HomeMy WebLinkAbout06-06-05
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COMMONWEALTH OF
PENNSYLVANiA
DEPARTMENT OF REVENUE
DEPT 280601
HARRISBURG, PA 17128-0601
REY-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I OFFICIAL USE ONLY
I. FILE NUMBER
II 05
COUNTY CODE YEAR
SOCIAl- SECURITY NUMBER
252
NUMBER
REV.151)l) E>t + {6.oo)
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I DECEDENT'S NAME (~ST. FIRST, AND MIDDLE INITIAL)
i Haaf, Esther M.
\ DATE OF DEATH (MM-DD-YEAR) I Dt>.lE OF BIRTH (MM-DO-YEAR)
! 12-30-2004 07 -20-1917
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
197-07-1422
THIS RETURN MUST ElE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
limited Estate
Future Interest Compromise (date ofdaath after
12-12-82}
7, Decedent Maintained a living Trust (Attach
copy of Trust)
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3, Remainder Return (date of death prior to 12-13-82)
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o 2. Supplemental Return
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[!J 6. Decedent Died Testate iMtach 0
copy of Will)
O 9. Litigation Proceeds Received D 10. Spousal Poverty Credit (dale of death between D 11.Election to tax under Sec. 9113(A) {Attach SchO)
12<~1-91 and 1-1-15}
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NAME COMPLETE MAILING ADDRESS
Lf-rank P. Ippolito, Esq.
I FIRM NAME (It applicable)
Zimmerman, Pfannebecker, Nuffort & Albert
I T~L:~HONE NUMBER
~-299-0711
, 1. Real Estate (Schedule A)
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=:]4
Original Return
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5. Federal Estate Tax Return ReqUired
8 Total Number of Safe Deposit Boxes
22 South Duke Street
Lancaster, PA Lancaster
(1)
None
., gFICI~L.:USE ONLY I
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2. Stocks and Bonds (Schedule B) (2) None
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) None
4. Mortgages & Notes Receivable (Schedule D) (4) None
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 12,398.18
(Schedule E)
z 6. Jointly Owned Property (Schedule F) (6) None
0 o Separate Billing Requested
;:::
j 7.lnterNivos Transfers & Miscellaneous Non-Probate Property (7) None
::> (Schedule G or L) D Separate Billing Requested
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ii: 8. Total Gross Assets (total Lines 1-7)
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0 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 8,074.25
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10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 1,133.41
11. Total Deductions (total Lines 9 & 1 0)
12. Net Value of Estate (Line 8 minus Line 11)
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(8)
12,398.18
(11)
(12)
9,207.66
3,190.52
1,190.52
2,000.00
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has
not been made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(13)
(14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15.Amount of Line 14 taxable at the spousal tax rate, 0.00 x .00 (15)
or transfers under Sec. 9116(a)(1.2)
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0 .045 (16)
;::: 16.Amount of Line 14 taxable at lineal rate 0.00 x
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"- 17. Amount of Line 14 taxable at sibling rate 0.00 x .12 (17)
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0
0 18. Amount of Line 14 taxable at collateral rate 2,000.00 .15 (18)
>< x
~ 19. Tax Due
(19)
0.00
0.00
0.00
300.00
300.00
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
. . >>B~illillltOAll$iNEll~t\Oll$tji!lll$iCliiillliVl!lI$l5,SlQllAli[>REeHE~~IIiAlii'<<' i .'
Copyright 2002 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00:
~
Decedent's Complete Address:
STREET ADDRESS
3 Green Ridge Village
CITY Newville
I STATE PA
jZIP
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
300.00
0.00
Total Credits (A + B + C)
(2)
0.00
3, Interest/Penalty if applicable
D. Interest
E. Penalty
TotallnteresUPenalty (0 + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT,
Check box on Page 1 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.
A. Enter the interest on the tax due.
S. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(4)
(5)
(SA)
(58)
300.00
300.00
Make Check Payable to: REGISTER OF WILLS, AGENT
~l!rg,!ll!rJ!!ili!l:.~ill-~_ij .__ I'llil\!llll..,,, ,II_~' II - III _ - _
PLEASE ANSWER THE FOLLOWING QUESTIONS 8Y PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
8. retain the use or income of the property transferred; . ...................... D [.!J
~: ~::::~ ~h~e~~~;i:on:~s:~:~s~~~ .~.~.~.I.I.~~~.~~~.:..r.o.~.~.~..t.~~~~.~~~~~.~..~.~.i.t.~..i~~ome;. .................. .......... H ~
d. receive the promise for life of either payments, benefits or care? ........................... ..................... tJ [.!J
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration? ................................... .......... .... .... ....................................... ......... ....... D [.!J
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?.. D [.!J
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?.. ............................................................. ............ ......................... D [.!J
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 pe~ury, I declare that I have examined this retum, including accompanying schedules and statements, and 10 the best of my knowledge and belief, it is true. correct
and
C/)rnp~e!~~ Deo:l~ratlon_Of preE~~~_~!~rthanJ!!e person_~I.!.eE'~esentallve Is_~a.:;~~_~_I!~11 info.!!l~I(lnof_~~~E:.~pl3,rt!r_has any k_n~~~___ _ "______ __
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS - - DAT~
Gxr:t:Z: fILuL'
S,J.TDRE-OFPERSON'RESPONS'BLE' F6~~ETURN
,
530 Winchester Road
Warminster, PA 18974
____ Lf12cii?:S__
DATE
-ADDRESS--- -
.-- ADORES-SO
DATE
22 South Duke Street
Lancaster, PA Lancaster
i.j?5/tJ5
For dates 0 death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [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%
[72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and tho .,t':lhltnN rpnllirpments 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: N R P D
The tax rate imposed on the net value of transfers from a deceased child twenty.one years of age or yount
natural parent, an adoptive parent, or a stepparent of the child is 0% [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
~9116 1.2)[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% [72 P
defined under Section 9102, as an individual who has at least one parent in common with the decedent, ....
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Rav_150S EX\" i6-iS)
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SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Haaf, Esther M.
FILE NUMBER
21-05-252
ESTATE OF
Include Ihe proceeds of litigalion and Ihe dale Ihe proceeds were rece ived by the astale
All property Jointly-owned with the right of survivorshIp must be disclosed on schedule F.
ITEM
NUMBER DESCRIPTION
1 Adams County National Bank Checking acct # 193569
VALUE AT DATE
OF DEATH
2.429.52
2 IRS Refund - 2004 Personal Income Tax refund
742.00
3 Sovereign Bank Funeral CD # 0085034650 - Funeral CD
8.484.66
4 2004 Income Tax Refund Federal
742.00
TOTAL (Also enter on Line 5, Recapitulation)
12.398.18
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA.1500 Schedule E (Rev. 6-98)
Rev_1502 EX+16-98)
*'
SCHEDULE H-A
FUNERAL EXPENSES
continued
COIvlMONWEALTH OF PENNSYLVANIA
INHERITANCE TAA RETURN
RESIDENT DECEDENT
Haaf, Esther M.
FILE NUMBER
21-05-252
ESTATE OF
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Funeral Expense
6.193.00
Subtotal
6.193.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
REV-11S1 EX+ (12-99)
*'
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Haaf, Esther M.
FILE NUMBER
21-05-252
ESTATE OF
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 6,193.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid
2. Attorney's Fees Zimmerman, Pfannebecker, Nuffort & Albert 750.00
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 40.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 1,091.25
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 8,074.25
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA.15DD Schedule H (Rev. 6-98)
Rev-1502 EX+ (6-98)
.
SCHEDULE H.87
OTHER
ADMINISTRATIVE COSTS
continued
C0M'.10NWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
FlESIDENTDECEDENT
Haaf, Esther M.
FILE NUMBER
21-05-252
ESTATE OF
ITEM
NUMBER DESCRIPTION AMOUNT
1 Harry Page - Cleaning 5 hours at $20 per hour 100.00
2 Helen Peirce - Cleaning 17 hours at $20 per hour and 377.50
100 miles at 37.5 cents per mile
3 Pam Cloud - 7 Hours at $20 per hour 241.25
270 miles at 37.5 cents per mile
4 Patsy Kean - 14 Hours at $20 per hour 362.50
220 miles at 37.5 cents per mile
5 ZPNA - costs (postage, copies) 10.00
Subtotal
1.091.25
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B7 (Rev. 6-98)
Rev-1512 EX+ (6-98)
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SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
CQM\10NWEALTH OF PENNSYLVANIA
INHERITANCE TAX RfTURN
RESIDENT DECEDENT
Haaf, Esther M.
FILE NUMBER
21-05-252
ESTATE OF
Include unrelmbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1 Andorra Radiology Assoc
VALUE AT DATE
OF DEATH
8.58
2 Blue Mountain Anesthesia
6.94
3 Carlisle Medical Center
175.20
4 Colorectal Center
41.89
5 Continuing Care
14.14
6 CRMC Anesthesia
4.46
7 Graham Medical Clinic
28.17
8 Green Ridge Village - Phone charges
21.20
9 Lancaster HMA
12.71
10 Lancaster HMA
73.53
11 MGM Pharmacy - Medications
11.00
12 Newville Community Ambulance
12.10
13 Pension Check return - Return of Jan 05 payment
706.23
14 Swaim Health Center - Personal care/grooming
17.26
TOTAL (Also enter on Line 10, Recapitulation)
1,133.41
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule I (Rev. 6-98)
REV 1513 EX+ (9-00)
'*
SCHEDULE ..
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Haaf. Esther M. 21-05-252
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$)
Do Not Ust Trusteefs)
I. TAXABLE DISTRIBUTIONS [include outright sfrousal
aistributions, and ransfers
under Sec. 9116(0)(1.2)]
1 Gertrude Thieroff Niece Two Thousand
530 Winchester Road Dollars
Warminster. PA 18974
Total
Enter dollar amounts for distributions shown above on lines 5 through 18, as appropriate, on Rev 1500 cover sheet
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
See continuation schedule(s) attached 1,190.52
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 1,190.52
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule J (Rev. 6-98)
Rev_15t12 EX+ 16-98)
*'
SCHEDULE J.IIB
CHARITABLE AND GOVERNMENTAL
DISTRIBUTIONS
continued
C~NWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Haaf, Esther M.
FILE NUMBER
21-05-252
ESTATE OF
ITEM
NUMBER
1
DESCRIPTION
Maryville College, TN - Charitable bequest
AMOUNT
1.190.52
Subtotal
1.190.52
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule J-IIB (Rev. 6-98)
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LAST WILL AND TESTAMENT
OF
ESTHER M. HAAF
I, ESTHER M. HAAF, of the Township of East Lampeter, County of
Lancaster and Commonwealth of Pennsylvania, hereby declare this to
be my Last Will and revoke all Wills which I have previously made.
ITEM I.
I direct that the expenses of my last illness and
funeral be paid as soon as practicable after my death.
ITEM II.
I hereby declare that my husband, ARTHUR R. HAAF, and
I own all articles of household use and personal property located
in our residence, or any other residential property which we own as
tenants by the entireties, and upon my death he will be the sole
owner thereof by operation of law, if he survives me.
ITEM III.
I give, devise and bequeath all of the residue of my
estate, whether real, personal or mixed and wheresoever the same
may be situate, unto my husband, ARTHUR R. HAAF, absolutely, pro-
vided however that he shall survive me by thirty (30) days.
ITEM IV.
In the event that my husband, ARTHUR R. HAAF, fails
to survive me by thirty (30) days, or predeceases me, I then give,
devise and bequeath my entire estate as follows:
A. To my niece, TRUDY THIEROFF, the sum of Two Thousand
($2,000.00) Dollars; and
B. All of the rest, residue and remainder of my estate,
to MARYVILLE COLLEGE, Maryville, Tennessee.
ITEM V. I appoint my husband, ARTHUR R. HAAF, Executor of
this Will. Should he, for any reason, fail to qualify or cease to
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act as such during the administration of my estate, I appoint my
niece, TRUDY THIEROFF, Executrix of this Will, to act with the same
duties, powers and discretions as if originally appointed. No
fiduciary acting under this Will shall be required to enter bond or
furnish sureties in any jurisdiction.
IN TESTIMONY WHEREOF, I, ESTHER M. HAAF, the Testatrix, have
hereunto set
my hand and affixed
~(;J/Y'/A.(J h/
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my seal to this my Last Will and
, Pennsylvania, on the ,f" f.J!,
Testament at
~
day of ;;;;I~a;JJ///Y1!
, A.D., 2000.
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~Z2-?' k ." -/'/-0- (SEAL)
ESTHER M. HAAF
SIGNED, SEALED, PUBLISHED AND DECLARED by the above named,
ESTHER M. HAAF, as and for her Last Will and Testament, in the
presence of us who have hereunto signed our names at her request,
in the presence of said Testatrix and in the presence of each
lI~wa:rJ1 C1 p4
oJ 0"~ J./il>k re"ding a' {((%br?!tdDl,cj,
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residing at
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COMMONWEALTH OF PENNSYLVANIA
)
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SS. :
COUNTY OF LANCASTER
I, ESTHER M. HAAF, Testatrix, whose name is signed to the
attached or foregoing instrument, having been duly qualified
according to law, do hereby acknowledge that I signed and executed
the instrument as my Last Will; and that I signed it willingly and
as my free and voluntary act for the purposes therein expressed.
Sworn to or affirmed and
acknowledged before me by
/
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Explres:
C2Al~9}t, ~~
ESTHER M. HAAF,'Testa ix
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COMMONWEALTH OF PENNSYLVANIA
SS. :
COUNTY OF LANCASTER
WE, Role;! L.1f.V\l\e~€{\J.f'r and (yu=rc-u,'\e 51 , /c/ia/)';'~ the
witnesses whose names are signed to the attached or foregoing
instrument, being duly qualified according to law, do depose and
say that we were present and saw the Testatrix sign and execute the
instrument as her Last Will; that she signed it willingly and
executed it as her free and voluntary act for the purposes therein
expressed; that each subscribing witness in the hearing and sight
of the Testatrix signed the Will as a witness; and that to the best
of our knowledge, the Testatrix was at that time 18 or more years
of age, of sound mind, and under no constraint or undue influence.
Sworn to or affirmed and
me
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NOTARIAL SEAL
. NANCY E. FORNOFF, Notaly Public
Lancaster, Lancaster County
Commission Ex . as Se 29, 2003
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