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HomeMy WebLinkAbout01-14-13 -J REV-1500 EX(02-11)(H) 1505610105 J~1 PA Department of Revenue pennSsyyl?vania OFFICIAL USE ONLY °EE.w.-E° F^EIEI°E County Co Year File Number Bureau Individual. Taxes INHERITANCE TAX RETURN ty PO BOX 2 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ! Z Q S 3 r ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 193-24-1220 04/13/2012 12/15/1926 Decedent's Last Name Suffix Decedent's First Name MI Hoover Esther M' (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 (ID 1. Original Return O 2. Supplemental Return O 3. Remainder Return (Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained 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 Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Ronald E. Johnson, Esq (717) 243-0123 C~l aM06TER OF ~ LLS USH1D4101( C_ 6> First Line of Address r-- F-+ fr1 I,.f 78 West Pomfret Street 1x1 ~ _r ;X C* 4 Second Line of Address -r I City or Post Office 43 DATE F LI l) G I'TS tY State ZIP Code Carlisle PA 17013 Correspondent's e-mail address: rejohnson@pa.net Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and 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 based on all information of which preparer has any knowledge. SIGN URE OF P SO R PO LE FOR FILING RETURN DATE X 7 ADDRESS c/o 78 est Pomfret Street, C isle, PA 17013 S R ROT REPRESENTATIVE DATE A DRE /o 78 West Pomfr treet, Carlisle, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610105 1505610105 1505610205 REV-1500 EX (FI) Decedent's Social Security Number Decedent's Name: Esther Mae Hoover 193-24-1220 RECAPITULATION 1. Real Estate (Schedule A) 1. ! 0.00 2. Stocks and Bonds (Schedule B) 2.i 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) 3. 0.00 4. Mortgages and Notes Receivable (Schedule D) 4. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 17,268.00 6. Jointly Owned Property (Schedule F) O Separate Billing Requested 6. ! 0.00 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 34,922.93 8. Total Gross Assets (total Lines 1 through 7) 8. 52,190.93 9. Funeral Expenses and Administrative Costs (Schedule H) 9. 13,573.58 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule 1) 10. 0.00 11. Total Deductions (total Lines 9 and 10) 11. 13,573.58 12, Net Value of Estate (Line 8 minus Line 11) 12. j 38,617.35 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 13. 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13) 14. 38,617.35 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 .0_ 15. 0.00 16. Amount of Line 14 taxable at lineal rate X .0 45 38,617.35 16. 1,737.78 17. Amount of Line 14 taxable at sibling rate X .12 17. 0.00 18. Amount of Line 14 taxable at collateral rate X .15 18. 0.00 19. TAX DUE .........................................................19. 1,737.78 _ 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p Side 2 L 1505610205 1505610205 REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Esther Mae Hoover STREETADDRESS 706 Adams Road CITY STATE Zip Carlisle PA 17015 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 1,737.78 2. Credits/Payments A. Prior Payments 0.00 B. Discount 0.00 3. Interest Total Credits (A+ B) (2) 0.00 (3) 0.00 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. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 1,737.78 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 ❑ 0 b. retain the right to designate who shall use the property transferred or its income p E c. retain a reversionary interest ❑ E d. receive the promise for life of either payments, benefits or care? ❑ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ❑ N 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 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 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 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(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)]. 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. REV-15o8 EX+ (08-12) SCHEDULE E 5 > pennsylvania DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Esther Mae Hoover 21-12-0537 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 1. Checking account no: 1280309 - M&T Bank 9,082.53 2. Certificate of Deposit no: 31003920248779 - M&T Bank (see letter attached) 5,893.03 3. 1994 Chevrolet Caprice Classic 4 door automobile - very good condition (see attached letter) 1,500.00 4. Penn Treaty Insurance Company - refund 792.44 ii TOTAL (Also enter on Line 5, Recapitulation) $ 17,268.00 If more space is needed, use additional sheets of paper of the same size. M&T Bank 499 Mitchell Road, Millsboro, DE 19966 Adjustment Services Phone 888-502-4349 Fax (302) 934-2955 May 17, 2012 Anderson & Johnson 78 West Pomfret Street Carlisle, PA 17013 Re: Estate of Esther Mae Hoover Social Security: 193-24-1220 Date of Death: April 13, 2012 Dear Sir or Madam: Per your inquiry on May 11, 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 Checking Account Account Number 1280309 Ownership (Names of) Lee A. Hoover, Sr. Donald R. Hoover (POA) Esther M. Hoover Opening Date 11/15/1995 Balance on Date of Death $9,082.50 Accrued Interest $ .03 Total $9,082.53 2. Type of Account Certificate of Deposit Account Number 31003920248779 Ownership (Names o,) Donald R. Hoover (POA) Esther M. Hoover Opening Date 041092010 Balance on Date of Death $5,890.53 Accrued Interest $ 2.50 $5, Total 893.03 Kelley Blue Book Page 1 of 2 Kelley Blue Book The T,-zed Resource' f~f~~~sIQEf1lUF $9900 wm The Not, Your Price`Tool. Only from Progressive i~~~( r+ r s~ 3 sli advertisement why ads? Your Blue Book- Value 1994 Chevrolet Caprice Classic Style: Sedan 4D a " Mileage: 67000 i Y3 tsar ' ,.y Trade-In Value Vehicle Highlights - - Excellent $1,575 MPG: City 16/Hwy 24 Max Seating: 6 Very Good Doors: 4 Engine: V8, 4.3 Liter $1,50 Drivetrain:RWD Transmission: Automatic Good EPA Class: Large Cars Body Style: Sedan $1,425 Country of Origin: United States Country of Assembly: United States Fair $1,200 , Your Configured Options Our pre-sefected options, based on typical equipment for this car. options that you added while configuring this car. Engine Comfort and Convenience Safety and Security V8, 4.3 Liter Air Conditioning Dual Air Bags Transmission Power Windows Wheels and Tires Automatic Power Door Locks Steel Wheels Drivetrain Cruise Control RWD Steering Power Steering Tilt Wheel Entertainment and Instrumentation AM/FM Stereo Cassette i Y~ Glossary of Terms `'f Kelley Blue Book@ Trade-in Value - This Is the amount yr Dave McCoy your car to a dealer. This value is determined based on the sl Sales Consultant indicated. Kelley Blue Book@ Private Party Value - This is the star between a private buyer and seller. This is an "as is" value tl Graham 717 243 3066 [t] price depends on the cars actual condition and local market '1,„i„r 717 249 7998 [f] 717 960 7006 [d] davemccoy@grahammotors.com www,grahammators.com htt„•//WWW khh.com/chevrolet/caprice-classic/1994-chevrolet-caprice-classic/sedan-4Q/ : Ve... 1/10/2013 REV-1510 EX+ (09-09) j i pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Esther Mae Hoover 21-12-0537 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1. Nationwide Platinum V Plus Annuity contract no: 1163532 34,922.93 34,922.93 Opened: 3/5/2007 Beneficiaries: Lee A.Hoover, Jr. (son) Garry E. Hoover (son) Donald R. Hoover (son) (see attached) TOTAL (Also enter on Line 7, Recapitulation) $ 34,922.93 If more space is needed, use additional sheets of paper of the same size. i Quarterly Statement Nat°onwidd© Jan 1, 2012 to Mar 31, 2012 On Your Side Contract Number: 07-1163532 Nationwide Platinum V Plus Visit nationwide.com/paperiess and register for eDelivery, and we'll plant a tree on your behalf through our partnership with American Forests. Account Summary Quarter-To-Date Year-To-Date Inception-To-Date Beginning Date 01/0112012 01/01/2012 03/0512007 Beginning Contract Value $34,612.22 $34,612.22 $.00 Purchase Payments $.00 $.00 $30,000.00 Withdrawals/Charges $.00 $.00 ($1,882.35) Annuity Performance $310.71 $310.71 $6,805.28 Ending Contract Value as of 03/3112012 $34,922.93 $34,922.93 $34,922.93 ® Benefit Election Summary ® Death Benefit: Contract Value As of ® 0313112012 ® Death Benefit Value $34,922.93 Fixed Account Summary Year of Purchase Withdrawals Ending Credited Base Rate Purchase Payment Since Purchase Value on Interest Rate Guaranteed Payment Amount Payment 03!31/2012 Through 2007 $30,000.00 ($1,882.35) $34,922.93 1.60% 0 3/0 42 0 1 3 Fund Total $34,922.93 Purchase Payments/Credits from 01/01/2012 through 03/31/2012 Transaction Dollar Amount Credited Base Rate Date Type Interest Rate Guaranteed Through NO TRANSACTIONS Withdrawals/Charges from 01/01/2012 through 03/31/2012 Transaction Dollar Amount Date Type NO TRANSACTIONS No N n O a NPV2N 00 Fl 071163532 070000592071 Page 2 of 3 0000OW2000000030W2954100045379 NATIONWIDE LIFE AND ANNUITY INSURANCE COMPANY APPLICATION FOR P.O. Box 182021 INDIVIDUAL SINGLE Columbus, OH 43218-2021 PURCHASE PAYMENT 1-800-848-6331 (For any inquiries) DEFERRED FIXED ANNUITY CONTRACT OWNER: --S E A- • ~ 0 V = SEX ❑ M I~ r Maximum Issue Age 90 ADDRESS (39 AGr(-,s Pcc-ck- SOC. SEC. # I 19 12 1 2 11-4111 ;2 ; O CITY/STATE/ZIP Cc { , 5 1 , PA ~ ~ 4 I S DATE OF BIRTH r a/ is / I G MM DD YYYY ANNUITANT: Cs-L~,L - H SEX ❑ M R IF Maximum Issue Age 90 ,rrr ADDRESS i~`~~SOC. SEC. # -3 ~ CITY/STATE/ZIP p I s f z ~ A f O i$ DATE OF BIRTH Q11-S' / 4 S Zr MM DD YYYY JOINT OWNER: SEX ❑ M ❑ F Maximum Issue Age 90 Spouse only except in HI, PA and VT ADDRESS SOC. SEC. # CITY/STATE/ZIP DATE OF BIRTH MM DD YYYY CONTINGENT OWNER SEX ❑ M ❑ F Maximum Issue Age 90 ADDRESS SOC. SEC. # CITY/STATE/ZIP DATE OF BIRTH MM DD YYYY CONTINGENT ANNUITANT: SEX' ❑ M ❑ F Maximum Issue Age 90 DATE OF BIRTH SOC. SEC. # MM DD YYYY BENEFICIARY: (Whole percentages only. Must equal 100%.) Relationship Birthdate Prim"' Contingent Print Full Name (Last, First, MI) Allocation toC~Annuitant Soc. Sec. No. IA,c\,ek_ Lee- A. JEz. y3c10 ~Jcrl ?b51 IC- 50 33°~ S;a ar~si ❑ ❑ CONTRACT TYPE (an option must be elected): ❑ IRA ❑ Roth IRA Non-Qualified WAIVER OF PRINCIPAL GUARANTEE OPTION (Subject to availability) j=j i cicCt L ec liv ai i?T Of Sri=lCap=: *tia:2n ce option. i FAA-0100AO NPV2Q/N STANDARD 1.5 (5/2004) IL/ly%Ub $ 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 Esther Mae Hoover 21-12-0537 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: Ewing Brothers Funeral Home 5,984.08 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 860.00 Name(s) of Personal Representative(s) Donald R. Hoover Street Address 706 Adams Road City Carlisle state PA zip 17015 Year(s) Commission Paid: 2013 2. Attorney Fees: 2,750.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) 3,500.00 claimant Donald R. Hoover Street Address 706 Adams Road city Carlisle State PA zip 17015 Relationship of Claimant to Decedent son 4. Probate Fees: 114.50 5• Accountant Fees: 6• Tax Return Preparer Fees: 7. Register of Wills - filing fee 15.00 8. Reserve for closing and accounting 350.00 TOTAL (Also enter on Line 9, Recapitulation) $ 13,573.58 If more space is needed, use additional sheets of paper of the same size. REV-1513 EX+ (01-10) pennsylvania SCHEDULE DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Esther Mae Hoover 21-12-0537 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).] I. Donald R. Hoover, Sr., 706 Adams Road, Carlisle, PA 17015 son 1/3 2. Lee A. Hoover, Jr., 23 Fairfield Street, Carlisle, PA 17013 son 1/3 3. Gary E. Hoover, 702 Adams Road, Carlisle, PA 17015. son 1/3 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 ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET, $ If more space is needed, use additional sheets of paper of the same size.