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Home My WebLink About04-04-11 (3) 1505610148 REV-1500 EX ~°'-'°' PA Department of Revenue OFFICIAL USE ONLY _ Bureau of Individual Taxes County Code Year f=ile Number PO BOX 2806°1 INHERITANCE TAX RETURN 21, 11 016], Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW _ Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 223-26-61,00 0106201,1 01031925 Decedent's Last Name Suffix Decedent's First Name M I HOOVER CARL S (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M I Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - - REGISTER OF WILLS FILL IN APPROPRIATE BOXES 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 Tai; Return Required ^ 6 Decedent Died Testate ^ death after 12-12-82) 7 D d t M i t i d Li i . . ece en a n a ne a v ng Trust 8. Total Number of Safe: Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) ^ 9 Liti P ti d d ^ R i 10 ^ . ga on rocee s ece ve . 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) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JEFFREY A• ERNICO, ESQ- 717-232-5000 First line of address 3401, NORTH FRONT STREET Second line of address PO BOX 5950 City or Post Office State ZIP Code HARRISBURG PA 171100950 Correspondent's a-mail address: J A E R N I C O a^I NI E T T E• C O M 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. ~~N~TURE OF PERSON RESPONSIBLE FOR FILI RETU~N ,~ ~ DATE ADDRESS ~,~ PA 17 ~5 S 1003 W LISBURN RD, MECHANICSBURG~/ 61.6, S YORK RD, DILLSBURG, IPA 17019 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE D TE: ~1ETTE, EVANS & WOODSIDE u ~~ la ADDRESS 3401 N• FRONT STREET, PO BOX 59 0 HARRISBURG, PA 17110-095[] PLEASE USE ORIGINAL FORM ONLY t~•~ _> .. _, -- , _ _ _ ___ ; ~"~ ~. ~~~ REGISTER OF WILLS IISE ONLY f-.. ,:- . ,.... , , x r. ~~7 ~~ -~ ~~ I ~z . ~•: DA~E.E D_T Side 1 1505610148 9M46474.000 1505610148 J 1505610248 REV-1500 EX Decedent's Social Security Number 223-26-61,00 Decedent's Name: HOOVER CAR S RECAPITULATION _ 1. Real Estate (Schedule A) 1 0 • ~ ~ 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 0 • D 0 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) 5. 91, 6 7 6.11 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested 6 (] • ~ ~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested 7. 9 7 ,12 5 •9 3 8. Total Gross Assets (total Lines 1 through 7) $ 18 8 , 8 0 2.0 4 9. Funeral Expenses and Administrative Costs (Schedule H), .9 5 , 7 2 3 • 12 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) 10. 2 , 2 9 6.3 4 11. Total Deductions (total Lines 9 and 10) , 11 8 , 019.4 6 12. Net Value of Estate (Line 8 minus Line 11) 12. 1, 8 0 , 7 8 2 • 5 8 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) , , 1 g 0 . 0 0 14. Net Value Subject to Tax (Line 12 minus Line 13) _ , 14. 18 0 , 7 8 2. 5 8 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers un~er Sec. 9116 16. Amount of Line 14 t xable at lineal ratex o 4 ~ . 180, 782.56 1s. 8,135.22 17. Amount of Line 14 taxable at sibling rate X .12 0. 0 0 17. 0. 0 0 18. Amount of Line 14 taxable at collateral rate X .15 0. ~ 0 18. 0. 0 0 19. TAX DUE . 19. 8 , 13 5. 2 2 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610248 1505610248 9M4648 4.000 REV-1500 EX Page 3 Decedent's C~mnlete Address File Number DECEDENTS NAME HOOVER CARL S _ STREET ADDRESS CU~1B BLAND COUNTY CITY NEWVILLE STATE PA _ ZIP' 1~7241- Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments ~ . Q Q B. Discount 4 0 6.7 6 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (1) _ 8,1,35.22 406.76 (3) _ 0.0 0 0.00 (5> _ 7, 728.46 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCK;S 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; ^ ^X c. retain a reversionary interest; or ^ d. receive the promise for life of either payments, benefits or care?. ^ 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? ® ^ 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. §91 16 (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. X9116(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)]. A siibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Total Credits (A + B) (2) 9M4671 2.000 REV-1508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Carl S . Hoover 21 11 0161._ Include the proceeds of litigation and the date the proceeds were received by the estate. 3W46AD 1.000 (If more space is needed, insert additional sheets of the same size) REV-1510 EX + (08-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Carl S. Hoover 21 110161 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBS DESCRIPTION OF PROPERTY INCLLOE THE NMAE OF TFE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. AITACHA COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION IF APPl1CABLE TAXABLE VALUE 1• John Hancock Life Insurance _ Company Variable Annuity, Contract #RV02700412 60,366.39 100.0000 0.00 60,366.39 Beneficiarie are Delores Jean Hall and Randy Hoover; see attached information. 2 John Hancock Life Insurance Company Variable Annuity, Contract #VP1028962 15,753.95 100.0000 0.00 15,753.95 Beneficiaries are Delores Jean Hall and Randy Hoover; see attached information. 3 1,894.04 Shares John Hancock High Yield A mutual fund, Account #00005669867 7,576.16 100.0000 0.00 7,576.16 Transfer on death designation to Delores Jean Hall and Randy Hoover; see attached information. 4 2,001.41 Shares John Hancock Strategic Income A - mutual fund, Account ##00005669868 and 00777123783 13,429.43 100.0000 0.00 13,429.43 Transfer on death designation on both accounts to Delores Jean Hall and Randy Hoover; see attached information. TOTAL (Also enter on line 7, Recapitulation) $ 97,125.93 If more space is needed, use additional sheets of paper of the same size. 9W46AF 2.000 REV-1511 EX+ (10-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDEM' DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Carl S. Hoover 21110161 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. PREPAID FUNERAL B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address _ City State ZIP Year(s) Commission Paid: 2. Attorney Fees: 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: 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. 1 Cumberland Law Journal Legal advertisement 2 The Sentinel Legal advertisement Total from continuation schedules . 5,000.00 303.50 142.62 75.00 200.00 2.00 TOTAL (Also enter on Line 9 Recapitulation) ~ $ _ 5 , 723.12 swasA~ z.ooo If more space is needed, use additional sheets of paper of the same size. Estate of: Carl S. Hoover Schedule H Part 7 (Page 2) 3 PNC Bank Service Fees 21 11 0161 2.00 Total (Carry forward to main schedule) 2.00 REV-1512 EX + (12-08) pennsylvania SCHEDULE DEPARTMENTOF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Carl S. Hoover 21 11 0161 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. 8W46AH 2.000 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF: FILE NUMBER: (`~rl C T.7~~~~cr rf~ ~ ~ n~ i-~ RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. Delores Jean Hall 1003 W. Lisburn Road Mechanicsburg, PA 17055 John Hancock Life Insurance Company Variable Annuity, Contract #RV02700412 Inventory Value: 30,183.20 John Hancock Life Insurance Company Variable Annuity, Contract #VP1028962 Inventory Value: 7,876.98 1,000.71 Shares John Hancock Strategic Income A mutual fund, Account ##00005669868 and 00777123783 Inventory Value: 6,714.72 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1 8 OF REV-1500 COVER SHEET, AS APP ROPRIATE. [[ NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS 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. $ 0.00 Ir more space Is neeaecl, use addltlonal sheets of paper of the same size. 9W46A1 2.000 Estate of: Carl S. Hoover Schedule J Part 1 (Page 2) 21 11 0161 Item No. Description Relation Amount 1 947.02 Shares John Hancock High Yield A mutual fund, Account #00005669867 Inventory Value: 3,788.08 One Half of Residue: 41,828.32 Daughter 90,391.28 2 Randy L. Hoover 606 S. York Road Dillsburg, PA 17019 John Hancock Life Insurance Company Variable Annuity, Contract #RV02700412 Inventory Value: 30,183.20 John Hancock Life Insurance Company Variable Annuity, Contract #VP1028962 Inventory Value: 7,876.98 1,000.71 Shares John Hancock Strategic Income A mutual fund, Account ##00005669868 and 00777123783 Inventory Value: 6,714.72 947.02 Shares John Hancock High Yield A mutual fund, Account #00005669867 Inventory Value: 3,788.08 One Half of Residue: 41,828.32 Son 90,391.28 ~~ tea', ~,,, _. .:~ . ~,`' v w ~d :_ ~~> ~ ~ .. ~ w . . Y.f _ ~_ J ~~ ~ ~.~~1~s, ~ ~~. .. 1' y 0 ~. . ~.'. ~~ ~ ~ • S " ` m _ ~- 0 o a -- o a ~o 0 0 ~ ~ _ . , '-'r i~.9..~~3 cf~l f AF='R -~ ~`1 I ~ i ~. ,~ 0'~'~r ~ s, 7 - BURT C~~~~~~ `~"- ;t~., Pp, W ~ O E ~ Q F W o ~~~F o Oa~v~~~ ~o~z~,~ ~~ ~~ ~~~~oa ~zW~~~ ~~~~o~ W~~~~~ O .. W E.., ~ wo~z ~ ~~ o a ~ ~~ ~ a~ 0 o~ ~ U ~ ~ ~ ~ c~ ~~o~o ~~U ~a°^ ~~~~~ ~ o ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ o a~ °~ ~ ~ CJ ~ _ a~ a~ ~ ~ C7~U®U O E~