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HomeMy WebLinkAbout01-0140 /(" -ao7 - /Q, REV -1500 EX + (6-00) OFFICIAL USE ONLY COMMONWEALTH OF PENNSYLVI\NII\ REV-1500 DEPI\RTMENT OF REVENUE DEPT. 280601 INHERITANCE TAX RETURN FILE NUMBER HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 21 2001 0140 COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LI\ST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER HOFFMAN, KENNETH R. 195-07-7009 DECE- DATE OF DEATH (MM-DD-YEAR) TDATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE DENT 11/06/2000 12/05/1914 WITH THE REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LI\ST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 8 3, Remainder Return CHECK r"~-'" ~' '"._~,- (date of death prior 10 12-13-82) APPRO- 4. Limited Estate 4a. Future Interest Compromise 5. Federal Estate Tax Return Required ~ateot death after 12-12-82:) PRIATE 6. Decedent Died Testate 7. acedenl Maintained a Living Trusl 8. Total Number of Safe Deposit Boxes (Attach copy of Will) Attach a copy of Trust BLOCKS 9. Litigation Proceeds Received 10. ~pousal Poverty Cradil (date of death between 011. Electlon to tal(, under Sec. 9113{l\} 12-31-918nd 1-1-95) (Attach 8eh 0) tlll$_.jt>>lIMj)$1~l!:p_IiMQMll~4p~~!l!j;~llillll'.'M;Wf~INm:lf.lMlItfIPN_ll!All~;1r,lIW!tJmiWif NAME COMPLETE MAILING ADDRESS COR- David H. Radcliff RE- FIRM NAME (If Applicable) 624 NORTH FRONT STREET SPON Cherewka & Radcliff, LLP WORMLEYSBURG, PA 17043 DENT TELEPHONE NUMBER (717) 236-9318 OFFICIAL USE ONLY 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) . . 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 94,314.91 Jointly Owned Property (Schedule F) , 6. 0 Separate Billing Requested (6) 41,559.04 RECA- PITULA- 7. Inter-Vivos Transfers & Miscellaneous TION Non-Probate Property (Schedule G or L) (7) 8. Total Gross Assets (total Lines 1-7) (8) 135,873.95 9. Funeral Expenses & Administrative Casts (Schedule H) (9) 6,250.66 10. Debts at Decedent, Mortgage Llabllltles, & Liens (Schedule I) (10) 1,730.41 11. Total Deductions (IOtal Lines 9 & 10) (11) 7,981.07 12. Net Value of Estate (Une 8 minus Line 11) (12) 127,892.88 13. Charltable and Governmental Bequests/Sec 9113 Trusts for which an election to tax (13) 0.00 has not been made (Schedule J) 14. Net Value Subject to Tax (Une 12 minus Line 13) (14) 127,892.88 SEE INSTRUCTIONS ON PAGE 2 FOR APPLICABLE RATES 15. Amount of Line 14 taxable allhe spousal lax rate, or tran'Sfers under Sec. 9116(a}\1.2.) X .0 (15) TAX 16. Amount of Line 14 taxable at lineal rate 127,892.88 X.O -;g- (16) 5,755.18 COMPU- 17. Amount of LIne 14 lallableal sibling rate X .12 (17) 0.00 TATION 18. Amount of Line 14 lallable al collateral rete X .15 (18) 0.00 19. Tax Due (19) 5,755.18 20. 0 I~KH!lRaiill!t6QA~~ii1m~.AII~i!IOjl\\!1~tm~ij(iiAYMmtX! ..........,...... ...,.......'"'"...... .'..........,.:.:.,.:.:".:.:..'. .. ............w, ,:,:,:,:,:,:,:,:",H",:,;,:'::::: """'JH*$ae:l$Wl;l!;TQ1V\!$W!\Il$U;!!:i!(Il!;STIQN$;;.Q(it'\y;qS.'Il,!\N!)~\"i!\Cl';;"Mrl'~,Hdi!i!'!}M!!!/(i,iiA:! .;.:.:.,:;,:..;...:.;. .'..............",- .:,:.:.:.:.:..._,:.:.:.:.:.:.:.:.;.:. :.:.:.~......,,: o PA 15001 NTF 29755 copyright 2000 Greatland/Nelco LP . Forms Software Only PA REV-l500 EX (6-00) C Page 2 Decedent's omDlete A ress: STREET ADDRESS 600 Tower Road CITY Enola I STATE PA !Z1P 17025 dd Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 5,755.18 0.00 5,300.00 278.95 Total Credits (A + B + C) (2) 5,578.95 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 0.00 4. Ii Une 2 is greater than Une 1 + Une 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 0.00 5. If Line 1 + Une 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 176.. 23 A. Enter the interest on the tax due. (5A) 0.00 B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) 176.23 ~t~~@')~~~!~~;'f~€~6EE6~i~d:~~~~lf~~~:~~!~~~~';~~f~i-:!~~f~+~g~p~'~6~~I~fg~t~~~g 1. Did decedent make a transfer and: Yes No a. retain the use or income at the property transferred; ~ ~ b. reta~n the right, to deS,i9nate who shall use the property 'b'"ansferred or its income; c. retain a reversionary Interest; or, . , . . . d. receive the promise for life of either payments, benefits or care? 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . . . , . 8 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .K.J 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........... ................. 0 K1 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 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 behef, it IS true, correct and complete. Declaration oi preparer other than the personal representative is based on information of which creparer has anv knowledqe. SIGNA RE Of PER ON P SIBLE fOR fiLING RETURN DATE 7 PA 17025 ADDRESS 624 North Front Street 17043 :':=:::}:::'?:'?:':%M?\W\tM?\W?i.WFg::::;.:::::~:~::.:~::.:':.':'~'~'~::'~:~:~:~:~:~:~:~::<::::::::::::;:::::;.:?:fm.i?i.{'iy,:':?i.:;::::..:~::<:::~::::'::':;:':':':::::::;:;??:?::;?:'i:<e??F..e:::t ::::::::::Y;:~:"::::::::::~:::::::?:::..:;::??=::?::::::;:::::...:~::..,::::::::::::::...:::::::?r::::::}:E:7::/::::~t~:::::::....-..:.:.:.:.:.:.:.:.:.:.:::::::'\:}i(;::;:tr;:::~;:;::::: For dates of death on or after July 1, 1994 and before January 1, 1995, Ihe talC rate Imposed on the net value of transfers to or for the use of Ihe surviving spouse is 3% [72 P.S. 19116 (a)(1.1) (i)]. For da1es of death onor atler January', 1995, the talC rate Is Imposed on the net value of transfers to or for the use of the survIvIng spouse Is 0% [72 P.S. IIS116 (a)(1.1) (II)J. The slatute dn...", ...nl ..,....m!'>! a Iransfer to a surviving spouse from tax, and the statutory requirements for dlsc;Josure ofasslittsand filing a talC return are sllll applicable even if the surviving spouse Is the only beneficiary. For dates of death on or after July', 2000; The talC rate Imposed on the net value of transfers from a deceased child twenty-one years of ase or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparen1 of the child Is 0% {72 P ,S.lia 116~a)(,1.211. The talC rate Imposed on the net value of transfers to or for Ihe use of the decedent's lineal beneficiaries is 4.5%, elCcepl as noted In 72.P.S.1 9116(1.2){72 P.S.19116(a)('l]. The talC rale Imposed on the net value of transfers to or for the use of Ihe decedent's slbllngs Is 12% [72 P.S.IiB116(a)(,1.3l1. A slb\\ngls defIned, under Sec110nS102, asan lndlvidual who has at least one pardnt In common with the decedenl, whether by blood or ;ldopUon. o PA15002 NTF 29756 Copyright 2000 Greatland/Netco LP - Forms Softwar. Only REV-150B EX+(1.97J COM MONWEAL TH OF PE NNSVL V AN\A INHERITANCE TAX RETURN A !DENT C DE T ESTATE OF KENNETH R. HOFFMAN SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21-01-0140 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 NUMBER 1 DESCRIPTION VALUE AT DATE OF DEATH Bank of America Certificates of Deposit 77,070.00 2 National Assoa Letter Carriers Medical reimbursements 712.91 3 Per diem insurance reimbursement 4BO.00 4 Personal property (See attachment) 513.00 5 Refund from prepaid funeral 489.00 6 U.S. Treasury 2000 Income Tax Refund 815.00 7 Vehicle - 2000 Buick Century Sedan 14,235.00 TOT ALrAlso enter on line 5 Recao~ulation I $ 94 314. 91 (l{ more space is needed, insert additional sheets of the same size) Copyright (c) 1991 form software onlyCPSystems, Inc. Form REV-1508 EX (Rev. 1-97) ESTATE OF KENNETH R. HOFFMAN S.S.#195-07-7009 PERSONAL PROPERTY Bedroom Suite $125 Sofa 50 Recliner 25 Coffee Table 10 Television 25 One Pair Lamps 10 Two End Tables 20 Two Corner Cupboards 25 Dining Table with 4 Chairs 50 Kitchen Table with 2 Chairs 10 Set Flatware 5 Set of Pans 2 Set of Dishes 5 Coffee Pot 2 Stereo 10 High Chair 2 Grandfather's Clock 50 Organ 75 Fishing Rods -1..Q $513 Antiques - None AEV-1509 EX +(1-97) COM MONWEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN A SIDENT DE ED T SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF KENNETH R. HOFFMAN FILE NUMBER 21-01-0140 If an asset was made joint within one year of the decedent's date of death, It must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME A. Byron Lee Hoffman ADDRESS RELATIONSHIP TO DECEDENT 600 Tower Road Enola, PA 17025 Son JOINTLY -OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial instllutlonand bank DATE OF DEATH DECD'S VALUE OF account number or sImilar identllylng number. NUMBER TENANT JOINT Attach deed for JoIntly-held real estate, VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1 A 10/06/00 Pennsylvania State Bank Checking Acct #10500015 2,589.02 100 2,589.02 2 A 10/06/00 Pennsylvania State Bank Savings Acct #26015057 38,970.02 100 38,970.02 this amount reflects $3,000 annual gift exclusion) TOTAL (Also enter on line 6, Recapitulation) $ (Ii more space is needed insert actd'ltional sheets of the same size) Copyright (c) 1997 form software only CPSystems, Inc. 41,559.04 Form REV-1509 EX (Rev. 1-97) REV-1511 EX+{1-97) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COM MONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN 10 NT E EOENT ESTATE OF KENNETH R. HOFFMAN FILE NUMBER 21-01-0140 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: None B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) I EIN Number of Personal Representative(s) - - Street Address City Slate _Zip Year(s) Commission Paid: 0.00 2. Attorney Fees 1,420.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant N/A Street Address City State _Zip Relationship of Claimant to Decedent 4. Probate fees 0.00 5. Accountant's Fees 0.00 6. Tax Return Pre parer's Fees 0.00 7. Byron Hoffman For Allied Van Lines - moving personal property 3,456.74 8. Byron Hoffman Transportation expense involved with moving personal property 1,345.92 9. Register of wills Filing Fee - Inheritance Return 15.00 Total miscellaneous expenses from continuation "ane(s) 13.00 TOTAL (Also enter on line 9 Recanitulatlon' $ 6 250.66 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1997 form software only CPSystems, Inc. Form REV-1511 EX (Rev.1~97) SCHEDULE H MISCELLANEOUS EXPENSES (continued) ESTATE OF: KENNETH R. HOFFMAN ITEM NO 10. DESCRIPTION Register of wills Filing fee - Inventory FILE NUMBER: 21-01-0140 Total. (Carry forward to main schedule) . . . $ AMOUNT 13.00 13 .00 REV -1512 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS ESTATE OF KENNETH R. HOFFMAN FI LE NUMBER 21-01-0140 Include un reimbursed medical expenses. ITEM NUMBER 1 Keystone Urology DESCRIPTION AMOUNT 41. 42 2 West Shore Emergency Medical Service 92 .60 3 Claremont Nursing & Rehab 558.52 4 Susquehanna Surgeons 79.50 5 Crumay Parnes Associates 73.18 6 EKG Associates 61.97 7 Conner-Rich-Kearney-Torchia Associates 323.77 8 PA Neurological Associates 499.45 TOTAL (Also enter on line 10 Rec"oil"I"';onl $ 1 730.41 (If more space is needed, insen additional sheets of the same size) Copyright (c) 1997 form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-97) REV- 1513 EX + (1-97) COMMONWEAL THOF PENNSVLVANIA INHERITANCE TAX RETURN ESI T DECEDE SCHEDULE J BENEFICIARIES ESTATE OF KENNETH R. HOFFMAN FILE NUMBER 2~-0~-0140 NUMBER I. NAME AND ADDRESS OF PERSONISl RECEIVING PROPERTY TAXABUE DISTRIBUTIONS (include outright spousai distributions) RELATIONSHIP TO DECEDENT Do Not Ust Trustee!s) AMOUNT OR SHARE OF ESTATE ~ Byron Lee 600 Tower Enola, PA Hoffman Road ~7025 Son 62,896.19 3 Angela Sue Hoffman Misrack P. O. BOx 420015 San Diego, CA 92142 Jan scott Hoffman 2 Barrick Lane Duncannon, PA 17020 Granddaughter 2,000.00 2 Son 62,996.69 ENTER DOLLAR AMTS. FOR DISTRiBUTIONS "HOWN ABOVE C\N LN. 15 THRU 17 AS APPROPRIATE ON REV 1500 CC\VER SHEET II. NON- TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 fOR WHICH AN EUECTION TO TAX IS NOT BEING MADE B. CHARITABUE AND GOVERNMENTAL DISTRIBUTIONS None TOTAL OF PART II - ENTER TOTAL NON- TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET Is (Ii more space is needed, insert additional sheets of the same size) Copyright (c) 1997 form software only CPSystems, Inc. 0.00 Form REV-1513 EX (Rev. 1-97) , LAST WILL AND TESTAMENT .QE KENNETH R. HOFFMAN I, KENNETH R. HOFFMAN, of the County of Pinellas, State of Florida, presently residing at 4647 Lake Villa Drive, Clearwater, being of sound and disposing mind and memory, do hereby revoke all Wills and Codicils, as well as all other instruments of a testamentary nature heretofore executed by me, and declare this to be my Last Will and Testament, in manner and form following: FIRST: I direct that all my just debts, funeral expenses, administration expenses, and all estate, inheritance, succession, legacy, and transfer taxes, both foreign and domestic, be paid as soon after my death as is convenient. SECOND: I may leave a written statement or list disposing of certain items of my tangible personal property not otherwise disposed of in this my Last Will. Any such statement or list in existence at the time of my death shall be determinative with respect to all items devised thereon. If no written statement or list is found and properly identified by my Personal Representative within 30 days after qualification, it shall be presumed that there is no such statement or list and any subsequently discovered statement or list shall be ignored. Page 1 of 5 Pages ://lJl K.R.H. THIRD: I give and devise the sum of TWO THOUSAND DOLLARS ($2,000.00) - ;4{ IS {I'l(/~ to my granddaughter, ANGELA SUE HOFFMAN MERICK, Sand Diego, California, if living. FOURTH: All the rest, residue and remainder of my property, real, personal or mixed, tangible and intangible, of whatever nature and wheresoever situated, including all property which I may acquire or become entitled to after the execution of this Will, including all lapsed legacies and devises, I give and devise as follows: A. ONE HALF (Y:.) to my son, JAN SCOTT HOFFMAN, if liVing and if not to my son, BYRON LEE HOFFMAN, if living. B. ONE HALF (Y:.) to my son, BYRON LEE HOFFMAN, if living and if not to my son, JAN SCOTT HOFFMAN, if living. In the event both of my said sons shalll:le predeceased my estate shall be distributed to all of my grandchildren living at the time of my death, in equal shares, share and share alike or to the survivor of them. If any beneficiary shall be under 21 years of age and become entitled to distribution under the provisions of this Will, that share shall be retained by my Personal Representative or Trustee herein named until they attain such age. During such time, the Personal Representative or Trustee shall pay to such beneficiary or expend on their behalf so much of the net income derived from that particular fund, or principal if necessary, as the Personal Representative or Trustee may deem advisable, at the Personal Representative's or Trustee's discretion, to provide properly for said beneficiary's mainten- ance, education and well-being, taking into consideration any other income that the child Page 2 of 5 Pages A:rf.f(. K.R.H. may have available to him or her, and may incorporate any income not so disbursed into the principal of the fund. Any such amounts shall be paid out by my Personal Representative or Trustee in such of the following ways as the Personal Representative or Trustee deems best: (a) directly to such beneficiary; (b) to the legally appointed guardian or conservator of such beneficiary; ( c) to some relative or friend for the car\:,!, support and education of such beneficiary; (d) by my Trustee, using such amounts dir~ctly for such beneficiary's medical care, education, and support in reasonable comfort. When each such beneficiary shall attain the age of 21 years, the trust shall terminate as to such beneficiary and the Trustee shall distribute their fund to such beneficiary in fee. FIFTH: I hereby nominate, constitute and appoint my son, BYRON LEE HOFFMAN, as Personal Representative of this my Last Will and Testament, and direct that he serve without bond. In the event my said son shall predecease me, or for any reason fail to qualify, I nominate and appoint my son, JAN SCOTT HOFFMAN, as Alternate Personal Representative and direct that he serve without bond. I hereby give my Personal Representative or Alternate Personal Representative full power and authority, without limitation, at any time or times to sell, mortgage, pledge, exchange or otherwise deal with or dispose of the property comprising my estate, real, personal or mixed, as they shall deem best; to settle and compound any and all claims in favor or against my estate as they shall deem advisable, and for any of the foregoing purposes, to make, execute and deliver any and all deeds, contracts, mortgages, and bills of sale or other instruments necessary or desirable therefor without necessity of Court order. Page 3 of 5 Pages ,fl?~ K.R.H. J . 'fI.-- IN WITNESS WHEREOF, I have hereunto set my hand and seal this /7 day of August, 1998. ~_di (i. ~~..J (SEAL) NNETH R. HOFFMAJ The foregoing instrument was signed, sealed, published and declared by KENNETH R. HOFFMAN to be his Last Will and Testament, in our presence who, at his request, and in his presence, and in the presence of each other, have hereunto set our hands as attes 'ng witnesses, the day and year last above written. C.m( SUSAN C. McGUIRK Pinellas Park, Florida Pinellas Park, Florida Pinellas Park, Florida WE, KENNETH R. HOFFMAN, SUSAN C. McGUIRK and KATHLEEN J. KARN, the . Testator and the witnesses respectively, whose names are signed to the attached or foregoing instrument, were sworn, and declared to the undersigned officer, that the Testator signed the instrument as his Last Will, and that each of the witnesses, in the presence of the Testator and in the presence of each other, signed the Will as a witness. ~-4f /? ~~,ytf~ {!. '-tn ( . . NNETH R. HOFF N USAN C. McGUIRK, WITNESS Testator ~ J ~ 00 i.. KATHLEEN J. " RN, WITNESS Page 4 of 5 Pages ~ K.R.H. STATE OF FLORIDA ) COUNTY OF PINELLAS ) The foregoing instrument was acknowledged before me this ;l!!aay of August, 1998, by KENNETH R. HOFFMAN, who is pers~nowl to me. .. r . NY L FRANCIS M. LEE Notary Public OFFICIAL NorARY SEAL FRANCIS M LEE NorARY PUBUCsrATE OF FLORIDA COMMISSION NO. CC7l56SS ...M.'\' COMMISSION EXP. MAR. 6{1.fYJ1. Page 5 of 5 Pages ~ K.R.H.