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Home My WebLink About10-15-12 (2)J REV-7 5~0 Ex(°'-10) 1505610143 PA De artment of Revenue ~ OFFICIAL USE ONLY p Pennsylvania County Code Year Bureau of Individual Taxes DEPARTMENT OF REVENUE PO 60X.280601 INHERITANCE TAX RETURN 2 1 11 Harrisburg, PA 17128-0601 RESIDENT DECEDENT File Number 1242 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 193 16 4903 09 22 2011 Decedent's Last Name Suffix HELLAM (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW ® 1. Original Return ^ 4. Limited Estate ® g Decedent Died Testate (Attach Copy of Will) ^ 9. Litigation Proceeds Received ^ 3. Remainder Return (date of death prior to 12-13-82) ^ 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes ^ 11.Election to tax under Sec. 9113(A) (Attach Sch. O) Date of Birth 08 16 1923 Decedent's First Name MI ARBUTUS J Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS ^ 2. Supplemental Return ^ 4a. Future Interest Compromise (date of death after 12-12-82) ^ ~ Decedent Maintained a Living Trust (Attach Copy of Trust) ^ 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name ~`~' Daytime Telep~gne Number ~~_--: RICHARD E CONNELL ESQ 717 23~~731 ~~:~~ --~-,` REGISTER ~ 1~tLLS US6~NLY : + ~--% First line of address ~-,,~ _~.~ "77 - . _:.~. --; 2 3 0 3 MARKET STREET ~-_?-, ~ ~ ~.~ ~ Second line of address ~', City or Post Office State ZIP Code CAMP HILL PA 17011 Correspondent's a-mail address: C o n n e l l @ b m C- l a W. n e t Under penalties of perjury, I declare that I have examined this return, including accompanying schedules d 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 base informat' f wh~ h preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ~y~ ~ m ATE / Deborah Sheaffer ~ j ~. --/ ~, ADpj2~,S~ Lanf~y ,~/~. , /i'l~chu~,cs6u ~°~ y less 5~(2(1~ echanicsburg, PA 155 SIG ATURE OF PREReRER HER AN RE NT IVE DATE ~ Richard E Connell Esq !D ~!,'Z ~~oi Z ADDRESS 2303 Market Street, Camp Hill, PA 17011 Side 1 1505610143 DATE FILED 1505610143 J 1 1505610243 J REV-1500 EX Decedents Name: H E L L A M, ARBUTUS J. Decedent's Social Security Number 193 16 4903 RECAPITULATION 0 0 0 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 8~ Miscellaneous Personal Property (Schedule E) ................ 5. 3 4 , 8 0 3 0 0 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............. 6. 5 , 8 8 8 6 9 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ............. 7. 8. Total Gross Assets (total Lines 1-7) ....................................................................... 8. 4 O , 6 91.6 9 9. Funeral Expenses & Administrative Costs (Schedule H) ...................... ................... 9. 6 , 1 4 2 . 2 2 10. Debts of Decedent, Mortgage Liabilities, ~ Liens (Schedule I) ............ .................... 10. 5 6 5 2 9 11. Total Deductions (total Lines 9 & 10) .................................................. .................... 11. 6 , 7 0 7 5 1 12. Net Value of Estate (Line 8 minus Line 11) ......................................... .................... 12. 3 3 , 9 8 4 1 8 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. 3 3 , 9 8 4 1 8 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .00 15. 16. Amount of Line 14 taxable at lineal rate X .045 3 3 , 9 8 4.18 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. Tax Due ................................................................................................................... .. 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505610243 1505610243 1,529.29 1,529.29 ^ J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 - 11 - 1242 DECEDENT'S NAME Hellam, Arbutus J. STREET ADDRESS 911 Robert St. CITY Mechanicsburg STATE PA ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest Total Credits (A + B) (1) 1,529.29 (2> 0.00 (3) 10.78 (4) (5) 1,540.07 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. 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 :.................................................................................. ^ ^x b. retain the right to designate who shall use the property transferred or its income :.................................... ^ ^x c. retain a reversionary interest; or .................................................................................................................. ^ ^x 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? ...................................................................................................................... ^ ^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 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)1. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, w ether by blood or adoption. SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF Hellam, Arbutus J. 21 - 11 - 1242 All real property owned sole)y or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a wilting seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on schedule F. Attach a copy of the settlement sheet if the property has been sold. Include a copy of the deed showing decedent's interest if owned as tenant in common. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 911 Robert St. 0.00 Mechanicsburg, PA 17055 Parcel ID #17-23-0563-163 Total Assessed Value $162,000.00 Executors are seeking to sell the property and will file a supplemmental return upon sale with Exhibits to include HUD-1 and other appropriate documentation. TOTAL (Also enter on Line 1, Recapitulation) ~ 0.00 SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT -- FILE NUMBER ESTATE OF Hellam, Arbutus .1. 21 - 11 - 1242 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 2006 Honda Civic 8,000.00 VIN 1 HGFA16566L066822 Mileage: 12,522 Condition: Good 2 I RBC Acct. No. 312-07133 ~ 26,303.00 3 ~ Personal effects and household goods. ~ 500.00 ~ TOTAL (Also enter on Line 5, Recapitulation) ~ 34,803.00 ' ~ SCHEDULE F COMMOERTANCETAXRETURNANIA JOINTLY-OWNED PROPERTY RESIDENT DECEDENT ESTATE OF I FILE NUMBER Hellam, Arbutus J. 21 - 11 - 1242 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 Alan Hellam 205 Lantzy Road Son q Mechanicsburg, PA 17055 JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY Include name of financial institution and bank account number similar identifying number. Attach deed for jointly-held real estat DATE OF DEATH rVALUE OF ASSET °,6 OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST 1 A 07/2011 Sovereign Bank 11,777.38 50% 5,888.69 Acct. No. 1681788799 50% 0.00 TOTAL {Also enter on line 6, Recapitulation) I 5,888.69 SCHEDULE H FUNERAL DCPENSES & COMMONWEALTH OF PENNSYLVANIA '~+ ~/~ n /~ ^/'~ INHERITANCE TAX RETURN ~~INIJTIV'1T1 V G ~.~7~ RESIDENT DECEDENT FILE NUMBER ESTATE OF Hellam, Arbutus J. 21 - 11 - 1242 Debts of decedent must be reported on Schedule I. ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT A. 1 Malpezzi Funeral Home 4,735.49 2 Rev. Chester P. Snyder -Honorarium 125.00 3 Royer Flowers 543.25 4 Funeral Luncheon 368.19 B. ADMINISTRATIVE COSTS: ~. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(s) Commission paid 2. Attorney's Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant 4. Street Address City State Zip Relationship of Claimant to Decedent Probate Fees Cumberland County Register of Wills 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 Shipping of Verizon hardware 315.50 24.79 TOTAL (Also enter on line 9, Recapitulation) 6,142.22 Schedule H C ES COMMONWEALTH OF PENNSYLVANIA Funeral INHERITANCE TAX RETURN A~dminlsh'dtiVle 00615 COt~nued RESIDENT DECEDENT ESTATE OF Hellam, Arbutus J. FILE NUMBER 21 - 11 - 1242 2 Cumberland County Register of Wills - ITR Filing Fee 15.00 Cumberland County Register of Wills -Inventory Filing Gee 15.00 Page 2 of Schedule H SCHEDULEI DEBTS OF DECEDENT, MORTGAGE COMMONWEALTH OF PENNSYLVANIA LIABILITIES & LIENS INHERITANCE TAX RETURN ~ RESIDENT DECEDENT FILE NUMBER ESTATE OF Hellam, Arbutus J. 21 - 11 - 1242 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 House Maintenance -grass cutting, general upkeep prior to death 350.00 2 MCHS Nursing Facility, Walnut Bottom Road, Carlisle, PA 17013 150.00 3 I Cumberland Goodwill Fire and Rescue I 50.00 4 I Verizon I 15.29 ~ TOTAL (Also enter on Line 10, Recapitulation) ~ 565.29 REV-1513 EX+ (11-08} SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Hellam, Arbutus J. 21 -11 -1242 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) SHARE OF ESTATE (Words) AMOUNT OF ESTATE ($$$) I ' TAXABLE DISTRIBUTIONS[include outright spousal dlstnbutlons, and transfers under Sec. 9116 (a) (1.2)] ~ _ ! 1 Deborah Sheaffer Daughter / Z„ 5212 Oxford Dr. Mechanicsburg, PA 17055 !/ /~ 2 Alan Hellam Son 205 Lantzy Rd. Mechanicsburg, PA 17055 Enter dollar amounts for distributions shown above on lines 15 t hrough 18 on Rev 1500 cover sh eet, as appropriate. II NON-TAXABLE DISTRIBUTIONS: . 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 ~ , O.OyO ,~