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Home My WebLink About05-04-091505607120 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 80X.280601 2 1 0 8 0 8 4 6 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 08 01 2008 12 31 1927 Decedent's Last Name Suffix Decedent's First Name MI HERR STEPHEN L (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 X 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate qa. Future Interest Compromise 5. Federal Estate Tax Return Required (date of death after 12.12-82) X - 6 Decedent Dietl Testate I ~ Decedent Maintained a Living Trust O 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received 1 p, spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A) _. : between 12-31-91 and 1-1-95) (Attach Sch. ~) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATfON SHOULD BE DIRECTED TO: Name Daytime Telephone Number MARCI S. MILLER 717 540 4332 Firm Name (If Applicable) HAZEN ELDER LAW First line of address 2000 LINGLESTOWN ROAD Second line of address SUITE 202 City or Post Office State ZIP Code HARRISBURG PA 17110 REGISTER OF WILLS US~NLY c~ c? n ~ l TP n -.,{ ~~ I <<_ ,~ ~_ = c;; I 1 !-F'j ~ ~ I _ _ ;~ ~ DA _ LED ~,y ,- r , ~, 0 _~? -; ~~ ~~~ ~_ 7 i 'i _ .,~ _~ 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 antl belief, it Is true, correct and complete. Declargtion of preparer other than the perso tative Is based on all information of which preparer has any knowledge. Judith E. Dress 126 Lancaster d., Mechanicsbur , PA 17055 SIG ATUR F REP THER THAN REPRESENTATIVE DATE ~ ~~~~ J-~--~ Marci S. Miller ,C fly ~ ~~ q 2000 Linglestown Rd., Harrisburg, PA 17110 Side 1 1505607120 1505607120 1` 1505607220 REV-1500 EX Decedent's Social Security Number oeceaenrg Hama: Stephen L. Herr ____. RECAPITULATION 205,000.00 1. Real Estate (Schedule A) .......................................................................................... 1. 2. 4,624.82 2. Stocks and Bonds (Schedule B) ............................................................................... 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3. 4. Mortgages & Notes Receivable (Schedule D) .......................................................... 4. 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ................ 5. 3 9 , 9 6 6 6 1 6. Jointly Owned Property (Schedule F) L_ 1 Separate Billing Requested ............. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested ............. 7. 4 0, 4 3 1 5 9 8. Total Gross Assets (total Lines 1-7) ....................................................................... 8. __ 2 9 0, 0 2 3 0 2 __ __ 9. Funeral Expenses 8 Administrative Costs (Schedule H) ..................... ......... 9. 2 3 , 3 4 9 7 8 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................... . 10. 2 4 , 4 2 4.13 11. Total Deductions (total Lines 9& 10) ..................................................................... . 11. 4 7, 7 7 3 9 1 12• Net Value of Estate (Line 8 minus Line 11) ............................................................ . 12. 2 4 2 , 2 4 9 . 1 1 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. 2 4 2 , 2 4 9 1 1 --_ __ _ _ 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 .00 16. Amount of Line 14 taxable at lineal rate X .045 2 4 2, 2 4 9. 1 1 16, 1 0 9 0 1. 2 1 r 17. Amount of Line 14 taxable at sibling rate X .12 0. 0 0 17. 0. 0 0 18. Amount of Line 14 taxable at collateral rate X .15 0. 0 0 18. 0. 0 0 19. Tax Due ..................................................................................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. l0,9o1.z1 Side 2 15D5607220 150560722D J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-08-0846 Stephen L. Herr _ _ _ _ -_ -_ _ STREET ADDRESS 350 Willow Ave. CI1 Y -- - _. _ _- - ---- '; STATE .ZIP Camp Hill ~ PA 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments 1 1,000.00 C. Discount 545.06 Total Credits (A + B + C) 3. InteresUPenalty if applicable p. Interest E. Penalty _ -_ _ Total InteresUPenalry (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. (1> 10,901.21 _ ___ (2> 11,545.06 (3) (a> 643.85 (5) (5A) (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 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 j .- b. retain the right to designate who shall use the property transferred or its income :.................................... x c. retain a reversionary interest; or .................................................................................................................. _' xl 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 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)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 zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exemat 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)]. 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)J. 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. Rev-1802 EX+ (8.98) COMMONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF (FILE NUMBER Herr, Stephen L. 21-08-0846 All real property owned solely or as a tenant In common must be reported at felt 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 buy or sell, both having reasonable knowledge of the relevant facts. Real property which Ia Jolntlyowned with 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 A (Rev. 6-98) Rev-150 EX+ (8-98) SCHEDULE B STOCKS 8~ BONDS COA,Y,tONWEALTH OF PENNSYLVANIA I INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Herr, Stephen L. 21-08-0846 All property jointly-owned with right or survivorship must be disclosed on Schedule F. !TEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 481 shares of Sovereign (formerly Waypoint) Stock 9.615 4,624.82 TOTAL (Also enter on Line 2, Recapitulation) 4,624.82 (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 B (Rev. 6-98) Rev-1608 EX+ (8-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONYVEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Herr, Stephen L. 21-08-0846 InUude 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 VALUE AT DATE OF DEATH 1 Refund from State Farm Insurance -for car insurance premium 59.84 2 Refund from State Farm Insurance -for homeowners insurance premium 78.44 3 PNC Checking Acct. #50-0464-2898 1,254.06 4 PNC Money Market Acct. #50-0443-1206 6,676.36 5 PSECU Checking Acct. #0201 2,128.78 6 Sovereign Bank Checking Acct. #2331048002 632.92 7 2002 Buick Park Avenue - as per attached Kelley Blue Book valuation 8,475.00 8 MetLife Insurance IRA Annuity #A2052696 - Estate of Stephen Herr, Sr., beneficiary 3,886.48 9 MetLife Insurance Nonqualified Annuity #A2052527 - Estate of Stephen Herr, Sr., 8,769.24 beneficiary 10 MetLife IRA Annuity #A2052528 -Estate of Stephen L. Herr, Sr., beneficiary 8,005.49 TOTAL (Also enter on Line 5, Recapitulation) I 39,966.61 (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) Rev-1510 EX+ (8-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COAMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Herr, Stephen L. 21-08-0846 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER THE DATE OF RANSFER.SATTACH AHCOPY OF TIHOE DEED OR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 PNC IRA #0043713098 -Judith Dress, daughter 25,835.94 100.000 25,835.94 and beneficiary 2 Gift to Judith Dress, daughter -gifted in July, 10,000.00 100.000 3,000.00 7,000.00 2008 3 Ameriprise Financial -Mutual Fund Acct. 4,333.84 100.000 4,333.84 #010122235822002 - TOD to Judith Dress, daughter 4 M8~T Bank Checking Acct. #42498635 - -owner, 3,261.81 100.000 3,261.81 Stephen L. Herr 8~ Doris Herr Revocable Trust, Agreement dated Oct. 17, 2001 TOTAL (Also enter on Line 7, Recapitulation) 40,431.59 (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. 6-98) REV-1151 Ex+ (12-99) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES ~ IN RES DENTEDECEDENTRN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Herr, Stephen L. 21-08-0846 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A, FUNERAL EXPENSES: See continuation schedule(s) attached I 13,827.15 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid 2, Attorney's Fees Hazen Elder Law 7,000.00 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 Register of Wills, Cumberland County 380.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 332.00 7. Other Administrative Costs 1,810.63 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 23,349.78 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Herr, Stephen L. 21-08-0846 ITEM AMOUNT NUMBER DESCRIPTION Funeral Expenses 1 Hollinger Funeral Home 2 Larry Veno -funeral wreaths 13,719.56 107.59 H-A subtotal 13,827.15 Other Administrative Costs 3 A&D Reisman -yard maintenance 826.00 4 Borough of Camp Hill -sewer 122.09 5 Cumberland Law Journal -Estate Notice 75.00 6 Leon Gerlach, Certified Real Estate Appraiser -real estate appraisal fee 325.00 7 Penn American Water 58.75 8 Penn Waste Inc. 48.75 9 PPBL Electric 134.50 10 Register of Wills -filing fee for Inventory and Inheritance Tax 30.00 11 The Sentinel -Estate Notice 190.54 H-B7 Subtotal 1,810.63 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev? b12 EX+ (g.88) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Herr, Stephen L. 21-08-0846 Include unrelmbuiaed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 ADM Electrical Services, Inc. - Repair of a ectrical service at decedent's real 925.00 property 2 Ambulance Transport - -medical expense',. 116.03 3 Basement Services 911 - Repair of walls it~ basement of decedent's real property 13,400.00 4 Bethany Village - -skilled nursing care, de~edent resided here immediately prior to 4,116.00 death !, I 5 II Borough of Camp Hill -Sewer I 58.04 6 II Continuing Care Rx -Medical costs i 1,280.53 7 Cumberland Crossings -final assisted livi~g bill, decedent resided here prior to 1,685.00 receiving skilled care at Bethany Village I 8 Goodwill EMS - -medical expense ~I 114.30 9 Penn American Water '~, 17.13 10 Philhaven - -doctor visit II 100.92 11 SERS - re a ment of Au ust ension the k pY g p 825.93 12 Shipley Energy II 429.80 13 State Farm Insurance -car/homeowners i~surance premium 120.00 14 United States Treasury - 2008 personal in~ome tax 1,143.00 15 Verizon -final bill ', 92.45 To~al of Continuation Schedule See attached page TOTAL (Also enter on Line 10, Recapitulation) 24,424.13 (If more space is needed, additi nal pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) _ _ REV•1517 EX+ (9.00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER Merr, Stephen I_. 21-08-0 846 NUMBER NAME AND ADDRESS OF RELATIONSHIP TO DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE PERSON(S) RECEIVING PROPERTY (Words) ($$$) Do Not List Trustee s I~ TAXABLE DISTRIBUTIONS [include outright spousal distributions and transfer , under Sec. 9116(a)(1.2)] Judith E. Dress ~ Daughter 100% of Estate 126 Lancaster Blvd. Mechanicsburg, PA 17055 Total Enter dollar amounts for distributions shown above on fines 1 5 through 18, as appropri ate, on Rev 1500 cove r sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 91 3 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE ANO GOVERNMENTAL DISTRiBUT ONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DIS RIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 vuNynyrn tc~ cuuc wnn sonwate onry 1 ne LaCKner hrOUp, Inc. Form PA-9500 Schedule J (Rev. 6-98) I~[AZ~v F~.n~ L.AW An Estate Planning and Elder Law Firm 2000 langlestown Road, Suite 202 Harrisburg, PA 17110 Ta.: (717J 540-4332 Fax: (717) 540-4313 CERTIFIED MAIL Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013-3387 Re: Estate of Stephen L. He File No.: 21-08-0846 Social Security No.: 16 Inheritance Tax Return To: The Register of Wills: 1, 2009 www HazenElderLaw.com Marielle F. Hazen, CELA* Marti S. Miller, Associate n C ~ .o . ~ . ~ , , ~ ~ _ - `~~ f J : 1._. ~~ N ~ : i ---r A - ~ Q Enclosed for filing please find th original and one copy of the above-referenced Inheritance Tax Return and Inventory, along with a copy of the first page of the Inheritance Tax Return. Please date sta p the first page of the return and a copy of the Inventory and return them to my office i the enclosed self-addressed envelope. Also enclosed is a check for the If you have any questions or hesitate to contact me. fee in the amount of $30.00. ire any additional information, please do not Sincerely, Corinne Eggers Woodhouse Paralegal Enclosures cc: Judith Dress, Exec. "Certified Elder Law Attoraey by the National Elder LaW Foundation as authorized by the F~nnsyluania Supreme Court I C ~ tom. U ~~ ` - r ~ -,~ '\ a~~ a ~ ~ _~x r~ y~ 4 i ~ `{ . `'' ~ O ~~ u. a " ,~ N !i`~:31 6 ~ ~ `~ -., ~5~311Nn ~ : > a ., o ~--- ~ +rn ,~- -~ ~ ~- _- o o o ~- ~---- ------ o o •----- _' u-1 ____------ o ~= ~- ~ ....~ lr~~ LIIJ ~,u I ~a l 2Q09 MAY -4 P~ 42~ 4 i vrtFN~'' ~ 1 ~.,.__ N O N ~ O ~ r-, a ~ ~ Q~a W o ~ ~~ W ~ •~ d xox 0 0 N F O O ~ 0~0 U ~ M ~ ~ M ~~~ o ~ o ~U ~~ 0 o ~ ~ a ~ ~ '" '~ o a~ ~ N.~U.~ •~~~~ ~ U O U