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Home My WebLink About10-26-09 (3)REV 1500 1505607120 ~ r~ :: ~, .,~~ EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN 2 1 0 9 0 8 2 6 PO 80X.280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 185221952 07262009 Decedent's Last Name HOFFMAN (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Spouse's Social Security Number Date of Birth 01031913 Suffix Decedent's First Name MI MILDRED E Suffix Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ® 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death prior to 12-13-82) ^ 4. Limited Estate ^ ga. Future Interest Compromise ^ 5. Federal Estate Tax Return Required (date of death after 12-12-82) 1 ® 6 Decedent Died Testate ^ ~ Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) ^ 9. Litigation Proceeds Received ^ 10~ between l2 31 91 and;dat9e5jf death ^ 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 TO: ame Daytime Telephone Number GREGORY M KERWIN 7173623215 Firm Name (If Applicable) KERWIN & KERWIN First line of address 4245 ROUTE 209 Second line of address City or Post Office State ZIP Code ELIZABETHVILLE PA 17023 Correspondent's a-mail address: g m k e rw i n@ h o t m a i l. c o m Under penalties of perjury, I declare that 1 have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. eclaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge. SIGN~F~S~ESPO ISLE FOR FILING RETURN DATE yC ~ ~ Robert L. Kissinger ~ a,,,,,~/-~.~9 ADDRESS 25 East Broad S reet PO fox 574, Elizabethyille, PA 17023 SIGN R F PRE jR OTHER A PRESENTATIVE DATE ~~~~~L~~ "'~ Gregory M Kerwin ~~ ~r~..~~9 ADDR Ro~fte 209, Elizabethville, PA 17023 Side 1 1505607120 1505607120 REGISTER OF V.~LLS USE OI+,~( c ~.;, ~~ .~ ~ -~ ~ :. ~ ..-„~ __ I ' ~~' ~Vr~ ~~ V l .~' ;, , ..._, .~_~ ~ DATE D ~r, .. -~':i ..~ ,-r"7 ._~ t ~,.: i '13 7 - '-t ..I ))~ .../ ti-~~ i ' .~7 '~~-'"t 1 1505607220 .J REV-1500 EX Decedents name: H O FFMAN, MILDRED E Decedent's Social Security Number 1 8 5 2 2 1 9 5 2 RECAPITULATION 1. Real Estate (Schedule A) .......................................................................................... 1. 135,843.74 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. 389,989.15 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ................ 5. 2 5, 3 9 4 5 3 6. y p rty ) ^ Separate Billing Requested ............. Joint) Owned Pro a (Schedule F 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ............. 7. 551,227.42 8. Total Gross Assets (total Lines 1-7) ....................................................................... 8. 2 2, 9 7 7 0 0 9. ......................... Funeral Expenses 8 Administrative Costs (Schedule H) ................ 9. 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ................................ 10. 22,977.00 11. Total Deductions (total Lines 9 & 10) ...................................................................... 11. 5 2 8, 2 5 0 4 2 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. 528,250.42 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 at lineal rate X .045 16. 17. Amount of Line 14 taxable 5 2 8, 2 5 0 4 2 17 at sibling rate X ,12 . 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. Tax Due .................................................................................................................... . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 63,390.05 63,390.05 Side 2 1505607220 1505607220 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 - 09 - 0826 Hoffman, Mildred E STREET ADDRESS 355 Sporting Hill Road CITY Mechanicsburg STATE PA ZIP 17050 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 6 3 , 3 9 0.0 5 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3,169.50 Total Credits (A + B + C) (2) 3,169.50 3. Interest/Penalty if applicable - p. Interest E. Penalty _ _ Total Interest/Penalty (D + E) (3) 0.00 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) 60, 220.55 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) s 0 ~ 2 2 0 , 5 5 Make Check Payable to: REGISTER OF WILLS, AGENT -~ .,5.. 1 _ .q ~;4 n• ' '..~~' ° - - s' -,~ ~:,, ,yj ..,.. it :~ ~ rty,.~..ti~r.~ ~ - tY ~~~'',.,~~}n-.. _i!rmvw~~Gl~cs~s~rm+cwcx~..n ssr.a..Y,..p~,. ~.~,u:.w~~ ... rs'1~~~~~a#.'~fii?'v .d'- ~ .- ~:'.!*.. _..~~,r[fpd .. ~i~,. ~, irh 2 ri. .~ I~~;...av'.< ,,. ~ ~,,~.~"~~f~,~~ ~~~Cne~.~ae~- say ~^~arsfa ~ea.~~r-KSwr +?,~-~7'75~. . _G'' . kv~.;~~~~ 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 .................................................................................................................. ^ 0 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? ...................................................................................................................... ^ 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 Juty 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)]. 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. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS FILE NUMBER ESTATE OF Hoffman, Mildred E 21 - 09 - 0826 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM ' DESCRIPTION UNIT VALUE VALUE AT DATE OF NUMBER ~ _ _ _ _ _ DEATH 1 ~~, 9,022.427 shares Franklin Income Fund, Class A ~'~ 1.87 16,871.94 ~~ 2 ~ 25 Series E & EE United States Savings Bonds, see Inventory list attached ~ 118,971.80 hereto TOTAL (Also enter on line 2, Recapitulation) ~ 135,843.74 SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF Hoffman, Mildred E 21 - 09 - 0826 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 OF NUMBER DEATH 1 Checking Account #10001170 at Mid Penn Bank, 349 Union Street, Millersburg, PA 17061 4,280.93 2 Certificate of Deposit #302076359 at Mid Penn Bank, Millersburg, PA 45,018.35 3 Certificate of Deposit #310706628 at Mid Penn Bank, Millersburg, PA 111,531.05 4 Certificate of Deposit #310706629 at Mid Penn Bank, Millersburg, PA 37,613.92 5 Checking account #XXXXXXXXXX7933 at Wachovia Bank, N.A. 5,055.47 6 Checking Account #1606788509 at Susquehanna Bank, Elizabethville, PA 42,232.85 7 Certificate of Deposit #1299114032 at Susquehanna Bank, Elizabethville, PA 42,901.06 8 Certificate of Deposit #1606377925 at Susquehanna Bank, Elizabethville, PA 10,015.43 9 Account #0012 655 5020 at Bank of America, N.A., PO Box 407090, Fort Lauderdale, FL 11,882.02 10 Savings Account #0012 6489 2259 at Bank of America, N.A., Fort Lauderdale, FL 64,418.07 11 Cash in safe deposit box 15,000.00 12 One $1.00 United States Note Series 1917 40.00 J TOTAL (Also enter on Line 5, Recapitulation) I 389,989.15 SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hoffman, Mildred E FILE NUMBER 21 - 09 - 0826 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 Robert L. Kissinger 25 East Broad Street Brother q PO Box 574 Elizabethville, PA 17023 JOINTLY OWNED PROPERTY: ---- ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT I~F~SCRIPT.lOftlltC~F PRO~'ERTY Include name o financial Ins I u Ion an bank account number or similar identifying number. Attach deed for jointly-held real estate. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1 A 07/16/2009 2,091.381 shares American Funds valued at 30,680.56 50% 15,340.28 $14.67 per share 2 A 05/16/2008 Certificate of Deposit #10004770227 at 10,015.43 50% 5,007.72 Susquehanna Bank, Elizabethville, PA 3 A Certificate of Deposit #3333087 at Bank of 10,093.05 50% 5,046.53 America, PO Box 407099, Fort Lauderdale, Florida TOTAL (Also enter on line 6, Recapitulation) 25,394.53 SCHEDULE H FUNERAL E)CPENSES & COMMONWEALTH OF PENNSYLVANIA p/~''/'~' ~+ INHERITANCE TAX RETURN ~~~~TfW I IYE ~V~7~ RESIDENT DECEDENT FILE NUMBER ESTATE OF Hoffman, Mildred E 21 - 09 - 0826 Debts of decedent must be reported on Schedule I. ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT A. 1 I Hoover Boyer Funeral Home, Elizabethville, PA, funeral 2,722.00 B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip ~~ Year(s) Commission paid I 2. ~ Attorney's Fees Kerwin & Kerwin -- Gregory M Kerwin 3, '~ Fatuity Exemption: (If decedent's address is not the same as claimant's, attach explanation) !~ Claimant 19, 525.00 ', Street Address I, City State Zip ~, Relationship of Claimant to Decedent 4. II Probate Fees Register of Wills '~~ 5. ~ Accountant's Fees I 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 The Sentinel, Legal, Estate Advertisement 140.00 TOTAL (Also enter on line 9, Recapitulation) 22,977.00 Schedule H COMMONWEALTH OF PENNSYLVANIA Funeral SG'~S INHERITANCE TAX RETURN ~'111n1Sb'di~Ve Costs continued RESIDENT DECEDENT ESTATE OF Hoffman, Mildred E FILE NUMBER 21 - 09 - 0826 2 ~ Bank of America, account verification 3 Register of Wills, additional probate 4 ~ Reserved for closing costs 20.00 370.00 200.00 Page 2 of Schedule H REV-1613 EX+ (8-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Hoffman, Mildred E FILE NUMBER 21 - 09 - 0826 NUMBER RELATIONSHIP TO NAME AND ADDRESS OF PERSON(S) DECEDENT RECEIVING PROPERTY oo Not ust Trustee(s) SHARE OF ESTATE AMOUNT OF ESTATE (Words) ~ ($$$) I~ TAXABLE DISTRIBUTIONS [include outright spousal f i ib i d t ons, an rans ers str ut d under Sec. 9116 (a) (1.2)] 1 Robert L. Kissinger 'Brother Entire Estate 25 East Broad Street PO Box 574 Elizabethville, PA 17023 ', i i i ~! Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, 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