HomeMy WebLinkAbout10-18-13 _ _ _
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� 1505610140
REV 1500 �` �02-,,,�F'> i
PA Dep2rtfflent of RevenUe � OFFICIAL USE ONLY
Bureau of IndiWdual Taxes � � � Counry Code Year File Number
ao Box 28oeo� INHERITANCE TAX RETURN 2 1 1 3 0 1 5 9
Harrisbur PA 17128-0801 RESIDENT DECED NT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDOVYVY Date of Birth ' MMDDYVYY
0 1 3 0 2 0 1 3 1 1 0 3 1 9 3 0
Decedenfs Last Name Suffix DecedenPs FI t Name MI
H E M M A H I L ' E E
(if Appflcable)Enter Suniving Spouae's Information Below
Spouse's Last Name Suffix Spouse's FirSt Name MI
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Spouse's Social Security Number
THIS RETURN MUST BE FILE IN DUPLICATE WITH THE
REGISTER O WILLS
FILL IN APPROPRIATE OVALS BfLOW
Q 1.Original Retum � 2.Supplemental Retum 3.Remalnder Retum(Date of Death
Priorto 72-13-82)
� 4.Limited Estate � 4a.Future Interest Compromise(date of 5.Federel EsMate Tax Return Required
death after 12-72-82)
� 6.Decedent Died Testate � 7.Decedent MainNained a Living Trust 8.Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
� 9.Litigatlon Proceeds Received � 70.Spousal Poverty Credit(Date of DeaN ; 11.Electlon to Tax under Sec.9113(A)
Behveen 1231-91 and t-t-95) (Attach Schedule 0)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDE L TAX INPORMATION..�4HOULD BE DIRECTED T0:
Name DaqtlmeTelephorieNumb,pj m
M U R R E L W A L T E R 3 , I I I E S Q '�'�7ra7 6 ;� 7cros�'6 5 0
--t <n �'
��� I#EGiSTER�EWILL NLY
� O'J jj F�
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First Line of Address -. =.o -,i -+'t
.'., :=3 _. "�*�
5 4 E • M A I N 3 T R E E T �== <�
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Second Line of Address -� '"
J-" ._ U�� � 'TI
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City Of POSt OffiCe State ZIP Code DATE FILED
M E C H A N I C 3 B U R G P A 1 7 D ' S
Comspond�M's ameil addr�ss: RIUffB 81l81'S IIOW9 .COIII
UMer penaltles of perJury,I declere tlwt 1 have examined Ihis reWm,InclWirp e�companylrq saMdules end s menls,and to tha bast of my krwwiedge antl baliei,
it Is true,cortxt arM complete.Dedarotion of proparer other Man the paroonal roprcseMative Ia besed on atl i �� atlan o1 whkh pnparer hea any krawbdpe.
SI T REOF PERS R IBLE FOR ILING RETURN ppT
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ADD SS
LI3A C • RHOAD , 8 ACRI ROAD MECHANI SBURG PA 17050
SIGNATURE R � E AN REPRESENTATNE DATE
_ 7
ADDRESS
MURREL R • ALTERS, III, 54 E • MAIN ST MECHAN SBURG PA 17�50
PLEASE USE ORI6INAL PORM ONLY
Slde 1 i
L 150561U140 1505610140 J \
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� 1505610240 �
REV-1500 EX(FI) ��
�I DecedenPs Social Security Number
oxaaenesName: HILDE E• HEMMA
Recnairuu►noN
1. Real Estate(Schedule A) . . . .. . .. . .. . .. . . . . . . ... . . . . . .. . .. . .. .. .. . . . 1. � 9 5 0 0 0 . � 0
2. Stocksand Bonds(Schedule B) . .. ... . .. . ... . . .. . . .. . .. . . . . .. . . . .. . . . 2. �
3. Closely Held Corporation, Partnership or SolaProprietorship(Schedule C) .. . .. 3. •
4. Mortgages and Notes Receivable(Schedule D) . .. . . .. . . ... .. . .. .. . . .. .. . 4. � •
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). . . .. . . 5. � 7 1 9 7 , 3 1
6. JoinBy Owned Property(Schedule F) ❑ Seperete 8illing Requested .. . . . . . 6. � 2 7 6 7 . 5 8
7. Inter-�vos Transfers&Miscelianeous N -Probate Properry
(Schedule G) � Separate Billing Requested .. .. . . . 7. .
8. Total Gross Assets(total Lines 1 Mrough 7) .. . ... . . .. . ... ...... .. .. . .. 8. ' 1 0 4 9 6 4 . 8 9
9. Funeral Expenses and Administrative Costs(Schedule H) . ... .. . ... .. . .. ... 9. ' 1 L 9 1 1 . 4 1
10. Debts of Decedent,Mortgage Llabilities,and Liens(Schedule I) . . .. . .. . .. . .. 10. I 4 2 � 2 . 4 3
11. Total Deductlons(total Lines 9 and 10) . . . . . . .. . . .. . . .. . .. . .. . . . . . . . .. 11. �i 1 6 1 1 3 . 8 4
12. Net Value of Estate(Line e minus Llne 11) . . ... . .. . . .. . . . . . . . .. . .. . . . . �2. 8 8 8 5 1 . 0 5
13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which
� an election to tax has not been made(Schedule J) .. . . .. . .. . . . . .. .. . . . . . �3� .
14. Net Vatue Subjact to Taz(Line 12 minus Line 13) .. . .. . . .. . .. . .. .. .. . . . 14. '��, 8 8 8 5 1 . 0 5
TAX CAICULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 tauble
at Ne spousa�fax rete,or
t2nsfers under Sec.9116 '
(a)(1.2)X.0 _ � . � 0 15. � Q . 0 �
16. Amount of Line 14 haxable
at linea�rate x.045 8 8 8 5 1 . 0 5 �g, ! 3 9 9 8 . 3 0
17. Amount of Une 14 taxable
at sibling rete X.72 0 . 0 0 77. 0 . 0 0
18. Amount of Line 14 Wxable
at collaterel rate X.15 � . � � ig, � . 0 �
is. rnx oue . .. . . . . . . . .. . . .. . . .. .. . . .. . . .. . . .. . . . .. . .. . .. . . . . .. ... �s. j 3 9 9 8 . 3 0
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20. FIIL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF/W OVERPAYMENT �
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Side 2
� 1505610240 I 1505610240 J
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A . _ _ _____
REV-1500 EX(FI) Page 3 Flle Num r
DecedenYs Complete Address: 2� 13 o15s
DECEDENT'S NAME
HIIDE E. HEMMA
STREETADDRESS
793 LEE LANE
CITY STATE ZIP
ENOLA PA 17025
Tax Payments and Credits:
� Tau Due(Page 2,line 19) (1) 3.988.30
2. Credits/Paymenls
A.Prior Payments 4.000.00
B.Discount 200.00
Total Credits�(A+B) (2) 4.200.00
3. Interest
(3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT.
Fill in oval on Page 2,Ll�e YO to request a refund. (4) 201.70
5. If Line 1 +une 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0.00
Make check payable to: REGISTER OF WILL , AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" ` THE APPROPRIATE BLOCKS
1. Did decedent make a Vansfer and: Yes No
a. retain the use a income oi the property transferted ..............................................:. ..................... ❑ �
b. retain the nghl lo designate who shall use the propeAy transferted or its income .......i. ..................... ❑
c. retain a reversionary interest .............................................................................';. ..................... ❑ �
d. receive the pranise for life of either payments,benefits a care? ...............................�. ..................... ❑ �
2. If death ocwrred after December 12,1982,did decedent transfer property within one year of� th
without receiving adequate consideration? ...............................................................�. ..................... ❑ �
P Y P� . . .........Y.............� death7 ......... ❑
Y -P P Pe Y h
4. D����aryndesignaUonlementb�unt annu�ibaokoth�ern norrobatet rothrtowh'. ..................... ❑ �
IF THE ANSWER TO ANY Of THE ABOVE�UESTIONS IS YES,YOU MUST COMPLETE SCHEDU� G AND FILE IT AS PART OF THE RETURN.
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Fa dates of death on or after July 1, 1994,and before Jan. 1, 1995,the tax rate imposed on the net valu of transfers to or for the use of ihe surviving spouse is
is 3 percent[72 P.S.§9116(a)(1.1)(i)].
For dates of death on or after Jan. i, 1995,the tax rate imposed on the net value of transfers to or for th se of the survivi�g spouse is 0 percent
[72 P.S.§9116(a)(1.1)(ii)j.The statute dces not exempt a transfer M a surviving spouse from tax,and� statutory requirements for disdosure of assets and
filing a lax retum are still applicable even if the surviving spouse is the only beneficiary.
For dates of dealh on or after July 1, 2000: i
• The tau rate imposed an the net value of transfers from a deceased child 21 years of age or younger� death to or for ihe use of a natural parent,an
adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(12)]. �
• The tax rate imposed on the net value of transfers to or for the use of the decedenPs lineal benefiaari is 4.5 per�nt,except as noted in pz a.s.gstts(a)(1)].
• The tax rate imposed on the net value of hansfers to or for ihe use of the decedenPs siblings is 12 p nt[72 P.S. §91 i6(a)(1.3)].A sibling is defined,
under SecHon 9102,as an individuai who has at least one parent in common with the decedent,whe by blood or adoption.
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REV-1502 EX+(12-12)
pennsylvania SCHEDULE A
�EPARTMENTOFREVENUE
REAL ESTATE
INHERIiANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
HILDE E. HEMMA 21 13 0159
All real property ovmed solely or aa e tenant in eommon muat be reportad at fair market value.Fair market alue is defined as the price at which propeAy
would be exchanged belween a willing buyer and a willing seller,neither being compelled to buy or sell,bot having reasonable knowledge of the relevant facts.
Real property that ia Jointlyawned wRh right af aurvlvonhip must be dlscl ed on Sehadule F.
Atlach a copy of the setllement shcet if the property has been sold. 'i;
ITEM Include a copy of the deed shoxAng decedent's interest i(owned as tenant in�mmon. VAIUE AT DATE
NUMBER OFDEATH
DESCRIPTION
1. 793 LEE LANE 95,000.00
ENOLA, PA 17025 !;
SALE PRICE
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TOTAL(Also enter o Line 1,Recapitulallon.) S 95 000.00
If rtare space is needed,use addHional sheafs ot paper of Me sama siz
. . . .. . . . . . . . _ . .. _ _ .. _..__. . __. — .I , _.__ __--- � � ----- . .
,,v ' caoµ- T-sre oazivaa F-�so
'oMa wo.:soxaaca
B. �'YPEOF
U.3.OEPARTMSNTDFHOUlM168UR6ANOEY844PMEM 1` � 2 RmMp 3. CONV.UNINS.. 4. VA S.QCONV.INS.
B, R: 7. LOAN N
SE7TLEMENSSTA3EMENT ta
0� MOKf6A6E INS CASE NUMBER: ���.
C. NOTE TAia/orm b Mm�ahsE ro gM yar a a1�Mnento/ae�uN aMMUm.nf wab� Amouna pM ro anObY�+���Nnf ne Nwwrt.
1hnu+rMeAM7�}�w+nP�wbldttMdo+h+C:�l'anshmaeMrobr�MxmaRCnatR�wMa,CannM mNroRfe/x
LO 1AS �a. �
D. N+1ME ANO�QORESS OC 60RROYYFR: L'. N�ME ANO ADDRE&B OF SEIIER: i. ttlitME ANO 55 OF lEN6ER:
AMRV J.GOUFFEN ESTA7E OF MQDE E.MEMMA CASH
810CMAR40TTEWAY./1t02 '78�LEELANE
6NCLA.PA tT025 EN�SA,PA 1T02i
G. PROPlq1YtACATION: M. 5lTT{.�MEMAOENT: 23-1b19011 1. $E77LE67Ery7pq1E:
��U� TRtIAUMY ABSTRACT SE0.VICE
anou.�n rsars ,�u�zx.za��
CamH.Pannsl+h'e�ie GIACE Oi SE7TLlMENT
4lCENTqALOOULEVARD
tlAMP MILL,PA 17011
1 sur ncrwr� . urawn �.w�x�a n,s�cnw+
� wicx+a �oo. sa� R:
�o�. canna es oo i. co a aoo.00
�m. n.sen rM ""
�ui sea�meMmrsa�'�""fnsa+�.e.a"►Hao z a.so
ta. _ ,
+ns.
FerMUna B in Fu P�itl ' tivs
108. TYM M . lo
IqT. . ��.��� 0�1/13 G1/OtA4 � 1s7.p . 7M 1H4 1 .r9
i� AX 1R4..1a Atlt.�. 2i.t2 AX 9 . 3 .tY
�� t%3 7Jt .,,,,'.. f0. i09.. Yi�DA85 C6R te 1P1tt 4Q.00
1 0. Mi�6 13 _ 111710 P ID'IA3 _ 14.74 Ui tn i U.1
111. 11 .
It2 •• ....... �1 .
t20. $A083�+vOtlNT[WEfRO�tHdJMWWER 9T,�MSi tIO. f.ROSSMlOtXJTGU$TOSBlER 9dRi2AD
:00.AMOilM1�NIID�YO MBEM+LLFOF90RROSIlR 2
g. t.Q�p���p�umqfly�,r�_ 1.�
iiia.'�- FrNt�i� a�nt NN�w Laan(cl �SN�nwd ' 1 7 020.00
'.0.t. Esu1Nq bMb)fak�n whi�d lo
+At.
AS. ,_,,, wenna
x18.
t 7.����� AO�. o�lt tl .n
Ae 8.
'AS.
Fallpe+rit tkteaid9r�ser lpr�ns
�16.�pyMibms � !7 .0 pvn qo
:11. CounNTtrs � b 1. a�a
�rz. scHOa�rnx m eyz r e
43. Y1
14 . H.
ib. f5.
18. �.�.' 76.
77. 1 .
�e. _,. � .
14. 61L
t0. TOTN.MAIDBY/FdRdORpOWER 2..T00.00 520. TOTALMWGTIONMIO(INTW6T T.01C.00
tlQ A . CAfM
r�� 720I B� /l8.58 7. Orws Ou�To �S 5 � OB
� G H�1�1 f 7�D780RR04 FR ��Z. . ta� Ous T,t�U.
���as.ees.sg am. ctsH(X7oil vnoatYBgtEn aaa7�.ce
7n.une«�.a e.mw wma.n.nu•�p or s mmWexe mar d ww+u maa.wuman a aro.ur�»��.mremw w m.
IHAVEG�RMU�LYREYI6.WEDTNEHW78ETTLEMENf3TATBMlN[ANCITOTHE�$YOFMTIWONM1CDOEANCIBE IT13A7Rt/EANO
AGCUWC7&STA7EMEMTOFALLRE'C.HiPTSAN6D1i8t1RSEMENTBM�tUEOMA4YAtCOGNTORlYN�1NTWSTRANS �1. IFUR7HERCERT7fY
TNnT t MAVE Fl6CENED A COP'Y#THE Ftt/61 SE'R1E1.�N'i'BTATEMQtC.
9arra+ler Sailer
J. R 88TA MILDE E.
70 TNE O@$f OF MY KNONILE�E,TM6 MJ0.�SERLlMENT STA7EMeNT WMIC,M I H114E pREPMEp IS A TRUE ANp URATE ACCOUNf OF TFIE
fUND3NMNCH4VERENEC�lYEOAND}NVEBEENORN7LlBGDISBURB@DBYTHEVNOERSP[iNlDA8PNtTOFTt1R OFYM18
iRANSACTfON.
NARN�Nd: IT IS A CRNAC TO K WWNOLY MAKE FNA.SE STATBMEMS TO THE UNITEO$T/17E6 ON TMIB OR ANY$IMI�FORM, PENILL71E3 UPON
.ONVICTICIN CAN INCLUOE A FINE ANO IMPRISpNMEM. FOR DETML9$88; TITLE 1!U.$.COOE SECTION 7001 8 BSC 1 N 1b10.
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.,rM PA01f T-678 �P.003/003 F-150
ry.z
L.SETTLEMENT CHARGES
� .a.TOT COIIMMp10M e�Mlu S % ! r�o mou nuo oxox
W � w.no+airs s�uaa
le suu��r rtmoart
emerrurt smWRrrt
meM •�
tp 750.
tN. P � M CONMEC710N WRM LAAN
Fw %
W2.lu�n a
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Fw
Im .Ra� �o
FN b
B00.
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pqRlNl{ yWGOSYLlMOlRTOK�NDN�OVANC!
aw.w�w.r F� w s �ew c a x
a�
10.1.F1are� nnw M�mam m. t.o m
903.
1 .RAl1lUl6 ONOlfIPDYYITN LE/O@R
� �, moNlr S �
�pp=, y�w�ne� morRM S mmN
1 avnTm moMS r monN
7001. Tsrn meMln f r mwim
1006. OOITAX maNln f p�r manM
t�le I �Ilo11�11
ioos. �nns s w. �
IppR, qp S r m
1700.
1701. x F�e le
�70t, CTIONLETTER lo FIR AIAERICANTITLEINSUMNCECOMPANY
110�. la
na.ne. sw�ae. m
nos. w
nas, w c�sH s.00 �o.00
110'I. �Fw to
l�OOH numw.s:
i� A I MF t e72
.eo..Rwn�.nw.awi i�+z-aa�ie�as
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in , • s
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t73.
xW.60VlRNMENT�AND71uN6FRRCHAROE4
201. Htl: Oaae S 67.OU:MOrt S Wbsam f 67.00
950. ' 9 .
Ml ShM T �Rawllw S s 930.00:Mo 930.77
=a.
2D6.
ADDRION�L ETTLW[NTCH11ROi8
70 a
�,pap ' lo
3. o/RewN GR, te WESTWOOD V UAOE GONOOMINIUM ABSOCUITION 200.00
3p{, b VYlS D VIIUOE CONDOMINIUM ASSOCNTION ]OO.DD
305.1Mm91 CwiGfia110n la Eut P�muCOro Towns�b 10.00
Mq.7pTM,aEfTL@IhIT CHAilGlE Enpr en LGra 107 BMbn J a�M SxNan K 2214.50 7.020.00
!�qwOpM�tlYi pfF�l YMYpiwM�aOOw�wN��N Y.mA4W mpya yp�a wVia M.a e4 MMm�nl
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7RLCOUNiYABSTRACT3ERVICE �
SeNem�nlAgart
G�eamis a W�copy.
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IGWIDI.I�IG0111041�f1�
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REV-1508 EX+(08-12)
pennsylvania SCHEDULE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS 8 MISC.
INHERITANCE TAX RETURN
RESIDENTOECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
HILDE E. HEMMA 21 13 0159
Include the proceeds of litigatlon and the date the proceeds were recei � �� by the estate.
All propeRy Jolntly ownad with right of survivorship must be disclo � on ScMdule P.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. JACKSON LIfE INSURANCE 4,641.86
ANNUITY
2. COMCAST 55.45
REFUND
3. AUTOMOBILE � 2,500.00
2003 BUICK REGAL
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TOTAL(Also enter Line 5,Recapituladon) = 7 �97.31
If more space Is needed,use additional aheets of paper of the me size.
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REV-1509 EX+(01-10) I
pennsylvania SCHEDULE F I
DEPARTMENTOFREVENUE �OINTLY-OWNED PROPERTY I
INHEPoTANCETAXRETURN
RESIDENT DECEDENT
ESTATE OF: FtLE NUTABER:
HILDE E. HEMMA 21 13 0159
If an asset was made jolnGy owned wlMdn one year of the decedenCa date of death,R u�st be ropoRed on Schedula G.
SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
n.LISA C. RHOADS 835 ACRI ROAD DAUGHTER
MECHANICSBURG, PA 17050
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JOINTLY�OIMNED PROPERTY:
LETfER DATE DESCWPTION OF PROPERN X OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUOE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR �ATE OF OEATH OECEDENTS VALUE OF
NUMBER TENANT JOINT IDENi1FYINGNUMBERATTACHOEEDFORJ0INTLV�HELDREALESTATE. VALUEOFASSET INTEREST DECEDEM'SINTEREST
1. A. 11N99B M&T BANK 5,535.15 50. 2,767.58
CHECKING ,
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TOTAL(Also enter on L 6,Recaptulafion) S 2 76T.58
If rtare space is needed,use addiM1O�al sheeb of paper of Me sa ize.
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REV-1511 EX+(�0-09) �
pennsylvania SCHEDULE H
OEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCETAXRETl1RN ADMINISTRATIVE COSTS � I
RESIDENT OECE�ENT
ESTATE Of FILE NUMBER
HILDE E. HEMMA 21 13 0158
DeeadenPs debts must be repoRed on Sehedule[.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERALEXPENSES:
1. AUER FUNERAL HOME, HARRISBURG 1,790.00
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B. ADMINISTRATIVE COSTS: I
1. Personal Repragentative Commissions: j
1 Name(s)of Persanal Repreaentative(s) LISA C. RHOADS
StreelAddress 835ACRI ROAD
ciry MECHANICSBURG state PA I 17050
Year(s)CommissbnPaid: �RENOUNCED) i
p, AttomeyFees: MURREL R.WALTERS, III i 2,900.00
3. Family Exemptbn:(If decedenYs address is not the same as daimanCs,attech ezplanatlon.)
Claimant
Street Address
City State I
ReWtionship of Claimant to qecedent
4. ProbateFees: CUMBERLAND COUNTY REGISTER OF WIILS i 353.50
5 AcoounYantFees: � i
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6. Taz Retum Praparer Fees: �
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7. DEATH CERTIFICATES � 60.00
8. CUMBERLAND COUNTY CORONER 30.00
9. NET DEDUCTIONS IN REAL ESTATE SALE i 6,777.91
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TOTAL(Also enter Line 9,Recapitulation) S �1 911.41
If more space is needed,use additlonal sheeta of paper of the sam ize.
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REV-1512 EX+(12-12) I
pennsylvania SCHEDULE I i
DEPARTMENT OF REVENUE DEBTS OF DECEDENT�
INHERITANCETAXRETURN MORTGAGE LIABILITIES&LIENS
RESIDENT DECEDENT
ESTATE Of FILE NUMBER
HIIDE E. HEMMA 21 13 0159
RepoR debts incurted by the dacedent prior to death that remained unpald at the date of death, cluding unreimbuned medlcal axpenaea.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. PA AMERICAN WATER COMPANY 154.17
WATER
2. PPL i 83.09
ELECTRIC
3. VERIZON i 10.16
TELEPHONE ,
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4. WADLINGER'S � 680.00
WINDOWS �
5. WESTWOOD V ILLAGE CONDOMINIUM ASSOCIATION � 380.00
CONDOFEE I
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6. DEBBIE LUPOLD,L TAX COLIECTOR 302.07
2013 COUNTY/TOWNSHIP TAXES
7. EAST PENNSBORO MUNICIPAL AUTHORITY I 128.70
SEWER/SANITATION i
8. SEARS ROEBUCK � 543.77
DISHWASHER !
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9. NATIONWIDE 23.25
HOMEOWNERS
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10. LOWE'S � 1,567.86
KITCHEN FLOOR&CARPET i
11. RALPH RHOADS 348.26
PAINT, PLUMBING&MISC
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?OTAL(Also enter Line 10,Recapitulation) S 4 202.43
If more space is needed,insert additional sheets of fhe sam size.
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REV4513 E%*(01-10) i
pennsylvania SCHEDULE J I
OEPARTMENTOFREVENUE BENEFICIARIES �'
INHEWTANCETAXRETURN �
RESIDEM DECEDENT
ESTATE OF: FILE NUMBER:
HILDE E. HEMMA 21 13 0158
RELATION P TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND AD�RESS OF PERSON(S)RECEIVING PROPERTY Do No ial Truetee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS pnclude outnpht spousal distributlons and Uansfers under .
Sec.9116(a)(1.2).]
1. LISA C. RHOA�S Lineal
835 ACRI ROAD
MECHANICSBURG, PA 17050
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ENTER OOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 F REV-t500 COVER SHEET,AS APPROPRIATE.
Ij, NON•TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS N TAKEN:
1.
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8.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS I
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TOTAI OF PART II-ENTER TOTAL NON-TAXABIE DISTRIBUTIONS ON LINE 13 OF REV-1 COVER SHEET. S
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LABT WILL AND T891'�AMHNT
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BE IT REMEMBERED THAT
( I, HZLDE E. AF.F4iA, a reside� af Cumberland County,
Pennsylvania, being of sound and d�ispoeing mind, memory and
� unflerstanding, do make, publish and deq are this to be my LAST WILL
and TESTAMENT, hereby revoking any � d all Wills and Codicile
previously made by rae. I
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Z declare that I am married to H.� IXON HEMMA and that I have
two (2) children; LZSA CIiRISTINE A� and 76HATHAN F. HSMMA.
II
I direct that all my 7�st debts d funeral expenses shall be
paid from my residuary estate as s n aa practicable after my
decease. I
III �
Z direct that all taxes that may 1� assessed in aonsequence trf
my death, of whatever nature and by w� tever jurisdiction impose8,
shall be paid from my residuary estat as a part oP the expense of
the administration of my estate.
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I give, clevise and begueath all y property, whether real or
persanel, wherever sitnate, includinq ny property over which I may
hsve a power of appaintment to my hus nd, AZXON, provided that he
survives me by thirty (30) days. I
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If my husband, DTXON, shall pre cease or fail to survive ma
by thirty {30) days, I qive, 8ev e and bequeath all of my
property, whether real or pezsonal, w rever situate, including any
property over which 2 may have a ower of appointment, to my
da�ghter, LISA, per stirpes. �
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VI
Z nominate, constitute and appoi t my husband, DIXON, as
Executor of this LAST WILL, to serve wij hout bond. If my husband
1s unable or unwilling to act in that � apacity, then I naminate,
oonstitute and appaint my daughter, LIS1� as Sxecutrix of this LAST
WILL, to serve without bond.
IN� WITNESS WHEREOF, I, HTLDE E. ' , hava set my hand to
. this LAST WZLL this /3 � day of y� t'LLG.1't? , i94b.
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HILDE E. HEMMA
Signed, sealed, published and d lared by the above-named
RZLOE E. HEMII3A, as and for her Last .ill and Testaraent, in e
presenoe of us, who, at her request an in her gresence, and i �the
presence o£ each ather, have hereun subsaribed ovr na s as
witnesses.
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ACRNOWLEDG �
COMMONWEALTFT OF PENNSYLVANTA .
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COUNTY OF CVMBERLAND .
I, HILDE E. HEMMA, Testatrixl whaae name is signed to the
attaahed or fareqaing instrument, E having been duly qualified
according ta law, do hereby acknowle e that I signed and executed
the instrument as my LAST WILL; th I eigned it as my free and
voluntary act for the purposes thar �n e pressed.
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H 'DE E. HEMMA
( Sworn or a£firmed ta and acknowled e before me by AZLDE E. HEMMA,
Testatrix, this /.�� day af � y^urzi^c.� , 1496.
s
N �ary Bublic '
Ohrie si.s�t�id�y Q+tic
My�pmrcix' on�'fivphas 2z.Ane .t9�36
AFFIDAV
COMMONWEALTH OF PENNSYLVANIA .
COUIVTY OF CUMBERLAND .
We �Lt!(1� l�', Lt/ctff'.tlS ttT d �„L1QNfvz /7't. pytr��'fs
the witnesses whose names are signe to the attaahed or foregoing
instrument being duly qualified acoo � ing to law, do depose and eay
that we were present and saw Te ��atrix sigzr and execute the
instrument as her LAST WILL; that N E E. AEPII�SA signed willingly
and that ahe executed it as her f �a and voluntary aot for the
purposes therein expressed; that e ch of us in the hearinq and
sight af the Testatrix signed the �11 as witnesses; and that to
the best a£ aur knoxiedge, the Pest rix was at the time 18 yeaz
of age or more, of sovnd mind and nder no canstr int oz un e
inflnence.
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, _ -,''� ,j t"r- . g�t.l,:`..,..
Sworn or affirmed to nd acknowledged before me
this /3Y� day o£ .��f�,i,a ty , 1996.
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- N ary Publie
L�ar»dt�5r�r,tJd�rt P�ptic
M�hwO Ho,u,Cumbenark!CpypY�
MY��+YSSron E�'ueeJune22�1896