Loading...
HomeMy WebLinkAbout10-24-111505610143 REV-1500 Ex(°'-'°' OFFICIAL USE ONLY PA Department of Revenue Pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE Po Box.2soso~ INHERITANCE TAX RETURN 21 11 0909 Harrisburg, PA 17128-0601 RESIDENT DECEDENT _ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 267 82 4570 07 31 2011 08 29 1947 Decedent's Last Name HULL (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Decedent's First Name MI THOMAS J 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 ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ qa. Future Interest Compromise ~ 5. Federal Estate Tax Return Required (date of death after 12-12-82) ^ g Decedent Died Testate ^ ~ Decedent Maintained a Living Trust 0 8. Total Number of Safe De osit Boxes (Attach Copy of Will) (Attach Copy of Trust) P 9. Litigation Proceeds Received ~ 1 p. Spousal PovertyV Creditl(date of death 11. Election to tax under Sec. 9113(A) between 12-31 51 and -1-95) ~ (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number LAUREN E BOGAR 717 737 8761 First line of address ONE WEST MAIN STREET Second line of address City or Post Office State ZIP Code SHIREMANSTOWN PA 17011 Correspondent's a-mail address: IbOgar@bogarlaW.COm REGISTER OF ~I USE ONLY -~ - . .. - .. _i ]~:. 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, correct and complete. Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ,~,)~~1 ~-L ~. j~ev~ Nancy S. Kone l4 ,~O ~~/ ADDRESS ~~ 426 Appletree Road, Camp Hill, PA 17011 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ./~~ ~ ~~'pq!/y~ Lauren E. Bogar l r~ ~ .t f'1 / 1' 1 One West Main Street, Camp Hill, PA 17011 Side 1 15D5610143 150561D143 Fi4MIL ,,. ~o 170 Yorl< Rd. Carlisle, ['A 17013 Carlisle (7l7) 249-2215 Harrisburg (717) 234-0662 l -800-745-481 1 Fax (717) 249-1437 q-i~-i~ `P I P9 S-~ ~ CGY c~ I S--~ T `~ ~l ~ ~ ~`' r~~ L( ~~~~~~~~~ i~,(b-~Z~~ ~-5 ~,~-,~y94i ,Y,~1~5 ~ ~i~ ~~-><-~ ~~ ~-~~qs ~ tom, I ~ ~ ~~ ~~~-~ ~ i `'C-i"~.. `n(~`-_ _~ I ~~~~~r 1 ~ ~- 2004 Chevrolet TrailBlazer T S Sport Utility 4D Trade In V"aloes, Reviews -Kelley I31ue ... Page 1 of 1 Used Car Private Party Vatues 2004 Chevrolet TrailBlazer ~~~ ~ LS Sport Utility 4D ..... ~ ~ r "' Mileage: 98,000 edit options change style Private Party Values F..xt:el lent ~$,~~~ _'"°\ ~~~~oad ~ ' ~1,52C? / air Vehicle Highlights MPG: City 14/Hwy 19 Doors: 4 Drivetrain:4WD EPA Class: Sport Utility Vehicles Country of Origln' United States Max Seating: 5 Engine: 6-Cyl, 4.2 Liter Transmission: Automatic Body Style: Sport Utility Country of Assembly: United States ', ~~,54$ Your Configured Options Our pre-selected options, based on typical equipment for this car. / Options that you added while configuring this car. Engine Comfort and Convenience Seats 6-Cyl, 4.2 Liter Air Conditioning / Power Seat Power Windows Transmission Power Door Locks Cargo and Towing Automatic / Cruise Control Towing Pkg Drivetrain Steering Wheels and Tires 4WD Power Steering Alloy Wheels Tilt Wheel Braking and Traction Entertainment and Instrumentation ABS (4-Wheel) AM/FM Stereo CD (Single Disc) Safety and Security Dual Air Rans Glossary of Terms Kelley Blue Book® Private Party Value: This is the starting point for negotiation of a used-car sale between a private buyer and seller. This is an "as is" value that does not include any warranties. The final price depends on the car's actual condition and local market factors, Excellent Condition: 3 % of all cars we value meet this criteria. This car looks new and is in excellent mechanical condition. The car has never had any paint or faodywork, does not need reconditioning and is free of rust. The engine compartment is clean and free of fluid leaks, and the body and interior are free of wear or visible defecYS. It has a clean Title history and will pass a safety and smog inspection. It also has complete and verifiable service records. Good Condition: 82 % of all cars we value meet this criteria. This car is free of any major defects and major mechanical problems. The paint, body and interior have only minor (if any) blemishes and there is little or no rust on the car. The tires match and have substantial tread left. Though it may need some reconditioning, it has a clean title history, Fair Condition: 15 % of all cars we value meet this criteria. This car has some mechanical or cosmetic defects and needs servicing, but is still in safe running condition and has a Uean title history. The paint, body and/or interior may need professional servicing. The tires may need replacing and there may be some repairable: rust damage. © 19954011 Kelley Blue Book Co.', [nc All rights reserved. Copyright & Trademarks Terms of Service Privacy Policy Ad Choices http://www.kbb.com/chevrolet/trailblazer/2004-chevrolet-trailblazer/ls-sport-utility-4d/?ve... 9/16/2011 Rev-1510 EX+(6-98) COMMONWEALTH OF PENNSYLVANIP. INHERITANCE TPJC RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS 8~ MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Hull, Thomas J. 21-11-0909 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY THE DATE OF TRANSFER.SATTACFI A COPY OF TORE DEED FOOR REAEESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 Diversified Investment Advisors - 401 K -Account No. 251.99 251.99 QK6226900001. Date of death value - $251.99. Karen Turner, cousin of the Decedent, is the named beneficiary of this Account. 2 Prudential Annuity -Contract No. 99347918. Date of 9,307.75 9,307.75 death value $9,307.75. Nanci E. Wills, friend of the Decedent is the named beneficiary of this Annuity. TOTAL (Also enter on Line 7, Recapitulation) I 9,559.74 (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 G (Rev. 6-98) ~~ NVESTMENT ~~ADVISORS Baltimore Boston Cedar Rapids Charlotte Chicago Cincinnati Dallas Denver iktcoit Houston Little Rack t.os Ang~le~; Mihvauke~e New Clrleans New York Philadelphia Porftanci Satt Lahc Gty Scattle son k=,ancisro September 12, 2011 Ms. Karen Turner 2625 N. Rose Garden Blvd. Mechanicsburg, PA 17055 Re: Thomas Hull QK62269 00001 Dear Ms. Turner: We were recently informed of the death of Thomas Hull. We are very sorry for your loss and will do all that we can to work with you in quickly settling the account as directed by the beneficiary designation. Our records indicate that you are the designated beneficiary of your cousin's 401(k) Plan. The value of this account as of close of market September 9, 20i 1 was $251.99. As beneficiary, the following option is available to you: • LUMP SUM LUMP SUM Under this option, the entire account balance is withdrawn, and the distribution is reported as ordinary income. Required tax withholding wilt be taken as indicated. Before making a decision, we encourage you to seek advice from your accountant or tax advisor. To select your option, please complete and return the following: • Survivor Benefits Form (enclosed) + Proof(s) of Age for yourself • Certified Death Certificate with Raised Seal Please be sure to return all forms no later than December 15~' follaw.ing the participant's death >f you have any questions, please call the Retirement Analysis Department at 1-800-755-5803 Ext 1203424. Sincerely, Retirement Analysis Department I~CTY(lti'Y.S' itt zr1('€£t"'Yr'1E1'i~ :~±)!•r(!1!)!i,t ' . , ~d *e. vooci Kc,ad ?`~ pia tz '+ic1~, 1, ';~ 5g ~~ InNIVESTMENT ~~ ADVISORS Please be sure to return all forms no later than December 1.5°i following the participant's death If you have any questions, please call the Retirement Analysis Department at 1-800-755-5803 Ext 1203424. Sincerely, Retirement Analysis Department Baltimore Boston Cedar Rapids Charlotte Chicago Cincinnati Dallas Denver Detroit Houston Little Rock Los Angeles Milwaukee New Orleans New York Philadelphia °ortland Salt Lake Ciq~ Seattle San Francisco ~Li7"..*?I('?'S i?t h'e.'ZYP~3~iii ~'OlL((?0775 1i?. t'd?eWOtid R03C !V L.. i.' 1~1= 12.ti~ LrIS. i." [~c;qU --. -.. Prudential Annuities 1 ~ A Business of Prudential Financial, Inc. P.U. Box 79(10 Philadelphia, PA 19(76 (888) 778-2888 TTY: (800) 6~4-7637 www.prudentiaLcom James D Bogar Atton~ey at Law One West Main Street Shiremanstown, PA 17011 Re: THOMAS J HULL Contract Number: 99347918 September 8, 201 1 Dear Sir or Madam: Thank you for your inquiry on the above non qualified annuity contract issued 4/271] 990. The contract value as of 7/31 /2011 was $9,307.75. If you have any questions, please call the Prudential Annuity Service Center at (888) 778-2888. The Service Center is open Monday through Thursday between 8:00 a.m. and 7:00 p.m. and Friday between 8:00 a.m. and 6:00 a.m. Eastern time. If you are using a telecommunications device for the hearing impaired, you may call (800) 654-7637, Monday through Friday between 8:00 a.m. and 8:00 p.m. Eastern time. Sincerely, Annuity Service Center Prudential Financial Variable annuities are issued by Pruco Life Insurance Company (in New York, by Pruco Life Insurance Company of New Jersey). Both companies are located in Newark, N I. Variable annuities are distributed by Prudential Annuities Distributors, lnc., Shelton. C'1~. Fixed annuities are issued by The Prudential Insurance Company o1~ America. All are Prudential 1=inancial companies and each is solely responsible for its o~n~n financial condition and contractual obligations. Page I of 1 J 093; ~o~Q -. CC ~'rudential r~. Financial Annuity Services P.O. Box 13467 Philadelphia, PA 19176 April 12, 2007 >01988 352831 X02 092001 THOMAS J. HULL 9 N LOCUST ST # 100 SHIREMANSTOWN, PA 17011-6308 Dear Thomas J. Hull: Contract Ownet Thomas J. Hull Annuitant: Thomas J. Hull Contract Number: 99347918 1 ant w:itir_g io conTirrrt that we have processed a change/correction listed below as per your request. Enclosed are any endorsements that may be relative to ownership or beneficiary changes performed. This letter and any endorsements, when applicable, should be attached to your contract for future reference. Contract Change/Correction: We have recorded the Beneficiary as requested. Please see the enclosed Beneficiary Endorsement. If you feel this change/correction was made in error please call our Anmrity Service Center immediately at the phone number listed below so we may resolve in a timely fashion. If you have questions, please contact your financial professional or our Annuity Service Center at (800) 843-4124. If you are using a telecommunications device for the hearing impaired, please call (800) 654-7637. Representatives are available to assist you Monday through Thursday between 8:00 a.m. and 7:00 p.m., and Friday between 8:00 a.m. and 6:00 p.m. Eastern Time. You may also obtain additional information on our website, www.prudential.com. Please send all correspondence to Annuity Service Center, P.O. Box 7960, Philadelphia, PA 19176. Thank you for choosing Prudential Financial for vour financial needs. Sincerely, Z~ Kathleen M. Kelly Director, Contract Maintenance and Tax Support Registered Representative American Skaudia Marketing, Inc A Pn~dential Financial Company One Corporate Drive Shelton, CT 06484-0883 Enclosure: Beneficiary Endorsement c: Nornzan W. Stine Arwuities ara issued by The Prudential Insurance Company of America or Pn~co Life Insurance Company (in N}', Pruco Life Insurance Company of New Jersey). Variable annuities are distributed by Pn~dential htvestment Management Services LLC. All are Prudential Financial companies located in Newark, NJ. Each is solely responsible for its financial condition and contractual obligations. Securities and insurance products are not insured by the FDIC or any federal govet7unent agancy, may lose value, and are not a deposit of or guaranteed by the bank or any bartk affiliate. A- RE:LATIONCH 001 Agent# 89823/ Ot~ice# W SH PAGE t of 3 01988 3520831 002131 002978 00001!00002 ~~udential !_ Financial 993q~a1R The Prudential Insurance Company °f America Pruco Life Insut•a~ice Compm~y Pivco Life Insurance Company of New Jersey ,hwner: Thomas J. Hull Annuitant: Thomas J. Hull Annuity Contract No: 9937918 Subject to Terms and Conditions of section titled "Beneficiary", the following beneficiary(ies) are hereby designated: BENEFICIARY PROVISION The proceeds that arise from the Annuitant's death will be payable in one sum as follows: Class 1 100.0% Nanci E. Wills, Friend. Endorsed or Acknowledged for the Company by ~~ Kathleen M. Gibson Secretary Date: April 12, 2007 Attest Pnfco Life hlsurance Company and Pruco Life Insurance Company of New Jersey are both Prudential companies. A- RELA'I'IONCH 001 PAGE 3 of 3 01988 3520831 002132 002980 00002/00002 REV-1151 EX+~10-06) COM INOHERITANCE TAX RETURN ANIA RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES 8~ ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Hull, Thomas J. _ 21-11-0909 ITEM DESCRIPTION AMOUNT N MBER q. FUNERAL EXPENSES: See continuation schedule(s) attached ~ 2,349.02 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(sl Commission paid 2. Attorney's Fees Bogar 8~ Hipp Law Offices 5,250.00 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 108.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 2,524.33 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 10,231.85 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 Hull, Thomas J. 21-11-0909 ITEM NUMBER DESCRIPTION AMOUNT Funeral Ex enses 1 Malpezzi Funeral Home -Funeral bill 2,100.00 2 Malpezzi Funeral Home -Balance of funeral bill 249.02 H-A 2,349.02 Other Administrative Costs 3 Family Ford -Vehicle repair 237.26 4 Office Max -Printer supplies 117.41 5 RESERVES: -Costs to conclude administration of Estate, including filing PA Inheritance Tax 850.00 Return and Inventory, preparation and filing of final Personal Income Tax Returns and Fiduciary Income Tax Returns 6 Servpro -Apartment cleaning 1,110.66 7 State Farm -Automobile insurance payment 209.00 H-67 2,524.33 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX+(12-08) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8~ LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Hull, Thomas J. 21-11-0909 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. (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+(11-08) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES IN RESIDENTEDE~ DENTRN ESTATE OF I FILE NUMBER Hull. Thomas J. ~~_~~_n4na NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(Sl RECEIVING PROPERTY DECEDENT es (Words) ($$$) I TAXABLE DISTRIBUTIONS [include outright spousal _ ~ distributions, and transfers under Sec. 9116 a 1.2 See attached schedule Total Enter dollar amounts for distributions shown above on lines 1 5 throw h 18 on Rev 150 0 cover sheet, as a r o riate. NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08) SCHEDULE J BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Thomas J. Hull 07/31/2011 267-82-4570 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) 1 James Bowman Cousin One-third of one-sixth 7553 Mountain Top Road of rest, residue and Harrisburg, PA 17112 remainder 2 Marsha Boyer Cousin One-third of one-sixth 1699 Turkey Valley Road of rest, residue and Herndon, PA 17830 remainder 3 Nancy Burke Cousin One-fourth of one-sixth 6601 Lake Charm Circle of rest, residue and Oviedo, FL 32765 remainder 4 Betty Fitzgerald Cousin One-fourth of one-sixth 699 Griswald Road of rest, residue and Jay, FL 32565 remainder 5 Susan Hartman Cousin One-half of one-sixth of 1501 Marymount Drive rest, residue and Franklin, TN 37067 remainder 6 Nancy S. Kone Aunt One-Sixth of rest, 426 Appletree Road residue and remainder Camp Hill, PA 17011 7 Margaret Leuschner Cousin One-fourth of one-sixth 516 Green Street of rest, residue and Williamstown, PA 17098 remainder 8 Sally Mace Cousin One-fourth of one-sixth 215 Swatara Circle of rest, residue and Jonestown, PA 17038 remainder 9 Susan Maletich Cousin One-fifth of one-sixth of P.O. Box 88 rest, residue and Lykens, PA 17048 remainder 1 SCHEDULE J BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Thomas J. Hull 07/31/2011 267-82-4570 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) 1o George 5hreffler Cousin One-fifth of one-sixth of 113 S 2nd Street rest, residue and Lykens, PA 17048 remainder 11 Leroy Shreffler Cousin One-fifth of one-sixth of 58 E Rosebud Road rest, residue and Myerstown, PA 17067 remainder 12 Patricia Taylor Cousin One-sixth of rest, 1645 Lisburn Road residue and remainder Wellsville, PA 17365 13 Karen Turner Cousin One-half of one-sixth of 2625 Rosegarden Boulevard rest, residue and Mechanicsburg, PA 17055 remainder 14 Andrea Underkoffler Cousin One-fifth of one-sixth of 320 Lawley Road rest, residue and Lykens, PA 17048 remainder 15 Jeanne Willard Cousin One-fifth of one -sixth P.O. Box 23 of rest, residue and Wiconisco, PA 17048 remainder 16 Diane Young Cousin One-third of one-sixth 399 Oak Street of rest, residue and Millersburg, PA 17061 remainder 2