Grandson $10,000.00 7000 Wertzville Road Mechanicsburg, P A 17050 WILL OF JANET C. HORN I, Janet C. Horn of Cumberland County, Mechanicsburg, Pennsylvania, declare this to be my last Will and hereby revoke all prior Wills and Codicils. 1. I direct that all my just debts, funeral expenses, gravemarker and administrative expenses shall be paid from my residuary estate as soon as practicable after my death. 2. I direct that all inheritance, estate, transfer, succession and death taxes of any kind whatsoever which may be payable by reason of my death shall be paid out of my residuary estate. 3. I direct that my entire estate be distributed as follows: A. I direct that $50,000 go to each of my daughters, Kelly F. Stanley and Carol A. Horn. B. I direct that $10,000 go to each of my grandchildren, Morris Stanley, III., Joseph R. Stanley, Matthew C. Stanley, Mark Stanley and Timothy Stanley. C. I direct that $10,000 go to each of my great- grandchildren, Morris Stanley, IV, and Christian Stanley. D. I direct that the remainder of my estate go to my husband, David R. Horn. E. Should David R. Horn predecease me, then I direct that the remainder of my estate be divided into equal shares between my daughters, Kelly F. Stanley and Carol A. Horn. 4. I appoint Kelly F. Stanley as guardian of the estates of Matthew C. Stanley, Mark Stanley and Timothy Stanley until they reach 21 years of age. 5. I appoint Morris Stanley, III as guardian of the estates of Morris Stanley, IV and Christian Stanley until they reach 21 years of age. LAW OFFICES OF STEPHEN J. HOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 9--~ e. 'y~ ) (! y. KwT . . 6. I appoint Kelly F. Stanley, as Executrix of this my last Will. If Kelly F. Stanley should predecease me or cease to act in such capacity, I appoint Carol A. Horn as alternate. 7. The Executrix of this Will shall have the power to distribute my estate in kind or in cash, or partly in eith er. 8. I direct that no Executrix acting under this Will shall be required to enter bond in any jurisdiction. IN rlTNESS WHE Z day of LAW OFFICES OF ,TEPHEN J. HOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 . , LAW OFFICES OF STEPHEN J. HOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 The preceding instrument consisting of this and two other pages was on the day and date hereof signed, published and declared by Janet C. Horn as and for her last Will in the presence of us, who at her request, in her presence and in the presence of each other have subscribed our names as witnesses hereto. ~ .~AH Ifu~ ITN ESS &;:d.. uJ~bk-- WITNESS LAW OFFICES OF iTEPHEN J. HOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 ACKNOWLEDGMENT State of Pennsylvania ss County of Cumberland I, Janet C. Horn, the Testatrix, whose name is signed to the attac.hed or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my last Will; that I signed it willingly and as my free and voluntary act for the purposes therein expressed. ~e.~ #net C, Horn Sworn to or affirmed and ackno Horn the Testatrix, this E day of 2006. NOTARW.. iiI\l. !IT[PHEN J. HOQQ, NOTN<< PIIIlI.lC CARI.JlllE llORO. ~ co., /'A MY cow..lSIllON EXPlR/$ llUTEM~f1 ;\, It(l($ , ~......,...~ before me by Janet C. AFFIDAVIT State of Pennsylvania ss County of Cumberland We, SkG\rQY\ c~yot/.rr.s and -;:?c.ti~ LJ\r-l.....I\,\~ ,the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the instrument as her last Will; that the Testatrix signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testatrix signed the Will as a witness; and that to the best of our knowledge the Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. /JUhL (!r ~W~V.~~ Sworn to or aff' this ~day of to before me by witnesses, ,2006. ""'AAIAl.lII!AI. ll'fvHEN J. ~ NOTAA'( fVilUC lIiY~,~'~co,.Pj\ -.uN~~~~