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Home My WebLink About05-25-05 REV-1500EX+.I8-00) .. , COMMONWEALTH OF PENNSYLVANIA , . DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 I- Z W C W U w C w ... ",:5., u"'''' w..u %i9 u8:1D .. REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENT'S NAME (lAST. ARST. AND MIDDlE INITIAL) HERTZLER DATE Of DEATH (MM-llll-Yea) GLADYS E. DATE Of BIRTH (MtMlQ.Yea) OFACIAl USE ONLY FilE NUMBER 0 5 21- 0219 ""lil5t:NlYcooe ~---~-- ~SECU~TYNUMBER 00 1. Original Return D 4.lImlledEs1ate D 6. Decedent Died T_ __"WI) D 9. litigation Proceeds Received D 2. Supplemental Return D 4a.FulurelntsreslCompromise(......__'2-12<l2j D 7. Decedent Mainlaineda lNingTrust__"T""'I D 10. Spousal Poverty CredR 1......__'..,-91...'.'..~ 2 0 7 - 0 7 - 4 3 5 S TIllS RElURN MUST BE ALED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER D 3. Remainder Return 1...."-.....12.'''''J D 5. Federal Es1a1B Tax Return Required _ 8. Total Numberof Safe Deposit Boxes D 11. ElecIiontolaxunderSee. 9113(A)_SohOI z o 5 :) l- ii: c( u w It: z o S :) D.. ::E o U ~ 0~~OO5 01M5M917 (IF APPUCABLE) SURVMNG SPOUSE'S NAME (lAST. FIRST, AND MIDDlE INITIAL) ... z w Q Z l[ ., w '" '" Q U NAME MURRIlL R. WALTERS III ESQUIRE FIRM NAME (W Applicable) COMPUETE MAIUNG ADDRESS S4 I!AST MAIN STREET TELEPHONE NUMBER 717_7~ MECHANICSBURG 19,522.08 X .:!!!!.. (15) X _(16) X .12 (17) X .15 (18) (19) 1. Real Es1ate (ScheduJeA) (1) 2. SlDcks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Pa_lp or BoIl>PrcprielDrshlp (3) 4. Mortgages & NoIBs Receivable (Schedule D) (4) 5. Cash. Bank llepoeillI & Miscellaneous ~I Propsrty (5) (Schedule E) 6. JoinIIy Owned Property (Schedule F) (6) D SeparaIB BlIIIng RequesIed 7. InIBr-VIvos Transfera & Miscellaneous Non-P_ Property (7) (Schedule G or l) 8. TolaIG....._(lDIaIUnesl-7) 9. Funoral Expenses &Adrnin_ CosIs (Schedule H) (9) 10. DebIs 01 Decedent, ~o Uablllies. & Lions (Schedule I) (10) 11. TotlIl Dlducllonl (lDIaI Unes 9 & 10) 12. Net V.... 0'_ (Uno 8 minus Uno 11) 13. Charitable and Governmental BequBSt9lSoc 9113 TIIISIs forwlllch an 0_ to lax has not boon mado (Schedule J) 14. NetValu1 Subjecllo Tax (Uno 12 minus LIIo 13) SEE INSTRUCTIONS ON REVERSE SIlE FOR APPLICABLE RATES 15. Amount of line 14_ at tho spousal lax raIB. or_ under See. 9116 (aXl.2) 18. Amount of Uno 141axable at lineal raIB 17. Amount of Uno 141axable atslblng raIB 18. Amount of Uno 141axable at caIateraI rate 19. Tax Duo :;;.0 -:rJ ;~~"'20 .~"...1-1 . ;Zrn - ::0 (f) ?' 00 24,538.09 (25,2"" \..,) 55 --< tJ )';;.. (8) 1,790.70 3,225.33 (11) (12) (13) (14) PA 17085 OFFIC = USE ONl'S::, c:.n [__,O_j :x S~ J:;i;oo ::~-5 -< C'l N - r-f1 U1 '::'..J ". ::JI: CO N U1 ,'--' :.::,,,'1 -n ('') r.n 24,838.09 5,016.03 19,522.08 19,522.08 678.49 878.49 Dcedt'C I t Add e en s omDle e ress: STREET AOllRESS 100 MY. ALLEN DRIVE OTY I STATE I ZIP MECHANCISBURG PA 17055 Tax Payments and Credits: 1. Tax Duo (Page 1 Uno 19) 2. CreditsIPaymonls A. Spousal Poverty Credit 8. Prior Paymenls C. Discount (1) 878.49 43.92 3. InterostJPenalty ~ appIicablo D. Interest E.Ponalty TotaICredtts(A+8+C) (2) 43.92 TotallnterostlPenalty ( 0 + E) (3) 4. WUne 2 is greater than Une 1 +Une3, enter the dilforence. This is the OVERPAYMENT. Chock box on Page 1 Una 20 to request a refund (4) 5. WUno 1 +Uno3 is greater than Uno 2, enter the dilforence. This is the TAX DUE. (5) A. Enter the interest on tho tax duo. (SA) 8. Enter the total 01 Une 5 + SA. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT 834.57 834.57 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN.X" IN THE APPROPRIATE BLOCKS 1. Did decedent mako a transfer and: Ves No a. rotaIn the use or incomo 01 the property transferred; ........................................................................... 0 ~ b. retain tho right to designate who shall use tho property transferred or ils incomo; ........................................ 0 ~ c. retain a reversionary interest; or ...................................................................................................... 0 ~ d. receive tho promise for life 01 either payments, benefits or care? ............................................................. 0 ~ 2. W death OCQJned alIor December 12, 1982, did decedent \JansIer property within one year 01 death without receiving adequate oonsidoratlon?.............................................................................................. 0 ~ 3. Did decedent own an 'in trusttor' or payable upon death bank account or security at his or her death? ................. 0 ~ 4. Did decedent own an Individual Retiremont Account, annuity or other non-probato property which contains a benoficiary 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. Undotjlllll8liosalpoljuly.I_IhliI___lhls...... ~ '!"""'I""Yngsched....and.-. and lolheboolalmy mowtodgea-d boIlef. ftls.... COlIllCtand_ DecIaraIion ofpl8pll8l'oIB IhaJ lhe penIOI'I8 ...,.._1IBh1l is beNd on all infrrmaIion ofwhlch pntpEnrhBs any knowledge. SIGNATURE OF RESPONSIBLE FOR FlUNG RETURN DATE 5I24l2OO5 ADDRESS PA 17055 DATE 5I24l2OO5 ADORESS WALTI!U III, I!SQUIRI! N STRI!I!T, MECHANICSBURG PA 17055 For datos of death on or alIor July 1, 1994 and boIoro January 1, 1995, the tax rate Imposed on the net value 01 transfers to or for the use 01 the surviving spouse is 3% [72 P.S. S9116 (a) (1.1) (ill. For datos of death on or alIor January 1, 1995, tho tax rate imposed on the net value 0' transfers tD or for the use 01 the surviving spouse is 0% [72 P.S. S9116 (a) (1.1) (iI)]. The statuto does not oxernol a transfor to a surviving spouse from tax, and the statutory requiremonls for disclosure of assets and filing a tax return are still applicable oven ~ tho swviving spouse is the only beneticiary. For dates of death on or alIor July 1, 2000: The tax rate imposed on tho net value 01 transfers from a deceased child twenty-ooe years 01 age or yoonger at death to orlor the use of a natural parent, an adoptive parent, or a stepparent 01 the child is 0% [72 P.S. ~9116(aXl.2)). The tax rate Imposed on the net value 01 transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. S9116(1.2) [72 P.S. S9116(aXl)). The tax rate imposed on the net value 01 transfers to or for tho use of the docedonfs siblings is 12% [72 P.S. S9116(aX1.3)). A sibling is defined, under Section 9102, as an individual wIIo has at Ioast ono parent in oornmon with the decedent, whether by blood or adoption. REV-15118 EX + (6-98) * COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF HERTZLER FILE NUMBER GL ADYS E 21 05 Include 1he JlI!la.lOds of litigation and the dats the proceeds...... _by 1he_. All property joIn11y-owned wfth dght of survivorship muat be dlacloaed on Schedule F. 0219 ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 23,838.09 PNc BANK CHECKING ACCOUNT 2. DIAMOND RING - PER APPRAISAL 900.00 TOTAL (Also enter on line 5, Recapitulation) $ (M more space is needed. Insert addlllonal_ of1he same size) 24.538.09 REV-15~1 EX +(12-99) * COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX REnJRN RESIDENT DECEDENT ESTATE OF HERTZLER GLADYS SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS E. FILE NUMBER 21 05 0219 Debta old_ must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. MYl!RS FUNI!RAL HOMI! . PRI!PAlD 2- MYI!RS FUNERAL HOME. OBITUARY PUBLlCAnONS 297.70 3. GINGRICH MI!MORIAI.S . ENGRAVING TOMBSTONE 100.00 B. ADMINISTRATIVE COSTS: 1. PeIsonal Representative's Commissions Name 0/ PeIsonaI Rep....ntative (s) SANDRALI!I!BROWN (RI!NOUNCI!D) SocIal Sealri4' Number(s)/EIN Number 01 Personal Represenlative(S) City MI!CHANICSBURG Slate PA Zip 170115 Year(s) Commission Peid: 2. AtIDmey Fees MURREL R. WAL Tl!RS III, I!SQUIR 1,280.00 3. Family Exemption: (H deoadent's addleSS is not1he same as _so atlach explanation) C_ StreelAddIeSS City StaIB ZIp Relationship 0/ C_ to Oeoedent 4. P_ Fees CUMBI!RLAND COUNTY REGISTI!R OF WILLS 88.00 5. Accountanfs Fees 6. Tax Return Prepme(s Fees 7. MUMMA'S .II!WELRY - RING APPRAISAL 35.00 TOTAl (Also enter on line 9, Recapitulation) $ 1790.70 (Hmore space is needed.___oI1hesamesize) . . SEV-1512 EX + (-l 'w COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX REnJRN RESIDENT DECEDENT ESTATE OF HERTZLER GLADYS SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS E Include u.reimbursed modlcal expenses. FILE NUMBER 21 05 0219 ITEM NUMBER DESCRIPTION 1. VERlZON TELI!PHONE BILL VALUE AT DATE OF DEATH 9.33 2- MI!SSIAN VILLAGE RESIDI!NnAL RENTAL 3,216.00 TOTAL (Also enter on line 10, Recapitulation) $ (RIl1OI8 spac:e is _. _additionaJsheelsol1l1esamaslze) 3 225.33 .~-.'~1:t.El<.(" COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FilE NUMBER ~R "" ArW" ~ 21 05 02111 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not LIst Tru.-(.) OF ESTATE I. TAXABLE DISTRIBUTIONS r- ~ht~ distributions, and benslats under Sec. 9116 (a (1. )] 1. SUSAN CAROL SIEG DAUGHTER PERSONAL PROPERTY 47.1UNCTlON ROAD PLUS 113 RESIDUI! DILL8BURG, PA 17019 2. DENNIS P. HI!RTZLI!R SON PERSONAL PROPI!RTY 285 KARSTEN COURT PLU8113 Rl!8IDUI! RENO, NY 8lIlI08 3. SANDRA LEI! BROWN DAUGHTER PERSONAL PROPERTY 505 ~ COOVER STRI!ET PLUS 113 RI!SIDUE MI!CHANJC8BURG, PA 17088 4- CAROLYN FIELDS GRANDDAUGHTER 1,000.00 4884 WALNUT STRI!ET SIMI VALLEY, CA 93083 S. .lILL I!LIZA8I!TH SM"H GRANDDAUGHTER 1,000.00 12890 SILVI!R WOLF ROAD RENO, NY 89511 6. MARUN PAUL BROWN GRANDSON 1,000.00 104 S. WALNUT STRI!ET MI!CHANIC8BURG, PA 17088 7. CHERYL LI!I! HOUCK GRANDDAUGHTER 1,000.00 140 OLD U.s. RT.1S YORK SPRINGS, PA 17372 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET n. NON- TAXABlE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE 1. . B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART n - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET S .. (W more space IS needod, Insert additional sheets of tI\e same SIZe) , . Continuation of REV-1500 Inheritance Tax Return Resident Decedent 'HERTZLER Decedenfs Name GLADYS E. Page 1 21 05 0219 File Number Schedule J - Beneficiaries - 1 NAME AND ADDRESS OF PERSONIS\ RECEIVING PROPERTY RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER Do Not LIst TIU_.I OF ESTATE I TAXABLE DISTRIBUTIONS (include outright spousal distributions) 8. DARYL JOHN HERTZLIIR GRANDSON 1,000.00 sooa ARROYO LANII #107 SIMI VALLEY, CA 93083 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG. PA 17128-0601 ,. ._..._0'......__.._____..,.__,_ REV-'162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT BROWN SANDRA LEE 505 E COOVER STREET MECHANICSBURG, PA 17055 ----unfold ESTATE INFORMATION: SSN: 207-07-4355 FILE NUMBER: 2105-0219 DECEDENT NAME: HERTZLER GLADYS E DATE OF PAYMENT: OS/25/2005 POSTMARK DATE: OS/25/2005 COUNTY: CUMBERLAND DATE OF DEATH: 02/26/2005 NO. CD 005361 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $834.57 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: S L BROWN CHECK# 107 SEAL INITIALS: VZ RECEIVED BY: REGISTER OF WILLS $834.57 GLENDA FARNER STRASBAUGH REGISTER OF WILLS