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Home My WebLink About05-31-11 (2)150561143 REV-1500 E%{01 -t 0) OFFICIAL USE ONLY PA Department of Revenue Pennsylvania County cone vea. File Number Bureau of Individual Taxes °~'""'"'~"TOF Po BOx.2so6o1 INHERITANCE TAX RETURN 21 11 014 6 Harrisburg, PA 17128-ost)~ RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Deafh Date of Birth 183 18 8678 01 17 2011 10 03 1912 Decedent's Last Name Suffix Decedent's First Name MI REgM HAZEL M (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 Origins! Return ^ 2. Supplemental Return ^ 3. poor ond2 13 82) (date of death (~ ~ 4. Limited Estate qa, Future Interest Compromise ^ 5. Federal Estate Tax Return Required LJ ^ (date of death after 12-12.82) 6 Decedent Died Testate ^ 7, (De~de~oNplya~~ Tnnl)a Living Trust ~ 8. Total Number of Safe Deposit Boxes (ANach Copy of Wilq 9. Litigation Proceeds Received ^ 10, bePweenl P2 31 ~J~a dt~ 1at~5prdeath ^ t t.Election to tax under Sec. 9713(A) 1 (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED-ALL CORRESPONDENCE ANO CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JON A YOST 717 533 5101 First line of address 320 W CHOCOLATE AVENUE Second line of address FO BOX 437 City or Post Office HERSHEY State ZtP Code PA 17033 ~~ ':T'-, -~ i REGISTER OF WELLS USE QNLY E'3 '_' ~ °~ -~ ~ ~: ~ ,-~ .c. i3 -. ~~~ -[ i' _ ~~x C:~ ,,.~ DAT ~D ""' - -_ --I .. ~_ ~%~ t~.. Correspondent's e-mail address: IYOSt@y03tdaVidsOn.COm 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. Declaratlon of preparer other than the personal representative is based on all information of which preparer has any knowledge. MARLIN E. REHM -- %~.~ - ~(G i i 530 RED MILL ROAD ETTERS PA 17319 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DAT ~ '~~~- JON A. YOST .~ L~ ~~ I ~ ~~.r` ~ .~ 320 WEST CHOCOLATE AVENUE, Hershey, PA 17033 Side 1 L„~ 3505610143 1505610143 J y t` REV-1500 EX oecedenYs Name: REHM, HAZEL M. Decedent's Social Security Number 183 18 8678 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 & Notes Receivable (Schedule D) ........................................................ 4. 63,878.70 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers & Miscellaneous Nan; Probate Property (Schedule G) u Separate Billing Requested............ 7. g. Total Gross Assets (total Lines 1-7) ..................................................................... g. 63 , 878.70 4,007.07 9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 6,192.12 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 10,199.19 11. Total Deductions (total Lines 9 & 10) ................................................................... 11. 53,679.51 12~ Net Value of Estate (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. 53,679.51 14. Net Value Subject to Tax (Line 12 minus Line 13) .............................................. . 14. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15 0 . 0 0 (a)(1.2) X .00 . 16. Amount of Line 14 taxable 53 , 67 9.51 16. 2 415.58 ~ at lineal rate X .045 17 Amount of Line 14 taxable 0. 0 0 17. 0. 0 0 at sibling rate X .12 18. Amount of Line 14 taxable 0 0 0 18. 0. 0 0 . at collateral rate X .15 19. Tax Due ................................................................................................................. . 19. 2 , 415.58 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 1505610243 Side 2 1505610243 1505610243 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-11-00146 DECEDENT'S NAME REHM, HAZEL M. STREET ADDRESS 100 MT. ALLEN DRIVE CITY Mechanicsburg STATE PA ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 2,200.00 115.79 (1) Total Credits (A + B) (2) 2,415.58 2,315.79 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 2 Line 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. (3) (4) (5) 99.79 ~~ _ ~ ~ d: 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 :................................. ^ ^x c. retain a reversionary interest; or ............................................................................................................... ^ ^x d. receive the promise for life of either payments, benefits or care? ........................................................... ^ ^x 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................................................................................................... ^ ~X~ 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? .................................................................................................................. ^ 0 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)]. For dates of death on or after January 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)]. 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. Rev-1508 EX+(6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER REHM, HAZEL M. 21-11-00146 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) REV-1151 EX+110-06) COM IN~ ERIETANCEOT~ REN URN ANIA RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER REHM, HAZEL M. 21-11-00146 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached ~ 812.57 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zio Year(sl Commission paid 2. Attorney's Fees YOST & DAVIDSON 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's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 3,000.00 194.50 TOTAL (Also enter on line 9, Recapitulation) I 4,007.07 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER REHM, HAZEL M. 21-11-00146 ITEM NUMBER DESCRIPTION AMOUNT Funeral Ex en rases 1 CULHANE'S STEAK HOUSE-FUNERAL LUNCHEON FOR FAMILY AND FRIENDS OF THE 720.00 DECEDENT 2 PARTHEMORE FUNERAL HOME -EXPENSE NOT COVERED BY PRE-ARRANGEMENT 92.57 CONTRACT H-A 812.57 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev1512 EX+ (12.08) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER REHM, HAZEL M. 21-11-00146 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 ALERT PHARMACY-PRESCRIPTIONS 57.83 2 MESSIAH VILLAGE-CHECK WRITTEN BEFORE DEATH FOR NURSING FACILITY BUT NOT 2,981.99 PROCESSED UNTIL AFTER CLOSE OF MONTHLY BANK CHECKING ACCOUNT STATEMENT LISTED ON SCHEDULE E 3 ~ MESSIAH VILLAGE-FINAL PAYMENT FOR RESIDENCE AT NURSING FACILITY ~ 3,152.30 TOTAL (Also enter on Line 10, Recapitulation) I 6,192.12 (If more space is needed, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08) REV-1513 EX+111-08) SCHEDULE J COM INOHERIETANCEOT~ RETURN ANIA BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER REHM, HAZEL M. 21-11-00 146 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$) Do Not List Trustee s I TAXABLE DISTRIBUTIONS [include outright spousal ~ distributions, and transfers under Sec. 9116 a 1.2 See attached schedule Total 53,679.52 Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 15 00 cover sheet, as a ro riate. NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEETI Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08) SCHEDULE J BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: HAZEL M. REHM 01/17/2011 183-18-8678 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) 1 CRAIG LAUGHMAN Grandson 3,354.97 290 LONG LANE York Haven, PA 17370 2 GEARY LAUGHMAN Grandson 3,354.97 c/o York County Prison (#183120 3400 Concord Road York, PA 17402 3 ROGER LAUGHMAN Grandson 3,354.97 1087 HIGHLAND DRIVE Mechanicsburg, PA 17055 4 MARSHAL D. REHM Son 13,419.88 5771 HARWICH COURT Emmaus, PA 18049 5 WILLIAM P. REHM Son 13,419.88 466 SHELLEY'S LANE Etters, PA 17319 6 SHARON YOST Granddaughter 3,354.97 404 N. WALNUT STREET Mechanicsburg, PA 17055 7 MARLIN E. REHM Son 13,419.88 530 RED MILL ROAD Etters, PA 17319 Total 53.679.52 1 `~,; C i ~~ ~ ii1 ~zn~ ~~ Y~n~ ~~~ ~ of :HAZEL M. R I, Hazel N!. Rehm, of Goldsboro Borough, York County, Pennsyl- i vania, being of sound and d? sposing mind and memory, do make, publish `•- Viand declare the fo3low~g as and for my last wiZZ,and testament here- i D7 .y e~ki.rg all former ~'~ls by me ~Zt &I].y time heretofore made. It'e1n I. I direct mq hereinafter named personal represer_tative to 'pay a.Ll my ~ us t debts' and Funeral expenses as soon as nay b e corive~,e~tt aft my decease. 7t~e~ 'TI. I give, devise and bequeath my entire estate, real, personal and ~mi~ed, of xhatsoever kind and wheresoever situate unto mfr husband, Frank t~. Rehm:, to be his absolute'!y. Item III. ' Should rr~t husband predecease ne or should k*e die as the result 1 - ~af• ',a;._eom~cn~. aceider~t;~ I~ direct. z~~ Executroi} to ~c.orivert into cash ~ ;entire estate, and distribution thereof to be as follows: ~ (a) I give and bequeath aone-fourth (~.) share thereoz"' i unto ir~q daughter, $everly D. Loughman, or if ~e- ~ ceased, to rer children. (b) I give and bequeath Gone-fourth ('~) share thereof ur_to mp son, I~.arlin E. Rehm, or if deceased, to i his children . (c) I give and 'bequeath 'a one-fourth ('~) share thereof ~ unto iffy son, William P. Rehm, or i~' deceased, to his children. 1 b00/E00~d ZLEO# Ab'a9 3NN~dIO E08EbLLLIL 8~~Z0 IIOZ 10/OE y • ¢ , ~. - - (d) S give and bequeath cone-fourth (~) share thereof unto my son, N~asshall Dean Rehm, or if deceased, to his children. - ItIt e I hereby nominate, constitute anal appoint my husband, Frank ~'. M.~; . Rehm. to be the Executor of this ~y last will and testament. In the event that ~p husb-and should predecease me ar refuses to serve as ~ecutor, I do then nominate-and appoint my son, Marlin E. Rehm to ~~~ ~L~a ~~e.`ator. ?, d~Tect• what ~y zersonal representative shall serve without posting bond. IN TdITNF.SS 1~iP~REOF, I, Hazel Ni. Rer~, the ^estatrix above n2.med, have hereunto subscribed my name and affixed my seal this /~~ ~ day of ~, 1983. ,~. s'' ~- ', .d _ %~ (SEAL) 5ign.ed, sealed, published and declared by Hazel hi. Rehm, the ~ foregoing Testatrix, as armed for her last will •ar_d testament, in the presence of us, who •at .her request, jn her presence, and in the presence of each other, have hereunto •subscribed. our names as ;witnesses. :.~.,.~_ ~~CIl~ O~~Hi (j YOST & DAVIDSON 320 WEST CHOCOLATE AVENUE P.O. BOX 437 HERSHEY, PENNSYLVANIA 17033-0437 E-Mail: jyost@yostdavidson.com JON A. YOST JOHN S. DAVIDSON May 26, 2011 Glenda Farner Strasbaugh Cumberland County Register of Wills One Courthouse Square Carlisle, PA 17013 Dear Ms. Strasbaugh: TELEPHONE 717-533-5 l01 FAX 717-534-1293 Please find enclosed herewith two copies of the PA Inheritance Tax return for the Estate of Hazel Rehm, 21-11-0146, together with a payment of Inheritance Tax in the amount of $99.79 and a check of $15.00 representing the filing fee. Please clock in the extra first page of the Tax Return and mail it to me in the stamped, self-addresses envelope I have enclosed. Thank you. Sincerely yours, Yost & Davidson U- By: Jon A. Yost n ,, .~, ~ -z~ ~ ~-' ~~~ ~. r_. ~ '~ ~ ~ N ` `~ :1, 1 `~7 D ~ r~ N ft^ u. rr ~~ ~ ~ N ~ I~- I ~-~ :z ~~'~~ ~ ja a ~° ~ C .a ~% ~ , ~ ~ r' A(~ ~c c-l: r {!'` isr C.~ ~ .t ~ Cr'; ~ ~ t.u ,__ .' ~ t~i_s ~': .,,t ,~ 1 .V C1. ~: _ C,I~ C'') reC ~: .~ . M ~~ z ~ '~ ~ ~ M o ~ _ ~ O < a ox~ A ~~~ ~ ~ ~ a- .~ a?j x O z Faz .~ O rn ;!? aW. .. N N ~+ ^~ 0 a~ ~ ~ °''~ ~ ~ ~ ~~ ~ ~ ~~ ~~~~ ~ o ago a`~ U o r c a ~ ~ ~ ~ ~ ~ ~ ~~o~; ~~U ~ c - ~Em' - ~ c c~ C'3000