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Home My WebLink About12-30-09 (3)J REV-1500 1505607120 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN 21 0 9 0 0 6 2 0 PO BOX.280601 Harrisburg, PA 1712s-osol RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 219076556 06202009 04261922 Decedent's Last Name Suffix Decedent's First Name MI HIZER ANNA R (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 Retum ^ 3. Remainder Return (date of death prior to 12-13-82) ^ 4. Limited Estate ^ qa, Future interest Compromise ^ 5. Federal Estate Tax Retum Required (date of death after 12-12-82) ® 6 Decedent Died Testate ^ ~. A° n"~ceco aintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) ( py of Trust) ^ 9. litigation Proceeds Received ^ 1 p. Spousal Poverty Credd (date of death ^ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach SCh. 0) -CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: name Daytime Telephone Number DEBRA R. WALLET 7177371300 Firm Name (If Applicable) LAW OFFICES OF DEBRA R. WALLET First line of address 24 NORTH 32ND STREET Second line of address City or Post Office CAMP HILL 79 Hilldale Drive, Ephrata, PA 17522 State ZIP Code PA 17011 r.~ t~LLS USC~NLY`~" REGISTER'S . _' ~ l`~~~n r~ t7 t' U ,~, r-- . `-~ ~~ O F -n C~ ~ -r-1 3IG r~ C ~ ~„-.. . ~ DBE FILED ::`j' ...~ ,, '~; "~ _Y ;` € :_ _; ~,:, 7 `_;t r'r-, "~? -+ a SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ~~N+.• 1[. i>,J~+~+w' Debra K. Wallet ~Z~?,2,loe~ ADDRESS 24 North 32nd Street, Camp Hill, PA 17011 Side 1 L 1505607120 1505607120 J ~"i Corrsspondent'se-mailaddress: walletdebr~aol.com Under penaltles of perjury, I dedare that I have examined this return, inGuding accompanying schedules and statements, and to the best of my knowledge and belief, R is true, correct and complete. DeGaraGon of preparer other than the personal representative Is based on all information of which preparer has any knowledge. 1505607220 REV-1500 EX Decedent's Social Security Number oeceuenrs Name: H I Z E R, ANNA R. 219 0 7 6 5 5 6 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 Deposits 8 Miscellaneous Personal Property (Schedule E) ................ 5. 3 2 , 2 5 5.31 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............. 6. 10 0 , 6 0 8 . 7 2 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ............. 7. 8. Total Gross Assets (total Lines 1-7) ....................................................................... 8. 13 2 , 8 6 4 . 0 3 9. Funeral Expenses & Administrative Costs (Schedule H) ................................ ......... 9. 7 , 7 6 1 . 9 0 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ....................... ......... 10. 1 , 3 6 9 . 0 0 11. Total Deductions (total Lines 9 & 10) ............................................................. ......... 11, 9 , 13 0 . 9 0 12. Net Value of Estate (Line 8 minus Line 11) ................................................... .......... 12. 12 3 , 7 3 3.13 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. 12 3 , 7 3 3.13 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 12 3 , 7 3 3.13. 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. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505607220 1505607220 5,567.99 5,567.99 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 - 09 - 00620 Hizer, Anna R. STREET ADDRESS 100 Mt. Allen Drive CITY Mechanicsburg STATE PA ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 4,000.00 210.53 (1) 5,567.99 Total Credits (A + B + C) (2) 4, 210.53 3. Interest/Penalty if applicable p. Interest E. Penalt)r Total InteresUPenalty (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) 1, 357.46 q. Enter the interest on the tax due. (5A) g. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) ~ , 3 5 7.4 6 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 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 property within one year of death without receiving adequate consideration? ....................................................................................................................... ^ ^x 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. ~~l~T.. --~- - - - - } ; --~ fz p. . 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 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 Juy 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 iwelve (12) percent p2 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. coMMONwEn~ni of PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DEC W ENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER ESTATE OF Hizer, Anna R. 21 - 09 - oos2o 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 Wachovia Bank acct. #1010049618798 30,562.45 2 Refund of Blue Cross/Blue Shield premium 591.40 3 Independence Blue Cross payment -refund of supplemental insurance 1,068.00 4 Lancaster Emergency Associates -patient credit 33.46 5 No personal items -only clothes (in skilled nursing) 0.00 6 No cash in possession of Decedent (in nursing home) 0.00 ~ TOTAL (Also enter on Line 5, Recapitulation) ~ 32,255.31 i SCHEDULEF COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hizer, Anna R. FILE NUMBER 21 - 09 - 00620 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 Nancy H. Weimer 713 Alberta Avenue Daughter A Mechanicsburg, PA 17050 JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT Include name o~Tina vial I~OSiITUtIOrlPanpd bank account number or similar identi in number. Attach deed for'ointl -held real ~ 9 I y estate. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST _ 1 A 09/18/2007 Citizens Bank acct. #6224557474 190,111.40 50% 95,055.70 2 A 09/18/2007 Citizens Bank acct. #6224557466 I I i 11,106.04 ' 50% 5,553.02 TOTAL (Also enter on line 6, Recapitulation) 100,608.72 SCFEDI~E H FI~Ef~L D~EIVSES 8~ coMMONwEUTrI of rENNSV~vANia w^ ~~~~Q*~w ~/~ INHERRANCE TAX RETURN ~'Y~17~~7'I IY111Yr ~~ RESIDENT DECEDENT FILE NUMBER ESTATE OF Hizer, Anna R. 21 - 09 - 00620 Debts of decedent must be reported on Schedule L ITEM AMOUNT NUMBER FUNERAL EXPENSES: DESCRIPTION A. 1 Toppitzer Funeral Home 697.38 2900 State Road, Drexel Hill, PA 19026 2 ,Arlington Cemetery 210.00 3 Casey's Restaurant (funeral luncheon) 1,368.78 B. 1 2. 3. 4. 5. 6. 7. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Soaal Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid Attorney's Fees Debra K. Wallet, Esq. 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 Probate Fees Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs Clarke American (estate checks) 5,000.00 400.00 55.74 TOTAL (Also enter on line 9, Recapitulation) 7,761.90 G ~Sdied~ie H p COMMONWEALTH OF PENNSYLVANIA ~ ~p « INHERITANCE TAX RETURN ~~~~~"~~~ ~~~,~ RESIDENT DECEDENT FILE NUMBER ESTATE OF Hizer, Anna R. 21 - 09 - 00620 Photocopies, postage, mileage, etc. 30.00 Page 2 of Schedule H SCHEDULEI ~! DEBTS OF DECEDENT, MORTGAGE COMMONWEALTH DF PENNSYLVANIA LIABILITIES & LIENS INHERRANCE TAX RETURN 7 RESIDENT DECEDENT FILE NUMBER ESTATE OF Hizer, Anl1a R. i 21 - 09 - 00620 Include unreimbursed medical expenses. ITEM DESCRIPTION AMOUNT NUMBER 1 Messiah Village 301.00 2 MS Hershey Medical Center 1,068.00 TOTAL (Also enter on Line 10, Recapitulation) ~ 1,369.00 Rtll•1813 E7(+ (~) SCHEDULE) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Hizer, Anna R. 21 - 09 - 00620 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) RECEIVING PROPERTY Do Not uat Trustee(s) I ' TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 Nancy H. Weimer Daughter 1/2 of residuary 713 Alberta Avenue Estate Mechanicsburg, PA 17050 2 Mary L. (Martino) Cibroski ~ Daughter 1/2 of residuary 79 Hilldale Drive Estate Ephrata, PA 17522 Enter dollar amounts for distributions shown above on lines 1 5 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 LAST WILL AND TESTAMENT OF ANNA R. HIZER I, ANNA R. ffiZER, of the Borough of Clifton Heights, Pennsylvania, being of sound and disposing mind, memory and under- standing, do hereby make, publish and declare the following to be my LAST WILL AND TESTAMENT, hereby revoking all other and former wills by me at any time heretofore made. FIRST: I direct that all my just debts and funeral expenses be paid as soon after my decease as may be convenient to my Executor. SECOND: All the rest, residue and remainder of m9' Estate, real na d personal, I give, devise and bequeath to my beloved ,Husband, EDNIiTND E. HIZER, his heirs and assigns, forever, conditioned, however, that in the event of his death within a period of thirty (30) days after my death, or if he should pre- decease me, the said devise and bequest of residue shall lapse or be divested, and in such event, I give, devise and bequeath the rest, residue and remainder of my Estate to my children, itheir heirs and assigns, in equal shares, share and share alike. THIRD: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary Estate as a part of the expense of the administration of my Estate. FOURTH: I nominate, constitute and appoint my beloved ~_.___ Husband, EDMUND E. HIZER, as Executor of this my LAST WILL AND TESTAMENT, and I direct that he shall not be required to enter security in any jurisdiction in which he may act; and in the event of his death, renunciation or inability to serve, then I nominate, constitute and appoint my daughters, MARY LOUISE MARTINO and NANCY JEAN W~TI~IER, or the survivor of them, in his place and stead. F TFTH: I nominate, constitute and appoint the surviving) parent as Guardian of the Estate of any minor to whom anything passes under this Will or otherwise and with respect to whom T am authorized to appoint a Guardian. IN WITNESS WHEREOF, I, ANNA R. HIZER, have hereunto set my hand and seal on this last page and my name on the margin of the one preceding page, this ~~ y~l day of June, 1975• Q. ~ (SEAL) SIGNID, SEALED, PUBLISHED AND DECLARED by the above named Testator, as and for her LAST WILL AND TESTAMENT, in the presence of us, who, in her presence, at her request, and in the presence of each other, have hereunto subscribed our names as witnesses hereto. .~c _,~ ~.G' N i AD R NAME ADD