HomeMy WebLinkAbout05-07-12
1505610143
REV-1500 Ex,°'_'°'
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania county rode veer File Number
Bureau of Individual Taxes °EP"giM°Ni°""'"""`
Po Box.zaosol INHERITANCE TAX RETURN 21 li 0954
Harrisburg, PA 17126-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
18 2011 09 07 1957
Decedent's Last Name
HERSHEY
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
Suffix Decedent's First Name MI
STEVEN D
Suffix Spouse's First Name MI
THiS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
1. Original Re[um ^ 2. Supplemental Re[um
^ 4. Llnlltetl Estate ^ 4a. Euture Interest Compromise
tleath after t2-12-92)
(
tlele M
1
1 g Decetlent Dietl Testate
- ^ p
p
7~ (At ac~GOpYlor~iu~1 Living Tmst
(Alta~COpy of Wilq
9. L'digation Proceeds Received ^ 1g. ~°~~PZ'ai ~~a^Et~Eat9e5~fdeeth
^ 3. Remaintler Re[urn (tlate of death
priorto 12-13-82)
^ 5. Fetlerel Estate Tax Return Require
8. 'Total Number of Safe Deposit Box
^ 11. Election to tax under Sec. 9113(A)
(Attach Sch. O)
d
es
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
BRADLEY L GRIFFIE (717) 243 X551
First line of address
200 NORTH HANOVER ST
Second line of address
City or Post Office
CARLISLE
REGISTER OF
~SE ONL'~
~~ ]a
7 CC rT
n
W
,
r
~
'z~ rT1 '~ c J.
.; r
~, r " ;
-~-
'
- _
~^
n '' fU ~
-'
_ 'T
~
DATE FILED CT'•
State ZIP Code
PA 17013
Correspondent's a-mail atldress:
Untler penalties of perjury, I dedare that I have examined this return, inclutling accompanying schedules antl statements, and to Ne best of my knowletlge and belief,
it is true. correct and complete. Dedaration of preparer other loan the personal representative Is based on all information of which preparer has any knowletlge.
J.
ADDRESS
SIGyWitl P ARER OTHER THAN REPRESENTATIVE DATE
C Bradley L. Griffie S'~y~/ ~
PA 17013
1505610143
Side 1
1505610143
~~
PA Inheritance Tax Return
Signature of Additional Fiduciaries
ESTATE OF FILE NUMBER
Hershey, Steven D. 21-11-0954
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 #2 (/,~' -~
Name v John L. Hershey Jr.
AddreSS1 337 West Penn S[.
Address2
City, State, Zip Carlisle PA 17013
Date ~ ~' ~
1505610243
REV-1500 EX
Decedent's Social Security Number
oeceaam~s Name= Hershey, Steven D.
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.
6. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5. 3 , 750 • 30
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers & Miscellaneous I~(oq-Probate Property
(Schedule G) LJ Separate Billing Requested............ 7. 0.00
g. Total Gross Assets (total Lines t-7) .................................................................... . 8. 3 , 750.30
9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 19 , 939.88
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 25 , 777.02
11. Total Deductions (total Lines 9 & 10) ................................................................... 11, 45 , 716.90
12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. -41 , 966.60
13. Charitable and Governmental BequestslSec 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. -41 , 96 6.60
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 0.00 i6. 0.00
at lineal rate X .045
17. Amount of Line 14 taxable 0.00 17. 0.00
at sibling rate X .12
18. Amount of Line 14 taxable
~- 0 0
18.
x• 0 0
at collateral rate X .15
19. Tax Due ................................................................................................................. . 19. 0.00
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
1505610243 1505610243
REV-1500 EX Page 3
Decedent's Complete Address:
Flle Number 21-11-0954
DECEDENT'S NAME
Hershey, Steven D.
STREET ADDRESS
34 East High St., Apt. 2
CITY
Carlisle STATE
PA ZIP
17013
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
0.00
3. Interest
q, 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.
Check Payable to: REGISTER OF WI
(1)
0.00
0.00
0.00
Total Credits (A + B) (2)
(3)
(q)
(5)
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 :.................................. ^
c. retain a reversionary interest; or .............................................................................................................. ^
d. receive the promise for life of either payments, benefits or rare? ............................................................ ^
2. If death occurred after December 12, 1962, 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?....... ^ ^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 OF THE RETURN.
For dates of death on or after July 1, 1994 and before Jan. 1, 1995, the taz 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-061)8 F-1(. 16-98)
COMMONWENLTH OFPENNSYLVRNIN
INHERITANCE TAX RETURN
RESIDENT OECEOENT
ESTATE OF
Steven D. I
Indutle the proceetls of litigation entl the tlate the procaetls were receivetl by fhe estate.
All property jcirHlyownetl wllh the right of aurvivorehip Rwst be tllscloaetl on achetlule F.
ITEM
NUMBER
DESCRIPTION VALUE AT DATE
OF DEATH
1 Personal property in apartment (de minimis) - (property of no auctionable value) 0.00
2 1997 Chevrolet Blazer - (See attached statement) 250.00
3 Members 1st Federal Credit Union -Regular Savings Account No. 161736-DO (See attached 10.00
statement)
4 Members 1st Federal Credit Union -Checking Account No. 161736-11 (See attached 107.45
statement)
5 Automobile Insurance Refund - (State Farm) 138.92
6 Final paycheck from Carlisle Syntek Incorporated (net) 1,750.93
7 2011 Personal Federal Income Tax Refund 1,493.00
TOTAL (Also enter on Line 5, Recapitulation) I 3,750.30
SCHEDULE E
CASH, BANK DEPOSITS, 8 MISC.
PERSONAL PROPERTY
FILE NUMBER
21-11-0954
(If more space is needed, atldttional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-g6)
Rev-1510 EX+ (b-aBt
SCHEDBJLE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANW
INHERITANCE TA%RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hershey. Steven D. 21-11-0954
This schetlule musl ba c°mpeletl antl flatl if the answer 1° any DI quesli°ns 1 Through 4 on the reverse site of the REV-1500 COVER SHEET is yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
THE DATE OAF TRANSFERSATTACHTA COPYEOF THE DEED ~DR REAL ESTATE. DATE OF DEATH
VALUE OF ASSET r oP DecD~s
INTEREST EXCLUSION
(IF APPLICABLE) TAXABLE
VALUE
1 Carlisle Corporation Employees Incentive Savings 24,576.62 100.000% 2a,676.62 0.00
Ptan (CCEISP) - (See attached statement)
2 Retirement Plan for Employees of Carlisle Corporation 24,477.41 100.OD0°/a 24,a77.a1 0.00
(RPECC) - (See attached statement)
TOTAL (Also enter on Line 7, Recapitulation)
0.00
(If more space is neetle4 atltlitional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-g6)
REV-1161 E%• tie-06)
COMM~J R~,AENNT oECEDN~RNVANIA
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COST:
ESTATE OF FILE NUMBER
Hershey. Steven D. _ 21-11-0954
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
A, FUNERAL EXPENSES:
See continuation schedules) attached
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Lucy J. Hays John L. Hershey, Jr.
street Address 9451 Pinesville Rd.
City Shippensburg State PA Zio 17257
Year(sl Commission oaid 2012
2. Attorney s Fees Griffie & Associates
3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zio _
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees Cohick 8 Associates
6. Tax Return Preparer's Fees
7. Other Administrative Costs
10,287.64
4,000.00
4,500.00
150.00
225.00
777.04
TOTAL (Also enter on line 9, Recapitulation) 19,939.88
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
NUMBER
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Expenses
Hoffman-Roth Funeral Home 8 Crematory, Inc. 9,269.44
Carlisle Memorial Service, Inc. - (Memorial stone and engraving) 1,018.40
H-A 10.287.84
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Hershey Steven D. 21-11-0954
ITEM
NUMBER DESCRIPTION AMOUNT
Other Administrative Costs
1 The Sentinel -Advertising 189.54
2 Cumberland Law Journal -Advertising 75.00
3 Bank fees on estate checking account 12.50
4 Reserves 500.00
H-B7 777.04
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
Rav-1512 E%+ (12-06)
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTHOF PENNSYLVANIA
INHERITANCE TA%RETINiN
RESmENr DECEOENi
ESTATE OF FILE NUMBER
Hershey Steven D. 21-11-0954
Report tlebh Incurred by the decetlsnt prior to death that remained unpaid at the data of deMh, including unrelmbureed metlleal ezpenaes.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 AeroCare/Care Plus Oxygen 1,000.55
2 Carlisle HMA Physician Management 35.87
3 CitiFinancial - (Account ending 2669) 1,462.22
4 Comcast Cable - (Eastern Account System of Connecticut, Inc.) 268.35
5 Discover Bank - (Account ending 8396) (DB Servicing Corporation) 11,033.31
6 Fraternal Order of Eagles -Delinquent Rent 1,600.00
7 Guistwite Family Practice 41.20
8 Lung Asthma Sleep Associates 453.66
9 Members First Visa - (Account ending 9969) 3,942.04
10 Moffitt Heart 8 Vascular Group 57.99
11 PPL Electric Utilities 552.17
12 Rodale - (Books) 53.96
13 2011 Per Capita Tax 5.50
14 One Main Financial - (Auto loan -encumbrance on 1997 Blazer) 287.82
15 Carlisle Regional Medical Center (Medical) 17.52
16 Members 1st Federal Credit Union Personal Loan 4,964.84
TOTAL (Also enter on Line 10, Recapitulation) I 25,777.02
(If more space is neetle4 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-1513E%+111~U8) ~p~Cy{ gp%~EEq~Nry~rrr...~~T
COM INOP{VJ IDErJTEDECEOEN~RLN ANIA
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUMBER
Hershe ,Steven D. 21-11-0954
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(Sl RECEIVING PROPERTY DECEDENT (Words) ($$$)
I TAXABLE DISTRIBUTIONS [include outright spousal
• distribubons, and transfers
under Sec. 9116 a 1.2
Sonia L. Hershey Mother all
1 Longsdorf Way
Carlisle, PA 17013
Total
Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 150 0 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 SHEET
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-150D Schedule J (Rev. 11-08)
Rowe's Auction Service
2505 Ritner Highway
Cazlisle, PA 17015
717-249-1978 215-1044 574-1008
Sept. 26, 2011
Tc: Bradley L. Griffie Esquire
200 N. Hanover St
Carlisle, PA 17013
From: Rowe' Auction Service
2505 Rimer Highway
Carlisle, PA 17015
Re: Personal Property Appraisal
Estate of Steven Hershey
28 E. High St.
Carlisle, PA 17013
*Personal Property at 28 E. High St. has no monetary value and has been designated for
donation.
C o -- r
William G. Rowe
Barrick's Towing LLC LC ND 0 0 5 5
591 Willow Grove RD
Carlisle, PA 17015-7734
PH: 717-386-4888
Dale: ~- < / ~ ~~
LICENSE PLATEN VEH MARE ti MODEL
1 / ~ ~
~ VEH COLOR
~ .~
//
/
3
4
5
6
7
8
9
10
I1
l2
13
14
15
lb
TOTAL PER PAGE ~ ~^~/
OUR ORDER NUMBER MUST APPEAR ON ALL 7 (/
INVOICES-PACKAGES, ETC.
PLEASE NOTIFY US IMMEDIATELY IF YOU ARE UNABLE ~l~i`IGH MASTER #; 73345
TO SHIP COMPLETE ORDER EY DATE SPECIFIED.
neTF nF PiRTH PHONEN
MEMBERS 1"
PEOEEAL CREDIT UNION
REGULAR SAVINGS ACCOUNT:
Account NumberlSuffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accruetl Interest
Name of Joint Owner
CHECKING ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
LOAN ACCOUNT:
Acwunt Number/Suffix
Date Opened
Principal Balance at Date of Death
Loan Type
Interest Rate
Name of Co-Borrower
161736-00
os/ov1 sss
$10.00
$.00
$10.00
None
161736-11
10/06/1999
$107.45
$.00
$107.45
None
161736-05"
11/01/2003
$4,860.74
Personal Service Loan
11.00%
None
`LOAN DOES HAVE LIFE COVERAGE
VISA CREDIT CARD ACCOUNT:
Account Number
Date Account Established
Balance at Date of Death
Name of Joint Cardholder
4672090000169969"
09/04/2001
$4,169.35
None
"CONTRACTUAL PLEDGE OF SHARES
~M ERS 1sT ~F~E~EQRAL REDIT U~N ~~A p
Danielle A. Kline
Lending Insurance Support ;Specialist
October 16, 2011
Estate of: STEVEN D. HERSHEY
Date of Death: 08/18/2011
Social Security Number: 205.50-8649
5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 28`5-2328 wwwmemberslst.org
Carlisle Companies Inc,
13925 Ballantyne Corporate Place, Suite 400 ~~~~~
Charlotte, NC 28277
(704) 501-1185
Griffie & Associates, P.C.
ATTN: Bradley Griffie
200 North Hanover Street
Carlisle, PA 17013
April 17, 2012
Ref: Steven D. Hershey (Deceased)
Dear Bradley:
Thank you for providing the additional information requested. Based on this information, you
represent the co-administrators of Steven's estate. Neither of the co-administrators of Steven's
estate are the named beneficiary for Steven's account in the Carlisle Corporation Employees
Incentive Savings Plan (CCEISP) or his benefit in the Retirement Plan for Employees of Carlisle
Corporation (RPECC). Steven's named beneficiary for both the CCEISP and the RPECC is Sonia
Hershey. My understanding is that you can provide cun•ent contact information for Sonia Hershey.
We would appreciate having this information so that we may contact her regarding the benefits due
her.
On Steven's date of death on August 18, 2011, he had a vested, accrued account balance in the
CCEISP of $24,576.62. He also had an outstanding loan balance in the CCEISP at time of his death
in the amount of $3,528.40 (which is not included in the account balance). The outstanding loan
has now been defaulted and the outstanding loan balance reduced to $0.00.
Also on Steven's date of date on August 18, 2011, he had a vested accrued benefit in the RPECC.
This benefit is not valued daily but rather the first of the month following a termination (including
termination due to death). Steven's benefit in the RPECC as of September 1, 2011 was $24,477.41,
which is payable as a single (one-time) lump sum benefit to his beneficiary.
Should you have further questions about this matter, please contact me at (704) 501-1196.
Sincerely,
G~~~l~
Vickie K. Mills
Director of Benefits