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Home My WebLink About06-26-13 1 1505610143 ""� REV-1500 �`°Z."' �` PA 6e artment ot Revenue y 6FPFGIAt USE ONL.Y p penns Ivania CouMyCOde Yaer FiieNumEar Bureau of Individua)Texes 0°"'"'"*"*o'"+"a"'tl ao eOx.zaoso� INHERITANCE TAX RETURN �1 �� Harris6urg,Pn ��2e-o8ot RESIDENT DECEDENT ENTER BECEDENT iNFBRMATtON BELOW Socia�Security Number Date of Death Qate of Birth 09 23 2013 02 21 Z927 DecetlenYs Laat Name Suffix Decedenf's First Name MI HERSEY CLZFEORD F pf AppNca6k)Enter Survivfng Spouse's information Beiaw Spouse's last Name Su�x Spouse's First Narrre Mi Spousa's Social Security Number THlS RETURN MUST SE F►LED IN DUPLICATE WITH THE REGISTER OF WILLS PILL IN APPROPRIATE OVALS BELdW � 1. Originai Retum � 2. 5upplementel ReNm � S. Pepm fi9,Z �R�m{Da�o!Death � 4. Limited Estate � Aa.Fuux°kser�t Ca"�xw"'se � 5. Federel Estaie Tax Retum Required {deteMtleetheker 2-12�82) � g, DeceaempiedTestNe � 7, DAe�caetl�entMai�g��j LivinqTruc4 � 8. TotaitdumberaiSafeDepoeit8oxes tAttacnCopYMNhn} t wPY � S, tNigationProceedsReceived � 10. %��P��j!��oa�g}tpeatn � »,ElectiontalazuntlerSec.91t3(A) (AKech Sch9dule�) GORRESPONDENT•TH�S SECT�ON MU3T BE COMPlETEO.ALL CORRESPONDENCE AND CONFIDENTIAI TAX INFORINATION�iOULD BE DIRECTED TO: Name Daytir�Telephone�mba� � �ARY L JAt�5 E3Q 71'1�533 3�0 �'T� c�'.� � � ai �,, REtil��O�F Wiki�$US�'1hpY "D�' "�` mT, 05 � �""� First Line ot Address z � � � �� i�a SIPE AvErrvE � ° Q � � Tt ° � c�, - `,', Second Line af Address � --! � � � � '*'t DATE FILED City or FaBt Otfice State Zlp Code HUL�SELSTdWN PA 17036 Corres�ndenYs e-matl address: 9�IG�d�dG.Cflm Untler penaidea M peryury,I dedare that 1 have ezaminetl tnis reWm,includi�accortw ying pchedules aM atatementa,antl to the best of my knowiatlpe and beliei, it is true,cortecl arN compiete.DeGaretion of preperer pther than the parsonal rep s�re ntativa is 6esetl on al!infrnnation#wnich preperer has arn�knwAedge. SIGNA R OF PERSON RESPONSIBL F R FILING ftETUftN � T� ��j^,,,,,,( �. '�,tL,^� Cheryi L.Starr (� lJY �LOJ� ADDRESS 24 Harasrs Perrv Wav Meehanicsbura PA 17050 SIGNA EOFPiiEPAR OTMERTMANREPRESENTATNE DA7E Gary L.James Esq• -- C7 — � ADDRES6 134 S A nue ummelstown PA Side 1 � 150561[1143 b5Q5610143 � t 1505610243 .�i REV-1560 EX Decedent's Social5ecuriry Number DecaifenPSName: f{@fBBi/� Cliffard F. RECAPI7UI.ATIQN Ji ' 1. RealEState{SCheduleA)........................................................._...............__..._.... 1. 2. Stocks and Bonds{SchedWe 8}............................................................................. 2. 3. Glosely Held Corporation,Partnership or Sote-Propnetorehip(Scheduie C)........, 3. 4. Mortgages&Motes Receivabie tSchedute D}........................................................ 4. �' . Y 5. Cash,Bank 6eposits&MisCelleneous Personal Prpperty(Schedule E)............... 5. $t$71. QD B. J4intty Owned Property(SchedWe F) ❑ Separate Billing Requested,_......,.. 6. 'rJ� 789. 72 7. inter-Vivos Trensfers&Miscellaneous�eq Probata Property (Schedule G) U Separate Biliing Requested............ 7, $4 �739. 57 8. 7otal 6ross Asseta itotBl Lines 7 throu9h 7)........................................................ 8. 94 �1OO .2 9 -_�-_.-_-._.,_..- _.�_. 9. Funerei Expenses end AdminisRrative Cost5(Schedule N)_.._.............._.,............ 9. � a.��53 . 64 10. Debts of Decedent,Mortgage liabllities end Uens{Schedule I),......._.....,...,._.,... t0. 1 �774 . 00 i�. Toai oeducaons Ro�ai�.ines s and�u�................................................................ ��. 21 , 627 . 64 12. NetvalueofEatate(LineaminusLinett)............................_................._....._.. 1z. 72 � 472 . 65 �g, Charitahle and Govemmentai BequestaJSec 9913 Trusts for which an electian to tax has noS been made(Schedule J}............................................... 13. 14. Net Yalue Sub}ect to Tax tline t2 minus�ine 13)............................................... 14. 7��472. 65 TAX COMPU7ATION-SEE lNSTRUCTIQNS FOR ApPCiCABLE RATESu ^ � 75. Amounf of Line 14 laxabie at the spousal tax rafe,or transfersunderSec.9tt6 t5 Q � 40 {a){72)X.00 78. Amountof�inel4taxabie 72 4T2 . 65 ts. 3,2b1 . 27 at Il�eal rete X .045 � 17. Amonnt of i.ine�4 taxable m=s;biir,�rate x.�z 0 . 00 n. 0 . 88 18. Amnunt of i.ine 14 taxable 0 . 40 1 B. 0 . 0 0 at cottaterai rafe X.15 ts. TAXDUE................................................................................................................ 79. 3,261.27 2Q. FILL!N!'HE 6YAl IF YOU ARE REQUESTiNG A REFUND OF AN OVERPAYMENT. � Side 2 � 15Q56102q3 15�561D243 � REV-7500 EX Pege 3 Ftie Number 21 DecedenYs Camplete Address. DECEDENTSNAME Hersey, C(ifford F. STREE7A�DRESS ��iii— 24 Harpers Ferry Way CiTY�i� ` � STATE Z!P Mechanicsburg PA 17050 Tax Payments and Credits: 7. Tax Due(Page 2,Line 19) (1) 3,261.27 2 CreditstPayments A. Prior Payments B. Discount 163A6 Total Credits{A +g) {2) 163,06 3. �nterest i37 d, If Line 2 is greater than Lina 1 +Line 3,enter the difference. This is the OVERPAYMEN7. {4) Check box on Page 2,Line 20 to request a retund "�" 5. If line t t Lir�e 3 in greaterr than Line 2,eiKdr the difference. This is the TAX DUE. (5) 3 098."�� Make Check Pa able to: REGISTER OF Wl�LS AGENT. PlEA3E ANSWER THE FOLLOWING QUESTIONS BY PLAClNG AM"X"tN THE APPROPRIATE BLOCKS f_ Did decedent make a tra�sfer and: � Yes No � � a. retain tkte use or income of the property trensferrad:............................................................................... b. retai�the righf to designate who shaii use tbe properky transferred or its income:........................._....... c. retain a revsrsionary intarest�or............................................................................................................... d, receive the promise for Iife of either paymenks,benefits or care?................................................._......... x 2. if death occurtad afler Dec. 12, 1882, did decedent kransfer praperty within ane year of death witttuut receiving adequate consideration9.................................................................................................................... ❑ � 3. Did decadent own an"in trust for" or payable upon death bank ar,count or sacurity at his or her deaih?....... ❑ `� 4. Did decedent own an individual retirement account,annuity,or other non-probaie proparty which r� contains a beneficiary designatio�7..................................................................._............................................. LJ 0 IF TWE ANSWER TO ANY OF THE ABOVE QUESTIONSIS YES,YOU MUST COMPLETE SCHEDULE G AND FILE 1T AS PAR7 OF THE RETURN. For datas of deakh on pr after July 1, 1994 and before Jan. 7, 1995,the tax rate imposed on the net value of trensfers to or for the use of the sarviving �«,se i�3 ae.cent[�z P.s.gs�is ta7 tt i}�i>j. Fprdate9 of death on or after January 1, 7995,the tax rata imposed on the net value of trensfars tC or for the uae of the survlving spouse is 0 percent [72 P.S.§91I6(a}(1.t)(iijj. The statote does not exempt a transfer to a surviving spouse from tau,and the statutory requirements for discbsure of assets and filing a tex retum are stiii app�icabie even if the surviving spousa is thb only beneflciary. For detes of death on ar after July 1,2000: . Tha tau rate imposed on the ne!value of transfers from a daceased chitQ 21 years of age or younger at death to or for tha use of a natural pareat,an adqptive parent,pr a stepparent of the child is 0 percent[72 P.S.§9N8(a){L2)j. . The tex rate imposed o�the nat vslue of VBnsfera ta or for the use of the dacecienYS lineat beneficiaries is 4.5 percent,axcept as noted in [72 P.S.§9178(a}(1)1. . The tau rate impased on the net value of translers to or for the ase of the decedeM's sibiings is 12 perceM(72 P.S.§9116(a)(1.3)j. A sibling is defined under Saction 9102,as an individuel whp has at least one parent irt common with the decedent,whether by btood or adoption. Rsv.1608 EXa(71.70� SCHEDULE E pennsylvania CASH, BANK DEPQSITS, 8 MISC. DEPARTMENTOFREVENUE INNERITANCETAXRETURN PERSONAL PROPERTY RE51DENt DECEDENT ESTATE QF FILE NUMBER Hersey, Cliffard F. 21 i�awama��roceae.a��p�i ena�mmmspr«�a.�.rere�aweao-yuree.tere. AII propsrty 7o ni tlyawnsqwMfl Me dphl ohunivonhlp must M Oiwlas�tlon se�edula F. ITEM VR�UE AT DATE NUMBER DESCR�PTION OF DEATH 1 20q4 Pontfac Grend Prix-vatued per Ke(ley biue book 3,571.00 70TA1 tAiso errter an Line 5,Recapituiation} 3,571.00 pf more mpace is neetletl,additional pages of the same size) Gopyright(c)2010 fortn soRware only The lackner Group,Ina Farcn PA-0500 SchedWe E(Rev. 17-10) ftsv75C8 EXr(Ot•10) pennsyivania SCNEDULE F DEPAR7MENTOFREVENUE JOlM7LY-0WNED PROPERTY INHERI7ANCE TA%R@TURN RESIDENT DECEOENT ESTATE OF FILE NUMBER Hersey,CliffoM F. 21 If m u�st wu m�W Jolne wlNin on�y�ual MfedxaCerti's Mts af tluN,tt mu�t M npaftM on ache0uia G. SURVIVING JOINT TENANT{S)NRME ADDRESS RELATIONSNIP TO DEGEOENT A. Gheryl L.Starr 2d Harpers Ferry Way Daughter Meohanicsburg, PA 17880 B. C. JOINTIY OWNED PROPERTY: DESCRIPTION OF PROPERTY 9'o OF �TE oc o�ATH �TEM FOR,JOIN MADE 'NUMBER QR�IMlLAR WEN71fYiNG NUMBER�ACH p E�O OR DATE OF DEATH �ECD�S OECEdENTS INTEREST NUMBER -�NANT JOWT ,roinr�v��oa�ai.esTnrE. ALUEOFASSE INTEREST 1 A Q8l1Sl2U08 PNC Bank Checkittg Account#51<0243234- 11,579.40 50.d00% 5,789.70 valued perletter dated June 3,2813 A 0811 512 0 0 8 Accrved income on Item 1 through date of 0.04 50.Q04% 0.42 death TOTAL(Also anter on Line 8,RecaRytutation} g,7$g.�Z pt mpre space ia neetletl,atltlitional peges of the aeme sae7 Copyright{e)20i Q torm software only The Lacknar Gro�p,tna Fortn PA-7500 5clredub P(Rev.Ot-t D} Rsvd370 EXf(OBAB� SCHEDUlE G pennsytvania lNTER-YlVOS TRANSFERS AND DEPARThIENTOFREVENUE ��gC. NON-PROBATE PROPERTY MNERRANCETAXRETURN RE51pENT OECEDENT ESTATE OF FILE NUMBER Hersey,Ciiffard F. 21 This schedWe muat be wnpigted aiE filed p Me erawar ta amy W questions 1 through 4 on peBe inrea oi fhe REV-1500 ie yea. �TEp� C DESCRIPTION OF PROgPERTY QATE OF pEATH �s fl�oeco�s exausioN TAXABtE NUMBER THEDA'�fEOFTER�ANSFER.A'R CHTAOOPYEOFTTHEtlEEO�aaEREn°EESinrE. VALUEQFRSSET INTEREST {�Fppp�pg�� VALUE 1 peth Starr-give made in Juty 2412 t6,880.00 3,000.00 7.0OO.OQ 2 Personat Property 500,U4 500.06 S PNC Bank Savings Account#5130t73893-titted in �7,238.84 77.238.04 the CliffoM F. Hersey Living Trust dated May 27, 1997; valued per letter dated June 3,2013 Accrued interest on item 3 through date of death 1.53 t.53 TOTAL(Also enter on kJne 7,Recapitulationt 84,738.87 Qf more space ia needeO,adtlitional pages of the same size} Copyright ic)2009 form software oniy The Lackner Group,Ina Form PA-1880 Scheduie 0(Rav.OS•09} aEV-ysty�«��o-aet pennsylvania SCHEDULE H DEPARTMENTOFREVENUE FUNERAL EXPENSES ANQ RESIDENTDEC E�°R" ADMtN187RAT1VECOSTS ESTATE OF F1LE NUMBER Hersey,CliffoM F. 27 Decederrt's debts must be reportsd on Schedule 1. ITEM pE3GftIPTtQN AMOUNT p, FUNERAL EXPEMSES: See continuatian schednfe(s)attached 10,931.09 8. ADMINIS7RATlYE COSTS: 1. Personai RepreseMative's Commissions Name of Parsonal fteprgsentative{s) Street Atldress Gity St�te Zio Year(s)Commission Paid p, Attomev's Fees James,Smith, Dietterick�Conneliy, LLP 3,5oq.0a 3. Family Exemption: (if decedenYs addross is not tha same as daimant's,attach expla�ation) 3,504.00 c�a�mant Cheryl Starr SfrsetAddress 24 Harpers Ferry Way ctty Mechanicsburg scate PA zto 17050 Reletionahip 4f Glaimaat to Decedent Daughtar 4. Probate Fees 43.5Q 5. Accountsnt's Fees 6. Tax Retum Preparar's Fees 7. Other Rdministrative Cosis 7,879.05 See conUnuatioo schedule(s)attached TO7A►.fAtso enter on iina 8,RacapltWatlon► 78,853.64 Copyright{c)2009 form sofrware on7y The tackrrer Group,ina Form PA-75Q4 Schadule H(Rev. 14-09} —i SCHEDULE N FUNERAL EXPENSES ANQ ADMINtSTRATiVE Ct3STS con#inued ESTATE OF FlIE NUMBER Hersey,Clifford F. 21 iTEM NUMBER DESGRtPTtON AMOUNT Funeral Expenses 1 Chery!Starr-reimburssment for meat after funerai 1,314.27 2 Malpeui Funeral Hcme-funerat 8.326.82 3 New Cumberland Church of the Nazarene-eontribution 1,290.00 H-A 10,931.Q9 Other Administrative Costs 4 Cheryl Starr-reimbursement for 2012 federai personat income tax 1,577.OQ 5 dove's Rest•lot fee for Flo�ida residence 22T.46 6 TECO-final electric biil-seroice for FForida residence 6.59 7 Watts-air corxl7tioning servlce for Fiorida residence 68.00 H-B7 7,879.05 Copyright(c)2002 form sottware only The Cackrter Group,tna Form PA-1544 Schedule H{Rev.&98y Rev-tb12 E%«{12-08� scHEOU�E � pennsylvania pEgT3 OF DEGEQEMT, DEPRRTMENTOFREVENUE MORTGAGE LIABILI7IES AND LIENS INHERiTANCE TAX RETURN i2E5iDENi OECEDENT ESTATE OF FlLE NUMBER Nersey, Clifford F. 21 R�port tl�bts Incumd by Me EscsCeotprla ta d�Nh tlutmnYin�d unpNd rtth�diM o(A�Nh,Inelutlinp�nnlmWmEmMictl�zp�n�u. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 7 AT&T Mastercard 1,538.89 2 Bright House Gable-service for Fforfda residence 99.37 3 TECQ-electaie service for Florida residence 127.92 4 Verizon 87.82 TQTAL{Alsa enter qn Line 1p, Recapitulation} 1,774.00 (if more space is ngetletl,additional pages o(th9 same eize) Copyright ic)2008 form software only The Lackner Group,Inc. Form pA-180q Schedule I{Rev. 12-08) REV.tBriIX�t07.10) pennsylvania SCHEDULE J DEPARiMENT OFREVENUE INNERI7ANCE TH1(RETURN BENEFiCtARlES ftES1�ENT DECEOEMT ESTATE OF FlLE MUMBER Ners ,GliffoM F. 21 NAME AND ADDRESS OF RElATIONSHIP TO gNARE OF ES7ATE AMOUNT OF ESTATE NUMBER PERSONtS7 RECEIViNG PROPERTY DECEDENT �ob$� �$�� i TAXABLE DISTRIBUTIONS [induda outright spousal distri6utions,and transfers underSec.91i6a 72 1 Cheryl L,Starr Daughter joint bank 72,A72.65 24 Harpers perty Way account; 100°!e Mechanicsburg, PA 17850 residue Total M.472.BS Enter tlqltar ampunts for distributions shown above on lines 1 S lhro h t B an Rev 15p0 asver sfieet as a ro riate. NON-TAXABLE OISTRiBU710NS: II. A.SPdUSAL DISTRIBUTI4NS UNDER SECTION 9113 FOR WtiiCH AN ELECT90N TO TAX IS NOT TAKEN 8.CHARITABLE AN6 GOVERNMENTAL DiS7ft�8UTiONS TOTAL OP PARTl1-ENTER TqTAI NON-TAXABLE DISTRIBUTIONS 4N LINE 13 OF REW7500 CAVER SHEET Copyright(o}2010 form software oNy The Lacknar Graup,Ina Fortn PA-1500 Schadute J(Rav.0140)