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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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: FILE NUMBER
1 21
__ ___ _ ___COU_t>LT'(COQ,~,_ _'r'I:AR___'
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG. PA 17128-0601
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OFFICIAL USE ONL.Y
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QR..20
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SOCIAL SECURITY NUMBER
187-05-5861
THIS RETURN MUST BE FILED IN DWPLICATE WITH THE
_ RE~I~r~ROEWI~L~_
SOCIAL SECURITY NUMBER
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3. Remainder Return (daieof cieaitiPjiorio12--,3:82j--
5. Federal Estate Tax Return R quired
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4a. Future Interest Compromise (date 01 death after
12-12-82)
7. Decedent Maintained a Living Trust (AUach
copy of Trust)
10. Spousal Poverty Credit (date of death between
1 - - 5
-', OFFICiAL USE ONLY
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(8)
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-r :~:~~;'~~~~(LASi. FIRST,ANDMIDDLE INITIAl)'-
IDA TEOFDEATH (MM-DD~YEA-Rj--- DArE OF sIRTiTiMM:l5D:YEAR)
06/27/2005 10/12/1914
j-(IF APPLICAEiLEi- SURVIVING-SPOUS-E'S NAME ( LAST, -FIRST-AN-D MIDDLE INITIAL)
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--t -g-1:-0~igin;rRe~rn
I 0 4. Limited Estate
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. COMPLETE MAILING ADDRESS
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\ 5521 Carlisle Pike
Mechanicsburg, P A 17050
--.....---.----.--.--
(1 ) None
(2) -0-
(3) None
(4) None
(5) None
(6) None
(7) 330,925.22
(9) 11 ,683.00
(10) 1,844.96
13. Charitable and Governmental Bequests/Sec 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)
6. Decedent Died Testate (AUach copy
of Will)
9. Litigation Proceeds Received
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
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30,925.22
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113,527.96
~17,397.26
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~17,397.26
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114,282.88
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14,282.88
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Copyright 2000 form software only The Lackner Group, Inc.
-nrr2~S~PPlemental Return
AME
Thomas 1. Ahrens
f -- ----,--.- -' no"~ ---
IRM NAME (If applicable)
I Ahrens Law Office, P.c.
~ELEPHONE NUMBER
==-=--t}17/697-1800
I 1. Real Estate (Schedule A)
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2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
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4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
(11 )
(12)
(13)
(14)
15.Amount of Line 14 taxable at the spousal tax rate, x .00 (15)
or transfers under Sec. 9116(a)(1.2)
z 317,397.26 .045 (16)
0 16. Amount of Line 14 taxable at lineal rate x
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II. 17.Amount of Line 14 taxable at sibling rate x .12 (17)
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g 18. Amount of Line 14 taxable at collateral rate x .15 (18)
19. Tax Due (19)
It _..._"".........,.._......".~_.._._.
, Decedent's Complete Address:
STREET ADDRESS
100 Mt. Allen Drive
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CITY
Mechanicsburg
STATE PA
U U[2:IP 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
714.14
Total Credits (A + B + C)
3. InterestlPenalty if applicable
D. Interest
E. Penalty
TotallnterestlPenalty (0 + E)
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.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
(1 )
!t,282.88
(2)
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______171~.14
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---- -- -1- 0.00
A~687~
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(3)
(4)
(5)
(SA)
(5B)
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and:
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;....................................
c. retain a reversionary interest; or............................................... ................................... ................................
d. receive the promise for life of either payments, benefits or care?..............................................................
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration? .................. ............... ............... .................... ................. ..................................
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?................................................................................................................... ..
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o 181
o 181
o 181
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF T E RETURN.
129 Bainbrid.K.e Road
W. Hartford, CT 06119
ADDRESS
ADDRESS
5521 Carlisle Pike
Mechanicsburg, PA 17050
ATE
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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 0 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 v..h,.. "ft.<>""f"." l^ M 1M ....- 00_- _..~ - 1urviving spouse is b%
[72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a survivi uirements for discldsure
of assets and filing a tax return are still applicable even if the surviving spouse il I
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty
parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. ~9116 (a)
The tax rate imposed on the net value of transfers to or for the use of the decedl
1.2) [72 P.S. 99116 (a) (1 )1.
The tax rate imposed on the net value of transfers to or for the use of the deced,
under Section 9102, as an individual who has at least one parent in common wil
K> A Pi)
or for the use of a nbtural
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is noted in 72 P.S.IS9116
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1.3)]. A sibling is dJined,
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SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
ITEM
NUMBER
ThJ~ ~c~!-ful_e-,,"us~li! co~~~~_ and !U~difthe answer t~_aIlYc:lfqu~~tions J tI1roug~.~ 011 paa~~ !S-Y~r", ______
DESCRIPTION OF PROPERTY I % OF . I I
Include the name of the transferee, their relationship to decedent and the date of transfer. , DATE OF DEASTH DECO'S I EXCLUSION T A*ABLE VALUE
I Attach a copy of the deed for real eslale. IV ALUE OF AS ET INTEREST] (IF APPLICABLE) i I
~~~d ~:g~;~~~;,~:~i# 5o~7ooi-li27j;, hdi~;ng-Tru;;,i [00% t - .-1 - I
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100%
Hess, BAnton
2
Brokerage account in Living Trust with Westminster
Financial, account # 6CW-071202 - Statement of value
attached
324,864.7
FILE NUMBER
21 - 05 -
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6,060.51
324,864.71
TOTAL (Also enter on line 7, Recapitulation)
t-------i-------
I ! 330,925.22
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SCH3JULE H
FUNERAL EXPENSES &
ADNINIS1RA11VE COS1S
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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__L____
ESTATE OF
I FILE NUMBER
21 - 05 -
Hess, BAnton
Debts of decedent must be reported on Schedule I.
N01~~ 1------- ---- - DESCRIPTION
A. ---h=UNERAL EXPENSES:-----
1 I M yers- Harner Funeral Home
2
Funeralluneheon
B.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
1.
Social Security Number(s) I EIN Number of Personal Representative(s):
2.
Street Address
City State _ Zip
Year(s) Commission paid
Attorney's Fees Ahrens Law Firm, P.C.
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
State
Zip
4. Probate Fees
5. Accountant's Fees
6.
Tax Return Preparer's Fees Estimated tax return prep fee
7.
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Other Administrative Costs
Mise Administrative expenses
TOTAL (Also enter on line 9, Recapitulation)
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6,643.00
1,250.00
3,500.00
150.00
140.00
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~ 1,683.00
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COMMONWEAL 1H OF PENNSVL VANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Hess, BAnton
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
Include unreimbursed medical expenses.
ITEM
NUMBER
1
2
3
4
5
6
AT&T phone bill
Verizon phone bill
DESCRIPTION
Messiah Village - final nursing home bill
Rotary Club Fees
Dr. Paul D. Dalbey - final bill
Alert Pharmacy
FILE NUMBER
2 I - 05 -
TOTAL (Also enter on Line 10, Recapitulation)
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AMOUNT
74.55
15.67
1,580.36
12.68
12.00
149.70
1,844.96
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R~V.1513JX+ (9-001 ~
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
_~~SIDENT DECE[)E:NT _______L__
SCHEDULE J
BENEFICIARIES
ESTATE OF
Hess, BAnton
FILE NUMBER
21 - 05 -
2
Margaret N. Greenawalt
7815 Escala Drive, Austin, TX
: Daughter
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Son
T
I AMOUNT OR SHARE
OF ESTATE
-+ ~-:--------
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11I3rd 9fresidue
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Il/3rd o~ residue
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NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
RELATIONSHIP TO
.. DECEDENT
_ i---OoJ\ID1JJst Trust...(s)_
i Daughter
I.
TAXABLE DISTRIBUTIONS (include outright spousal distributions)
Kathleen L. Paquette
129 Bainbridge Road, W. Hartford, CT
3
David F. Hess
,
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1I/3rd ohesidue
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I Enter dollar amounts for distributions shown above on lines 15 through 18, as appropria~e, 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
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CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
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TOTAL OF PART 11- EN~ER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEETI
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COMMONWEALTH OF PENNSYLVANIA REV-1162IEX( 11-961
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
PENNSYL VANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
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OFFICIAL RECEIPT I
NO. CD 008812
AHRENS THOMAS J
5521 CARLISLE PIKE
MECHANICSBURG, PA 17050
ACN AMOUtT
ASSESSMENT
CONTROL
NUMBER I
nn_u_ fold ---------- --------
101 I $13,568 74
ESTATE INFORMATION: SSN: 187-05-5861 I
FILE NUMBER: 2105-0836 I
DECEDENT NAME: HESS BANTON I
DATE OF PAYMENT: 09/19/2005 I I
POSTMARK DATE: 09/16/2005 I
COUNTY: CUMBERLAND I
DATE OF DEATH: 06/27/2005 I
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TOT AL AMOUNT PAID: $13,568 .74
REMARKS:
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CHECK# 3698
INITIALS: JA
SEAL RECEIVED BY: GLENDA FARNER STRASBAL GH
REGISTER OF WILLS
REGISTER OF WILLS
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