HomeMy WebLinkAbout11-08-13 .J REV-1500 1505610143
EX(02-11)
i
PA Department of Revenue OFFICIAL USE ONLY
p Pennsylvania County Code Year File Number
Bureau of Individual Taxes DEPARTMENT OF REVENUE
PO BOX.280601 INHERITANCE TAX RETURN 21 13 0198
Harrisburg,PA 17128-0601 RESIDENT DECEDENT_
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
02 07 2013 09 13 1926
Decedent's Last Name Suffix Decedent's First Name MI
HOBBS AUDREY 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
® 1. Original Return ❑ 2. Supplemental Return ❑ 3.Remainder Return(Date of Death
Prior to 12-13-82)
❑ 4. Limited Estate ❑ 4a.Future Interest Compromise ❑ 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
g Decedent Died Testate 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
® (Attach Copy of Will) ❑ (Attach Copy of Trust)
❑ 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
GERALD J BRINSER 717 838 6348
F-7
RIj(jjlSTER OF W41:S UM OWLY
Ca
First Line of Address
6 E MAIN STREET CO rzz rfl
r"n Second Line of Address
PO BOX 323 ' C> -71
c a c> r �'
�y C DATE FILED 7
City or Post Office State ZIP Code
PALMYRA PA 17078 w Cn
Correspo dent'se-mail address: gjbrin @aol.com t
Under pe Ities of perjury,I decl t I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true, orrect and mplete ecl ation of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGN E OF PERSO RE 0 SI E FOR FILING RETURN DATE
x Karen J. Durbin ) .�-Y-
r �-
A RESS
21 Laurel Drive, Mechanicsburg, PA 17055
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
Gerald J Brinser JYZ13
ADDRESS
Brinser,Wagner Zimmerman
6 E. Main Street, Palmyra, PA 17078
Side 1
1505610143 1505610143
ll�\
1505610243
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: H O B B S, A U D R E Y M.
RECAPITULATION
1. Real Estate(Schedule A).......................................................................................... 1.
2. Stocks and Bonds(Schedule B)............................................................................... 2.
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C).......... 3.
4. Mortgages&Notes Receivable(Schedule D).......................................................... 4.
5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)................ 5. 11 , 384 . 76
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested............. 7. 61 , 548 . 9 9
8. Total Gross Assets(total Lines 1 through 7).......................................................... 8. 72 , 933 . 75
9. Funeral Expenses and Administrative Costs(Schedule H)..................................... 9. 6 , 486 . 45
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................. 10. 8 , 687 7 4
11. Total Deductions(total Lines 9 and 10).................................................................. 11. 15 , 174 . 19
12. Net Value of Estate(Line 8 minus Line 11)............................................................. 12. 57 , 759 . 56
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J)................................................. 13.
14. Net Value Subject to Tax(Line 12 minus Line 13)...................................:............. 14. 57 , 759 . 56
TAX COMPUTATION-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.00 15.
16. Amount of Line 14 taxable
at lineal rate X .045 57 , 759 . 56 16. 2 , 599 . 18
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18..Amount of Line 14 taxable
at collateral rate X .15 18.
19. TAX DUE................................................................................................................... 19. 2 , 599 . 18
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
1505610243 1505610243
REV-1500 EX Page 3 File Number 21 - 13 - 0198
Decedent's Complete Address:
DECEDENT'S NAME
Hobbs, Audrey M.
STREET ADDRESS
100 Mt. Allen Drive
CITY STATE ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 2,599.18
2. Credits/Payments
A. Prior Payments 2,470.00
B. Discount 129.96
Total Credits(A +B) (2) 2,599.96
3. Interest
(3) 0.00
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) 0.78
Check box on Page 2,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)
Make Check Payable to: REGISTER OF WILLS, AGENT.
— " 7*^ '-"'nab. �"' ---•roS,"_" / x'�",�° .°"'' /' "-#^rb j '�
4 z,
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;.................................................................................. ❑ ❑
b. retain the right to designate who shall use the property transferred or its income;.................................... ❑ ❑
c. retain a reversionary interest;or.................................................................................................................. ❑ Ox
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?....................................................................................................................... ❑ ❑x
3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?......... ❑ ❑x
4. Did decedent own an individual retirement account,annuity,or other non-probate property which
contains a beneficiary designation?...................................................................................................................... ❑x ❑
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 January 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 ta)(1.3)1. A
sibling is defined under Section 9102,as an individual who has at least one parent in common with the decedent,wfiether y blood or adoption.
pennsylvania SCHEDULE E
DEPARTMENT NCETA RETURN CASH BANK DEPOSITS AND MISC.
INHERITANCE TAX RETURN ,
RESIDENT DECEDENT PERSONAL PROPERTY
FILE NUMBER
ESTATE OF Hobbs, Audrey M. 21 - 13 -0198
Include the proceeds of litigation and the date the proceeds were received by the estate.All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE OF
NUMBER DESCRIPTION DEATH
1 PNC Bank-Checking Account#9100812728 8,528.37
(Includes accrued interest of$0.07)
2 PNC Bank-Savings Account#9185030767 104.03
3 Long-Term Care Insurance 2,480.00
4 Verizon - Refund 51.84
5 CNA Annuity Payment 20.52
6 Miscellaneous Personalty- Little or no Value 200.00
TOTAL(Also enter on Line 5, Recapitulation) 11,384.76
REV-1510 EX+(08-09)
rc Pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN INTER-VIVOS TRANSFERS &
RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY
ESTATE OF Hobbs,Audrey M. FILE NUMBER
21 - 13-0198
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF EXCLUSION
NUMBER Include the name of the transferee,their relationship to decedent VALUE OF ASSET INTEREST (IF APPLICABLE) TAXABLE VALUE
and the date of transfer. Attach a copy of the deed for real estate.
1 Transamerica-Annuity#0200PB00015,with three 61,548.99 100% 61,548.99
children named as beneficiaries.
Note: These funds were used by the beneficiaries to
pay expenses of$3,789.43 in excess of probate
assets, leaving the beneficiaries a net amount of
$57,759.56.
TOTAL(Also enter on line 7, Recapitulation) 61,548.99
REV-1511 EX+(10-09)
Pennsylvania SCHEDULEH
'ilk i DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT MLA11� h71 IW
ESTATE OF Hobbs, Audrey M. FILE NUMBER 21 - 13 -0198
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER FUNERAL EXPENSES:
A. 1 Myers-Harner Funeral Home- Balance of Funeral Expenses 2,124.00
2 Messiah Village- Funeral Luncheon 802.95
3 Gravestone 2,266.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zip
Year(s)Commission Paid
2. Attorney's Fees Brinser, Wagner&Zimmerman --Gerald J. Brinser 900.00
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 Register of Wills (Ltrs. Pd. $60.00 = $10,001 -$25,000) 143.50
5. Accountant's Fees
6. Tax Return Preparer's Fees Laird Gemberling 250.00
7. Other Administrative Costs
Note: Beneficiaries of Annuity on Schedule G paid expenses over and above amount
of probate assets.
TOTAL(Also enter on line 9, Recapitulation) 6,486.45
pennsylvania SCHEDULE
!\\' DEPARTMENT REVENUE DEBTS OF DECEDENT
Li��yr INHERITANCE TAX RETURN , MORTGAGE
RESIDENT DECEDENT LIABILITIES & LIENS
FILE NUMBER
ESTATE OF Hobbs, Audrey M.
21 - 13 -0198
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
1 Alert Pharmacy 23.64
2 Messiah Lifeways 8,654.20
3 AD & D Insurance-ACH Deduction 9.90
Note: Beneficiaries of Annuity on Schedule G paid expenses over and above amount of
probate assets.
TOTAL(Also enter on Line 10, Recapitulation) 8,687.74
REV-1513 EX+(01-10)
vs, pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF Hobbs,Audrey M. FILE NUMBER
f�
21 - 13-0198
,RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY Do Not ListTrustee(s)
I TAXABLE DISTRIBUTIONS[include outright spousal
distributions,and transfers-
under Sec.9116(a)0 2)]- -
1 Karen J. Durbin Daughter 1/3 Personalty; 19,638.25
21 Laurel Drive. Portion of Schedule
.Mechanicsburg, PA 17055 ,, i. G; 1/3 Residue s
2 David W. Hobbs t }! 1' Son 1/3 Personalty; 19,060.66
411 Kingsley Blvd. ,P,ortion of Schedule
Peckville, PA .18447 .'" +' . G; 1/3 Residue, '
3 William D. Hobbs Son 1/3 Personalty; 19,060.66
1055 Mill Road Portion of Schedule,
Pen Ar'gyl, PA 18073 1 ' '"' G; 1/3 Residue .
it
i
Enter dollar.amounts for distributions shown above on lines 15 through 18 on 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
I 1 1
{
,
{
B.CHARITABLE AND,GOVERNMENTAL DISTRIBUTIONS
I 1 Child Evangelism Fellowship of Eastern PA, Inc. 0.00
P.O. Box 4375, Harrisburg, PA 17111-0375 (5% Residue)
2 Messiah Village, 100 Mt.Allen'Drive 0.00
Mechanicsburg, PA 17055 1I s (5% Residue)
1
' - 1
TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
WILL
OF
AUDREYM. HOBBS a
I, AUDREY M. HOBBS, currently of Upper Allen Township, Cumberland
County, Pennsylvania, declare this to be my Last Will and Testament, hereby revoking
any and all prior Wills and Codicils made by me.
I. I direct that all my just debts and funeral expenses be paid from the assets of my
estate as soon as practicable after my demise.
II. I direct that all estate and inheritance taxes that may be assessed in consequence
of my death, shall be paid out of the principal of my general estate to the same effect as if
said taxes were expenses of administration and all property includable in my taxable
estate whether or not passing under this Will shall be free and clear thereof.
III. I bequeath unto my husband, William T. Hobbs, all tangible personal property
which I own at my death.
IV. All the rest, residue and remainder of my estate, of whatever nature and wherever
situate, including property over which I hold a power of appointment, I devise and
bequeath unto my husband, William.
V. In the event that my husband, William, does not survive me, I devise and
bequeath my estate that would have otherwise.passed under Paragraphs III and IV above
as follows:
A. I bequeath equally unto my children, namely, Karen J.
Durbin, David W. Hobbs and William D. Hobbs, all tangible personal
property they can agree upon. Any items not chosen shall pass as part of
my residuary estate below.
B. The residue of my estate shall be divided as follows:
1. Five percent (5%) unto Child Evangelism -
Fellowship, Dunmore, Pennsylvania, to be used as it
determines best;
2. Five percent (5%) unto Messiah Village,
Mechanicsburg,Pennsylvania, to be used for its Endowment
Fund for Benevolent Care;
3. Ninety percent (90%) to be divided equally
among my children, Karen, David and William. If any child
predeceases me, his or her share shall pass unto his or her
issue per stirpes.
VI. I appoint my husband, William T. Hobbs, Executor of this my Will. In the event
that he fails to qualify or ceases to act as Executor, I appoint my daughter, Karen J.
Durbin, Executrix of this my Will. In the event that she fails to qualify or ceases to act as
Executrix, I appoint my son, David W. Hobbs, Executor of this my Will. In the event that
he fails to qualify or ceases to act as Executor, I appoint my son, William D. Hobbs, -
Executor of this my Will.
VII. I direct that no bond be required of my fiduciaries for the faithful performance of
their duties in any jurisdiction.
IN WITNESS WHEREOF, I, AUDREY M. HOBBS, herewith set my hand to
this my Last Will, typewritten on two (2) sheets o paper including the attestation clause,
and signatures of witnesses, this 144' day of , 2011. . -
��i (SEAL)
j
AUDREY M. HOBBS
Signed by AUDREY M. HOBBS, by her declared to be her Will in our presence,
who have hereunto subscribed our names as witnesses in her presence and at her request,
this 7 day of +4--(- , 2011.
residing at
residing at h_ `
1
-2-
COMMONWEALTH OF PENNSYLVANIA _
COUNTY OF LEBANON
WE, AUDREY M. HOBB S, GERALD J. BRINSER and K AT S► �• 1Q��b.�� ,
the testatrix and the witnesses, respectively, whose names are signed to the attached or
foregoing instrument, being first duly affirmed, do hereby declare to the undersigned
authority that the testatrix signed and executed the instrument as her Last Will and that
she signed willingly (or willingly directed another to sign for her), and that she executed
it as her free and voluntary act for the purposes therein expressed, and that each of the
witnesses, in the presence and hearing of the testatrix, signed the Will as witnesses and
that to the best of our knowledge the testatrix was at that time eighteen years of age or
older, of sound mind and under no constraint or undue influence.
AUD Y M. HOBBS
WITNE7
S
Subscribed, sworn or affirmed and acknowledged before me by AUDREY M.
HOBBS the testatrix, GERALD J. BRINSER and Kp,cery witnesses,
this ''1` day of qua- ' 2011.
U�v (SEAL)
Notary Publi
COMMONWEALTH OF P NNSYLVANIA
NOTARIAL SEAL
WENDY L.CRAWFORD,Notary Public
Palmyra Boro..Lebanon County
My Commission Expires Septemker ihaoa
-3- -
COMMONWEALTH OF PENNSYLVANIA REV-1162 EX0 1-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.280601
HARRISBURG,PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 017495
i
i
DURBIN KAREN J
21 LAUREL DRIVE
MECHANICSBURG, PA 17055
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
-------- fold
---------- --------
101 $2,470.00
ESTATE INFORMATION: SSN:
FILE NUMBER: 2113-0198
DECEDENT NAME: HOBBS AUDREY M
DATE OF PAYMENT: 04/25/2013
POSTMARK DATE: 04/24/2013
COUNTY: CUMBERLAND
DATE OF DEATH: 02/07/2013
TOTAL AMOUNT PAID: $2,470.00
REMARKS: KAREN DURBIN
CHECK# 1
INITIALS: WZ
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
TAXPAYER
Apr. 22. 2013 10: 55AM PNC Bank No. 2908 P. 1/2
A.pnil 22, 2013
Gerald J Brinser Esq.
Brinser 'Wagner &Zimmerman
6 E main St 2°d Fl
P 0 Box 323
Palmyra, PA 17078
i
RE: Audrey M Hobbs
SSN: 189-20-0278 l'
DOD: 02-07-2013
Dear Mr. Brinser:
In response to your request for Date of Death (DOD)balances for the customer noted above, our
records show the following:
Checking Account
.Account#9100812728 Established: 09-29-1954
AUDREY M HOBBS
DOD balance: $ 8,528.30+0.07 accrued interest
Savings Account
,Account 4 9185030767 Established: 01-28-1983
AUDREY 14013BS
DOD balancer $ 1 04.03 +0.00 accrued interest
Please note that this office provides date of death balances for deposit accounts(IRAs, CDs, Checking and
Savings). We do not process any fmabcial 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
Page 1 of 2
Apr. 22. 2013 10: 55AM PNC Bank No. 2908 P. 2/2
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 lave-.
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. ,lf you have received this
communication in error,please note me immediately by reply or by telephone at 800-762-1775 and
immediately destroy this faxed document.
Page 2 of 2
RECEIPT FOR PAYMENT
GLENDA FARNER STRASBAUGH Receipt Date : 2/19 2013
Cumberland County - Register Of Wills Receipt Time : 11 : 0 :36
One Courthouse Square Receipt No. : 1073116
Carlisle, PA 17613
HOBBS AUDREY M
Estate File No. : 2013-00198
Paid By Remarks : BRINSER WAGNER ET AL
HMW
------------------------ Receipt Distribution ------------------------
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS TEST 60 . 00 CUMBERLAND COUNTY GENERAL FUN
WILL 15 . 00 CUMBERLAND COUNTY GENERAL FUN
SHORT CERTIFICATE 10 . 00 CUMBERLAND COUNTY GENERAL FUN
JCS FEE 23 . 50 BUREAU OF RECEIPTS & CNTR M.D
AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN
INVENTORY 15 . 00 CUMBERLAND COUNTY GENERAL FUN
INH TAX RETURN 15 . 00 CUMBERLAND COUNTY GENERAL FUN
----------------
Check# 3885 $143 . 50
Total Received. . . . . . . . . $143 . 50
4/2
2
✓4
LAW OFFICES
BRINSER,WAGNER&ZIMMERMAN
6 EAST MAIN STREET-SECOND FLOOR
(EAST MAIN&SOUTH RAILROAD STREETS)
P.O.BOX 323
PALMYRA,PA 17078
PHONE:(717)838-6348
FAX:(717)838-6912 MECHANICSBURG OFFICE
MESSIAH VILLAGE
GERALD J.BRINSER 100 MT.ALLEN DRIVE
KEITH D.WAGNER MECHANICSBURG,PA17055
JOHN M.ZIMMERMAN PHONE/FAX(717)697-4666
CALEB J.ZIMMERMAN
November 4, 2013
Glenda Farner Strasbaugh, Register of Wills
Cumberland County Courthouse c Co rn
1 Courthouse Square -
Carlisle, PA 17013 )> --+
r M oo
In Re: Audrey M. Hobbs Estate Cn -�
File No. 21-13-0198 c� �
C) =` C*'�p
w r-- rn
Dear Register of Wills, E—• c
D ;n
Enclosed you will find two (2) copies of the PA Inheritance Tax Return for the above-
captioned estate.
If you have any questions,please feel free to contact me.
Thank you.
Very truly yours,
BRINSER,WAGNER& ZIMMERMAN
Gerald J. Brinser
GJ13/wlc
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