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Home My WebLink About08-07-121505610143 REV-1500 Ex ~0,-,0, .~. PA Department of Revenue penes lvania OFFICIAL USE ONLY }~ County Cade Year File Neanber Bureau of Individual Taxes °~"RT'~'~°F PO 60X.280601 INHERITANCE TAX RETURN 21 12 0657 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Binh 164 30 3424 05 11 2x12 11 24 1834 Decedent's Last Name Suffix Decedent's First Name MI HAWKINS DA~TID L (If Applicable) Enter Surviving Spouse's Information Befow Spouse's Last Name Suffix Spouse's First Name MI HAWKINS PATRICIA A Spouse's Soaal Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Retum ~ 2. Supplemental Retum 4. Limited Estate ~ 4a, Future Interest Compromise (date of death artr+r 1 ~-17-R~1 g Decedent Died Testate 7 Decedent Maintained a Living Trust X (Attach Copy of Witl) ~ (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. ~~ 239-TJ ~it~date~~fdeath 3. Remainder Retum (date of death 11. Election to tax under Sec. 9113(A) (Attadt Sch. O) c prior to 12-13-82) 5. Federal Estate Tax Retum Required ~ 8. Total Number of Safe Deposit Boxes CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMA OULD BREC"~t3 Name Daytime Teleph~~umber ~ <.~ 1 <"~~ ~ - ,,~ RICHARD L WEBBER JR 717 532 -- ~~$ 1 ~:,: = T~, r' r.-_t ._.. ~. ..-. ~' ._ REGISTER OF~IS USE ~Y : _. ~~- J ~: ' C' -, ; N ~ _ ;-s-t First line of address --p =~i • • ;;r~ ~ 126 EAST KING STREET ~ Second line of address City or Post Office SHIPPENSBLTRG State ZIP Code PA 17257 Correspondent's e-mail address: rwebber@weigieassociates.com Under penalties of perjury, I dedare that I have examined this return, induding accompanying schedules and statements, and to the best of my knowledge and belief, it is true, coned and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON PONS LE FOR F LING RETURN D/ATE ~~ ~'~v1,1~ ci (~k~ Donna L. Negtey ~ 1 ~' ~ ~ ADDRESS 202 Whiskey Run Road. Newvitle. PA 17241 SIGNATURE OF PREPARER OTHER THAN RE PRESENTATIVE PATE /'~ ~~`/' ~' `(' , "~~ Richard L. Webber, .tr. ~ ~ ADDRESS 126 East King Street, Shippensburg, PA 17257 L b505610143 DATE FILED Side 1 1505610143 ~u~ 1505610243 REV-1500 EX Decedents Social Security Number o~d~,rs N~,e: Hawkins, David L. 164 3 0 3 4 2 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 & Notes Receivable (Schedule D) ........................................................ 4. 5• Cash, Bank Deposits ~ Miscellaneous Personal Property (Schedule E) ............... 5. 5 8 , 814.4 9 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested............ 6. 903.62 7. Inter-Vnros Transfers ~ Miscellaneous Ilan; Probate Property (Schedule G) ~J Separate Billing Requested............ 7. 11 , 5 O 7 _ 0 9 8. Total Gross Assets (total Lines 1-7) ..................................................................... 8. 71 , 225.20 9. Funeral Expenses & Administrative Costs (Schedule H) .................. 9. 12 , 8 0 8 . 0 9 10. Debts of Decedent, Mortgage Liabilities, ~ Liens (Schedule I) .............................. 10. 11. Total Deductions (total Lines 9 ~ 10) ................................................................... 11 _ 12 , 8 0 8 . 0 9 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 5 8 , 417.11 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. 5 8 , 417 _ 11 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 5 8 417.11 (a)(1.2) X .00 ~ 15. 0 . 0 0 16. Amount of Line 14 taxable 0 0 0 16 0. 0 0 . at lineal rate X .045 . 17. Amount of Line 14 taxable 0 0 0 17 0. 0 0 . at sibling rate X .12 . 18. Amount of Line 14 taxable 0 0 0 18 0. 0 0 . at collateral rate X .15 . 19. Tax Due ...................... •-• .......................•-------...------...........-------------------------------------- 19. 0 . 0 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505610243 1505610243 J REV-1500 EX Page 3 Decedent's Complete Address: Fite Number 21-12-0657 DECEDENTS NAME Hawkins, David L. STREET ADDRESS 152 Bullshead Road CITY Newvi[te I STATE ~ ZIP PA ,~ 17241 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest 0.00 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) Total Credits (A + B) (2) (3) (4) (5) 0.00 0.00 0.0~ Make Check Pa able 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 transferred :............................................................................... ~ Ox b. retain the right to designate who shall use the property transferred or its income :.................................. ~ ~x c. retain a reversionary interest; or ............................................................................................................... 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 without receiving adequate consideration? .................................................................................................................... 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 beneficary 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 is 3 percent [72 P.S. §9116 (a) (1.1) (~]. 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 decedents lineal benefiaaries is 4.5 percent, except as noted in 72 P.S. §9116 1.2)172 P.S. §9116 (a) (1)]. . The tax rate imposed on the net value of transfers to or for the use of the decedents 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-1508 DC+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY conr~..aLT-i os: I~1snv~NV, IPEERfrAN^..E TlJC RETURN RESIDENT DECEDENT ESTATE OF FELE PLUMBER Hawkins, David L. 21-12-Of:57 Indude the pnx~eds of litigation and the date the proceeds were received by the estate. X411 property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Highmark -Refund 65.00 2 MONY Life Insurance Company -Refund Check 841.75 3 ACNB Bank Christmas Club #5528895 840.00 Accrued interest on Item 3 through date of death 0.22 4 ACNB Bank FNB Passbook #9111662 57,064.64 Accrued interest on Item 4 through date of death 2.88 TOTAL (Also enter on Line 5, Recapitulation) I 58,814.49 (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 E (Rev. 6-98) Rev-1509 EX+ (s-98j r, SCHEDULE F cot~,oNwE<.LrHOF~easvLVE.NIa JO[NTLY-OWNED PROPERTY INHERrTANCEThXRETI eT'2~1 RESIDENT DECEDENT ESTATE OF F[LE NUMBER Hawkins, David L. 21-12-0657 ff an asset vras made jairrt witivn one year of the decedert's date o: death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAtJE ADDRESS RELATIONSHIP TO DECEDENT A. Patricia A. Hawkins B. C. 152 Builshead Road Wife Newvi[le, PA 17241 JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOIN TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANKACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY-HELD REAL ESTATE DATE OF DEATH ALUE OF ASS % OF DECD S INTEREST DATE OF DEATH DECEDENT'S INTEREST 1 A 06/30/2003 ACNB Bank Checking Account #137022 1,807.22 0.500% 903.61 2 A 05/10/2012 ACNB Bank Checking Account #137022 - 0.02 0.500% 0.01 Accrued Interest TOTAL (Also enter on Line 6, Recapitulation) I 903.62 (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 F (Rev. 6-98) Rev-1510 p(+ (6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY conneonoNVUEnLTH o~ PENNSV~vaNna IN6~IERITANCE TaX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Hawkins, David L. 21-12-0657 phis schednile Est be onnnpleted a~ fated if tBne answer to any of ~estiions 1 throa~gdhs 4 on tine reverse sidle off tgne REV-15m0 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY THE DATE OAF TROANSFRERSATTAC~i A COPY~OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD"S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 ACNB Bank Individual Retirement Acct. 5,581.19 100.000% 5,581.19 #455172900002 -Transferee - Patricia A. Hawkins, Spouse Date of Transfer 5110112 Accrued income on Item 1 through date of death 5.14 100.000% 5.14 2 Orrstown Bank Checking Acct. #106003709 - 8,920.74 100.000% 3,000.00 5,920.74 Transferee -Patricia A. Hawkins, Spouse Date of Transfer 5/11/2012 Accrued income on Item Z through date of death 0.02 100.000% 0.02 TOTAL {Also enter on Line 7, Recapitulation) I 11,507.09 (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. fi-98) REV-1'!51 EX+(10-06) _~, SCHEDULE H COIuBNHEN ~T}iE~~E~,4N~ FUNERAL EXPENSES ~ RESIDEN DECEDE ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Hawkins, David L. 21-12-0657 Debts of decedent must be reported on Schedule 1. ITEM DESCRlPTlON AMQUNT NUMBER A, FUNERAL EXPENSES: See continuation schedule(s) attached 7,647.59 B. 1. ADMINISTRATIVE COSTS: Personal Repnesentative's Commissions Name of Personal Representative(s) Donna L. Negley StreetAddn~s 202 Whiskey Run Road City Newville State PA zip 17241 Year(s) Commission paid 3,000.00 2. Attomev's Fees Weigle ~ Associates, P.C. 2,000.00 3, Family Exemption: (If decedent's address is not the same as daimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountants Fees 6. Tax Retum Preparer's Fees 7, OtherAdministrative Costs 160.50 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 12,808.09 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 PLUMBER Hawkins, David L. 21-12-0fi57 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Fogelsanger-Bricker Funeral Home 7,647.59 H-A 7,647.59 Other Administrative Costs 2 Register of Wills of Cumberland County -Filing Fee for Wiil 15.00 3 Register of Wills of Cumberland County - Petiition Ltrs. Test, JCS Fee, Automation Fee 118.50 4 Register of Wills of Cumberland County -Short Certificates 12.00 5 Register of Wills of Cumberland County -Filing fee for inheritance tax return 15.00 H-B7 160.50 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) REV-1513 pC+ (11-08j ' SCHEDULE J c~~ ""ANTED EER"~~ BENEFICIARIES ESTATE OF I FILE NUMBER Hawkins, Qavid L. 21-12-0657 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(Sl RECEMNG PROPERTY DECEDENT (Words} (~$~) Do hiot LFst Tnest s I TAXABLE DISTRIBUTIONS [indude outright spousal • distributions, and transfers under Sec. 9116(a (1.2) Patricia A. Hawkins Wife One Hundred 58,417.11 152 Bullshead Road Percent Newville, PA 17241 Total 58,417.11 Enter dollar amounts for distributions shown above on lines 15 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 SHEE11 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08) ACNB BANK June 20, 2012 Weigle & Associates Attn: Richard L Webber Jr, Esq 126 E King St Shippensburg PA 17257 RE: Estate of David L Hawkins, aka David L Hawkins Sr Dear Mr. Webber: The following information is being provided as per your request: Acct. Type Account No. Balance at Accrued D.O.D. Interest to D.O.D. Christmas 5528895 $840.00 $0.22 Club FNB Passbook Esteem Checking Account Individual Retirement Account Ownership Individual 9111662 $57,064.64 $2.88 Individual Date Opened/Joint 1 /20/06 7/25/01 137022 $1,807.22 $0.02 Jt w/ Patricia A Hawkins 6/30/03 455172900002 $5,581.19 $5.14 Individual-Beneficiary: Patricia 10/26/07 A Hawkins Inquiries concerning ACNB Corporation stock information should be directed to the Registrar and Transfer Company at 1-800-368-5948. If you need any additional information, please contact me at (717)339-5122. Sincerely, Ir s ~ n t: •~ ~ ~ ` :~ Barbara J Wa ~e ACNB Ban Deposit Serve es Representative II PO Box 3129, GETTYSBURG, PA 17325 I rxoNF 717.334.3161 I TOLL FxFE 1,888.334.2262 I acnb.com I acnbbusiness.com VKK~'1'(~Wly BALVK A Traditio~i of Excellence June 1 S, 2012 Weigle & Associates, P.C. Attorneys At Law Richard L. Webber, JR 126 East King Street Shippensburg, PA 17257 Fax: 532-6552 Re: Estate of David L. Hawkins Social Security Number 164-30-3424 Date of Death 5/11 /2012 IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD THE FOLLOWING ACCOUNT WITH ORRSTOWN BANK: CHECKING ACCOUNT Account No.- Account Type- Date Opened- Joint Account (name/date)- Balance- Accrued Interest- 106003709 50+ Interest Checking 5/6/2005 Patricia A. Hawkins, 5/10/2012 $8,920.74 $0.02 Best Regards, ~~ r Jil R. Worthington Deposit Processing Clerk 2695 Philadelphia Avenue Chambersburg, PA 17201 1.888.ORRSTOWN ~~.+~r~~~~a~~u~oc~~ JERRY A. WEIGLE Associates JQSEPH P. RUANE RICHARD L. WEBBER, JR. Of Counsel THOMAS L. BRIGHT WEIGLE & ASSOCIATES, P.C. Attorneys-at-Law 126 EAST KING STREET SHIPPENSBURG, PENNSYLVANIA 17257-1397 TELEPHONE (717) 532-7388 or (717) 776-4295 FAX (717) 532-5289 August 6, 2012 Cumberland County Register of Wills 1 Courthouse Square Carlisle, PA 17013 RE: David L. Hawkin s Estate No. 2012-00657 ,., Pa. No. 21-12-0657 ~ °~'' : ,. Dear Ladies and Gentlemen: ~ ~- ~ ~; ,y_ _.t _~__,_ r--- ~:: I : _ -- I have enclosed the following items: ~-. J ~ `.'z ~ 1. Inheritance tax return, along with a copy; ; ~= ~? ~--= ~ 2. Copy of the return to be returned to me; ..~ ~' ~ `~~ -~-~. 3. Check #5655 in the amount of $15.00 for the filing fee; and 4. Self-addressed stamped envelope. Please time-stamp my copy and return it to me in the envelope. Thank you for your assistance. Very truly yours, WEIGL & ASSOCIATES, P.C. ~' , Richard L. Webber, Jr., Esquire RLW/paf Cc: Donna L. Negley, Executrix ~ V~ o ~ ~~ ~~ ~ ~ ~. oho w~ ~ ~~ O ~ ~ O O ~+, N ~ N ~ ~ rn ~ `~ mn,~c~ ~~~ a ~ cQ cQ ~ ._.~ ~ ~ ~ ~.~~ ~ ~ rn ~-~~w... ~ ~ ~ `~~W ~ ~ ~-.~ ~. ~, ~ .__. ~ ., :: ~-, ~~ :~ "~ ~ ~ ~ ~ ~-~ n c~~ :~? ~ ~ ' ..,., c.~ C7 c. _, --~r~ •~ ~-` r {.~~ ,k..a~. '. .. a o ~ UNlT~p r=- ° ~'~, ~ ~ rn `~ rn .o O ~ j~ n ~ o aye r~ ~ ~~ ~ D C7~®rn- ~c~~~,, rvo~p cn--~~~