HomeMy WebLinkAbout03-02-15 � � pennsylvania 15�5 6141,�5
� °L""�"�'F�+�E"J� EX(03-14)(FI}
REV-15QQ OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
Po Box 2so601 INHERlTANCE TAX RETURN �/ I c iJ� �
Harrisburg, PA 17128-0601 RESIDENT DECEDENT J L-
ENTER DECEDENT IhiFORMATION BELOW
Social Security Number Date of Death t�1MDDYYYY Date of Birkh MMDDYYYY
/�' O/ -O/ �oZO�`f OG - /Q— /9��
decedent's Last Rlame Suffix DecedenYs First Name MI
f�DGFHE/S7E�G IJC���y L
(If Appiicable}Enter Surviving Spouse's Information Below
Spouse's Last Name Su�x Spouse's First Name MI
THIS RETURN MUST BE FILED IN DUPLfCATE WITH THE
REGISTER QF WILLS
FILL IN APPROPRIATE OVALS BELOW
� 1.Original Return p 2.Suppiemental Return p 3. Remainder Retum(date of death
prior to 12-13-82}
p 4.Agriculture Exemption(date of p 5. Future Interest Compromise{date of a 6. Federai Estate Tax Return Required
death on or after 7-1-2012) death after 12-12-82)
_ 7. Decedent Died Testate p 8. decedent Maintained a Living Trust _ 9. Total Number of Safe Deposit Boxes
(Attach copy of wi{i.} (Attach copy of trust.)
p 1�. Litigation Proceeds Received p 11. NomProbate Transferee Retum p 12. DeferrallElection of Spousai Trusts
(Schedule F and G Assets Only)
O 13. Business Assets O 14. Spouse is Sole Beneficiary
{No trust invoived)
CORRESPONDENT- THIS SECTION MUST BE COYIPLETED.ALL GORRESPONDENCE AND GONFIDENTIAL TAX INFORMATIQN SNOULD BE DIRECTE�TO:
Name Daytime Telephone Number
NE15 A- f�crF,yE�.cTEG , ✓,� 7��- �as-6�.rs'
First�ine of Address
3'1 G'o�.�ar� �,e�v�
Second Line of Address
City or Post Office State ZIP Code
LAHP /-�/6L �/� /70//
Correspondent's email address:
REGISTER OF WIL�'S USE OI�'
REGISTER�F 4VILLS USE ONLY � � !'7 rn
C� �_ � C?
DATE FILEQ MMDDYYYY ":� � � > C::�
C:J - -_;, � :t.)
C, , r 1
' 1
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_ . _ . �.,,
DATE FILED Sjl'AMP � ,,
_ . . �.,.,.
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PLEASE USE ORIG{NAL FORM ONLY �—+
Side 1
� I IIIIII IIIII illll lilil IIIII tllll IIIlI illll IIIII IIIII Illl IIII
1505614105 ],50561,4105 �
U_
�
J Z5056142�5
REV-1500 EX(FI)
DecedenYs Social Security Number
DecedenYs Name:
RECAPITULATIQN
1. Real Estate{Schedule A). ............ ................. ..... .. .... .... 1. 6. D O
2. Stocks and Bonds(Schedule B) . .......... ....... .. .... ............... 2. Q . D d
3. Clasely Held Corporation. Partnership or Sol�Proprietorship{Schedule C) ..... 3. d. D D
4. Mortgages and Notes Receivabie (Schedule D). .. .. .... .................. 4. O- D D
5. Cash, Bank Deposits and Miscellaneous Personal Praperty(Schedule E)....... 5. �� O/• 38
6. Jointiy Owned Properry(Schedufe F) O Separate Billing Requested ....... 6. 0 • D D
7. Inter-Vivos Transfers&Miscelianeous Non-Probate Property
(Schedule G) O Separate Billing Requestad........ 7. p. p 0
8. Total Gross Assets{total Lines 1 through 7)............................. 8. S gD/. 3 g
9. Funera! Expenses and Administrative Costs(Schedule H)........ .. ........ . 9. �� f j�. 7y
90. Debts of Decedent, Mortgage Liabilities and Liens(Schedule I)............... 10. 9g/ . 0.3
11. Tota!Deductions(total Lines 9 and 16}... .... ......... .. ............. .. 11. ��,/�9, 7,�
12. Net Value of Estate(Line 8 minus Line 11) .. .. .......................... 12. �3/�p, 7j7 )
13. Charitable and Govemmenta!Bequests/Sec. 9113 Trusts for which �
an election to tax has not besn made(Schedule J) ............... .. .. .. ... 13.
14. Net Yalue Subject to Tax(Line 12 minus Line 13) ............. ...... .. ... 14. a. O 1)
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICASLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a){1.2)X.0_ �5.
16. Amount of Line 14 taxable
at lineai rate X.�_. 16.
17. Rmount af Line 14 taxable
at sibling rate X.12 17•
18. Amount of Line 14 taxable
at coliateral rate X.15 18•
19. TAX QUE ............. .... .......................... .. .. ........ .. 19.
20. FILL IN THE OVAL iF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
UndEr penalties of perjury,I dectare I have examined this return,induding accompanying schedules and statements,and to the best of my knowledge and beiief,
it is true, correct and complete. DeGaration of preparer other than the person responsible for filing the return is based on all information of which preparer lias
any knowledge.
•.� SIGNA�E P ON R O LE F DATE
, _-, � 3 i �-ois
AD RES
?l LG�1TCe ��, P lF/LL. �� / //
SIGNATURE QF PREPAR OTHER THAN PERSON RESPONSlBLE FOR FILtNG THE RETURN DATE
ADDRESS
� ��"�����"�'����"�'�11111 i��'�����������������I���������'� Side 2
15�5614205 1505614205 �
REV-1500 EX (FI) Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
�E�lr y L. /7�GGHF/STE,P�
------------------------ --------------------------
STREET AQDRESS
33s w�s<�y �z , A�r. �i y-------
-CITY------------------------------------------ - i S7ATE - -I ZIP
�v1�CNAN/LS�H/L� � ,�A � /�Os.t�
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19} (1} O . 6 D
2. CreditslPaymenis
A. Priar Payments __ _ _ ___
B.Discount
(See instructions.) Total Credits(A+B) 12)
3. I nterest
(3}
4. If Line 2 is greafer than Line 1 +Line 3,enter the dif�eren�e. This is fhe OVERPAYMENT.
Fill in ovai 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)
Make check payabie ta: REGISTER OF WILLS, AGENT.
FLEASE ANSWER THE FOlLOWiNG QUESTtONS BY PLACING AN "X" IN 1'HE 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 ............................................ ❑ Q
c. retain a reversionary interest.............................................................................................................................. ❑ �
d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ �
2. If death occurted after Dec.12,1982,did decedent transfer property within one year of death
without receiving adeauate consideration?.............................................................................................................. ❑ �
3. Did decedent own an"in trust for"or payabl�upon-death bank accaunt or security at his or her death?.............. ❑ �
4. Did decedent own an individual retirement account,annuiiy or other non-probate properry,which
contains a beneficiary designation? ........................................................................................................................ ❑ �
IF THE ANSWER TO ANY OF THE ABOVE QUEST(ONS i5 YES,YOU MUST COMPLETE SGHEDULE 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 far the use of fhe 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 sti►I appiicable 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 frarn 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 step-parent af the child is 0 percent[72 P.S.§9116(aj(1.2)).
• The tax rate imposed on the net value af transfers ta or fnr 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 ar for the use of the decedent's siblings is 12 percent[72 P.S. §9116(aj(1.3j].A sibiing is defined,
under Section 9102,as an individual who has at least ane parent in common with the decedent,whether by biood or adoption.
REV-z5o8 EX+(a&iz)
i pennsylvania SCNEDULE E
� DEPARTMEN70FREVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX REfURN pERSONAL PR4PERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
/��G�y �. f�ci'��isrE�
Include the proceeds of litigation and the date the proceeds were received by the estate.
Ail property joindy owned with right of survivorship must be disdosed on Schedule P.
ITEM VALUE AT DATE
NUMBER DESCRIPTlON OF DEATH
�. �F7�Ld �gKK L�/a�"CK/K,lj /�G�G'oL/�!T �/a• J 34��oxs'� /i � ?Jli . ��
.Z. ✓�NSRl.[FNAN�Slq G�aFt�� C���s t{�vio,� A«e�,vr�vo. �3sdl�o� �,, ���{• s"7
'3. 17/AMOnlD !L�'.SD�S /N�Ni1TlONAL— 1ONE•k1FFi� YA�'.�7'TlGW
Z� �f60. DD
TiM�SiI�E �/�Ee,5oN14L /'��ZoPi�ZT+�� /I!o T-QLIE ��4L �S�AT�
�/ALl�tG D,2 /KCo�lk' DEQ.i YE D r'�Ci�y T/M�6El,4�,t6 OI.�XEe.S�/i,P�
NO 9ulG6�S0� /.V1rsR�57 �•L- �F"SA2.d i.VT�NTls.v )
/
TOTAL{Also enter on Line 5, Recapitulationj $ rS. 90�. 3 g
� i t pennsylvania SCHEDULE H
� DEPARTMENTOFRE\�ENUE FUNERAL EXPENSES AND
INHERtTANCETAXREfURN QDMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
P���N �• �Fi'�1�iS7�G
decedent`s debts must be reported on Schedufe i.
ITEM
NUMBER QESCRIPTICN AMOUNT
A. FUNERAL EXPENSES: f(.,c/. ,rLN/v,�/r �iias�,a�/,��*�, 3i Z�d sT /��b�s�°jiP�P s�i �7 3,7y
1. ��D 3� — /a<t, EX��vsaS, i�/cc a ni.�r y i.t�il�Gv.�f�^rT'
B, ADt�iINISTRATIVE COSTS;
1. Personal Representative Commissians:
Name(s)of Personai Representative(s)____________ __
Street Address__ __._ ____ _ — ---
City_._ _ _______ _ _State ZIP
Year�s)Commission Paid:
2. Attorney Fees: ,fDMW�vO �-• ���5, Jol��v,fo�/ Dyri�E,cfis✓ OFF/G63 , Soo.a o
So i M�f,G�rcat ST, P• o. �lo�! ♦o q. �E.No y�l6, P�t �,o�/3
3. Family Exemption; (If decedent's address is not the same as daimant's,attach explanation.;
Claimant---------------------- ---
SCreet Address ------------------ ----
City_ _ __ _ _ _ _State_ ZIP _ _
Relativnship of Claimant to Decedent�_______________ _ _ _--_._
4. Probate Fees:
5. Accauntani Fees:
6. Tax Return Preparer Fees:
7• aE7NANt' i ol.�►EL 3 3� l.��sc�y D�, /i'/EC.�/AN�GS�(!�l.,/A i7o�S' 01/S,G D
• TLE��74< .EKTE�lSis.c/ Ta .�/9Po,sM: D� I7tt'�'AEN�6
?LO P�L7'y AND ��GA�! APAL�1��/�
TOTAL(Also enter on Line 9, Recapitu(ation) $S, 1�f• 7Y
y �i pennsylvania SCHEDULE I
� DEPARTMENTOFREVENUE pE6TS OF DECEDENT,
INHERITANCE TAX REfURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDEkT
ESTATE OF FILE NUMBER
PE�-`y � . �r�,���s>E�
Report debts iricurred by the decedent prior to death that remained unpaid at the date af death,induding unreimbursed medical expenses,
�EN� VALUE AT DkTE
NUMBER DESCRIPTION OF DEATH
1, .Slf56F!lGNA�✓NR �D�L C,�'rD�T 6«//oN V/6A C'A�GD 3 9S.SS'
�. C NM�L�ANp �l/N� T�XeS - ySONN/t= �• �//LLG�' /O, D D
3. .r'�D ie.t< ��Pe�rav-�
eSG,a o
• No�is�'c��<S �C <i.�.
• 3pc�+c�i �a,��nr,e�3rs 30. d0
- ��+���ss. G'�O,ea�a v.�s�u��� 3G' ��
. /��y.Siciq�vs .�1a��t� k• z.l��1 io. o d
/
. Tffg �fa D i ci�✓F oS�o,� �r, o�
. T,�iS�ArG lMAFri.vy i o. a a
• f1 N���s O� �•t�� 3 g/. L 5�
TOTAL(Also enter on Line 10, Recapitulation) $ 9�/.D 3 "��
vu�luy-uuwl�ul.l���u��cJNLtiL:lilju�lL.1 � -
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oF
PEGGY L. HOFFMEISTER
I, PEGGY L. HOFFMEISTER, A/K/A PEGGY S. HOFFMEISTER, of Upper Allen
� Towns"hip, Cumberland County, Pennsylvania, being of sound and disposing inind, memory aald
understanding, do hereby make, publish and declare this as and for my Last Will and Testament,
hereby revoking and making void any and all Wills or Codicils at any time heretofore made by me.
ARTICLE I
DEBTS '
I direct the payment of all my legal debts, and the expenses of my last illness and funeral
from my Estate as soon after my death as conveniently may be done.
ARTICLE II
TANGIBLE PERSONAL PROPERTY
I give and bequeath my motor vehicle(s), household and personal effects and other tangible
personalty of li.ke nature (not including cash or securities), together with any e�sting insurance
thereon, unto those of my children who survive me, to be divided between them by my Executor
with due regard for their personal preferences in as nearly equal shares as practicable.
ARTICLE III
REST,RESIDUE AND REMAINDER
I give, devise and bequeath all the rest, residue, and remainder of my Estate, of whatsoever
nature and wheresoever situate unto my son, NED A. AOFFMEISTER, JR., and my daughter,
OUS1Uy-UUUUl/U1.1'�:UU/�:G1VliKL'1'/13U712.1 ' �
,., -
�1NDREA K. GOOCH, in equal shares,provided that should either predecease me, I give, devise
and bequeath such deceased child's share unto lus or her then-living issue,per stirpes.
ARTICLE IV
UNIFORl�2 TRANSFERS TO MINORS ACT
In the event that any beneficiary of my Will shall not have reached the age of fwenty-one
(21) years at the tiule for distribution of his or her share, distribution of said share may be made in
tlie discretion of my Personal Representative after considering the age and needs of the beneficiary,
either directly to the Ueneficiary or to a Custodiau under the Pennsylvania Uniform Transfers to
Minors Act, 20 Pa. C.S.A § 5301 et seq., or the applicable Uniform Gifts to Minors Act or Uniform
Transfers to Minors Act iu the state of residence of such beneficiary as the case may be. My
Persona.l Representative may designate as such C�.istodian any institution or person, including my
Personal Representative, qualified to act as a Custodian for such beneficiary under such Act in
effect at the time such distribution is made. A receipt for any payment or distribution so made shall
be a full discharge therefor to my Personal Representative,who sliall not be responsible to see to, or
be liable for,the application of such proceeds thereafter.
ARTICLE V
PERSONAL REPRESENTATIVE
I r�e, �e�tifiate �� aY��i.nt �:�� �e�, NFL� A. II(3�F1�1�IS'�'��, T�?, �:ecutor ef t��
my Last Will and Testament. Should my son, NED A. HOFFMEISTER, JR., fail to qualify or
cease to so act, I name, constitute and appoint my daughter, ANDREA K. GOOCH, alteinate
Executrix to complete the ad�istration of my Estate. I direct that no fiduciary appointed herein
shall be required to post bond for the faithful adiiiv.ustration of the duties in any jurisdiction.
. 2
W�1Vy-VUUUl/U1.1�:VUl�liN17KL1Y13U'/1Z.1 ' �
�- �
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will
and 1 estament,this � `�� day of �-�'v'i,t,�?�� ,2000.
.., ,
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.z.�;,�,u,�Y�, . �����.�.€.�=`-(SEAL)
PEG�'�,.HOFF113'�,+ISTER
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��✓n'�' �� l ��y , ,�,�„[.�,(-SEAL)
A1K./A�'����r'�Y S.uO���l!^�.�5'�'�A
Signed, sealed., published and declared by the above-named TestatriY, as and for her Last
Will and Testament,in the presence of us,who at her request,in her presence and in the presence of
each other,have hereunto subscribed our names as witnesses.
� �� �
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ACKNOWLEDGMENT
COMA�IONWEALTH OF PENNSYLVANIA :
: SS
COIJNTY OF CUMBERLAND :
We, PEGGY L. HOFFMEISTER, AJKIA PEGGY S. HOFFMEISTER,
������,�,�=��;,>.:;�,�f� � a�id �.�� �.��.���� , the Testatrix and the
7� ,FJ E
witnesses, respectively,whose names are signed to the attached or foregoing irLsfrument,being first
duly swom, do hereby declare to thP und�r�ignPd a�the�;� tr�+ tue T�stutr-;� sigr��d a�d execnted
the iustnzment as her Last Will and that she had signed willingly and that she executed it as her free
and voluntaty act for the ptuposes therein expressed, and that each of the witnesses, in the presence
and hearing of the Testatrix, signed the Will as witness and that to the best of his/her l�iowledge the
Testafr�was at that time eighteen years of age or older, of sound mind and under no constraint or
undue iufluellce.
'�`���_` , l � <
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t..El:��..i'f-'{ i/ X�N�:iW���SLi:.i`'. 'E.J
PEG��(,�.`HO� " "STER
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` -u'�,/',2� � � J , Y���,�..-�-
A/K/A�P'�GGY S.HOOFFMEISTER
��'�%`,�
Wi ss
�� �� �
Witness
5ubscribed, sworn to and acknowledged before me by PEGGY L. HOFFMEISTER,
A/K/A PEGGY S. HOFFMEISTER, Testatrix, and subscribed and sworn to before me by
`���.:.�1.�,� �,``���.�.::m.� _� . and �.-� �,�-,-�.=�.�.�.-,;A� witnesses, this
U
��'��iay of��.�r�.��.,�, 2000.
,
, .
� 11�e1 N� ..c '� �—"X�-���e90
Notary Public � �
f i�aiA€�iAL SEAL
€�ffiN�EE LENl�, Nofary Pubiic
4 Lemoy�e �arou�h Cumberland Co.
�y Cor�mission�x.�ires Qec.21,200�