HomeMy WebLinkAbout04-26-13 1505611180
REV-1 500 EX(02-11)(FI)
OFFICIAL USE ONLY
PA Department of Revenue pennsylvania DEPARTMENT OF REVENUE County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN _
PO BOX 280601 I
Harrisburg.PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
07282012 01151919
Decedent's Last Name Suffix Decedent's First Name MI
HYKES DOROTHY C
(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 BOXES BELOW
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)
0 6,Decedent Died Testate Q 7,Decedent Maintained a Living Trust 0 8 Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
Q 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 Schedule O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
ROBERT G . FREY 7172,-435838
r- C_.., M
A,E TER OF Vql[�LS Ue6 ,4 Y
co •- - 3
M
First Line of Address r- r? C7)
n 7
5 S . HANOVER ST . '- - '
Second Line of Address ---
i 11T B
DATE"I'ED
City or Post Office State ZIP Code
CARLISLE PA 17013
Correspondent's e-mail address: R F R E Y a@ F R E Y T I L E Y . C O M
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 basedag all information of which preparer nas any knowledge
SIG URE F PERSO R NSIBLE OR FILING RETURN _ DA
AD RESS
SIGNAT R F PR PA HE THA R PRESENTATIVE CAT
ADDRESS
5 SOUTH HANOVER STREET CARLISLE PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505611180 150561118E
1505611280
REV-1500 EX(Fl)
Decedent's Social Security Number
Decedent's Name: DOROTHY C HYKES
RECAPITULATION
1. Real Estate(Schedule A) . 1 NONE
2. Stocks and Bonds(Schedule B) . . . . . . . . 2. NONE
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . 3. NONE
4. Mortgages and Notes Receivable(Schedule D) . . . . . . . . . . . . . . . . . . . . 4 NONE
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). . . 5 44410 . 00
6. Jointly Owned Property(Schedule F) =Separate Billing Requested . . . . . . . 6. NONE
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) =Separate Billing Requested . . 7. 245233 . 00
8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 289643 . 00
9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . 9 8774 . 00
10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule 1). . . . . . . . . 10. 303 . 00
11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . _ . 11. 9077 . 00
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . 12. 280566 . 00
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. 28051313 . 00
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 0 15. 0 . 00
16.Amount of Line 14 taxable
at lineal rate X 45 280566 . 00 16. 12625 . 47
17.Amount of Line 14
taxable at sibling rate X ###I 17 0 . 00
18.Amount of Line 14 taxable
at collateral rate X ##4 18. 0 . 00
19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 12625 . 47
20 FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
1505611280 1505611280 J
REV-1500 EX(Fl) Page 3 File Number 184-07-4194
Decedent's Complete Address: 21-12-841
DECEDENT'S NAME
DOROTHY C HYKES
STREET ADDRESS
825 NORTH HANOVER STREET, APARTMENT 207 _T CITY STATE ZIP
CARLISLE _7PA 17013
Tax Payments and Credits:
1. Tax Due(Page 2, Line 19) (1) 12625.47
2. Credits/Payments
A. Prior Payments
B. Discount
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
Fill in box 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) 12625.47
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 ..... . ........ .... __.... .. _....... ....... ... __ [] Q
b. retain the right to designate who shall use the property transferred or its income.. ..... . .._.._.........._ ____ []
c. retain a reversionary interest..... ...... ......._.........................._........ .. .... . .. _._ .____.._.................. _ []
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? ..... .. . ❑ 0
3. Did decedent own an"in trust for"or payable-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? ..... ... [] Q
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-1508 EX+(11-10) SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT NCETA RETURN PERSONAL PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Dorothy C Hykes 21-12-841
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 PNC Account No. 21001052970 5,182
2 PNC Account No. 5140410346 5,626
3 PNC Account No. 5004087003 4,698
4 Refund due from US Treasury 903
5 Refund due from PA. Department of Revenue 261
6 Refund from Church of God Home for apartment 27,200
7 Property receivable from Commonwealth of Pennsylvania, Unclaimed Property 540
TOTAL(Also enter on line 5, Recapitulation) $ 44,410
If more space is needed, use additional sheets of paper of the same size.
f
REV-1510 EX+(08-09) SCHEDULE G
Pennsylvania
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS &
RESIDENT EDEN TURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Dorothy C Hykes 21-12-841
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.
DESCRIPTION OF PROPERTY
ITEM 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 APPLI-8LE) VALUE
1. Transamerica annuity purchased through PNC Investment Acct 128,812 100.00% 0 128,812
2. Nationwide Life Annuity purchased through PNC Investement Acci 116,421 100.00% 0 116,421
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
TOTAL Also enter on Line 7, Recapitulation) $ 245,233
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX i (10-09)
Pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN
RESIDENT DECEDENT ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Dorothy C Hykes 21-12-841
Decedent's debts must be reported on Schedule Ie
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERALEXPENSES:
1. Egger Funeral Home, Inc. 4,833
B. ADMINISTRATIVE COSTS:
1 Personal Representative Commissions.
Name(s)of Personal Representative(s)
Street Address
City _ State ZIP
Year(s)Commission Paid:
2. Attorney Fees: 3,500
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. 166
5. Accountant Fees:
6. Tax Return Preparer Fees.
7. Advertising fee to Cumberland Law Journal and The Sentinel 275
TOTAL(Also enter on Line 9, Recapitulation) $ 8,774
If more space is needed, use additional sheets of paper of the same size
REV-1512 EX-(12-C8)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN
RESIDENT DECEDENT MORTGAGE LIABILITIES & LIENS
ESTATE OF FILE NUMBER
Dorothy C Hykes 21-12-841
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
Final Bills owed to Church of God Home 303
t
TOTAL(Also enter on Line 10, Recapitulation) $ 303
If more space is needed.insert additional sheets of the same size.
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Dorothy C H kes 21-12-841
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1
Darlene E. Lindsay
3146 Ritner Highway, Newville, PA 17241 Daughter 10%of Residue
Edward Stouffer
2 6574 Swains Road, Marshall,VA 20115 Son 30% of Residue
Linda Jackson
3. 9 Thornhill Ct., Carlisle, PA 17015 Daughter 30% of Residue
4.
Doris Swartz
180 Bulls Head Road, Newville, PA 17241 Daughter 30% of Residue
1
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
0.00
If more space is needed,use additional sheets of paper of the same size
Sep 13 2012 10: 58RM Egger Funeral Home 7177764589 p. 1
16 Big Spring Avenue
NEWVILLE, PENNSYLVANIA 17241
F. CHARLES EGGER, Supervisor 717-776-34i 4 FRANK C. EGGER, Funeral Director
August 14,2012
Funeral bill for Dorothy Hykes
Date of Service July 31, 2012
Professional Services $4,350.00
10 Death Certificates $6.00 a piece $60.00
Clergy offering $75.00
Sentinel Obituary $107.39
Valley Times Star obituary $50.00
Flowers $190.80
Total $4,833.19
Funeral Paid In Full
n_
7u F�it v ark a P,
i NS TW Y,
August 13, 2012
Robert Gr Frey
Frey &Tiley
5 South Hanover St
Carlisle, PA 17013
RE: Name: Dorothy C Hykes
SSN: 184-07-4194
DOD: 07-28-2012
Dear Sir/Madam:
In response to your request for Date of Death (DOD) balances for the customer noted above, our
records show the following:
Certificate of Deposit
Account# 21001052970 Established: 03-09-1990
DOROTHY C HYKES
DOD balance: $ 5,181.46 +0.71 accrued interest
Interest paid 01-01-2012 thru 07-28-2012 $ 7.57 YTD
Checking Account
Account# 5140410346 Established: 03-07-1984
DOROTHY C HYKES
DOD balance: $ 5,625.67+0.03 accrued interest
Interest paid 01-01-2012 thru 07-28-2012 $ 0.35 YTD
Savings Account
Account# 5004087003 Established: 05-12-2003
DOROTHY C HYKES
DOD balance: $ 4,697.57+ 0.09 accrued interest
Interest paid 01-01-2012 thru 07-28-2012 $ 3.25 YTD
Investment Account
The decedent maintained Investment Account#4569836. For further information,you may call the
Brokerage Department at 1-800-762-6111_
Page 1 of 2
P n
L z ,�-P,
please note that this office provides date of death balances for deposit accounts(IRAs, CDs, Checking and
Savings). We do not process any financial transactions or provide statements. If you need assistance with
any of these items,please call 1-888-PNC-BANK(1-888-762-2265) or stop by your local PNC Bank branch
office.
Sincerely,
National Financial Services Center
PNC Bank,N.A.
Member FDIC
This message is intended for the use of the individual or entity to which it is addressed and may
contain information that is privileged, confidential and exempt from disclosure under applicable law.
If the reader of this message is not the intended recipient or the employee or agent responsible for
delivering this message to the intended recipient, you are hereby notified that any dissemination,
distribution or copying of this communications is strictly prohibited If you have received this
communication in error, please notify me immediately by reply or by telephone at 800-762-1773 and
immediately destroy this faxed document.
Page 2 of 2
Nationwide
On Your Side
August 29, 2012
Frey & Tiley
Attn Sharon DeVos
5 South Hanover Street
Carlisle, PA 17013
RE: 01-6019658
Insured: Dorothy Hykes (deceased)
Dear Ms. Devos,
This is in response to your inquiry about the date of death calculation on Ms. Cameron's
contract. The date of death value on this annuity as of July 28, 2012 was $116,392.85 and
represents an estimation of the present value of future payments due, as of the date of
death. This value is Nationwide Life Insurance Company's interpretation of the valuation
required for federal estate taxes as defined in Section 20.2031-8 of the Internal Revenue
Code. In providing this estimation, Nationwide does not recommend use of this value for
any other purpose.
We're here to help. If you require any further assistance, please contact us within the next
60 days at 1-800-848-6331, Monday through Friday 8:30 a.m. to 8:00 p.m. Eastern Time.
Our annuity service center specialists will be happy to assist you.
Sincerely,
Nationwide Financial
Enclosure
Annuities and life insurance products are issued by Nationwide Life Insurance Company or Nationwide Life
and Annuity Insurance Company, Columbus, Ohio. The general distributor for variable insurance products is
Nationwide Investment Services Corporation, member FINRA. In MI only: Nationwide Investment Svcs.
Corporation.
Administrative Ofce:TRANsAmEmCA
4333 Edge4vood Road NE
a LIFE INSURANCE COMPANY Cedar Rapids,1A 52499
www.transamericaannuities.com
August 9 , 2012
DARLENE LINDSAY
3146 RITNER HWY
NEWVILLE PA 17241
RE: Annuity Number(s) 02CBT106924
Dear Claimant:
We have received notification of the death of Dorothy C Hykes . We
extend our sincere condolences to you for your loss . The information
in this letter is being provided to assist you in submitting death
claim paperwork. Our records reflect the following information
regarding this annuity:
Annuitant : Dorothy C Hykes
Owner: Dorothy C Hykes
Claimant: Darlene Lindsay 10%
Annuity value: $128, 812 . 49 as of 07-28-2012
Annuity type: Non-Qualified
Tax Information
This letter includes general tax information that should not be relied
upon for personal tax planning. Transamerica Life Insurance Company
does not give legal, tax, or accounting advice. You may want to
consult your attorney, tax advisor, or accountant with questions
regarding the direct tax consequences when selecting an option.
General Information
The financial professional of record will remain on this annuity
unless we are notified of a change in writing.
Please be advised automatic operations such as Systematic Payouts and
Automatic Payments have been stopped.
an AEGON company
Please submit the following documents upon selection of an
option:
• An original certified death certificate for Dorothy C Hykes
indicating the manner of death
• The original annuity contract (excluding the Continue Option)
• The completed Annuity Claimant' s Statement
The following option(s) is/are available to the claimant :
Lump Sum Payment
The death proceeds value will be distributed to you in a lump sum
payment.
The taxable amount of any distribution will be reported on a Tax Form
1099-R in January of the following year.
Settlement Option
The proceeds of this annuity policy will be distributed in periodic
payments over a minimum of five years calculated on a minimum value of
$5, 000 . 00 . The following restrictions or requirements may also apply,
depending on the settlement option chosen and as described in the
contract provisions :
• The period may not exceed your life expectancy;
• The payments must begin within one year of the date of the death;
• A minimum number of annuity policy payments may be required; and
• An annuitization request form must be completed and submitted to
US .
The taxable amount of any distributions will be reported on a Tax Form
1099-R in January of the year following the distribution.
Please contact us for information regarding annuity products available
to you.
Delay the Lump Sum Payment up to 5 years following the date of death
You are responsible for requesting we distribute any remaining
proceeds prior to December 31St of the fifth year following the death.
The taxable amount of any distribution will be reported on a Tax Form
1099-R in January of the following year.
LAST WILL AND TESTAMENT
OF
DOROTHY C. HYKES
1, DOROTHY C. HYKES,widow,of North Newton Township(mailing address: 440
Shippensbu.rg Road,Newville,Pennsylvania 17241),Cumberland County,Pennsylvania,being
of sound and disposing mind,memory and understanding,do hereby make,publish and declare
this as and for my Last Will and Testament,hereby revoking and making void any and all Wills by
me at any time heretofore made.
L I direct my hereinafter named Executors to pay all of my just debts and funeral
expenses as soon after my death as may be found convenient to do so. I direct that my funeral
services be conducted by the Egger Funeral Home in Newville,Pennsylvania,and that my body be
interred beside that of my husband, Robert L. Hykes, on our burial lot in Cumberland Valley
Memorial Gardens located along Governor Rimer Highway near the Borough of Carlisle,
Pennsylvania.
2. All of the rest, residue and remainder of my estate, real, personal and mixed, and
wheresoever the same may be situate,I give,devise and bequeath to my four(4)children, their
heirs and assigns,in the fractions indicated,provided each of them shall survive me by a period of
ninety(90)days,but should any of my said four children fail to so survive me then the share such
deceased child of mine would have received shall pass to such of his or her issue as shall survive
me by a period of ninety(90)days,their heirs and assigns,per stirpes, and if there be no such
issue the same shall lapse and be added proportionately to the remaining shares,per stirpes:
a) Ten(10%)percent to my daughter,Darlene Elizabeth Lindsay;
b) Thirty(30%)percent to my son,Edward Lee Stouffer;
c) Thirty(30%)percent to my daughter,Linda Kay Jackson;and
d) Thirty(30%)percent to my daughter,Doris Jean Swartz.
3. 1 hereby nominate,constitute and appoint my three(3)children,Edward Lee Stouffer,
Linda Kay Jackson,and Dorris Jean Swartz,as co-Executors of this my Last Will and Testament
and I further direct that none of them shah be required to post any bond to secure the faithful
performance of his or her duties in the Commonwealth of Pennsylvania or in any other
jurisdiction.
IN WITNESS WHEREOF,I have hereunto set my hand and seal to this my Last Will
and Testament,written on one(1)page,this 12th day of August,1994.
—(SEAL)
Dorothy C.Hy es
Signed, sealed, published and declared by DOROTHY C. HYKES, the Testatrix above-
named, as and for her Last Will and Testament, in our presence, who, in her presence, at her
request, and in the presence of each other, huve hereunto subscribed our names as attesting
witnesses.
71