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Home My WebLink About10-19-091505607120 REV-1500 ~ (p~05) OFFICIAL USE ONLY PA Department of Revenue cwnry cotle year file Number Bureau of Individual Taxes INHERITANCE TAX RETURN Po BOX.28D601 2 1 0 9 0 510 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Data of Birth 198 07 3321 O5 11 2009 10 24 1919 Decedent's Last Name Suffix Decedent's First Name MI BSTZ HBNRY G (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffuc Spouse's First Name MI Spouse's Social Secudry Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW X 1. Odginal Retum ~ 2. Supplemental Realm 3. Remainder Rehm (date of death pdor to 12-13-92) 4. Limited Estate qa. Pwure Interval compromise ~ 5. Federal Estate Tax Rehm Required (Gale or tleaM aver 12-12-82) X g. DeceGenl Diet TeRa1e ^ T DecetleM MaMeinetl a Livirg Tvsl (At1aM Copy of WII) (At1aCi Copy Pt TrubYJ 8. Total Number Of Safe DepO81f BoxeB 9. Lltigadan Proceeds Received ~ 10. Spousal Povenv Cretlit lmle d tleem ~ trotween 1231-91 entl f-1-95) 11. Elecgon to taz under Sec. 9113(A) (AltaCh Sch. 0) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JOSL O. SBCHRIST BSQ. 717 938 3396 Firm Name (If Applicable) J08L O. SSCHRISTa ATTORNSY REGISTER OF ILLS USE Y ~~ -1-) , .v _ ,~ First Ilne of address i':-i Ti O ' r ~~ 566 OLD YORK ROAD tr.~ -1 '.rri _i n1r~t ~ z:~;_7 Second tine of address ~ -~ ~ _~, _~ 1 ~~ cl p - ~ -)C_. DATE Fll~ _ a ~ ` 1 City or Post Office Sfate ZIP Code ~ ~ "~ v t ETTSRS PA 17319 ~ Correspondent's e-mail address: SBChrlatlaW~gnlall.COm Untler penalties of perjury, l tledare that I have examined this rehm, indutling acwmpanying schedules and statements, and to the best of my knowledge antl belief, It Is bue, certect and camplele. Dedaretigp M preparer other than the personal reDresenteuve is based On all information of which mreoarer has env knaelxlna `Y ~`+~ f . ~~2/~ Robert EAnderson ~~ - /S- O 9 ss South E ola Dri , Enola PA 17025 IGNA RE P RER 0TH THAN REP ENTATI DATE Joel O. Sechrist Esq. ~ D / ~ ~ 9 /~68 Old York Road, Etters, PA 17319 Side 1 1505607120 1505607120 ~ ,\~ \D' `~ ~~ o~ ~ '~~ CTS ~~\`~e9'~`~ ~~ ~~ PA Inheritance Tax Return Signature of Additional Fiduciaries ESTATE OF I 1i-09-05 OBER 1 Betz, Henry G Under penalties of perjury, I declare that 1 have examined this return, including accompanying schedules and statements, and to the Vest of my knowledge and belief, it is true, correct and complete. Deelaretion of preparer other than the personal representative is based on all information of which preparer has any knowledge. Signature #2 Name Addressl Addressl City, State, Zip David B Emey 480 Paddletown Road Date 1505607220 REV-1500 EX Decedent's Social Security Number o~aern~s Name: Henry G Betz 198 07 3321 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. 5. Cash, Bank Deposhs & Miscellaneous Personal Property (Schedule E) ............... . 5. 9 , 5 4 9 . 2 2 6. Jointty Owned Property (Schedule F) ~ Separate Billing Requested ............ . 6. 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested ............ . 7. B. Total Gross Assets (total Lines 1-7) ...................................................................... . 8. 9 , 5 4 9 . 2 2 9. Funeral Expenses & Administrative Costs (Schedule H) ........................................ . 9. 2 , 4 0 0 . 0 0 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. .. 10. 1 4 2 , 4 6 7 . 0 0 t 1. Total Deductions (total Lines 9& 10) .................................................................... .. i 1. 1 4 4, 8 6 7. 0 0 12. Net Value of Estate (Line 6 minus Line 11) ........................................................... .. 12. - 1 3 5 , 3 1 7 . 7 8 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 3 5 , 3 1 7 . 7 8 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 .o0 0. 0 0 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate X .045 0. 0 0 16. 0. 0 0 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 16. 0. 0 0 19. Tax Due ..................................................................................................................... 19. 0 . 0 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 L 1505607220 1505607220 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-09-0510 DECEDENTS NAME Henry G Betz STREET ADDRESS 801 North Hanover Street CITY Carlisle STATE PA ZIP 17013 Tax Payments and Credits: 1, Tax Due (Page 1 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 0.00 0.00 Total Credds (A + g + C) (2) 0.00 3. InteresUPenalty'rf appliceble p. Interest E. Penaby Total InteresVPenalty (D + E) (3) 4, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (q) Check box on Page 2 Llne 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) 0.00 A, Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) ~ , ~ ~ Make Check Payable to: REGISTER OF W/LLS, 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 b. retain the right to designate who shall use the property transferred or its income :.................................... x c. retain a reversionary interest: 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 properly within one year of death without receiving adequate censideration7 ....................................................................................................................... ~ 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 procerty which For dates of death on or after Juy 1, 2000: The tax rate imposed on the net value of trensfers 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 lrensfen: 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-1608 EX+ JB-88) COMAIONN£FLTH OF PENNBYLVFNW INHERRPNCE TPX RENRN RE8IDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Betz, Henry G 21-09-0510 i~aDae kre praceeda m iniaero~„ha sx mle me pr«wd: wan receives cr kre a:lxe. All property JolnayawnM vam the fight of survNOnhip nRnt M dleelowd on whedula F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Blue Cross refund 120.83 2 Cash 1,740.00 3 Cash from Church of God account 2,081.32 4 Church of God Home refund 152.28 5 Fulton Bank checking account 5.454.79 TOTAL (Also enter on Line 5, Recapitulation) I 9,549.22 (If more space is needed, addttional pages of the same size) Copyright (c) 2002 form software ony The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) REV-1161 EX4 n=-89) SCHEDULE N COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES ~ IN RE3 DENTEDECE~ENT N ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Betz, Henry G 21-09-0510 Debts oT decedent must be reported on Schedule L ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: William E. Little Funeral Home 1,082.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Robert E Anderson David B Erney Social Security Number(s) / EIN Number of Personal Representative(s): Street Address 568 Old York Road Ciry Etters State PA Zip 17319 Year(s) Commission paid 2009 See continuation schedule(s) attached 2. Attorney's Fees Joel O. Sechrist Esq. 3. Famiy Exemption: (If decedent's address is not the same as Gaimant's, attach explanation) Claimant Street Address City State Zip _ Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparers Fees 7. I Other Administrative Costs TOTAL (Also enter on line 9, Recapitulation) I 2,400.00 500.00 750.00 68.00 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 Betz, Henry G FILE NUMBER 21-09-0510 ITEM NUMBER DESCRIPTION Personal Representative Commissions David B. Erney Executors fee 2 Robert E. Anderson Executors fee H-61 SuMofal AMOUNT 250.00 250.00 500.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1513 EXa (6-M) SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COM.UNWEALTN oc vENNSnvnNu INHERRANDE TAX RENRN RE81DENi OEDEDENr ESTATE OF FILE NUMBER Befz, Henry G 21-09-0510 NGUde unnlmbunnM metlleel eXpenses. (K more space is needed, adtlitianal pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV-161] EXa je-0O) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA INHERITANCE TA%RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Betz, Henry G 21-09-0510 NUMBER NAME AND ADDRESS OF RELATIONSHIP TO DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE PERSON(S) RECEIVING PROPERTY (Words) ($$$) Do na ua Truaee . I TAXABLE DISTRIBUTIONS [include outright sppoousal distributions and Vansfers under Sec. ~116(a)(1.2)) See attached schedule Total Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropri ate, on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Fonn PA-7500 Schedule J (Rev. 6-98) SCHEDULE J BENEFICIARfES (Part I, Taxable Distributions) ESTATE OF: Henry G Betz O5H1/2009 198-07-3321 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) 1 Raymond F Anderson Nephew one sixteenth 5145 Susquehanna Trial York, PA 17402 2 Richard L Anderson Nephew one sixteenth 7 Reynolds Avenue Mont Alto, PA 17237 3 Robert E Anderson Nephew one sixteenth 122 South Enola Drive Enola, PA 17025 4 Ronald G Anderson Nephew one sixteenth 361 Rohlers Church Road Dover, PA 17315 5 George D Betz Jr. Nephew one sixteenth 1979 Brenda Road York, PA 17406 6 Wendy Betz Niece one sixteenth 5502 Long Leas Drive Wichita Falls, TX 76310 7 Sandra Burk Niece one sixteenth 2479 Sweet Gum Circle York, PA 17406 8 Ruth Camerlin Niece one sixteenth 725 Cly Road York Haven, PA 17370 9 David B Erney Nephew one sixteenth 460 Paddletown Road Etters, PA 17319 10 Donna Fink Niece one sixteenth 465 Miller Road York Haven, PA 17370 11 David Frye Nephew one sixteenth 308 Stone Row Lane New Cumberland, PA 17070 1 SCHEDULE J BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Henry G Betr 05/11/2009 198-073321 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) 12 Esther Haskins Niece one sixteenth 2700 Emerold Street Roswell, NM 88203 13 Tina Rinker Niece one sixteenth 1625 SR 174 Grand Coulee, WA 99133 14 John Rohler Nephew one sixteenth 2904 South Lea Avenue Roswell, NM 88203 15 Paul Smyser Nephew one sixteenth P.O. Box 224 Duncannon, PA 17020 16 Roxanna Spangler Niece one sixteenth 700 Andersontown Road Dover, PA 17315 2 LAST WILL AND TESTAMENT OF HENRY G. BETZ I, HENRY G. BETZ, of Newberry Township, York County, Pennsylvania, being of sound mind and memory, do make, publish and declaze this my Last Will and Testament, hereby revoking and making void any and all wills by me heretofore made. FIRST: I order and direct that all of my just debts and funeral expenses be paid by my hereinafter named Co-Exec-~tors as soon after my death as may be found convenient. SECOND: To my sister, CATHERINE ANDERSON, I give the sum of Ten Thousand ($10,000.00) Dollars provided that she survives me. In the event that she fails to survive me, the bequest provided for in this Pazagraph SECOND shall lapse. THIRD: I direct that all the rest, residue and remainder of my estate, real, personal and mixed, of whatever nature and wheresoever situate, which I may own or have the right to dispose of at the time of my death be divided equally among those of my nieces and nephews who survive me. The share of any individual provided for in this Pazagraph who predeceases me shall lapse. FOURTH: I hereby nominate, constitute and appoint my nephew, ROBERT E. ASDERSON, and my nephew, DAVID B. ERNEY, as Co-Executors of this, my Last Will and Testament, and I do direct that ao bend shall be required of such Co-Executors hereunder. My said Co-Executors shall have full power at their discretion to do any and all things necessary for the complete administration of my estate, including the power to sell at public or private sale and without order of Court, any real or personal property belonging to my estate, and to compound, c Henr~ et f '~ compromise or otherwise to settle or adjust any and all claims, charges, debts and demands, whatsoever, against or in favor of my estate, as fully as I could do if living. In the event that either of my aforementioned Co-Executors should not survive me or fails to qualify, then the other shall serve as my sole Executor. IN WITNESS WHEREOF, I, HENRY G. BETZ, the above Testator have set my hand and seal to this my Last Will and Testament, which consists of tw~o~(2) ppalges, to each of which I have affixed my signature this ~ 5 ~-day of ~ C' / " V ""- , 2002. .~~~r. Henry G. Betz Signed, sealed, published and declazed by the above named Testator as and for his Last Will and Testament, in the presence of us, who at his request and in his presence and in the presence of each other have hereunto subscribed our names as witnesses. rv~»~/d i~ ww-~ 2 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CV//1 ~(,IZL~d`'Y I, HENRY G. BETZ, the testator whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. Swo d acknowledged before me by Henry G ~ ~ , ~ooz. Betz, the testator, this v2 ~~ day of ~4 ~~-- %a Henry G. Betz NOTARIAL SEAL SUE A. CLAIR, Notary public Lower Atlen Twp., CumbarisrxJ Co., PA My Commission Expires Dec. 28, 2002 COMMONWEALTH OF PENNSYLVANIA COUNTY OF e~h'IIjC`'~~-/~-^~IQ We, Joel O. Sechrist, and ~ V ~ ~ ~/ C ~ ~ yS~ D~ ~ ,whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the testator sign and execute the instrument as his Last Will; that the testator signed willingly and executed it as his free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight ofthe testator signed the will as a witness; and that to the best of our knowledge the testator was at that time 18 or more yeazs of age, of sound mind and under no constraint or undue influence. Swom to and subscribed to before me by Joel O. Sechrist and C -Z (4 / S{~¢ R (= ,witnesses, this ;~ f77d day of (~ C-~ ~ Q Witness: vf~N 2002. Witness: r ~-~ ~. NOTARIAL SEAL SUE A. CLAIR, NMary Public Lower Allen Twp., Cumberland Co., PA My Commission E~irea Dec. 28, 2()02 4 September 4, 2009 Joe10. Sechrist 568 Old York Road Etters, Pennsylvania 17319 Dear Mr. Sechrist: RE: Henry G. Betz, deceased May 11, 2009 In response to your recent inquiry concerning the accounts maintained in the name of the decedent, please be advised that the following accounts were open at the date of death: --------Checking # 0004-31729, open 2/1/1979, date of death balance $5,454.44 (any accrued interest ($ .19) would not have been payable had the account been closed on the date of death) in his name only with Robert E. Anderson as Power of Attorney. If you should have any fiuther questions, please do not hesitate to contact me at (717) 291-2437. Very truly yours, Kazen D. Hillegas Credit Inquiry Processor a ~,. r i ~F o ~ ~; - _ ~~ _. e-.~ a5a,e a.[,e.~: w L,~~::~.> 4'r/1'fiGL"i rl~i.,z Exhibit to Schedule E P O Box 4887 Lancaster, PA 17604 fultonbank.com ~ 1-800-FULTON-4 COMMONWEALTH OF PENNSYLVANL4 DEPARTMENT OF PUBLIC WELFARE BUREAU OF FINANCIAL OPERATIDNS DNISION OF THIRD PARTY LVIBILITV ESTATE RECOVERY PROGRAM PO BOX 8486 HARRISBURG, PA i]105A486 May 21, 2009 SECHRIST LAW OFFICE JOEL 0 SECHRIST ESQUIRE 568 OLD YORK RD ETTERS PA 17319 Re: HENRY BETZ CIS #: 900188940 SSN: 196-C7-3321 Date of Death: 05/11/2009 Dear Attorney Sechrist: Please be advised that the Department of Public Welfare maintains a claim is for restitution of medical assistance granted on behalf of the decedent for which the Probate Estate is now responsible to reimburse the Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's itemized statement of claim. A portion-of this medical expense, namely $27,498.43, was incurred during the last six months of the decedent's life; therefore, it is a Class 3 claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $114,939.92, is to be entered as a priority Class 5.1 claim against the estate. Please acknowledge receipt of this letter and advise whether the Commonwealth's claim is admitted and when payment may be expected. If the estate accounting is complete, please provide a copy. 2£ the estate contains real estate, please provide copies of the deed, the latest tax assessment, and a current appraisal, i£ available. Sincerely,~T1~y I{1_- Elizabeth M. Wilson TPL Program Investigator 717-219-1868 717-772-6553 FAX Enclosure cc : Robert E Anderson - ~ - --. 122 E Enola Dr _ - - .. ...-- Enola PA 17025-2711 Exhibit to Schedule I II O ^ 6. o T O (~ Ib V• N W T ^ p U h4Q~~ ~QOd l` ~ u~ n LL ~ d N W mod. O - ~( T Pip c S^'1Mn O o ._~ ..._..,...p~n `.; N M ~1 r N Id O ~ p r r-I b' •.I V] 3~~ wNa o ~ o H ,~ N N +~ .-I +~ N N N ~ •rl •.~ O ~ tr~ U N v ro fx .- U Joel O. Sechrist, Esquire Attorney at Law 568 Old York Road Etters PA 17319 717 938-3396 Facsimile 717 938-9613 October 16, 2009 Cumberland County Register of Wills 1 Courthouse Squaze Cazlisle, PA 17013 Estate of Henry G. Betz 21-09-0510 Deaz Register: Enclosed aze two copies of the inheritance tax return and a check for $15.00 for the filing fee, all in regazd to the above estate. V truly yo , oel O. Sechrist o -;f?<< ,n ~ C~ O ~ t °~ j ~ `' ~ ~ ~ ~ .. is -`~r~ ' ~ % C .. ~1 .. G - j n „-, '... A> _~ ~ W ~ v .