HomeMy WebLinkAbout03-31-14 (2) ,
,_ ,
,
,_ . _
J 150561�105
REV-1500 EX`°2.">�F`> �
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania
Bureau of Individual Taxes "`� �'` County Code Year File Number_
PO BOX z8o6oi (NHERITANCE TAX RETURN /j� �n
Harrisburg PA 1�128-0601 RESIDENT DECEDENT �� ` J �lX ��
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
06/02/2013 11/28/1923
DecedenYs Last Name Suffix Decedent's First Name MI
Jensen Earl N
(If Appticable)Enter Surviving Spouse's Information Below
Spouse's�ast Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FIIED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BEIOW
� 1. Original Retum O 2. Suppiemental Retum p 3. Remainder Retum(Date of Death
Prior to 12-13-82)
p 4. Limited Estate O 4a. Fuiure interest Compromise(date of p 5. Federal Estate Tax Return Required
death after 12-12-82)
C� 6. Decedent Died Testate q 7. Decedent Maintained a Living Trust _____ 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit(Date of Death O 1 L 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
Jeffrey N Yoffe (717) 343-1120
�
REGI�R OF WII.LS�ONIY�,
C -�
� � � t�7
First Line o(Address � -� �y �y
2 Lemoyne Drive � � � w �;� �
�__ �p �.�; �,, -_.�
,M _
Second Line of Address p, �^ ; ; �...., �_
Suite 100 " `�' � � ° i
�� c-� -,f --
City or Post Office State ZIP Code Q87E FILED �
N
Lemoyne PA 17043 -o � �-, crr, Q
�, � -T�
CorrespondenYs e-ma�i adaress:j�roffe@yoffelawoffice.com
Unde�penalhes of perjury.i declare that I have examined this retum,including accompanying schedules and statements,and to the bes[of my knowledge and beiief,
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
SIGNATU OF PERSON RESPpNSBLE FOR FI�ING RETURN OATE
ir. .�t L �,J- ��'��J �C c�3- u� - zo►�.
ADDRESS
2048 Chevy Chase Drive, Harrisburg, PA 17110
S�N TURE O�PRE�� OTHE$, �AN REPRESE ATIVE� /� �E
N �� �
ADDRESS
2 Lemoyne Drive, Suite 100, Lemoyne, PA 17043
PLEASE USE ORIGINAI. FORM ONLY
Side 1
� 1505610105 1505610105 �
J 1505610205
REV-1500 EX(FI)
Decedent's Social Security Number
DecedenCs Name:
RECAPITULATION
1. Real Estate(Schedule A). . . . . . . . . . . . . . . . . . . . . . .. . . . . .. .. .. .. . . . . . . . . . 1.
2. Stocks and Bonds(Schedule B) . . . . . .. . . .. .. . . .. .. . . .. .. . . .... . . . .... . 2.
3. Ciosely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) .. . . . 3.
4. Mortgages and Notes Receivable{Scheduie D) . . .. . . .. .. . . .... . . .. .. . . ... 4.
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E).. . . . . . 5. 6,337.74
6. Jointly Owned Property(Schedule F) O Separate Billing Requested . . . . . . . 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Properiy
(Schedule G) O Separate Billing Requested.. . . . . . . 7.
8. Total Gross Assets(total Lines 1 throu h 7 8. 6,337.74
9 ). .. . . .. .. . . .. . . . . .. .. . . . . . . .
9. Funeral Expenses and Administrative Costs(Schedule H). . . . .. .. . . .. .. . . . . . 9. 3,213.08
10. Debts of Decedent, Mortgage Liabiiities and Liens(Schedule I).. . . . .. . . . . . . . 10.
11. Total Deductions(total Lines 9 and 10). . . . . .. . . . . . . . . . . .. . . . .. . . . . . . . . . 11. $,213.08
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . .. . . . . .. . . . . .. . . . .. . 12. 3,124.66
13. Charitab�e and Governmentai 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. 3,124.66
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 3,124.66
(a)(1.2)X.045 15. 140.61
16. Amount of Line 14 taxable
at lineal rate X.0_ 16.
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collaterai rele X .15 18.
19. TAX DUE . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . .. . . .. .. . . . . . . . 19. �4�.61
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
� 1505610205 1505610205 J
REV-1500 EX(FI) Page 3 file Number
Decedent's Complete Address:
DECEDENT'S NAME
Earl N. Jensen
STREETADDRESS
551 Old Orchard Lane
CITY STATE ZIP
Camp Hill, PA PA 17011
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) - (1) 140.61
2. CreditslPayments
A.Prior Payments _
8.Discount
Total Credits�A+B) (2)
3. Interest
(3) 0.35
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT,
Fiil 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) 140.96
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
contains a 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,antl 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)J.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 chiltl 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 lineai 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.
RF..V 15Q2. FX+ (I2.-12)
�� �� � ��� pennsytvania SCHEDULE A
� DEPARTMENT OF REVENUE
INHERITANCETAX RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Earl N Jensen 21-13-0685
All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property
would be exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts,
Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
ITEM Include a copy of the deed showing decedenYs interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1• 551 Old Orchard Lane,Camp Hill,PA
Real estate not yet sold. Fair market value to be reported on a supplemental
inheritance tax retum.
TOTAL(Also enter on Line 1, Recapitulation,) $ 0.00
If more space is needed,use additional sheets of paper of the same size.
REV-i5o3 EX+(8-iz)
� pennsylvania SCNEDVLE B
DEPARTMENT OFREVENUE
INHERITANCETAXRETURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Earl N. Jensen 21-13-0685
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1' Cetera Advisor Networks,LLC. Value to be disclosed on a supplemental return.
TOTAL(Also enter on Line 2, Recapitulation) $
If more space is needed, insert additional sheets of the same size
REV-15o8 EX+(o8-iz)
� pennsylvania SCHEDULE E
�EPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Earl N. Jensen 21-13-0685
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. Integrity Bank Savings Account(Acct.#0406000023). Value to be disclosed on a supplemental return.
2. Integrity Bank Checking Account(Acct.#0206000051).Value to be disclosed on a supplemental return.
3. Integrity Bank Checking Account(Acct.#02201034638). Value to be disclosed on a supplemental return.
4. Refunded John Hancock insurance premium 1,912.74
5. 1 gun 125.00
g, 2002 Pontiac Sunfire 4,000.00
7, Miscellaneous household personal property 300.00
TOTAL(Also enter on Line 5, Recapitulation) $ 6,337.74
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+ {OS-13)
� pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Earl N. Jensen 21-13-0685
DecedenYs debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B. ADMINISTRATIVE COSTS;
1. Personal Representative Commissions;
Name(s)of Personal Representative(s)
Street Address
City State ZIP_
Year(s)Commission Paid:
2,700.00
2. Attorney fees:
3. family Exemptlon: (If decedenYs address is not the same as claimanYs, attach explanation,)
Claimant
Street Address
Clty ____ State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: 333.50
5. Accountant fees:
6. Tax Return Preparer Fees:
�� The Carlisle Sentinel(advertising) 104.58
Cumberland Law Journal(advertising) 75.00
TOTAL(Also enter on Line 9, Recapitulation) $ 3,213.08
If more space is needed, use additional sheets of paper of the same size.
REV-1513 EX+ (01-10)
�,`V`�i pennsylvania SCHEDULE �
� OEPARTMfNT OFRfVfNUE
]NHERITANCE TAX RETURN BE N E FICIARI ES
RESiDENT DECEDENT
ESTATE OF: FILE NUMBER:
Earl N Jensen 21-13-0685
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[Include outright spousal distributions and transfers under
Sec,9116(a)(1.2).]
1. Eric W.Jensen Son 1/2
Nancy K.Jensen Unremarried Daugh inLaw 1/6
PeterJensen Grandson 1/6
Phillip Jensen Grandson 1/6
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. $
If more space is needed,use additional sheets of paper of the same size.
LAST WiLL AND TESTAMENT OF EARL N.JENSEN
I, Earl N. Jensen, of Cumberland County, Pennsylvania, being of sound mind and
memory, do make, publish and declare this my Last Will and Testament, hereby revoking any and
all Wills by me heretofore made.
FIRST: 1 direct that my funeral be conducted in a manner corresponding with my estate and
situation in life,and that all my just debts and funeral expenses be paid and satisfied
by my Executor or Executrix hereinafter named, as soan as canveniently may be
after my decease.
SECOND: After payment of debts and funeral expenses set forth in paragraph FIRST above, 1
specifically devise the sum of $30,000,00 to my former daughter-in-law Diane
Jensen.
THIRD: After payment of debts and funeral expenses set forth in paragraph FIRST and after
payment of the specific devise set forth in paragraph SECOND, I give, devise and
bequeath 1) one-half(50%) of the remainder of my estate, both real, personal and
mixed, of whatsoever kind and wheresoever situate, to my son, Eric William
Jensen; 2) one-sixth (16.6667%) of the remainder of my estate, both real, personal
and mixed, af whatsoever kind and wheresoever situate, to my daughter-in-law
Nancy K. Jensen; 3) one-sixth(16.6667%) of the remainder of my estate, both real,
personal and mixed, of whatsoever kind and wheresoever situate, to my grandson
Peter Jensen; and 4) one-sixth (16.6667%)of the remainder of my estate, both real,
Page 1 of 5
�' �
E. .J.
personal and mixed, of whatsoever kind and wheresoever situate, to my grandson
Phillip Jensen,
FOURTH: If any one or more of the Beneficiaries set forth in paragraphs SECOND or THIRD
do not survive me for a period of at least 60 days, then I direct that the deceased
Beneficiary(ies)share(s)be divided into as many equal shares as there are surviving
Beneficiaries and then the resulting share(s) shall be distributed to the surviving
Beneficiaries.
FIFTH: Anything herein to the contrary notwithstanding, if any Beneficiary set forth herein
has not at the date of distribution of my estate, attained 21 years of age, I direct that
the share(s) allocable to such Beneficiary be paid in Trust upon the fol)owing terms
and conditions and for the following uses and purposes:
a) T'he Trustee shall invest and reinvest the Trust assets.
b) A separate Trust shall be maintained for each Beneficiary of mine
whose share is paid to said Trustee.
c) The Trustee may in its sole and uncontrolled discretion pay any amounts
of income and/or principal for the health, support, education, welfare
and maintenance of said Beneficiary(s).
d) All payments by the Trustee relating to a particular Beneficiary(s), or
expenses charged or paid allocable to a particular Trust, shall be paid
out of and from that Trust.
Page 2 of 5
V• �'
E. .J.
e) The Trusts shall be managed and the Trust funds invested in accordance
with the provisions of the Pennsylvania "Probate, Estates and
Fiduciaries Code", its supplements and amendments, except as
otherwise provided herein.
� Upon a Trust Beneficiary attaining age 21, that Trust shall terminate and
the Trustee shall pay to such Beneficiary, free and clear of the Trust, all
remaining assets of that Trust.
SIXTH: No interest in principal or income shall be assignable by any Trust beneficiary
hereinunder or available to anyone having a claim against such beneficiary until
actual distribution thereof to such beneficiary.
SEVENTH: I hereby nominate, constitute and appoint Eric William Jensen, to be the Executor
af this my Last Will and Testament. If the said Eric William Jensen is unable or
unwilling to serve as such,I then appoint Diane Jensen to so serve.
EIGHTH: I nominate, constitute and appoint Nancy K. Jensen to be the Trustee of any Trust
established pursuant to this Last Will and Testament.
NINTH: I direct that the Trustee may compensate herself out of any Trust over which they
are Trustee but that such compensation shall not exceed 1%af the net asset value of
the Trust per year.
TENTH: I direct that any fiduciary of mine herein named, be permitted to serve without bond
in any jurisdiction where a bond would be required for the faithful performance of
his or her duties, in the absence of this provision.
Page 3 of 5
� �
E. .
ELEVENTH: [ direct that any and all inheritance, estate and transfer taxes imposed upon my
estate, passing under my Wilt or otherwise, shall be paid out of the principal of my
estate before any distributions are made to any Beneficiaries set forth herein.
I, Earl N. Jensen, the Testator whose name is signed to the foregoing instrument,
having been duly qualified according to law, do hereby acknowledge that C signed and executed the
instrument as my Last Will; and that I signed it willingly and as my free and voluntary act for the
purposestherein expressed.
��C�?� � .�P (Seal)
Earl N.Jenscn
Sworn to or affirmed and acknowledged before me by Earl N. Jensen, the Testator,
this i��-�-�-1---day of � , 2008.
10A1MONlvE:11�111 UP NI�N�SYLVAI'dlA
NOYafIP� ;iC1�
Jeffrey N. Yofle- Nutary Puhlic AR UBLIC
East Pennsburo T�vp Cumberland County
My Commission Expirel Oct 23, 2008
Member,PennsylvaniP Association nf Notaries My Commission Expires:
We, �IldiiSS�i S e�y��� and �v/n'ltt� �. %vf��; the witnesses, whase
names are signed to the foregoing instrument, being duly qualified according to law, do depose and
say that we were present and saw the Testator sign and execute the instrument as his Last Will;that
the Testator signed willingly and executed it as his free and voluntary act for the purposes therein
expressed;that each subscribing witness in the hearing and sight ofthe Testator signed the will as a
Page 4 of 5
� �
E. .J
witness; and that to the best of our knowledge the Testator was at that time 18 or more years of
age,of sound mind and under no constraint or undue influ�nce.
. =��'�!' �( �-
Witness
.. , n �
/� - ��;�/
wim ss
Sworn to or affirmed and subscribed to before me by �/v/�u� /l�l yU t^f({ and
M�ll/��Sti S C��yG'i , witnesses this�day of // ,2008.
___._..._.s<<��:_._._�__ ``n�''�/�.
Ji�;��}C) iv. l�U�i�;�. ti`Ji.11)� ;�C;�i(C •
r.,.� ��,�,�:;��r��, n �, �_�,,»i,«i.,�,a c��,�,�v TAR AUBLIC
1�9}� ('ontmi;siun f�.����.s' Uc[ 23. 2008�
tvtanih-;i, ;un vdr,,..�•,,:s�:.��hoii v,Notones
My Commission Expires:
Page 5 of S
< /�` �
E. ,J.
LAW OFFICE
YOFFE & YOFFE,P.C.
2 Lemoyne Drive, Suite 100
Lemoyne,PA 17043
NORMAN M. YOFFE(1929-2010) Telephone(717)343-1120
JEFFREY N. YOFFE Fax(717)303-5226
March 28, 2014
Office Of Register Of Wills
Cumberland County Courthouse
1 Courthouse Square, Room 102
Carlisle, PA 17013
Re: Estate of Earl N. Jensen; 2013-00685
Dear Interested Person:
Please file the enclosed inheritance tax return. Thereafter, return to me a time stamped
copy of the 1 S` page of the return. A check for 140.96 is enclosed.
Thank you.
Sincerely,
YOFFE & YOFFE, P.C.
By -�"�:
Jeffrey N. Yoffe
jyoffe@verizon.net
N
n O
� o � � m
� � � � �
-a � o
''' z c� � cn �s
� �, r. _-� c�
,.,��, � n"; � +-rl F7'"1
� '. ""� C7
;� • ^>,, `:::> f.'�
C"7 �y "p ..�'7 ,,.rl
c� c -� � _ -�r
. � ►-� ,�H �
�, --r rv � rn
� c.� cn o
-�.7 'r]
_ . .,�. �.�.,».�,�.:���„-�
_. ��. . _
� N O
O � �
j O Q° �
� � j �
■� � "p N �
� �■ Dp�
'� v < �
� � � �
� � �
�
y � �
� o �
Vf ,�,
t� �
� y
VN
�
� � `
� �
� � _, �
._ ,.
u. -� � �
_
� `
� � -� � o �• �
�
� � c) � � ' �
�. O 3 n
� C � (D .�orw�.� U1�
� � � O �>
D c�/� p. '�
rn
� N cn
v � ny.
�� � � I �
W C � -s �
� � � vi..�.,� ��
'"`.
N n � � �
< ,
� � � �, t..:
O � N
� O �
e �
O N °`�
�
N � M � `
� �
��o�� � �
�
„�r
° v�-
��
o � `
m � �
..._. �c� ��U� �;"�4'���5�'�n� � O
1.�f�43 ,SfJ7Nd�0 =��_ � >
�,� ,'; -..��
._ _ ;
o C
L� ZI Wd T� ��W hIOl < �
� . � �
• �,--. .
� � �
� ; ,:._ _ ��-:, =�oz � �
� .�0 �JI.��O a3Q�0�3� �
�__ _. �/
.�.x�_ . _� � � � _�