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HomeMy WebLinkAbout08-22-11 1505610140 REV-1500 ~` ~°'-'°' OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes Coun Code Year ty File Number PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 1 0 0 1 8 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYW Date of Birth MMDDYYYY 1 9 6 1 4 2 5 3 4 1 2 2 8 2 0 1 0 0 5 2 3 1 9 1 9 Decedent's Last Name Suffix Decedent's First Name MI H E I G E S H EL E N 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 INAPPROPRIATE 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) ® 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe 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) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD B~: QI~tECTED T0: Name Daytime Telept~~Number~'T.' ~~ R O G E R B I R W I N E S Q U I R E 7 1 7 ~ _~,'`/+9.~i 2/~~.B 5 <<~ ti: .. Fwd `'~ ...l.n REGISTER- _. S US~NLY - ~~' _. - ,, ~~~ ~. 1 First line of address ,, ,---. _._.~ ~ -- - - r , ~ ~_ I R W I N & M c K N I G H T P C~~ ~' -~ ~`~~`~' Second line of address ~:~ , 6 0 W E S T City or Post Office C A R L I S L E P O M F R E T Correspondent's a-mail address: S T R E E T State ZIP Code L P A 1 7 0 1 3 DATE FILED 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, and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SI c F PER ON ~ LE FOR FILING RETURN ~ U ~ ~ ~) p~D ~~ ADDRESS / ~' " 72 LADNOR LANE CARLISLE PA 17013 SIGNAT PREPARER~THER T N REPRESENTATIVE D TE ADDRESS 60 WEST FRET STREET CARLISLE PA 17013_ PLEASE USE ORIGINAL FORM ONLY L 1505610140 Side 1 1505610140 J ~,v .J 1505610240 14. Net Value Subject to Tax (Line 12 minus Line 13) .. . 1 -~ 2 ... . . . ..... . . 4. 3 7 8 0 8. 2 2 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.o D. 0 0 15. 0 0 0 16. Amount of Line 14 taxable . at lineal rate X .0_ 0. 0 0 16. O D 0 17. Amount of Line 14 taxable . at sibling rate X .12 D D D 17. D D D 18. Amount of Line 14 taxable . at collateral rate X .15 D D D 18. D. D D REV-1500 EX Decedent's Social Security Number decedent's Name: HELEN M• H E I G E S :L 9 6 1 4 2 5 3 4 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. 5 3 9 1 , 3 9 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested 6 7. .... Inter-Vivos Transfers & Miscellaneous N Probate Property (Schedule G) ~ ... . Separate Billing Requested .... ... 7. 8. Total Gross Assets (total Lines 1 through 7) ......................... .. 8. 5 3 9 1 , 3 9 9. Funeral Expenses and Administrative Costs (Schedule H) ................ .. 9. 2 1 2 7 . 5 6 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ..... . ..... ..10. 2 4 1 0 7 2. 0 5 11. Total Deductions (total Lines 9 and 10) ............................. .. 11. 2 4 3 1 9 9. 6 1 12. Net Value of Estate (Line 8 minus Line 11) ..... ..................... ..12. -• 2 3 7 8 D 8 2 2 13. Charitable and Governmental BequestslSec 9113 Trusts for which . an election to tax has not been made (Schedule J) .................... .. 13. 19. TAX DUE ......................................................19. D • D D 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610240 150.5610240 J REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 11 0018 DECEDENTS NAME HELEN M. HEIGES STREET ADDRESS 1000 CLAREMONT DRIVE CITY STATE. PA ZIP 17013 CARLISLE 'Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 0.00 2. Credits/Payments A. Prior Payments B. Discount Total Credits (A + B) (2) 0.00 3. Interest (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. 00 0 Fill in oval 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. (5) 0.00 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; . ^ X b. retain the right to designate who shall use the property transferred or its income; .............................. . ^ c. retain a reversionary interest; or ............................................................................................... . X 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 ^ 0 without receiving adequate consideration? ....................................................................................... 3. Did decedent own an "intrust for" orpayable-upon-death bank account or security at his or her death? ........ . . ^ Did decedent own an individual retirement account, annuity or other non-probate property, which 4 . ^ ^ X 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 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 an 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, un 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 FILE NUMBER HELEN M. HEIGES 21 11 0018 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. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. M&T BANK -CLASSIC CHECKING #42008514 547.04 2. ~M&T BANK -SAVINGS ACCOUNT #15004208613073 4,844.35 TOTAL (Also enter on line 5, Recapitulation) I $ 5,391.39 (If more space is needed, insert additional sheets of the same size) REV-1511~EX+ (10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER HELEN M. HEIGES 21 11 0018 Decedent's debts must be reported on Schedule I. ITEM AMOUNT NUMBER DESCRIPTION A, FUNERAL EXPENSES: 520.06 ~, HOFFMAN-ROTH FUNERAL HOME g, ADMINISTRATIVE COSTS: 1, Personal Representative Commissions: Name(s) of Personal Representative(s) PHILLIP V. HOFFMAN 750.00 Street Address 72 LADNOR LANE City CARLISLE State P= ZIP 17013 Year(s) Commission Paid: 2. Attorney Fees: IRWIN & McKNIGHT, P.C. 750.00 3, Family Exemption: (If decedents address is not the same as claimants, attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: REGISTER OF WILLS 77.5C 5 Accountant Fees: 6, Tax Return Preparer Fees: 7, REGISTER OF WILLS -FILING FEE 30.Ot TOTAL (Also enter on Line 9, Recapitulation) I $ 2,127.5 If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-08) pennsylvania SCHEDULE i DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER HELEN M. HEIGES 21 11 0018 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreirnbursed medical expenses. VALUE AT DATE ITEM OF DEATH NUMBER DESCRIPTION ~, DPW CLAIM -CIS #170188994 241,072.05 TOTAL (Also enter on Line 10, Recapitulation) I $ 241, 072. C If more space is needed, insert additional sheets of the same size. REV-1513 E3(+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF: HELEN M. HEIGES 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. PHILLIP V. HOFFMAN 1000 CLAREMONT DRIVE CARLISLE, PA 17013 FILE NUMBER: 21 11 0018 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Collateral AMOUNT OR SHARE OF ESTATE REMAINDER I ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. jI, 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. I $ If more space is needed, use additional sheets of paper of the same size. F:\FILES\DATAFIG.E\W ILLS\84:9. W IL LAST WILL AND TESTAMENT I, HELEN MAE HEIGES, of Dickinson Township, Cumberland County, Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking any and all former Wills or Codicils by me made. 1. I direct that all my just debts, funeral expenses, testamentary expenses and all inheritance taxes (whether such taxes may be payable by my estate or by any recipient of any property) shall be paid from my residuary estate as soon as practicable after my decease and as part of the administration of my estate. My Executor shall have no duty or obligation to obtain reimbursement for any such tax so paid, even though on proceeds of insurance or other property not passing under this Will. 2. I give, devise and bequeath all of my estate, both real and personal property, unto my nephew, PHILLIP V. HOFFMAN, absolutely. 3. I nominate, constitute and appoint my said nephew, PHILLIP V. HOFFMAN, as Executor of my estate. 4. I direct that my Executor shall not be required to file a bond to secure the faithful performance of his duties in any jurisdiction. 5. I authorize and empower my personal representative, in his sole and absolute discretion, to purchase or otherwise acquire and retain any investments of which I die seized or any real or personal property of any nature; to sell, lease, pledge, mortgage, transfer, exchange, dispose of or grant options in regard to any or all property of any kind forming a part of my estate for such terms Ga ~~ ~•, `afid suc _p~ces as he may deem advisable; to borrow money for any purposes connected with t e _~ ~~ '~~~-, ; _ . `' `LC-_~ H.M.H. r :t .^; ;~ ~': U f-; .c-L CJ ~`J ~--~ `-'- ' ~ .3 0 ~ Page 1 of 3 Pages ~..~ ~ ~ -_ --- U ~~ ..~.~ `< rotection and preservation of my estate; to mortgage or pledge any real. or personal property forming P a art of my estate or to join in or secure the partition of same; to compromise any claims or P demands of m estate against others or of others against my estate; to make distribution in kind and Y to cause any share to be composed of cash, property or undivided fractional shares in property different in kind from any other share; to employ agents, attorneys and proxies and to delegate to them such ower as my personal representative considers desirable and to pay reasonable P com ensation for such services as may be rendered by such agents, attorneys and proxies; and to P execute and deliver such instruments as may be necessary to carry out any of these powers. ereunto set m hand and seal this ~~ ~ day of IN WITNESS WHEREOF I have h Y 1996. 7 (SEAL) Helen Mae Heiges SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named Testatrix, as and for her Last Will and Testament, in the presence of us, who at her request, have hereunto subscribed our ames as witnesses thereto, in the presence of the said Testatrix and of each other. ~. f ~' a Page 2 of 3 Pages COMMONWEALTH OF PENNSYLVANIA ) SS. COUNTY OF CUMBERLAND ) I, Helen Mae Heiges, Testatrix, whose name is signed to the attached or foregoing instrument Navin been duly qualified according to law, do hereby acknowledge that I signed and g executed the instrument as my Last Will; that I signed it willingly; and that I signed rt as my free an voluntary act for the purposes therein expressed. Helen Mae Heiges Sworn or affirmed to and acknowledged before me by Helen Mae Heiges, the Testatrix, this ~~i`~ day of , 1996. Notarial Seal Corrine L. Myers, Notary Public NOt Public Carlisle Boro, Cumberland County ~ My Commission Expires May 27, 1999 COMMONWEALTH OF PENNSYLVANIA ) SS. COUNTY OF CUMBERLAND 1 We, , vd U D ~-- the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified the Testatrix, according to law, do depose and say that we were present and saw Helen Mae Heiges, si nand execute the instrument as her Last Will; that the Testatrix signed willingly and that the g Testatrix executed it as her free and voluntary act for the purposes therein expressed; that each o us, in the hearing and sight of the Testatrix, signed the Will as witnesses; and that to the best of our knowledge the Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Address ~ - ~ l ~` ~" `r ~, ~ ~ l ~ 7vi ~ _ ~//~ 'c~ ~- A ess ' ~l/'i~C~ . is C~/t ~'yi~ ~ me this '~~ da of , 1996. Sworn or affirmed to and subscribed before Y Notarial Seal ~ ~ Corrine L. Myers, Notary Public ~ l~J Carlisle Boro, Cumberland County otar public My Commission Expires May 27, 1999 y Page 3 of 3 Pages ::G~:':,::.:...«.':: ~. ::::•.: P,~1..~:...:...,.......,......:. 1 OF 1 DEC.07-Jp,N.06,2011 ---- HELEN M HEIGES _ _ 72 LADNOR LN CARLISLE PA 17015-9215 17457 CARLISLE WEST VI ::~D~lTE: s:: ;: > :.:.:.:.:.:.:.:.: ...........,.:. ,,... _.------- $ 3 9 6.04 12-07-10 BEGINNING BALANCE 996.04 600.00 12-21-10 In Branch Transfer/Deposit 4 249.00 12-23-10 CHECK NUMBER 1732 200.00 547 12-24-10 CHECK NUMBER 1731 50.00 497.04 12-30-10 CHECK NUMBER 1733 $497.04 ENDING BALANCE ... ::... :. ....::.•,., ... ,... ,............. 5 0.0 0 1732 12-23-10 249.00 1733 12-30-10 1731 12-24-10 200.00 ECTIVE DECEMBER 31,2010 THROUGH DECEMBER 31,20IgLEFTO ECp~EIR~GERESTLWILL B ICO~IEREDNUPOTOI$250E000 EFF BEARING ACCOUNTS. ACCOUNTS THAT EARN OR ARE ELI PER DEPOSITOR. 38358 DANIEL R HEIGES OR HELEN M HEIGES 7 2 Lp,DNOR LN CARLISLE PA 17015-9215 0.06 r.,re.z•n t~CT PAID YEAR TO DATE _. :::.~::: .....~....... 1 OF 1 OCT.30-JAPT.28,2011 CARLISLE WEST I V 1'1' wsz:kr~~:::.: 10-30-10 BEGINNING BALANCE 0.23 11-29-10 INTEREST PAYMENT 12-21-10 In Branch Transfer/Withdrawal 0.21 12-29-10 INTEREST PAYMENT 0.06 01-07-11 INTEREST PAYMENT 01-07-11 CLOSEOUT ENDING BALANCE AN~Jpi,, PERCENTAGE YIELD EARNED = 0 • (14 ~ $5,444.12 5,4 .35 600 .00 4, 84 4--35 4,844.56 0.00 4,844.62 $0.00 GREEN FLAG FOR SMART L~TDING OPTIOBY F~ ~ T PB,N~KKB~~ I~~L AGE OF RAISE THE GREAT-P24MO222NOR VISIT MTBI~/LENDING TODAY! 1 800 7 j\,k. F[.JNERr1.I_ HcJME &~ ~R'~NIATOR~', IN %'' - 219 Norfh Hanover Street Carlisle, Pennsylvania 17013 717.243.4511 toll free 1.866.451.451 ~ fax 717.243.3723 www.hoffmanroth.com info~hoffmanroth.com January 7, 2011 Philip Hoffman 72 Ladnor Lane Carlisle, PA 17015 Statement of Funera! Expenses for: Helen Mae Heiges _ Account Id: 16117-291 Date of Death: December 28, 2010 PACKAGE: Traditional Funeral Service $ 4,550.00 TRADITIONAL FUNERAL SERVECt= PACKAGE Sub Total: $ 4,550.00 MERCHANDISE: ~ $ 1,560.00 Casket: Viceroy er: Monacch -Concrete Vault i t $ 1,220.00 b Total: $ 2,780.00 S n a Outer Con u - $ 7,330.00 TOTAL FUNERAL HOME CHARGES: CASH ADVANCES: $ 1,595.Of? Cumbed~d Valley Memorial Gardens th Certificates at $ 6.00 each ~ $ 18.00 06 - 125 3 Certified Dea $ , Newspaper Notice -Sentinel $ 100.00 Clergy $ 159.00 Flowers Hairdresser $ 40.00 Sub Total: $ 2,037.06 ALTERATIONS: (820.00) Jan 6, 2011: Professional Discount Sub T©tal: $ -820.00 Total Funeral ~ Made: $ 8,027.00 Total Paymen Payments Made: PreNeed Disc Discount Monumental Life Check Cont vs PreN Jan 6, 2011 3469091 Jan 6, 2011 911.86 7,115.14 Balance: pennsylvan~a DEPARTMENT OF PUBLIC WELFARE August 2, 2011 IRWIN & MCWIN ESQUIRE ROGER B IR WEST POMFRET PROFESSIONAL BUILDING 60 WEST POMF 7013 3222T CARLISLE PA 1 Re: Helen Heiges CIS # : 170188994 SSN : # # eath :: 12/28/2010 Date of D ~ECENED ': f~U~ ®V ~o l~ 6RWIN & McKNIGH3 ~,AW GF~ICES Dear Attorney Irwin: the De artment of Public Welfare maintains a for restitut on Please be advised that P 72, 5 against the above-mentioned estatehich thel Probate Estate is now amount of 524 medical assistance granted on behalf of the dened a Act 49, 62 P.S. 1412, effective of responsible to reimburse the DepaA ~ 20t95ceffectve June 30, 1.995. Enclosed is the August 15, 1994, as amended by Department's itemized statement of claim. ed during the last ~~~_227.68, was incurr A portion of this medical expense, namely ...___ __- ursuant to Section 3392 of onths of the decedent's life; therefore, it is a al C S A.13392(3). The balance of the six m the Decedents, Estates, and Fiduciaries Code, 20 is to be entered as a priority Class 5.1 claim against the claim, namely 5207844.37, estate. i t of this letter and advise whether the Comb n n sealth's Please acknowledge rece p be expected. If the estate acc lease provide ment may claim is admitted and when PaY If the estate contains real estate, sisal, if available. complete, please provide a copy. f the deed, the latest tax assessment, and a current app copes o Sincerely, Elizabeth M. Wilson TPL Program Investigator 717-214-1868 717-772-6553 FAQ: Enclosure Division of Third Party Liability I Recovery Section Bureau of Program Integrity PO Box 8486 i Harrisburg, Pennsylvania 17105-8486