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Home My WebLink About11-20-08 (4)~ REV-1 500 15056041147 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX.280601 2 1 O 8 O~p~jl.l- Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 174201090 06102008 12281926 Decedent's Last Name Suffix Decedent's First Name MI HOFFNER BETTY E (tf Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW ® 1. Original Return ^ 4. Limited Estate ® B Decedent Diad Testate (Attach Copy of Will) ^ 9. Litigation Proceeds Received GREGORY M KERWIN Firm Name (If Applicable) KERWIN & KERWIN First line of address 4245 ROUTE 209 Second line of address THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS ^ 2. Supplemental Return ^ 3. Remainder Return (date of death prior to 72-13-82) ^ qa. Future Interest Compromise ^ 5. Federal Estate Tax Return Required (dale of death after 12-12-82) ^ ~ Decedent Maintained a Living Trust O 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust) ^ ~ p Spousal Poverty Credit (dale of death ^ t ~. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRF~TED TO: Daytime Telephone Number ~ --~ 71736232 c' ~=''.-=` ~C~ . ..r ~ ~. ~ ~ REGISTER OF WILL$QNLI'N t 1 1..._ i ~ ~_.? ~.~_:Z3 C7 `J _': _ - : - c: -> _j:~ ~ ;--,~~ - "t7 - ~, DATE FILED City or Post Office State ZIP Code ELIZABETHVILLE PA 17023 Correspondent's a-mail address: g m k e rw I n t~ h o t m a i I. C O m Under penalties of perjury, 1 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. SIGNATURE OF PERSON RES NSIBLE FOR FILING RETURN DATE _~, , -- _ ~ ~~,~~„ , '~ Ammon E. Hoffner, III ~/-/7-D +G 44 Bill Dugan Driyv~, Etters, PA 17319 iIGNCRLIRf~.OF PREPARE ER THAN REPRESENTATIVE Gregory M Kerwin DATE 209, Elizabethville, PA 17023 Side 1 /7-Q~ ~„ 15056041147 15056041147 15056042148 REV-1500 EX oecede~ee Name: H O F F N E R, BETTY E Decedent's Social Security Number 174201090 RECAPITULATION 1. Real Estate (Schedule A) .......................................................................................... 1. 36,637.76 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. 367,240.37 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ................ 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ............. 7. 403, 878.13 8. ........................ Total Gross Assets (total Lines 1-7) .............................................. 8. 18,833.22 9. Funeral Expenses & Administrative Costs (Schedule H) ........................................ . 9. 2,601.60 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................... . 10. 21,434.82 11. Total Deductions (total Lines 9 & 10) ..................................................................... . 11. 382,443.31 12. Net Value of Estate (Line 8 minus Line 11) ............................................................ . 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ................................................ . 13. 382,443.31 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 .00 15. 16. Amount of Line 14 taxable 3 8 2, 4 4 3 3 1 16, 1 7, 2 0 9 9 5 at lineal rate X .045 17. Amount of Line 14 taxable 17 at sibling rate X .12 . 18. Amount of Line 14 taxable 18 at collateral rate X .15 . 19 17,209.95 19. Tax Due ................................................................................................................... . .. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 15056042148 15056042148 REV-1500 EX Page 3 rlnrnrlnn4°c rnm111P_t'p OddreSS_ File Number 21 - 08 Hoffner, Betty E STREET ADDRESS 100 Mt. Allen Drive CITY Mechanicsburg STATE PA ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable p, Interest E. Penalty (1) 17,209.95 15,895.00 836.58 Total Credits (A + B + C) (2) 16, 7 31.58 Total Interest/Penalty (D + E) (3) 0.00 (4) (5) 478.37 (5A) (5B) 478.37 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. g. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable fo: REGISTER OF WILLS, AGENT ,, . .r., ~. ~j ,,. ~. . .. - ~~ ? ~...~.f~..: _ . s.. w ,.. .. , ,.. ~ _ _. 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 :.................................................................................. ^ 0 b. retain the right to designate who shall use the property transferred or its income :.................................... ^ 0 x c. retain a reversionary interest; or ................................................................................................................. d. receive the promise for life of either payments, benefits or care? .............................................................. ^ 0 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?......... ^ Lx] 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. y ~, a of the For dates of death on or after Jul ` 1~1994 and before Janua 1, 1995, the tax rate imposed on the net value of transfers to or for the us 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 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. §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 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. CO~vMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS FILE NUMBER ESTATE OF Hoffner, Betty E 21 - 08 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM DESCRIPTION NUMBER 1 16 Shares Prudential Financial, Inc. 2 5 Series HH U.S. Savings Bonds T( SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hoffner. Betty E FILE NUMBER 21 - 08 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 DESCRIPTION .,~~~ .. ~ .. DEATH 1 Checking Account #1241001606 at Susquehanna Bank PA, Camp Hill Office, 201 St. Johns 15,654.71 Church Road, Camp Hill, PA 17011 2 Savings Account #1297606220 at Susquehanna Bank PA 632.54 3 Certificate of Deposit #1202061932 at Susquehanna Bank PA 5,941.32 4 Certificate of Deposit #1204034530 at Susquehanna Bank PA 12,005.37 5 Certificate of Deposit #1241001630 at Susquehanna Bank PA 42,032.54 6 Certificate of Deposit #1241001635 at Susquehanna Bank PA 6,472.99 7 Certificate of Deposit #1291775330 at Susquehanna Bank PA 6,000.00 8 Certificate of Deposit #1400678133 at Susquehanna Bank PA 61,073.22 9 Certificate of Deposit #1400678134 at Susquehanna Bank PA 54,124.23 10 Certificate of Deposit #1400678135 at Susquehanna Bank PA 1,035.96 11 Certificate of Deposit #4500092130 at Susquehanna Bank PA 32,803.09 12 Certificate of Deposit #4500092132 at Susquehanna Bank PA 9,000.00 13 Certificate of Deposit #5402634530 at Susquehanna Bank PA 93,374.41 14 Certificate of Deposit #403500004326 at Susquehanna Bank PA 27,089.99 TOTAL (Also enter on Line 5, Recapitulation) 367,240.37 SCHEDULE H FUNERAL EXPENSES & COMMONWEALTH OF PENNSYLVANIA ~- p^~~ T ^~~ INHERITANCE TAX RETURN rv~ "~/~, V~/~7 RESIDENT DECEDENT ESTATE OF Hoffner, Betty E Debts of decedent must be reported on Schedule I. _ _ _ _ _ _ ITEM DESCRIPTION NUMBER FUNERAL EXPENSES: A. I j B. I, ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions i Social Security Number(s) ! EIN Number of Personal Representative(s): Street Address ~, City State Zip Year(s) Commission paid 2. Attorney's Fees Kerwin & Kerwin -- Gregory M Kerwin 'il 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 a. ~i Probate Fees Register of Wills 5. ~ Accountant's Fees 6. Tax Return Preparer's Fees 7, Other Administrative Costs 1 ;Vital Records -Death Certificates 452.00 36.00 __ TOTAL (Also enter on line 9, Recapitulation) 18,833.22 FILE NUMBER 21 - 08 '' AMOUNT 17,905.00 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Schedule H Funeral E~ & Admiri~strative Costs crorrtinued ESTATE OF Hoffner, Betty E 2 ~ DHL - to Vital Records 3 I'~ Cumberland Law Journal, Estate Advertisement 4 I The Sentinel -Legal -Estate Advertisement 5 I Register of Wills, filing Inheritance Tax Return and Inventory 6 ~ Reserved for closing costs 16.50 75.00 118.72 30.00 200.00 FILE NUMIStK ~~ _ nQ Page 2 of Schedule H SCHEDULEI DEBTS OF DECEDENT, MORTGAGE Conm,ONWEALTH OF PENNSYLVANIA LIABILITIES, & LIENS INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF Hoffner, Betty E 21 - 08 _ __ ___ Include unreimbursed medical expenses. ITEM DESCRIPTION AMOUNT NUMBER __ _ _ __ __ 1 Messiah Village, account payable for room and board 1,951.42 2 Alert Pharmacy Services, Inc., account payable 650.18 TOTAL (Also enter on Line 10, Recapitulation) 2,601.60 SCHEDULE) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT BENEFICIARIES --- -~- FILE NUMBER ESTATE OF Hoffner, Betty E 21 - 08 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE d ($$$) NAME AND ADDRESS OF PERSON(S) I DECEDENT s) (Wor NUMBER RECEIVING PROPERTY ~ Do Not List Trusteels) -- I T I AXABLE DISTRIBUTIONS [include outright spousal ii . distributions, and transfers under Sec. 9116 (a) (1.2)] 1 Nicole Hoffner ~ Granddaughter 500.00 RR #1, Box 760 McAllistervilfe, PA 17049 2 Brianne Hoffner 'Granddaughter 500.00 506 Bridge Street New Cumberland, PA 17049 3 Robert Hoffner ~ Grandson I 500.00 5 West Green Street, Apt. B ~, Shiremanstown, PA 17011 Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, onlRev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 REV-1613 EX+ (8.00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES continued INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hoffner, Betty E RELATIONSHIP TO NAME AND ADDRESS OF PERSON(S) DECEDENT NUMBER RECEIVING PROPERTY p ~~ _ _oo Not fist Trustee(s) I~ TAXABLE DISTRIBUTIONS dl s1r butlonsr~ and transfers under Sec. 9116 (a) (1.2)] 4 Ammon E. Hoffner, III 'Son 44 Bill dugan Drive Etters, PA 17319 FILE NUMBER 21 - 08 SHARE OF ESTATE I AMOUNT OF ESTATE (Words) j ($$$) - Residue of Estate Page 2 of Schedule J