HomeMy WebLinkAbout06-04-12 (2)J 1505610105
REV-1500 EX (oz-v) (FI)
PA Department of Revenue Pennsylvetda OFFICIAL USE ONLY
Bureau of Individual Taxes "`"""'"`° ""` County Code Year File Number
Po Box zaoaol ~ INHERITANCE TAX RETURN (~ nn
Harrtsburc, PA t7tz8oaol RESIDENT DECEDENT '. (/) ~ '. I I '. l l °I (~}~/
Social Security Number Date of Death
Decedent's Last Name
Hass
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
MMDDYYYY Date of Birth MMDDYYYY
08/14/1921
Suffix Decedent's First Name
Sarah
Suffix Spouse's First Namie
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
OTD 1. Odginal Retum O 2. Supplemental Retum
O 3. Remainder Return (Date of Death
Prior to 12-13-82)
O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
m 6. Decedent Died Testate O 7. Decedent Maintained a Living Tmst 0 g. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Tmst.)
O 9. Litigation Proceeds Received O 10. Spousal Poverty Credk (Date of Death O 11. Election to Tax under Sec. 9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFOR
Name MATION SHOULD BE DIRECTED T0:
Daytime Telephone Number
Ken Hass (767)306-9364
First Line of Address
URB SUMMIT HILLS
Second Line of Address
590 CALLE SINAI
City or Post Office State ZIP Code
SAN JUAN PA 00920
waLs
MI
G:
MI
C
z
t
F'
Dr
+.t
Correspondent's e-mail address: _Ken. Hass@GMBII.COm
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statement:;, and to the best of my knowledge and belief,
it is true t and c m ate. Declaration of preparer other than the personal representative is based on all information of which preperer has any knowledge.
SIGN E OF PE S RESPONSIBL FOR FILING RETURN DATE
-"n""1 05/31/2012
(above)
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
D
~_
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610105 1505616105 J
"' ""ll
J
1505610205
REV-1500 EX (FI)
~~~ems Name:
RECgpRULATION arch G HaSS Decedent's
Social Security NumY
1 Real Estate (Schedule A)....... 480-22-492
...........
2~ Stocks and Bonds
(Schedule B) „ ._.,. ~ ......... 1
3. Closel ~ ........ .__
Y Held Corporation, Pa ~ ~ ~ ' ' ' ' ~ ~ ' '
rtnershiP or Sole- ~ ~ ~ ~ ~ ~ 2' _
4, proprietorship (Schedule
Mortgages and Notes C) „ 3 1, 553.26
Receivable (Schedule D) , , _ . , .
5. Cash, Bank Deposits antl Miscellaneous P ~-
6. Joint) ersonal ProPertY (Schedule E)_ , ...
Y Ownetl Property, (Schedule F
7~ Inter-Vivos Transfers & Miscellaneous N
(Schedule G ) O Separate Billing Requested .. 63,170.96
) on-Probate Property 6. '
8. Total Gross O Separate Billing Requested - --- 1, 555 41
Assets (total Lines 1 through 7 ~ ~ ~ ' T ~ -
9. Funeral Ex ) ~ ~ ~ " --
Penses ~ '~~~~
antl Administrative Costs ~ ~ ~ ~ ~ ~ 8' - ~ --
10. Debts of Dec (scnetlme H).. 66,279.63
etlent, Mortgage Liabilities antl ~ 9
1L Total Dedu Liens (Schedule I). - 11,314 77
coons (total Lines 9 and 10 , , _ , ~ ~ ~ ~ '
) 10.
12. Net V ' ~' '-
alueo/E ~~""~~~ -
13. state (Line 8 ~ ...... 11 _
Charitable and minus Line 11)
an ele G°vemmental Be ~ ~ ~ _
coon to tax bas not bean quests/Sec 9113 Trusts for ~ ~ ~ 12.: - ~ x,314.77
made (Schedule J) , , which -
14. Net Value Subject to Tax (Line 12 minus Line 13 -- Q00
TAX CALCU .. ... 13. ..
15. Amount oA7 pgQ SEE INSTRUCTIONS F )
taxable OR APPLICABLE ~ ~ ~ ~ ' ' ~ 14 -- _
of the spousal tax rate, or RATES
transfers underSec. x,964.86
(8)(1.2) X .0 • - 9116
16. Amount of Line 14 taxable
at lineal rate X ;0 45
17. Amount - __ ... 15.
of Line 14 taxable
at sibling rate ~ .12 _ 54, 964. $g , _ _ _
__.
18. Amount of Line l4 '~- 16. -- ~ -..-.
at collateral rate taxable ~ ,473.42
X.15 _. .--_ _ 17.
19. TAX DUE ... ~ - _.. 2
18.
... _.
..... ......... 19.: ._ _
20. FILL IN THE OVAL IF YOU ARE RE -
2,473.42
QUESTING A REFUND OF qll pyERPgyMENT
O
1505610205 side 2
1505610205
12EV-1500 EX (FI) Page 3
Decedent's Complete Address:
Pile Numtrer
DECEDENTS NAME
Sarah G Hass
-- -_ -
STREETADDRESS
121 Brindle Road
CITY __... _._-- -__.
Mechanicsburg srnrE PA zP 17055
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credds/Paymen4s
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.
Fill in oval on Page 2, Line 20 to request a refund.
Total Credits (A+ B) (2)
(3)
(4)
(1) 2,473.42
5. If Line 1 + Line 3 is greater than Line 2, enter the di0erence. This is the TAX DUE. (5) 2,473.42
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
a. retain the use or income of the property tmnsferred .................................................................................... ...... ^
b. retain the right to designate who shall use the property lransfened or its income ...................................... ...... ^
c. retain a reversionary interesl ........................................................................................................................ ...... ^
d. receive the promise for life of either payments, benefls or care? ................................................................ ...... ^
2. If death occurred after Dec. 12, 1982, did decedent Uansfer propedy within one year of death
without receiving adequate consideration? ........................................................................................................ ...... ^
3. Did decedent own an "in trust for" or payable-upon~eath bank account or security at his or her death? ........ ...... ^
4. Did decedent own an individual retirement account, annuity or other non-probate property, whiGr
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.
w _ _ `~~
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 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 far 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(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,
under Section 9102, as an individual who has at least one parent in common with the decedent, whether tly blood or adoption.
REV-a5o.~ EX+ (T-ss)
Pennsylvania
~iT OEPRRTMEHTOFgFVENUE
INHERITANCE TA%RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF FILE NUMBER
Sarah G Hass 2011-00969
Ali property jointly Owned With right Of survivorshie must ~ AIe~IffaM ,... 4tiu..~e e
u mine syafx is neetletl, insert atltll[lOnal sheets of the same size
REV-1508 EX+ (1140)
~ Pennsylvania SCNEDIILE E
DEPARTMENT OF NEVENUE CASH, BANK DEPOSITS 8t MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Sarah G Hass 2011-00969
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.
u more space is needetl, use additional sheets of paper of [he same size.
REV-1509 EX+ (oiao)
~ Pennsylvania
DERARTMENT OF REVENUE
INHE0.ITANCE TA% RETURN
RESIDENT DKEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF: FILE NUMBER:
Sarah G Hass 2011-00969
If an asset became joindy. owned wkhin one year of the decedent's date of death, It must be reported on Schedule G.
SURVNING ]DINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A• Ken Hass URB SUMMIT HILLS SON
590 CALLE SINAI
SAN JUAN PR 00920-4333
e' Neth Hass 3215 HASH RD SON
ANNA IL 62906-3810
Tave Hass 6904 ASPEN ST SON
ALLENDALE MI 49401-9600
C.
Kara Hass 121 BRINDLE RD DAUGHTER
MECHANICSBURG PA 17055-9780
IOINTLY OWNED PROPERTY:
^EM
NUMBER LETTER
FOR ]DINT
TENAM DATE
MADE
JO(M DESCRIPIION OF PROPERN
INCLUDE NAME OF FINANCIAL INBTINTION AND &ANK ACCOUNT NUMBER OR SIMIIAR
IDENTI%ING NUMBER. ATTACH DEED FOR JOINTLY HELD REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET % of
DECEDENT5
INTEREST DATE DF DEATn
VALUE OF
DECEDENT'S INTEREST
1. A
. 02/20/08 State Central Bank (Now Pilot Grove Savings Bank) 186966 7,777.05 20 1,555.41
TOTAL (Also enter on Line 6, Recapitulation) I $ 1,555.41
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+ (10-09)
Pennsylvania
DERARTMENT OF REVENUE
INHERITANCE TA% RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Decedent's debts must be reported on Schedule I.
ITEM
A. I FUNERAL EXPENSES:
t' Malpezzi Funeral Home, Mechanicsburg PA
Barr Memorial Chapel, Fort Madison IA
B.
1
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
2.
3.
4.
5.
6.
7.
CitY_ _. __ State ZIP __ ~ _ ~~
Relationship of Claimant to Decedent
S[reet Address
City - .. _ _ _..__ _ __ State -.
Year(s) Commission Paid:
Attorney Fees:
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
Claimant
Street Address
Probate Fees:
Accountant Fees:
Tax Retum Preparer Fees:
6, 900.12
4,114.65
300.00
TOTAL (Also enter on Line 9, Recapitulation) I; 11,314.77
IF more space is needed, use additional sheets of paper of the same size.
ZIP
1
C~~~ (%1~4
~.V V.G~4(%l~.iiWGA1~{~
~ J~
S~ r
'..~
~
y
.V~ .
_
7~.r - -
== crime uY - ._-
70-'n
~7J _
~-
Ti
SARAHAMELIAGROESBEC%HASS ~--+ ;
-~ ~„G
- --,
I, Sazah Amelia Groesbeck Hass, of Fort Madison, Lee County, Iowa, declaze this to be my
Last Will and Testament and revoke all former Wills or Codicils thereto :heretofore by me made.
ARTICLE I
I state that I am single, being the widow of Kenneth Octave Hass, a~td that I have four living
children who are: Ken Marik Hass presently residing at 590 Sinai, Summit IlHills, Rio Piedras, Puerto
Rico 00920-4333, Neth M. Hass presently residing at 3215 Nash Road, Anna, IL 62906-3810, Tave
Erin Hass presently residing at 4208 East Oak Knoll, Springfield, MO, Kara Jenann Hass Miller
presently residing at 410 Fairway Drive, Mechanicsburg, PA 17055-5713. Wherever the word
"child" or "children" are used herein it shall be deemed to mean the children herein named.
ARTICLE II
In the event I have made a separate written statement, letter or list to dispose of items of
tangible personal property not otherwise specifically disposed of by this Will, I direct my executor
to distribute such items in accordance with such writing. Such writing need not be in existence at
the time of the execution of this Will, but it shall be dated, and either be in my handwriting or
signed by me, or both, and may be altered, added to or changed in an}~ respect by me after its
preparation, and it may be a writing which has no significance apart from its effect upon the
dispositions made by this Will. This provision is intended to comply with Section 633.276 of the
1999 Code of Iowa.
ARTICLE III
I direct that my estate shall be divided in equal shares with one share for each living child
of mine and one share for each deceased child of mine who is survived by lineal legitimate
descendants. I give one shaze to each child of mine and one share to the: lineal descendants, per
stirpes, for each deceased child of mine.
ARTICLE IV
I nominate and appoint my oldest child who is qualified and willing to so serve as Executor
of this my Last Will and Testament. The children in such order therefore would be Ken Hass, Neth
Hass, Tave Hass and Kara Miller. I direct that my Executor shall be authorized and empowered to
sell, mortgage, lease w amvey real or personal property without the necessity of obtaining order of
the Court and in all events I exonerate my Executor from giving bond. '.[ further state that unless
there is agreement among all of my beneficiaries that any land that I might own in Union County,
Iowa, shall be disposed of or sold by my Executor in the administration of my estate, rather than
have fractional interest in said real estate distributed. I authorize and emlwwer my Executor to do
all things that are necessary to sell or otherwise dispose of such real estate as my Executor in his or
her sole discretion sees fit. No bond shall be required for such sale.
IN WITNESS WHEREOF, I have subscribed this my Last Will and Testament on this
2~1~~day of a ~pbE ,( , 1999.
/¢{72.L.:.1`L.,~I-L-?~7t1CCr.,.~'~7 a'~-Ea~-C C~,/~2:'
.:/
SARAH AMELIA C+ROESBECK HASS
On this 2~.~ day of Oc~r:~ ,( , 1999, the foregoing instrument was in ow
presence signed and executed by Sarah Amelia Crroesbeck Hass, and by her declared to us to be her
Last Will and Testament, and at her request, and in her presence, and in the presence of each other,
we have subscribed ow names as witnesses thereof.
J~tn.n.rv`n.~ ~ m. ~~. ~. Mo_d,~sor, sA
W/itn~ess`~ / ~ Address
~l%/,1,~iJ `•..i+:~:l~/~::7t , `lf,~flt.''.2.~ ..~~6'G!.~Cy
Witness :% Address
STATE OF IOWA
COUNTY OF LEE
ss:
Before me, the undersigned, on this day personally appeared, Sarah Amelia Groesbeck Hass, _
Suznx,.~. ,,1 M . P,~r~ and ~7 (i S. , jn1~ n:5nn ,known to me to be the Testator and the
witnesses, respectively,wlhose names are signed to the attached instrument;, and all of these persons
being by me first duly sworn, Sarah Amelia Groesbeck Hass, the Testator, declared to me and to the
witnesses, in my presence, that said instrument is the Testator's Last Will and Testament and that
the Testator willingly signed and executed such instrument, or expressly directed another to sign the
same for the Testator, in the presence of said witnesses, as the Testator's flee and voluntary act for
the purposes therein expressed; that said witnesses and each of them declared that such Last Will
and Testament was executed and acknowledged by the Testator as the Testator's Last Will and
Testament in their presence and that they, in the Testator's presence, at the Testator's request, and
in the presence of each other, did subscribe their names thereto as attesting witnesses on the day of
the date of such Last Will and Testament; and that the Testator, at the time of the execution of such
instrument, was of full age and of sound mind, and that the witnesses were sixteen years of age or
older and otherwise competent to be witnesses.
SARAHAMELIAGROESBI?CKHASS, TESTATOR
S
Witness
~' h s f .~ CSI ,-`fit n a.o ,--,,, ,
Witness
Subscribed, sworn and acknowledged before me by Sarah Amelia Groesbeck Hass, the Testator;
and subscribed and sworn before me by Sywo_.,'~t~o, t~ P:r and : I ; ~ 1 5 . ~J r~6~~~=drl
witnesses, this 2R~ day of `~ ~ ~~, f 1999.
Ckw~~ Notary Public yi'~d~ the State of Iowa
w
p
Q 2 N u~
_.
i
~
OOZ~ _2 ~
/
Wa
MC
ya7o°
a
~
Lbw
{f}ci
~ ¢ 2
N ~
-~
-~~
~~ M
b
-_ r,
~__
y~•
4V
Q V
O
Yj O
~g
- ~
, O'
I
o
~ ~ ~
'~' o
~-
I~ M1
~
`~ s
!
~ _
N
O
M1
-V\
v
V
V ,
- 1
7
Z
Y
QED QFfICE OF
!1t~11~r~Trfi ~- ~~MI ~
2~iYJUN-4 Ah`II=57
'~r,^L~.i...C3V '.Jf
`~ Y 1 .'. ,iJ ~~v
~r~ I
V
_C o
W~~.
..
l V
<~
1
0
a ",i.
w"r ..
ppy~
R 11~ ^
=w, !~
pp~~ ~w
4Y~ _ v
~~e,
Fp 4M 1
~ irr
fu
,:~'~