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HomeMy WebLinkAbout11-29-07 (2) -.J 15056051058 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 Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year "1 File Number 21 07 :0290 Date of Birth 203-10-8521 03/20/2007 01/08/1916 Decedent's Last Name Suffix Decedent's First Name MI HAMM LEANDER H (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix First Name MJ Social Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Retum c::> 2. Supplemental Retum c::> 3. Remainder Retum (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required <:t: 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) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name [)aytirne TEllephone Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received __L 8. Total Number of Safe Deposit Boxes 4. Limited Estate c::J ROBERTL.KNUPP,ESQ (717) 238-7151 REGISTER OF ~LS USE '::;;:0 ;~::-:o "i~O "'"~r- '7[7; "'-:: 3) 'J)X Firm Name (If Applicable) KNUPP LAW OFFICES, LLC ~~~'.. ";.7 r:-:-~'1 fJr';;~. , .) C) :.:) 1:J r-., r::...., First line of address C) -< P.O. BOX 630 N \.0 Second line of address -u , r -"'-~', 407 NORTH FRONT STREET ~.. .......... _Uj"{ (~"", rTl City or Post Office State ZIP Code HARRISBURG PA 17108 co Correspondent's e-mail address:robert.knupp@verizon.net AD RESS Flowers & Flowers, CPAs, 5775 Allentown Blvd, Suite 102, Harrisburg, PA 17112 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051058 15056051058 ---I -.J REV-1500 EX Decedent's Name: LEANDER RECAPITULATION 15056052059 H HAMM 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) c) Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) C) Separate Billing Requested.. . . . . .. 7. 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., 8. Decedent's Social 203-10-8521 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. 954,101.46 111,108.93 1,065,210.39 93,196.94 18,845.11 112,042.05 953,168.34 953,168.34 TAX COMPUTATION. SEE 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 taxable at lineal rate X.O_ 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 FOR APPLICABLE RATES 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 15. 16. 17. 18. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 L Side 2 38,126.73 95,316.83 133,443.56 C) 15056052059 .-J REV-1500 EX Page 3 Decedent's Complete Address: DECEDENrs NAME LEANDER H HAMM STREET ADDRESS MESSIAH VILLAGE 100 MOUNT ALLEN DRIVE CITY MECHANICSBURG E!!t!!.Ym~r ".' 10290 DECEDENTS SOCIAL SECURITY NUMBER 203-10-8521 STATE PA ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 133,443.56 100,000.00 5,263.00 Total Credits (A + 8 + C ) (2) 105,263.00 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) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. 28,180.56 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5) (5A) (58) A. Enter the interest on the tax due. 28,180.56 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 ~ b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 ~ c. retain a reversionary interest; or.......................................................................................................................... 0 [iJ d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [iJ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 [iJ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 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. ~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 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. ~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-1503 EX+ (6-98* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 8 STOCKS & BONDS ESTATE OF LEANDER H. HAMM FILE NUMBER 21070290 All property Jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. DESCRIPTION BP PLC SPONS ADR (BP) 668.27 SH 0.0.0. Mean = $60.04/SH ALCATEL-LUCENT ADR (ALU) 18 SH 0.0.0. Mean = $11.85/SH AT&T INC (T) 93.8739 SH 0.0.0. Mean = $37.71/SH BANK OF AMERICA CORP (BAC) 404.0376 SH 0.0.0. Mean including $.56 ExDiv = $51.13/SH BAXTER INT'L INC (BAX) 1012.1813 SH 0.0.0. Mean including $.1675 ExDiv = $52.03/SH BOWATER INT'L INC (BOW) 255.9746 SH 0.0.0. Mean including $.20 ExDiv = $23.10/SH BRISTOL MYERS SQUIBB CO (BMY) 812.8534 SH 0.0.0. Mean = $27. 14/SH BURLINGTON NORTH. SANTA FE (BNI) 403.2787SH D.O.D.Mean incl $.25 ExDiv = $80.25/SH CARDINAL HEALTH INC (CAH) 186.7279 SH 0.0.0. Mean = $72.221SH DEL MONTE FOODS CO (DLM) 133.4675 SH 0.0.0. Mean = $11.16/SH DWS GLOBAL THEMATIC FUND (SCOBX) 1867.221 SH 0.0.0. Close = $33.74/SH DWS MANAGED MUNI BD FD (SCMBX) 9080.95 SH 0.0.0 Close incl $.032 ExDiv = $9.07/SH DWS TECHNOLOGY FD (KTCAX) 1784.755 SH 0.0.0. Close = $11.62/SH EATON VANCE NAT'L MUNI (EANAX) 13494.99 SH 0.0.0 Close incl $.04 ExDiv = $11.88/SH EDWARDS L1FESCIENCES CORP (EW) 100 SH 0.0.0. Mean = $48.78/SH FOOT LOCKER INC (FL) 404.9662 SH 0.0.0. Mean = $23.04/SH H.J.HEINZ CO (HNZ) 306.2849 SH 0.0.0. Mean = $46.30/SH HERSHEY COMPANY (HSY) 1834.204 SH 0.0.0. Mean = $53.48/SH HOST HOTELS & RESORTS INC (HST) 186.2716 SH 0.0.0. Mean = $26.771SH INT'L BUSINESS MACHINES CORP (IBM) 801.9506 SH 0.0.0. Mean = $94.04/SH MONEYGRAMS INT'L INC (MGI) 400 SH 0.0.0. Mean including $.05 ExDiv = $28.oo/SH MOSAIC COMPANY (MOS) 90 SH 0.0.0. Mean = $26.94/SH PEPCO HOLDINGS INC (POM) 822.3475 SH 0.0.0. Mean including $.26 ExDiv = $27.1O/SH PERKIOMEN VALLEY PA SCH AUTH $5000.00 6.5% Mat 12/01/07 0.0.0. Close = 101.98 TOTAL FROM SCHEDULE B (Continued -Items 25 to 29) VALUE AT DATE OF DEATH 40,122.93 213.30 3,539.98 20,658.44 52,663.79 5,913.01 22,060.84 32,363.12 13,485.49 1,489.50 63,000.04 82,364.22 20,738.85 160,320.48 4,878.00 9,330.42 14,180.99 98,093.23 4,986.49 75,415.43 11,200.00 2,424.60 22,285.62 5,099.00 187,273.69 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 954,101.46 REV-1503 EX+ (6-98* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF LEANDER H. HAMM FILE NUMBER 21070290 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER t DESCRIPTION VALUE AT DATE OF DEATH 27. CONTINUATION SHEET: PITTSBURGH PA WTR&SWR AUTH $5000.00 7.25% Mat 9/01/14 D.O.D. Close = $112.51 PPL CORP (PPL) 2028.9725 SH 0.0.0. Mean including $.305 ExOiv = $38.92/SH SCHLUMBERGER L TO (SLB) 1204.4017 SH 0.0.0. Mean including $.175 ExDiv = $65.92/SH STARWOOD HOTELS & RESORTS WW INC (HOT) 301.8957 SH O.O.D. Mean = $64.58/SH VIAD CORP - NEW (WI) 100 SH O.O.D. Mean = $37.90/SH 5.625.50 78.967.61 25. 26. 29. 79.394.16 19,496.42 3.790.00 28. TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 187.273.69 REV-1508 EX+ (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF LEANDER H. HAMM FILE NUMBER 21070290 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. M&T Bank - Checking #28797515 (0.0.0. Bank Confirmation Attached) 2. M&T Bank - Money Market #15004214737734 (0.0.0. Bank Confirmation Attached) 3. M&T Bank - CD Acct#31 003913448021 (0.0.0. Bank Confirmation Attached) 4. M&T Bank - CD Acct#31 003914775142 (0.0.0. Bank Confirmation Attached) 5. Internal Revenue Service - Refund on Decedent's 2006 Form 1040 25,019.00 25,620.22 16,237.06 43,233.40 988.00 6. Highmark Blue CrosslBlue Shield - Refund of premium. 11.25 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed. insert additional sheets of the same size) 111,108.93 REV-1511 EX+ (12-99). COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21070290 ESTATE OF LEANDER H. HAMM Debts of decedent must be reported on Schedule L ITEM NUMBER A. B. 1. 10. 11. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: Neill Funeral Home, 3501 Derry Street, Harrisburg, PA 17111 11,298.80 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Elwood R. Gotshall Social Security Number(s)/EIN Number of Personal Representative(s) Street Address 8 Manor Drive 34,750.00 City West Chester . State P A Zip 19380 Year(s) Commission Paid: 2. AttomeyFees Knupp Law Offices, LLC 34,750.00 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 4. Probate Fees 738.95 5. Accountant's Fees Flowers & Flowers, CPAs 8,500.00 6. Tax Retum Preparer's Fees H & R Block 278.00 7. Cumberland Law Journal - Estate Advertising The Patriot News - Estate Advertising Knupp Law Offices - Recoverable Administrative Costs Citizen's Bank - stop payment charge Reserve for future administrative costs and expenses 75.00 226.62 44.57 35.00 2,500.00 8. 9. 93,196.94 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF LEANDER H. HAMM FILE NUMBER 21070290 Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Internal Revenue Service - Decedent's 2006 Form 1040, Balance due with return filed 3/22/07. 2. 3. PA Dept. of Revenue - Decedent's 2006 Form PA40, Balance due with return filed 3/22/07 12,344.00 2,061.00 Albert Pharmacy Servo Inc. 124.61 4. Pinnacle Health Hospitals 224.54 5. Capital Area Health Associates 120.00 7. Spirit Physician Services 3,300.16 38.40 6. Messiah Village 8. PA Dept. of Revenue - underpayment penalty on Decedent's 2006 PA income tax return 89.98 9. Mobile X Ray Imaging Inc. 525.00 10. Moffitt Heart & Vascular Group 17.42 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 18,845.11 REV-1513 EX+ (9-00) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF LEANDER H. HAMM FILE NUMBER 21070290 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 pnclude outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Dorothy M. Gotshall, Rm 123, Messiah Circle, Mechanicsburg, PA 17055 Sibling 317,722.78 2. Elwood R. Gotshall, 8 Manor Drive, West Chester, PA 17380 Collateral 317,722.78 3. Ronald L. Gotshall, 1824 Hearthstone Lane, Middletown, PA 17057 Collateral 317,722.78 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) <I: a.. 1'. ;;:,iJo- .. c. 17M t.:lN. 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