HomeMy WebLinkAbout04-1029 OFFICIAL USE ONLY
COMMONWE^LTROFPENNSYLVA"'A REV-1 500 INHERITANCE FILE NUMBER
DEPARTMENT OF REVENUE DEPT
280601 HARRISBURG, PA 17128-0601 TAX RETURN RESIDENT DECEDENT ~-1 (? ~1 I[~
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
I--
z Herr, Kathryn H. 173-03-4115
I~ lATE OF DEATH (MM-DD-YY) DATE OF BIRTH (MM-DD-YY) THIS MUST BE FILED iN DUPLICATE
'" 3/30/2004 9/14/1907 WITH THE REGISTER OF WILLS
I~J IF APPLICABLE) SURVIVING SPOUSE'S NAME SOCIAL SECURITY NUMBER
LU X~ 1. Original Return [] 2. Supplemental Return [] 3. Remainder Return
~ ~' ~ ~1 4. Limited Estate [] 4a. Future interest Compromise [] 5 Fed. Est Tax Return Req'd
(~ ~ ~ X--I 6, Decedent Died Testate [] 7. Decedent had Living Trust 0__ 8. Total number of SDB's
<c 9. Lit'g'tion Proceeds Rec'd 10. Spousal Povedy Credit 11. Election to tax w/Sec. 9113(A)
Z COMPLETE MAILING ADDRESS:
uJ NAME:
z Patricia R. Brown, Esquire
o Patricia R. Brown, Esq.
a_ FIRM NAME:
LU
a: 10 W. Pomfret St.
o TELEPHONE NUMBER
o 717249-3024 Carlisle, PA 17013
1. Real Estate (Schedule A) (1) $0.00 OFFICIAL USE ONLY
(2) $0.00
2. Stocks and Bonds (Schedule B)
3,Closely Held Corpora on, Partnership or Sole-Prop. (3)
4. Modgages & Notes Receivab[e (Schedule D) (4) $0.00
~ S. Cash, Bank Deposits & Misc. Personal Prop.(Sch. E) (5) $987.48
,~ $. Jointly Owned Property (Schedule F) (6) $0.00
r--] Separate Billing Requested
:~ Inter-Vivos Transfers & Misc. Non-Propate Prop. (7)
I--
~' Total Gross Assets (total [ines 1-7) (8) $987.48
~: Funeral Expenses & Administration Costs (Sch H) (9) $7,358.00
I.IJ ). Debts of Decedent, Mortgage liabilities, & Liens (10) $87,676.36
IZ: 11. Total Deductions (total lines 9&10) (11) $95,034.36
12. Net Value of Estate (Line 8 minus Line 1 t) (12) ($94,046.88)
13. Charitable and Governmental Bequests/Sec 9113 Trusts
for which an election to tax has not been made (13)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) ($94,046.88)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
Z
_o 15. Amnt of Line 14 taxable at the spousal rate,
~ or transfers under Sec.91 t 6(a)(1.2) x0__ (15) $0.00
~ 16. Amount of Line 14taxable at lineal rate $0 x.045 (16) $0.00
~: 117 Amount of Line 14 taxable at sibling rate $0 x.12 (17) $0.00
Oo 1181 Amount of Line 14 taxable at collateral rate "~ x.15 (18) $0.00
~ 19 Tax Due (19) $0.00
20 [~ CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Decedent's Complete Address:
ISTREET ADDRESS 871 Cranes Gap Road
CITY STATE ZIP
Carlisle PA 17013
Tax Payments and Credits:
1. Tax Due (1) $0.00
2 Credits/Payments
A. Spousal Poverty Credit
B, Prior Payments
C. Discounts
Total Credits (A+B+C) (2) $0.00
3 Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Pentalty (D+E) (3) $0.00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference This is the OVERPAYMENT (4)
Check box on Page 1 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. (5)
A. Enter the interest on the tax due. (SA)
B Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) $0.00
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
I Did decedent make a transfer and: yes no
a retain the use or income of the property transferred:
retain the right to designate who shall use the property transerred or its income
b
c retain a reversionan/interest or
d retain the promise for life of either payments 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 security at his or her death?
4 Did decedent own an Individual Retirement Account, annuity, or other non probate proper~ which
contains a beneficiary disignation'~ r-~ r~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declale 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 ot~er than the personal representative is based on all information of which preparer has any knowledge
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
DATE
ADDRESS
SIGNATURE OF PREPARER OTHER.~.J4AN REPRESENTATIVE
10 West Pomfret Street, Carlisle, PA 17013
LAST WILL AND TESTAMENT
OF
KATHRYN H. HERR
I, KATHRYN H. HERR, a resident of and domiciled at the Mennonite Home,
Harrisburg Pike, Lancaster County, Pennsylvania, being of sound mind and disposing
intent, do hereby make, publish and declare this to be my Last Will and Testament,
hereby revoking all Wills amd Codicils at anytime heretofore made by me. FIRST
I order and direct my Executrix, hereinafter named, to pay all of my debts, funeral
expenses and expenses involved or connected with the administration of my estate as
soon after my death as is reasonably possible. However, my Executrix need not
accelerate and pay those unma[ured obligations which, in her opinion, might be proper
and more advantageous to retain or renew and pay as they become due and payable.
SECOND
I direct that 1 be given a funeral and service in conformity with my station in life,
as discussed with my Executrix, with burial in the family plot in Mellinger's Mennonite
Cemetery, Lincoln Highway East, Lancaster, Pennsylvania. THIRD
I give, devise and bequeath all the remainder of my estate, real or personal, and
my property of every kind amd description (including lapsed legacies and devises and any
property over which I may have a power of appointment) and whether acquired before
Page 1 of 4
or after the execution of this Will, to my sister, ALBERTA H. KEEN, Carlisle,
Pennsylvania.
FOURTH
I hereby nominate, constitute and appoint as Executrix of this, my last Will and
Testament, my sister, ALBERTA H. KEEN, Carlisle, Pennsylvania. In addition to the
powers conferred by law I authorize my ExecutrLx:
A. To retain in the form received, or to sell at either a public or private sale any
real or personal property;
B. To exercise any options to subscribe for stocks, bonds, or other investments.
C. To sell, transfer, convey, mortgage, pledge, lease or exchange any property, real
or personal, which at any time may form part of my estate, for the payment of debts or
taxes, or for any purpose of administration or distribution, for such prices and upon
such terms as my Executrix, in her discretion, may deem wise, and to execute and
deliver deeds of conveyance or transfer thereof;
D. To make settlements and compromises on such terms as my Executrix in her
discretion may deem wise without the necessity of obtaining any court approval thereof;
E. To make distribution hereunder either in cash or kind, as my E~ecutrix, in her
discretion, deems wise.
FIFTH
I direct that no executrix, trustee or any fiduciary under this instrument shall be
required to give bond or surety for the faithful performance of their duties in any
jurisdiction.
Page 2 of 4
IN WITNESS XVHEREOF, I have hereunto set my hand and affixed my seal this
/ (~' "~' day of December, 2000.
COMMONWEALTH OF PENNSYLVANIA :
:ss
COUNTY OF (h4 t~( :
TestatrLx and the witnesses, respectively, whose names are signed to the attached or
foregoing instrument, being first duly sworn, do hereby declare to the undersigned
authm:it~, that the Testatrix signed and executed the instrument as her Last Will and
Testament, and she had signed willingly and that she executed it as her free and
voluntai3~ act for the purposes therein expressed, and that each of the witnesses, in
the presence and hearing of the Testatrix, signed the Will as witness and that to the
best of his/her knowledge, the Testatrix was at that time eighteen years of age or
older, of sound mind, and under no constraint or undue influence.
Witness - { ' ~ :
Witness
Page 3 of 4
Subscribed, sworn to and acknowledged before me by KATHRYN H. HERR, the
Testa ~.t~ ,, , and subscribed/) and sworn to before me by It]~/~'l/,-~/~i--' ' ' '
and ' ' /
Page 4 of 4
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANIOUS PERSONAL PROPERTY
ESTATE OF FILE NUMBER
HERR, Kathryn H.
(All property jointly-o~ed with Righl of Survivorship must be disclosed on Schedule F)
ITEM DESCRIPTION VALISE AT DATE
NUMBER OF DEATH
i Fulton Bank checking acct no: 0118-43945 $987.48
2
3
4
5
6
7
TOTAL (a so on line 5, Recapitulation) $987.48
SCHEDULE H
FUNERAL EXPENSES, ADMINISTRATIVE
COSTS AND MISCELLANEOUS EXPENSES
ESTATE OF FILE NUMBER
HERR, Kathryn H
(All property jointly~o~ned wilh Pdght of Survivorship must be disclosed on Schedule F)
ITEM DESCRIPTION AMOUN 1
NLqViBER
A. Funeral Expenses:
1 Richard A. Sheetz Funeral Home
Services $2,885.00
Merchandise $2,75.00
Open/Close Grave
Certs/Flowers, etc $1,008.20 $6,608.00
B. Administrative Costs:
I Personal Representive Commissions
Social Security Number of Personal Representative:
2 Attorney fees to Patricia R. Brown, Esquire $750.00
3 Family Exemption
Claimant Relationship:
Address of Claimant at decedent's death:
Street:
City: State & Zip
4 Probate Fees to Register of Wills
C. Miscellaneous Expenses:
1
2
3
4
5
6
7
8
9
TOTAL (also on line 9, Recapitulation) $7,358.00
SCHEDULE I
DEBTS OF DECEDENT
MORTGAGE LIABILITIES AND LIENS
ESTATE OF FILE NUMBER
HERR, Kathryn H
ITEM DESCRIPTION
NUMBER AMOUNT
1 Prudential Securities, Inc. (nka Wachovia)
Claim No: 3803559 Acct No: 04433156 $1,293.83
2 Fulton Bank overdraft on checking acct no: 0118-43945 $90.52
3 Mennonite Home, Lancaster, PA $1,538,20
4 PA Dept of Public Welfare - Estate Recovery Program $84,753.81
(CIS No: 530153507)
TOTAL (al~o on line 10, Recapitulalion) $ 87,676.36
SCHEDULE J
BENEFICIARIES
FILE NUMBER
ESTATE OF
ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR SHARE
OF ESTATE
NUMBER
I Alberta H. Keen (deceased)
2
3
4
ITEM NAME AND ADDRESS OF BENEFICIARY AMOUNT OR SHAR
OF ESTATE
NUMBER
B. Charitable and Goverrunental Bequests:
$0
TOTAL CHARITABLE AND OOVERNMENTAL BEQUESTS (also enter on line 13, Recapimlalion)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
_.D=.r:".0f!"rr'\ J',\[C\('c:nC
BUREAU OF INDI~l'lliiS\J' 1 'VL '01
INHERITANCE TAX DIVI~~.:C. I
PO BOX 280601 ! ",-.
HARRISBURG PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLDWANCE
DF DEDUCTIDNS AND ASSESSMENT DF TAX
2"QS 1111 III fl1 3: 38
!J ~ t '- ,Ht
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
01-17-2005
HERR
03-30-2004
21 04-1029
CUMBERLAND
101
("L-tJ~f/\ Of
v 1.\ -
OR?HN'l'S Cq~\RI
PATRIlfi!A\1RiiRDWiiESQ
10 W POMFRET ST
CARLISLE PA 17013
*'
REV-1S41Ell'FPI12-U4J
KATHRYN
H
Allount Rellitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
u"y=r!\"'"Ex""m'""Clil"=ur"Niii"fcE"oF"1:NHER"ifAN"cE"TA'X"A"pjlRAYSEH"€N'f~""Ar.towllifcE"OR"""""""""""""""""
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF HERR KATHRYN H FILE NO. 21 04-1029 ACN 101 DATE 01-17-2005
TAX RETURN WAS: I X I ACCEPTED AS FILED
I CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. stocks and Bonds (Schedule B)
3. Closely Held stock/Partnership Interest (Schedule CJ
4. Mortgages/Notes Receivable (Schedule DJ
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule f)
7. Transfers (Schedule G)
8. Total Assets
III
121
131
141
151
161
171
.00
.00
.00
.00
987.48
.00
.00
181
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Govern.ental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
191
llOI
7,358.00
87. 676.36
1111
ll21
ll31
ll41
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
987.48
9~.034 36
94,046.88-
.00
94,046.88-
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
NOTE: If an assessment was issued previously, lines
reflect figures that include the total of ALL
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
.00 X 00 =
.00 X 045 =
.00 X 12 =
.00 X 15 =
ll91=
.00
.00
.00
.00
.00
TAX CREDITS:
rAfn<N u, AMDUNT PAID
DATE NUMBER INTEREST/PEN PAID I-I
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
I IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TDTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YDU MAY BE DUE :<-
A REFUND. SEE REVERSE SIDE OF THIS FDRM FDR INSTRUCTIDNS.I~~
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
Herr, Kathryn H.
Date of Death: 03-30-2004
Will No.
21-04-1029
Admin. No.
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1.
Stat~whether administration of the estate is complete:
Yes No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes No
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes x No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
Da~:
o
I / 3/1 Ob-
I .",,1
{.,
"-P~ ~~..> 'rf, ~~
Signacure
)
f'\j
Patricia R. Brown
Name (Please type or print)
'C')
10 West Pomfret Street, Carlisle, PA 17013
Address
( 717 ) 249-3024
Tel. No.
Capacity:
Personal Representative
](
Counsel for personal
representative ~
(MAH: rrnfi AM3 )