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Home My WebLink About10-13-12t 15D5610143 J REV-1500 ~`(°~-"' OFFICIAL USE ONLY PA Department of Revenue Pennsylvania c«rmy case Year Fila Number Bureau of Individual Taxes 0°"'"-ARO' PO 60X.280601 INHERITANCE TAX RETURN 21 12 0513 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 174 20 0115 02 04 2012 O1 25 1927 Decedent's last Name Suffix Decedent's First Name MI GRISSINGER HERMAN F (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Finst Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW 0 1. Original Return ~ 2. Supplemental Return ~ 3. P~ o , Zr 3e 2~ (Date of Death 4. Limited Estate ~ 4a. Future Imerest Cornppromiae ~ 5. Federal Estate Tax Return Requiretl (dale of OeaM after 12-122) g, Deoaaer,t died Testate t (Attain copy a wip ~ T As t~ai~~N ~!a Livinp Truss ~ 8. Tote! Number of Safe Deposit Boxes 9. Litigation Proceeds Received ~ 10. ski Pq~~'tt`~~a dot{~e~or death ~ y ,Election to tax under Sec. 9113(A) (Attach Schetlule O) CORRESPONDENT -THIS SECTION MUST 8E COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number EDMUND G MYERS (717) 761 4540 First Line of Address 301 bII~RKET STREET Second Line of Address PO BOX 109 City or Post Office LEMOYNE State ZIP Code PA 17043 z~W, REGISTER~4~ILL3 US~3JNLY ~~jj ~ ~ ~m as {~ ~ ' -~ ~~ ~ . O D FILED ~ Gr'k Q i7 C~ r'r": c~ C rn correspondent's a-mail address: egm~jdsw,com Under penalties of perjury, I deGare that t have examined this return, inGuding accromparrying schedules and statements, and to the best of my knowledge and belief, is true, correct and comdete. Dedaratron of preparer other than the personal representable is based on all information of which Dreparer has any knowledge. ': i William L Albert EDMUND G. MYERS DATE ADDRESS (/ 301 MARKET STREET, Lemoyne, PA Side 1 150561D143 15D561D143 J 15D561D243 REV-1500 EX Decedent's Social Security Number ~•'•-+•m•~ Grissinger, Herman F 174 20 0115 RECAPITULATION 1. Real Estate (Schedule A) .........................................................................:............. 1. 2. Stocks and Bonds (Schedule B) ............................................................................. 2. 3. Closely Hekl 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. 23 , 504.04 6. Jointly Owned Property (Schedule ~ ^ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers & Miscellaneous Nnq Probate Property f Separate Billing Requested J l 7 ............ _ (Schedu e G) . 8. Total Gross Assets (total Lines 1 through 7) ........................................................ 8. 23 , 504.04 9. Funeral Expenses and Administrative Costs (Schedule H) .................................... 9. 6 , 337.60 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I} ............................ 10. 521.60 11. Total Deductions (total Lines 9 and 10) ................................................................ 11. 6 , 65 9.20 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 16 , 644.84 13, Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............................................... 13. 14. Net Value Subjsct to Tax (Line 12 minus Line 13) ............................................... 14. 16 , 644.84 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 0 . 0 0 16 0 . 0 0 at lineal rate X .045 . 17. Amount of Line 14 taxable 8 322.42 17. 998.69 at sibling role X .12 ~ 18. Amount of Lina 14 taxable 322 .42 8 18. 1, 2 4 8.3 6 , at collateral rate X .15 19. TAX DUE ................................................................................................................ 19. 2,247.05 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 L 150561D243 15D5610243 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-12-0513 DECEDENTS NAME Grissinger, Herman F STREET ADDRESS 46 Erford Road CITY Enola STATE PA ZIP 17025 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 2,247.05 2. Credits/Payments A. Prior Payments e. Discount 0.00 Total Credits (A + B) (2) 0.00 3. Interest (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2, Line 20 to request s refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) Yr24T.OrJ Make Check Pa able to: REGISTER OF WILLS AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decadent make a transfer and: Yes No a. retain the use or income of the property transferrod :............................................................................... b. retain the right to designate who shall use the property trensferred or its income :.................................. c. retain a reversionary interest; or ............................................................................................................... z d. receive the promise for life of either payments, benefits or care? ............................................................ x 2. If death occurred after Dec. 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?....... ^ 4. Did decedent own an individual retirement ecxount, 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 survNing spouse is 3 percentj72 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 trenafer 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 paront, 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 trensfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in [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 p2 P.S. §9116 (e) (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. corwoNr~wt1H of rewr+artu s»+ErtrtnNCE rnx t1EfURN RESIDENT DECEDEM SCHEDULE E CASH, BANK DEPOSITS, ~ MtSC. PERSONAL PROPERTY ESTATE OF (FILE NUMBER Grissingtrr, Herman F 21-12-0513 InCp~tls the or I ~ arW tl» oats me woce.d$ ware receiwtl tM estate. All pmpsNty Myownsd the ryht of suTVlvonhlp nwsl be dlaelos on sehseule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 M&T Bank Select Account with Interest No. 73771244 21,783.87 2 Golden Living Center -Camp Hill -Refund on Account 90.89 3 Golden Living Center -Camp Hill -Refund on Account 1,323.11 4 Highmark 306.17 TOTAL (Also enter on Line 5, Rscapitulatianl ~ 23,504.04 (If more space is needed, additional pages of the same size) Copyright (c) 2010 form softwrare onty The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 11-10) 499 Mitchell Road, Millsboro, DE 19966 Adjustment Services Phone 888-502-4349 F ax (302) 934-2955 May 22, 2012 Johnson Duffie Law Vices 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 Re: Estate of Herman F. Crrissin¢er Social Security: 174-20-0115 Date of Death: February 4, 2012 Dear Sir or Madam: Per your inquiry on May 14, 2012, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account Account Number Ownership (Names ofl Opening Date Balance on Date of Death Accrued Interest Total Checlang Account 73771244 Herman F. Grissinger Lester E. Wonders (POA) OI~6/1999 $21,783.87 $ .IS $21,784.02 -----`------- RECEIVED MAY 2 4 2012 JOHNSON DUFFIE REV-7157 Exa 11u-0al COM~I~~~~ANIA ESTATE OF FILE NUMBER Grissinger, Herman F 21-12-0513 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT A, FUNERAL EXPENSES: See continuation schedule(s) attached B. ADMINISTRATIVE COSTS; 1. Persona! Representative's Commissions Name of Personal Representative(s) William L Albert Street Address 339 Stoner Road Ext city Mechanicsburg state PA zip 1755 Year(s) Commission Paid 2. Attomev's Fees JOHNSON DUFFIE 3, Family F~cemption: (If decedents 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 2,735.00 750.00 2,000.00 155.50 6. Tax Retum PrepareYs Fees 137.00 7. Other Administrative Costs 566.10 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 6,337.60 Copyright (c) 2009 form software only The Lackner Group, Inc. SCHEDULE H FUNERAL EXPENSES AND Fonn PA-1500 Schedule H (Rev. 10-09) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF (FILE NUMBER Grissinger, Herman F 21-12-0513 ITEM NUMBER DESCRIPTION AMOUNT Funeral Exusnses 1 Myers-Buhrig Funeral Services -Remaining Funeral Costs 2,735.00 H-A 2,735.00 Other Administrative Costs 2 Cumberland County Register of Wills Office -Additional Probate fees for new Administrator 3 Cumberland County Register of Wills Office - Flling Foss for Inheritance Tax Return and Inventory 4 Reserves: Additional Miscellaneous Costa and Expenses 5 The Cumberland Law Journal -Notice of Estate Administration 6 The Patriot News Company -Notice of Estate Administration H-B7 110.00 30.00 200.00 75.00 151.10 566.10 Copyright (c) 2002 form software only The Lackner Group, Inc. Fonn PA-1500 Schedule H (Rev. 6-98) Rw-1672 l7(* {72.08) co-+-~oauuFxrH of rErx+sr~vu+w n.+etrtu~cs r~x nErunN RE&DENT oECecerrr SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LfABILITtES AND LIENS ESTATE OF FILE NUMBER Grissinger, Herman F 21-12-0513 Report da6ts Ineurrod by the dapdmR prior 1o daaM dtn romalnsd unpaid attlw data or daalh, IndudMg umafmbumdmaglcal expanaaa. (If more apace is needed, add(tional pages of the same size) Copyright (c) 2008 form software only The Lackner Group, Inc. Form PA-1500 Schedule 1(Rev. 12-OB) REV-1517 EXa (01-10) k;ouer~~N1`b~nNU{ E5TATE OF SCHEDULE J BENEFICIARIES FILE NUMBER Grlt;sin er, Herman F 21-12-05 13 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE OUNT OF ESTATE NUMBER PERSON(Sl RECEIVING PROPERTY DECEDENT (Words) ($$$) I TAXABLE DISTRIBUTIONS [include outright spousal . drstnbubons, and transfers under Sec. 9116 a 1.2 1 Edna Garrick Sisffir 25% of intestate 105 Susan Lane estate Carlisle, PA 17013 2 Susan Cordell Grand Niece 1.67°k of 121 Gregory Place intestate estate Winchester, VA 22603 3 Donna Feliksik Niece 5% of intestate 835 Lewisberry Road estate Lswisberry, PA 17339 4 Steven Gieixner Grand Nephew 1.67% of 124 Grand Avenue intestate estate Vestal, NY 13850 5 William Gleixner Grand Nephew 1.66% of 708 Valley Road intestate estate Marysville, PA 17053 See continuation schedule attached Continuation Total Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 15 00 cover sheet, as a ro 'ate. NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS f' Vii. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEETL Copyright (c) 2010 form softwaro only The Lackner Group, Inc. Form PA-1500 Schedule J (Rav. 01-10) SCHEDULE J BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: , Herman F Grissinger 02/04/2012 174-20-0115 Item Name and AddrBSS of Person(s) Share of Estate Amount of Estate Number Receiving Properly Relationship (Wonis) (SSS) 6 David Grissinger Nephew lY.D7o or mresww 5337 Cobblestone Drive estate Mechanicsburg, PA 17055 7 Joseph Grissinger Nephew 12.5% of intestate 7253 Dr. Phillips Blvd. estate Orlando, FL 32819 8 Robert Krone Nephew 5% of intestate estate 814 Moores Mountain Road Lewisberry, PA 17339 9 Sharon Shaffer Niece 5°k of intestate estate 276 Conewago Creek Road Manchester, PA 17345 10 Estate of Ruth A. Wonders Sister 25% of intes~te estate William L. Albert, Executor 411 E. Lisburn Road No. 10 ~ Mechanicsburg, PA 17055 11 Mary Wunderlich Niece 5°k of intestate estate 6185 Longview Drive Spring Grove, PA 17362 1