HomeMy WebLinkAbout05-19-08 (2)
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15056051047
REV-1500 EX (06-05)
PA Department of Revenue .
Bureau of Individual Taxes 'Illi
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
Date of Birth
Decedent's Last Name Suffix
Decedent's First Name
MI
(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
_ 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
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c::::> 4a. Future Interest Compromise (date of
death after 12-12-82)
c::::> 7. Decedent Maintained a Living Trust
(Attach Copy ofTrust)
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 Da ime Tele hone Number
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
8. Total Number of Safe Deposit Boxes
4. Limited Estate
c::::>
c::::>
c::::>
DATE FILED
Correspondent's e-mail address:
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.
R FILING RETURN
DATE
$'- / t" (;J
MECHANICSBURG, PA 17055
PRESENTATIVE
DATE
S-I'-f)~
ADDRESS
2 EAST MAIN STREET
SHIREMANSTOWN, PA 17011
PLEASE USE ORIGINAL FORM ONLY
Side 1
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15056051047
15056051047
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REV-1500 EX
Decedent's Name:
RECAPITULATION
'I. Real estate (Schedule A).
15056052048
. . . . . . . . . . . . . . . . . . . . . . . . . .. 1.
2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2.
:l. 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 . . . . . .. 6.
1 Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) <::::) 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 .0_
16. Amount of Line 14 taxable
at lineal rate X.O.A..5
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
19. TAX DUE. . .
......................19.
15.
16.
17.
18.
:W. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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(/ [lfY
15056052048
Side 2
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15056052048
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REV-1500 EX Page 3
File Number 21-08-00091
Decedent's Complete Address:
DECEDENT'S NAME
GOLDIE E. HARTMAN
STREET ADDRESS
23 EAST HIGH STREET
CITY
STATE
ZIP
ENOLA
PA
17025
Tax Payments and Credits:
1, Tax Due (Page 2 Line 19)
2, Credits/Payments
A, Spousal Poverty Credit
B, Prior Payments
C, Discount
(1)
1,664.86
3, Interest/Penalty if applicable
D, Interest
E, Penalty
Total Credits ( A + B + C ) (2)
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 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.
B, Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5)
(5A)
(5B)
1,664.86
A, Enter the interest on the tax due.
1.664.86
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 IKJ
b, retain the right to designate who shall use the property transferred or its income; ......."................................... D ~
c. retain a reversionary interest; or................................................"......................""............."..................".......... D KJ
d, receive the promise for life of either payments, benefits or care? ..."...................."........................................... D lXJ
2, If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? "..,...........,......."........,....,....,............"......,.......".."..,............................ D lXJ
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ............., D I;J
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ......."..,..,....,......,..,.......",....,.................,....,..,......."."..,.................,................ D KJ
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, S9116 (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. S9116 (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 PS. s9116(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. S9116(1.2) [72 P.S. s9116(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. s9116(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-j:S02 EX+ (6-98)
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
GOLDIE E. HARTMAN
21-08- 00091
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is delined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge 01 the relevant lacts.
Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
House
DESCRIPTION
13 High Street, Enola, PA
VALUE AT DATE
OF DEATH
57,500.00
TOTAL (Also enter on line 1, Recapitulation) $
(II more space is needed, insert additional sheets 01 the same size)
57,500.00
REV-150S EX' (1-97}
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
GOLDIE E. HARTMAN
21-08-00091
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
2
DESCRIPTION
Soverign Bank acct# 921710194
Misc household goods - sold at auction
VALUE AT DATE
OF DEATH
1,466.75
23.40
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
1,490.15
REV-1511 EX+ (10-06)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
GOLDIE E. HARTMAN
FILE NUMBER
21-08-00091
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A. FUNERAL EXPENSES:
1. Women's Miaistry
2. Rice Memorial
DESCRIPTION
AMOUNT
150.00
125.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name 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
Street Address
City
State _Zip
Relationship of Claimant to Decedent
4.
Probate Fees
285.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
8.
9.
10.
Advertising costs
Utilities
John the Junk Man - trash removal
House settlement fees - HUD-1
225.64
1,524.34
200.00
4,624.63
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
7,933.33
REV-1512 EX+ (12-03)
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
GOLDIE E. HARTMAN
FILE NUMBER
21-08-00091
ESTATE OF
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. Mortgage - Redevelopment Authority 14,060.00
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
14,060.00
REV-1513 EX+ (9-00)
ESTATE OF
NUMBER
I
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
GOLDIE E. HARTMAN
1.
RELATIONSHIP TO DECEDENT
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s)
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
Judith E. Stazewski Daughter
21-08-00091
AMOUNT OR SHARE
OF ESTATE
100%
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.
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)
A. Settlement Statement
U.S. Department of Housing end Urban Development
B. Type of Loan OMB ADDroval No. 2502-0265 (exDires 11/30/2009\
1. DFHA 2, DFmHA 3. DConv. Unlns. .1- 6. File Number 1 7. Loan Number I 8, Morlgage Insurance Case Number
4. OVA 5. OConv, Ins. 08-1015NM
C. Note: r ~",!~"l 0 U . Arnol.mll Pili . \ TIlle Express Selllement Syslem
lIems marked W(p.o.e.)~ were paid outJlde the closl~: they .re ,t'lown her. for Inform_lion purpose, Ind .r. nollncluded In lne lolals,
WARNING: It Is. crime 10 knowl~~:r-k' '.Ise ,I' emen'a 10 the Unned Slales on Lhls or .n~ olher -'mtlar form. Ptnll\les upon
con'll'tc\lon can Include I floe ,nd I rl.onment. For details see: TItle 18 U. S. Cod' Section 1 01 and Sedan 1010, Prtnted 04/15/2008 a113:57 DB
D. NAME OF BORROWER: Michael P. Long
ADDRESS: 773 Lancaster Avenue Enola PA 17025
E, NAME OF SELLER: Estate 01 Goldie E. Hartman
ADDRESS:
F. NAME OF LENDER:
ADDRESS:
G. PROPERTY ADDRESS: 13 High Street, Enola, P A 17025
East Pennsboro TownshlD
H. SETTLEMENT AGENT: North Mountain Settlement Services, LP., Telephone: 717.364.3140 Fax: 717-364.3144
PLACE OF SETTLEMENT: 1250 North Mountain Road Harrlsbura. PA 17112
I. SETTLEMENT DATE: 04/18/2008
J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION:
100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER
101. Contract sales Drtce 57 500.00 401. Contract sales Drtce 57500.00
102, Personal ProDerlv 402. Personal ProDerlv
103. Setllemenl charees 10 borrower (line 1400' 1 375.58 403,
104. 404.
105. 405.
Adiustments for Items Daid bv seiler in advance Adlustments for Items oald bv seller In advence
107. County laxes 04/18/08 to 12/31/08 136.84 407. Counly laxes 04/18/081012/31/08 136.84
108. School laxes 04118/081006130108 135.24 408. School taxes 04/18/08 1006/30/08 135.24
109, Sewer AlM/J 04/18/08 to 06/30/08 55.70 409, Sewer AlMlJ 04118/08 \006/30108 55.70
110, 410.
111, 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 59 203.36 420. GROSS AMOUNT DUE TO SELLER 57827.78
200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER
201. DeDosl1 or eamest money 1 000.00 501. Excess DeDosil (see inslruclions\
202. PrtnciDal amounl of new loans 502. Settlemenl charDeS 10 seller Cline 14001 4 624.63
203. Exlslino loanls\ laken subiect to 503, Exislina loanlsllaken subiecllo
204. 504. PavoH of First Morlnane Loan 14 060.00
Redevelopment Authorltv 01 Cou
205, 505.
206, 506.
207. 507.
208. 508.
209, 509,
Adlustments lor Items unDald bv seller Adlustments lor Items unDaid bv seller
213, 513,
214. 514.
215, 515,
216. 516.
217. 517.
218, 518,
219. 519,
220. TOTAL PAID BY/FOR BORROWER 1 000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 18.684.63
300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENTTO OR FROM SELLER
301. Gross amount due from borrower (line 120\ 59.203.36 601. Gress amounl due 10 seller (line 420\ 57.827.78
302. Less amounts oald by/lor borrower (line 220\ 1 000.00 602. Less reduction amount due seller Cline 52m 18 684.63
303. CASH FROM BORROWER 58 203.36 603. CASH TO SELLER 39143.15
SUBSTITUTE FORM 1099 SELLER STATEMENT: The Informlllon contained her.ln Islmpor1anllllC InrormaUon end Is be/ng rornlshed 10 lhe Inlemal Revenue Service. If ~u.... required 10 me. relurn,
:n':t1~~~~V~~~~I~I:'"'I~' '~:~::'~~~:Sl:'~~~' \\em 'I required \0 be reported end lhe IRS d,\ermln'lthllll hIS not been report.d. The Contract 5,111 Prk;e detcrlbed on
~~mb:,f;~=Y~'\:b)~~:'; ~~=en~:~ tr,:,:: ~~I:~~ Under pen.llte. Of pe~:: lY:~ltn~tlJ:::r:b:~hl=160nnlh~~~:I~~~IUI:~~~ttrr:~~:;.U;;id:~t~~e~~~~~ceuon
1IN:_,_,_I_'_'_ SELLER(S)SIGNATURE(S): I
SELLER(S) NEW MAILING ADDRESS:
SELLER(S) PHONE NUMBERS: (HI (W)
seffLEMENT STATfM'Er:if V"vnn u~.~~v, "'~'"
rllt! l'iUIlIUer; VO-IV I o l'tIVI
j'JAW:2
Til eExoress Selllemenl Syslem Prinled 04/15/2008 a113:57 DB
L. SETTLEMENT CHARGES PAID FROM PAID FROM
700. TOTAL SALES/BROKER'S COMMISSION based on oriee $57 500.00 @ 6.000 = 3 45\).00 BORROWER'S SELLER'S
DiYision 01 commission lline 700l as foliows: FUNDS AT FUNDS AT
701. S to SETTLEMENT SETTLEMENT
702. S 3 450.00 to Remax Realtv Professionals
703. Commission oaid at Selllemenl 3 450.00
704. Processina Fee to Remax Realtv Professionals 175.00 175.00
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Orioinalion Fee %
802. Loan Discount %
803. Aooralsal Fee
804. Credit Reoort
805. Lende~s Insoeclion Fee
806. Mortoaoe Annlication Fee
807. Assumolion Fee
808.
809.
810.
811.
900.ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Inlerest From to @$ Iday
902. Mortoaoe Insurance Premium for 10
903. Hazard Insurance Premium for \0
904.
905.
1000. RESERVES DEPOSITED WITH LENDER FOR
1001. Hazard Insurance mo. @S Imo
1002. Mortoaoe Insurance mo. @S Imo
1003. City Prooertv Tax mo.@$ Imo
1004. County Prooertv Tax mo.@$ 16.18/mo
1005. School taxes mo. @S 55.74 /mo
1009. Aooraoale Analysis Adiustment 0.00 0.00
1100. TITLE CHARGES
1101. Seltlemenl or closino lee
1102. Abstract or Iitle search
1103. Titie examination
1104. Title Insurance binder
1105. Documenl Preoaralion \0 Thomas D. Gould ESQuire 100.00
1106. Nolarv Fees to Deborah K. Bocian 10.00 10.00
1107. AUomev's lees
lincludes aboye items No: I
1108. Title Insurance to North Mountain Settlement Services. L.P. 546.08
/includes above items No: 1101-1104 Re.lssue Rate I
11 09. Lende~s Policv 0.00
1110. Owne~s Policv 57500.00 .546.08
1111.
1112.
1113.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recordino Fees Deed S 38.50 . Mortoaoe S . Release $ 38.50
1202. City/County tax/slamos Deed 5575.00 . Mortoaoe S 575.00
1203. Stale Tax/stamos Deed $575.00 . Mortoaoe $ 575.00
1204. MortoaOll Satisfac\lon \0 Cumberland Countv Recorder 01 Deeds 27.00
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Ovemlah\ Fee \0 North Mountain Settlement ServIces, L.P. 20.00
1302. Tax Cert Fee 10 North Mountain Settlement Services 5.00
1303. Sewer. 4/110 6/30/08 10 East Pennsboro Township 68.50
1304. Trash. 4/18 \0 6130/08 \0 East Pennsboro TownshlD 31.00
1305. 2008 County Taxes 10 Debbie LUDOld 194.13
1400. TOTAL SETTLEMENT CHARGES lenler on lines 103 Section J and 502 Seclion Kl 1 375.58 4624.63
HUD CERTIFICATION OF aUYER AND SEllER
I hIve carefully revtewed the HUo.1 Sem'menl Slalement and 10 the bell of my knowledge and belief, It Is . lrue and 'teurel. Ilat.menl of 8" receipts and dlsbur.ements made on my account
or by me In this tr.nsacllon. I further ce fy Ihalll'lave rec,lved I copy of Ihe HUO~1 Seltlement Slalemtlrn.
I.
Eslele of Goldie e. Hartrnan
J~Skl'~~ g7~ ~
WARNING: IT IS A CRIMe TO KNOWINGlY MAKE FALse STATeMENTS TO THE
UNiTEO STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION
CAN INCLUDE A FINE AND iMPRISONMENT. FOR DETAilS SEE TITlE ,e:
U.S. COOE seCTION 100\ AND SECTlON 1010.
SETTLEMENT AGENT:
E crliflor