HomeMy WebLinkAbout06-18-08REV-/500 EX.(5-00) w ~` (_~ 500 ~ OFFICIAL USE ONLY
INHERITANCE TAX RETURN ~FILe NUMBER
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE RESIDENT DECEDENT
280601
DEPT 2t o7 oo83s
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HAaalssuRO,PA nlza-osoi _ _ _ _
- COUNTY CODE YEAH. _ NUMBER
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DECE'_DENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
Hollinger, Eva M 191-18-2793
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~ DATE: OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) _
THIS RETURN MUST BE FILED IN DUPLICATE WRH THE
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09/07/2007 09/15/1919
REGISTER OF WILLS
~ (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL) '. SOCIAL SECURITY NUMBER
Hollinger, Clarence E
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® 1. Original Return ^ 2. Supplemental Retum ^ 3, Remainder Retum (date of death prior to 12-13-82)
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^ Future Interest Compromise (date of death after
4. Limited Estate 4a.
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^ 5. Federal Estate Tax Return Re wired
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V 12 12 92)
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~I 6. Decedent Died Testate (Attach copy ^ 7. Decedent Maintained a Living Trust (Attach
' 0 8. Total Number of Safe Deposit Boxes
as m
a ~ of Will) copy of Trust)
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^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (date of death between
^ 11.Election to tax under Sec. 9113(A) (Attach Sch O)
__ . _ 12.31-91_and 1.-L-95) _. __. ... _. __. _ _. __
;THIS SECTION MUST B8 COMPLETED. ALL CORRESPONDENCE AND GONRDENTIAL TAX INFORMA'fiON SHOULD BE DiREGTED TO: _ __
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NAME COMPLETE MAILING ADDRESS
N z Thomas P. Gacki
¢ o FIRM NAME (If applicable) 213 Market Street
g a Eckert, Seamans, Cherin & Mellott 8th Floor
TELEPHONE NUMBER ~ HarrlsbUrg, PA 17101
71 "7/237-6093
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__ _ _ _
_
1. Real Estate (Schedule A) (1) None OFFICIAL use oN~Y
2. Stocks and Bonds (Schedule B) (2)
None F,..~
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3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) None ~ C_...
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4. Mortgages & Notes Receivable (Schedule D) (4) None !-'
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5. Cash, Bank Deposits & Miscellaneous Personal Property (5) _
3, 800.00 ~
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(Schedule E) _, ~-, .-, < ~ -
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6. Jointly Owned Property (Schedule F) (6) None ` ~ ~' -"
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z ^ Separate Billing Requested - ~ - '
a 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) None
F (Schedule G or L) ~
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a 8. Total Gross Assets (total Lines 1-7) 3,800.00
(8)
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9. Funeral Expenses & Administrative Costs (Schedule H) (9)
300.00
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10) (11) 300.00
12. Net Value of Estate (Line 8 minus Line 11) (12) 3,500.00
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13)
made (Schedule J)
14. INet Value Subject to Tax (Line 12 minus Line 13)
__ (14) 3,500.00
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of tine 14 taxable at the spousal tax rate, 3 , S 00.00 x .00 (15) 0.00
or transfers under Sec. 9116(a)(1.2)
16.Amount of Line 14 taxable at lineal rate x .045 (16)
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~ 17. Amount of Line 14 taxable at sibling rate x .12 (
0
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F 18. Amount of Line 14 taxable at collateral rate x ,15 (18)
1 s. Tax Due (19) 0.00
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BE SURE TO ANSrWER ALL QUEStIONS ON REVERSE SIDE AND RECHECK MATH « ___ _
Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00)
Dec:edent's Complete Address:
STREET ADDRESS
15 Johns Drive
CIT1C Enola STATE PA ZIP 17025
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1) 0.00
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + B + C) (2) 0.00
3. lnterest/Penalty if applicable
D. Interest
E. Penalty
Total InteresVPenalty (D + E) (3) 0.00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
Check box on Page 1 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5} 0.00
A. Enter the interest on the tax due. (5A)
g. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 0 . ~ ~
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 :.................................................................................. a
b. retain the right to designate who shall use the property transferred or its income :....................................
c. retain a reversionary interest; or ..................................................................................................................
d. receive the promise for life of either payments, benefits or care? ..............................................................
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without ^
receiving adequate consideration? .......................................................................................................................
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... ^
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ...................................................................................................................... ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
__ __
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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 basetl on all information of which preparer has any knowledge.
SIGN - E O ,PERSON E ONSIB FOR FILING RETURN ADDRESS DATE ~--•'"
15 Johns Drive
Enola, PA 17025 ~6
IGNATU OF PERSON RESPONSIBLE F FILING ADDRESS ~ DATE
SIGNA PREPARE T THA REPRESENT TIVE ADDRESS 213 Market Street DATE
8th Floor
_ Harrisburg, PA 17101 ~ ~b~~
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 3% [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 0%
[72 P.S. §91116 (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 0% [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 4.5%, except as noted in 72 P.S. §9116
1.2) (72 P.S. §9116 (a) (1)].
The tax rate immposed on the net value of transfers to or for the use of the decedent's siblings is 12% [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.
SCHEDULE E
CASH, BANK DEPOSITS, &~MISC.
COMMONWEALTH OF PENNSYLVANIA PERSONAL P1lOPE~Ti
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF. _ _ _ _ FILE NUMBER...
Hollinger, Eva M 21 - 07 - 00838
_.
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 DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 1996 Mercury Grand Marquis 3,800.00
TOTAL (Also enter on Line 5, Recapitulation) I 3,800.00
Sq-E:DIAE H '
FUNERAL ExREIVSES &
COMMONWEALTH OF PENNSYlVAN1A
INHERITANCE TAX RETURN ~ ADIVNNS7RATNE ('~,~ ~'
RESIDENT DECEDENT vw ~ v '
- _ ~---._
ESTATE OF
Hollinger, Eva M
Debts of decedent must be reported on Schedule I.
~~.,
NUMBER'.
A, ~ FUNERAL EXPENSES:
AMOUNT
FILE NUMBER
21 - 07 -00838
DESCRIPTION
g, I ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) ! EIN Number of Personal Representative(s):
Street Address
City State Zip
Year(s) Commission paid
2. I Attorney's Fees Eckert, Seamans, Cherin & Mellott -- Thomas P. Gacki
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant Clarence E Hollinger
Street Address 15 Johns Drive
' City Enola State PA Z;p 17025
Relationship of Claimant to Decedent Spouse
4. ! Probate Fees
5. Accountant's Fees
6. ~~ Tax Return Preparer's Fees
7. I Other Administrative Costs
1
1
I
300.00
TOTAL (Also enter on line 9, Recapitulation) 300.00
SCHEDULE)
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hollinger, Eva M
21 - 07 - 00838
RELATIONSHIP TO AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE
- _ _ _ _ _ _ Ilo Not trstirustee(sl
I~ TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1 Clarence E. Hollinger Husband 100% Residue
15 Johns Drive
Enola, PA 17025
Enter dollar amounts for distributions shown above on lines 15 through 17, 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
13. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
WILL OF EVA M. HOLLINGER
I, EVA M. HOLLINGER, of Camp Hill, Cumberland County,
Pennsylvania, declare this to be my last will and revoke any will
previously made by me.
ITEM I. I give all my automobiles, and all other articles of
personal and household use, together with all insurance relating
thereto, to my husband, CLARENCE E. HOLLINGER, if he survives me
by thirty days. If he does not so survive me, I give all such
property and insurance to my stepdaughter, MICHELLE DVORYAK, if
she survives me by thirty days.
ITEM II. I have deliberately made no bequest in this will
to my only child, ROBERT WARREN KOCHER, who has caused me years
of grief and pain. I have also deliberately but sadly made no
bequests to the issue of ROBERT WARREN KOCHER, as I fear that any
such bequest would cause ROBERT WARREN KOCHER to disown the
recipient of any such bequest, as he has so threatened.
ITEM III. I desire a simple funeral with no open casket.
I should be buried in the cemetery plot my husband and I already
- ,' _,
own in Marysville, Pennsylvania. _,_
Page 1 of 5 Pages.
ITEM IV. I give all the residue of my estate, real and
personal, to my husband, CLARENCE E. HOLLINGER, provided that he
survives me by thirty (30) days; if he does not so survive me, I
give the residue of my estate, real and personal, to my
stepdaughter, MICHELLE DVORYAK, provided she survives me by thirty
days. If she does not so survive me, I give the residue of my
estate, real and personal, to the issue of MICHELLE DVORYAK, per
stirpes.
ITEM V. No interest in income or principal shall be
assignable by, or available to anyone having a claim against, a
beneficiary before actual payment to the beneficiary.
ITEM VI. All federal, state, and other death taxes payable
on the property forming my gross estate for tax purposes, whether
or not it passes under this will, shall be paid out of the
principal of my residuary estate just as if they were my debts,
and none of those taxes shall be charged against any beneficiary.
ITEM VII. I authorize my executor:
A. to retain and to invest in all forms of real and
personal property, regardless of (i) any limitations imposed by
law on investments by executors or trustees, (ii) any principle
of law concerning delegation of investment responsibility by
Page 2 of 5 Pages.
executors or trustees, or (iii) any principle of law concerning
investment diversification;
B. to compromise claims and to abandon any property
which, in my executor's opinion, is of little or no value; to
borrow from, and to sell property to others, and to pledge
property as security for repayment of any funds borrowed;
C. to sell at public or private sale, to exchange or
to lease for any period of time any real or personal property, and
to give options for sales or leases;
D. to join in any merger, reorganization, voting-trust
plan or other concerted action of security holders, and to
delegate discretionary duties with respect thereto;
E, to use administrative or other expenses of my
estate as income tax or estate tax deductions and to value my
estate for tax purposes by any optional method permitted by the
law in force when I die, without requiring adjustments between
income and principal for any resulting effect on income or estate
taxes; and
F. to distribute IN KIND and to allocate specific
assets among the beneficiaries in such proportions as my executor
Page 3 of 5 Pages.
may think best, so long as the total market value of any
beneficiary's share is not affected by such allocation.
These authorities shall extend to all real and personal
property at any time held by my executor and shall continue in
full force until the actual distribution of all such property.
All powers, authorities, and discretion granted by this
will shall be in addition to those granted by law and shall be
exercisable without leave of court.
ITEM VIII. I appoint my husband, CLARENCE E. HOLLINGER,
executor under this will. Should my husband, CLARENCE E.
HOLLINGER, fail to qualify or cease to act as executor, I appoint
my stepdaughter, MICHELLE DVORYAK, executor under this will. No
personal representative appointed hereunder shall be required to
give bond or furnish sureties in any jurisdiction.
ITEM IX. The term "executor" and "trustee" or any pronoun
used to indicate the executor, trustee, any other fiduciary or any
beneficiary shall be deemed to apply to one or more than one
Page 4 of 5 Pages.
person or corporation and to the masculine, feminine or neuter
gender as the case may be.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to
this, my last will, this 1.~° day of July, 1994.
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(.~~.~~.. ~~' ~/.--4'-~-~ ~~ (SEAL)
~: .r,
EVA M. HOLLINGER
SIGNED, SEALED, PUBLISHED, and DECLARED by the above
testatrix, as and for her last will, in the presence of us, who
thereupon at her request, in her presence and in the presence of
each other, have hereunto subscribed our names as witnesses.
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Page 5 of 5 Pages .
STATE OF PENNSYLVANIA }
( ss:
COUNTY OF DAUPHIN )
We, EVA M. HOLLINGER, ~~/~-~ ~~ t=~~i~c.1 and
~`~t~rf'~' ~• ~~~~.~.~~", the testatrix and witnesses, respectively,
whose names are signed to the attached or foregoing instrument,
being first duly sworn do hereby declare to the undersigned
authority that the testatrix signed and executed the instrument
as her last will and that she had signed willingly and that she
executed it as her free and voluntary act for the purposes therein
expressed, and that each of the witnesses, in the presence and
hearing of the testatrix, signed the will as witness and that to
the best of our knowledge, the testatrix was at that time eighteen
years of age or older, of sound mind and under no constraint or
undue influence.
1.
EVA M. HOLLINGE ,/'''
~~_ ~~-~
Witness ~~
Witness / ~ `--
SUBSCRIBED, sworn to or affirmed, and acknowledged before me
by the above-named testatrix and by the witnesses whose names
appear above on ~1-~-~ t ~ 7-994
Not y P Yilic ~~ ``'
Notaraf Sea!
Ja~uelyn A Ze:~emoyer, Notary Public
}i~mskx:rg, DaupY:in County
My Co. nmissian E res Jai. 29, f 985
AA.~..-r.4.~.. i_...,_,,..
SEAMANS
Eckert Seamans Cherin & Mellott, LLC rE~ 717 237 6000
213 Market Street - 8th Floor FAx 717 237 6019
Harrisburg, PA 17101 www.eckertseamans.com
Thomas P. Gacki
717.237.6093
tgacki@eckertseamans.com
June 16, 2008
Glenda Farner Strasbaugh, Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013-3387
Re: Estate of Eva M. Hollinger
File No. 21-07-0838
Dear Ms. Strausbaugh:
Enclosed for filing please find the original and two (2) copies of the Inheritance Tax Return in
the above-referenced matter. Please date-stamp one (1) copy of the Return and return it to my
office in the enclosed self-addressed, stamped envelope.
Thank you for your attention to this matter. Should you have any questions regarding the
enclosed, please do not hesitate to contact me
Very truly yours,
Thomas P. Gacki /~~
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cc: Clarence E. Hollinger (w/enc.) = c~
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HARRISBURG, PA PITTSBURGH, PA PHILADELPHIA, PA BOSTON, MA WASHINGTON, DC WILMINGTON, DE
{LO358907.1} MORGANTOWN, WV SOUTHPOINTE, PA WHITE PLAINS, NY
SEAMANS
Eckert Seamans Cherin & Mellott, LLC rLL 717 237 6000
213 Market Street - 8th Floor rax 717 237 6019
Harrisburg, PA 17101 www.eckertseamans.com
Thomas P. Gacki
717.237.6093
tgacki@eckertseamans.com
June 18, 2008
Glenda Farner Strasbaugh, Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013-3387
Re: Estate of Eva M. Hollinger
File No. 21-07-0838
Dear Ms. Strasbaugh:
By letter dated June 16, 2008, we forwarded the Inheritance Tax Return for the above-referenced
estate, but inadvertently did not send the filing fee. Enclosed please find a check in the amount
of Fifteen and 00/100 Dollars ($15.00) to cover the cost of filing the Inheritance Tax Return.
Please date-stamp one (1) copy of the Return and return it to my office in the self-addressed,
stamped envelope previously provided.
Thank you for your attention to this matter. Should you have any questions regarding the
enclosed, please do not hesitate to contact me
Very truly yours /`
/ ~. r°~.
Thomas P. Gacki ~ 't_ ~,
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Enclosure - - ' ' -°-
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HARRISBURG, PA PITTSBURGH, PA PHILADELPHIA, PA BOSTON, MA WASHINGTON, DC WILMINGTON, DE
{IA3S92OZ.1} MORGANTOWN, WV SOUTH POINTE, PA WHITE PLAINS, NY
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