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Home My WebLink About12-04-12 (3)F J 1505610140 REV-1500 EX (01-10) OFFICIAL USE ONLY PA Department of Revenue Coun Code Year File Number Bureau of Individual Taxes h' Po Box 2sosol INHERITANCE TAX RETURN 2 1 1 2 0 0 4 3 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 2 2 5 2 0 1 1 1 2 1 8 1 9 3 2 Decedent's Last Name Suffix Decedent's First Name MI H A L BERT J O H N W (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW a 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) OX 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number MELANI E WALZ SCARI NGI 71 7 657 7770 REGISTER OF WILDS USE ONLY First line of address 2 0 0 0 L I Second line of address S U I T E 1 City or Post Office NGL E S TOWN 0 6 H A R R I S B U R G R O A D State ZIP Code P A 1 7 1 1 0 Cor~ndent's e~,,eti3t~ress: MELANIE~SCARINGILAW.COM ~° v Lm~ ~ ~ W ~ C? n, r --t +v r"'zrn a U, ~, --~ mrr~ ~ ~~ z .~ n n ~ Ca ~4 _ -n TE ~ o ~~ C C~ D , ~ y w .r4J _~ F~..._e _ y Y.- A L_._ $y C.3 KJ3 G') U er pen ies of p ju declar tha I h ve examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it s true, c ect an co ete. D clar ion f prep er other than the personal representative is based on all information of which preparer has any knowledge. !GNAT F P N IB RETURN / DATE ADDRESS ` ~~ -~ 525 NORTH STAR DRIV HARRISBURG PA 17112 SIG F PREPARER OTH A PRESENTATIVE ~ DATE ~~-- ADDR S 2000 NGLESTOWN ROAD, SUITE 1 6 HARRISBURG PA 17110 PLEASE USE ORIGINAL FORM ONLY 1505610140 Side 1 1505610140 J REV-1500 EX 1505610240 Decedent's Social Security Number Decedents Name: JOHN W. HALBERT RECAPITULATION 1. Real Estate (Schedule A) ................................ 1. 1 4 1 5 0 0, 0 0 2. Stocks and Bonds (Schedule B) .................................... .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 4. Mortgages and Notes Receivable (Schedule D) ........ ............... .. 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. 1 4 7 0 7 3 • 0 4 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ..... .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ..... . 7. , 8. Total Gross Assets (total Lines 1 through 7) ......................... .. 8. 2 8 $ 5 7 3 . 0 4 9. Funeral Expenses and Administrative Costs (Schedule H) ........... .... ... 9. 5 1 6 8 0. 1 5 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ...... .... ... 10. 2 4 4 3. 8 0 11. Total Deductions (total Lines 9 and 10) ........................ ..... .. 11. 5 4 1 2 3 . 9 5 12. Net Value of Estate (Line 8 minus Line 11) ..................... ..... .. 12. 2 3 4 4 4 9 , 0 9 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) . ..... .. 13. 6 6 9 5 1 3 2 14. Net Value Subject to Tax (Line 12 minus Line 13) .............. ..... .. 14. 1 6 7 4 9 7 . 7 7 TAX CALCULATION -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 .o _ 0. 0 0 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate X .0 _ 0 . 0 0 16. 0. 0 0 17. Amount of Line 14 taxable at sibling rate X .12 0 0 0 17. Q, Q O 18. Amount of Line 14 taxable at collateral rate x .15 1 6 7 4 9 7. 7 7 1 s. 2 5 1 2 4. 6 7 19. TAX DUE ................................. ..... .. 19. 2 5 1 2 4. 6 7 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT a sae 2 1505610240 1505610240 J REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME JOHN W. HALBERT STREET ADDRESS 9 South Rupp Ave CITY STATE ZIP Shiremanstown PA 17011 File Number 21 12 0043 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 34,000.00 B. Discount 1,256.23 (1) 25,124.67 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. (4) 10,131.56 (5) 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 : ...................................................................... ^ ^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? ....................................................... ^ 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 "intrust for" orpayable-upon-death bank account or security at his or her death? ......... ^ Q 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 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 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)]. Asibling is defined, undE Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Total Credits (A + B) (2) 35,256.23 (3) REV-1502 EX+ (Ot-10) pennsylvania ~ SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: JOHN W. HALBERT 21 12 0043 All real property owned solely 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 willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property that 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. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 9 South Rupp Ave, Shiremanstown, PA 17011. Jointly owned with predeceased wife, Rose A. Halbert who died on January 12, 2001, thereby vesting full fee-simple title in her widower, John W. Halbert, the Decedent herein. Appraised Value on 3/15/2012 was $156,000. Gross sales price in arms length sale on 9/7/12 was $141,500. Expenses related to sale are on Schedule H as admin. costs, reimbursements for buyer's portion of prorated items are on Schedule E. TOTAL (Also enter on Line 1, Recapitulation.) ~ $ 141, 500.00 141, 500.00 If more space is needed, use additional sheets of paper of the same size. RSV-1508 EX+ (11-10) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, 8~ MISC. PERSONAL PROPERTY ESTATE OF: FILE NUMBER: JOHN W. HALBERT 21 12 0043 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~. Ford Escape, 2008, KBB trade in value $11,278 as of 3/5/2012 11,278.00 2. Members 1st Savings Account - 173833-0 15.09 3. Members 1st Money Management - 173833-05 ($121,254.06 + $43.85 int.) 121,297.91 4. Metro Bank Checking Account - 32002925 8,492.95 5. State Farm Insurance Refund (2/10/12) 223.09 6. Highmark Blue Shield -Ambulance Reimbursement (5/9/12) 720.00 7. U. S. Treasury -IRS Tax Refund from 2011 taxes (5/25/12) 3,179.00 8. County Tax Adjustment for paying in advance (on HUD) 223.19 9. School Tax Adjustment for paying in advance (on HUD) 1,604.95 10. Sewer Adjustment for paying in advance (on HUD) 13.86 11. Erie Insurance Premium Refund 25.00 TOTAL (Also enter on Line 5, Recapitulation) I $ 147 073 04 If more space is needed, insert additional sheets of paper of the same size REV-1511 EX+ (10-09) ~ pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER JOHN W. HALBERT 21 12 0043 Decedent's debts must be reported on Schedule t. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Malpezzi Funeral Home -Funeral Services 109.85 2. Hoss's Steak & Sea House -Funeral Meal 239.22 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Diane Acri-Sheffer Street Address 525 North Star Drive Cary Harrisburg State PA zIP 17012 Year(s) Commission Paid: 2012 2 Attorney Fees: Scaringi &Scaringi, PC 3. Family Exemption: (If decedents address is not the same as claimant's, attach explanation.) Claimant Street Address City State Relationship of Claimant to Decedent ZIP 14,428.65 13, 765.00 4. Probate Fees: Cumberland County Register of Wills (adv by Executrix) 423.50 5 Accountant Fees: 6. ~ Tax Return Preparer Fees: InClUded In Attorney Fees (#2 above) 7. PPL (3/24 - 9/11) 135.55 8. PA American Water (3/24 -10/19) 126.59 9. Lower Allen Township (3/24 - 8/18) 181.50 10. Interstate Waste Services (3/24 - 8/18) 111.06 11. Leffler Energy (3/24 - 8/18) 2,109.46 12. Snow Removal (adv by Executrix), Ed Michael, 14 N. Stoner Ave, Camp Hill, PA 50.00 13. Dugan Appraisal Services (residence appraisal) 350.00 14. Commonwealth of PA (adv by Executrix) for vehicle transfer 58.50 15. Carlisle Sentinel (adv by S&S PC) 168.30 16. Cumberland County Law Journal (adv by S&S PC) 75.00 17. Copy, Postage, Fax, Mileage reimb, misc admin expenses (adv by S&S PC) 92.95 18. Cumberland Cty Register of Wills -Short certificates (adv by Executrix) 8.00 TOTAL (Also enter on Line 9, Recapitulation) $ 51.680.15 If more space is needed, use additional sheets of paper of the same size JOHN W. HALBERT Decedent's Name Continuation of REV-1500 Inheritance Tax Return Resident Decedent Page 1 21 12 0043 File Number Schedule H -Funeral Expenses & Administrative Costs - B7. ITEM NUMBER DESCRIPTION AMOUNT 19. PA Department of Health -Death Certs for Rose Halbert (adv by Executrix) 37.00 20. Lawn services (adv by Executrix), Ed Michael, 14 N. Stoner Ave, Camp Hill, PA 820.00 21. Joy Daniels Group Real Estate Broker Fee 395.00 22. School Real Estate Taxes 1,939.50 23. The Virtus Group (home inspection) 275.00 24. Seller's Assistance -Real Estate Sale -see HUD 4,245.00 25. Real Estate Broker Commission -Real Estate Sale -see HUD 8,235.30 26. Notary -Real Estate Sale -see HUD 10.00 27. Tax cert. fee to Abstract Land Associates, Inc. -Real Estate Sale -see HUD 5.00 28. Realty Transfer Tax -Real Estate Sale -see HUD 1,415.00 29. Radon Mitigation to Central Penn Radon, Inc. -Real Estate Sale -see HUD 820.00 30. County Real Estate Taxes 779.22 31. PA Department of Revenue (Decedent's 2011 State Income Tax payment) 23.00 32. Postage (adv by Executrix) 18.00 33. Advertising fee for Account and Petition for Adjudication 80.00 34. Filing fee for Account and Petition for Adjudication 150.00 SUBTOTAL SCHEDULE H-B7 I 19,247.02 REV-1512 EX+ (12-OS) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8~ LIENS ESTATE OF FILE NUMBER JOHN W. HALBERT 21 12 0043 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. Verizon (check#107 - $29.03; check#108 - $3.05) 32.08 2. AAA fees paid 1 /27/2012 (adv by Executrix) 41.50 3. Quantum Imaging & Therapeutic Associates 23.87 4. Quest Diagnostics (check#122 - $8.64; check#123 - $6.95) 15.59 5. Andrews & Patel Associates (check#124 - $51.09;check#125 - $52.94; check#126 - $3.16; 117.19 check#127 - $10) 6. Holy Spirit Hospital (check#128 - $135.15; check#129 - $1186.29; check#155 - $27.42; 1,374.21 check#162 - $25.35) 7. Hope Medical Services (check#136 - $19.36) 19.36 8. Silver Spring Ambulance Assn (check#138 - $820) 820.00 TOTAL (Also enter on Line 10, Recapitulation) I $ 2 443 If more space is needed, insert addftional sheets of the same size. REV-1513 EX+ (01-10) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF: FILE NUMBER: RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. Patricia R. Stewart Collateral 89,387.88 10 Fieldcrest Dr. Mechanicsburg, PA 17050 2. Diane L. Acri-Sheffer (niece) Collateral 78,109.89 525 North Star Drive Harrisburg, PA 17112 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE. Il. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. Hospice of Central PA, 1320 Linglestown Rd, Harrisburg, PA 17110 33,475.66 2. St. Elizabeth Ann Seton Parish, 310 Hertzler Rd, Mechanicsburg, PA 17055 33,475.66 TOTAL OF PART 11 -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 66 951.32 If more space is needed, use additional sheets of paper of the same size. 1 REV-1500 Discount, Interest and Penalty Worksheet Discount Calculation Total Amount Paid within three calendar months of the decedent's date of death: 34,000.00 Discount: 1,256.23 Interest Table Year Before 1981 1982 1983 1984 1985 1986 1987 1988 through 1991 1992 1993 through 1994 1995 through 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 through 2012 Days Delinquent Balance Due Interest this time period this year this period TOTALS Penalty Calculation If the decedent's date of death was on or before March 31, 1993, insert the applicable amount: Total Balance Due on January 17, 1996: Penalty: