Loading...
HomeMy WebLinkAbout11-24-10~ 1505610101 REV-1500 Ex `01-1°' OFFICIAL USE ONLY PA Department of Revenue Pennsylvania ~ENANTME»T~~HEVEN~E County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO Box z8o6o1 RESIDENT DECEDENT 21 10 0246 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 191-54-4787 02/27/2010 03/04/1924 Decedent's Last Name Suffix Decedent's First Name MI HEFFELFINGER TENETH C (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 O 2. Supplemental Return O 4. Limited Estate O 4a. Future Interest Compromise (date of death after 12-12-82) Cip 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) O 3. Remainder Return (date of death prior to 12-13-82) Q 5. Federal Estate Tax Return Required 0 8. Total Number of Safe Deposit Boxes O 11. Election to tax under Sec. 9'113(A) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number KEITH O. BRENNEMAN, ESQ (717) 697-8528 First line of address 44 West Main Street Second line of address City or Post Office Mechanicsburg State ZIP Code PA 17055 REGISTEP~F WILLS USEILY '~_:_ ~ - - -- ~ ~= ~ ~' i i ~,. - . ~,., r t~ _ - _ --~, Zfi4TE FILED t __, _,_ ~ t._-~ _, .~ 1 ~ +~ ,~--, :--~ _, .. Correspondent's a-mail address: Under penalties of perjury, 1 declare that 1 have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correcye~nd complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SI~GNATUy'~E~F~~ ~SOJJ F~!E ~JONSI~L ~ iR~~ING R~~`R~ ~ Executrix j/~~ ~ ~f n ADDRESS "`" / 913 Front Street, New C mberland, PA 17070 SI~ ~ E OF PREPARER OTHER THAN REPRESENTATIVE d~~ ~ A~ / t P~ ADDRESS 44 West Main Street, Mechanicsburg, PA 17055 PLEASE USE ORIGINAL FORM ONLY Side 1 15056101,01 1505610101, J J 1505610105 REV 1500 EX Decedent's Social Security Number Decedent's Name: Teneth C . Hef f elf finger 191-54-4787 RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. 120,000.00 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. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 26,838.83 6. Jointly Owned Property (Schedule F} O Separate Billing Requested ....... 6. 3, 871.46 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. 150,710.29 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. 15,971.22 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .............. 10. 1, 595.56 11. Total Deductions (total Lines 9 and 10) ................................. 11. 17,566.78 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 133,'143.51 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. 133,143.51 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~ 15. 16. Amount of Line 14 taxable at lineal rate X .0 45 133,143.51 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. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 5,991.46 5,991.46 Side 2 150561,01,05 1,5056],01,05 REV-1500 EX Page 3 File Number Decedent's Complete Address: 21-10-0246 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1} 5,991.46 2. Credits/Payments A. Prior Payments 6, 500.00 B. Discount 299.57 Total Credits (A + B) (2) 6,799.57 3. Interest (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fili in oval on Page 2, Line 20 to request a refund. (4) 808.11 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 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 ...................................................................... ^ x 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 : ............................................ ^ 0 c. retain a reversionary interest; or .......................................................................................................................... ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 0 2. If death occurred after Dec. 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? .............. ^ L~ 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 Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)J. 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)J. 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 PS. §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-1502 EX+ (11-0$) pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF FILE NUMBER Teneth C. Heffelfinger 21-10-0246 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property that is iointly-owned with right of survivorship must be disclosed on Schedule F. If more space is needed, insert additional sheets of the same size. REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ~CNEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Teneth C. Heffelfinger 21-10-0246 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. (If more space is needed, insert additional sheets of the same size) REV-i5og EX+ (oi-io) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F ]OINTLY-OWNED PROPERTY ESTATE OF: FILE NUMBER: Teneth C. Heffelfinger 21-10-0246 Yf an asset became iointly owned within one year of the decedent's date of death, it must be reported on Schedule G. REV-1511 EXt (10-09) ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Teneth C. Heffelfinger 21-10-0246 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Stone and Murray -funeral expense 8,430.00 Woodlawn Memorial Gardens 1,493.00 B. 1 ADMINISTRATIVE COSTS: Personal Representative Commissions: Waived Name(s) of Personal Representative(s) Street Address __ ,____`____________ City Year(s) Commission Paid: __~_ ` 2. Attorney Fees: Snelbaker & Brenneman, P. C. 3,500.00 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: to Re aster of Wills 327.50 g' ($277.50); additional probate fee ($50.00); total: 5. Accountant Fees:, miscellaneous filing fees and reserve 750.00 6. ~~~~~~~~ Sovereign Bank, fee for date of death values • 20.00 ~• RSR Appraisers and Analysts, real estate appraisal 350.00 s. Advertise grant of letters: a. Cumberland Law Journal $ 75.00 b. The Sentinel 230.00 305.02 Auctioneer -auction fee and costs 795..70 State ZIP TOTAL (Also enter on Line 9, Recapitulation) I $ 15,971.22 If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-©8) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RE5IDENT DECEDENT ESTATE OF FILE NUMBER Teneth C. Heffelfinger 21-10-0246 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1• PA American Water Company - payment on account 55.08 2. PP&L - payment on account 49.19 3. Quantum Imaging - payment on account -medical 8.34 4. Associated Cardiologists - payment on account -medical 37.23 5. Heritage Medical Group -payments on account -medical 298.00 6. New Cumberland ambulance - payment on account 70.31 7. U.C.P.A. - payment on account -medical 66.18 8. Senior Helpers - payment on account 18.50 9. Comcast - payment on account 13.19 10. Verizon - payment on account 14.39 11. New Cumberland EMS - payment on account 71.66 12. Pulmonary Cardiologists - payment on account -medical 43.14 13. Center For Kidney Disease - payment on account -medical 25.35 14. Golden Living Center, West Shore, payment on account 825.00 TOTAL (Also enter on Line 10, Recapitulation) I $ 1, 595.56 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10} pennsylvania SCHEDULE ~ DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Teneth C. Heffelfinger 21-10-0246 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).] 1~ Martha Wheeler daughter 50~ of residue 913 Front Street, New Cumberland, PA 17070 Franklin M, Heffelfinger, Jr. Son 50~ of residue 660 Moores Mountain Road, Mechanicsburg, PA 17055 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 DI5TRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I $ If more space is needed, use additional sheets of paper of the same size. t..l .l` TEHETH ~A~EH.~1 HEFFE]LF~~~GER. I, TENETH CARENA HEFFELFINGER, of 315 Geary .avenue, New Cumberland, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void ariv and all farmer Wills, Codicils, or writings in the nature thereof, by me at ar y time heretofore made. FIRST: I hereby order and direct my Executor or Executrix, hereinai`ter r~,a,med, tee pay all my ,just debts, funeral expenses, testan~enta~ry expenses and alI Inheritance, Estate, Trans.fe:r and Suct:.~ssican T~axew, as s©on as may be co.ra.veniently done after my death, aut caf my rEy ~~iduar~r estate. SIiJCUND: All the rest, residue and remainder af' my estate, be it read., persr~nal aa~ mixed y a$' whatsoever kind and wheresoeve~^ situate, I hereby give, devise and bequeath to my husband, Franklin Martin ~e:~feifinger a/kla ~rankl:€n Cab~.ugh, l~rc>~r3c~cd lae survive me for a, period of thirty {3®) days. ~`i-~Il~~t~ In ~.he event that my said busbanc~ shall predecease me car net stiar. ~Ti ~~ ~: me i~;,% ~~ai~°t3- (30J ~ d~,;~Ts, T hereb~r gi~cTet ~~yvise a.nd bee~ueat~h ka:~.s tii:~l.e''~~~' Ct~~ ~s ~; ~~ 6i~,j."~: ~~~:: 7.~, i~~'~~GA.~.e ~Je'~"'~4J'T'io~~. Cox` ~~ii~'ths ~.` 'V~I~A€~',i.~r".'';~'~ver ~4~~1d c't.27C~ ~r~~~.t^.~3~es~~~~~rP~^ r:~~~~t~~r~.~:,e.., ~.~:~ ~~~% ~,~hi~~~~er~..; t~i~,;~`~,h~; ~~~heelF~~ a~c~ F'ra~~~.~~r~ I~~~.~~t~z"~ ~efl'elfirAge.~:~g .~r.<, ~.~~ equal s~a.ares, pe:° stir°pe. I,A,STL~': I nominate, canstitute and. appc~i~:~t mY daughter, Mart~a.s. Wheeler, to be the Executrix of this my Last Will and Te>>tament. Shou-1d I~7[artl~.a Wheeler be unable to act for any reason, then I app©int .ny son, Franklir~ Martin Heffelfinger. , 3r. to act as .Executor in her .place and .stead. No executri-x or executor or shall be required to file bond in this or an Y other ,jurisdiction. _ .~ { .... .... ...,~,,,,w..sr ;".!erca~*lfTlr,?A..:W.°' ~?~:!!~?°'fi;Y~.'• r*r:- ~",e' -^" .`ice r _ '..: '.,~ ; Ti+TESS WHEREUF, r have hereunto set my hand and seal tc~ this Will IN WI ~ , a es this;-~ daY of , °, f ~ consisting of P g ~~ 1. I ~ ~" ..t ,~ ~.~ ~ ,fir; ~~ er ~~ ~es~a-triX `'r Tenet:E2 Cerena li,effelfing SIGI~TED, SEALED, PL]Bsenee o fand DECLARED in the Pr is ,~~, .~~ > (WI'~NES S 2 ) 2 ACKNOWLEDGEMENT AND .AFFIDAVIT COMMONWEALTH l+~F PENNSYLVAI~TIA :ss COUNTY OF , r'~ s ~~; ;^~ ~~~' ~ ~!~~f~~ 1 i~~ f, r ... Teneth Carena Heff~elfinger, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law! does hereby acknowledge that she signed and executed the instrument as her Last i~i11; that she signed it willingly; and that she signed it as her free and voluntary act for the purposes therein expressed, ire, the witnesses whose names are signed to the attached az^ f~arego:ing instrument, being duly sworn and qualified according to law, do depc-se and c3ay that we were present arld saw ~'enetl~a Carena Heffelfinger sign and execute the instrument as her Last mill; that 'Teneth Carena Heff+~Ifirnger signed willingly and that she executed it as her f'z°ee and ~rolun.tary act fear the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the ~~i11 as witnesses; and. that tca the best of caur knowledge the Testatrix was at that time 18 or more years o>` agel of sound mind and under no constraint sir undue influence. -~, k ~ ar^`7 ~:~ t,.L ^ ..~'~....,^~ 5.. _'~~f'6.,~n',. E ~`' ~,.~ .3::, ` ~~~^t.'4. 5„ pkg..±,..r Teneth Carena Heffelfinge~A ~ T~s`ta~t ;.-.. s. ..,. -- V~Titne~s ~ -~y G ~: Witness r ;Sw©rn or affzr~ne,c~ ~ to and acknowledged and subscribed before me this ,; ~ `~ ~ , day of ~ ' ' '' ~ ; ~ ~' P,. ~ , ~ 199 ~~. ~ ~ ~ ~ ~~Totary Public ~ ~~ ~!lgSTINE ~I~N~QT~I~tY PtpIBLIC 3 Mtt ~ P1tiES OCT~Z~ 199G