HomeMy WebLinkAbout06-25-14 (2) �1 REV-1500°"03-11'(" 1505610105'
PA Department of Revenue Pennsylvania
OFFICIAL USE ONLY
ennsy
Bureau of Individual Taxes County Code Year File Number
PO BOX 28o6o1 INHERITANCE TAX RETURN �I I I ' � 'C
Harrisburg,PA 17128.0601 RESIDENT DECEDENT `-'�-
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
04/06/2014 11/13/1923
Decedent's Last Name Suffix Decedent's First Name MI
Hubert Sarah A
(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
OW 1.Original Return O 2.Supplemental Return C=) 3. Remainder Return(Date of Death
Prior to 12.13-82)
C=D 4.Limited Estate C=) 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Retum Required
death after 12-12-82)
C=D 6.Decedent Died Testate O 7.Decedent Maintained a Living Trust 8.Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
CC 9.Litigation Proceeds Received CO 10.Spousal Poverty Credit(Date of Death CM 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
John S Hubert Jr (717) 532-8645
REGISTER OF WILLS USE NbbY
C7 s 23 M
First Line of Address O C— CD
O
8 Roger Ave M = c') z
n r
Second Line of Address f", CCn --T 0
l7 C7 '-. � '•1 'r1
City or Post Office State ZIP Code WE
O C n
Shippensburg PA 17257 = ry M
N Cn O
D 03 M
Correspondent's e-mail address:palionsfan @yahoo.c.Om
Under penames of perjury,I declare that I have examined this retum,including aeoompanyktg schedules and statements,and to the bast 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 preparar has any knowledge.
SIGNgC DATE
Y O
1441 06/25/2014
-ZDFVSS
8 Roger Ave., Shippensburg, PA 17257
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610105 1505610105 J
J 1505610205
REV-1500 EX(FI)
Decedent's Social Security Number
Decedent's Name: Sarah A Hubert
RECAPITULATION
1. Real Estate(Schedule A). ................:........................... 1.
2. Stocks and Bows(Schedule B) ....................................... 2. 513,551.02
3. Closely Held Corporation,Partnership 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. 108,230.85
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6.
7. Inter-Vrvos Transfers 8 Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested........ 7. 39,000.00
8. Total Gross Assets(total Lines 1 through 7)............................. B. - 660,781.87
9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. 4,541.36 .
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............... 10.
11. Total Deductions(total Lines 9 and 10)................................. 11. 4,541.36
12. Net Value of Estate(Una 8 minus Una 11).............................. 12. 656,240.51
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. 656,240.51
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.0- 15.
16. Amount of Line 14 taxable -
-
atlinealrate X.045 656,240.51 . 16. 29,530.82
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. 29,530.82
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p
Side 2
L 1505610205 1505610205 J
r—
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address:
DECEDENTS NAME
Sarah A Hubert
STREETADDRESS
206 East Burd St
CITY STATE ZIP
Shipperlsburg PA 17257
Tax Payments and Credits:
1. Tax Due(Page 2,Una 19) (1) 29,530.62
2, CreditsrPayments
A.Prior Payments
B.Discount 1,554.21
Total Credits(A+B) (2) 1,554.21
3. Interest
(3)
4. It Una 2 is greater than Una t+Line 3,enter the difference. This is the OVERPAYMENT,
Fill in oval on Page 2,Line 20 to request a refund. (4)
5. if Una 1+Line 3 is greater than tine 2,enter the difference.This is the TAX DUE. (5) 27,976.61
Make check payable to: REGISTER OF WILLS,AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN"X"IN THE APPROPRIATE BLOCKS
1. Did decedent crake a transfer and: Yes No
a. retain the use or income of the property transferred.......................................................................................... D 0
b. retain the right to designate who shag use the property transferred or its income............................................ ❑ ■
c. retain a reversionary interest...............................................................................................----------.............. D ■
d. receive the promise for life of either payments,benefits or cam?...................................................................... D 0
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 host for'or payabte-upondeath bank accoml or security at this or her death?,....._...... D
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation? ....._................................................................................................................. D
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,IM,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 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)).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 0m net value of transfers to or for the use of the decedents fineal 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.
REV4503 EX+(8-W
pennsylvania SCHEDULE B
INHERITANCE TAX RETURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Sarah A Hubert
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIP710N OF DEATH
11 GrovA Fund of America Class A 1,786.962 sh.@ 43.03 76,892,97
2 Investment Company of America Class A 2,558.092 sh.@ 37.34 95,519.16
3 Income Fund of America Class A 5,013.230 sh.@ 20.99 105,227.70
4 DNP Select Income Fund Class A 265.000 sh.@ 9.71 2,57315
5 Capital income Builder Class A 1,366.271 sh.@ 58.77 80,295.75
6 CSX Corp., CUSIP 126408GP2,300 sh.common @ 28.76 8,628.00
7 Campbell Soup Co., CUSIP 134429109,265 sh.common @ 44.31 11,742.15
8 DuPont E.I.DeNemours&Co.,CUSIP 208251306,125 sh,common @ 67.34 8,417.50
9 Duke Energy Corp., CUSIP 264410204,90 sh.common @ 70.49 6,344.10
10 International Paper Co., CUSIP 460146103,250 sh.common @ 45.81 11,452.50
11 Mondelez International Co., CUSIP 609207105,100 sh.common @ 34.64 3,454.00
12 Southern Company, CUSIP 842857107,250 sh.common @ 43.70 10,925.00
73 Vedzon Communications Inc„ CUSIP 92343V104,265 sh.common @ 48.04 12,730.60
14 Exxon Mobil Corp., CUSIP 30231G102,50 sh.common @ 97.36 4,868.00
15 PPL Corp., CUSIP 69351T106,90 sh.common @ 32.71 2,943.90
16 York Water Co., 600 sh.common @ 20.13 12,078.00
17 Fed.Home Loan Mtg.Corp.,Multicl.,CPN 5.5%,Due 1-15-33 4,686.22
18 PA St.Turnpike Common Oil,Franchise Talc Sub Rev.B,CPN 4.375%,Due 12-1-28 10,425.70
19 South Carolina SL,tnstn.Coastal Carolina D,CPN 4.5%,Due 9-1.21 10,092.90
20 John Hancock Venture Annuity Active Bond,Inception 11-29-93,1,851.9495 sh.@ 1850 34,253.72
TOTAL(Also enter on Line 2, Recapitulation) & 513,551,02
If more space is needed,insert additional sheets of the same size
REV-1508EX+(08-u)
r : pennsylvania SCHEDULE E
DEPARiMMOFREVOWE CASH, BANK DEPOSITS &MISC.
1"EMANCE TAX RMAn PERSONAL PROPERTY
AMOM DECEDOI
ESTATE OF: FILE NUMBER:
Sarah A Hubert
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.
TIEM VALUE AT DATE
NUMBER DESCRIfTiON OF DEATH
1. Insured Cash Acct.,LPL Financial Corp.,9785 Tower Center,San Diego,CA 92121 Acct.#29891680 14,975.87
2 Insured Cash Acct.,same address as above,Aoct.#29891682 661.27
3 PA St.Employees Credit Union,PO Box 67013,Harrisburg,PA 17106.7013
Savings account 21,253.41
Interest,April" 0.52
Checking account 23,036.41
Interest April 1.6 0,37
Money Market account 38,40114
Interest April 1.6 1,26
4 Automobile: 2007 Buick Lacrosse Sedan CX w/26,000 miles in good condition 8,500,00
5 Single bad w/boxspring,mattress,pillows,linens 300.00
6 Nightstand wllamp 75.00
7 40"TV 30000
8 Wicker chair w/cushions and ottoman 100.00
9 Lamp,stand-alone,comer 25.00
10 Dresser 150.00
11 Desk,small,wOair 100.00
12 Mirror,above desk 25.00
13 Wicker chest of drawers 100.00
14 Summer clothing:blouses,stacks,pajamas,underwear,socks,t-shirts,dresses,shoes,belts,pug 100.00
15 Winter clothing:coat stacks,sweaters,tops,boots,purse,hat scarves,gloves 100.00
16 Bathroom items:toothpaste,sham,cologne,towels,washchith,bathrobe 25.00
TOTAL(Also enter on Line 5, Recapitulation) # 108,230.85
If more space is needed,use additional sheets of paper of the same size.
REV-1510 EX+(08-09)
.( pennsylvania SCHEDULE G
DEPARTNENTOFREVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE DE DafTTURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDBEr
ESTATE OF
Sarah A Hubert FILE NUMBER
This schedule must be completed and filed If the answer to any of questions 1 through 4 on page three of the REV-1500 Is yes.
it DESCRIPTION OF PROPERTY
v TME TPANSEREE,TMR RFLMON"M DEC I DATE OF DEATH %OF DECDS EXCLUSION TAXABLE
M DATE ar TRA?ISFM ATTa A 00r OFM DES rap REU MAn. VALUE OF ASSET INTEREST vARVU VALUE
Hubert Jr,son,2-11-2014,cash in form of a check 14,000.00 3,000.00 11,000.00
A Hubert,daughterin law,2-21.2014,see above
14,000.00 14,000.00
3 Kyle H Hubert,grandson,2-7-2014,see above
14,000.00 14,000.00
TOTAL(Also enter on Line 7,Recapitulation) $ 39,000.00
If more space Is needed,use additional sheets of paper of the same size.
REV-1511 EX+(08-13)
-� pennsylvania SCHEDULE H
Ilk I
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Sarah A Hubert
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' Fogelsanger-Bricker Funeral Home,Inc.,direct cremation 2,695.00
2 Certified copies of death certificate(12) 72.00
3 Cumberland Co.coroner 30.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Names)of Personal Representative(s)
Street Address
City State ZIP
Years)Commission Paid:
2• Attorney Fees:
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: 408.50
5. Accountant Fees:
6. Tax Return Preparer Fees:
7. Sarah A Hubert memorial service @ Grace UCC,Shippensburg on 4-12-14
Stipends to minister and organist 200.00
Kathys Deli,Shippensburg,catered luncheon 508.38
Christine Cutchall:services rendered/decorating supplies for memorial serviceAuncheon prep 500.00
s Estate notices:Cumberland Law Journal 75.00
Carlisle Sentinel newspaper 52.48
TOTAL(Also enter on line 9, Recapitulation) ; 4,541.36
If more space is needed,use additional sheets of paper of the same size.
REV-1513 EX+(01-30)
- pennsylvania SCHEDULE
DEPARTMENT OF REVENUE
INNERTTANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Sarah A Hubert
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. John S Hubert Jr Son 100%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON UNES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
13 NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART U—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.