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Home My WebLink About12-18-0815056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes ~ INHERITANCE TAX RETURN ~/ il PO BOX 280601 2 I OO IZ~T Z Harrisburg PA 17128 0601 '~ RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 352-30-9576 12/10/2008 10/19/1920 Decedent's Last Name Suffix Decedent's First Name MI Henson Hertha A (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Return 4. Limited Estate 4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Regwred death after 12-12-82) 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Monika M Post (717) 731-6778 t'J Firm Name (If Applicable) REGISTERt~ WILLS USE ~v First line of address 4430 Packard Lane Second line of address City or Post Office Camp Hill Correspondent's a-mail address: State ZIP Code PA 17011 3. Remainder Return (date of death prior to 12-13-82) ~~ ~ ~'i t~ ~~ Q Q ~ ~ V J~ FILED a G7 _.~ -a r~ ~; `:_:_; C Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my Knowieoge anc oeuei, it is true, correct and complete. Declaration of prep~rer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF P RSON RESPONSIBLE FO (LING DATE -- A/D~DRESS ~ ~ /~~ ,~ ~ =L.~~~_J~~~~~~~!c..'^i~Q~'--n~-- ~ ~~ f- _C~.' _~~~ ~ DATE SIGNATURE OF PREPARER OTHER THA REPRESENTATIVE -.- --- ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 15056052059 REV-1500 EX Hertha A Henson Decedent's Name: 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. g ( ) ......................... Mort ages & 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. 7. 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/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. 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_ 15. 16. Amount of Line 14 taxable at lineal rate X .0 45 4,271.18 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. TAX DUE ...................................................... ...19. Decedent's Social Security Number 352-30-9576 6, 830.66 6,830.66 1,983.00 576.48 2,559.48 4,271.18 4,271.18 192.20 192.20 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: File Number DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER _ Hertha __A Henson 352-30-9576 __ _ _ STREET ADDRESS 1200 Carlisle Rd CITY STATE ZIP Camp Hill ~ PA 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. InteresUPenalty if applicable D. Interest E. Penalty 9.61 192.20 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. Fill in oval 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. (3) (4) (5) (5A) (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 9.61 0.00 0.00 182.59 0.00 182.59 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 :.................................................................................... ...... ^ 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 "intrust 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? .................................................................................................................. ...... ^ 0 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 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)]. 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+ (6-98) ~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Hertha A. Henson 21-08-1242 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE FI FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Hertha A. Henson 21-OS-1242 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t' Auer Cremation service of PA 1,881.00 Service fees attached B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) _ Street Address City .State Zip Year(s) Commission Paid: 2. Attorney Fees 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 5. Accountant's Fees 6. Tax Return Preparer's Fees ~. Petition Letters 45.00 Registration of Will 15.00 Short Certificate 12.00 JCP Fee 10.00 Automation Fee 5.00 Estate settlement filing fee 15.00 TOTAL (Also enter on line 9, Recapitulation) $ 1,983.00 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) COMMONWEALTH Of PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER ESTATE OF Heltha A. Henson 21-08-1242 _ ... _ ___ ~ ~...~_ ~___ ..........:... ~., dn~fh which rnmainPd unpaid as of the date of death, including unreimbursed medical expenses. (If more space is needed, insert additional sheets or me same size IzE'.-1SI3 cx+ -L~ 04' pennsylvania SCHEDULE DEPARTMENT OE REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Hertha A. Henson 21-08-1242 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON{S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 2116 (a) (1.2).] 1. Monika M Post Daughter 4271.18 4430 Packard Lane, Camp Hill, PA 17011 111 ph# (717) 731-6778 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, A S APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 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. . Commerce • Bank THE YES .BANK History for HERTHA HENSON ~-- ~/%S /'S Ci. ~py~~ ~ Q ~~v/~~ ~~ ~j Account Number 0000000032081879 ,/~ ~ From 12/ 8/2003 w 12/14/2008 ~~~~~~ % > > /-QS~'"~ Starting Balance: $1,393.46 -4 Checks: -$492.94 -1 Withdrawals: -$89.40 0 Deposits: $0.00 Ending Balance: $811.12 Date Description ~ Amount Balance 12/ 9/2008 ACfI Withdrawal - AC-UGI UTILITIES -UTIL PMT -$89.40 $1,304.06 CK-~"`00!`0000003073. 12/10/2008 Check 3072 -$285.00 $1,019.06 12/10/2008 Check 3074 -$126.00 $893.06 ' 12/11/2008 Check ~OG-4 -$25.00 $868.06 12/11/2008 Cher': ~u ` ~ -$56.94 $811.12 ~ ~~ X05. S~ ~~ 's Page 1 r r ti O fn r ~n ~] ~ .. W r W r r m .: r O O O 0 w m ;. OFFI ;,,,.,.;:: CIAL CHECK>. ~. ...- NOTICE TO CUSTOMERS ~~ THE PURCHASE OF qN INDEMNITY BOND WILL BE R£'t5U1REf1".. BEFE ENT IT IS LOST, MISPLACEDP STOLE OR DE,STROYED~~ V O~ m ,. .ZJ m ~C r _. ~ , \ ~ , . .. ~ ~ ~. :i, '~. ~ r..: _ _. ,.vim. >m. ' ., J° o o;' ~- _ ' . G ;' t. ... .. ~. , t .. `~ ~< 3 .,>, •:. '~.... ,;;'~~ xl ~ ;~ ;, ~ n ~,.<, •~ ,~ ,~ :g ~:: ;: "~ . ,..,.. ; ,, . ;~ ., .~ ~~ ;, , . ~ ~. .. ~ .•`~ I Q°.'~.;~~~. G .Q~.: ~, N ..,.\ . ~~ `\ O :1 ~~~ ~~~~~,>~M?-T[ON SER`'C~N AVER CREMATION SERVI , CES OF PENNSYLVANIA, INC. ~ioA ,~G 4100 Jonesu)~an Road • Harrisburg, PA 17109 • t-800-710-8111 • Fax %l?-5ti1-994 ~ Shawn E. C~rperySuper~isor ~'NNSYL~'AN1~' ,:~ i'"!~:r+'ti<_;i,.=1:" [; ~ ~.. L c 1 ( ,~ . r~ .. .r..~.i t.' 'f.li". y(<1 , ~,~. ~~ ~<.. ~: .. ,' 281199 JT-5 ,... r~ : , . 1 ~. ; ~ ~, . ; Mrs. Monika M. Post 4430 Packard Lane Camp Hill, PA 17011 DeC 10, 2008 i~.'~~.'.~IRci•~~...; ,.Ip"'_ .,.. Herta A. Henson - ' •n i.• . '~ ,. '`_. ! - Deceased =.l y,, t'' i:9:1A ~ t `1- ... . , SPECK;` G''.HARGES -' ._ ~ 1 .r ~ <.., ~:. ~ ~+ - -~ ; ;~:~: ; t)~, .. ~~ ; , , X Direct Cremation S1,395 .00 Nationwide Guarantee Program _ Worldwide Travel Protection Program ' ~; . :TOTAL SPECIAL CHARGES .: 1.1.-' ~, ~" ::~..,-st; :~"' :... $'1',.395.00 PROFESSIONAL SERVICES 1~::~F~t,~; tii1 ~r`i~ ji •il -'•+ X Services of Funeral D'i•rsctar ~ & Staff ~ . . . ; ._~ < <: ;; In~lvded Dress i ng/Cosmet i z i ng ~•: "~ ~ - ~ _. ~ -. _ ~ , i ;, j ; , , Facilities & Staff fo~`~ Msmorial Service • s~~: . i~ Staff & Equipment fo~~>Menio~ial Ser~tice'. _ • ~. :. ,,::.. ,;~, ~ X Private ID Family Vietai.ng~: _ ~+.: ,-. , ~,,:>5,~,75;,:00 Witnessing the Cremation Packaging/Forward'Lng o~ Cremated Remains ,~ ., . , a; 1.~ X Personal Delivery o'f Cremated Remains . , $85,0O~tr.:~-; Scattering of Cremated Remains <• .r;-.~~ •.. , i,,;.;<~ ~r:;, ;,, f_ F` '•1 , ~. , .~ , ~), ^, t .. .. :~~. t _ '.i~.i_i TOTAL PROFESSIONAL SLRVI~ES ~:.I ~' •~,'t i'~?~ :'Irk ~ • ' '' `>r,~~IS2'60.00 AUTOMOTIVE EQUIPMENT ` X `Rd~io-va1 •~V'ek>ri+c'le~ "1 ~ i; _ "~,(_ ,.'~ ~ ~',~• ~~;a ;;" .~'ri.Tna.lt3~led Lead Car/Clergy Car Family Car Service Vehicle TOTAL AUTOMOTIVE EQUIPMENT $0.00 MERCHANDISE Register Book Memorial Cards Thank You Cards Remembrance Package Alternative Container X Walnut Scattering Urn 5125.00 "' ~ Wooden Keepsake 540.00 Veterans Flag Case Grave/Memorial Marker TOTAL MERCHANDISE ~ 5165.00 CASH ADVANCED ITEMS Grave Opening Cemetery Equipment Newspaper Notre Newspaper Notice ~' ~ Newspaper Notice ~ Clergy , . ,.. Church/Sexton/Organist/Soloist Flowers ..~- .. ,. . ,,~~ X Crematory Charge Included X County Coroner Fee $25.00 X 6 Certified Copies of Death Certificate -. $36.00 .. TOTAL CASH ADVANCED ITEMS ~ 561.00 SiJI~UlARY OF CHARGES .. Spec i`a.l .Charges 51, 395-. 00 Professional Services $260.00 Merchandise - ,.,,.$.0',. 00.- Automotive Equipment 5165:00 ~•y , , Cash' Advanced Items ._ $61.00 ~ ;, ,, ; >, ., ; . , SUH TOTAL , , ~ ~ , ; 51;,881..00 ~~ L , CREDITS . .. ! .. • . $0.00 -, . AMOUNT PREPAID Date -- 50.00 , TOTAL 51,881.00 AMOUNT PAID Date Dec ii, 2008 -51,841.00 BALANCE DUE 5°40.00 ~ .. .THIS: STATEMENT MAY NOT REFLECT ALL NEWSPAPER CHARGES ... ! ~. ~ ; .1 ~ L C C ~~ .... o ~~ ; ~ U ~, ~, 0 ~ ` l\ W W v) U U Z Z a a J J a ~ m~ m Q. ~ W O ~ a z d I m D v ~ ~ U a~ rn ~ U r m ^ ^ a ~ 9u U (~1 t U LL ~ ~ I ~~; II I V L n C C ~ ~ s ~ d L ~l ~ a ~. ~ S 3 ~ s ~ `~ --~ ~ ~ o . ~ ~ ~ d ~ ' d oo C ~ ~ ~ J 5. ~ ~ ~. 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