HomeMy WebLinkAbout02-18-09-~ REV-1500 1505607120
EX (06-05) OFFICIAL USE ONLY
PA DepartmentofRevenue county code Year File Number
Bureau ofindividualTaxes INHERITANCE TAX RETURN
PO 60X.280601
Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 0 7 0 6 5 7
ENTER DECEDENT INFORMATION BELOW
Social Secu rity Number Date of Death Date of Birth
169442562 07032007 09251957
Decedent'sLastName Suffix Decedent'sFirstName MI
HAMMACHER ARCHIE F
(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 IN APPROPRIATE OVALS BELOW
® 1. Original Retum ^ 2. Supplemental Return ^ 3. Remainder Return (date of death
prior to 12-13-82)
^ 4. Limited Estate ^ qg, Future Interest Compromise ^ 5. Federal Estate Tax Return Required
(date of death after 12-12-62)
~
® g Decedent Died Testate
^ ~. Decedent Maintained a Living Trust
(Attach Copy of Trust) 8. Total Number of Safe Deposit Boxes
(Attach Copy of WiII)
^ 9. Litigation Proceeds Received ^ 1D, Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95) ^ 11.Election to tax under Sec. 9113(A)
(Attach SCh. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
ame Daytime Telephone Number
NORA F. BLAIR 7175411428
Firm Name (If Applicable)
First line of address
5440 JONESTOWN ROAD
Second line of address
PO BOX 6216
City or Post Office
HARRISBIIRG
State ZIP Code
PA 17112-0216
Correspondent'se-mail address: NFBLAW a~COmCast.net
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. DeGaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
c
,~~~ Donna Berkheimer Z -
ADDRESS
2160 Sand Beach Road, Hummelstown, PA 17036
SIGaRTURE OF PREPARER OTHE AN REPRESENTATIVE ~--~ DATE
_ ~.,~,--~_~-' Nora F. Blair 7- I ~ . n a
5440 Jonestown Road, Harrisburg, PA 17112-0216
Side 1
1505607120 1505607120 J
C.:~
REGISTER tLS USE~ILY
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1505607220
REV-1500 EX
Decedents Name: HAMMACHER, ARCHIE F.
Decedent's Social Security Number
169442562
RECAPITULATION
1 6 5, 0 0 0. 0 0
1. Real Estate (ScheduleA) ........................................................................................ ...
.
2. Stocks and Bonds (Schedule B) ............................................................................. .... 2. 5, 2 3 1. 6 3
3. CloselyHeldCorporation,PartnershiporSole-Proprietorship(ScheduleC) .......... .... 3.
4. Mortgages & Notes Receivable (Schedule D) ......................................................... ... 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ................ .... 5. 1 6 , 7 7 8 . 8 1
6. Jointly Owned Property(ScheduleF) ^ SeparateBillingRequested ........... ... 6. 2 6 , 19 3 . 9 9
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ^ SeparateBillingRequested ........... ... 7,
g, Total Gross Assets (total Lines 1-7) ..................................................................... ... g. 1 1 3, 2 0 4. 4 3
9. Funeral Expenses &AdministrativeCDsts (Schedule H) ................................. ........... 9. 1 9 , 4 9 3.11
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ........................ ........... 10. 6 6 , 19 9 . 8 5
11. Total Deductions (total Lines 9 & 10) ............................................................ ........... 11. 8 5 , 6 9 2 . 9 6
12. Net Value of Estate (Line 8 minus Line 11) .................................................... .......... 12. 2 7 , 5 1 1 . 4 7
13. Charitable and GovernmentalBequestslSec9113Trustsforwhich
an election to tax has not been made (Schedule J) .......................................... .......... 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) ........................................ ........... 14. 2 7 , 5 1 1 . 4 7
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Linel4taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2)X .00 15.
16. Amount of Linel4taxable
at lineal rate X .045 1 , 8 17.4 8 16.
17. Amount of Line 14 taxable
at sibling rate X .12 2 5, 6 9 3. 9 9 17.
18. Amount of Line14taxable
at collateralrateX .15 18.
19. Tax Due .................................................................................................................... . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
1505607220 1505607220
81.79
3,083.28
3,165.07
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21 - 07 - 0657
DECEDENT'S NAME
Hammacher, Archie F.
STREET ADDRESS
1800 Sheepford Road
CITY
Mechanicsburg STATE
PA ZIP
17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. SpousalPovertyCredit
B. PriorPayments
C. Discount
3. InteresUPenaltyifapplicable
p, Interest
E. Penalty
(1)
Total Credits (A + B i C) (2)
Total InteresUPenalty (D * E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
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. (5)
A. Enter the interest on the tax due. (5A)
g. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56)
Make Check Payable to: REGISTER OF WILLS, AGENT
3,165.07
0.00
165.29
3,330.36
3,330.36
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 :......................................... x
c. retain a reversionaryinterest; or ..................................................................................................................... x
d. receive the promise for life of either payments, benefits or care? .................................................................. x
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receivingadequateconsideration? ......................................................................................................................... ^
3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ............... ^ ^x
4. Did decedentown an Individual RetirementAccount,annuity, orothernon-probate propertywhich
containsabeneficiarydesignation? ........................................................................................................................ ^ 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 doesnotexemot a transferto a surviving spousefrom 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)].
The tax rate imposed on the net value of transfers to or forthe 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.
165.29
COMMON WEALTH OF PENNSYLVANIA
INHERRANCETA%RETURN
RESIDENiDECEDENT
SCHEDULE A
REAL ESTATE
FILE NUMBER
ESTATE OF Hammacher, Archie F. >
~_1 - 07 - 0657
All real property owned solely or as a tenant in common must be reported affair market value. Fair market value is defined as the
price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buyy or sell, both having
reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on
schedule F.
ITEM DESCRIPTION VALUE AT DATE
NUMBER OF DEATH
1 1800 Sheepford Road, Mechanicsburg, PA 17055--See attached HUD-1 65,000.00
TOTAL (Also enter on Line 1, Recapitulation) ~ 65,000.00
11/21!06 4:53 PM OMB No. 2502-0265
A. U.S. Department of Housing B. Type of Loan
and Urban Development 1. [ ]FHA 2. [ ] FMHA 3. [ ]Conv. Unins.
4. (] VA 5. Conv, Ins.
6. File Number 7, Loan Number
20080301
Settlement Statement 8. Mortgage Ins. Case No.
C. Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement
agent are shown. Items marked ("POC") were paid outside the closing: they are shown here for information
purposes and are not included in the totals
D. Name of Borrower: Timothy F Straub, 157 S 32nd Street, Camp Hill, PA 17011
' Johnathan L. Ruhsam, 1780 Pinetown Road, Wellsville, PA 17365
E. Name of Seller: Donna Berkheimer executrix of the Estate of Archie F. Hammacher, 1800 TIN:
Shepford Road, Mechanicsburg, PA 17055.
F. Name of Lender: Integrity Bank, 3345 Market Street, Camp Hill, PA 17011
G. Property Location: Lower Allen Township; Lower Allen Township
1800 Sheepford Rd., Mechanicsburg, PA 17055
H. Settlement Agent: Great Road Settlement Services, LLC (717) 731-1040
Place of Settlement: 765 Poplar Church Road, Camp Hill, PA 17011
I. Settlement Date: 11121!2008 Proration Date: 11/21/2008
100. Gross amount due from borrower: 400. Gross amount due to seller:
101. Contract sales price 65,000.00 401. Contract sales price 65,000.00
102. Personal property 402. Personal pro erty
103. Settlement charges to borrower (line 1400) 50,188.24 403.
104. 404.
105. 405:
106. Cityltown taxes
107, Count taxes 11/21!2008 to 1/1/2009
108. Assessments
109. School Taxes 11/21/2008 to 7/1/2009
110. County Taxes-026 11/21/2008 to 1/1/2009
111. School Taxes - 026
112. 4th Qtr Refuse
120. Gross amount due from borrower:
zpti: wf ~/;,~b~51t§zl~atd~hY~Qf3~~a~i,3tl~~~,p?i~1,efi,`~s1
201. Depositor earnest money
202. Principal amount of new loan(s)
203. Existing loan(s) taken subject to
204.
205.
206.
207.
208. Repair Credit
209.
Ad~l%str{1@~~.ti~b~~~e('~i'i, ~)j~p'dA'ti~'~1IeY~~.._
210. Cit /town taxes
211. County taxes
212. Assessments
213. School Taxes
214.
215.
216.
217.
218.
219.
220. Total paid bylfor borrower:
301. Gross amount due from borrower (line 1
302. Less amount paid bylfor borrower (line
303. CASH (X)FROM ()TO BORROWER
406. Cityltown taxes
63.01 407. County taxes 11/21/2008 to 111/2009
408. Assessments
729.36 409. School Taxes 11!2112008 to 7/1/2009
15.01 410. County Taxes -026 11121/2008 to 1/1/2009
191.07 411. School Taxes-026
6.22 412. 4th Qtr Refuse
116,192.91
,Yts~~;
1,000.00 420. Gross amount due to seller:
UQ r7•P .
501. Excess deposit (see instructions
112,000.00 502. Settlement charges to seller (line 1400)
503. Existin loan(s) taken subject to
504. Payoff of first mortgage loan Fulton
505. Paycff of second mort age loan
506. Overnight Pa off to Fulton
507.
500.OD 508. Repair Credit
509.
511. County taxes
512. Assessments
513. School Taxes
514.
515.
516.
517.
518.
619.
113,500.00 520. Total reduction in amount due seller:
116,192.91 601. Gross amount due to seller (line 4:
113,500.00 602. Less total reduction in amount due
2,692.91 603. CASH ()FROM (X)TO SELLER
63.01
729.36
15.01
191.07
66,004.67 ~
25.00 I
47,626.15
66,004.67
47,626.15
18,378.52
SUBSTITUTE FORM 1099 SELLER STATEMENT -The Inlormation contained In Blocks E, G, H and I and on line 401 (or, if line 401 is asterisketl, Ilnes 403 ono 40a), 40s, 407 an0
4178-412 (applicable part of buyers real estate tax reportable to the IRS) Is Important lax information and Is being furnished to the Internal Revenue Service. If you are n~qulred to Ne a
return, a negligence penalty or other sanction will be imposed on you if this item Is required to be reported and the IRS determines That it has not been reported.
SELLER INSTRUCTION - If this real estate was your principle residence, fde form 2119, Sale or Exchange of Principal Residence, for any gain, wllh your income lax return; for other
Transactions, complete the applicable parts of form 4797, Form 6252 and/or Schetlule D (Farm 1040).
YOU ar glllre0 Dy IdW to prOV oe lireat ti0a0 Jelllemenl ServlCes, LLG (/ 1 /J /31-1 U4U Wlln your correct taxpayer ItlentlflCBGOn num0ef.
If you o t provide Great R d Settle a Services, LLC (717) 731-7040 with your correct taxpayer identification number, you may be subject to civil or criminal penalties.
nJ
Donna Berkheimer executrix of the Estate of Archie F. Hammacher
700. I_. ~:aeulernenecu:r~al ea:
Total salesPoroker commission ,~..-,..: .:,'-.,~,-~ ~,..,, „„v. ~,,. ..,.. -,,:...
based on :565,000.00= 53,000.00 ..._.. __..
Paid From
Pald From
Division of commission (line 700 as lollows: Bonowefs Seller's
701. 51,925.00 to Straub & Associates Real Eslale Grou ,Inc. Funds al Funds at
702. 51,975.00 to John Glise Selllemenl Selllemenl
707. Commission aid al selllemenl 83,900.00 3,900.00
704.
705. Transaction Fee-Bu ar to Straub 8 Asaoclales Reel E51eleGrou ,Inc. 125.00
706. Transaction Fee-Seller to John Gllse
6001 .,;;,11ems('payiiole'iii cGh(+ecilon with loan"-~,p,,,, ~E ti 'M., ~. ~''~rt^v47ifd.+-u~ -.. ~,~.. .. ~.~~~{y. ~
~...
~'- - 125.00
.~
~
6171. Loan on Inalion fee
602. Loan discount
BOJ. Ap retest fee
BOd. credit re on
605. Lentlefs InSDecllon tee
606. Mon a e Insurance application lee
807. Assumption lee
806. Processin Fee
809. Document Preparation Fee to Inle ril Bank 300.00
810. Flood Cert to Inle nl Bank 15.00
811. Points to Inle nl BanY, 560.00
812. Rehab Escrow to Integrity Bank
900'r1~r~Cl..aR1s:R0ulf$~'_Y,AgnI~~Rito„(S-e oald'T-B'4'~.,vrt~P ~`' ~.„I .A.k~7R~., .. a. .. .. ~- o,.
901. Inleresl Irom 47,000.00
.: ., .;z.~~
r .:~~ ;i,.,
902. Mon a e insurance remlum for
903. Hazartl Insurance remlum for
904.
905.
1000 =..Rase esdeptisileB tv Vfi;lgild''.~}i`;, ,~ ~~ '~ r^~: ,:-,. :r ~~:~ H y~°7! ,..._.. ~ .: .:..~i'9`(:
7001. Hazard insurance "
7002, Mon a a insurance
1007. Cil propen lazes
1004, Count propen lazes
1005. Annual a55essm¢n15 (mainl.)
1006. School Propert Taxes
1007.
loos.
1009. Aggregate Adjustment
1iDC • :Title c6a gesT-` - ~ r •£,tii;
1101. Selllemenl or closln fee to Great Roatl Selllemenl Services, LLC PO(:8 0.00
1102. ADSlract or tills search to ACE Abstracters POCB 150.00
1107. Title examination to Great Road Selllemenl Services, LLC PO(:B 0.00
7104, Title insurance bintlar to Great Road Selllemenl Services, LLC PO(:B 0.00
1105, Document ra station to Great Road Selllemenl Services, LLG 125.00
1706. Nola lees to Cash 25.00 70.00
7107. Allorne 's fees to PO(:B 0.00
includes above IremS no.:
1108. Title insurance to Great Road Selllemenl Services, LLC 918.75
includes above Items no.:
1109. Lentlefs covers a 5112,000.00 5270.00
1110. Ownefs covers a 565,000.00 $646.75
1111. Endorsemenls•100,300,800 to Great Road Selllemenl Services, LLC 150.00
1112. Closln Protection Leller to Great Roatl Selllemenl Services, LLC ~ 35.00
111 J. Real Eslale Tax CeniOCallon to Bonnie K, Miller, Lower Allen Townshl Tax Collech 20.00
1114. Overnl hlM/ire
1115.
1200
1201. Exewlor Deed to Attorney Nora Blair
~:r":'G ;6yflment record dg~'n~},g9rc~ ;1, ,~,` ~ ... '.. ~; Fit"~ ...
Recordin fees: Deed 548.50 Mon a e 562.50 125.00
111.00 125.00
~...
1202. CII /count lax/slam s; Deetl 5515.12 515.12
1207, Stale lax/stamps: Deed 5515.12 575.12
1204. Recordin Fee to Recorder of Deeds 48.50
1205. CII /Count lax/slam s to Recorder of Deeds 134.87
1206. Stale laxlslamps
YJOOg,~Ewi,~!;ddill .a-~Stelllel7(bn~' el9e~."
1701. Surve to Recorder of Deeds
'.i,,. .. ..•. : «~,:. ~.4 ' x. ti i 134.87
1'..
1702. Pest Ins action
1 JOJ. 2006 Cl /Tw Tax 025)(10/7/00 to Bonnie K. Miller, lower Allen Townshl Tex Collech PO(:S 562.47
1 704. OB-09 Schl Taz(025 to Bonnie K. Muter, Lower Allen Township Tax Collacll 1,322,71
1705. 2008 CI Rwp 026 to Bonnie K. Miller, Lower Allen Townshl Tax Collech 147.35
1706. 2008 Schl (026) to Bonnie K. Miller, Lower Allen Townshl Tax Collector 348,50
1307. Reluse - 4Ih Qlr to lower Allen Townshl Municl al Aulhoril POCS 55.50
1100. Total selllemenl char es entered on Ilnas 103, cecllon J and 502, cection K) 50,188.24 6,648.55
- uny raweweo cne nuu-1 Jet[lemenl 5nramant nntl to the Dssl of knowlatlge and belief, It a true am accurate statement o! all ra
and disbursements made on my a nl or Dy me In Ihis Iranaacllon. I funher ceniy Thal I have recei d coDY of HLD-1 $elllem Stale enl. J
T moth auD ~ gonna Berkheimer execulr ; of the Eslale of Archie F. Hammacher
To Ina bad f my knowledge,Jl+e D-1 Selllemenl Slalemenl whkh I have preparetl Is a True and accurate account or the lands which ware received and nave been or will b
disbursed bolhe undersjgrtEd pan of the battlement or this transacllon, // ~ g ~ sj
Gr,PROad SelUemfnl Services, LLC Dela
ELLER'S AtjDIbR PURCHASER'S STATEMENT Sallafs and Purohatefe signature hereon acknowledpsa hlMnelr approval of lax prorallons antl algnlfea Ihelr
nderalanyyldq Thal proraeona were based on lazes for the preceding year, or esllmales for Ina wrrenl year, antl In the event of any change br the current year, all necessary
adrys tints must Oa made between Seller and Purcnaber, IiNewise any delaull in Oalln4uenl taxes will ba reimbursed to Title Company Dy the Seller.
Title Company, In its capacity as ESUOw Apsnl, Is aM has been eulhorlxed to deposit all lunch II receives In this Irinbac6on In any 6nanUal Melllullon, wheNer
atflialed or not. Such BnanUal Insllludan may provide Tills Company computer accpunllnq and audit services directly pr Ihrouph a sepsrale entity whkn, Ir aelllaled with Title
Company, may charge the nnanGal Inslllullon reasonable and proper compensallon Iheralore and retain any pro6U Iherelrom. Any asuow fees Deid by any pony Involved In
This Irancacdon shall only be for checkwrllinq and Input to the wmpulers, Dui not for aloreaald accounting and audit services. 7rlla Company snail not De Gable for any Inleresl
r other Charges on Ne eameEl money and shall be under no duly la InvsA or reinvest IuMe held by II al any Ilma. SadlerE antl Purcnaaera hereby acknowledge antl rAnafinl
l0 Ina tlepoell or the escrow money In finanGal InslllullOna wlm which Tllle Company has or may nave other bankln9 relallonshlDa and lunher consent to the retention by Tllle
Company and/or its afnlialea or any end all bene0lb (IncludlnD atlvenlegeoua Inleresl raise on lOene7 Tllle Company antl/Or Its amllslea may receive Irom ouch tlnanclal
inblilullona py reason OI Iheir malnleMM of aaltl aaUOw accOUnla. ~~--J/-//~/"[~~~[Q~~
Pure acts/gr.owers ...-.-. ,. .,.-.. Sell ..._.... ,.-.,..,_.. ... ,...-...
Tlmol y F Gtr a arkhelmer execu riz of the Ea~lale of Archie F. Hammac er
Joh el, n L. Ruhsam '
WARNIN II Ise [rime to knowingly make false elalaments to \hs Unllatl Slnlea on Ihis or any other similar loan. Panalllea upon [onvlcllon tan Include a Ilna Bnl
imprisonmen For tlalails see'. Tills 16'. U.S. Cotle Secllon 1001 and $ecllan 1010.
SCHEDULE B
COMMONWEALTH OFPENNSVLVANIA STOCKS & BONDS
INHERfTANCETAXRETURN
RESIDENTDECEDENi
FILE NUMBER
ESTATE OF Hammacher, Archie F. ;?1 - 07 - os57
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE
OF DEATH
1 Prudential Financial, Inc. 98.71 5,231.63
TOTAL (Also enter on line 2, Recapitulation) 5,231.63
COMMONWEALTH OFPENNSYLVANIA
INHERfTANCETAXRETURN
RESIDENiDECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
ESTATE OF Hammacher, Archie F. 2.1 - 07 - 0657
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
NUMBER OF DEATH
1 Fulton Bank Checking Account 1,180.34
2 Lincoln Financal Insurance Group 1,300.00
3 Refund from Blue Cross and Comcast 687.14
4 Refund from Patriot News and AT&T 111.61
5 Refund from Blue Cross 572.00
• 6 2003 Honda Accord (sold) 9,000.00
7 1982 Ford Truck (sold) 500.00
8 Refund from IRS 1,369.00
9 Stimulas check from IRS 431.00
10 Cash found in house 600.00
11 Tools (sold) 270.79
12 1976 Honda 550--poor condition--not running 150.00
13 1981 Honda 750--poor condition--not running 200.00
14 Savings Bonds 256.93
15 Wood chipper (sold) 150.00
~ TOTAL (Also enter on Line 5, Recapitulation) ~ 16,778.81
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF FILE NUMBER
Hammacher, Archie F. 21 - 07 - 0657
If 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
Donna J. Berkhimer
q 2160 Sand Beach Road
Hummelstown, PA 17036 Sister
Archie Hammacher
g 5933 Linglestown Road
Harrisburg, Pa 17112 Father
JOINTLY OWNED PROPERTY:
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT [~~SCRJPTIOt~ ~F PR~~ERkTY
Includenameo Inanclal Instl u lonan an accountnumber
or similar identifying number. Attach deed forjointly-held real
estate.
DATE OF DEATH
VALUE OF ASSET % OF
DECD'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENTS INTEREST
1 A ~ 03/07/2003 Fulton Trust 16,902.04 50% 8,451.02
2 A 03/08/1994 Fulton Cheching Account 34,485.94 50% 17,242.97
3 B 10/01/2006 1986 Ford Dump Truck 1,000.00 50% 500.00,
TOTAL (Also enter on line 6, Recapitulation) 26,193.99
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TA%RETURN
RESIDENTDECEDENT
SCHEDULE H
AFU~NERA~L eD~EEN/S~~E~S-~&C
/'V./Ilw'N, , V'~~~.IV~ ~ V
FILE NUMBER
ESTATE OF Hammacher, Archie F. 21 - 07 - 0657
Debts of decedent must be reported on Schedule 1.
ITEM DESCRIPTION AMOUNT
NUMBER FUNERAL EXPENSES:
A. 1 Hoover Funeral Home 5,430.00
2 Luncheon 217.14
B. ADMINISTRATIVE COSTS:
1. PersonalRepresentative'sCommissions
Social Security Number(s) / EIN Number of Personal Representative(s):
StreetAddress
City State Zip
Year(s) Commission paid
2. Attorney's Fees Nora F. Blair, Esquire 2,500.00
3, Family Exemption: (If decedent's address is notthe same as claimant's, attach explanation)
Claimant
StreetAddress
City State Zip
Relationship of Claimantto Decedent
4. ProbateFees Cumberland Register of Wills 248.00
Cumberland County Bar Journal 75.00
Paxton Herald 38.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. CKherAdministrativeCosts
1 PPL Electric 579.83
TOTAL (Also enter on line 9, Recapitulation) 19,493.11
Schedule H
Funeral F~errlses &
COMMONWEALTH OF PENNSYLVANIA A~;n /+~,,,~,,, ~n~
INHERITANCE TAX RETURN /~XA' Y ~~OM7
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Hammacher, Archie F. 21 - 07 - 0657
2 Service Oil Company 603.27
3 Peerless Insurance--Homeowners Insurance 1,109.50
4 Lower Allen Township--trash 55.50 + + 55.50 - 6.22 (HUD-1) + 222.00 326.78
5 Bonnie K. Miller--Real estate taxes 1,632.51+562.47 + 1,322.71 + 147.35 + 346.50 - 3,013.09
998.45 reimbursed at settlement
6 Executor's Expenses (postage, mileage, etc.) 247.50
7 Settlement charges for sale of real estate (realtors commission, transfer tax, transaction 5,105.00
fee, certifications, other fees & repair credit)
Page 2 of Schedule H
COMMONWEALTH OFPENNSVLVANIA
INHERfTANCETAX RETURN
RESIDENTDECEDENi
SCHEDULEI
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
ESTATE OF Hammacher, Archie F.
FILE NUMBER
21 - 07 - 0657
Include unreimbursed medical expenses.
ITEM DESCRIPTION AMOUNT
NUMBER _
1 Fulton Bank-Mortgage 49,685.84
2 Fulton Bank--Visa 4,694.58
3 Fulton Bank Car Loan 6,878.30
4 Fulton Bank Installment loan 696.29
5 Fulton Bank Installment loans (2) 118.33 +2363.04 2,481.37
6 West Shore EMS 680.47
7 Lower Allen EMS 572.00
8 Spirit Physician Services 511.00
~ TOTAL (Also enter on Line 10, Recapitulation) ~ 66,199.85
REV-151? EX+ (9.00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hammacher, Archie F. 21 - 07 - 0657
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY Do Not List Trustee(s)
I TAXABLE DISTRIBUTIONS[includeoutrightspousal
~ distributions, and transfers
under Sec. 9116 (a) (1.2)]
1 Brandi L. Hammacher daughter One-half of the net
414 Brandy Lane estate
Mechanicsburg, PA 17055
2 Jessica L. Hammacher daughter One-half of the net
414 Brandy Lane estate
~ Mechanicsburg, PA 17055
Enter dollaramountsfordistributionsshown above on lines 15 through 18, as appropriate, on Re v 1500 coversheet
II NON-TAXABLE DISTRIBUTIONS:
I 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 SHEETI 0.00
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