HomeMy WebLinkAbout11-23-09
1505607120
REV-1500
PA Department of Revenue EX (06-05)
OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
Po Box.2sosol INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 0 9 0 4 4 0
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
192 O1 5327 02 13 2009 O1 30 1914
Decedent's Last Name
Suffix Decedent's First Name
MI
HAMARA
GEORGE
W
(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
0 1. Original Return ~ 2. Supplemental Return
3. Remainder Return (date of death
^
4. Limited Estate ~ prior to 12-13-82)
4a Future Interest Compromise ^
(date of death after 12-12-82) 5. Federal Estate Tax Return Required
g, Decedent Died Testate ~
(Attach Copy of Will) ~ Decedent Maintained a Living Trust
(Attach Copy of Trust) 8. Total Number of Safe Deposit Boxes
9. Litigation Proceeds Received ~ 1 p, 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 INFORMATI
Name
ON SHOULD BE DIRE CTED TO:
DIANE KERR Daytime Telephone Number
814 262 4804
Firm Name (If Applicable)
SOMERSET TRUST COMPA NY REGISTER O~'VILLS USE ~LY --,- ,
First line of address ~.~ ~ ~
`~ ~
~
P
'' ; ~,;-+
1 4 1 6 SCALP AVENUE V
'
~~-`~~, :~ ~ ~' ` '.~; r; ~,
Second line of address '"' `~' `r: W ~ ' ° `-=~
`~~~~ ~
.:::~ ~" ~ r-t
City or Post Office DA FILLED
State ZIP Code r .r, ~ ,w°
JOHNSTOWN ~~
PA 15904 ~
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 and belief,
it is true, correct and complete. Declaration of preparer other than the personal representatwe is based on all information of which preparer has any knowledge.
SI A URE OF PERSON RESPONSIBLE FOR FILING RETURN
ADDRESS
1416 Scalp Avenue, Johnstown, PA 15904
SIGNAT E OF PREPARER OTHER THAN REPRESENTATIVE
~/C.
cP~
ADD
DATE
RESS l ' ~~ 0
Debra A Phillippi, CPA
3447 Alliene Avenue, Johnstown, PA 15904
Side 1
G
~- /~ - d ~
~~ 1505607120 1505607120 J
1505607220
REV-1500 EX
Decedent's Social Security Number
Decedents -vame: George W H a m a r a 19 2 01 5 3 2 7
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 & Miscellaneous Personal Property (Schedule E) ................ 5. 1 , 7 0 6 . 1 1
6. Jointly Owned Property (Schedule F) [] Separate Billing Requested ............. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ~ Separate Billing Requested ............. 7, 2 7 0, 1 6 8. 9 9
8. Total Gross Assets (total Lines 1-7) ............................................... g, 2 7 1, 8 7 5. 1 0
9. Funeral Expenses & Administrative Costs (Schedule H) ................. ........, g, 3 , 6 14.7 7
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10. 2 , 7 0 5 . 8 1
11. Total Deductions (total Lines 9 & 10) ......................................................................
11. 6 , 3 2 0 . 5 8
12. Net Value of Estate (Line 8 minus Line 11) ............................................................. 12. 2 6 5 , 5 5 4 . 5 2
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ................................................. 13, 13 , 2 7 7 . 7 3
14. Net Value Subject to Tax (Line 12 minus Line 13) .........................
........................
14. 2 5 2 , 2 7 6 . 7 9
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.oo 0.00 15• 0.00
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 siblingrateX .12 119, 499.50 17~ 14
339
94
18. Amount of Line 14 taxable ,
.
at collateral rate X .15 13 2, 7 7 7 2 9 18• 1 9 9 1 6. 5 9
19. Tax Due ..................................................................................................................... 19. 34, 256.53
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
1505607220
a
15056D7220 J
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
George W Hamara
STREET ADDRESS
29 Plymouth Avenue
cITY
Johnstown
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. Interest/Penalty if applicable
D. Interest
E. Penalty
41,000.00
1,712.83
File Number 21-09-0440
STATE
PA
ZIP
15906
Total Credits (A + B + C)
Total Interest/Penalty (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) 34,256.53
(2) 42, 712.83
(3)
(4) 8,456.30
(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
..............................................
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
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?.........
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)].
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 exemot 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 (O) 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.
Hev-1508 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Hamara, George W
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
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1 Cash in Possession
13.00
2 Cumberland Crossing -Refund from petty cash acc
t
oun 187.19
3 Somerset Trust Company Personal Checking A/C #20004603
67
319.65
4 Tangible personal property -Dresser & chest valued at sales proceeds
100.00
5 AARP Health Indemnity Plan -Anticipated refund
230.40
6 Cumberland Goodwill Fire & -Refund
134.88
7 Diakon Lutheran Ministries -Anticipated refunds
217.75
8 Highmark -Premium refund
477.74
9 Patriot News -Subscription refund
25.50
TOTAL (Also enter on Line 5, Recapitulation) 1,706.11
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Grouo. Inc.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
21-09-0440
Form P/~1500 Schedule E (Rev. 6-98)
Rev-1510 FJ(+ (8-98)
SCHEDULE G
INTER-VIVOS TRANSFERS &
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY
ESTATE OF
Hamara, George W FILE NUMBER
21-09-0440
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 DE RIP I N F R PER
NUMBER
THE DATE OF TRANSFER. ATTACH A COPY OF THOE DEED OR REAL ESTATE. DATE OF DEATH
VALUE OF ASSET % OF DECD'S
INTEREST EXCLUSION
(IF APPLICABLE) TAXABLE
VALUE
Assets Held by Somerset Trust Company under
Trust Agreement dated March 21, 2008 and
amended on May 29, 2008 in A/C #200034090:
1 181 shares of Aegon N.V. 906.81 906.81
2 127 shares of Allegheny Tech Inc. 3,163.57 3,163.57
3 $10,000 Berkshire Bond, 5%, Due 8/15/13 10,340.60 10,340.60
Accrued interest on Item 3 through date of death 147.23 147.23
4 312 shares of Brunswick Corp 1,151.28 1,151.28
5 $10,000 FHLB Bond, 4.25%, Due 1/2/15 9,909.40 9,909.40
Accrued interest on Item 5 through date of death 49.59 49.59
6 $10,000 FHLB Bond, 4.259'0, Due 5/14/13 10,075.00 10,075.00
Accrued interest on Item 6 through date of death 106.25 106.25
7 $10,000 FHLB Bond, 5.459'0, Due 2/25/19 9,950.00
9,950.00
Accrued interest on Item 7 through date of death 240.71 240.71
8 1,072 shares of JC Penney, Inc. 16,905.44
16.905.44
9 $10,000 Kimberly Clark Bond, 6.15%, Due 8/1/17 10,710.40
10,710.40
Accrued interest on Item 9 through date of death 21.82
21.82
Total of Continuation Schedule
ee attached page
TOTAL (Also enter on Line 7, Recapitulation)
270,168.99
(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)
Rsv-1510 EX+ (6-98)
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERffANCE TAX RETURN continued
RESIDENT DECEDENT
ESTATE OF
Hamara, George W FILE NUMBER
21 _~~0
ITEM DESCRIPTION OF PROPERTY
NUMBER
THE DATE OF TRANSFER. ATTACH A COPY OF THOE DEED OR REAL ESTATE. DATE OF DEATH
VALUE OF ASSET % OF DECD'S
INTEREST EXCLUSION
(IF APPLICABLE
) TAXABLE
VALUE
10 $10
,000 P & G Bond, 4.859'0, Due 12/15/15 10,774.70 10,774.70
Accrued interest on Item 10 through date of 79
48
death . 79.48
11 Prime Obligation Fund 83,767.50 83,767.50
Accrued interest on Item 11 through date of 29
01
death . 29.01
12 Somerset Trust Company CD, 2.889'0, Due 7/24/09 100
000
00
,
. 100,000.00
Accrued interest on Item 12 through date of 883
68
death . 883.68
13 36 shares of Teledyne Tech, Inc. 956
52
. 956.52
TOTAL (Also enter on Line 7, Recapitulation)
270,168.99
Copyright (c) 2002 form software only The Lackner Group, Inc. Form P~41500 Schedule G (Rev. 6-98)
REV-1151 EX+ (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
C~tAlt Vf
Hamara, George W
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION
A. FUNERAL EXPENSES:
See continuation schedule(s) attached
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
Clty State
Zip
Year(s) Commission paid 2009
2. Attorney's Fees
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
1,500.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
1,025.00
7. Other Administrative Costs
1,089.77
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 3,614.77
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PAr1500 Schedule H (Rev. 6-98)
FILE NUMBER
21-09-0440
AMOUNT
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF
Hamara, George W
FILE NUMBER
21-09-0440
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Expenses
1 Hindman Funeral Home -Funeral service 1,500.00
H-A Subtotal 1,500.00
Other Administrative Costs
2 Somerset Trust Company -Trust Department Fees through 9/30/09 1,089.77
H-B7 Subtotal 1,089.77
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form P~41500 Schedule H (Rev. 6-98)
Rev-1512 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
t5 ~-ATE vF
Hamara, George W
Include unrelmbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1 Continuing Care Rx -Debt
2 Diakon Lutheran Ministries -Debt -room and board
3 PA Department of Revenue -Balance due on 2008 PA 40
4 Quality Care Pharmacy Inc. -Debt
FILE NUMBER
21-09-0440
VALUE AT DATE
OF DEATH
472.20
1,780.04
294.00
159.57
TOTAL (Also enter on Line 10, Recapitulation) 2,705.81
(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 I (Rev. 6-98)
REV-1513 EX+ (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
t~IA~E OF
Hamara, George W
NUMBER NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
I~ TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116(a)(1.2)]
1
Copyright (c) 2002 form software only The Lackner Group, Inc.
II.
13,277.73
2
3
4
5
1
Gladys Carlson
29 Kitzel Avenue Sister ,~j27 _ ~,~~/t,
2 119,499.50
Carlisle, PA 17013 ~~
~ ~ ~
Randall Jon Carlson
417 Candlewood Drive Nephew ~/V~ r~c~Cf~T' 13,277.73
State College, PA 16803
Thomas Gerald Carlson Nephew ~~~~ ~~l~Cf~~/T
536 Westgate Drive 13,277.73
State College, PA 16803
Susan C Galbraith
10026 Stedwick Road #201 Niece ~y~ /'~.2Cf- 13,277.73
Montgomery Village, MD 20886
Dreena Gohn
2031 Chadds Ford Dr. Niece
`7-~N' ~c~R ~
26,555.45
Reston, VA 20191
See continuation schedule attached Continuation 66,388.65
Enter dollar amounts for distributions shown above on li nes 1 5 throu h 18, as appropria te, on Rlev 1500 cover sheet 252,276.79
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
Grace Lutheran Church C,Cjt`p~, /~~QC-~'ti~y)
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1 Snn rrni~Q cu~~T
Form P/~1500 Schedule J (Rev. 6-98)
FILE NUMBER
21-09-0440
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
DECEDENT (Words) ($$$)
Do Not Llst Trustee s
Y
SCHEDULE J
The BENEFICIARIES
(Part I, Taxable Distributions)
ESTATE OF:
George W Hamara 02/13/2009 192-01-5327
Item Name and Address of Person(s)
Number Receiving Property
6 Mark Alan Havers
245 Hampshire Drive
Chalfont, PA 18914
7 Daniel Kisha
2031 Chadds Ford Drive
Reston, VA 20191
8 Doris Kisha
802 Olim Street
Johnstown, PA 15904
9 Fred Palm
445 W. 59th Street
3532 N
New York, NY 10019
10 Ronald Palm
PO Box 2047
Rockville, MD 20847
Share of Estate Amount of Estate
Relationship (Words) (~~~)
Nephew ~I /~ ~~~ ~ ~~Y 13,277.73
Nephew ~/ V~ ~~~ ~ ~'~ 13,277.73
Niece j ~~L ~'~~ ~~i/`1
13,277.73
Nephew /'%/ I/ ~ ~~~ ~ ~~ 13,277.73
Nephew ! ~G'~ /~c~i~T 13,277.73
U~-
Total _ ~ 3~8 ~
1