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Home My WebLink About01-11-08 ... ~ 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 Security Number Date of Death 164-36-2414 Decedent's Last Name Herlt INHERITANCE TAX RETURN RESIDENT DECEDENT Date of Birth 09/13/2007 02/26/1944 OFFICIAL USE ONLY County Code Year File Number 21 07 0878 Larry Decedent's First Name Suffix (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Egawa Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW .-',' .......-1 1. Original Return 4. Limited Estate (e, 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received Spouse's First Name Yumiko THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Return 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 between 12-31-91 and 1-1-95) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch. 0) MI B MI CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Robert P. Grubb, Esq. Firm Name (If Applicable) Metzger, Wickersham, PC First line of address 3211 North Front Street Second line of address P.O. Box 5300 City or Post Office Harrisburg State ZIP Code PA 17110-0300 Correspondent's e-mail address:rpg@mwke.com , , - .~ DATE FILED ~ .~{~. f') 1'-) \"',) Under penalties of perjury, 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. DATE am, P.O. Box 5300, Harrisburg, PA 17110-0300 PLEASE USE ORIGINAL FORM ONLY L 15056051058 Side 1 / -c; -- 2 00 Y DATE 12-7..0-z...o07 15056051058 -.J --.J 15056052059 REV-1500 EX Decedent's Name: Larry B Herlt RECAPITULATION 1. Real estate (Schedule A). 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) . . . . . . .. 5. 6. Jointly Owned Property (Schedule F) Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested. . 8. Total Gross Assets (total Lines 1-7). 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) . . . . . . . . . . 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 taxable at lineal rate X.O 45 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 ...14. 19. TAX DUE. . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 L Decedent's Social Security Number 164-36-2414 1. 2. 6. 8,751.05 309.57 7. 8. 9,060.62 13,186.32 10,202.22 23,388.54 14,327.92 -14,327.92 15. 16. 17. 18. 0.00 ce> 15056052059 .-J REV-1500 EX Page 3 Decedent's Complete Address: 21 File"Number 0878 DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER Larry B Herlt 164-36-2414 STREET ADDRESS 603 Louisa Lane CITY I STATE I ZIP Meehan iesbu rg PA 17050 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) 3. InteresVPenalty if applicable D. Interest E. Penalty TotallnteresVPenalty ( 0 + 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) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SA) (58) 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;.......................................................................................... D [K] b. retain the right to designate who shall use the property transferred or its income; ............................................ D [K] c. retain a reversionary interest; or.......................................................................................................................... D [iJ d. receive the promise for life of either payments, benefits or care? ...................................................................... D [iJ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. D [iJ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D [K] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ D [K] 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-15GB EX+ (6-9B) \';' * COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Herlt, Larry B. FILE NUMBER 2107-0878 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. 1999 Oldsmobile Cutlass Sedan, VIN 1 G3N852J9X6313834 3,720.00 Valued as per Blue Book Value copy of which is attached. 2. Belco Community Credit Union Account No. 836981 - S1 1,545.18 1,191.97 Account No. 836981 - S4 Account No. 836981 - S3 1,467.57 3. AT&T Final Pension Payment 826.33 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 8,751.05 REV-1509 EX+ (6-98* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF Herlt, Larry B. FILE NUMBER 2107-0878 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Yumiko 603 Louisa Lane, Mechanicsburg, PA 17050 Wife B C. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. Belco Community Credit Union - Account No. 847779 - 34 112.00 50% 56.00 2. A Belco Community Credit Union - Account No, 847779 - 31 507.13 50% 253.57 3. 4. 5. TOTAL (Also enter on line 6, Recapitulation) $ 309.57 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99)* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Herlt, Larry B. FILE NUMBER 2107-0878 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: Parthemore Funeral Home 1303 Bridge Street, New Cumberland, PA 17070 8,864.32 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. Attorney Fees 750.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Yumiko Egawa Street Address 603 Louisa Lane 3,500.00 City Mechanicsburg State PAZip 17050 Relationship of Claimant to Decedent wife 4. Probate Fees 72.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Estate Notice - Cumberland County Reporter 8. Estate Notice - Patriot News TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 13,186.32 REV-1512 EX+ (6-98) '* SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Herlt, Larry B. FILE NUMBER 2107-0878 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1 Belco Community Credit Union - 847779 L6 ; Personal Loan Debt 2. Belco Community Credit Union - 847779 L 14; Personal Loan Debt VALUE AT DATE OF DEATH 2754.11 3889.46 3. Capital One - Credit Card Debt; Mastercard No. 5178-0572-3250-9401 1265.65 4. Holy Spirit Hospital - Account Number 30584189 - Medical Debt 142.00 5. Camp Hill Emergency Physicians - Account Number HYP30584189 - Medical Debt 967.00 6 Spirit Physicians Service - Account Number 1455930 - Medical Debt 94.00 7. Cardiovascular Surgical Institution - Account Number 47232-1-1 - Medical Debt 350.00 8. Hematology and Oncology Consultants - Account Number 1945 - Medical Debt 740.00 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 10,202.22 REV-1513 EX+ (9-00) '* SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Herlt, Larry B. FILE NUMBER 2107-0878 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)] 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 Yumiko Egawa 100% 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) SINCE 1888 3211 North Front Street P.O. Box 5300 Harrisburg, PA 17110-0300 717-238-8187 Fax: 717-234-9478 December 20, 2007 Cumberland County Register of Wills 1 Courthouse Square Carlisle, P A 17013 Other Offices Lancaster Mechanicsburg 717-431-0138 717-691-5577 Shippensburg York 717-530-7515 717-843-0502 Wilkes-Barre 570-825-7500 RE: Estate of Larry B. Herlt Cumberland County Estate No.:2107-0878 Dear Register of Wills: Please find enclosed three (3) copies ofthe REV 1500 Pennsylvania Inheritance Tax Return. Kindly file one in your office, one with the Pennsylvania Department of Revenue, and date stamp the third copy and return it to my office in the enclosed envelope. Should you have any questions please feel free to call my office at the above phone number. Thank you for your prompt attention to this matter. Sincerely, METZGER, WICKERSHAM, KNAUSS & ERB, P.C. o ~?Q . '. II ,"0 r-.:> = c::.." CO ~y., ~~ -0 :--~ N '.. .s;::- .s;:- RPG/csc Enclosures: James F. Carl Edward E. Knauss, IV' Clark DeVeret Francis J. 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