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HomeMy WebLinkAbout09-19-12J 150561D143 REV-~ Sao Ex to,_,~, OFFICIAL USE ONLY PA Department of Revenue Pennsylvania cry code y~ ~~ N Bureau of Individual Taxes "~*~*~ PO 80X.280601 INHERITANCE TAX RETURN 21 12 (G ~ ~j Harrisburg, PA 17128-Ofi01 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 195 16 353$ 06 15 2012 Decedent's Last Name Sufftx HECKENDORN (If Applicable) Enter Surviving Spouse's Informatlat Below Spouse's Last Name Suffix Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW Date of Birth Q7 04 1923 Decedent's First Name MI DOROTHY Z Spouse's First Name MI THIS RETURN MUST BE FlLED IN DUPLICATE 1MTH THE REGISTER C?F WILLS 0 1. Original Return ~ 2. Supplemental Return ^ 4. Limited Estate ~ 4a. Future Interest Compromise (date of death after 12-12-82) g. Decedent Died Testate (Attach copy of wn) ^ 7 p~d~t a Livtt~g Trust tAtta~ Copy) ^ a. Litigation Proceeds Received ^ 10. ,~ ~~~,~- ~ij - d 3. Remaitsder Return {date of death prior to 12-13-82) 5. Federal Estate Tax Realm Required ~ 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 5113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX MIFOt~MATtON SHOULD BE DIRECTED T4: ~~ Daytime Telephone Number JESSICA L FISHER 717 69? 3223 First line of address 555 GETTYSBIIRG PIKE Second line of address STE C100 City or Post Office MECHANICSBURG State ZIP Code PA 17055 ~, -, f ._.. n~i E'~-~ ~' ~ ~ -x ; ~ ~ ~~ Q correspon~nt's e-mail address: Jessica~keystoneeklertaw.corn Under penalties of perjury, I declare that ! !save examined this return, irtduding aconmpanying sds~lules artd statemerrts, arxt to the best of my knowledge and belief, ft is true, correct and cxartplete. Declaration of preparer other than the personal representative is based on aU information ofi whirls rer has preps arty knowledge. ADDRESS Michael l Heckendorn _ 327 Huntsman Drnre, Goose Greek, SC 29445 S{GNATURE OF PREPARER OTHER THAN REPRESENTATNE D,y~ nP n n ~ r• nb ~ ~ o n1~, ,-, ,. Jessica L Fu~her C~ _ I c~ - t ~ ADDRESS V - _ _ _~ 555 Gettysburg Pike ,Mechanicsburg, PA Side 1 1505610143 150561D143 J 1~ REGISTER OF WILLS USE ONLY Q ;~~ ` ~ ." r~ ~ ~ r- : ...._ DA C>` ~ ~ J 1505610243 REV-1500 EX Decedent's Social Security Number Decedent's Name: Heckendorn, Dorothy Z 195 16 3538 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 8~ Notes Receivable (Schedule D) ........................................................ 4. 5~ Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 5 , 9 60.5 7 7. Inter-Vivos Transfers 8~ Miscellaneous Ian; Probate Property (Schedule G) ^ Separate Billing Requested............ 7. 32 , 377.43 8. Total Gross Assets (total Lines 1-7) ..................................................................... 8. 3 8, 3 3 8. 0 0 9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 3 0 . 0 0 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 12 , 7 01.14 11. Total Deductions (total Lines 9 & 10) ................................................................... 11. 12 , 7 31.14 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 2 5 , 6 0 6. 8 6 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. 2 5 , 60 6. 8 6 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 25 , 60 6. 8 6 16. 1,152.31 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. 1 , 1$ 2.31 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ Side 2 L 1505610243 1505610243 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-12 DECEDENT'S NAME Heckendorn, Dorothy Z STREET ADDRESS 123 Steelstown Road CITY STATE PA ZIP Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest 1,094.69 57.62 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. Make Check Payable to: REGISTER OF WILLS, AGENT. (1) 1,152.31 1,152.31 0.0~ Total Credits (A + B) (2) (3) (4) (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 :.................................. ^ ^x c. retain a reversionary interest; or ............................................................................................................... ^ 0 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 ................................................................................................................... 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 } (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-1509 EX+ (6-98) SCHEDULE F I COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Heckendorn, Doroth Z 21-12 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. B. C. JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSE % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1 ACNB Bank 11,921.14 50.000% 5,960.57 TOTAL (Also enter on Line 6, Recapitulation) I 5,960.57 (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 EX+ (6-98) ,. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Heckendorn, Do SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY Z FILE NUMBER 21-12 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 TRANSFERSATTACFi A COPY OF TIOHE DEED FOOREREAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST ( EXCLUSION IF APPLICABLE) TAXABLE VALUE 1 Gift to Son, Michael Heckendorn, 3/15/2012 35,377.43 3,000.00 32,377.43 TOTAL (Also enter on Line 7, Recapitulation) 32,377.43 (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) REV-1151 EX+ (10-06) COMMNHERITANCEOT~ RETURNANIA RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Heckendorn, Doroth Z 21-12 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A, FUNERAL EXPENSES: See continuation schedule(s) attached 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 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) ('laimant Street Address City State Zip Relationship of Claimant to Decedent 4. I Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. ~ Other Administrative Costs 30.00 TOTAL (Also enter on line 9, Recapitulation) I 30.00 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 Heckendorn, Dorothy Z 21-12 ITEM NUMBER DESCRIPTION AMOUNT Funeral Ex e 1 After Funeral Reception 30.00 H-A 30.00 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, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Heckendorn, Doroth Z 21-12 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Alpha Diagnostics LLC- Medical Bill 22,52 2 Carlisle Regional Medical Center- Medical Bill 750.00 3 Green Ridge Village Nursing Care -Medical Bill 10,602.89 4 Milennium Pharmacy- Medical Bill 90.25 5 Milennium Pharmacy- Medical Bill 10.48 6 Mollen Immunizations Clinic II, LLC- Medical Bill 25.00 7 Pinnacle Health Hospitals -Medical Bill 600.00 8 Pinnacle Health Hospitals -Medical Bill 450.00 9 Special Event Emergency Medical Services -Medical Bill 150.00 TOTAL (Also enter on Line 10, Recapitulation) I 12,701.14 (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 INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Heckendorn, Doroth Z 21-12 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT Do Not List Tru tee (WOrdS) ($$$) I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 a 1.2 Michael L Heckendorn Son 100% 25,606.86 327 Huntsman Drive Goose Creek, SC 29445 Total 25,606.86 Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 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-1500 Schedule J (Rev. 11-08)