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Home My WebLink About10-21-11 (4)-~ REV-'150£x(°'-,~, • tisn5~~ro~-a~ 4 OFFICIAL USE ONLY PA Department of Revenue pennsy vents cormlycoae veer Fee Number Bureau of individual Taxes ~..M~a ~~e Po BoxzBOSOt INHERITANCE TAX RETURN 21 11 0 6 5 9 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DSCEDENT INFORMATION BELOW Socia! Security Number Date of Death Dale of Birth 160 16 8076 05 29 2011 09 11 1917 Decedent's Last Name Suffix Decedent's First Name Mt HERMAN MARIE E (If Applicable} Enter Surviving Spouse's [nformation Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's SoGal Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FELL IN APPROPRIATE OVALS BELOW ® 1. Orightaf Return ^ 2. Supplemental Retum ^ 3. Remainder Relum (date of death prior to 12.13.82) [~ 4. Cimfted EstafB ^ 4a. Future Interest Compromise ^ 6. Federal Esta[e Tax Return Required (date or dealA aver Y2-72S2) ® 6. Decedent Died Testate (Attach Copj of WsM) ^ ~• pecedanl btaintatned a LNin9 Trust (Attach Copy of Trusq 8. Total Number of Sate De sit 80%eS lm ^ 9. Litigation Proceeds Received ^ 10. spousal Poverty Crean (date or death betusen t23t•st and t-,-s5) 11,Election [o tax ender Sec, g113(A) ^ (Attach sch. o) CORRESPONDENT • THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION 8HOULD BE DIRECTED TO: Name Daytime Telephone Number JEAN D SEIBERT 717 2360301 •--• .~;,-, ~.: _ REOESTER OF tl~t.~~t: ONuq m (`~,~ First line of address " «~ ~ """ 109 LOCUST STREET -~`-J`~ -"~~ ~,'J ~_.) T ter. -_ ~ Second line of address ~ ~^~ -- ~T' Zr~ ~.;'- ~' > ~.l -- r~ City or Past Office State DATE FILED ~~ ZtP Code HARRISBURG PA 17101 Correspondent'se•mailaddreas: W2st~mindspring.Cam Under nalUes of perjury I deGare that I have examined this return, inctuding aocompanyiog schedules and statements, and to the best of my knowledge and belfel, ~ it is Uu correcl and complete. Declaration of preparer other titan Ute personal representative is based on all inf ormation of which preparer has any know[edge. SIGNATURE 0 SON R£SPQN E FQR FILING RETURN DATE ~~ ' e+u.,~ H. Frank Arya i°~~~') ~'~ 1 apDRESS T' 136 Yorkshire Drive, Mechanicsburg, PA 17055 SIG t`ATURE OF PREP~AFR OT~ER Tt~tAN REPRES£tJTA71VE pAT£ Jean D Seibert 10~acust Street, Harrisburg, PA 17101 Side 1 L b505610143 Ir50S6bQ143 ~~~ , r , I , 1505610243 REV-1500 EX Decedent's Social Security Number oe~eaenrs Name: HERMAN , MARIE E. 1 6 0 16 8 0 7 6 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. 5• Cash, Bank De osits & Miscellaneous Personal Pro e P p rty (Schedule E) ................ 5. 8 0 2 1 . 4 7 r 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ............. 7. 8. Total Gross Assets (total Lines 1-7) ....................................................................... g. 8 , 0 2 1 . 4 7 9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9. 3 , 2 8 1 . 7 7 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10. 11. Total Deductions (total Lines 9 & 10) ...................................................................... 11. 3 , 2 8 1 . 7 7 12. Net Value of Estate (Line 8 minus Line 11) ............................................................. 12. 4 , 7 3 9 . 7 0 13. Charitable and Governmental 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 13) ................................................. 14. 4 , 7 3 9 . 7 0 TAX COMPUTATION -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 .00 15. 16. Amount of Line 14 taxable at lineal rate X .045 16. 17. Amount of Line 14 taxable at sibling rate X ,12 17. 18. Amount of Line 14 taxable at collateral rate X .15 4, 7 3 9. 7 0 18. 19. Tax Due ................................................................................................................... .. 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 L 1505610243 1505610243 710.96 710.96 REV-1500 EX Page 3 File Number 21 - 11 - 0659 Decedent's Complete Address: DECEDENT'S NAME Herman, Marie E. STREET ADDRESS Bethany V[Ilage, 325 Wesley 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 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. (1) 710.96 Total Credits (A + B) (2) 0.00 (3) 0.00 (4) (5) 710.96 Make Check Payable to: REGISTER OF WILLS, AGENT. ,. ~ _ ~,'1 ~"~, _. .~R ~'"~9!`~';;~y~ ~`'~'~'`~'.Se~`r. ~r S`~-~ ~,f ;'L ~~•~y ;t ?; ~.s..t~~ ~:~.tr'`~ti"-,., 4 _, ..4'~ 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 :.................................................................................. ^ ^x 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? ....................................................................................................................... ^ 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... ^ ^x 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ...................................................................................................................... ^ ^x IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART O F 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 retturn 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. 59116 (a) (1.3)1. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, w ether y blood or adoption. SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF Herman, Marie E. 21 - 11 - 0659 ~~~.,~uu~ ulcrlu~ccua ul IIIIyGIIVII QIIU ulc uaic uIC NiuL:eeus were recelvea oy ine estate. Hu propeRy~omtiy-ownea wnn the rignt of survivorship must be disclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 PNC Investment Account No. 43706839 6,253.60 2 -PNC Checking Account No. 50-8003-2725 1,745.36 3 :Refund from Bethany Village 22.51 TOTAL (Also enter on Line 5, Recapitulation) I 8,021.47 SCHEDULE H COMMONWEALTH OF PENNSYLVANIA ~~ INHERITANCE TAX RETURN ~M/tIN'~e'~/~' ('~nCTC RESIDENT DECEDENT rv.n~~ w,, v-~,,n`wv~~7 FILE NUMBER ESTATE OF Herman, Marie E. 21 - 11 - 0659 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER FUNERAL EXPENSES: A. 1 Woodlawn Memorial Gardens 983.00 2 Bethany Village -Funeral Luncheon 288.32 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) H. Frank Arva 400.00 Street Address 136 Yorkshire Drive city Mechanicsburg state PA zip 17055 Year(s) Commission paid 2. Attorney's Fees Wion, Zulli and Seibert -- Jean D Seibert 1,250.00 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 Register of Wills 124.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7, Other Administrative Costs 1 Journal Publication -Advertising 150.00 TOTAL (Also enter on line 9, Recapitulation) 3,281.77 ~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Schedule H Funeral E~er~ses & Administrativle Costs continued FILE NUMBER ESTATE OF Herman, Marie E. 21 - 11 - 0659 2 I Cumberland Law Journal -Advertising 3 ~ Frank Arva -Postage 75.00 10.95 Page 2 of Schedule H REV-1513 E7C+ (11-OS) ~ SCHEDULE) COM MNHERITALNCEOTAX RETURNANIA BENEFICIARIES RESIDENT DECEDENT ESTATE OF Herman, Marie E. FILE NUMBER 21 - 11 - 0659 NUMBER NAME AND ADDRESS OF PERSON(S) RELATIONSHIP TO DECEDENT SHARE OF ESTATE (Words) AMOUNT OF ESTATE ($$$) RECEIVING PROPERTY Do Not List Trustee(s) I~ TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 Robert Herman Nephew in Law 3,000.0( 4210 Concord Street Harrisburg, PA 17109 2 James Herman Nephew in Law 3,000.0( 73 Greenfield Street Manchester, PA 17345 3 Virginia Wise Stevens Friend 7,500.0( 717 Scottsdale Drive Richardson, TX 75080 Enter dollar amounts for distributions shown above on lines 1 5 through 18 on Rev 1500 cover sheet, as appropriate. II NON-TAXABLE DISTRIBUTIONS: I A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES continued INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Herman Marie E. FILE NUMBER , 21 - 11 - 0659 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) RECEIVING PROPERTY Do Not List Trustee(s) I~ TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)) 4 Richard Oberholtzer Half Sister's Son 2,500.OC 39 Penn Court Drive Mt. Joy, PA 17552 5 Sondra Gepfer Niece PO Box 2 Campbelltown, PA 17010 6 Yvonne Yeich Niece 1857 Grace Avenue Lebanon, PA 17046 7 Conrad Smith Nephew 3268 Bigs Springs Avenue Simi Valley, CA 93063 8 Kim Smith Niece 180 East Market St. Apt.B Palmyra, PA 17078 9 Tracey Sattazahn Niece 10 Lewis Road Annville, PA 17003 Page 2 of Schedule J