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Home My WebLink About10-10-14 (2) • J REV-1500 EX(02-11) 1505610143 PA Department of Revenue y OFFICIAL USE ONLY P Penns Ivania County Code Year File Number Bureau of Individual Taxes DEPARTMENT Of REVENUE PO BOX.280601 INHERITANCE TAX RETURN 21 13 0967 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW 08 20 2013 04 05 1958 Decedent's Last Name Suffix Decedent's First Name MI HUFE74M CAROL 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 0 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) 6 Decedent Died TestateDecedent Maintained a Living Trust (Attach Copy of Will) ❑ (Attach Copy of Trust) 8. Total Number of Safe Deposit Boxes F—] 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 0) ( ) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number L REBECCA ABLES 717 263 2121 REGISTER OF WILLS,UE ONLY M First Line of Address C?�7 M o 79 ST PAUL DR z�- r- ►--� r�1 rn Second Line of Address r-"' _: Ch a Ci or Post Office DA ILEDZ3 City State ZIP Code c� CHAMBERSBURG PA 17201 - =; ry r - rn Cn o Correspondent's e-mail address: lables(a�salzmannhughes.com 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 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 RETURNDAT v G'. -7,--2`,,_�„� Doris C. McCans f(� ir I� ADDRESS 304 Franklin Way, Shippensburg, PA 17257 SIGNAT=ORE RER OTHER THAN REPRESEKTATIVE DATE L. Rebecca Ables ESS 79 St. Paul Dr., Chambersburg, PA 17201 Side 1 L 1505610143 1505610143 J -tNI, 1505610243 REV-1500 EX 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. 11,292 . 66 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) a Separate Billing Requested............ 7. 1 , 102 . 34 8. Total Gross Assets (total Lines 1 through 7)........................................................ 8. 12 , 395 . 00 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 3, 925 . 90 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 7 ,300 . 38 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 11 ,226. 28 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 1f168 . 72 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. 1, 168 . 72 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. 0 . 00 16. Amount of Line 14 taxable 1 168 . 72 16. 52 . 5 9 at lineal rate X .045 17. Amount of Line 14 taxable at sibling rate X.12 0 . 00 17. 0 . 00 18. Amount of Line 14 taxable at collateral rate X.15 0 . 00 18. 0 . 00 19. TAX DUE................................................................................................................ 19. 52 . 59 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑ Side 2 1505610243 1505610243 J REV-1500 EX Page 3 File Number 21-13-0967 Decedent's Complete Address: DECEDENT'S NAME Huffman, Carol A. STREET ADDRESS 141 Cottage Rd. CITY STATE ZIP Shippensburg PA 17257 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 52.59 2. Credits/Payments A. Prior Payments B. Discount 0.00 Total Credits(A +B) (2) 0.00 3. Interest (3) 0.64 4, If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) 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) 53.23 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;............................................................................... ❑ ❑x b. retain the right to designate who shall use the property transferred or its income;.................................. ❑ ❑x c. retain a reversionary interest;or............................................................................................................... ❑ 0 d. receive the promise for life of either payments,benefits or care?............................................................ ❑ ❑x 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?....... ❑ ❑x 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 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(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. Rev-1508 Ex+(11-10) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Huffman, Carol A. 21-13-0967 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 NUMBER DESCRIPTION OF DEATH 1 Orrstown Bank-lifetime savings account#70200108 634.54 ------. 2 Orrtstown Bank,lifetime checking account#569925 2,046.92 3 Refund-Comcast television cable 77.48 4 Refund-unused premium COBRA health insurance 3,168.68 5 Refund-The Standard, unused long-term care premium benefits 3,452.20 6 Refund-Central Penn Gas utility 12.84 7 Refund-Carlisle Hospital 100.00 8 Vehicle,2005 Ford Explorer,sold as is-VIN#1 FMZU72KX5UA96542(wrecked) 1,800.00 TOTAL(Also enter on Line 5, Recapitulation) 11,292.66 (If more space is needed,additional pages of the same size) Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev. 11-10) Rev-1510 EX-1(08-09) SCHEDULE G pennsylvania INTER-VIVOS TRANSFERS AND DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Huffman, Carol A. 21-13-0967 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. ITEM DESCRIPTION OF PROPERTY ENT AND DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TNAMRANSFERSATTAck THEIR COPY OF THHE RELATIONSHIP FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1 ING-retirement annuity payout, beneficiary,son 1,102.34 1,102.34 Jeremy Gehrett TOTAL(Also enter on Line 7, Recapitulation) 1,102.34 (If more space is needed,additional pages of the same size) Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule G(Rev.08-09) REV-1511 EX+(10-09) SCHEDULE H pennsylvania DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RESIDENT DEC ENTTURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Huffman, Carol A. 21-13-0967 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached 2,447.40 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Doris C. McCans Street Address 304 Franklin Way City Shippensburg State PA ziD 17257 Year(s)Commission Paid 2014 650.00 2. Attorney's Fees Salzmann Hughes, P.C. 650.00 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) Claimant Street Address City State Zio RelationshiD of Claimant to Decedent 4. Probate Fees 128.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 50.00 See continuation schedule(s)attached TOTAL(Also enter on line 9, Recapitulation) 3,925.90 Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev. 10-09) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Huffman, Carol A. 21-13-0967 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Dugan Funeral Home-funeral expenses 2,447.40 H-A 2,447.40 Other Administrative Costs 2 Cumberland County Orphan's Court-cost to file Capital One satisfaction of claim 10.00 3 Cumberland County Orphan's Court-cost to file Ascension Point satisfaction of claim 10.00 4 Cumberland County Register of Wills-filing fee paid to file Return 30.00 H-67 50.00 Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98) ' . Rev-1512 EX+(12-08) SCHEDULE 1 pennsylvania DEBTS OF DECEDENT, DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Huffman, Carol A. 21-13-0967 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 AAA-monthly fee 36.15 2 Capital One credit card-final payment in full,acct#9536(20169323) 638.43 3 Chase Bank-credit card payment,written before death,cleared bank after death 117.00 4 Chase Bank credit card-final payment in full-payment sent to DCM Services(#9603401) 3,200.00 5 Check 5336 -written before death,cleared bank after death 127.47 6 Check 5338-written before death,cleared bank after death 48.17 7 Commercial Acceptance Company-Cumberland Goodwill Fire-Rescue EMS,ambulance bill 718.43 for date-of-service 8/6/13 8 Commercial Acceptance Company-Cumberland Goodwill Fire-Rescue EMS,ambulance bill 718.43 for date-of-service 8/14/13 9 Department of Public Welfare-medical lien 1,191.18 10 Millennium Pharmacy Solutions-medications 84.68 11 Penelec-final electric bill 40.63 12 QVC Credit card-final payment in full - payment sent to Ascension Point 379.81 (6045761031363055) 2013-00967 TOTAL(Also enter on Line 10, Recapitulation) 7,300.38 (If more space is needed,additional pages of the same size) Copyright(c)2008 form software only The Lackner Group, Inc. Form PA-1500 Schedule I(Rev. 12-08) r REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Huffman, Carol A. 21-13-0967 NAME AND ADDRESS OF RELATIONSHIP TO DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S)RECEIVING PROPERTY (Words) ($$$) DoNoWst'r steels) I TAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] 1 Jeremy M. Gehrett Son As per Item III of 13.15 24 Mooney Rd. Will Shippensburg, PA 17257 Total 13.15 Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate. NON-TAXABLE DISTRIBUTIONS: II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev.01-10) 10/15/13 Deposit Inquiry Page DI of 15 09 : 17 :03 ,Carol A Huffmaxi', CIF number: H000204 141 Cottage Rd Phone: (H) (717) 300-3948 Birth date: Shippensburg PA 17257 (B) (000) 000-0000 4/05/1958 Tax ID number: 172-52-2829 Br#: 002 Account type: Free Checking Account number: --569925 Closed Messages PassPort ATM/Dr card 1 Of 1 Available Balance: . 00 Date last active: 9/10/13 Collected balance: .00 Last Dep: 8/14/13 1, 308.00 Current balance: . 00 Date last overdrawn: 5/15/07 Yesterday's bal: . 00 Date opened: 2/13/98 Last stmt balance: . 00 Date last statement: 9/15/13 Avg collected bal: . 00 Date last contact: 0/00/00 Avg ledger balance: . 00 Closing balance: . 00 Interest rate: .000000% Accrued interest: .00 Stmt/Service chg/Int cycle: 15 Service charge: Yes Automatic NSF fee: Yes SC waive expiration: 0/00/00 Statement/passbook code: Statement Service charge code: 60 More. . . Fl=Addl functions F2=Image F3=Exit F4=Sweep Inquiry F5=History F6=Messages F8=Maintenance F24=More Keys 1A �y b WCL 11 ell 10/15/13 Deposit Inquiry 09 : 16 :25 Carol A Huffman Account number: 569925 -, Closed Messages PassPort ATM/Dr Card 1 of 1 Last stmt balance: . 00 Last stmt date: 9/15/13 Current balance; .00 Statement cycle: 15 1=View 6=Print T=Tset Control: From To Posted Check No S T/C Debit Credit Balance 8/12/13 T 227 360.00 1,690.05 8/12/13 T 227 400 . 00 1,290.05 8/12/13 5332 C 183 50.00 1,240.05 8/12/13 5333 C 183 50. 00 11190.05 8/12/13 5335 C 183 73 .13 1,116.92 8/14/13 C 163 1, 308. 00 2,424.92 8/15/13 T 227 300.00 2, 124.92 8/15/13 $ 333 5 . 00 2., 119.92 (-8/20/13",- 5337 C 183 73 . 00 x2,046.92, 8/21/13 5339 C 183 117.00 1,929.92 — 8/23/13 5336 P 091 127.47 1, 802.45 — 8/26/13 5338 P 091 48 . 17 1,754.28 8/27/13 C 183 36. 15 1,718.13 — 9/10/13 P 050 1, 718. 13 .00 Bottom F4=Redsply F6=Bal Inq F7=Scan Fwd F8=Scan Bkwd F11=Prior bal F15=EFT F16=Sort F17=Top F18=Bottom F19=EDI F20=Unfold F22=T/C F23=Checks 10/15/13 Deposit Inquiry Page DI of 15 09 : 17: 53 .Carol- A-Huffman, CIF number: H000204 141 Cottage Rd Phone: (H) (717) 300-3948 Birth date: Shippensburg PA 17257 (B) (000) 000-0000 4/05/1958 Tax ID number: 172-52-2829 Br#: 002 Account type: Statement Savings Account number: 11702OO1008 Closed Messages PassPort ATM/Dr Card 1" of 'I Available Balance: . 00 Date last active: 9710/13 Collected balance: .00 Last Dep: 7/21/11 55 .21 Current balance: . 00 Date last overdrawn: 0/00/00 Yesterday's bal: . 00 Date opened: 3/20/00 Last stmt balance: .00 Date last statement: 9/30/13 Avg collected bal: .00 Date last contact: 3/20/00 Avg ledger balance: . 00 Closing balance: . 00 Interest rate: .1500005 Accrued interest: .00 Stmt/service chg/Int cycle: 32 Service charge: Yes Automatic NSF fee: Yes SC Waive expiration: 0/00/00 Statement/passbook code: Statement Service charge code: 81 More. . . Fl=Addl functions F2=Image F3=Exit F4=Sweep Inquiry F5=History F6=Messages F8=Maintenance F24=More Keys ZL Js . U)C6 A C (Opy 10/15/13 Deposit Inquiry 09 : 17:32 Carol A Huffman Account number: c 102001GOR,, Closed Messages PassPort ATX/Dr Card 1 of 1 Last stmt balance: . 00 Last stmt date: 9/30/13 Current balance: .00 Statement cycle: 32 1=View 6=Print T=Tset Control : From To Posted Check No S T/C Debit Credit Balance 12/31/12 160 . 53 812 .23 1/15/13 151 .15000000% 812.23 2/18/13 151 .150000005 812.23 3/17/13 151 .150000001 812.23 3/31/13 160 .30 812.53 4/15/13 151 .15000000% 812.53 5/15/13 151 .150000005 812.53 6/16/13 151 .15000000% 812.53 6/30/13 160 .30 812.83 7/03/13 S 644 178.48 634.35 7/15/13 151 .15000000% 634.35 151 .15000000% ( 6 "35 9/10/13 P 160 . 19 634.5 4-,\ 9/10/13 P 050 634 .54 Bottom F4=Redsply F6=Bal Inq F7=Scan Fwd F8=Scan Bkwd F11=Prior bal F15=EFT F16=Sort F17=Top F18=Bottom F19=EDI F20=Unfold F22=T/C F23=Checks FOGLE'S AUTO SALES AND SERVICE Invoice 12608A STONEWALL RD. - PA 17257 �j Date Invoice# 9/26/2013 11 Bill To P.O. No. Terms Project Quantity Description Rate Amount UIQ IFZ�►�zs �� —ro OAJ G Vth t, fist : CHECK NUMBER:0016954988 DATE:09/24/2013 A965627 '�RE�t3� �12 �n GROSS AMOUNT1,402.34 MVA ADJUSTMENT .00+ ADJ. GROSS AMOUNT `1,102.34 MAINTENANCE FEE 00 SURRENDER FEE .00 LOAN OUTSTANDING 00 STATE INCOME TAX .00 MUN I C LPA L I NG.DME-JAX .. ..0.0 NET,CHE K AMOUNT 992.1.1 DIRECT.INQUIRIES AND ADDRESS CHANGES TO ING"LI.FE INSURANCE AND ANNUITY CO PO BOX 990063 HARTFORD, CT 06199-0063 1-800-262-3862