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Home My WebLink About12-05-14 1505611185 REV-1500 EX(02-11)(FI) OFFICIAL USE ONLY Department of Revenue Bureau of Individual Taxes County Code Year File Number Bu PO BOX 280601 INHERITANCE TAX RETURN 21 14 838 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 09022014 02271943 Decedent's Last Name Suffix Decedent's First Name MI HIRONIMUS RAYMOND (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 BOXES BELOW 0 1. Original Return ❑ 2. Supplemental Return F] 3. Remainder Return(Date of Death Prior to 12-13-82) ❑ 4. Limited Estate ❑ 4a. Future Interest Compromise(date of ❑ 5. Federal Estate Tax Return Required death after 12-12-82) 0 6. Decedent Died Testate ❑ 7. Decedent Maintained a Living Trust (J 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) ❑ 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 O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number VICKY ANN TRIMMER 717-620-2440 REGISTER OF WILLS V�$J ONLY O First Line of Address s = L= 6C-) - ;I r-r-t PERSUN & HEIM, PC Second Line of Address Cn ; C!y PO BOX 659 c7 �DATEr111LE� City or Post Office State ZIP Code MECHANICSBURG PA 170550659 CnC=) Correspondent's e-mail address: V A T R I M M E R a3 P E R S U N H E I M -C O M 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 repres5plative is based on all information of which preparer has any knowledge. SIG NA �F E S N RESPONSIBLE FOR FILIN RE RN DATE MIA 2 J � 1 AD 75t W TRAIL NORHT, GRAYSLAKE, IL 533 LITH TiSLEMONT, IL SIGN/ATU E/OF{P PARER OT—ER-THAN REPRESENTATIVE DATE //b,,hit ADDRESS' PO BOX 659 MECHANICSBURG, PA PLEASE USE ORIGINAL FORM ONLY Side 1 1505611185 OM46473.000 1505611185 1505611285 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: H I R 0 N I M U S RAYMOND RECAPITULATION 1, Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 11-00 2. Stocks and Bonds(Schedule B). . . . . . . . . . . . . . . . . . . . . . . . . 2. 3-,488,180 - 00 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C). . . . . 3. G-00 4. Mortgages and Notes Receivable(Schedule D) . . . . . . . . . . . . . . . . . 4. 0 .00 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E) . . . . . 5. 2,119 -00 6. Jointly Owned Property(Schedule F) F-1 Separate Billing Requested . . . . 6. 2101691-00 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) El Separate Billing Requested . . . . 7. 525,423- 00 8, Total Gross Assets(total Lines I through 7) . . . . . . . . . . . . . . . . . . 8. 41226i413 - 00 9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . 9. 34,672 -00 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule 1) . . . . . . . . . 10. 11809-00 11. Total Deductions(total Lines 9 and 10). . . . . . . . . . . . . . . . . . . . . 11. 36,481-00 12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . 12. 4 -1189,932 -00 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J). . . . . . . . . . . . . . . . 13. 0 .00 14. Net Value Subject to Tax(Line 12 minus Line 13) . . . . . ... . ..- . . . . 14. 4n189i932 -00 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.0.0_ 1 0.00 15. 0.00 16. Amount of Line 14 taxable at lineal rate x o-4-5 3A25i336.00 16. 1721ll-10.00 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 3641595-00 18. 54,689 -00 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 2261829-00 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT JArV__1 I Side 2 1505611285 1505611285 OM4648 1000 REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: 21 14 838 DECEDENTS NAME H RONIMUS RAYMOND STREET ADDRESS 995 GRANDON WAY CUMBERLAND CIT/ STATE ZIP MECHANICSBURG PA 17050 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 226,829 -00 2. Credits/Payments A.Prior Payments 0 .00 B.Discount 111341 - 0 0 Total Credits(A+B) (2) 11,341-00 3. Interest (3) 0 . 00 4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT. Fill in box on Page 2,Line 20 to request a refund. (4) 0 .00 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 2151488 - 00 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 . . . . . . . . . . ❑ a 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ 0 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X❑ ❑ 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)(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. OM4671 2.000 REV-1503 EX i(6-12) Pennsylvania SCHEDULE B DEPARTMENT OF REVENUE INHERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF FILE NUMBER Ray Hironimus 21 14 838 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Morgan Stanley #341-902518-562 778,233 2 Morgan Stanley #341-901770-562 1,138,608 3 Merrill Lynch #872-43883 1,071,587 4 Morgan Stanley #341-900695-562 102,792 5 Morgan Stanley #341-909492-562 396,960 TOTAL (Also enter on Line 2,Recapitulation) $ 3,488,180 2w4696 2.000 If more space is needed,insert additional sheets of the same size REV-1508 EX+(0&12) pennsylvania SCHEDULE E DEPARTWNTOF REVENUE CASH,BANK DEPOSITS& MISC. INHERTANCE TAX RETURN RESIDENTDECE ENTPERSONAL PROPERTY ESTATE OF: FILE NUMBER: Ray Hironimus 21 14 838 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointlyowned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Tangible Personal Property 2,000 See attached list of items returned to estate from property owner. Value estimated due to nature and condition of items. 2 Lowers Refund 119 TOTAL(Also enter on line 5„Recapitulation) $ 2,119 2W46AD 2.000 If more space is needed,use additional sheets of paper of the same sae. REV-l6oqEx-(oi-io) pennsylvanla SCHEDULE DEPARTMENT OF REVENUE INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Ray Hironimus 2114 838 If an asset became jointly owned within one year of the decedent's date of death,it must be reported on Schedule G SURVUMJOWTENANTS)NAME(S) ADDRESS REIATXONSHPTO DECEDENT * Hironimus, Jeffrey 796 W Trail North, Grayslake, IL 60030 Son * Kieff, Margaret 995 Grandon Way, Mechanicsburg, P] 17050 None JOINTLY OWNED PROPERTY: LETTER DATEDESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT IVIADE 04CLUDE NAW OF FINANCIAL INSTRUrION AND BANK ACCOUNT NUMERORSSWAR DATE OF DEATH DECIEDWS VALUEOF NLWER TENANT DONT tDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VALLEOFASSEr IRN��i�rESRMEST DECE1)e4rS NTEREST 1 B 7/10/2006 995 Grandon Way, Mechanicsburg, PA 405,603 50.0000 202,802 2 A 11/12/201OM&T Bank Checking Account 14,115 50.0000 7,058 3 B 7/10/2006 M&T Savings 1,662 50.0000 831 TOTAL(Also enter on Line 6,Recapitulation) $ 210,691 SW46AE 2.000 If more space is needed,use additional sheets of paper of the same size. REV-1510 EX+(08-09) SCHEDULE G pennsylvania DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC.NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Ray Hironimus 21 14 838 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. DESCRIPTION OF PROPERTY ITEM INCLLDETHEWMEOFTHE TRANSFEREE,THEIR RELATIONSHIP TODECEDENT AND DATE OF DEATH %OFDECD'S EXCLUSION TAXABLE NUMBE THE DATE OFTRANSFER.ATTACH ACOPY OFTHE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST IFAPPLICABLE VALUE 1. Merrill Lynch IRA #872-86778 364,461 100.0000 0 364,461 Children are beneficiaries 2 Morgan Stanley IRA #341-906539 -532 160,962 100.0000 0 160,962 Margaret Rieff is beneficiary TOTAL(Also enter on line 7,Recapitulation)$ 525,423 If more space Is needed,use additional sheets of paper of the same size. 9W46AF 2.000 REV-1511 EX+(08-13) al SCHEDULE H pennsylvani DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Ray Hironimus 2114 838 Decedent's debts must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: Geigle Funeral Home 12,400 B. ADMINISTRATIVE COSTS: I Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: 2. Attorney Fees: 20,000 1 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: 2,226 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. 1 Cumberland Co ROW Exemplified Record 40 2 Morgan Stanley Service Fee 6 TOTAL(Also enter on Line 9,Recapitulation) $ 34,672 3W46AG 2.000 If more space is needed,use additional sheets of paper of the same size. r REV-1512 EX+(12-12) pennsylvania SCHEDULE! DEPARTN ENTOF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES& LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Ray Hironimus 21 14 838 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 PPL 216 2 GranULawn 117 3 Home Instead 159 4 Penn State Hershey Medical Center 51 5 Verizon 566 6 Riverside Landscape 700 TOTAL(Also enter on Line 10,Recapitulation) $ 1,809 2w46AH 2.000 If more space is needed,insert additional sheets of the same size. Estate of: Ray Hironimus 21 14 838 Schedule J Part 1 (Page 2) Item No. Description Relation Amount 2 James Hironimus 6120 Blue Grass Avenue Harrisburg, PA 17112 Merrill Lynch IRA #872-86778 Inventory Value: 60,744 One Sixth of Residue: 575,636 Son 636,380 3 John Hironimus 754 Greg's Drive harrisburg, PA 17111 Merrill Lynch IRA #872-86778 Inventory Value: 60,743 One Sixth of Residue: 575,636 Son 636,379 4 Debbie Borosky 533 4th Street Lemont, IL 60030 Merrill Lynch IRA #872-86778 Inventory Value: 60,743 One Sixth of Residue: 575,636 Daughter 636,379 5 Donna Wilson 312 Rent Drive Harrisburg, PA 17111 Merrill Lynch IRA #872-86778 Inventory Value: 60,744 One Sixth of Residue: 575,636 Daughter 636,380 6 Patricia Sawka 9 Pavilion Road Voorhees, NJ 08043 Merrill Lynch IRA #872-86778 Inventory Value: 60,744 One Sixth .of Residue: 575,636 Daughter 636,380 Estate of: Ray Hironimus 21 14 838 Schedule J Part 1 (Page 3) Item No. Description Relation Amount 7 Margaret Kieff 995 Grandon Way Mechanicsburg, PA 17050 995 Grandon Way, Mechanicsburg, PA Inventory Value: 202,802 M&T Savings Inventory value: 831 Morgan Stanley IRA #341-906539-532 Inventory Value: 160,962 None 364,595