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Home My WebLink About06-17-05 (3) . RfV-Iolit)[Xib_OO', REV-1500 .. '''~''^''"'' -' PENNSYLVANIA ','illi/,' DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER _ ' DEPT 280601 d-L-()S_ QtlQ.6{ , HARRISBURG, PA 17128-0601 RESIDENT DECEDENT COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST'. AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER I- Hoffman, Jennie 8, __ J 200-36-0495 Z W - --- --- --- ..---- ---- -- - ---',--- - ----._------- - --- C DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) I THIS RETURN MUST BE FILED IN DUPLICATE WITH THE W 12/16/2004 __-.l07/19/1~0_ __ ____ _ _ J __ _ REGISTE~ OF WILLS U -- --- -- --- --- -- -- W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST'. FIRST'. AND MIDDLE INITIAL) I SOCIAL SECURITY NUMBER C w ~ 1. Original Return o 2. Supplemental Return o 3. Remainder Return (ddle of death pnorto 12-13-82) ... lI::g(f.l o 4. Limited Estate o 4a. Future Interest Compromise {date ofdeatM after 12-12-B21 o 5. Federal Estate Tax Return Required 0."" w"O ",00 o 6. Decedent Died Testate (Altaeh copycf Will) o 7. Decedent Maintained a Living Trust (Attach copy of Trust) 8. Total Number of Safe Deposit Boxes oo:~ ..'" - .. D 9. litigation Proceeds Received o 10. Spousal Poverty Credit idate a/death betwef!n 12.31-91 and 1-1-95) o 11. Election to tax under Sec. 9113(A) (Attacr Scil 0) " ... THIS SECTlOPlMUSTBECOI>IPLeTEP, ALL CQRRE$l'ONDENCEAPlD CONFIPEPlTIAL TAX IPlFORMATIOPl SHOULP BE DIRECTEP TO: z COMPLETE MAILING ADDRESS w NAME 0 Elizabeth A Hoffman z 106 Walnut Street 0 - --- -- --- ----- ----- -- -- --- -- -- .. FIRM NAME (lfAppkable) Harrisburg, PA 17101 '" w 0: 0: TELEPHONENlJMBER-- - - - - -- - -- -- - - 0 0 (717) 236-2956 1. Real Estate (Schedule A} (1) 2. Stocks and Bonds (Schedule B) (2) 65,874.80 3. Closely Held Corporation. Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 125,016,98 Z (Schedule E) 0 6. Jointly Owned Property (Schedule F) (6) ~ o Separate Billing Requested ...J (7) ~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property I- (Schedule G or L) ii: 190,891.78 <( 8. Total Gross Assets (total lines 1-7) (B) U 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10,590,55 W II:: (10) 1,101,72 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) (II) 11,692.27 12. Net Value of Estate (Line 8 minus Line 11) (12) 179,199.51 13 Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been 113) made (Schedule J) 14 Net Value Subject to Tax (Line 12 minus Line 13) (14) 179,199.51 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES Z 15. Amount of Line 14 taxable at the spousal tax 0 !;;: rate, or transfers under Sec. 9116 (a)(1.2) x .0 (15) -- -- __ .J~lil9.li1 x 01.5_ (16) 8,063.97 I-' 16. Amount of Line 14 taxable at lineal rate ~ a.. 17_ Amount of Line 14 taxable at sibling rate x .12 (17) ::E 0 18 Amount of Line 14 taxable at collateral rate x 15 (IB) U g 19. Tax Due (19) 8,063.97 20.0 . Decedent's Complete Address: STREET ADDRESS - Cowntry,Meadows LivingJ;entElL _ _ _ _ _ _ ___ ___ _ _ _ _ __ _ _ _ _ Trindle & Sportil1g Hill Roads_ __ _ _ _ _ _ __ ___ __ ____ _ ClTY- - -, - - - STATE ZIP Mechanlcsbwrg PA 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 8,063.97 2, Credits/Payments A. Spousal Poverty Credit _ _ __ _ __ __ _ ___ B. Prior Payments _ _ ____ _ _ _ ____ C. Discount - ---- - - - - - TotaICredils(A+B+C) (2) 3. InteresUPenalty if applicable D. Interest __ __ _ ____ __ E, Penalty - - - - - - - - - - TolallnteresVPenal1y ( D + 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 (4) 5, If Line 1 + Line 3 is grealer Ihan Line 2, enter the difference. This is Ihe TAX DUE. (5) 8,063.97 A. Enter the interest on the tax due. (5A) 8, Enter the lolal of Line 5 + 5A This is the BALANCE DUE. (58) 8,063.97 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; ..............................".................. n. ................. ................ 0 [i] b. retain the right to designate who shall use the property transferred or its income; .......... . ...... ....................... 0 [KJ c. retain a reversionary interest; 0 [i] d. receive the promise for life of either payments, benefits or care? .....................,...... . ........,............... . ......,... 0 [KJ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .........................................-........,. .................................................... ... 0 [i] 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? ...... ........................................... ... ................................. .'........ ..................., 0 [KJ 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 belief, it is true, correct and complete. Declaration of preparer other than the personal representative i s based on all informaton of which preparerhas any knowledge. SI N T RE OF PERSON R.EESS::JP NS.IBL ?...... .. A.. 11.... OA~E ~. I- rf . ,l::.J./~I'/13E'iH If. !1NPMAl 7/(,;0..5 AD DR ss 106 Walnwt Street, Harrisbwrg, PA 17101 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS For dates of 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 PS S9116 (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, S9116 (a) (1.1) (ii)] The statute does not exemot 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 dales of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a slepparent ot the child is 0% [72 P,S. S9116(8)(12)). The tax rate imposed on the net value of 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 PS. s9116(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.S. s9116(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,'5a3 EX. 16'98. SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT I , ESTATE OF FILE NUMBER Jennie 8, Hoffman All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1, Columbia Funds TR IV - PNC Investments 41,615,05 2 GE Funds CL A - PNC Investments 23,983.47 3 Money Market - PNC Investments 276.28 TOTAL (Also enler on line 2, Recapilulatlonj $ 65,874,80 (If more space is needed, insert additional sheets of the same size) REV,150B EX. (6,9B) . SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT I , ESTATE OF FILE NUMBER Jennie B Hoffman 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. PNC Bank (1) #51402268123 95,40795 (2) #5003816649 21,247,03 2 Prepaid Funeral Expenses, Including Interment 8,362.00 TOTAL (Also enler on line 5, Recapitulalion) $ 125,016,98 (If more space is needed, insert additional sheets of the same size) REV,1511 EX+ 112,99:' SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Jennie 8, Hoffman Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: " Funeral Service, Casket, Etc. 7,877,00 Interment 485.00 Luncheon 414,55 B. ADMINISTRATIVE COSTS: " Personal Representative's Commissions 1,500.00 Name of Personal Represenlative(s) Elizabeth A. Hoffman, Betty Adams Social Security Number(s)/EIN Number of Personal Representative(s) 20 6445930 - Slreel Address 106 Walnut Street City Harrisburg State PA Zip 17101 Year(s) Commission Paid: 2005 2, Attorney Fees 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant SlreelAddress City Slale Zip Relationship of Claimant to Decedent 4, Probate Fees 314.00 5, Accountant's Fees 6, Tax Return Preparer's Fees 7, TOTAL (Also enter on line 9, Recapitulation) $ 10,590.55 (If more space IS needed, Insert additional sheets of the same size) . REV-1512 EX+(12-03) '* SCHEDULE I COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS RESIDENT DECEDENT ESTATE OF FilE NUMBER Jennie B. Hoffman Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Choice Nursing 686,50 2 West Shore EMS 306.46 3 Central Medical Equipment 48.76 4 Income Tax Preparation (2004) 60.00 TOTAL (Also enler on line 10, Recapilulation) $ 1,101,72 (If more space is needed, insert additional sheets of the same size) . REV-1513 EX+ (9-00) '* SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT , I ESTATE OF FILE NUMBER Jennie B, Hoffman RELATIONSHIP TO DECEDENT AMOUNT DR 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 See, 9116 (al (1.211 1 Denise Hoffman Brandt Grandchild 0,25 2 Sharon Hoffman Smith Grandchild 0,25 3 Michael R Hoffman Grandchild 0.25 4 Jason C, Hoffman Grandchild 025 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV,1500 COVER SHEET " NON,TAXABLE DISTRIBUTIONS: A, SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART" - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV,1500 COVER SHEET $ 0.00 (If more space is needed, insert additional sheets of the same size)