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Home My WebLink About06-14-1015056051058 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 280601 21 08 1048 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth ' 10/05/2008 ' 03/27/1931 Decedent's Last Name Suffix Decedent's First Name MI Haffly ` Jr. Albert ', S (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Haffly 'Sandra Y Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE ..204-30-8475 REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW a 1. Original Return 2. Supplemental Return ," 3. Remainder Return (date of death 4. Limited Estate ,:>i,+ 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 4a. Future Interest Compromise (date of death after 12-12-82) ,.~...+ 7. Decedent Maintained a Living Trust (Attach Copy of Trust) fw 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) prior to 12-13-82) 5. Federal Estate Tax Return Required _ _ 8. Total Number of Safe Deposit Boxes °~n:a 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 T0: Name Daytime Telephone Number Robert P. Grubb, Esq. ! ' (717) 238-8187 Firm Name (If Applicable) N _._..._ --- ---~' - ~ , ^" _. ~ REGISTER 6~WfgLS USE O~£i -^ z Metzger Wickersham ', # ,; First line of address ~ ~'-- _ .._ m ".' - ~ ~ 3211 North Front St. __ _ ' ,..3 ~~ ~; ::.-~ ~~~ _ ,---7 ~ , Second line of address ~-~ -~ ~ ^:; + : P.O. Box 5300 N :_~ --i ~ {-,~ - _ DA~ FILED -~ . j L.~ City or Post Office State ZIP Code _._ . ~, Harrisburg PA 17110-0300 Correspondent's a-mail address: rpg@mwke.COm Under penalties of perjury, 1 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. SIGNATU OF PERSON RESPONSIBL F FILING RETURN DATE ADDRESS Q~ Sandra . H ffly, 1479 Maplewoo Drlve, ew Cumberland, PA 17070 SIGNATU O EPA R THAN REPRESENTATIVE D TE ___ _ v~ ~ _ ADDRE Rob .Grub Esq., Metzger Wickersham, P.O. Box 3500, Harrisburg, PA 17110-0300 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 15056052059 REV-1500 EX Decedent's Social Security Number Decedent's Name: Albert S Haffly 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. 12,961.55 6. Jointly Owned Property (Schedule F) Separate Billing Requested .... ... 6. 10,499.70 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested..... ... 7. 8. Total Gross Assets (total Lines 1-7) ................................. ... 8. 23,461.25 9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. 20,258.91 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .. 10. 4,110.52 11. Total Deductions (total Lines 9 & 10) ................................. .. 11. 24,369.43 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. -908.18 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. -908.18 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 .0 00 15. 0.00 16. Amount of Line 14 taxable at lineal rate X .0 _ 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. 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~ 15056052059 Side 2 150.56052059 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 08 1048 DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER Albert S Haffly __ 161-28-8396 _ STREET ADDRESS -- -- - 1479 Maplewood Drive CITY New Cumberland STATE 'ZIP PA 17070 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit __ B. Prior Payments _ C. Discount 3. Interest/Penalty if applicable D. Interest E. Penalty (3) (4) (5) (5A) (56) Total Credits (A + B + C) (2) Total InterestlPenalty (D + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval 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. 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 :................................................................................... ....... ^ Q b. retain the right to designate who shall use the property transferred or its income : ..................................... ....... ^ c. retain a reversionary interest; or ................................................................................................................... ....... ^ 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? ....................... ................................................................................ ^ ....... 3. Did decedent own an "intrust 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? .................................................................................................................. ...... ^ 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 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)]. Asibling 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-1508 EX+ (6-98) r :..~ SCHEDULE E ALTH CASH BANK DEPOSITS & MISC OF PENNSYLVANIA COMMONWE , . INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Haffly, Jr. Albert S. 21-08-1048 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. M&T Bank - Savings/Club Account No. 25004920109970 as valued by M&T Bank 1,201.40 2. M&T Bank -Checking Account No. 1233858 as valued by M&T Bank 1,216.47 Member's 1st Federal Credit Union - as valued by Members 1st. 3. Regular Savings Account No. 165703-00 1,051.02 4. Checking Account No. 165703-11 126.96 5. Sovereign Bank -Checking Account No. 2471704131 1,031.21 6. Wachovia Bank -Savings Account No. 3000075129887 as valued by Wachovia Bank 400.97 Account is titled as an Irrevocable Burial Reserve 7. Automobile - 2003 Toyota Sedan -Vehicle Identification No. 4TLBF32K23U053606 7,250.00 Valued at actual sale price of $7,250.00 8. Mt. Zion United Methodist Church -uncashed check no. 1621 - 341.76 10. Mt. Airy United Methodist Church -uncashed check no. 115 341.76 TOTAL (Also enter on line 5, Recapitulation) $ I 12,961.55 (If more space is needed, insert additional sheets of the same size) REV-1509 EX+ (6-98) .. SCHEDULE F COMMONWEALTH OF PENNSYLVANIA 101NTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Haffly, Jr., Albert S. 21-08-1048 JOINTLY-OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. kTTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET °% DF DECD'S INTEPEST DATE OF DEATH VALUE OF DECEDENT'S INTEREST t. A. 10/10/07 Members 1st CD -Account No. 165703-40 10,499.70 100 10.499.70 TOTAL (Also enter on line 6, Recapitulation) $ 10.499.70 (If more space is needed, insert additional sheets of the same size) If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. REV-1511 EX+ (12-99) SCHEDULE H COMMONWEALTH OP PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Haffly, Jr., Albert S. 21-08-1048 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~' Franklin Matinchkeck Funeral Home -Middletown, PA 8,094.00 Funeral Lucheon 151.42 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 3,500.00 Name of Personal Representative(s) Sandra Y Haffley Social Security Number(s)lEIN Number of Personal Representative(s) 204-30-8475 Street Address 1479 Maplewood Drive city New Cumberland state PA zip 17070 Year(s) Commission Paid: 2009 2. Attorney Fees 4,013.00 3. Family Exemption: (Ii decedent's address is not the same as claimant's, attach explanation) 3,500.00 claimant Sandra Y Haffley street address 1479 Maplewood Drive city New Cumberland state PA .zip 17070 Relationship of Claimant to Decedent SpOUSe 4. Probate Fees 99.00 5. Accountant's Fees 6. Tax Return Preparer's Fees ~. Cumberland Law Journal -Estate Publication 75.00 s. The Carlisle Sentinel -Estate Publication 190.54 9. Metzger Wickersham -misc. expenses, copies, postage, etc. 55.00 to. Progressive Insurance Co. - to protect automobile until sold 580.95 TOTAL (Also enter on line 9, Recapitulation) I $ 20,258.91 (Ii more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Haffly Jr., Albert S. 21-08-1048 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (5-00) :.~ ~. .. SCHEDULE J COMMONN~EALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Haffly Jr., Albert S. 21-08-1048 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS (include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-t500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1 ~ Sandra N. Yetter, 1479 Maplewood Drive, New Cumberland, PA 17070 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ~ $ 100% (If more space is needed, insert additional sheets of the same size) SlNCE1888 3211 North Front Street PO. Box 5300 Harrisburg, PA 17110-0300 717-238-8187 Fax:717-234-9478 June 10, 2010 Cumberland County Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 RE: The Estate of Albert S. Haffly, Jr. Cumberland County Estate No.: 2108-1048 Our Matter No.: 3-131 Dear Register of Wills: Other Offices Lancaster Shippensburg 717-431-0138 717-530-7515 Wilkes-Barre York 570-825-7500 717-843-0502 Please find enclosed three (3) copies of the Pennsylvania REV 1500 for the above referenced estate. Kindly file one in your office, one with the Department of Revenue, and date stamp the third copy and return it to my in the enclosed self addressed envelope. If you have any questions please feel free to contact my office at the above referenced phone number. Thank you for your prompt attention to this matter. Sincerely, GER, Esquire RPG/ Enclosures: KNAUSS, & ERB, P.C. c~ c~ ' ~ - r- v -T~ ~ -~ :'~ -.. ~= ins F--- _ r~, - ' ~ '~ 3 _ ~ C__ - James F. Carl Edward E. Knauss, IV* Clark DeVeret Francis J. Lafferty, IV Andrew W. Norfleet Michael J. 6oone Robert E Grubb Of Counsel ~_ * Board Certified in civil ~'~^.t trial law and adz~ocncy +~~\.~1/.~+ by the Nationnl Board nFTw'n1 A.h,nrnn, ~ {, '~' '; ,~ 4~.,,, ~, ; d C,` ,. ~ '~ ° . ~ ~ ~, r ,~,; c •- v u.! ~" FA N O N W ~ ~ ~ ~ ~ o ~ ~ ~ ~ ~ ~ ~U ~ z ~ ~~~ W O ~ C C (!~ M U ~ ~ o00 U U 0 = ~ ~.,, x F'' m ~ ,'~ o 'D ~ L Q W O x ~ ~ C C ~ N ~ ~` ~ ~ z o ~ o ~~U N w ~ ~+ ~ O a ~ ~ ~ ~ ~ ~ UUOU z u-> N i c~