HomeMy WebLinkAbout01-17-14 (3) � 15�5610105
REV-1500 Ex�oz_��,�F�,4: .��
OFFICIAL USE ONLY
PA Department of Revenue pennsylvania County Code Year File Number
oEP�w.rE�,o�aE�Ex��
Bureau of Individual Taxes INHERITANCE TAX RETURN / ' (,,� '
PO BOX 28o6oi RESIDENT DECEDENT �"f � 2�' G� 1�
Harrisburg PA 1�128 o6oi
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
07/25/2012 04/12/1973
DecedenYs Last Name Suffix DecedenYs First Name MI
Hockenberry Tyler � ',
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
N/A ' '
Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPUCATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
� 1.Original Return O 2•Supplemental Return O 3. Remainder Return(Date of Death
Prior to 12-13-82)
p 4.Limited Estate O 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
O 6. Decedent Died Testate O 7.Decedent Maintained a Living Trust _ S. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
p 9.Litigation Proceeds Received O 10.Spousal PoveRy Credit(Date of Death O 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 T0:
Name Daytime Telephone Number
Thomas P. Gleason Esquire '
REGISTER qF WILLS USE�,ONLY
C7 _...� 'C7 rn
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First Line of Address � �' � Q
� � � � �
49 West Orange Street � � r�... �, �� �
Second Line of Address r � � � "� �
_ _ D Uy � Q w�
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_ ' � C? G" DATF.�. ILED-^"G '"�,..,
City or Post Office State ZIP Code �
c7 ` � r— rz7
Shippensburg _ PA 17257 .� � � � �
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CorrespondenYs e-mail address:
Under penalties of pery'ury,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 based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE
� ADDRESS
1 OF PREPAR THE THAN EPRESENTATIVE ATE '
a. ' � �, 5 /
ADD ESS
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PLEASE USE ORIGINAL FORM ONLY
Side 1
� 1505610105 1505610105 J
� ;
� 1505610205
REV-1500 EX(FI) DecedenYs Social Security Number
oe�edent•S Name: Tyler D. Hockenberry
RECAPITULATION
1. Real Estate(Schedule A). ..... .. ......... ... ...... .......... . ...... .. 1.
2. Stocks and Bonds(Schedule B) .. . ....... ....... ......... .... .... ... .. 2.
3. Closely Held Corporation, PaRnership or Sole-Proprietorship(Schedule C) ... .. 3.
4. Mortgages and Notes Receivable(Schedule D)... ............ ... .. ....... 4. '
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)... .. . . 5. 64,249.32
6. Jointly Owned Property(Schedule F) O Separate Billing Requested . . .. ... 6. '
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested..... . .. 7.
8. Total Gross Assets total Lines 1 throu h 7 . ...... ..... . 8. ' 64,249.32
� 9 )..... ...... .....
9. Funeral Expenses and Administrative Costs(Schedule H). . ... ..... ...... ... 9. 14,882.40
10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule I)... ... .. .. ..... 10. 14,712.79
11. Total Deductions(total Lines 9 and 10)... ... ... ......... .. ...... ..... .. 1L 29,595.19 '
12. Net Value of Estate(Line 8 minus Line 11) ...... ... ..... .. .... ...... ... . 12. , 35,290.13
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) ..... .... .. ...... .. . .... 13. ,
14. Net Value Sub'ect to Tax Line 12 minus Line 13 . ........ ... . 14. ', 34,654.13
J � ) ... .. . .....
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 A- 15. , _
16. Amount of Line 14 taxable
at lineal rate x.0 45 34,654.13 �g. 1,559.44 '
17. Amount of Line 14 taxable
at sibling rate X.12 ' �7. '
18. Amount of Line 14 taxable
at collaterai rate X.15 18•
19. TAX DUE .. ........ ... ... . .. ... ... ... ... .. ........ .... ..... ... ... . 19. 1,559.44
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
� 15D5610205 1505610205 J
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
Tyler D. Hockenberry _.
---- _
STREETADDRESS
8 Cleversburg Road _ .
- -- -- -— - ---
CITY ' STRTE ' ZIP
Shippensburg PA , 17257
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 1,559.44
2. CreditslPayments
A.Prior Payments
B.Discount
Total Credits(A+B) (2)
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,Line 20 to request a refund. �4)
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 1,559.44
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.......................................................................................... ❑ �
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?...................................................................... ❑ �
2. If death occurred after Dec.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 property,which
containsa beneficiary designation? ........................................................................................................................ ❑ �
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 tlates of death on or after Jan. 1, 1995, the tax rate imposetl 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,antl 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 chiltl 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 decedenYs 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,
untler Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
REV-i5o8 EX+(08-1z)
� pennsylvania SCHEDULE E
DEPAHTMENTOFREVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Tyler D. Hockenberrry
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 P.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
�. First National Bank&Trust Co.of Newtown Checking Account No.5272950 3,339.15
2. First National Bank&Trust Co.of Newtown Savings Account No.4258323 26,285.15
3. 2012 Jeep Rubicon 26,603.00
4, Northwestem Mutual Final Disability Insurance Payment 8,022.02
TOTAL(Also enter on Line 5, Recapitulation) $ 64,249.32
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+ (08-13)
� pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
DecedenYs debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' Dugan Funeral Home 11,772.90
2. Cumberland Valley Memorial Gardens 2,470.00
B. ADMINISTRATIVE COSTS;
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid;
500.00
2, Attorney Fees:
3. Family Exemption: (If decedent's address is not the same as claimanYs,attach explanation.)
Claimant
Street Address
City State ZIP _
Relationship of Claimant to Decedent_ _ _____._...._.__
4, Probate Fees: 139.50
5. Accountant Fees:
6. Tax Return Preparer Fees:
7.
TOTAL(Also enter on Line 9, Recapitulation) $ 14,882.40
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+(12-12)
� pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCETAXRETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Tyler D Hockenberry
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• Citizens Bank payoff of loan for Jeep(Loan No.00002745374310) 10,375.41
2. Peco Gas for final gas bill 378.09
3. Chase VISA 158.18
4. Orrstown Bank for checks for Estate Account 41.75
5. Comcast for final cable bills 401.90
6. IRS for 2012 income tax payment 683.00
7. PA for 2012 income tax payment 42.00
8. Econo Storage for storage Estate items 699.60
9. AT&T for final phone bill 32024
10. AMICA for insurance on Jeep 819.33
11. Windsor Apartments for rent �93.29
TOTAL(Also enter on Line 10, Recapitulation) $ 14,712.79
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(01-10)
�m� pennsylvania SCHEDULE J
. DEPARTMENT OP REVENUE
���� INHERITANCETAXRETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Tyler D. Hockenberry
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS[Inciude outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1. Larry D.Hockenberry 8 Cleversburg Road,Shippensburg,PA 17257 Father 100%
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;
L
TOTAL OF PART II—ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed,use additional sheets of paper of the same size.