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Home My WebLink About10-26-12 (2) ENTER DECEDENT INFORI ____ Social Security Number Date of Death 203-10-8521 03/20/2007 Decedent's Last Name HAMM _ _ _ (If Applicable) Enter Survlving Spouse's Information Below Spouse's Last Name Spouse s Socal Secunty Number FILL IN APPROPRIATE OVALS BELOW O i. Original Retum Date of Birth 01/08/1916 Suffix _.. Decedent's First Nama MI LEANDER _ _ _ H Suffx _ Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS C~1 2. Supplemental Retum (~ 3. Remainder Retum (date of death prior to 12-13-82) O 4. Limited Estate m0 4a. Future Interest Compromise (date of O 5. Federel Estate Tax Return Required death aker l2-12-82) W 6. Decedent Died Testate O 7. Decedent Maintainetl a Living Trust ,,,,,,.,. 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to taz under Sec. 9113(A) between 12-31-91 antl 1-1-95) (AttaU Sch, O) CORRESPONDENT - THIS SECTION MUS7 BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name _ Daytime Telephone Number ROBERT L. KNUPP, ESO _ _ (717) 238-7151 ~ m+n ~ FmrmName (If Applicable) ~ .v ~ - ~ ~~ Rl Smigel Anderson & Sacks I REGISTER OF ~sE i oNLy ~ ~ C~ - Z~ First line of address - - ~~ ~ c^ ( Sri _, v- P.O. BOX 630 ~ nC." a ` -, Second Ilne of address ~ '. ~~+ 3L = _. r -n -°_- C~ 4431 North Front Street W - 1 Qty or Post Office... State ZIP Code _ DATE FILED IV _ 'HARRISBURG PA 17108 Correspondent's a-mail address: Under penalties of perjury, I dedare that I have examinetl this return, inducting accompanying schedules and statements, and to the best of my knowledge end belief it is tmue, coned and complete. Dedaration of preperer other than the permonal representative is basetl on all information of which preperer: has any knowledge. SIGNATUREQF PyRSON RE$P nSIBLE FOREIL121G ~RFETURN DATE Elwood R. Gotshall, Jr, 8 Manor Drive, West Chester, PA 19380 ~ THAN ADDRESS ~ ~ ~~ ~ ~ 7 - ~ ~ ~ Flowers & Flowers, CPAs, 5775 Allentown Blvd, Suite 102, Harrisburg, PA 17112 PLEASE USE ORIGINAL FORM ONLY 15056051058 Side 1 I_r ]:5056051058 15056051058 REV-1500 EX (O6-OS) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number Poeoxzeosot INHERITANCE TAX RETURN 21 07 ..0290 Harrisburg, PA 17128-0601 RESIDENT DECEDENT J 15056052059 REV-1500 EX Decedent's Nama: LEANDER H HAMM RECAPITULATION 1. Real estate (Schedule A) ............................................. 1 2. Socks 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 6,717,51 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. '. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Properly !,---~~___...___.___.w~...._____..,_.___._._..,~..w._____..,, (Schedule G) O Separate Billing Requested........ 7. ', '.. 8. Total Gross Assets (total Lines 1-7) .................................... 6. 9. Funeral Expenses & Atlministrative Costs (Schedule H) ..................... 9. 10. Debts of Decedent, Mortgage Liabilities, 8 Llens (Schedule 1) ................ 10. 11. Tolal Deductions (total Lines 9 8 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 Tex (line 12 minus Line 13) ........................ 14. 2,631.78 2,631.78 4,085.73 4,085.73 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 .0_ 15. 16. Amount of Line 14 taxable ~`~ ~`~-"~'"`-"-`"`""-'-"""^""'""""'~""j at lineal rate X .0 _ '; 16 17. Amount of Line 14 taxable ', ~~ ~"' , at sibling rate X .12 ', 1,361.91 i ~ 17 18. Amount of Line 14 taxable - 'a ~ at wllaleral rate X .15 2,723.82 ~ 18 19. TAX DUE .................................. ... ....... ... ........ .. 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side2 Decedent's Social Secudty Number 2',03-10-8521 6,717.51 163.43 408.57 572.00 O 15056052059 REV-7500 EX Page 3 Decedent's Complete Address: Flle Numbar,,,__.___ _ 21 ~07-~iD29D~ DECEDENTS NAME ~-'"J ~"'~~"' .1 DECEDEITS SOCIAL SECURITY NUMBER LEANDER H HAMM 203-10-8521 STREET ADDRESS Messiah Village 100 Mount Allen Drive CITY Mechanicsburg STATE ZIP PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poveny Credit _ B. Prior Payments C. Discount - Total Credits (A+B+C) 3. Interest/Penalty if applicable D. Interest E. Penalty Total InterestlPenalty (D + E J 4. If Line 2 is greater than Line 1 + line 3, enter the diRerence. This is the OVERPAYMENT. FIII in oval on Page 2, Llne 28 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (1) 572.00 (2) (3) (4) (5) 572.00 (5A) 124.56 (58) 696.56 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 trensferred :........................................................................... ^ b. retain the right to designate who shall use the property transferred or its income : ............................ 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 secudty at his or her death" ........ ...... ^ 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 January 1, 1995, the tax rate imposed on the net value of transfers to or for Che use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dales 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 zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute do not x mot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and fling a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July i, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one 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 zero (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 four and one-half (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 twelve (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 by blood or adoption. REV-1503 EXt (6-9a) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER LEANDER H. HAMM 21070290 All property Jolntlyowned wlth right of aurvivonhlp must be dlacloaed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH t Zimmer Holdings, Inc. 100 SH @ $67.175 per share on date of discovery and sale by Legal Claimant Services (see attached documentation) 6,717.51 TOTAL (Also enter on line 2, Recapitulation) E 6,717.51 (If more space is needed, insen additional sheets of the same size) REV-1511 EX~ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES 8 ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER LEANDER H. HAMM 21070290 Debts of decedent moat be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: e. ADMINISTRATIVE COSTS:..... .. _... .. 1. Personal Representative's Commissions Name of Personal Representative(s) EIWOOdR. GOIShall Soda( Security Number(s)IEIN Number or Personal RepresenWdve(s) 207-34-7175 _' Stmef Address 8 Manor Drive ary West Chester State PA Z;p '19380 Year(s) Commission Paid: 2. Aborney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) . . Claimant Street Address City .. ._ _.. State ..Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 400.00 6. Tax Relum Pmparer's Fees T. Postage _ 16.00 a. Legal Claimant Services, Inc -account recovery firm s fee wdh regaM to Zimmer Holdings Inc shares 2 21 78 , , 6. TOTAL (Also enter on line 9, Recapitulation) S'. 2,631.78 (If more space is needed, insert additional sheets of the same size) REV-7517 E%~ (9-DD) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT OECEOENT SCHEDULE J BENEFICIARIES eslnte of FILE NUMBER LEANDER H. HAMM 21 07 0290 NUMBER NAME AND ADDRESS OF PERSON(S) RECENING PROPERTY RE Dol Not Llat Trustee(a~ENT AMOOF ESTATE ARE t TAXABLE DISTRIBUTIONS [include outright spousal distdbutions, and transfers under Sec. 9116 (a) (1.2)] 1 Dorothy M. Gotshall, Deceased 5/02/2009 (File#21-09-0449) Sibling 1361.91 2. Elwood R.Gotshall, 8 Manor Drive, West Chester, PA 19380 Collateral 1361.91 3. Ronald L. Gottshall, 1824 Hearthstone Lane, Middletown, PA 17057 Collateral 1361.91 (Two T's in Ronald's name is cortect) ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV 1500 COVER SHEET N NON-7AXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEFT S (I(more space is needed, inseh additional sheets of the same size) Personal Income Tax e-Services Center /;~ mM Page 1 of 1 ~~~_v~_ ~~ti<o Penalty and Interest Calculations CALCULATION DATES- 12/20/2007 TO 10/31/2012 TAX DEFICIENCY $ 572.00 CALCULATED INTEREST $ 124.56 BALANCE AS OF 10/31/2012 $ 696.56 https://www.doreservices.state.pa.us/pitservices/Default.aspx 10/18/2012 October 11, 2012 Case No: 1959-1120 Elwood R Gotshall Jr. 8 Manor Drive West Chester, PA 19380 RE: LEANDER H HAMM Dear Mr. Gotshall: Legal Claimant Services America's #1 Account Recovery Firm Enclosed please find a check in the amount of$4,500.73. Included below is a breakdown of the account we have recovered on your behalf. The Zimmer Holdings, Inc. account has now been updated so that any and all future mailings will be sent directly to you' current address. The breakdown is as follows: Zimmer Holdings, Inc. shares sold: 100 Price per share: $67.175 Date of sale: September 27, 2012 Your liquidated share amount: $6,71.7.51 - Legal Claimant Services' fee: 2 216.78 Net Proceeds: $4,500.73 Please be sure to retain this breakdown for use when filing your income tax return. If you have any questions, please do not hesitate to contact me. Thank you for your courtesy in this matter. Yours very truly, ~RC~iCG Rachel Zwell Account Executive Extension: 7164 RZwell@gokeane.com RZ \ SGM Encl. A DIVISION OF Corporate Offices Operations Center KE/~N C7 7001 Avenue of the Americas 640 Freedom Business Center 14th Floor • New Vork, NY 10018 6th Floor • qng of Prussia, PA 19406 wwwJegaklaimant.com 1.RSR.876.7635 Midwest Offl<e 513 Easl Bismarcl; Expressway Suite 21 • Bismarck, ND 58504 West Coast Office 2377 Gold Meadow Way Suite 295 • Gold River, CA 9567q, versa PLC tlaa Keane Capital One Disbursement To: Elwood Gotchall, Executor of [hE 01959-0001120-A Invoice Number Date Description SALE50000114946 10/10/2012 Check Number: 02028747 Date: 10/11/2012 Amours[ Discount Pald Amount $4,500.73 $.00 $4,500.73 TOTALS: $4,5(10.73 $.00 $4,SOOJ3 Important Na[e: On December t9, 2010 Venlo, LLC an0 The Keane Orpanliatlon JoInM farces to bemme the clear N!etler In Ne unoelmetl property IMUStry. The candnetl campanY, now operatlng uMer Me name Keane, proWtles unmatchM communkatbn, consul[Inp antl camplWnce seances. - __. _. __ Vdnio LLC tlba KegHe capital one sank 02028747 `i640'Preadom'BusiriaaSCenter 50791/214 Btlr~loor IOrt9 of Prussia, PA 14M106 ' CaplplOneDisbuisement 01959-0001120-A October 11, 2012 $4,500.73 ,. Fay ..~., .: _ :, .., .... - to the Order of: Elwood Gotchall, Executor of the Estate of Leander Hamm JOID 6 MONTHS AFTER DATE OF ISSUE 8 Manor Drive West Chester, PA 19380 ~~~ ./) ~// 11.0202B74711' t:0 2 14079 1 2t:705 71 6296611'