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HomeMy WebLinkAbout06-17-101505607120 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue co~x,ty Cody trees Fie Number Bureau of Individual Taxes INHERITANCE TAX RETURN Po Box.2so6o1 21 0 7 0 6 5 7 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDEI~i"f tNFORiIIiATlON BELOW ' Soaai Security Number Date of Death Date of Birth 169442562 07032007 09251957 Decedent's Last Name Suffix Decedent's First Name MI SAMMACHBR ARCRIL* F (If Applicable) Eller Surviving Spouse's Infonnadon Below Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number THIS RETURN MUST BE !FILED IN DUPLICATE NATL.:., THE REGt~-TER OF W~L.LS F{LL IN APPR~RIATE OVALS BELOW ^ 1. Original Retum ® 2. Supplemental Retum ^ 3. Remairxkr Retum (date of death prior to 12-13-82) ^ 4. Limited Estate ^ 4a. ~~ death ~~°" ~~~) ^ 5. Federal Fatale Tax Retum Required ® g, Deoederrt Died Testate ^ 7. Dsosdsr~t Mairnainad a Living Tnsc 0,__ 8. TONaI Nutter of Safe Deposit Boxes (Add Cry pr yyip) (Attach Copy d Trust) ~~ 9. Lidgation~Proceeds Received ^ 10. bstw~er-1P29ti- ~jr death ^ 1l.;Electjort t0 tax under Sec. 9113(A) (AtCUCh Sch. O) ESPO~NT - TH18 SECTION MUST BE COMPLETED. ALL CORRESPONDENCE Ai?~ C TAX II~ORMATfK~N SliOfULD BE OBtECTED TO: ~ iDaytlme Tsaphor~e Number ' FORA Ir'. BLAIR ~ 71754114.28 Firm Name (If Applicable) First line Of address 5440 JONBST01iN ROAD Second line of addross po Boz 6216 City or Post Office RARRISSURG State ~P Code REGISTER ~ WILLS USLY C o mow. ~~ LED """ .. t~ ~.. PA 17112-o216 i. ...~ t ~3 ~. rrr ~ •~ Correspondents a-n~sil adds: N F B LAW ~c o m c ast. n et Under penalties of perjury, I dedi~e that 1 tears ex~aneted this return, indudin~ aaaompaing scheciuNrs and atatterr>aMs, and tD the t~ d rrr1r knowledge and belief, it is true, correct and cx~mplete. Declsratiort d propsrer other than the personal repraaen a is based on all inforrnatiean'ot whid- prepa-er has any knowfec~e. ~^ Donna Berkheimer ADDRESS 21fi0 Sand Beach Road, Hummeistown, PA 17036 -{5- l© ` :` PRE . L7G+~ DATE St TUBE OF PREP ER OT THAN R ~ ~ ~ Nora F. Blair ~ ~- l J~ - l ~ 5440 Jonestown Road, Harrisburg, PA 17112-0216 Side 7 L 1505607120 1505607120 J 1 1505607220 .J REV-1500 EX o«~sder,rsr~: HAMMACHER, ARCHIE F. Decedent's Socaal Security Number 16944x562 RECAPITULATION 1. Real Estate (Schedule A) .............................__...................................................... 1. 2. Stocks and Bonds (Schedule B) .......................................................................... Z. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3. 4. Mortgages & Notes Receivable {Schedule D} .............................._........................ 4. 5. Cash, Bank Deposits 8 MisceNaneous Personal Property (Schedule E~ .............. 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested.............. 7. 8. Tots! Gross Assets{total Lines 1-7~ .................................................................. 8. 65,000.00 5,x31.63 16,778.81 72 ~ 909'.07 159,919.51 9. Funeral Expenses 8 Administrative Costs (Schedule H) ...................................... 9. 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ............................... 10. . 11. Thal Deduatiorus (total Lines 9 810~ ................`:::.........:.......:...._,.................... 11. 12. Net,'Valus of Estabe(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. Nest Value SubjaEa to Tax(Line 12 minus Line 13~, ............................................. 14. 19,493.11 66,199.85 85,69x.96., 74.,226.55 74,226.55 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (x)(1.2) X .00 15. 16. Amount of Line 14 taxable at lineal rate X .045 2 9, 4 0 0. 5 3 16. 17. Amount of Line 14 taxable at sibling rate X .12 4 4, 8 2 6. 0 2 1 ~• 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. Tax Dus ............................................................_.............................._................... 19. 20. FILL IN THE OVAL tF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 1,323.02 5,379.12 6,70x.14 Q Side 2 1505607220 1505607220 J REV-1500 EX Page 3 Decedent's Complete Address: Fite Number 21 - 07 - 0657 Hammacher, Archie F. STREET ADDRESS 1800 Sheepford Road CITY Mechanicsburg STATE PA ZIP 17055 Tax Payments and Gredlts: 1. Tax Due (Page 1 Line 19) (1 } 6, 7 0 2.14 2. CreditslPayments A. spousal Poverty credit e. Prior Payments 7,080.22 C. Discount Total Credits (A + B + C} (2) 7 , 0 9 0.2 2 3. InterosVPenalty if applicable p, interest 388.07 E. Penalty Tate! InterestJPenalty (D + E) (3) 388.07 4. If Line 2 is greater than line i + Une 3, enter the differencx. This is the13VERPAYMENT. (4) 0.01 Check box.on Pepe 2 Line 20 to request a nNund ' 5. tf Line 1 + Line 3 is gnaater than .Line 2, .eater the difference. This is thdfAX DUE ~ (5} A,°"Enter the interest cn the tax due. (5A) . B; ~~ Enter the total of Line 5 + 5A. This is theBALANCE DUE (5B) ~ . Q Q AAake Check Payable ta: RiI~TER QF II~ltLS, AGL~/VT PLEASE AN81AlER THE FOLLOWING QUESTIONS SY 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 transfemad :..........................................................._................ ^ ^x b. retain the rk3ht to designate who shalt use the property transferred oc its income;. ............................_.. ^ c. rotain a roversionary irtterost; o~ ............................._............................._.............................._................ ^ d. receive the promise for life of either payments, berrefits or care? ........................................................... ^ ^x 2. ff dead oaxarrod after December 12, 1982, did decedent transfer property within one year of death without roceiving adequate consideration? ................................................................................................................ ^ 0 3. Did decec~nt awn an "in trust for" or payable upon death bank account or security at h~ or her death?....... ^ ^x 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a benefaary designation? ............................................................................................................... ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETUR For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed an 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)j. For dates of death on ar 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 (O) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute~oes not exempla 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 ar after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased chile! twenty-one years of age or younger at death to or for the use of a natural parent, an adaptive 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 )j. The tax rate imposed an the net value of transfers to or for the use of the decedent's siblings is tweMe (12) percent [72 P.S. §9116 (a) (1.3)j. 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. SCHEDULE F CXNIANIONNtEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY lNNERITANCE TAX RETURN RESIDENT DECEDENT E3TATE OF Hammacher, Archie F. ~ FILE NUNN3ER 21 - 07 -0657 Man asset was made joint within on+e year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT Donna J. Berkhimer A 2160 Sand Beach Raad Hummelstown, PA 17036 Sister Archie Hammacher g 5933 Linglestown Road Harrisburg, Pa 17112 Father JOINTLY OWNED PROPERTY: ITEM NUM~R LETTER FOR JOINT ~~~ ~~ ' MADE 4 „~~- lncitJde name 1 tit a R account number or similar ides number. Attach deed for ' n -held real ~ ~ ~ estate. _ DATE OF DEATH VALUE OF ASSET % ~ DECD'S INTERES DATE OF DEATH vALt~ ~ DECEDENTS INTEREST 1 A ` 03/08!1994 ~ Fulton Cheching Account 34,485.94 50°l0 17,242.97 2 B 10/01/2006 1986 Ford Dump Truck ~ . 1, 000:00 ~ 50°~ ' 500.00 3 A B 09/19/2001 5933 Linglestown Road I ~ ~ .119,282.00 33°l° 39,363.06 , i ', Hamsburg, PA 17112 'Assessed at $81,700 x CLR 1.46 ~ 4 ~ A, 8 .0911912001 5928 Avis Lane ' 46,428.00 ~ ~ 33% 15,321.24 , 'Harrisburg, PA 17112 ~ ~ {Assessed at $31,800 x CLR 1.46 5 A, B 09/19/2001 5929 Rear Linglestown Road 1,460.00 33°!0 ~ 481.80 Harrisburg, PA 17112 Assessed at 1,000 x CLR 1.46 'i I TOTAL (Also enter on line 6, Recapitulation) 72,949.©7 ~ ~~~ z ~,, ,~~ ~.~° t a ~.~r ~'. ~ :`' ~. ~ ~ ~a~o ~u~ ~ ~ ~M ~ _ ~~ c~~~ ~R~ ORPH#~ ~D ~ ~;, ~4 t ~A !~+• A v h^ __ i~ F~ 0 W ~ ~ f~+ 1^+ ~• O x"~~~ o~~ ~. o ~, ~~~~ ~ cA ~ tii as ~ `~. bd ~~~ M+ { C .~ ~ ~.:' _ ~' ~ N ? 6~ ~~ ita..j