HomeMy WebLinkAbout07-20-15 (2) J � pennsylvania 15�5 618 4 0 3
� �EPARTMENTOFREVENU�X(03-14)
REV-1500 OFFICIAL USE ONLY
County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
Po Box.2so6o� 21 13 10 51
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
08 15 2013 04 07 1924
DecedenYs Last Name Suffix DecedenYs First Name M�
HENSEL RUTH L
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name M�
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
� 1. Original Return � 2. Supplemental Return ❑ 3. Remainder Return(date of death
prior to 12-13-82)
� 4. Agricultural Exemption(date of � 5. Future interest Compromise(date of ❑ g. Federat Estate Tax Return Required
death on or after 7-1-2012) death after 12-12-82)
� 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 ❑ �� Non-Probate Transferee Return ❑ 12. DeferrallElection of Spousal Trusts
(Schedule F and G Assets Only)
❑ 13. Business Assets ❑ 14. Spouse is Sole Beneficiary
(No trust involved)
CORRESPONDO�T-THS SECiION NRJST BE(�NPLE7ID.ALI.CCIFtRESPOt�ENCEAI�(�IDQ�TIP�L TAX WFORMAl10N SFIOULD BE Dtl2ECTED TO:
Name Daytime Telephone Number
GERALD J BRINSER 717 838 6348
First Line of Address
6 E MAIN STREET
Second Line of Address
PO BOX 323
City or Post Office State ZIP Code
PALMYRA , PA 17078
CorrespondenYs email address: 9lbrin@aol.com `v
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15056184�3 15056184�3 J
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J1505618411
REV-1500 EX
DecedenYs Social Security Number
oe�ede�t�s Name: H E N S E L� R U T H L.
RECAPITULATION
1. Real Estate(Schedule A).......................................................................................... 1.
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 Miscellaneous Personal Property(Schedule E)............. 5
6. Jointiy Owned Property(Schedule F) ❑ Separate Biiling Requested............. 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested............. 7.
8. Total Gross Assets(total Lines 1 through 7).......................................................... 8. � • 0 0
9. Funeral Expenses and Administrative Costs(Schedule H)..................................... g. 1 6 5 • � 0
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................. 10. - 4 , 6 8 4 • 6 0
11. Total Deductions(total Lines 9 and 10).................................................................. 11. - 4 , 5 19 • 6 0
12. Net Value of Estate(l.ine 8 minus Line 11)............................................................. 12. 4 , 5 19 • 6 0
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J)................................................. 13.
14. Net Value Subject to Tax(Line 12 minus Line 13)................................................. 14. 4 , 519 • 6 0
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 .00 15.
16. Amount of Line 14 taxable
at lineal rate X .045 4 , 5 1 9 • 6 0 16. 2 0 3 • 3 8
��� Amount of Line 14 taxable
at sibling rate X.�2 �7.
18. Amount of Line 14 taxable
at collateral rate X.15 18.
19. TAXDUE................................................................................................................... 19. 203 - 38
20• FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Under penalties of perjury,i declare i have examined this return,including accompanying schedules and statements,and to the best of my knowtedge and belief,
it is true,correct and complete.Declaration of preparer other than the person responsible for filing the return is based on ail information of which preparer has
any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN Linda Byers DATE
x ��, - � C), , `(3 Le� 1L, ,>- l�f� I S
ADDRESS
1270 Second Avenue, Chambersburg, PA 17202
SIGNATURE EPARER OT ER A REPRESENTATIVE Gerald J Brinser o.4TE
/ /��
ADDRESS grinser,Wagn immerman
6 E. Main Street, Palmyra, PA 17078
I III�I II�' IIIII I�III� I'III�I II'II �II'llll II'll III II'I Side 2
� 15�5618411 1505618411 J
REV-1500 EX Page 3 File Number 21 - 13 - 1051
Decedent's Complete Address:
DECEDENT'S NAME
Hensel, Ruth L.
STREET ADDRESS
Messiah Village, 100 Mt. Allen Drive
CITY STATE ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 203.38
2. CreditslPayments
A. Prior Payments
B. Discount
Total Credits(A +B) (2) 0.00
3. Interest (3) 0.0 0
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4)
Check box on Page 2,Line 20 to request a refund
5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. �5) 2�3.3 8
Make Check Payable to: REGISTER OF WILLS, AGENT.
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... . .. ,,,,_ ,,,,, �l�
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;or.................................................................................................................. ❑ X❑
d. receive the promise for life of either payments,benefits or care?.............................................................. ❑ 0
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?....................................................................................................................... ❑ x❑
3. Did decedent own an"in trust for" or payable upon death 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.
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.,,...,.,,, ..
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 spo
is 3 percent[72 P.S.§9116(a)(1.1)(i)].
For dates of death on or after January 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
r72 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 as.sets
filing a tax return are stdl 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 ears 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 decedenYs lineal beneficiaries is 4.5 percent,except asnoted in[72 P.S.§9116(a)('
•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 blood or adoption.
REV-1511 EX+(Q8-13)
.M : pennsylvania n' n�/� ��/�����H��+ Aw'
'�` DEPARTMENT OF REVENUE rVNEf�FiL CN-p�7Gv�vD
INHERITANCE TAX RETURN ��INh71 fV111V G�+W 1 J
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Hensel, Ruth L. 21 - 13- 1051
Decedent's debts must be reported on Schedule I.
ITEM AMOUNT
NUMBER FUNERAL EXPENSES: DESCRIPTION — —
A.
B. ADMINISTRATIVE COSTS:
�. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zip
Year(s)Commission Paid
2. Attorney's Fees Brinser,Wagner&Zimmerman--Gerald J. Brinser 150.00
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
5. AccountanYs FPes
6. Tax Retum Preparer's Fees
7, Other Administrative Costs
� Register of Wills- Filing Fee for Supplemental REV-1500 15.00
TOTAL{Also enter on line 9, Recapitulation) 165.00
.�. pennsylvania SCHEDULE I
�' DEPARTMENTOFREVENUE DEBTS OF DECEDENT, MORTGAGE
INHERITANCE TAX RETURN
RESIDENTDECEDENT LIABILITIES & LIENS
FILE NUMBER
ESTATE OF Hensel, Ruth L. 21 - 13 - 1051
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM DESCRIPTION AMOUNT
NUMBER
1 Commonwealth of PA, Department of Public Welfare- No Payments Made for Decedent -17,679.78
The above amount was taken as a deduction on the Qriginal Return, but was subsequently
determined not to be owed.
2 Negative Net Value of Estate as Originally Reported 12,995.18
TOTAL(Also enter on Line 10, Recapitulation) -4,684.60
REV-1513 EX+(01-10)
�W� p�nnsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BEN EFICIARI ES
RESIDENT DECEDENT
ESTATE OF I FILE NUMBER
Hensel, Ruth L. 21 - 13- 1051
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY DoNot�ist7rustee(s)
I� TAXABLE DISTRIBUTIONS[include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
1 Linda Byers Daughter Misc. Personalty; 1/2 259.80
1270 Second Avenue Residue
Chambersburg, PA 17202
2 Jeffrey Byers Grandson $1,000 Specific 1,000.00
815 Woodland Circle Bequest
Waupaca,WI 54981-1066
3 Judith (Byers) Benner Granddaughter $1,000 Specific 1,000.00
9320 Oak White Road Bequest
Nottingham, MD 21236-4725
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate.
I�� NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
-�����rra����r rrim� �
REV-1513 EX+(01-10)
�� pennsylvania ���ED�.��� ..�
OEPARTMENT OF REVENUE
INHERITANCETAXRETURN BENEFICIARIES continued
RESIDENI'DECEDENT
ESTATE OF I FILE NUMBER
Hensel, Ruth L.
21 - 13- 1051
RELATIC�NSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PRGPERTY DoNotListTrustee(s)
I� TAXABLE DISTRIBUTIONS[include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
4 Brian Frey Grandson $1,000 Specific 1,129.90
2808 Old Orchard Road Bequest; 1/4
Lancaster, PA 17601-5334 Residue
5 Gregg Frey Grandson $1,000 Specific 1,129.90
194 Springdale Lane Bequest; 1/4
Millersville, PA 17551 Residue
Page 2 of Schedule J
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� � I,`�2�'H L. HENSEL, currently of Upper Allen Township, Cumberland County,
H , .' �--�
��' N Pennsylvania, realizing the uncertainty of this life, but with confidence in God and trust in
His Son, my Lord and Savior, Jesus Christ, who died for my sins upon the cross and rose
again to redeem me and give me eternal life, do hereby make,publish and declare this to be
my Last Will and Testament, hereby revoking any and all prior VJills and Codicils made by
me.
I. I direct that all my just debts and funeral expenses be paid from the assets of my
estate as soon as practicable after my demise.
II. I direct that all estate and inheritance taxes that may be assessed in consequence
of my death, shall be paid out of the principal of my general estate to the same effect as if
said taxes were expenses of administration and all property includable in my taxable estate
whether or not passing under this Will shall be free and clear thereof.
III. I bequeath the sum of One Thousand Dollars ($1,000) unto each of my
grandchildren,namely,Jeffrey Byers,Judith Byers,Brian Frey and C'Jregg Frey,or their issue
per stirpes.
IV. +��le�t�t—t-�P �"m �f One Thcauusand Dollars ($1,000) unto my great
granddaugliter, Emma Jean Byers. �,�,.G,,��� J��,�-, ��=1�
V. Contingent upon the approval of Messiah Village,I grant unto my husband, John
�. Hensei, the right to cantir�ue living a� r�y r�sidence at 52? Dngweod Drive, Messiah
Village, Mechanicsburg, Pennsylvania, for one (1) year from the date of my death. At that
time, he must either purchase my equity in the cottage or move from the premises.
VI. I bequeath unto my husband, John, any of my items of household furnishings
he may desire. I bequeath any items not chosen by him unto my daughters, Linda and
Brenda, to be equally divided between them as they see best.
-1- � �
VII. All the rest, residue and remainder of my estate, of whatever nature and
wherever situate,including properly over which I hold a power of appointment,I devise and
bequeath equally unto my daughters, Linda and Brenda.
VIII. I appoint my daughter, Brenda Frey, Executrix of this my Will. In the event
that she fails to qualify or ceases to act as Executrix, I appoint my claughter, Linda Byers,
Executrix of this my Will. -
IX. I direct that no bond be required of my fiduciaries for the faithful performance
of their duties in any jurisdiction.
IN WITNESS WHEREOF, I, RUTH L. HENSEL, herewith set my hand to this my
Last Will, typewritten on two (2) sheets of paper including the attestation clause and
signatures of witnesses, this ID'�'day of �� , 1999.
. ' , (SEAL)
RUTH L. HENSEL
Signed by RUTH L. HENSEL, by her declared to be her Will in our presence, who
have hereunto subscribed our names as witnesses in her presence and at her request,this
��� day of fJ u.yw�' , 1999.
0 ,�
�� �'j residing at � ' I o-.
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�1 Gt�r���� .��.c�
residing a
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COMMONWEALTH OF PENNSYLVANIA :
COUNTY OF �
WE, RUTH L. HENSEL, ��'�'-�' �• � and 'n'��
��,�,� , the testatrix and the witnesses, respectively, whose naines are signed to the
attached or foregoing instrument, being first duly affirmed, do hereby declare to the
undersigned authority that the testatrix signed and executed the instrument as her Last Will
and that she signed willingly (or willingly directed another to sign f or her), and that she
executed it as her free and voluntary act for the purposes therein expressed, and that each of
the witnesses, in the presence and hearing of the testatrix, signed the Will as witnesses and
that to the best of our knowledge the testatrix was at that time eighteen years of age or older,
of sound mind and under no constraint or undue influence.
__ �� � y2 t��
RUTH L. HENSEI,
���� � �`�
WITNESS
y
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SS '�
Subscribed, swom or affirmed and acknowledged before me by RUTH L. HENSEL,the
testatrix, G3�:� �. and �� ��'Q"`''"'�'�"�� � �'itnesses, this
�0� day of �Qa� , 1999.
� �
_� .� c,, �sE�,�
Notar Public
Notarial Seal
Lona Sue Climenhaga,Notary Public
Upper ANen Twp.,Cumberland County
My Commission Expires April 28,20a1
Member,Pennsylvania Association of Notaries
-3-
„"'�:` pennsylvania � s �
DEPARTMENT OF HUMAN SERVICES �. �
June 15, 2015
WENDY L. CRAWFORD, PARALEGAL
BRISNER, WAGNER & ZIMMERMAN
6 EAST MAIN STREET SECOND FLOOR
P.O. BOX 323
PALMYRA PA 17078
Re: Ruth Hensei
SSiV: ###-##-8359
Dear Ms Crawford,:
Pursuant to your letter dated June il, 2015, the Department's, Estate Recovery
Program, has reviewed the information you provided regarding the above-referenced estate.
It has been determined that the above individual did receive rnedical assistance. �
,�'�f However, the medical assistance received is not recoverable in accordance with Act 49, 62
� '” P.S. § 1412.
Therefore, according to the information provided, the Deyaartment's Estate Recove�
Proaram will not seek any recoverv frorrithis estate.
Thank you for your cooperation in this matter. If you have any questions, please
contact me.
Sincerely,
��y � ��
Vince A. Porter
Recovery Section Manager
(717)772-6604
Bureau of Program Integrity � Division of Third Party Liabi�ity � Recovery Section
PO Box 8486 � Harrisburg, Pennsylvania 17105-84fl6
SUMMARY OF
ACTUAL ESTATE ASSETS
AND DEDUCTIONS
(Combined Original and Supplemental Returns)
Assets as Reported on Original Return $51,653.84
ACTUAL DEDUCTIONS:
Schedule H—
Funeral Expenses $ 1,802.62
Executor Fees 2,582.92
Legal Fees 2,500.00
Legal Fees (Supplemental) 150.00
Register of Wills—Probate Fees 148.50
Register of Wills—Additional Letters 75.00
Register of Wills, Filing Fee (Supplemental) 15.00
Total Schedule H Deductions: $ 7,274.04
Schedule I—
Messiah Lifeways $39,860.20
Total Schedule I Deductions: $39,860.20
TOTAL ACTUAL DEDUCTIONS: 47,134.24
BALANCE 4 519.60