HomeMy WebLinkAbout09-26-12J 1505610105
REV-1500°"°""`R'dd
ennsylvania OFFICIAL USE ONLY
PA Department of Revenue P County Code Year File Number
Bureau of Individual Taxes "~~ "~` -
PD eDX 280607. INHERITANCE TAX RETURN ~ ~ ~ /~ ~ /-~~ t
Harrisburo PA 1912&0601 RESIDENT DECEDENT _ CJ ~l
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MNDDYYYY
1180-01-9655 '',05/08/2012 '',12/04/1913
Decedent's Last Name Suffx Decedent's First Name MI
Hippensteel Edna M ',
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Sufix Spouse's First Name MI
__ _. ',,.
' i '
Spouse s Socal Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
OD 1. Original Return
O 4. Limited Estate
m 6. Decedent Died Testate
(Attach Copy of Will)
O 9. Lifigadon Proceeds Received
O 2. Supplemental Return
O 4a. Future Interest Compromise (date of
death after 12-12-82)
O 7. Decedent Maintained a Living Trust
(Attach Copy of Trust.)
O 10. Spousal Poverty Credit (Date of Death
Between 12-31-91 and 1-1-95)
O 3. Remainder Return (Date of Death
Prtor to t2-13-82)
O 5. Federal Estate Tax Return Required
~ 8. Total Number of Safe Deposit Boxes
O 11. Election to Tax under Sec. 9113(A)
(Attach Schedule O)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TA%INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number r„~
c-
Thomas P. Gleason ', (717; 532-3270 O r:,
_ rr?
REGISTER OF ~ONL
~._~: On
First Line of Address
7l ; "'D
49 West Orange Street 8~, -' ' =~
_' r"y
Second Line of Address
W
City or Posl Office Stale ZIP OOde DATE FILED
Shippensburg PA 17257
correspondent's e-mau address: tomgleason@tomgleasonlaw.com
Under penalties of perjury, I declare that I have examined Nis return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is Vue, coned and cromplete. Declaretion of preperer other than the personal representatNe is based on all I nformation of which preperer has any knowledge.
SIGNATJJRE OF PERSOyJ2ESPOyQIBLE FOR FILING RETURN _ ~ DATE
422 Kara Way, Shippensburg, PA 17257
SIGNATURE OF PREPARER OTHER THAN REPRESEN
DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610105 1505610105 J
I~rt 7
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REV-1500 EX (FI)
Decedent's Social Security Number
180-01-9655
Decedent's Name:
RECAPRULATION
_.
1. Real Estate (Schedule A) ... ....... .......... ........ ...... .. 1 0.00
2. Stocks and Bonds (Schedule B) ..................................... .. 2.:~ 0.00 ',
3. Closely Held Corporation, Partnership or SolaPropdetorship (Schedule C) ... .. 3. ( m
-- 0.00
4. Mortgages and Notes Receivable (Schedule D) .......... ....... .. .. 4 0.00 '..
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. ! 3,773.75 ',
6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. i 0.00 ',
7. Inter-~vos Transfers & Miscellaneous Non-Probate Property i
00 '
0
(Schedule G) O Separate Billing Requested..... ... 7. ! ,
.
~ ~
8. Total Gross Assets (total Lines 1 through 7) ......... .. ...... ..... ... 8. 3,773.75
9. Funeral Expenses and Administretive Costs (Schedule H) ................ ... 9. 1,879.00
10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............ ... 10. 90,738.01 '..
11. Total Deductions (total Lines 9 and 10) ................................. 11.
12. Net Value of Estate (Line 8 minus Line 11) .............................. 12.
13. Chadtable 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.
0.00
-88,843.25
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal taz rate, or
transfers under Sec. 9116 00 :
0
(a)(1.2) X .0_ ,
.
15.
i6. Amount of Line l4 taxable ~~~~~-~----.._...._-~----~~ ~~'-~. --~~-~
at lineal rate X .0 45 0.00 !. 1g, ',
17. Amount of Line 14 taxable
at sibling rate X .12 0.00 ', 17,
18. Amount of Line 14 taxable
0 00
at wllateral rate X .15 16
19. TAX DUE ............................................... ........ .. 19. ',.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
1505610205
92,417.01
-88,643.26
O
Side 2
L 1505610205 1505610205
REV-7500 EX (FI) Page 3 Flle Number
Decedent's Complete Address:
DECEDENT'S NAME
Edna M. Hippensteel
STREET ADDRESS
121 Walnut Bottom Road
CfTY --_ -_- - __ _~ ', STATE ',.. ZIP
Shippensburg PA ' 17257
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.
Fill in oval 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.
Total Credits (A + B) (2)
(5)
(~) o.oo
0.00
(3)
(4)
0.00
0.00
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 transferred .................................................................................... ...... ^
b. retain the right to designate who shall use the property transferred or its income ...................................... ...... ^
c. retain a reversionary interest ........................................................................................................................ ...... ^
d. receive the promise for life of either payments, benefits or pre? ................................................................ ...... ^
2. If death oxurred after Dec. 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ........................................................................................................ ...... ^
3. Did decedent own an "in Wst for" or payable-upon-death bank account or secudty at his or her death? ....... ....... ^
4. Did decedent own an individual retirement account, annuity or other non-probate property, which
contains a beneficiary designa8on? ................................................................................................................. ....... ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
REV-15Da EX+(o&u)
pennsylvania SCHEDt1LE E
ail DEPARTMENT OF REVENUE CASfIr BANK DEPOSITS 8t MISC.
INHERITANCE TAX 0.ETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
EDNA M. HIPPENSTEEL
Include the proceeds of I(tigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
I1EM VALUE A7 DATE
NUMBER DESCRIP'T10N
_ _ OF DEATH
1. M&T checking account
1,268.62
2, Refund from Shippensburg Health Care Center#1 1,223.57
3, Refund from Shippensburg Health Care Center#2 1,281.56
TOTAL (Also enter on Line 5, Recapitulation} ; 3,773.75
tf more space is needed, use additional sheets of paper of the same size
REV-1511 EX+ (30-D9)
pennsylvania
YT DEVARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
EDNA M HIPPENSTEEL _
Decedent's debts must be reported on Schedule I.
RFM
A. FUNERAL EXPENSES:
1' Fogelsanger Bricker Funeral Home
2. Rev. Herbert Hartman
3. Rev. Stevan Sheets
a. Rev. Robert Swank
s Musicians Pam Cramer (piano) & John Alt (guitar)
s. Lifeway Publications for Funeral Bulletins
7. -
B.
1.
2.
3.
a.
s.
6.
7.
8.
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s) _____
Street Address __
City State ___
Year(s) Commission Paid:
Attorney Fees:
Family Exemption: (IF decedent's address is not the same as daimant's, attach ezplanaUon.)
Claimant
Street Address
City __. Stale. __,_
Relationship of Claimant to Decedent
Probate Fees:
Accountant Fees:
Tax Retum Preparer Fees:
Publication cost in Shippensburg News Chronicle
Publication cost in Cumberland Law Journal
44.00
200.00
50.00'
25.00
80.00
8.75
0.00
1,000.00
0.00
91.50
0.00
0.00
104.75
75.00
TOTAL (Also enter on Line 9, Recapitulation) ~ 1.,679.00
ZIP
ZIP
If more space is needed, use additional sheets of paper of the same size.
REV-1512 EX+ (12-OB)
~pennsylvania SCHEDULE I
r~iiii DEPARTMENT OFflEVENNE DEBTS OF DECEDENT,
INHERITANCE TA%RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDEM
ESTATE OF FILE NUMBER
EDNA M. HIPPENSTEEL
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+ (Ol-10J
~pennsylvania SCHEDULE ]
DEPARTMENT OF REVENUE BENEFICIARIES
INHERRANCE TAX REl11RN
RESIDENr DECEDENr
ESTATE OF: FILE NUMBER:
EDNA M. HIPPENSTEEL
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECENING PROPERTY Do Not Llst Trustee(s) Of ESTATE
I TAXABLE DISTRIBUTIONS [[ndude outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
1. Patricia Anne Alt lineal 1/4
2. Nancy Elaine Kline Lineal 1/4
3. David B. Hippensteel, Jr. Lineal 1/4
4. Rick L. Wagner Lineal 1/4
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECI]ON TO TAX IS NOT TAKEN:
1. ...
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1. _..
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUITONS ON LINE 13 OF REV-1500 COVER SHEET. ~
If more space is needed, use additional sheets of paper of the same size
LAST WILL AND TESTAMENT
KNOW ALL MEN BY THESE PRESENTS, that I, EDNA M. HIPPENSTEEL, of
Pennsylvania, being of sound and disposing mind, memory and understanding,
do make, publish and declare this my Last Will and Testament, hereby revoking
all prior wills and codicils by me at any time heretofore made.
FIRST: I direct the payment of all my legal debts, funeral expenses
including my grave marker and all expenses of my last illness, state, federal
estate and inheritance taxes and administration costs shall be paid as soon as
may be conveniently done following my decease leaving all specific bequests free
of tax to the legatee.
SECOND: I give and bequeath my drop leaf table and the dishes with the
apple pattern to Patricia Anne Alt.
THIRD: I give and bequeath the white dishes with the pink rose pattern
and the white corner cupboard to Nancy Elaine Kline.
FOURTH: I give and bequeath the dishes with the blue and white pattern
to David B. Hippensteel.
FIFTH: I give, devise and bequeath the rest of my estate, in four equal
shares, one share to Patricia Anne Alt, or if she should predecease me to her
children; one share to Nancy Elaine Kline, or if she should predecease me to her
children; and one share to David B. Hippensteel, Jr., or if he should predecease
me, then to his wife, Darlene Hippensteel or if they both should predecease me
then to their children; and one share to Rick L. Wagner equally.
SIXTH: I nominate and appoint, David B. Hippensteel and or Darlene
Hippensteel, as the Executors of this my Last Will and Testament. If they should
fail to serve or be unable to serve, then in either of those said events, I nominate
and appoint, Nancy Kline, as the Executrix of this my Last Will and Testament.
IN WITNESS WHEREOF, I, EDNA M. HIPPENSTEEL, to this my Last Will
and Testament set my hand and official seal, this ~~'~ day of )OU . 2002.
~; ,~1r;~ ,.,(SEAL)
Enda M. Hippensteel
Sworn to and subscribed, declared and
Published by Enda M. Hippensteel, as
Her Last Will and Testament, and so
Done in the presence of we the
Witnesses, who sign at her request,
And in her presence, and in the presence
Of each other.
~1 Cam. ~ ~1 ~,-~ U
~~ ~~,~.
¢~ uitc~
COMMONWEALTH OF PENNSYLVANIA:
:SS
COUNTY OF CUMBERLAND
I, EDNA M. HIPPENSTEEL, whose name is signed to the foregoing
instrument, having been duly qualified according to law, do hereby acknowledge
that I signed it willingly; and that I signed it as my free and voluntary act for the
purpose therein expressed.
Endo M. Hippensteel
Sworn to and acknowledged, before me,
By Enda M. Hippensteel, the Testatrix,
This 4+=` day ofd 2002.
NiSu.
~ ~ > > Nomriel Seal
thony Adams, Notary Public
Notary Public Shippensburg Boro, Cumberland County
My Commias[on Expires May I5, 2(q6
Member, PenneyNenia AssaGaMOn tR Notaries
COMMONWEALTH OF PENNSYLVANIA:
:SS
COUNTY OF CUMBERLAND
WE, Darlene M. Bigler and Sharon Coleman Adams, the witnesses whose
names are signed to the foregoing instrument, being duly qualified according to
law, do depose and say that we saw the Testatrix sign and execute the
instrument as her Last Will and Testament; that she signed willingly and that she
executed it as her free and voluntary act for the purposes therein expressed;
that each of us in the hearing and sight of the Testatrix signed the Will as
witnesses, and that to the best of our knowledge and belief the Testatrix was at
the time at least eighteen (18) or more years of age and of sound mind and
under no constraint or undue influence.
,~
~~aS~r~~ - I_1~~~)
~= ~ ~~~,
Sworn to and subscribed before me by,
Darlene M. Bigler and Sharon Coleman Adams,
The witnesses, this y~ day of oU. 2002.
Notary Public
Noterlal Seal
H. AuthonY Adams. Notary PYbGc
Shippeeaburg earo. Cumberland Cnunt
My Commisrnm Expires May t~ !iw~
~vlember, Pennsywenia Assoctabrr ~. n *aoWnes
Notarial
H' Anthony Adn ~
S~PPensburg g,,, ~, CuN~Y Pablic
MY Commissieo Expiresmberland County
~~. PennaYNania May I5, 2006
atbndNOy~