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Home My WebLink About04-15-15 J 1505614134 EX(03-14)(FI) REV-1500 OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg PA 17128-0601 RESIDENT DECEDENT 2 1 1 4 0 6 7 5 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 0 5 2 5 2 0 1 4 1 1 � 9 1 9 2 6 DecedenYs Last Name Suffix DecedenYs First Name MI H 0 S T E T L E R P A U L I N E K (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW Q 1.Original Return � 2. Supplemental Return � 3. Remainder Return(date of death Prior to 12-13-82) � 4.Agriculture Exemption � 5. Future Interest Compromise(date of � 6. Federal Estate Tax Return Required (date of death on or after 7-1-2012) death after 12-12-82) ❑X 7. Decedent Died Testate � 8. Decedent Maintained a Living Trust 9.Total Number of Safe Deposit Boxes (Attach copy of will.) (Attach copy of trust.) � 10. Litigation Proceeds Received � 11. Non-Probate Transferee Return � 12. Deferral/Election of Spousal Trusts (Schedule F and G Assets only) ❑ 13. Business Assets ❑ 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 J A C Q U E L I N E A K E L L Y 7 1 7 5 4 1 5 5 5 0 First Line of Address 8 4 5 S I R T H O M A S C O U R T Second Line of Address � �3 � � fYl S U I T E 1 2 � �° `' C O � „� o City or Post Office State ZIP Code � � � c.n � i� � � �y�} � H A R R I S B U R G P A 1 7 1 0 9 .-� �- �..� � ; c:� .�_ `�� —, _� ,-� CorrespondenYs e-mail address: JACKIE a�JANBROWNLAW.COM ��y Y` ' � � �'�' ` •,�.� c�.� �,: __ REGISTER t�F V1fILLS SE C�}Q4L+Y y` ��1 F--'� r"' ..1.. � REGISTER OF WILLS USE ONLY � '"{ � CJ7 `�E' DATE FILED MMDDYYYY f v Q� � �-- I — -- . _ I DATE FILED STAMP PLEASE USE ORIGINAL FORM ONLY Side 1 I IIIIII IIIII IIIII IIIII�IIII IIIII IIIII IIIII IIIII IIIII IIII IIII � � 1505614134 1505614134 � �� J 1505614234 REV-1500 EX(FI) Decedent's Social Security Number oecedenesName: PAULINE K• HOSTETLER RECAPITULATION 1. Real Estate(Schedule A} . .. . . . . . . . . .... .. . . . . . . . . . . . . . ... . . .. .. . . . . �. • 2. Stocks and Bonds(Schedule B) . . . . . . . .. . . . . . . . . . . . .. . . . . . . . . . . ... . . . 2 • 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) . . . .. 3. . 4. Mortgages and Notes Receivable(Schedule D) . . . . . . . . . . . . . . .. . . .. . . . . . 4 . 5. Cash,Bank Deposits and Miscetlaneous Personal Property(Schedule E). .. . . . . 5 1 2 2 1 8 1 , 1, 7 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . .. ... 6. . 7. Inter-Vivos Transfers&Miscellaneous N Probate Property (Schedule G) � Separate Billing Requested . .. . .. 7. 2 2 8 9 1 , ], 3 8. Total Gross Assets(total lines 1 through 7) .. . .. . .. . ... ... . ....... .. .. 8, 1 4 5 0 7 2 . 3 0 9. Funeral Expenses and Administrative Costs(Schedule H) ...... . . .... ... . . 9. 1 7 9 4 7 . 9 2 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule q .. .... . . . . . . i0 6 6 2 2 6 . 4 1 11. Total Deductions(total Lines 9 and 10) .. . . .. . ... .... .. . . . ... . .... . . . 11. 8 4 1 7 4 . 3 3 f2. Net Value of Estate(Line 8 minus Line 11) . ... . .. .. . . .. . . . . .. . . . . . . 12 6 0 8 9 7 . 9 7 13. Charitable and Governmentai Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) .. ... . . . . .. ... . . . . 13. , S4. Net Value SubJect to Tax(Line 12 minus Line 13) .... ... .... .. . . . . . . . �4. 6 0 � 9 7. 9 � TAX CALCULATION-SEE INSTRUCTION3 FOR APPLICABLE RATES 15. Amount of Line 14 taxabie at the spousal tax rate,or transfers under Sec.9116 (a)(i.z)X�o � D . 0 � is 0 . 0 0 16. Amount of Line 14 taxable at�inea�rate X.045 6 D 8 9 7 . 9 7 t F;. 2 7 4 D . 4 1 17. Amount of Line 14 taxable at sibling rate X.12 0 . 0 0 17. � . D 0 18. Amount of Line 14 taxable at collateral rate X.15 � . 0 � t{;. Q . � Q 19. TAX DUE .... . . ... .. .. . .. . ... . . . . .. . . .. . .. . .. .. .. . .. .. .. .. .. . 19. 2 7 4 0 . 4 Z 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Under penalties of pery'ury,I declare I have examined this retum,induding accompanying schedufes and statements,and to the best of my knowledge and beliet, i[is true,correct and complete.DeGaration of preparer other than the person responsible for fifing the retum is based on all information of which preparer has arry knowledge. SiGN RE OF RSON RE O IB FOR FI ETURN DAT -��.�.._,�°,� ,.�JS'.��c�;�-.- DpRESS 40478 GLEN MEADOW PLACE ALDIE VA 2�105 SiGNA E OF PRE ' RER OT R ,SON RESPONSIBLE FOR FtLING THE RETURN D E �� - �_r�_� AD SS 84 SIR THOMAS COURT, SUITE 12 HARRISBURG PA 17109 �I'�I�I(II�I�IIII'�I'I'III��II�I II�II I�11'II'II II�II��II I�II Side 2 L 1505614234 15�5614234 �„' REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: 2� 14 0675 DECEDENT'S NAME PAULINE K. HOSTETLER ---- -- - - - ----- -- _ . __ . _ _ __ _ _ ___ _ STREETADDRESS 100 Mt. Allen Drive _ __ . __ _ _ _ _ CITY STATE , ZIP Mechanicsburg PA ' 17055 Tax Payments and Credits: 1� Tax Due(Page 2,Line 19) (1) 2,740.41 2. Credits/Payments A.Prior Payments ________ __ __ ____ _____ B.Discount —__ _-- (See instructions.) Total Credits(A+B) (2) 0.00 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) 0.00 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 2,740.41 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 ...................................................................... ❑ 0 b. retain the right to designate who shall use the property transferred or its income ............................... ❑ ❑X c. retain a reversionary interest ..................................................................................................... ❑ ❑X d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ 0 2. If death occurred after Dec. 12,1982,did decetlent transfer propeRy within one year of death without receiving adequate consitleration? ....................................................................................... �X ❑ 3. Did decedent own an"in trust for"or payable-upon-tleath 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 tleath 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,antl 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)J. • 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 decedenYs 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 blootl or adoption. :�..,,.,,. .., ,.r.�, REV-1508 EX+(08-12) pennsylvania SCHEDULE E DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC. INHERITANCETAXRETURN pERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: PAULINE K. HOSTETLER 21 14 0675 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Messiah Lifeways at Messiah Village; refund 633.92 2. Messiah Lifeways at Messiah Village; personal account 4,594.10 3. Maryland State Retirement Agency; pension paid to Estate 116,825.15 4. 2015 income tax refund 128.00 TOTAL(Also enter on Line 5,Recapitulation) $ 122 181.17 If more space is needed, use additional sheets of paper of the same size. .._..�� , ,,,..,,, REV-1510 EX+(08-09) pennsylvania SCHEDULE G DEPARTMENTOFREVENUE INTER-VIVOS TRANSFERS AND INHERITANCETAXRETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER PAULINE K. HOSTETLER 21 14 0675 This schedule must be compieted and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. DESCRIPT�ON OF PROPERTY ITEM INCLUDETHENAMEOFTHETRANSFEREE,THEIRRELATIONSHIPTODECEDENTAND DATEOFDEATH %OFDECD�S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER.ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (iF aP�icns�e� VALUE 1. PSECU savings account; Account#9402'`"**""-01 26,347.41 100.00 6,000.00 20,347.41 made joint with daughter, Romaine A. Hildebrand and son, Frederic L. Hartsock in January 2014 2. PSECU checking account; Account#9402**"***-04 2,098.16 100.00 2,098.16 made joint with daughter Romaine A. Hildebrand and son, Frederic L. Hartsock in January 2014 3. Everence Annuity; Agreement#5326979 445.56 100.00 445.56 Bene: 4 children, Frederic L. Hartsock, Denise J. Carr, Romaine A. Hildebrand and Sharon L. Cosner TOTAL (Also enter on Line 7,Recapitulation) $ 22 891.13 If more space is neetled,use additional sheets of paper of the same size. ,....,�� _,,,�,,�� REV-1511 EX+(OS-13) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCETAXRETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER PAULINE K. HOSTETLER 21 14 0675 DecedenYs debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Somerset County Memorial Park Inc.; gravemarker 1,920.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Frederic L. Hartsock 6,107.00 streetaddress 40478 Glen Meadow Place �;�y Aldie State VA Z�p 20105 Year(s)Commission Paid: 2014 2. Attorney Fees: Jan L. Brown &Associates 8,671.00 3, Family Exemption:(If decedenYs address is not the same as claimanYs,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: Cumberland County Register of Wilis 148.50 5 Accountant Fees: 6. Tax Return Preparer Fees: PBfkS &COCYlpBfly; preparation of personal &fiduciary tax returns 553.00 7, Cumberland Law Journal; legal advertising 75.00 8. The Sentinel; legal advertising �79�92 9. Register of Witis; FSA filing fee 20.00 10. Register of Wills; additional probate fees 230.00 11. FedEx fees 43.50 TOTAL(Also enter on Line 9,Recapitulation) $ 17 947.92 If more space is needed,use additional sheets of paper of the same size. �.,�,��. .., .ri••„.. , � REV-1512 EX+(�2_12) pennsylvania SCHEDULE I DEPARTMENTOFREVENUE DEBTS OF DECEDENT� INHERITANCETAXRETURN MORTGAGE LIABILITIES 8� LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER PAULINE K. HOSTETLER 21 14 0675 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. Department of Public Welfare; Estate Recovery Program 66,226.41 Restitution of inedical assistance; CIS#620236586 Claim of$237,894.95 Amount available for payment to DPW after fiduciary taxes deducted but before inheritance taxes deducted = $66,226.41 TOTAL(Also enter on Line 10,Recapitulation) $ 66 226.41 If more space is needed, insert additional sheets of the same size. �'�'l'll'II....�..T7�•'I�., . , REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: PAULINE K. HOSTETLER 21 14 0675 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. Frederic L. Hartsock, son Lineal 8,699.71 40478 Glen Meadow Place 1/7 of estate Aldie, VA 20105 2. Denise J. Carr, daughter Lineai 8,699.71 803 Lee Avenue 1/7 of estate Harrisonburg, VA 22801 3. Romaine A. Hildebrand, daughter Lineal 8,699.71 1245 Barley Corn Square 1/7 of estate Harrisburg, PA 17112 4. Sharon L. Cosner, daughter Lineal 8,699.71 361 Ridgemont Drive 1/7 of estate Louisa, VA 23093 5. Diane L. Summers, stepdaughter Lineal 8,699.71 1112 South Forge Street 1/7 of estate Palmyra, PA 17078 6. Vaughn R. Hostetler, stepson Lineal 8,699.71 48 Brunswick Lane 1/7 of estate Palmyra, PA 17078 7. Donna L. Denton, stepdaughter Lineal 8,699.71 7841 Hillsway Avenue 1/7 of estate Parkville, MD 21234 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. 1. B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS; 1. 1. TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed,use additional sheets of paper of the same size. ....n-�n.o....i...r�...�... . , � L F 1 LAST WILL AND TESTAMENT OF PAULINE K. HOSTETLER I, PAULINE K. HOSTETLER, now domiciled in Cumberland County, Pennsylvania, declare this to be my Last Will and Testament. I revoke all other wills and codicils that I may have previously made. Article I My just debts and expenses of my last illness, funeral, and adrninistration of my estate shall be paid by my Executor from the principal of my residuary estate as soon as practicable after my death. Article II All inheritance,estate, and succession taxes(including interest and penalties thereon,but not including any generation skipping tax) payable by reason of my death shall be paid out of and be charged generally against the principal of my residuary estate without reimbursement from any person. This provision is not a waiver of any right which my Executor has to claim reimbursement for any such taxes which become payable as the result of any property over which I have the power of appointment. .,.�-.,�i n i rn-.n..^ : Article III I give, devise and bequeath in accordance with any memorandum which I have either handwritten or signed, located with my will or with my valuable papers and found within 30 days of the probate of my will. Gifts may only be to persons who survive me or to organizations which exist at my death, and if there is a conflict, the memorandum having the latest date shall govern. To the extent that all of my personal property may not be disposed of pursuant thereto,I give and bequeath all my tangible personal property IN EQUAL SHARES to my daughter,DENISE J. CARR,to my daughter, ROMAINE A.HILDEBRAND,to my daughter,SHARON L.COSNER,and to my son, FREDERIC L. HARTSOCK, Per Stirpes. Article N All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, I give, devise and bequeath IN EQUAL SHARES to my daughter, DENISE J. CARR, of Harrisonburg, Virginia, to my daughter, ROMAINE A. HILDEBRAND, of Dauphin Co�uity, Pennsylvania, to my daughter, SHARON L. COSNER, of Mineral, Virginia, to my son, FREDERIC L.HARTSOCK,of Ashburn,Virginia,to my stepdaughter,DIANE L.SUMMERS, of Lebanon County, Pennsylvania, to my stepson, VAUGHN R. HOSTETLER, of Lebanon County, Pennsylvania, and to my stepdaughter, DONNA L. DENTON, of Parkville, Maryland. If any of my beneficiaries predecease me or fail to survive me by thirty (30) days, I give, devise and bequeath his or her share to his or her issue who survive me, per stirpes, or if he or she has no issue, the share(s) are to be added equally to the other shares. - 2 - �.-,n.0 _e i ir_ii , Article V If any person or entity other than me singularly or in conjunction with any other person or entity directly or indirectly contests in any court the validity of this Will, including any amendments or codicils thereto,then the right of that person or entity to take any interest in my estate shall cease, and that person or entity shall be deemed to have predeceased me. Article VI I nominate, constitute, and appoint my daughter, ROMAINE A. HILDEBRAND, as Executrix of my Last Will and Testament. In the event of the renunciation,death,or inability to act, for any reason whatsoever of my Executrix,I nominate,constitute and appoint my son,FREDERIC L. HARTSOCK as successor Executor of my Last Will and Testament. I direct that my Executrix or successor Executor be permitted to serve without bond and in addition to those powers granted by law, I grant them power to distribute in cash or in kind in like or in unlike shares and to file any qualified disclaimer I could have filed if living. My Executrix or successor Executor shall receive reasonable compensation for services rendered to my estate. Article VII In addition to the powers conferred by law,I authorize my Executrix and successor Executor, in his/her absolute discretion: (a) to retain in the form received and to sell either at public or private sale, any real estate or personal property except that which I specifically bequeath herein, (b) to manage real estate, (c) to invest and reinvest in all forms of property without being confined to legal - 3 - _.,�.,�� _, ��-�� investments, and without regard to the principal of diversification, (d) to exercise any option or right arising from the ownership of investments, (e) to compromise claims without court approval and without consent of any beneficiary, (� to file any federal income tax return for any year for which I have not filed such return prior to my death, (g) to make distributions in cash or in kind, or in both, and to determine the value of any such property, (h) to employ any attorney, investment advisor, or other agent deemed necessary by my Executor; and to pay from my estate reasonable compensation for all their services, (i) to conduct alone or with others, any business in which I am engaged in, or have an interest in at time of my death, and (j)to receive reasonable compensation in accordance with their standard schedule of fees in effect while their services are performed. IN WITNESS WHEREOF,I,PAULINE K.HOSTETLER,hereby set my hand to this my Last Will and Testament, on ��' � 2005. ✓ � ,,�� ,"�� r.�,�,, ,�> �, PAULINE IC. HOSTETLER In our presence,the above-named PAULINE K.HOSTETLER signed this and declared this to be her Last Will and Testament and now at her request, in her presence, and in the presence of each other, we sign as witnesses. Name Address '. 1 ' , �� 845 Sir Thomas Court Suite ]2 Harrisbur�, PA 17109 '/'��Q-��. LLl��— 845 Sir Thomas Court Suite 12 Harrisburg, PA 17109 - 4 - I, PAULINE K. HOSTETLER, Testatrix, who signed the foregoing instrument, having been duly qualified according to law, acknowledge that I signed and executed this instrument as my Will, and that I signed it willingly as my free and voluntary act for the purposes therein expressed. Sworn to or affirmed and acknowledged before me by PAULINE K. H TETLER, the Testatrix on 3''� 2005. ` -� � � � � �f� � � _;�-�. i� - � ( ota Public PAULINE K. HOSTETLER �. COMM'-TM��,IYANUI 11U�QUEUNEATAI(Ell SEAL �W�P�(TON 1MrP.,DANUPH N� A11�COMMISSION EXp�RES DEC.!7,ypp� We, the undersigned witnesses who signed the foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the Testatrix sign and execute this instrument as her Will;that she signed and executed it willingly as her free and voluntary act for the putposes therein expressed;that each of us in her sight and hearing signed the Will as witnesses,and that to the best of our knowledge, that she was at that time eighteen (18) years or more of age, of sound mind, and under no constraint or undue influence. Sworn to or affirmed and subscribed to before me � ; ,. by J��, A .�7x�f��,� � �.�� _ ��-� and , itness witnesses, on �- , 2005. ��C C��.�- �=C.c Witness � / - � ; otary ublic � COMMOMW�ITH OF pENN MOTARIAL S�! �VANI� - S - �W R PUNE A.I(Eur NOTARY PUBUC �1'COMMISSIOH IXPIRES DEC.�j�Z� Practitioner Portal Page 1 of 1 Penalty and Interest Calculations CALCULATION DATES- 2/25/15 TO 4/14/2015 TAX DEFICIENCY $ 2,7�0.41 CALCULATED INTEREST $ 10.78 BALANCE AS OF 4/14/2015 $ 2,751.19 � Start Qver �; https://www.doreservices.state.pa.us/pitservices/Default.aspx 4/1/2015