HomeMy WebLinkAbout01-08-101505607120
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 Box.2sosol 2 1 0 9 0 0 5 3 5
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
197 40 9472 05 13 2009 O1 22 1954
Decedent's Last Name Suffix Decedent's First Name MI
HESS KAY B
(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 Retum ~ ~ 2. Supplemental Return ` ,, 3. Remainder Retum (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)
~v I g Decedent Died Testate ~ ~• (AttacheCo a~of Tnest a Living Trust 8. Total Number of Safe Deposit Boxes
L^ ' (Attach Copy of Will) PY )
9. Litigation Proceeds Received L~ 1 D, Spousal Poverty Credit (date of death ! 11. Election to tax under Sec. 9113(A)
between 12.31-91 and 1.1-95) -~ (Attach SCh. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
JAN M WILEY 717 432 9666
Firm Name (If Applicable)
THE WILEY GRDUP, PC
First line of address
130 W. CHURCH STREET
Second line of address
City or Post Office
DILLSBURG
REGISTER OQ111
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State ZIP Code
PA 17019
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Correspondent's a-mail address:
Under penalties of pery'ury, 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 representative Is based on all information of which preparer has any knowledge.
r
nway Drive, Carlisle, PA 17015
OF PREPARER OTHER THAN~2EPRE~ENTATIVE
Derek D. Jardine
Jan M Wiley
Church Street, Dillsburg, PA 17019
Side 1
~, 1505607120
rl~l ~~
1505607120
J ~
PA Inheritance Tax Return
Signature of Additional Fiduciaries
ESTATE OF FILE NUMBER
Hess, Kay B. 21-09-00535
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 representative is based on all information
of which preparer has any knowledge.
Signature #2
Name Douglas L"". Pifer
Address1 40 W. Main Street
Address2
city, State, ZIP New Kingstown, PA 17072
Date
REV-1500 EX
Decedents Name: Kay B. H e s s
1505607220
RECAPITULATION
1. Real Estate (Schedule A) .......................................................................................... 1.
2. Stocks and Bonds (Schedule B) ............................................................................... 2.
3. Closety Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3.
4. Mortgages 8~ Notes Receivable (Schedule D) ....................................................... ... 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .............. .. 5.
6. Jointly Owned Property (Schedule F) [~ Separate Billing Requested ........... .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ~ Separate Billing Requested ........... .. 7.
8. Total Gross Assets (total Lines 1-7) ..................................................................... .. 8.
9. Funeral Expenses & Administrative Costs (Schedule H) ...................................... ... 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................. ... 10.
11. Total Deductions (total Lines 9 & 10) ................................................................... ... 11.
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.
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 0 0 0 15.
16. Amount of Line 14 taxable
16
at lineal rate X .045 0 0 0 .
17. Amount of Line 14 taxable
at sibling rate X .12 0 0 0 17.
18. Amount of Line 14 taxable
at collateral rate X .15 0 0 0 18.
19. Tax Due ..................................................................................................................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Decedent's Social Security Number
197 40 9472
5,557.96
5,027.02
10,584.98
11,187.40
11,187.40
-602.42
-602.42
0.00
0.00
0.00
0.00
0.00
Side 2
L 1505607220 1505607220 J
REV-1500 EX Page 3 File Number 21-09-00535
Decedent's Complete Address:
DECEDENT'S NAME
Kay B. Hess
STREET ADDRESS
32 W. Main Street
CITY '-STATE ZIP
New Kingstown PA 17072
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1) 0.00
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount 0.00
Total Credits (A + B + C) (2) 0.00
3. Interest/Penalty if applicable
p. Interest
E. Penalty __ - ______
Total Interest/Penalty (D + E) (3)
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) 0.00
A. Enter the interest on the tax due. (5A)
g. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Q , ~ Q
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 .................................................................................................................. ^ 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.
94 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
For dates of death on or after July 1, 19 ~ ~ H
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 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)].
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-1li08 E,(+ (6-~)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMIONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hess, Kay B. 21-09-00535
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property Jointly-owned with the AgM of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Cash found in decedent's car and residence: 324.31
2 Fulton Bank Checking Account 3622-22839: 35.43
3 Income tax refund (2008): 1,040.00
4 Last paycheck from Walmart: 556.22
5 Sale of 1995 Chevy Lumina: 1.500.00
6 Sale of personal property: 1.074.00
7 Vacation pay received from Walmart: 1,028.00
TOTAL (Also enter on Line 5, Recapitulation) I 5.557.96
(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)
Rev1510 FJ(+ (g•98)
SCHEDULE G
INTER-VIVOS TRANSFERS ~
MISC. NON-PROBATE PROPERTY
COA~MONWEALTH OF PENNSYLVANIA
MlHERRANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF (FILE NUMBER
Hess, Kay B. 21-09-00535
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 R
INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND
THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH
VALUE OF ASSET % OF DECD'S
INTEREST EXCLUSION
(IF APPLICABLE) TAXABLE
VALUE
1 Check from Walmart Corporation - 401(k) : 5,027.02 5,027.02
TOTAL (Also enter on Line 7, Recapitulation) I 5,027.02
(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•7161EX+l,z•88) SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INRESDENTDE EDENTRN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Hess, Kay B. 21-09-00535
Debts of decedent must be reported on Schedule 1.
ITEM DESCRIPTION AMOUNT
NUMBER
A, FUNERAL EXPENSES:
See continuation schedule(s) attached
9,058.86
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 The Wiley Group, PC 1,500.00
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 95.00
5. Accountant's Fees
6. Tax Return Preparer's Fees 85.00
7. Other Administrative Costs ~8•~
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 11,187.40
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
Hess, Kay B. 21-09-00535
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Expenses
1 Cocklin Funeral Home: 9,058.86
H-A Subtotal 9,058.86
Other Administrative Costs
2 Cumberland Law Journal (advertise estate): 75.00
3 Erie Insurance: 16.00
4 PPL (final): 70.04
5 Register of Wills (filing fee): 15.00
6 The Sentinel (advertise estate): 272.50
H-B7 Subtotal 44$,54
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
Hess, Kay B. 21-09-00 535
NUMBER NAME AND ADDRESS OF RELATIONSHIP TO
DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE
PERSON(S) RECEIVING PROPERTY
Do Not List Trustee a (Words) ($$$)
I~ TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116(a)(1.2)]
1 Donna M. Hoopengardner sister
5150 Harmony Grove Road
Dover, PA 17315
2 Dennis J. Jardine Nephew
687 Barnstable Road
Carlisle, PA 17013
3 Derek D. Jardine nephew
34 Penn Way
Carlisle, PA 17015
4 Lori M. Jordon niece
2301 Conewago Road
Dover, PA 17315
5 Darene N. Pifer sister
64 Sherwood Drive
Carlisle, PA 17013
See continuation schedule attached Continuation
Total
Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropr iate, on Rev 1500 cove r sheet
III NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ~ U.UU
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98)
SCHEDULE J
The BENEFICIARIES
(Part I, Taxable Distributions)
ESTATE OF:
Kay B. Hess 05/13/2009 197-40-9472
Item Name and Address of Person(s) Share of Estate Amount of Estate
Number Receiving Property Relationship (Words) ($$$)
Douglas L. Pifer nephew
40 W. Main St. PO Box 234
New Kingstown, PA 17072
7 Lisa J. Verbitsky niece
340 Old York Road
Wellsville, PA 17365
8 Betty D. Wagner sister
29 Valley View Drive
Mechanicsburg, PA 17050
Total
~~~t ~~1 ~xx~t~ ~.e~.~xn~.e~t~
OF
RAY B_ HESS
BE IT RE1{LMBERED, that I, RAY B. HESS, of 145 Fairview Drive, Carlisle,
Cumberland County, Pennsylvania, being of sound mind, memory and understanding,
do make, publish and declare this as and for my Last Will and Testament,
hereby revoking and making null and void any and all Wills and Testaments
and writings in the nature thereof, by me, at any time heretofore made.
ITEM 1: I direct that all my just debts and funeral expenses, be paid
as soon after my demise as may be convenient.
ITEM 2: All the rest, residue and remainder of my estate, of whatsoever
nature and wheresoever situate, whether it be real, personal or mixed, including
property over which I have a power of appointment, I give, devise and bequeath
unto my sisters, BETTY D. FIAGNER, DONNA M. HOOPENGARDNER and DARENE N. PIFER
and my nephews, DENAIS J. JARDINE, DERER D. JARDINE and DOIIGLAS L. PIFER,
and my nieces, LISA J. VERBITSRY and LORI M. JORDON, in equal shares per
stirpes.
ITEM 3: I direct my hereinafter named Co-Executors to pay all inheritance,
estate, succession and legacy taxes of whatsoever nature and kind, to which
my estate or the transfer of any property passing hereunder or otherwise
passing by reason of my demise, may be subject and to charge such taxes against
my residuary estate, it being my intention [hat none of the aforesaid taxes,
either federal or state, or any property required to be included in my gross
estate, under the provisions of any state or federal Law now in force or
hereafter enacted, shall be prorated among the persons interested in my estate
to whom such property is or may be transferred or to whom any benefit accure>.
ITEM 4: I appoint my nephews, DERER D. JARDINE and DOUGLAS L_ PLFER
as Co-Executors of this my Last Will and Testament.
WITNESS:
_ - ~-~ _t-~ -,
.-;~ ;'
1~{.t ti,~
~-
1M l~~ f ~~L' ~ %j ( S E AI. )
RAY B.' 'SS
ITEM 5: I driect that my Co-Executors, guardians or their successors
shall not be required to give bond for the faithful performance of their
duties in any jurisdiction.
IN WITNESS WHEREOF, Z have hereunto set my hand and seal this _~(~{-{~,
day of _) C~YIi l~ .~--~,y 1992.
WLT#ESS:
~'z
;~~Z~a
gg1l "i
RAY B. S
CQT~IEAL'IIi OF PII~INSYI,VANIA
SS
COUDfl'Y OF YOF~
We, KAY B. fiFSS, JAN M. WILEESt, F~¢)IRE, and PATRICIA A. OGG, the Testatrix
and the witnesses respectively, whose names are signed to the attached or foregoing
instrument, being first duly sworn, do hereby declare to the undersigned authority
that the Testatrix signed and executed the instrument as her Last Will and Testamen
and that she had signed willingly (or willingly directed another to sign for her),
and that she executed it as her free and voluntary act for the purposes therein
expressed, and that each of the witnesses, in the presence and hearing of the Testa
trix, signed this Last Will and Testament as witness and that to the best of their
lmowledge the Testatrix was at the time eighteen (18) years of age or older, of
sound mind and under no constraint or undue influence.
1 \~~' ~ C~~~~c VJJ
B. 11S' 7J
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Wl'ISIES.S U
Sworn to and subscribed
before me *_:~is ,~Cr(-:, day
of --7t~^ i~.t 1992.
NOTARY PUE3LIC
MY COMMISSION EXPIRES:
S Daa.~ GIa7i=~'c:. 1JOtary Pubtic
Ca~~llTnTi. ~o~lrCounry
M•,+ Comr, Lion Emir;:=May 7 7.1593
Mer, !k.:. ?ennsylwania A'.s/~ai~cn oiof 1k-?•es
July 3, 2009
The Wiley Group
130 W. Church Street
Suite 101
Dillsburg, Pennsylvania 17019
Dear Sir/Madam:
RE: Kay B. Hess, deceased May 13, 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 # 3622-22839, open 3/13/2003, date of death balance $35.43, in
her name only.
If you should have any further questions, please do not hesitate to contact me at (717)
291-2437.
Very truly yours,
~C~.. -~
Karen D. Hille as
Credit Inquiry Processor
P O Box 4887 - Lancaster, PA 17604
fultonbank-com - 1-800-FULTON-4
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i
Cocklin Funeral Home ,Inc.
30 N. Chestnut Street
Dillsburg, PA 17019
(717)432-5312
May 21, 2009
Mrs. Darene N. Pifer
64 Sherwood Drive
Carlisle, PA 17015-
The Funeral Service for Ms. Kay B. Hess
We sincerely appreciate the confidencte you have placed in us and will continue to assist you in every way we can. Please
feel free to contact us if you have any questions in regard to this statement.
THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT,
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
(A) OUR SERVICE:
BASIC SERVICES OF FUNERAL DIRECTOR & STAFF $3725.00
FUNERAL HOME SERVICE CHARGES - $3725.90
SELECTED MERCHANDISE:
Roman . $2215.00
Monticello , _ _ _ _ $1270.00
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE
THAT YOU HAVE SELECTED $7210.00
Cash Advances
Flowers. $188.68
Death Certiciates , _ $48.00
Clergy Honorarium $100.00
Cemetery Opening $750.00
Death Notices Harrisburg. $197.37
Yorl~ $155.30
Carlisle. $109.61
Cutting date on stone, _ $150.00
Cemetery Equipment. $150.00
TOTAL CASH ADVANCES AND SPECIAL CHARGES $1848.96
Total ~
Total Cost . _ $9058.96
SUB= TO"CAL $9058.96
INITIAL PAYMENT /DISCOUNT /CREDITS OAO
TOTAL AMOUN"r DUE $9058.96
unpaid balance over 0 days is subjected to a 0.50 % service charge per month - 6.0000 % pcr annum.
Ms. Kay B. Hess
Page 1
)an M. Wiley
David ). Lenox
THE WILEY GROUP
Attorneys at Law
January 6, 2010
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
In Re: Estate of Kay B. Hess, deceased
File Number 21-09-00535
Dear Register:
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Enclosed for filing please find an inheritance tax return in duplicate, and the status report with
regard to the above captioned insolvent estate. Also, enclosed is a check in the amount of $15.Q0
representing the filing fee.
Please return the recording receipt to my attention in the enclosed envelope.
Thank you for your cooperation.
Sincerely,
~~'.~
Dawn Gladfelter/Legal ssistant
/dg
encl.
130 W. Church Street, Suite 101 Diltsburg, PA 17019 • Phone: (717) 432-9666 • (800) 682-4250 • Fax: (717) 432-0426
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