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Home My WebLink About04-16-15 (3) pennsytvania 1505614105 OEPFRTMENT OF REVENUE EX(03-14)(FI) REV-1500 OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number INHERITANCE TAX RETURN j PO BOX 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ,I 14 ........ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY ............................... ..................................................... ............. ..........-......................................................................................................... 07072014......................................................................._! _0-528,1„928............................................................................ Decedent's Last Name Suffix Decedent's First Name MI LHoernerJ �— — Izora i..F___; (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI __......__._...... ._..._.._..._...._....._._.. —......--- _...._...__.........................._........., ..................... ................ ............... ................................._...._..........__.._............ ............................ ................... i.....__......., ... ._ __....__._ .__ -......_........_I _ .___.. __ ................................................................................................................................................. . _._. ........ __..._ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW m 1. Original Return O 2.Supplemental Return O 3. Remainder Return(date of death prior to 12-13-82) O 4.Agriculture Exemption(date of 0 5. Future Interest Compromise(date of O 6. Federal Estate Tax Return Required death on or after 7-1-2012) death after 12-12-82) O 7. Decedent Died Testate O 8. Decedent Maintained a Living Trust 9. Total Number of Safe Deposit Boxes (Attach copy of will.) (Attach copy of trust.) O 10. Litigation Proceeds Received O 11. Non-Probate Transferee Return O 12. Deferral/Election of Spousal Trusts (Schedule F and G Assets Only) O 13. Business 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 TO: Name Daytime Telephone Number Herschel Lock,_Esq._.._._._._........__-. _._._........._.... ............_. (717) 238-6661 First Line of Address i 13107 North Front St. Second Line of Address 1 City or Post Office State ZIP Code ----......_.___...... .............-....-- ......- ._....... �� :i1 c1-1 rn _.__ ........_...........__.._._.._... _....._ ....._.. __.. __........_._......._.._._......__.... ._.... 1-711PA --_.... n �Harrisbug ........_..._.........----..-_....._...._...... _.__....... ....... _...... _ Correspondent's email address: h1QGk@sq@veri�net "o p 1 c 1-11 17,11 REOIST k OFiWILL69111SE ONiLY� REGISTER OF WILLS USE ONLY »r A 'T' g9 Y"v DATE FILED STAMP PLEASE USE ORIGINAL FORM ONLY Side 1 1�iiiii 056 41 1505614105 r-� 1 1505614205 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: 170RA G WOERAIFR RECAPITULATION 1. Real Estate(Schedule A). . ....... .. ..... ... ... . . . .. ..... .......... ... 1. 0 I 2. Stocks and Bonds(Schedule B) .. . .... ....... .. ... .. ........ .. . ....... 2. 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . ... . 3. 0 4. Mortgages and Notes Receivable(Schedule D)..... ... .... ..... ..... . .... 4. ! 0 i 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E).. ..... 5. 55 344.40 6. Jointly Owned Property(Schedule F) O Separate Billing Requested .... ... 6. 0 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property ! (Schedule G) O Separate Billing Requested........ 7. i 26,426.50 8. Total Gross Assets(total Lines 1 through 7).... ...... ........... .... .... 8. f 81,770.90 9. Funeral Expenses and Administrative Costs(Schedule H). ... ........... .... 9. 3931.50 i 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1).............. . 10. I 511.70 11. Total Deductions(total Lines 9 and 10)......... .. ... ........... .... . ... 11. I 4443.20 12. Net Value of Estate(Line 8 minus Line 11) ....... . ............... ... . ... 12. j 77 327.70 13.-Charitable and Governmental Bequests/Sec.9113 Trusts for which an election to tax has not been made(Schedule J) ... . . .... ...... .... ... .. 13. 0 14. Net Value Subject to Tax(Line 12 minus Line 13) .. . . . .... .. .. ...... .. ... 14. 177,327.70 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- 15.1 16. Amount of Line 14 taxable at lineal rate X.04,&_ 1 77,327.701 16. 1 3479.74 17. Amount of Line 14 taxable 1 1 at sibling rate X.12 18. Amount of Line 14 taxable ! j at collateral rate X.15 19. TAX DUE ........ ... ........ ....... .. ....... ........... ....... .... 19.1 -_ 3479.74 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Under penalties of perjury.I declare I have examin tLtheu mAt incl din a companying schedules and statements,and to the best of my knowledge and belief, it is true,correct a mplete. Declarati�i of p pare pn res nsibl for filing the return is based on a�in o atio f, reparer has any knowledge.( SIGN U E OF PE SO R NSIBL F RFI I G RE URN ATE 7 �. ADD E S - 4 ' SIGNATURE PRE�PA FF OT O C(rN PERSON RESPONSIBLE FOR FILING THE RETURN J DgT ADDRESS l�� 1-7/IO Side 2 ��) 1505 1420 1505614205 REV-1500 EX (FI) Page 3 File Number ;j_/q_00-7 Decedent's Complete Address: DECEDENTS NAME _Izora-F-_�I.oeroer-_a/k/a-Izora—Fern-H.o.erne.— STREET ADDRESS J-O-.H.ouse.Ave..,--Rm.1-5— --- ---- -----..�----- -- -- —_ __----- -- CITY --�— ----------- —�--- STATE � ZIP ------- Camp Hall PA 17011 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 2479.74 2. Credits/Payments A.Prior Payments 3.3.0.0...0.0 B.Discount 13{68 (See instructions.) Total Credits(A+B) (2) 347368 3. Interest (3) 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. 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) F 05 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.......................................................................................... ❑ E b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ N c. retain a reversionary interest .............................................................................................................................. ❑ E 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?.............. ❑ 0 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation? .............................................................. 0 ❑ .......................................................... 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 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 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-15o8 EX+(08-12) INpennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS &MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: IZQRA F HOERNER a/k/a IZORA FERN HOERNFR 21-14-0697 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. Members 1st Federal Credit Union-acct.no.477428-00 5.00 2. Members 1st F.C.U.-acct.no.477428-11 37,670.86 3. Members 1st F.C.U.-acct.no.xxx220 16,688.05 4. Santander Bank-acct.no.571113095 433.28 5. Omnicare, Inc.-refund 0.21 6. 2014 U.S. Income Tax refund 547.00 TOTAL(Also enter on Line 5, Recapitulation) $ 55 344.40 If more space is needed, use additional sheets of paper of the same size. REV-1510 EX+ (08-09) pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER 170RA IF HOFRNFR a/ 17013A EFRN HnFRNER 21-14-0697 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 INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH %OF DECO'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (ff APPLICABLE) VALUE 1. Members 1st Federal Crediit Union IRA acct.no.477428.10 26,426.50 100 0 26,426.50 TOTAL(Also enter on Line 7,Recapitulation) $ 26,426.50 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+ (08-13) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER 170RA F HOFRNFR a/k/a 170RA FERN HCIFRNFR ?J-J4-0697 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A, FUNERAL EXPENSES: i. B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City._..._.........._._........._._._.... ............._._............. ................................_State------ ZIP....-........_......._..- _ .... Year(s)Commission Paid: 2. Attorney Fees: Herschel Lock, Esquire 3345.00 3. 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: Register of Wills 238.50 5. Accountant Fees: 6. Tax Return Preparer Fees: 225.00 7, Cumberland Law Journal-estate advertisement 75.00 8. The Paxton Herald-estate advertisement 48.00 TOTAL(Also enter on Line 9, Recapitulation) $ 3931.50 If more space is needed,use additional sheets of paper of the same size. REV-1512 EX+(12-12) INpennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF�/��p� ��p� �p FILE NUMBER IZE)RA F- HE)E lTVL,�R • ,�T IZE)RA FERCTi I IGERP4ER 1 12 0697 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. AlixaRx-outstanding bill 91.31 2. AlixaRx-outstanding bill 8.08 3. Golden Living-outstanding bill 412.31 TOTAL(Also enter on Line 10, Recapitulation) $ 511.70 If more space is needed,insert additional sheets of the same size. REV-1513 EX- (01-10) pennsytvania SCHEDULE DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: !--'E)RA F ' "_'_RNER a/!(/a 1zeRA FERN H(DERNER - A RELATIONSHIP TO DECEDENT A09SHARE Aftir 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. George T.Fahnestock,868 Pinetown Rd., Lewisberry, PA 17339 son 100% residuary estate 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. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ONLINE 13 OF REV-1500 COVER SHEET. $ 0 If more space is needed,use additional sheets of paper of the same size.