HomeMy WebLinkAbout06-25-15 J pennsylvania 1505618148
DEPARTMENT OF REVENUE EX(03-14)
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 115
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
01282015 08161928
Decedent's Last Name Suffix Decedent's First Name MI
HENDRICKS ROBERT L
(if Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
HENDRICKS HARRIET
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL INAPPROPRIATE BOXES BELOW
XQ 1. Original Return Q 2. Supplemental Return Q 3. Remainder Return(date of death
prior to 12-13-82)
Q 4. Agriculture Exemption(date of Q 5. Future Interest Compromise(date of Q 6. Federal Estate Tax Return Required
death on or after 7-1-2012) death after 12-12-82)
Q 7. Decedent Died Testate Q 8. Decedent Maintained a Living Trust 0 9. Total Number of Safe Deposit Boxes
(Attach copy of will) (Attach copy of trust.)
Q 10. Litigation Proceeds Received Q 11. Non-Probate Transferee Return Q 12. Deferral/Election of Spousal Trusts
(Schedule F and G Assets Only)
Q 13. Business Assets Q 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
ROBERT G . FREY 7172435838
First Line of Address
5 SOUTH HANOVER STREET
Second Line of Address
City or Post Office State ZIP Code
CARLISLE PA 17013
Correspondent's email address: R F R E Y a F R E Y T I L E Y . COM c,—
r rtl
REGISTERWF WILLS USE 6NtY C>
REGISTER OF WILLS USE ONLY M r <-) __q C:--,)
DATE FILED MMDDYYYY �
)
DATE FILE STAMP
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505618148 1505618148 J
W
J 1505618155
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: ROBERT L HENDRICKS
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. 5599. 95
6. Jointly Owned Property(Schedule F) =Separate Billing Requested. . .. . . .. 6 a . 00
7. Inter-Vivos Transfers,&Miscellaneous Non-Probate Property
(Schedule G) =Separate Billing Requested. . . . . . . . 7. 0 . 00
8. Total Gross Assets(total Lines 1 through 7) .... . . ... . . . . . . .. . . . . . . . . . . . . . 8. 5599 . 95
9. Funeral Expenses and Administrative Costs(Schedule H). . . . . .. . . . . . . . . . . . . . 9, 4407.28
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1). . . . . . . . . .. . . . . . 10, 0 . 00
11. Total Deductions(total Lines 9 and 10). . .. . . . . . . . . .. . . . . . . . . . . . . . . . . . . . .11. 4407.28
12. Net Value of Estate(Line 8 minus Line 11). . . . . .. . . . . . . . .. . . .. . . . . . . . . . . . 12. 1192. 67
13. Charitable and Governmental Bequests/Sec 9143 Trusts for which
an election to tax has not been made(Schedule J). . . . . . . .. . . . . . . . . . . . .. . . ..13. 0 . 011
14. Net Value Subject to Tax(Line 12 minus Line 13). . . . . . . . . . . . . . . . . .. . . . . .. 14. 1192. 67
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 0 1192.67 15. 0 . 00
16.Amount of Line 14 taxable
at lineal rate X.0 45 16. 0 . 110
17. Amount of Line 14
taxable at sibling rate X .12 17. 0 . 011
18. Amount of Line 14 taxable
at collateral rate X . 15 18. 0 .00
19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . 19. 0. 00
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Under penalties of perjury,I declare I have examined this return,indluding 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 RESPONSIBLE FOR FILING RETURN ATE
AD SS
8 DANNAH DRIVE CARLISLE PA 17015
SIGN �OFP `O�TH THAIVERSON RESPONSIBLE FOR FILING THE RETURN DATE
2
ADDRESS ,
5 SOUTH HANOVER STR CARLISLE PA 17013
11111111111111111111111111111111111 Jill 1111 Side 2
L 1505618155 1505618155
REV-1500 EX Page 3 File Number 527-24-0731
Decedent's Complete Address: 21-15-0285
DECEDENT'S NAME
ROBERT L HENDRICKS
STREETADDRESS
8 DANNAH DRIVE
CITY STATE ZIP
CARLISLE PA 17013
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 0.00
2. Credits/Payments
A. Prior Payments
B. Discount
(See instructions.) Total Credits(A+B) (2) 0.00
3. Interest
(3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT.
Fill in box 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) 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 property transferred............................................................................... ❑
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?.......................................................... ❑ Q
2. If death occurred after Dec. 12, 1982,did decedent transfer property within one year of death
without receiving adequate consideration?.................................................................................................. ❑ 0
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?............................................................................................................. ❑ ❑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 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-1508 EX+(02-15) SCHEDULE
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Robert L and Harriet E Hendricks 21-15-0285
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. Thrivent Life Insurance benefit payable at the time of death on the life of Martha Hendricks 5,599.95
TOTAL(Also enter on Line 5, Recapitulation) $ 5,599.95
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(02-15)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX
RESIDENT DECEDNT RETURN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Robert L and Harriet E Hendricks 21-15-0285
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
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: 500.00
3. Family Exemption:(If decedent's address is not the same as claimant's,attach explanation.) 3,500.00
Claimant Harriet E. Hendricks
Street Address 8 Dannah Drive
city Carlisle State PA zip 17013
Relationship of Claimant to Decedent Spouse
4. Probate Fees: 120.50
5. Accountant Fees:
6. Tax Return Preparer Fees:
7. Advertising, Cumberland Law Journal 75.00
8. Advertising,The Sentinel 211.78
TOTAL(Also enter on Line 9, Recapitulation) $ 4,407.28
If more space is needed,use additional sheets of paper of the same size.
REV-1513 EX+(02-15)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Robert L and Harriet E Hendricks 21-15-0285
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).]
Harriet E. Hendricks
1' 8 Dannah Drive, Carlisle, PA 17015 Spouse 100%of remainder
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 II—ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 0.00
If more space is needed,use additional sheets of paper of the same size,
tilt amb �Vot ament
OF
ROBERT L. HENDRICKS
I, ROBERT L. HENDRICKS, of the County of Cochise, State of Arizona,
being of sound and disposing mind, make this my Last Will and Testament, hereby
revoking all Wills and Codicils heretofore by me made.
FIRST: I declare that at the date hereof I am married to HARRIET E.
HENDRICKS (hereinafter referred to as"my wife") and I have three children, JOHN P.
HENDRICKS of Glendale, Arizona, DAVID G. HENDRICKS of Morenci, Arizona, and
CARL E. HENDRICKS of Gambrill, Maryland.
SECOND: I hereby direct that all my just debts and funeral expenses be
paid out of my estate as soon as practicable after my death.
THIRD: I give, devise and bequeath my estate as I have described by a
separate writing which is attached to this Will in accordance with Section 142513 of the.
Arizona Revised Statutes. In the absence of such a statement, I give, devise and
bequeath my estate as described in the following paragraphs.
FOURTH: I give, devise and bequeath the rest, residue and remainder of
my entire estate, whether real, personal or mixed and wheresoever located to my wife,
HARRIET E. HENDRICKS.
Page 1 of 5 pages
!/l. c
FIFTH: In the event my wife should predecease me, or we die in a
common disaster, then I give, devise and bequeath the rest, residue and remainder of
my entire estate equally to my children, JOHN P. HENDRICKS, DAVID G. HENDRICKS
and CARL E. HENDRICKS, share and share alike.
SIXTH: In the event any of my children should predecease me, his or
their share shall be distributed to his or their spouse(s).
SEVENTH: I appoint my wife, HARRIET E. HENDRICKS, as my Personal
Representative. In the event my wife should predecease me or is unable or unwilling to
so act, I appoint my children, JOHN P. HENDRICKS, DAVID G. HENDRICKS and
CARL E. HENDRICKS, or the survivor(s), as my Alternate Co-Personal
Representatives. I direct that neither my Personal Representative nor my Alternate
Co-Personal Representatives appointed in this or in any other jurisdiction be required to
fumish a bond, or if a bond is required by law, no surety on any bond shall be required.
Reference in this Will to "my Personal Representative" means the
Personal Representative for the time being in office, whether appointed in this or in any
other-jurisdiction.
EIGHTH: My Personal Representative and any successors shall have all
such rights, powers and discretions as may be necessary or appropriate for effective
administration of my estate, including, but without limitation, the following:
To pay, reject or compromise claims of all kinds against my estate; to
retain assets received; to acquire property of every kind and description by investment
Page 2 of 5 pages ` '
and reinvestment; to grant options to purchase; to manage property directly or by
exercising voting privileges; to lease, operate, change the form of or dispose of assets;
to borrow; to encumber assets; to improve, preserve and maintain assets; to hold
property in fiduciary name or in the name of a nominee with or without disclosure of
fiduciary capacity; to determine all questions with respect to the manner in which
expenses are to be bome and receipts are to be credited as between principal and
income; to employ and compensate attorneys, accountants, agents and brokers; to
make any elections under the income or estate tax laws which may be available and to
determine whether or not distribution adjustments as a result of any such election are
appropriate; to divide and distribute my estate in cash or in kind, or partly in cash or
partly in kind; and to exercise any and all of the foregoing rights, powers and discretions
without giving prior notice to any person and without first obtaining an order of any court
therefor. Should a trust become necessary, my Trustee shall be vested with the same
rights, powers and discretions to apply to the trust and to trust property.
I, ROBERT L. HENDRICKS, the Testator, sign my name to this Instrument
this 16th day of May, 2002. Being first duly swom, I do hereby declare to the
undersigned authority that I sign and execute this instrument as my Last Will and that I
sign it willingly, that I execute it as my free and voluntary act for the purposes therein
expressed, and that I am eighteen years of age or older, of sound mind, and under no
Page 3 of 5 pages
cdh8tr6iht:6 e undo a..influence, For identificatio' 'n. I:'haVe--1hjtialbde of ore five.,pages.
-of-this.Will.
ROBERT L. HENDRICKS
We,. MARRA X.. PL UMB- and— 'GALt. E. VAI'81ML`U`�i
ihevbe5ses,sigri'our a-Mes-to thisi : eng`fijt t diA .sWoefi..-�hd 6-hereby
:declA(e.Ao 1he unde"rs' ig''ii od:a'utho.tityAh:6t ROBERT-L HENDR.10.K--S:,'the'Testator,
.sk hed 6,hd.e�e"'utedthisl`�trub 6t.as his LaMVifland that ha.zigned.-it wifling'ly and
9 M me
. !"Will"',
thatdach-:of-us, in1he presence and'hearing,:df-.tho.T'.e'i�tator.,'her6by:'t. iOned-th.. . _.q. .. .. .as
witness,t6t.he'Testator's,signing,. Ahaf to-the best pfour:krip16dge:,the.Testator f is
w
qi0htee"n "N 6 and,�uhd r`nio.co' nstrairifor'unidue
years.o aye r e
f
WITNESS
Ptig"&4 of
STATEOFARIZONA
COUNTY OF COCHISE.
SUBSCRIBED, SWORN TO AND ACKNOWLEDGED:before me by
ROBERT Li.HENDRICKS,,t.h.e'Testa.t.qr,.and SUBSCRIBED AND SWORN To before
me by M&= K.; :PLOM and c-MY. -ri- yms mmixg.
witnesses,this 16.th day of May, 2002'.
�Notary.Publlc
My Commission Expires:
:A
Qu
NTY
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