HomeMy WebLinkAbout08-15-08 (2)15D56D41147
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
Po Box.zsosol 2 1 0 7 0 1 1 2 3
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
193 14 7139 11 15 2007 05 D9 1917
Decedent's Last Name Suffix Decedent's First Name MI
HERSHEY RUTH E
(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 INAPPROPRIATE OVALS BELOW
~~ 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death
prior to 12-13-E2)
L ~, 4. Limited Estate 4a. Future Interest Compromise 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
X ~ g Decedent Died Testate ~. Decedent Maintained a Living Trust S. Total Number of Safe DepOSit BOX2S
~~ (Attach Copy of Wilq (Attach Copy of Trusq
r ~i 9. Litigation Proceeds Received 1 D, spousal Poverty Credit (dace of seam 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 Daytime Telephone Number
JAN M WILEY 717 432 9666
~~.,
Firm Name (If Applicable)
THE WILEY GROUP, PC
First line of address
130 W. CHURCH STREET
Second line of address
City or Post Office
DILLSBURG
State ZIP Code
PA 17019
REGISTE~DF-,IrVILLS U~ONLY
-:;_ c
- c.'-~
_ Li ~.
-.e
_ ' ' =~°'~
~J
D~TE~FILED Ln
Correspondent's a-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.
Jan M Wiley
130 YN. Church Street, Dillsburg, PA 17019
Side 1
15056041147 15056D41147 J ~;
f3-S`~nset Court, Dillsburg, PA 17019
TSIGNAT E OF PREPARER OTHER THAN REPRESENTATIVE DATE
J
15056Q42148
REV-1500 EX
Decedent's Social Security Number
oecedent~s Name: Ruth E. Hershey 1 9 3 1~ 7 1 3 9
__
__ _
RECAPITULATION
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.
4 3 6 1 2 0 8
5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) .... ............ 5.
6. Jointly Owned Property {Schedule F) Separate Billing Requested . ............ 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
1 6 8
8 2 0
7 2
(Schedule G) Separate Billing Requested . ............ 7.
g. Total Gross Assets (tolal Lines 1-7) ........................................................... ............ 8. 2 1 2 4 3 2 $ 0
2 5 7 5 4 2 0
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. 2 5 7 5 4 2 0
12• Net Value of Estate (Line 8 minus Line 11) ................................................ ............ . 12. 1 $ 6 6 7 8 6 0
13. Charitable and Governmental Bequests/Sec 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. 1 8 6 6 7 8 6 0
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
0
0 0
15.
0
0 0
(a)(1.2) X .o0
16. Amount of Line 14 taxable
1 8 6 5 7 8
6 0 16_ $ 4 0 0 5 4
at lineal rate X ,045
17. Amount of Line 14 taxable
0
0 0
17.
0
0 0
at sibling rate X .12
18. Amount of Line 14 taxable
0
0 0
18.
0
0 0
at collateral rate X .15
19. Tax Due ....................................................................................................... ............. . 19. 8, 4 0 0 5 4
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
15056042148 15056042148
REV-1500 EX Page 3 File Number 21-07-01123
Decedent's Complete Address:
DECEDENT'S NAME
Ruth E. Hershey
STREET ADDRESS
2100 Bent Creek Blvd.,
__ __
CITY STATE ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
q. Spousal Poverty Credit
g. Prior Payments
C. Discount
3. InteresUPenalty if applicable
p. Interest
E. Penalty
Total Credits (A + B + C)
Total InteresUPenalty (D + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 2 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
(1) 8,400.54
(2) 4,210.53
(3)
_.
(4)
(5)
(5A)
(5B)
4,190.01
4,190.01
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 :.................................................................................. ~ ~ ~ x
b. retain the right to designate who shall use the property transferred or its income :.................................... I xJl
c. retain a reversionary interest; or .................................................................................................................. x
d. receive the promise for life of either payments, benefits or care? .............................................................. x''i
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration? ....................................................................................................................... ! X_~'~
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... ' x
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ...................................................................................................................... x '',
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 chi-d 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.
4,000.00
210.53
LAST WILL AND TESTAMENT
(Pour-Over Will)
OF
RUTH S. HERSHEY
IDENTITY
I, RUTH S. HERSI-IEY, residing in the County of Lancaster, Commonwealth of Pennsylvania,
being of sound mind and memory, and not acting under duress or undue influences of any person
whomsoever, hereby declare this to be my Last Will and Testament, and I do hereby revoke all other and
former Wills and Codicils to Wills heretofore made by me. My Social Security Number is t 93-14-7139.
All reference made herein to "spouse or my spouse" refers to the person to whom I am currently
married, namely, ISAAC L. HERSHEY. By the ensuing provisions of this Will, it is my intention to
dispose of my interest in cur property; I do not intend to dispose of anything belonging to my Husband or to
put him to any election.
I have the following children: RICHARD J. SCOTT, born June 2, 1943 and currently residing in
Dillsburg, Pennsylvania, and ELIZABETH A. LYEN, born March 13, 1949 and currently residing in
Towson, Maryland.
DEBTS, TAXES AND ADMINISTRATIONEXPENSES
I have provided for the payment of a!1 my debts, expenses of administration of property wherever
situated passing under this will or otherwise, and estate, inheritance, transfer, and succession taxes, other
than any tax on ageneration-skipping transfer that is not a liability of my Estate (including interest and
penalties, if any) that become due by reason of my death, under THE ISAAC L. HERSHEY AND RUTH S.
HERSHEY REVOCABLE LIVING "f RUST executed on even date herewith (the "Revocable Trust"), or if
my spouse predeceases me, under the Survivor's Trust created by the said Revocable Trust. If the
Kevocable Trust assets should be insufficient for these purposes, my Executor shall pay any unpaid items
from the residue of my Estate passing under this will, without any apportionmentor reimbursement. In the
alternative, my Executor may demand in a writing addressed to the Trustee of the Trust an amount
necessary to pa_y all or part of these items, plus claims, pecuniary legacies, and family alio~vanccs by court
order.
PERSONALAND HOUSEHOLD EFFEC'T'S
It is my intent that all my personal and household effects were transferred to the Revocable Trust as
a result of the Declaration of Intent signed this date. If there are any questions regarding the ownership or
disposition of these assets, it is my desire that such assets pour into the Kevocable Trust, signed by me this
date in accordance with the provisions of the section titled "Residue of Estate."
POUR-OVER WILLS
Page 1
RESIDUE OF ESTATE
I give, devise and bequeath all the rest, residue and remainder of my property of every kind and
description (including lapsed legacies and devises), wherever situated and whether acquired before or after
the execution of this Wi11, to the Trustee under that certain Trust executed by me on the same date of the
execution of this Wil{. The Trustee shall add the property bequeathed and devised by this item to the corpus
of the above described Trust and shat) hold, administer and distribute said property in accordance with the
provisions of the said Trust, including any amendments thereto made before my death.
If for any reason the said Trust shall not be in existence at the time of my death, or if for any reason
a court of competent jurisdiction shall declare the foregoing testamentary disposition to the Trustee under
said Trust as it exists at the time of my death to be invalid, then 1 give all of my Estate includingthe residue
and remainder thereof to that person who would have been the "Trustee under the Trust, a s Trustee, and to
their substitutes and successors under the Trust, described hereinabove, to be held, managed, invested,
reinvested and distributed by the Trustee upon the terms and conditions pertaining to the period beginning
with the date of my death as are constituted in the Trust as at present constituted giving effect to
amendments, if ary, hereafter made and for that purpose I do hereby incorporate such Trust by reference
into this my Will.
EXECUTOR
I hereby nominate and appoint ISAAC L. HERSHEY as my Independent Executor of this my Last
Will and Testament to serve without bond.
In the event the first named Executor shall predecease me, or is unable or unwilling to act as my
Executor for any reason whatsoever, then and in that event I hereby nominate and appoint RICHAKD 1.
SCOTT to serve without bond as my Independent Executor.
In the event the first successorExecutor shall predecease me, or is unable or unwilling to act as my
Executor for any reason whatsoever, then and in that event I hereby nominate and appoint ELIZABETH A.
LYEN to serve without bond as my IndependentExecutor.
Whenever the word "Executor" or any modifying or substituted pronoun therefore is used in this my
Will, such words and respective pronouns shall be held and taken to include both the singular a;:d the plural,
the masculine, feminine and neuter gender thereof, and shall apply equallyto the Executor named herein
and to any successor or substitute Executor acting hereunder, and such successor or substitute Executor
shall possess all the rights, powers, duties, authority, and responsibility conferred upon t:he Executor
originally named herein.
POUR-OVER WILLS
Yage 2
EXECUTOR POWERS
By way of illustration and not of limitation and in addition to any inherent, implied or statutory
powers granted to executors generally, my Executor is specifically authorized and empowered with respect
to any property, real or persona], at any time held under any provision of this my Will: to allot, allocate
between principal and income, assign, borrow, buy, care for, collect, compromise claims, contract with
respect to, continue any business of mine, convey, convert, deal with, dispose of, enter into, exchange, hold,
improve, incorporate any business of mine, invest, lease, manage, mortgage, grant and exercise options with
respect to, take possession of, pledge, receive, release, repair, sell, sue for, make distributions in cash or in
kind or partly in each without regard to the income tax basis of such asset and in general, exercise all of the
powers in the management of my Estate which any individual could exercise in the management of similar
property owned in its own right upon such terms and co-~ditions as to my Executor may seem best, and
execute and deliver any and all instruments and do all acts which my Executor may deem proper or
necessary to carry out the purpose of this my Will, without being limited in any way by the specific grants
or power made, and without the necessity of a court order.
My Executor shall have absolute discretio-~, but shall not be required, to make adjustments in the
rights of any Beneficiaries, or among the principal and income accounts to compensate for the
consequences of any tax decision or eleciion, or of any investment or administrative decision, that my
Executor believes has had the effect, directly or indirectly, of preferring one Beneficiary or group of
Beneficiaries over others. In determining the Federal Estate and Income Tax liabilities of my Estate, my
Executor shall have discretion to select the valuation date and to determine whether any or all of the
allowable administration expenses in my Estate shal l be used as Federal Estate Tax deductions or as Federal
(ncome Tax deductions and shall have the discretion to file a joint income tax return with my spouse.
SPECIFIC OMISSIONS
1 have intentionallyomitted any and all persons and entities from this, my Last Will and Testament,
except those persons and entities specifically named herein. If any person or entity shall challenge any term
or condition of this Will, or of the Living Trust to which I have made reference in the sections "Household
and Personal Effects" and "Residue of Estate," then, to that person or entity 1 give and bequeath the sum of
one dollar ($1.00) only in lieu and in place of any other benefit, grant, bequest or interest which that person
or interest may have in my Estate or the Living Trust and its Estate.
SIMULTANEOUS DEATH
If my spouse and I should die under circumstances such that the order of our deaths cannot be
determined, then it shall be conclusively presumed for the purposes of this my Will that my spouse survived
m e.
If any other Beneficiary should not survive me for sixty (b0) days, then it shall b~e conclusively
presumed for the purpose of this my Will that said Beneticiary predeceased me.
POUR-OVER WILLS
Page 3
`this instrument consists of 5 typewritten pages including the Attestation Clause, Self-Proving
Clause, signahire of Witnesses, and acknowledgment of officer. I have signed my name at the bottom of
each of the preceding pages his instrument is being signed by me on this __1 day of
G .e- ,19~-
..~.,
~:
RUTH S. HERSHEY,
Testatrix
POUR-OVER WILLS
Page 4
ATTESTATION CLAUSE
The Testatrix whose name appears above declared to us, the undersigned, that the foregoing
instrument was her Last Will and Testament, and she requested us to act as witnesses to such instrument
and to her signature thereon. The Testatrix thereupon signed such instrument in our presence. At the
Testatrix's request, the undersigned then subscribed our names to the instrument in our own handwriting in
the presence of the Testatrix. The undersigned hereby declare, in the presence of each of us, that we believe
the Testatrixto be of sound and disposingmind and memory.
Signed by us on the same day and year as this Last Will and Testamentwas signed by the Testatrix.
WITNESSES:
~Q ~ . w~
ADDRESSES:
a L~®tiler (~pac~
.L ~'sG /~ . ~,~ a ~ I
(Printed Name of W itness)
_ ~~';
<,
~~
(Printed Name of W itness)
/3 `T r~ct`~Y E 1,ry~ L ~- ~ e
~'har~o~~ , ~! ~ OS~~ 8
POUR-OVER WILLS
Page ~
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF (FILE NUMBER
Hershey, Ruth E. 21-07-01123
Include the proceeds of litigation and the dale the proceeds were received by the estate.
All property Jointly-owned with the right of survivorship must be disclosed on schedule F.
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
~~
I~ccount Number
Account Title
Date Opened ____
Account Type _ _ _
Principal Balance as of DOD
Interest from Last P_o_sting to DOD
Account Balance as of D_OD
~ r i'D tnterest to DOD
c~o~~
GI00751058
1ZUT'H S HERSHEY
- ---- __-
_5i 15/1~~72
_ Checking
___ _ - -- --- ------------ - .---------------
$16,170.54
$ .00
$16,170.54 ~--- -_ ----- ----
$101.43
I~ ~ (262} 549-8589 www.waukeshabank.com
uKest~a
j~V ~s~~~~~s ~1~ - 100 Bank Street • P.O. Box 648 • Waukesha, WI 53187-0648
December 24, 2007
"[~he Wiley Group
Attn. Dawn Gladfelter
130 W. Church Street, Suite 100
Dillsburg, PA 17019
llear Madam:
~~~~~f9
~---~ ~ ~ f
rhhis Ietter is in response to your query nn the holdings of Ruth S. Hershey. On the date
of death (1 1/15/2007), Ruth's MFS Government Securities Fund A had a value of
$13,820.92. ~hhis was an individually held account that was opened February 16, 1999.
Sincerely,
. , /~ . _ ~
~~
~~
Jonathan M. Krist
Sales Assistant
E,nelosure
Pri~~1e[/r ,~ /~nxrnru~! Se+rre~s. /iu ~~ <m rnr)c~~e~2~lent, re3iv~erPi1 brukr~id<r,/c~r ;l-If~~~ihw J/PC7~'ASD- Securhies unr! in.nnzrnrr p~odtrct+ n/~ciE'd 1n~ P~u~trl~~s[
;Vot Ff)IC/N(~f iSl1 nrcurerl, mar <u <In~~vT to ir~lne. not Jinancuil uictiurn"rr ~zuo>unte<=d. rair n c(Hpns~t, not nrstu~ec! hr tote fe~(eral {u~ e~r,mp+tr u;err ~
AV 1 VA
January 3, 2008
The Wiley Group
Jan M. Wiley
130 West Church St., Ste. 100
Dillsburg, PA 17019
Re: Policy #311824
- American Investors Life
Insured: Ruth Hershey
Dear Ms. Wiley:
~~~
Thank you for your recent request for information regarding the policy referenced
above. The date of death value is noted below.
Date of Death:
Principal Amount:
Interest Amount:
Account Value:
Nobember 15, 2007
$12,985.97
$16.79
$13,002.76
Should have any questions or need further assistance, please feel free to contact our
office at 1-888-ANNUITY (1-888-266-8489).
Sincerely,
Jamie Hubbard
Claims Specialist
,~ ~z
Aviva USR 555 Soulh Kansds ~+/:~nui~ R,,~>kd '<S o550;-i ~-a: Lei 8G0 7;5 Z40S w~ri :~usa _ ,~o
Rev-1610 EX+ (8-98)
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COA~AONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hershey, Ruth E. _ 21-07-01123
This schedule must be completed and filed if the answer to any of questions t through 4 on the reverse sitle of the REV-1500 COVER SHEET is yes.
ITEM
NUMBER D RIP 1 N P PERTY
INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND
THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH
VALUE OF ASSET %OF DECD'S
INTEREST EXCLUSION
(IF APPLICABLE) TAXABLE
VALUE
1 AVIVA Annuity #311823 -Beneficiaries are the 168,820.72 168,820.72
two children:
TOTAL (Also enter on Line 7, Recapitulation) I 168,820.72
{If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-913)
AV1VA
January 3, 2008
The Wiley Group
Jan M. Wiley
130 West Church St., ste. 100
Dillsburg, PA 17019
Re: Policy #311823
- American Investors Life
Insured: Ruth Hershey
Dear Ms. Wiley:
,~ ~
~G"%~~~i1~~
Thank you for your recent request for information regarding the policy referenced
above. The date of death value is noted below.
Date of Death:
Principal Amount:
Interest Amount:
Account Value:
November 15, 2007
$114,681.62
$54,139.10
$168,820.72
Should have any questions or need further assistance, pease feel free to contact our
office at 1-888-ANNUITY (1-888-266-8489).
Sincerely,
E
i~
:~
Jamie Hubbard
Claims Specialist
Aviva USA ,',~ Sourh Kansas Avenue R,~eka KS 60'503-3444 ial ~i0(1 ?'i~ J405 svw v avivausa ~;)in
.. ~ ~ ,-. ,, a,,E:~, ~, n ..,~~~c ~ .~. ., ~~~~~~
~~
,, .. ,~v,,~.~.~~,,
' REV-11b1 EX+(72-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Hershey, Ruth E. 21-07-01123
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A, FUNERAL EXPENSES:
See continuation schedule(s) attached
B.
1
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City State Zip
Year(s) Commission paid
10,520.75
4,000.00
2. Attorney's Fees The Wiley Group, PC 10,000.00
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 140.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 1,093.45
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 25,754.20
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
Rav-1b02 EX+t6-98)
SCHEDULE H-A
FUNERAL EXPENSES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF (FILE NUMBER
Hershey, Ruth E. 21-07-01123
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-98)
' Rev-1502 EX+(8.98)
SCHEDULE H-B7
OTHER
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA continue d
INHERITANCE TAX RETURN
RESIDENT OECEOENT
ESTATE OF (FILE NUMBER
Hershey, Ruth E. 21-07-01123
Copyright (c) 2002 form software only The Lackner Group, Inc. Form Pa-1500 Schedule H-f37 (Rev. 6-98)
..
~ REV-1ti13EX+t8-00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
rlersney, rcutn t. 21-07-0 1123
NUMBER NAME AND ADDRESS OF RELATIONSHIP TO
DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE
PERSON(S) RECEIVING PROPERTY (Words) ($$$)
Do Not List Trysteels)
I~ TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116(a)(1.2)]
1 Richard J. Scott Son one-half of 93,339.30
3 Sunset Court residuary
Dillsburg, PA 17019 estate.
2 Elizabeth S. Wetzel Daughter one half of 93,339.30
10532 Vernon Road residuary
Lake Stevens, WA 98258 estate.
Total 186,678.60
Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropri ate, on Rev 1500 cove r 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
TOTA L OF PART II -ENTER TOTAI NnN-TAXARI F I~IRTRIRI ITI(1NIS (1nl I IAIF 7Z nr oGV_unn ~nvro CL.ICLT n nn
copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98)
REGISTER OF WILLS OF
COMMONWEALTH OF PENNSYLVANIA } SS
CouNTY of Cumberland }
Richard J. Scott
INVENTORY
CUMBERLAND COUNTY, PENNSYLVANIA
File Number 21-07-01123
Personal Representative(s) of the Estate of Ruth E. Hershey
_____
deceased, depose(s) and say(s) that the items appearing in the following inventory include all of the personal assets wherever
situate and all of the real estate In the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each
item of said inventory represents its fair value as of the date of the decedent's death, and that Decedent owned no real estate
outside of the Commonwealth of Pennsylvania except that which//a~~pp~~ears in a memorandum at the end of this inventory. TM,
I verify that the statements made in this Inven- J\~-c'.~t r~-Zi- ~
tory are true and correct. I understand that false state- } ~ - - ~~ -
ments herein are made subject to the penalties of ~ Richard J. ott ~~ - ""-
4-)
18 Pa.C.S. § 4904 relating to unsworn falsification to ;~ ~ -,
authorities. _! t.:
_-~ ,,
-~,
_ ~-:~
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Attorney -- (Name) Jan M Wiley (Supreme Court 1.D. No.) ~ 6978
(F'n") The Wiley Group, PC
__ -__ ---
(Address) 130 W. Church Street, Dillsburg, PA 17019 _
(Telephone) 717-432-9666
DATE OF DEATH LAST RESIDENCE 2100 Bent Creek Blvd DECEDENT'S SOC. SEC. NO.
11/15/2007 Mechanicsburg, PA 17055 193-14-7139
FIGURES MUST BE TOTALED
Personal Property
Cash ...............................................................................................
Personal Property .........................................................................
Stocks/Listed .................................................................................
StockslClosely Held ......................................................................
Bonds .............................................................................................
Partnerships and Sole Proprietorships .....................................
Mortgages and Notes Receivable ...............................................
All Other Property .........................................................................
Total Personal Property .........................................
Total Real Property ................................................
Total Personal and Real Property .........................
43,612.08
43,612.08
43,612.08
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative include the value of each
item, but such figures should not be extended into the total of the Inventory. (See 20 Pa. C.S. § 3301(b))
Form RW-09 Rev. ~o-~s-zoos
` INVENTORY
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF Cumberland } SS File Number 21-07-01123
DATE OF DEATH LAST RESIDENCE 2100 Bent Creek Blvd DECEDENT'S SOC. SEC. N0.
11/15/2007 Mechanicsburg, PA 17055 193-14-7139
Cash
AVIVA Annuity #311824:
Citizens Bank Checking Account #100751058:
Federal Tax Rebate Stimulus Check:
Waukesha Investments - MFS Government Securities Fund A:
Total Cash
13,020.62
16,170.54
600.00
13,820.92
43,612.08
(Attach additional sheets if necessary) Total Personal Property and Real Estate 43.612.08
Jan M. Wiley
David J. Lenox
THE WILEY GROUP
Attorneys at Law
August 14, 2008
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
In Re: Estate of Ruth E. Hershey
No. 21-07-01123
Dear Register:
Enclosed for filing find an Inventory, the inheritance tax return in duplicate, and the status report
with regard to the above captioned estate. Also, enclosed is a check in the amount of~ $4,190.01
representing the tax due, and a check in the amount of $30.00 representing the filing fee.
Please note the postmark date, to ensure the estate is filed within the nine-month time frame.
Also, I would appreciate if you would return the recording receipts to my attention in the
enclosed envelope.
Thank you for your cooperation.
Sincerely,
~:~~« ~~fy~ ,,F~ l.~L _.L~~~
Dawn Gladfelter/Legal `ssistant
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130 W. Church Street, Suite 101 Dillsburg, PA 17019 • Phone: (717) 432-9666 (800) 682-4254 • Fax: (717) 432-0426
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