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1505610149
REV-1500 EXt°'-'°' ~"
p~~ OFFGAL USE ONLY
PADepartmsntofRevenus °"'"'"`A/0'"""""` County Cods Year File Number
BursauoflndividualTaxes INHERITANCE TAX RETURN
PO BOX 280801
Harricburp, PA 17128-0801 RESIDENT DECEDENT ' 1 1 p 0 5 41
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYY!Y
21? 22 6554 05 11 2010 08 12 1918
Decedern's Last Name Suffix Decedern's Frst Name MI
Hoffman Janet E
(If Applicable) Enter SuMvlnp Spouse's Information Below ',
Spouse's Last Name Suffix Spouse's Fret Name MI
j
Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICAtE (WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
~ 1. Original Retum D 2. Supplemernal Retum O 3. Remaindi:
. prior to 1 S
O 4. Limited Estate O 4a Future Irnerest Compromise (date of O 5. Federal E
death after 12-12-82)
~ 6. Decedern Dfed Testate ~ 7. Decedent Malrnained a Living Trust e. Total Nun
(Attach Copy of Wllp (Attach Copy of Trust)
O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death D 11. Election ti
between 12-31-81 and 1-1-95) (Attach Si
~tum (date of death
4-82)
~ Tax Retum Required
of Safe Deposit Boxes
K under Sec. 9113(A)
--
CORRESPONDENT - This sectlon must be completed. Ail Correspondence and Confidential Tax Information h utd bs Directed to:
Name Daytime Telep ne~l Number
Stephanie Kleinfelter, Esq• 717 90 '7786
REQIST WILLS US~"IINLY s~
Rrst line of address rte'
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Saidis Sullivan and Rogers ~'~ .
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-ta ' `n
Second line of address ~~ -~
t`~rrr
635 N• 12th Street, Suite 400 -,r
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~3ATE FILED
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Gty Or Post Office State ZIP Code
Lemoyne PA 17043
Correspondern's a-mail address: skteinfelter keefelW00d.COm
Underpenaltiee of perjury, I declare thatl have examined this return, including accompanying schedules and statements, and to the bs
it is trw, correctand Compleb. Declaration of the preparer other than personal representative is based on all information of which prep to my knowledge and belief,
rer Thais any knowledge.
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Side 1
L 1505610149
150567~0~,49 J
~-
Rev-1500 EX
1505610249
Decedent's Name: Janet E. Hoffman
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.
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) ....... 5.
6. Jointly Owned Property (Schedule ~ O Separate Billing Requested ...... 6.
7. Irner-~vos Transfers & Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested .. • • .. 7.
8. Total Gross Assets (total Lines 1 through 7) ............................ 8.
9. Funeral Expenses and Administrative Costs (Schedule H) • .. • .. • • . • • • • . • • • • 9.
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .... • ... • • • • • 10.
11. Total Deductions (total Lines 9 and 10) .............................. 11.
12. Net ValueotEstate(LineBminusLinell)..••.••.••••••••••••.•••••••• 12.
13. Charitable and Govemmernal 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 13j ... • ... • ...... • • • . • • . • • 14.
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116 D • D D
(a)(1.2) X .00 15
16. Amount of Line 14 taxable
D • D D
at lineal rate X .045 16.
17. Amount of Line 14 taxable
178
548.27
,
at siblingrateX.12 17.
18. Amount of Line 14 taxable 16 9
6 8 7 • ? 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
L 1505610249
Decedern'g Social Security Number
217 ~2 6554
13o,DOO•oD
0.00
0.00
D.oo
25,982.55
0.00
224,969.01
380,951.56
31,426.16
1,289.43
32,715.59
348,235.97
0.00
'' 348,235.97
D•00
', 0•D0
21,425.79
25, 453.16
46,878.95
~ ~. __~
Rev-1500 IX Page 3
Decedent's Complete Address:
Fle Number
21 10 0541
DECEDENTS NAME
Janet E. Hoffman
STREET ADDRESS
901 Sheffield Avenue
CITY
Mechanicsbur STATE
PA ' ZI P
17055
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
32,672.00
1.719.53 Total Credits (A + B)
(1) ^, 46.878.95
(2) ~ 34,391.53
(3) 0.00
(4)
(5) ~I ~ 12,487.42
3. Interest
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
FIII in oval on Page 2, Une 20 to request a refund.
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE API~R~PRIATE 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. retainareversionaryinterest;or •••••••••••••••••••••••••• .......................'..,^
d. receive the promise for life of either payments, benefks or care? ... • • . • . • • • • • • • • • • • • • • • • • • • ^
2. If death occurred after December 12, 1982, did decedent transfer property within one year
of death without receiving adequate consideration? ••••••••••••••..•••.•••••.•••••••••••L•• ^
3. Did decedent own an "in trust for' orpayable-upon-death bank account or security at his'or her death? i• . ',~ ^
4. Did decedent own an individual retirement account, annuity, or other non-probate property,
which containsabeneficiarydesignation? .•..•••.••••••••.•••..•••••••••••••••••••••'••'~ ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE ~T ASS 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. Sect. 9118(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 surviv ng spouse is 0 percent
[72 P.S. Sect. 9118(a)(1,1)(iq]. The statue does not exempt a transfer to a surviving spouse from tax, and the statutory n'~uireiments 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. Sect. 9116(ax1.2)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 peroent,l except as noted in
72 P.S. Sect. 9116(1.2) [72 P.S. Sect. 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. Set. 9118(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.
r~
REV -f 502 EX+i01-f 0)
Pennsylvania SCHEDULE A
DEPARTMENT DF REVENUE
INH ERITANCE TAX RETURN REAL ESTATE
RESIDENTDECEDENT
ESTATE OF: FILE U BER:
Janet E. Hoffman 21 1 041
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 pr ce aft which property would ba
exchanged between a willing buyarand a willing seller, neither being compelled to buy orssll, both having reasonable knowl dge,of the relevant facts.
Real ro ert that is'aintl -owned with ri ht ofaurvivorchi must be disclosed on 6chedule F,
Attach a copy of the settlement sheet if the property has been sold.
l-~ Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE
NUMBER DESCRIPTION ' OF DEATH
1 House and Lot Commonly Known As 901 Sheffield Avenue, ', 130,000.00
Mechanicsburg, Cumberland County, Pennsylvania
Held In The Janet E. Hoffman Trust, Agreement Dated November 9, 2006
Deed Book 277 Page 4021
PIN: 30-2108-027 ',
Gross Sale Value
TOTAL (Also enter on Line ~, Recapitulation.) ' I 130,000.00
If more space is needed, insert additional sheets of the same size.
REV -~ 608 EX+ (8-88)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE U SER
Janet E. Hoffman 21 11 0 01541
Include the proceeds of litigation and the date the proceeds were n3ceived by the est e.1
All property jointly-owned with right of survivorship must tie disclosed on Schell le 1~.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 PNC Bank, N.A.
I ' 7,396.20
'~
Money Market Account No.: 5004994287
Held In The Janet E. Hoffman Trust, Agreement Dated November 9, 2006
2 PNC Bank, N.A. 9,979.20
Checking Account No.: 5005151505 ',
Held In The Janet E. Hoffman Trust, Agreement Dated November 9, 2006
3 Members 1st Federal Credit Union 25.00
Savings Account No.: 3042472-00001
4 Wachovia Bank I~ 201.57
5 MetLife -Uncashed Annuity Check Dated 05/03/2010
~ 200.00
I
Account No. 073201110AB
6 MetLife -Uncashed Dividend Check Dated 05/03/2010 300.00
Lar a Ca Core- Class A
9 P '
7 MetLife -Uncashed Dividend Check Dated 04/30/2010
Il 101.68
il
High Yield Bond - Class A
8 Members 1st Federal Credit Union -Uncashed Check Dated 05/03/10 43.97
9 Cash Located In House 280.00
10 Met Life -Check I~ ' 400.00
11 Times Inc. -Cooking Light 44.46
Magazine Subscription Refund
12 Southern Progress -Magazine Subscription Refund ~I~ 22.78
13 National Geographic 17.00
Magazine Subscription Refund ~~~
14 Times Inc. Shared Services -People Magazine 19.35
Magazine Subscription Refund
15 Nationwide Insurance -Care Insurance Premium Refund (Insurance Paid 68.70
by The Trustee of The Janet Hoffman Trust)
Total from continuation Schedule(s) 6,882.64
TOTAL (Also enter on line 5, Recapitulation) ', 25,982.55
(If more space is needed, insert additional sheets of the same size) '
~_ __ _~
_~.~,
Estate of: Janet E. Hoffman
Schedule E -Cash, Bank Deposits, and Misc. Personal Property
Page 2
21 10 0541
Item Value at Date
Number Description of Death
16 Reader's Digest -Magazine Subscription Refund 12.72
17 Commonwealth Of Pennsylvania -Homeowners' Rebate ', 250.00
18 Commonwealth Of Pennsylvania -Income Tax Refund ' 80.00
19 Miscellaneous Receipt ', 16.67
20 Prudential Insurance -Refund Of Homeowners' Unused Premium 129.00
21 Washer And Dryer -Sales Value 550.00
22 End Table And Coffee Table -Sales Value ~ 75.00
23 CareSafe -Insurance Refund I '~ 1,169.25
24 Table And Lamps -Sale Value ~ 275.00
25 2004 Chrysler Sebring Sedan 4 Door I, 4,325.00
TOTAL. (Carry forward to main schedule) ...... ' 6,882.64
'~
I
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REV-1510 EX+(08-08)
Pennsylvania
DEPARTMENT OF REVENUE
INH E RITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS AND
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE INUIiY18ER
Janet E. Hoffman 21 1 d 0541
This schedule must ha comoleted and filed if the answer tc env of questions 1 through 4 on page three of the REV-1500 is yes. ',
ITEM
NUM DESCRIPTION OF PROPFJaTY
INCLUDE NAME OF TRANSFEREE, RELATIONSHIP TODECEDENT&
DATE OF TRANSFER. ATTACH COPYOF DEED FOR REAL ESTATE
DATE OF DEATH
VALUE OF ASSET
%OFDECD'S
INTEREST
IXCLU
(IFAPPLI
ICiN
ABLE)
TAXABLE
VALUE
1 Met Life high Yield Bond -Mutual Fund 16,216.33 ', 16,216.33
Transfer On Death To: Marian Cherry and ',
Deborah Priest
2 Met Life Large Cap Core - Class A -Mutual 39,284.27 I 39,284.27
Fund
Transfer On Death To: Marian Cherry and i
Deborah Priest '~,
3 Members 1st Federal Credit Union 16,226.58 ', 16,226.58
Certificate Of Deposit No.: 3042472-44 ',
Maturity Date: August 9, 2010 ',
In Trust For: Deborah L. Priest and Marian W.
Cherry
4 Members 1st Federal Credit Union 3,305.06 ' 3,305.06
Certificate Of Deposit No.: 3042472-46 ',
Maturity Date: August 9, 2010
In Trust For: Deborah L. Priest and Marian W.
Cherry
5 Wachovia Bank 12,000.00 12,000.00
Certificate Of Deposit No. 247402063483265
Maturity Date: June 30, 2010 ',
In Trust For: Marian Cherry and Deborah Priest
6 Met Life Annuity Contract No. 073121426AB ', 82,820.74
Beneficiary: Marianne W. Cherry, Decedent's
Sister
i
7 Met Life Annuity Contract No.073201110A6 55,116.03
Beneficiary: Marianne W. Cherry (Decedent's ',
sister) and Deborah C. Priest (Decedent's '~,
Niece)
TOTAL (Also enter on Line 7, Recapitulation)
If more space is needed, uSe additional sheets of paper of the same size.
REV-ib11 EX+(10-09)
Pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE U B'ER
Janet E. Hoffman 21 1 0541
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1 Malpezzi Funeral Home -Funeral Service 6,103.87
2 Giant Foods -Funeral Reception 142.13
B. ADMINISTRATIVE COSTS:
~. Personal Representative Commissions: 1,000.00
Name(s) of Personal Represernative(sQeborah C. Priest
street Address P.O. Box 109
aty Yeagertown state PA Z;p 17099
Year(s) Commission Paid: 2011
2. Attorney Fees I 12,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
Clalmarn
Street Address
City State Zip
Relationship of Claimant to Decedern
a. Probate Fees 45.00
s. Accountant Fees:
6. Tax Return Preparer Fees:
See schedule attached 12,135.16
TOTAL (Also enter on Line 9, Recapitulation) 31,426.16
If more space is needed, use additional sheets of paper of the same size. ',
I
III
~ T _ __
Estate of: Janet E. Hoffman
Schedule H, Part B -Administrative Costs
Miscellaneous Expenses
Item
Number Description
T-
7 Cumberland County Register Of Wills ',
Will $15.00
Short Certificiates $12.00
JCS Fee $23.50
Automation Fee $ 5.00
8 Lowe's -Changing Locks
9 Lowe's -Dehumidifier
10 Lawnscapes, Inc. -Lawn Maintenance
05/17/2010 and 05/24/2010 $ 78.00
06/07/2010 Sales Tax $ 9.36
07/30/2010 $206.70
08/25/2010 $ 82.68
10/05/2010 $165.36
10/15/2010 $124.02
11/09/2010 $124.02
01/14/2011 $ 41.34
11 PP&L -Electric Service To Residence
07/08/2010 $ 236.00
09/03/2010 $ 197.00
09/22/2010 $ 199.46
11 /09/2010 $ 206.99
12 United Water -Water Service To Residence
07/08/2010 $ 15.87
09/03/2010 $ 10.25
09/22/2010 $ 10.40
10/15/2010 $ 10.25
01/14/2011 $ 16.21 ',
13 T Mobile
14 Koppenhaver Appraisals -Real Property Appraisal ',
15 Nationwide Insurance -Homeowners' Insurance Premium
16 Upper Allen Township
-Sewer Service To Residence
10/15/2010 $ 230.78
11/15/2010 $ 112.00
11/15/2010 ($ 57.22) Refund/Proration Received At Settlement
TOTAL. (Carry forward to main schedule) ......
i
II
i
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Amount
Page 2
21 10 0541
55.50
33.32
189.84
831.48
839.45
62.98
5.44
350.00
90.00
285.56
2,743.57
~, .
Estate of: Janet E. Hoffman
Schedule H, Part B -Administrative Costs
Miscellaneous Expenses
Page 3
21 10 0541
Item I
Number Description Amount
17 Dish Network I 15.90
18 Notary Fee 5.00
19 Transactional Costs (i.e., Realtor's Commission and Realty Transfer Tax) - 9,325.00
Sale Of Real Property Was Necessary To Pay Debts, Administration
Expenses, and Inheritance Tax
20 Keefer Wood Allen & Rahal, LLP ' 15.69
- Miscellaneous Expenses
Landex Deed Copy $ 9.25 ',
Copies $ 4.68
Postage $ 1.76 ~
21 Register of Wills ', 30.00
-Filing Fees Inheritance Tax Return and Inventory
TOTAL. (Carry forward to main schedule) ...... ', 9,391.59
REV-1b12 EX+(12-08)
~ Pennsylvania SCHEDULE 1
DEPARTMENT OF REVENUE DEBTS OF DECEDENT, '
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RE6IDENTDECEDENT
ESTATE OF FILE UMBER
Janet E. Hoffman 21 1 Offi41
Report debts incurred by decedent prior to death that remained unpaid at the date of death, Including unrel bu medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Lawnscapes, Inc. -Lawn Maintenance 78.00
2 T. Mobile -Telephone Service 25.31
3 Discover -Credit Card 476.06
4 PP&L -Electric Service To Residence 236.00
5 United Water -Water Service To Residence 15.87
6 Verizon -Telephone Service 49.07
7 Dental Bill -Check Cleared After Death 287.10
8 Peace Church -Check Cleared After Death 15.00
9 Lawn Doctor -Check Cleared After Death 94.02
10 Delicious & Simple -Check Cleared After Death 13.00
''
TOTAL (Also enter on Line 10, Recapitulation) Ili 1,289.43
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+(01-10)
~ Pennsylvania SCHEDULE J
DF.VARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE UN~ BER:
Janet E. Hoffman 21 1 0 41
RELATIONSHIP TO DE AMOUNT OR SHARE
NUMBE NAME AND ADDRESS OF PERSONS RECEIVING PROPERTY Do Not LISt Tru ' OF ESTATE
t TAXABLE DISTRIBUTIONS [Include outright spousal distributions, and
transfers under Sec. 9116(a)(1.2).] i
Deborah C. Priest Niece ' 95,727.53
P.O. Box 109
Yeagertown,PA 17099 ',
Mariann W. Cherry Sister ~ 178,548.27
1463 N. River Road
Granville, PA 17029 ',
David Cherry Nephew ', 24,653.39
P.O. Box 48
Granville, PA 17029
Donald Cherry Nephew 24,653.39
4870 SR 103 N ',
Lewistown, PA 17044 ',
James Cherry Nephew ', 24,653.39
425 Snooks Hill Road
Granville, PA 17029
ENTER DOLLAR AMOUNTS FORDISTRIBUTIONSSHOWNABOVEONLINESISTHROUG H180FREV-~5000OVERSH ET, 9 APPROPRIATE.
ii NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAK~N: ',
i
'i
i
i
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: ',
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TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER
If more space is needed, use additional sheets of paper of the same size.