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Home My WebLink About01-07-15 (2) l J �;;pennsy�vania 15 0 5 6],410 5 OFREVENUE EX(03-14)(FI) REV��OO OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA 171z8-o6o1 RESIDENT DECEDENT �� l'' ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 167-16-0921 06252014 07141920 DecedenYs Last Name Suffix DecedenYs First Name MI Herman Edward (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M� N/A THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW � 1.Original Return p 2.Supplemental Return p 3. Remainder Return(date of death priorto 12-13-82) O 4.Agriculture Exemption(date of � 5. Future Interest Compromise(date of � 6. Federal Estate Tax Return Required death on or after 7-1-2012) death after 12-12-82) O 7.Decedent Died Testate p 8.Decedent Maintained a Living Trust _ 9. Total Number of Safe De osit Boxes (Attach copy of will.) (Attach copy of trust.) p p 10.Litigation Proceeds Received p 11.Non-Probate Transferee Return p 12. Deferral/Election of Spousal Trusts (Schedule F and G Assets Only) O 13.Susiness Assets O 14.Spouse is Sole Beneficiary (No trust involved) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Alan H. Herman (717)497-3013 First Line of Address 870 Crooked Stick Dr Second Line of Address City or Post O�ce State ZIP Code Mechanicsburg PA 17050 ,-.� Correspondent�s emaii address: al.herman.18@gmail.com � � � � r REGISTE�6F Jp�LS USE Y G'> REGISTER OF WILIS USE ONLY Y��'1 � '� ':�'3 4 DATE FILED MMDDWW ''3 �. (-� '""0 � r,.� � - `�� -J ,� C.,. y�� .... - . . ..:> .�.,,'� _" `,i x::i � -r r'!, ,..., <:: _.�: � DATf FICED STAMP 1-� r.^ _-r ..,_ fV U'� � .� pp "'y'1 PLEASE USE ORIGINAL FORM ONLY Side 1 � I I�II�I II��IIII��I�I'I�I��II�I II�II�I��I II�II�II�I�I�I I��I 1505614105 1,505614105 J J 15056142D5 REV-1500 EX(FI) DecedenYs Social Security Number Decedent�5 Name: Edward Herman RECAPITULATION 1. Real Estate(Schedule A). ............................................ 1. 0.00 2. Stocks and Bonds(Schedule B) ....................................... 2. 0.00 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. 0.00 4. Mortgages and Notes Receivable(Schedule D)........................... 4. 0.00 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. 31,474.09 6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....,.. 6. 0.00 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 0.00 8. Total Gross Assets(total Lines 1 through 7)............................. 8. 31,474.09 9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. 8,432.50 10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule I)............... 10. 11. Total Deductions(total Lines 9 and 10)................................. 11. 8,432.50 12. Net Value of Estate(Line 8 minus Line 11) .............................. 12. 23,041.59 13. Charitable and Governmental Bequests/Sec.9113 Trusts for which an election to tax has not been made(Schedule J) ........................ 13. 23,041.59 14. Net Value Subject to Tax(Line 12 minus Line 13) ........................ 14. 0.00 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- 15. 16. Amount of Line 14 taxable at lineal rate X.0_ 16. 17. Amount of Line 14 taxable at sibling rate X.12 �� 18. Amount of Line 14 taxable at collateral rate X.15 �$ 19. TAX DUE......................................................... 19. 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT � Under penalties of perjury,i declare 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 person responsible for filing the return is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON��SIBL�F R FILING RETURN DATE riiTi �� 01/06/2015 ADDRESS 870 Crooked Stick Dr., Mechanicsburg, PA 17050-2296 SIGNATURE OF PREPARER OTHER THAN PERSON RESPONSIBLE FOR FILING THE RETURN DATE ADDRESS � I I��I�I I��II�I��I��'��I��II�I I��II�I��I�II��I�I�III I��I Side 2 1505614205 1505614205 J REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: 2�� 2� DECEDENT'S NAME Edward Herman -- _ _ — -- STREETADDRESS _ _ _ — _ _ __ _ _ _ 5225 Wilson Lane, Suite 324 -- _- --- - --- -__ _ - _ _ CITY _ _- STATE i ZIP _ _ Mechanicsburg , PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 0.00 2. CreditslPayments A.Prior Payments __ __ _ _ B.Discount -_ __ _ __ _ _ _ (See instructions.) Total Credits(A+B) (2) 3. Interest 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (3) Fill 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) 0.00 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 properly 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,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 atloptive parent or a step-parent 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 decedenYs lineal beneficiaries is 4.5 percent,except as notetl in[72 P.S.§9116(a)(1)]. . The tax rate imposed on the net value of transfers to or for the use of the decedenYs siblings is 12 percent[72 P.S. §9116(a)(1.3)).A sibling is defined, untler Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or atloption. REV-15o8 EX+(o8-i2) � ; �, pennsylvania SCHEDULE E oEPnRrMENr oF REVENUE CA5H, BANK DEPOSITS & MISC. uvHeRirnNce rax ReruRru PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: Edward Herman FILE NUMBER: 21-14-0720 Include the proceeds of litigation and the date the proceeds were received by the estate. Ail property jointty owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. balance from PNC of Edward Herman's checking account,transferred to estate account 100.74 2, deposit,Schwab account balance 63.68 3. deposit,Asbury Communities, Inc[pro-rated refund portion of Bethany Viilage admission fee] 27,007.75 4, deposit,MD VIP refund 125.00 5. deposit, Saturday Evening Post refund 17.77 6, deposits,credit balance on PNC VISA account 49.15 7, deposit, United States Treasury-VA Pension:One Time Payment 4,110.00 TOTAL (Also enter on Line 5, Recapitulation} $ 31,474.09 If more space is needed, use additional sheets of paper ot the same size. i ` ennsYlvania SCHEDULE H � �PARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX REiURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF Edward Herman FIIE NUMBER 21-14-0720 Decedent's debts must be reported on Schedule I. ITEh1 NUMBER DESCRIPTION AMOUNT p• FUNERAL EXPENSES: 1' Auer Cremation Services;prepaid services 0.00 2 Hospice of Central PA 5,25Q.00 3 pastorai funeral honorarium 250.00 B. ADMINISTRATIVE COSTS: I• Personal Representative Commissions: Name{s)of Personal Representative(s) 0.00 _ - __ __ ___ Street Address _ _ _ _ --- __ _ City_ _ .- -— — - ___State ZIP ___ Year(s)Commission Paid: z� Attorney Fees; 0.00 3• family Exemption: (If decedent's address is not the same as claimanYs,attach expianation.) 0.00 Claimant _ __ _ __ __ _ _- _ _ Street Adtlress - _. _ _ _ __ City __ State ZIP Relationship of Claimant to Decedent 4• Probate Fees: 198.50 5• Accountant Fees: 0.00 6 Tax Return Preparer Fees: 0.00 �� Bethany Vil�age At Home-final billing for assisted living care 2,413.25 8 Medicine Shoppe-final billing 114.57 9 PNC-final credit card billinng 74.26 �o. Comcast-final billing 102.52 �� UPSP-postage expenses 29.40 TpTAL(Also enter on Line 9, Recapitu�ation) $ 8,432.50 If more space is needed,use additional sheets of paper of the same size. :IE�%?-:;.i13 E?X-.� tC:l-'ivi �� pennsylvania SCHEDULE J ' DEPART+":ENT OFHEVENUE INHERITANCE TAX REfURN B E N E FI CIARI ES RESiDENT DECEDENT ESTATE OF: FILE NUMBER: Edward Herman 21-14-0720 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. N/A 0.00 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. N/A O.OQ B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. Temple University-Temma M.Herman&Lisa Herman Peskoe Memorial Scholarship Fund 23,041.59 TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 23,041.59 If more space is needed,use additional sheets of paper of the same size. E�wAR�HERMAN... Es rA rE ALAN H. HERMAN EX �717)761-5026 870 CROOKED S77CKORII/E MECHANICSBUR6, PA IT050-2296 al.hern�an.l8�a�mail com O1/06/2015 Lisa M. Grayson, Esq. Register of Wills �� ca � � � Cumberland County ,� � � � � One Courthouse Square, Suite 102 �,� �? �., � c;, � Carlisle, PA 17013 ' -�- �� "�' `� � „, r,� r�� r'c� ._ m�_ ,. ;�;> - , :-;a ` � �` , -> c� RE: estute of Edward Herman, 21-14-0720 . `�' � �� ,� K,.� ,.� � `y�t , c:.„ r`'�: r� � �.t '"' �, r� DeQr Ms. 6rayson, �,�� a Enclosed please find two (2) copies of ectch of the foilowing documents: ➢ Pa. O.C. Rule 6.12 STATUS REPORT ➢ INVENTORY form ➢ ESTATE INFORMATION SHEET ➢ PA REV-1500 ➢ Schedule E - cash, bunk deposits & misc. personal property ➢ Schedule H - funer4l expenses and administrative costs ➢ Schedule J - beneficiaries As I best understand it, these documents complete the necessary steps to close the estate of Edward Herm4n. Please advise if there are any other documents or communications required. Sincerely, r � � r ��z�� Alan H. Herman �° . :�� °§. V:`:C; ;,f � ., ��. . �.�vi�,. , _ �.� � . • . � � V 1 m ��y .�lh �� `, � �� ` ~' �`'^ � x � � � � � �� V� � � � � � � � � �_ � � � � � o c� N � � �� ._ ; � _ c� . ►—+ _ � t,; -.. � � � � 4�.. t.r t:�. C� 2 c""" � � � �".� :�-" ^ _ ..— � L.4! zd�.i C�- C�"' V � C� � � � t� f .. � .. � ��i � C:� t%j �„ � - � v � � La Cr-_- �_. � � \ ` W �a � c,- �' \J � � `r' � � .--. h 7 � � � N N O h O n L]'^ .x d m�"0.ao �� x g.� dU.� �o ,", ��