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Home My WebLink About09-02-14 (2) 1505610101 REV-1500 ° 01 a' $ OFFICIAL USE ONLY PA Department of Revenue pernsylvania Bureau of Individual Taxes County Code Year File Number PO BOX28o6o1 INHERITANCE TAX RETURN oZ 0 9 Q 6 9 Harrisburg PA 27128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW %� A77720aq 1 o337iE Decedent's Last Name Suffix Decedent's First Name MI (if Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix am Spouse's First Name MI ® I I I I I Irn-r I I I 1 ❑ Spouse's Social Security Number I� THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW p 1.Original Return cog 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 S. Federal Estate Tax Return Required death after 12-12-82) �E rePwAte 'ow ewl ;.741 re1irrd 11� 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 1 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) Q 9.Litigation Proceeds Received Q 10.Spousal Poverty Credit(date of death O 11, Election to tax under Sec.9113(A) between 12-31.91 and 1-1-96) (Attach Sch.O) ~ CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Numbpt„r-�- C1 �, $ / L 5 I t r t �� r REGIS" .O L SE OT%Y� AM � Cn tv o First line of address l7 O C7 Second line of address - = t i r - City or Post Office state ZIP Coda I DATE FiW M CH W AA11cisfek lc El / 7105- ' T Correspondent's*-mail address: Ce,,S 3jq�;)eVM',!%Zf.Ae y Under penalties of perjury,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 E complete.Declaration of preparer other than the personal representative is based on all Information of which preparer has any knowedge. SIGG�O'R30 P SIBLE FO FILIN RETURN DATE r �i ADDRESS 5ccf .T HCr✓ E Sy CHR2/J T. /YE.YiYE-35V 00(0 / W tCtuR�"P� SIGNATU OF PREP/R DATE JTf �7`4�' �r� ADDRESS CRf/2� SNJi.c kssV PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610101 1505610101 J 1505610105 REV•1500 EX ♦ [� � RECAPITULATION 1. Real Estate(Schedule A). .4... ........... 2. Stocks and Bonds(Schedule B) ..... ............ ............... ....... 2. 1l � t �• r� 3- Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 1 '(J 4. Mortgages and Notes Receivable(Schedule D). ............ ....... ....... 4- 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. 6. Jointly Owned Property(Schedule F) p Separate Billing Requested . ...... 6. r 7- Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) p Separate Billing Requested,....... T 8. Total Gross Assets(total Lines 1 through 7)................ .......... ... 8. 9-•Funeral Expenses and Administrative Costs(Schedule H).............. 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) ........ ...... 10. 11. Total Deductions(total Lines 9 and 10).._............................. 11, J 7 l •,` S 12. Net Value of Estate(Line 8 minus Line 11) ...... ........................ 12. • 7 013, Charitable and Governmental Bequests/Sec 9113 Trusts for which _ �f•s ' an election to tax has not been made(Schedule J) .........:.......... C,4 ' t 14. Net Value Subject to Tax(Line 12 minus Line 13) ............ ............ 14. TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable _ at the spousal tax rate,or i transfers under Sec.9116 i . (01.2)X-00__ 15. •.Q d 16. Amount of Line 14 ie _ c+ at lineal rate x.a ' ,s. 3 17. Amount of Line 14 taxable at sibling rate X.12 17. •,Q 0 18. Amount of Line 14 taxable - - ' at collateral rate X.15 } 1 18. „ ' , L'6 C 19. TAX DUE........................ ...:.'^.,....�...'..,......s.:. 19, i . 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p Side 2 1505610105 1505610105 J REV-1500 EX'Page 3 - File Number p71-+09-619 Decedent's Complete Address: DECEDENT'S NAME -- STREETADDRESS - -- a6o . fir /rive_ — -------- -------- - --- CITY —'- -.—_— -- STATE A/ee)I intm lwluxal /Ji1` 11076 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) 2. Credits/Payments A.Prior Payments B.Discount fJ Total Credits(A+B) (2) 3. Interest (3) �r /2 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) O 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) ?3 , -- Make check payable to: REGISTER OF WILLS,AGENT. L 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................................................-.................................................................... .... ❑ 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?..........._ ❑ In 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, 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)(i)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure cf 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 172 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(1.2)(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 172 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. AEV-iSo8 EX+(u-ro) r pennsytvania SCHEDULE E DEPARTMENT OP REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: �Rrfs HenneSSf' FILENia� 09 of f Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must he disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH I. OfiiO L�rtslrq/fY , L44Ler ha' eopellea' & r&;o4urscd Amdc 6X7,oa TOTAL(Also enter on tine 5, Recapitulation) $ 71 0,0 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(14-06) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF ClILE NUMBER Clara Jr-.T llwessy a'1-04- 4;t9 Debts of decedent must be reported on Schedule 1 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERALEXPENSES: - 7. B. - ADMINISTRATIVE COSTS: i. Personal Representative's Commissions Name of Personal Representative(s) Street Address City_ State Zip Year(s)C/o�m�mission Paid: _cCtt J1� !� ! Z. Attorney FeesNa4es E.6h;e--lQ3 u Ir kudhn or 'T++x,C�3,, prV, 01 ,711kr, %A,c Pelsfrh, prep Reearj,t&,id fi weaves, Correa pond YFttef,427. 7 3. Family Exemption:(If decedent's address is not the same as claimant's,attach exploration) Claimant 111�+1E Street Address .— city —_.`—..—State ---._LP _—.—_—. Relationship of Claimant to Decedent 4. Probate Fees S. Accountant's Fees 6. Tax Return Preparer's Fees i. �;t�ky iMHer. Ty Rshcerr T /d`;or7 $. �eiMbNTS fi �anles f .Sir;eld5 ri, �,r e s, ce,f; ed ,»At l."nyi� ji`5(u a. ett,�shirr.� 1�a n— TOTAL(Also enter on line 8, Recapitulation) $ /7/, 1 (it more space is needed,insert additional sheets of the same size) �� - REV-1513 EX+(9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER H�`Nrt/&'S5Y, C°..L�Of7,¢ .7' •�/-o9-6/q RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAMEAND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustees) OF ESTATE I TAXABLE DISTRIBUTIONS(include outright spousal distributions,and transfers under Sec.6116(a)(tz)) 1 C NENN�3Sy son Y3 21.7 6#1w zvle Lane /NaClure f AA 17BY/ d Tf1CC1"uELl� CoHEnI �au1k.f.ea- yg S"oS %a�ryirto� fir, oxan N,!/, ttttd aa75F�' 8. aSE,grt/ iT. 1lEW414-33 y /°d 6 W. .4�hC�_°Ff or 17°11 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18,AS APPROPRIATE,ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTION&: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE t. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1, TOTAL OF PART H—ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (it more space is needed,inson additional sheets of the Same size) ' ep\w111s\KENNESSYC1.ara LAST WILL AND TESTAMENT OF . CLARA J. HENNESSY I, CLARA J. HENNESSY, of the Borough of New Cumberland, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me . ITEM S : I bequeath my automobiles, household and personal. effects and other tangible personalty of like nature (not including cash or securities) together with any existing insurance thereon to such of my children, JACQUELINE COHEN, CHRIS J. HENNESSY, and SEAN J_ HENNESSY, as are then living, to be divided among them by my Co-Executors with # due regard for their personal preferences in as nearly equal shares as practical . ITEM II : I hereby give my son, SEAN J . HENNESSY, the option to purchase my home at 200 Poplar Avenue, New Cumberland, Cumberland County, Pennsylvania, for the lesser of the appraised value of such property at the time of my death or One Hundred Twenty Five Thousand and N01100 ($125, 000 . 00) Dollars . Such option must be exercised within six (6) months following my death . Any share which my son, SEAN J. HENNESSY, may be entitled to receive under Item III below may ` be used by him as a credit to reduce the aforesaid purchase price, if Page J. of 4 i he so desires . Should my son, SEAN J. HENNESSY, predecease me or fail to exercise such option, I devise such residence as part of my residu- ary estate . ITEM III : I devise and bequeath all the rest, residue and remainder of my estate, of every nature and wherever situate, in equal shares to my children, JACQUELINE COHEN, CHRIS J. HENNESSY, and SEAN J. HENNESSY, or to the survivor of them. ITEM IV: I appoint my children, CHRIS J. HENNESSY and SEAN J. HENNESSY, Co-Executors of this my last will. . ITEM V: No fiduciary acting hereunder shall be required to post bond or enter security for the faithful performance of his duties in any jurisdiction. IN WITNESS WHEREOF, I, CLARA J. HENNESSY, have hereunto set my hand and seal this day of 2006 . CRA J. HENNESSY Q�� SIGNED, SEALED, PUBLISHED and DECLARED by CLARA J_ HENNESSY, the Testatrix above named, as and for her Last Will and Testament, and in the presence of us, who at her request, in her presence and in the presence of each othh�errte,-have subscribed our names as witnesses . Address dd r es sG Witness Address Page 2 of 4 COMMONWEALTH OF PENNSYLVANIA: : SS: COUNTY OF CUMBERLAND I, CLARA J. HENNESSY, the Testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law do hereby acknowledge that I signed and executed this instru- ment as my last will; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein contained- CLARA HENNESSY Sworn to or affirmed to and acknowledged before me by CLARA J. HENNESSY, the Testatrix, this It day of 2006. COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL Notary u li KATHLEEN KEIM,Notary Public New Cumberland Boro.Cumberland Co. My Commission Expires Dec.5,2006 Page 3 of 4 I COMMONWEALTH OF PENNSYLVANIA : : SS: COUNTY OF CUMBERLAND We, �� vT � and the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw Testatrix sign and execute the instrument as her last will; that Testatrix signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the will as witnesses; that to the best of our knowledge, the Testatrix was at that time eighteen or more years of age, of sound mind and under_ no constraint or undue influence . the Witness — / Sworn to or affirmed to and ackno dgedE iDefore me by fry and j l witnesses, this this r day of Ytt 2006 . i COMMNNWEALTH Of PEN —J NSYLVANiA Notary Pu 1 c NOTAR3AL SEAL KATHLEEN KEIM NaLtry'Pubilc New Cumberland 9oro.Cumberland Co. My Commission Expires Dec.5,200 6 } Page 4 of , 4 1