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Home My WebLink About06-26-08 COMMONWEALTH OF R~'~~"~`~ REV-1504 PENNSYLVANIA EVENUE DEPAR INHERITANCE TAX RETURN F~.E NUMBER DEPT.280 fl ~~' HARRISBURG, PA 17128-0601 RE S i D E N T DECEDENT ~~Nn~ -~~- -~ N~ ~ ~ - DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER F- Z Hernley, Fay E 188-12-3123 ____ W DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YFJ1R) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE W 05/23/2008 11/30/1921 REGISTER OF WILLS W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 0 w 0 1.Original Retum ~ 2. Supplemental Retum ~ 3. Remainder Retum (dace ordeath poor w 12-i~-a2) 4 a ~ ~ 4. Limited Estate ~ 4a. Future Interest Compromise (date ocd~ch after 12-r2-82) ~ 5. Federal Estate Tax Return Required ~ n m ~ 6. Decedent Died Testate {Aaacn copy or waq ~ 7. Decedent Maintained a Living Trust (Adach Dopy or rn,st) _ 8. Total Number Of Safe Deposit Boxes a 9. Litigation Proceeds Received ~ 10. SpOUSaI Poverty Credit (date of d~fh 6eNreen 1231-91 and t-1-95) ~ 11. Election to tax under Sec. 9113(A) (AUacn scn o) ~ THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTU>1L TAX INFORMATION SHOULD BE DIRECTED TO: w NAME COMPLETE MAILING ADDRESS c Susan E Lehmer 78 Greenspring Dr Mechanicsburg PA 17050 ay FIRM NAME (HApp~icable) w a C TELEPHONE NUMBER v Z O J H a a W QC Z Q F- a 0 V 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) {4) 5. Cash, Bank Deposits & Miscellaneous Personal Property 15) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) 3,422.70 Separate Billing Requested 7. {Hier Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assess (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) 12. Net Yalue of Estate {Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) ($) 947.84 (11) 8,947.84 (12) -5,225.14 (13) (14) 0.00 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or tn3nsfers under Sec. 9116 (a)(1.2) x .0 ~ (15) 16. Amount of Line 14 taxable at lines! rate x .0 _ (16 ) 17. Amount of Line 14 taxable at sibling rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate x .15 (18) (19) 0.00 19. Tax Due 20. ^ • ~ ~ ~ • • . 300.00 > > BE SURE TO ANSWER ALL QUESTWNS ON REVERSE SIDE AND RECHECK MATH < < Decedent's Complete Address: STREETADDRESS 78 Greens rip Dr DlnMechanicsburg sTATrPA ZIP 17050 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. InteresUPenalty if applicable D. Interest E. Penalty (3) (4) (5) (5A) (56) (1} Total Credits (A + B + C) (2) Total Interest/Penalty (D + E ) 4, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page i 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. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 0.00 0.00 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" !N THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; .......................................................................................... ^ Q 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? ...................................................................... ^ Q 2. If death occxtrred 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? ........................................................................................................................ ^ 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE !T AS PART OF THE RETURN Under penalties of perjury, I declare chat I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, ~! ~ true, correct and complete. Declaration of preparer other than the personal representative is based on aN irdormation of which preparer has arty knowledge. SIGNATURE OF PERSON RESPON FOR FILING RETURN DATE 78 Greenspring Dr, Mechanicsburg PA 17050 SIGNATURE pF PREP~IRER OTHER THAN REPRESENTATIVE 16 PA 17078 7n _ DATE 06/17/08 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~° j72 P.S. §9116 I;a} (1.1) (i)j. 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, §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the stahrtory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficary. For dates of death on or after Juty 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)j. 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. §91 f 6(aj(f )]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is f2% [72 PS. §9116(a)(1.3)j. Asibling 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-1508 EX+ (8-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCI~IEDt1LE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Hernley, Fay E Indude the proceeds of litigation and the date the proceeds were received by the estate. Alt property jointly-ormed with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-1549 EX+ (8-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Hem(ey, Fay E SCNEDi~LE F JOINTLY OWNED PROPERTY tf 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. Susan E Lehmer 78 Greenspring Dr, Mechanicsburg PA 17050 Daughter B. Thomas R Hemiey C. JOINTLY-OWNED PROPERTY: 203 S Harrison St, Palmyra PA 17078 Son ITEM NUMBER LETTER FOR JOMT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY•HEID REAL ESTATE. DATE OF DEATH VAIIIE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST ~~ A' 07/13/88 Members 1st Federal Credit Union Account 103017-05 4,787.27 1/2 2,393.64 2• AB 07!12/89 Members 1st Federal Credit Union Account 103017-00 2,598.49 1/3 866.18 3• AB 07/07197 Members 1st Federal Credit Union Account 103017-11 488.64 1/3 162.88 TOTAL (Also enter on line 6, Recapitulation) ~ ~ 3,422.70 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ 1;12-99) SCHEDULE H COMMI?NWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE 7AX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Hernley, Fay E Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t' Musselman Funeral Home 2,262.56 2. Rolling Green Cemetery Interment 1,295.00 3. Rolling Green Marker 1,133.00 a. Funeral Meal 607.28 B. 1 2. 3. 4. 5. 6. ~. city Mechanicsburg state PA .zip 17050 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)IEIN Number of Personal Representative(s) Street Address City ,State Year(s) Commission Paid: Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) claimant Susan E Lehmer Street Address 78 Greenspring Dr Relationship of Claimant to Decedent Daughter Probate Fees Aax>uuntant's Fees Tax Return Preparer's Fees TOTAL (Also enter on line 9, Recapitulation) ~ $ (If more space is needed, insert additional sheets of the same size) Zip 3,500.00 150.00 8, 947.84 Send Inquires to: 5000 Louise Drive PO Box 40 Mechanicsburg, PA 17055 www.memberslst.org Main Switchboard: (717) 697-1161 or (800) 283-2328 EZ Call: {717) 697-4372 or (800) 283-4372 TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 TeleBranch: (717) 795-6049 or (800) 237-7288 8291 1 AV 0.324 16581-8291 I~~~III~~~III~~~~I~I~II~~~I~~~II~I~~~I~~I~I~~II~~~II~~I~I~~I~I FAY E HERNLEY 78 GREENSPRING DR ME.CI-IANICSBURG PA 17050-7944 Statement of Accounts Apr 25, 2008 thru May 24, 2008 Account Number: 103017 Account Balances at a Glance: Checking : 488.64 Savings : 2, 598.49 Certificates : 0.00 Loans: 0.00 Money Management : 4, 787.27 Page : 1 of 2 Your current Member Loyalty Reward level is Silver Did you know that we offer FREE seminars? 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CHECKING ACCOUNTS 11 -CHECKING Date Transaction Description Additions Subtractions Balance Apr 25 Ba/ance Forward 382.02 Joint Owner: SUSAN E LEHMER Joint Owner: THOMAS HERNLEY May 02 Deposit Transfer From Share 00 500.00 882.02 May 05 Withdrawal ACH HARP HEALTH CARE 184.75- 697.27 TYPE: PREMIUM ID: 1526069387 CO: AARP HEALTH CARE May 08 Check 001812 Tracer 0027731079 '18.83- 648.44 Processed Check - VERIZON ARC TYPE: CHECK PYMT ID: 2005022221 May 08 Check 001814 Tracer 0001387018 86.92- 561.52 May 09 Check 001813 Tracer 0001890659 72.88- 488.64 May 24 Ending Ba/ance ~8 - ~ CHECK SUMMARY Check # Amount Date Check # Amount Date 001812 48.83 May 08 001814 86.92 May 08 001813 72.88 May 09 3 Checks C/eared for 208.63 SAVINGS ACCOUNTS 00 -REGULAR SAVINGS Date Transaction Description Additions Subtractions Balance Apr 25 Ba/ance Forward 2,600.02 Joint Owner: SUSAN E LEHMER Joint Owner: THOMAS HERNLEY Apr 25 Withdrawal at ATM #1002216 200.00- 2,400.02 ATM MEMBERS 1ST FCU 714 W MAIN ST MECHANICSBURG PA Apr 30 Deposit Dividend 1.000% 2.15 2,402.17 Annua/ Percentage Yee/d Earned f.0>O~ from 04/01/2008 through 04/30/2008 May 02 Deposit ACH SOC SEC 1,295.00 3,697.17 --- Continued on following page --- ~ Send Inquires to: Main Switchboard: (717) 697-1161 or (800) 283-2328 5000 Louise Drive PO Box 40 EZ Call: (717) 697-4372 or (800) 283-4372 Apr 25 , 2008 thru May 24 , 2008 Mechanicsbur , PA 17055 TDD: (717) 697-5372 or (800) 283-2328 ext. 5312 16583-8291 g Account Number: 103017 MEMBERS 1~~ www,memberslst.org TeleBranch: (717) 795-6049 or (800) 237-7288 '"" Page : 2 of 2 Date Transaction Descriation Additions Subtractions Balance ~- ID: 3031036030 CO: SOC SEC May 02 Withdrawal Transfer To Share 11 500.00- 3,197.17 May 02 Withdrawal at ATM #003107 300.00- 2,897.17 ATM MEMBERS 1ST FCU 714 W MAIN ST MECHANICSBURG PA May 12 Withdrawal at ATM #004374 300.00- 2,597.17 ATM MEMBERS 1ST FCU 714 W MAIN ST MECHANICSBURG PA May 20 Deposit 1.32 2,598.49 VISA CREDIT _ May 24 Ending Balance 2 , 598.49 05 -MONEY MANAGEMENT Date Transaction Descriation Additions Subtractions Balance Apr 25 Ba/ante Forward 4 , 782.40 Joint Owner: SUSAN E LEHMER Apr 30 Deposit Dividend Tiered Rate 4.87 4,787.27 Annua/ Percentage Yie/d Famed 1.250 from 04/01/2008 thro~~gh Q4/.30/2r108 May 24 Ending Ba/ante 4 787 27 YTD SUMMARIES TOTAL DIVIDENDS PAID 00 REGULAR SAVINGS 7.70 05 ~AONEY MANAGEMENT 26.23 11 CHECKING 0.00 Total Year To Date Dividends Paid NOTE: Total includes closed shares 33.93 Don't forget about our new Member Loyalty Rewards Pro ram. The more products you have with us, the more benefits you'll receive. Ask an associate for details or visit our website at www.members1st.org for details. N P: O ~ ~ d F .O ~~~~oo ~~°s ~° Z ~~ s ~ o // w~ O "' y O ~~ W O h N W F F j a .~ ~~ pd a ~~~ N fY v u ¢ ~ ~ 9 ~ ~ ~ ~ ~ ,} ,5 M `~ r ~ ~ ~ ~ v- w ~ ~ ~ ~, o i ~ ~ ~ ~ 7 N r ° ~ ~ o~ ~ ~~~~ ,~~ ,~~~ ~~ ~~ , ,~; 14~~~ v ~. ~ ~~ y.~ r j w