HomeMy WebLinkAbout10-12-101505610140
REV-1500 EX (01-10)
OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 0 CI 5 5 0
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
1 9 8 3 2 5 0 3 3 0 2 2 7 2 0 1 0 0 8 0 2 1 9 1 4
Decedent's Last Name Suffix Decedent's First Name MI
HAMPTON LAURA E
(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 Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required
death after 12-12-82)
1
0 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safes Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
9. Litigation Proceeds Received ~ 10. 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)
GORRESP~NDEN 1 - I ttl5 5tG I IVN MU51 tit I;VMt'Lt I tU. ALL LVKKt~t'Vnutnl,t Hnu wnriu~n i ir~~ i ran mrvr~mri i iv~~ ~nvuuu o~ vine. ~ cu ~ v.
Name Daytime Telephone Number
JOEL R. ZULLINGER 717 264 6029
First line of address
1 4 NORTH MA I N S T R E E T
Second line of address
S U I T E 2 0 0
City or Post Office State
CHAMBERSBURG P A
Correspondent's a-mail address:
ILLS US~ILY
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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.
SIG URE OF PERSON RES,QO I LE FO I ING RETURN DATE i
~O..y t -~'Yl~''~-~-~.-
AD ESS
4584 MCKENZIE ROAD CHAMBERSBURG PA 17202
AT E OF P~EPARE~NOjT'HER~Fh)f4N REPR~SF~ITATIVIE DATJ` 1 _
o,
14CKIORTH MAIN S'~t~ET, SUITE 240 CHAMBERSBURG PA 17201
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610140 1505610140 J
1 1505610240
~~
REV-1500 EX
Decedents Name: LAURA E . HAM PTO N
Decedent's Social Security Number
1 9 8 3 2 ~i 0 3 3
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 and Notes Receivable (Schedule D) ........................ .. 4. •
9 1 8 3 . 1 1
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5.
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ..... .. 6. 1 5 1 1 3 5
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested ..... .. 7. •
4 6
1 0 6 9 4
8. Total Gross Assets (total Lines 1 through 7) ......................... .. 8. .
9. Funeral Expenses and Administrative Costs (Schedule H) ......... ......... 9. 9 3 4 8. 4 0
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .... ......... 10. •
11. Total Deductions (total Lines 9 and 10) ...................... ......... 11. 9 3 4 8. 4 0
12. Net Value of Estate (Line 8 minus Line 11) ................... ......... 12. 1 3 4 6. 0 6
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. 1 3 4 6 • 0 6
TAX CALCULATION -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 0 0 0 15.
16. Amount of Line 14 taxable
1 3 4 6
0
6
at lineal rate X .045 . 16.
17. Amount of Line 14 taxable
0 0
0
17
at sibling rate X .12 .
18. Amount of Line 14 taxable
~ 0
~
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
1505610240 1505610240
0. 0 0
6 0. 5 7
0. 0 0
0. 0 0
6 0. 5 7
J
:EV-1500 EX Page 3
Decedent's Complete Address:
- _ __
DECEDENT'S NAME
LAURA E. HAMPTON
---
STREET ADDRESS
CITY
~ ax Payments and Credits:
~. Tax Due (Page 2, Line 19)
~. Credits/Payments
A. Prior Payments -
B, Discount
Interest
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.
If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
File Number
21 10 0550
(1)
Total Credits (A + B) (2)
(3)
(4)
(5)
Make check payable to: REGISTER OF WILLS, AGENT
60.57
0.00
0.00
60.57
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 : ................................................................. ..... ^ ^
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 "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? ............................................................................................ ...... ^ ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART' OF THE RETURN.
-or dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
3 percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 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 21 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 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 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 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, undE
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)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF
LAURA E. HAMPTON
ITEI
NUME
1.
2
FILE NUMBER
21 10 0550
(If more space is needed, insert additional sheets of the same size)
REV-1509 EX+ (01-10)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
--_
ESTATE OF:
LAURA E. HAMPTON
sul
A. Kenn
JOINTLY-OWNED PROPERTY:
__
LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF
dUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
i. A. Certificate of Deposit #43-338216-5, Juniata Valley 3,022.70 ~i0. 1,511.35
Bank
TOTAL (Also enter on Line 6, Recapitulation) I $ 1, 511.35
If more space is needed, use additional sheets of paper of the same size.
FILE NUMBER:
21 10 0550
SCHEDULE F
JOINTLY-OWNED PROPERTY
If an asset was made jointly owned within one year of the decedent's date of death, it must be reported on Schedule G.
REV-1511 EX+ (10-09)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
- ---
ESTATE OF
LAURA E. HAMPTON
FILE NUMBER
21 10 0550
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION
--__
A. FUNERAL EXPENSES:
1. Brown Funeral Home, balance due for funeral services
2. Engraving marker
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
2.
3.
City State ZIP
Year(s) Commission Paid:
Attorney Fees: Joel R. Zullinger
Family Exemption: (If decedent's address is not the same as claimants, attach explanation.)
Claimant
Street Address
4.
5.
6.
7.
City State ZIP
Relationship of Claimant to Decedent
Probate Fees: Letters - 20.00; will - 15.00; short certificate - 4.00; JCS fee - 23.50;
automation fee 5.00; filing return 15.00; additional probate fee 10.00
Accountant Fees:
Tax Return Preparer Fees:
AMOUNT
8,445.90
85.00
725.00
92.50
TOTAL (Also enter on Line 9, Recapitulation) I $ 9,348.40
If more space is needed, use additional sheets of paper of the same size.
:EV-1513 EX+ (01-10)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
--___ __
ESTATE OF:
LAURA E. HAMPTON
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. Audrey L. Kauffman
4584 McKenzie Road
Chambersburg, PA 17201
FILE NUMBER:
21 10 0550_
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Lineal
AMOUNT OR SHARE
OF ESTATE
residue
~ ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
--
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
-- - - --_
----
If more space is needed, use additional sheets of paper of the same size.
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LAST WILL AND TESTAMENT
I, LAURA E. HAMPTON, of Tuscarora Township, Juniata County,
Pennsylvania, being of sound mind and body, declare this to be my
Last Will And Testament, and do hereby revoke all Wi11s and Codicils
previously made by me .
ITEM l: I give, devise and bequeath all and every part of my
entire estate, real, personal and mixed, whatsoever and wheresoever
situate, including property over which I shall ]nave any power of
appointment, to my husband, CLARENCE M. ~LAMPTON, provided that he
shall survive me by a period of Ninety (90) days .
ITEM 2: Should my husband, CLARENCE M. ILAMPTON, fail to survive
me by a period of Ninety (90) days , I give, devise and bequeath all and
every part of my entire estate, real, personal and mixed, whatsoever
and wheresoever situate, including property over which I shall have
any power of appointment, to my issue then living, per stirpe:s, pro-
vided that he, she or they shall survive me by .a period of Ninety (90)
days.
ITEM 3: I appoint The Juniata Valley Bank, Mifflintown, Juniata
County, Pennsylvania, guardian of any property which passes, either
~~~
under this Will or otherwise, to a minor or with respect to which I
am authorized to appoint a guardian and have not otherwise specifically
done so, provided that this appointment of a guardian shall no~~t super-
sede the right of any fiduciary in its discretion to distribute such
share to another for the minor's benefit. My said guardian shall have
the power to use principal as well as income from time to time for the
minor's support, welfare and education (including education beyond the
high school level) , without further responsibility, to the minor o.r to
any person taking care of the minor .
ITEM 4: I direct that my just debts, funeral expenses, including
my grave marker, estate taxes , inheritance taxes , and all other
administration expenses are to be paid out of the residue of my estate
as soon as practicable after my decease, as a part of the expense of
the administration of my estate.
ITEM 5 : I appoint my husband , CLARENCE Ma HAMPTON, as Executor of
this my Last Will . Should my husband , CLARENCE M. ~LAMPTON, be. unwilling
or unable to so act, I then appoint my daughter, AUDREY L. KALrFFMAN,
~~
as Executrix of this my Last Will.
s~
IN WITNESS WHEREOF, I have hereunto set. my hand this ~~_~
day of _ dv,~~ _ , 1981.
:_~s
Laura E . Hampton
The preced ing instrument , cons is t ing of this and two (2) other
typewritten pages, each identified by the signature of the Testatrix,
was on the day and date thereof signed, published and declared by
LAURA E. HAMPTON, the Testatrix therein named, as and for her LAST
WILL in the presence of us, who, at her request, in her prese~zce and
in the presence of each other have subscribed our names as witnesses
hereto.
1
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LO10 6:23PM JVB Port Royal
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THE JUNIATA VALLEY BANK
po eox z3~
PORT ROYAL, PA 1,7082
Decedenti: Laura E Hampton
Date of Death: February 27, 2010
SSN : 198-32-5033
TYPE OF ACCT & RATE Checking TYPE OF ACCT & RATE _ _ Burial CD
ACCOUNT #: 56-331963-9 ACCOUNT #: 42-328752-0
BALANCE DOD: 3,224.83 BALANCE DOD: 5,916.65
ACCRUED INTEREST: 0.00 ACCRUED INTEREST: 4]..43
DOD VALUE: 3,224,83 DOD VALUE: 5,958.28
INTEREST PAID YTD: 0.00 INTEREST PAID YTD: 0.00
OPENING DATE: October 1, 1977 OPENING DATE: March 30, 1990
MATURITY DATE: NA MATURITY DATE: March 30, 2010
OWNERSHIP: Ind)vldual OWNERSHIP: Individuai
TYPE OF ACCT & RAPE CD TYPE OF ACCT & MATE
ACCOUNT #: 43-33816-5 ACCOUNT #:
BALANCE DOD: 3,000.00 BALANCE DOD:
ACCRUED INTEREST: 22.70 ACCRUED INTEREST:
DOD VALUE: 3,022.70 DOD VALUE:
INTEREST PAID YTD: 29.69 INTEREST PAID YTD: _
OPENING DATE: December 20, 1993 OPENING DATE: _
MATURITY DATE: December 20, 2013 MATURITY DATE: _ ~_
OWNERSHIP: Jo int with Kenneth Kauffman OWNERSHIP:
TYPE OF ACCT & RATE TYPE OF ACCT & RATE
ACCOUNT #: ACCOUNT #:
BALANCE DOD: BALANCE DOD:
ACCRUED INTEREST: ACCRUED INTEREST:
DOD VALUE: DOD VALUE: _,
INTEREST PAID YTD: INTEREST PAID YTD: _
OPENING DATE: OPENING DATE:
MATURITY DATE: MATURITY DATE: ~,
OWNERSHIP: OWNERSHIP:
Date: 9/ 10/ 2014
prepared by: ]en
Phoney 717-527-4I.].4
Fax: 717-5~7-4115
Received Time Sep, 10, b;21PM