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HomeMy WebLinkAbout10-04-05 RtN-15110 EX (&'00) OFFICIAL USE ONLY COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER I- Z W C w U w c DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) Hendle Helen DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 2/1/2005 2/21/1909 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) ~L COUNTY CODE -9!L 0120 _ _ _ YEAR NUMBER W SOCIAL SECURITY NUMBER 196-05-3727 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER w I- ~~CI) UO::~ wll.U J:oo uO::....I Il.CO 11. <( 001 04 00& 09. Original Retum Limrted Estate o 2. Supplemental Retum 0 3. Remainder Retum (date of death prior to 12-13-82) o 4a. Future Interest Compromise (date of death after 12-12-82) 0 5. Federal Estate Tax Return Required o 7. Decedent Maintained a Living Trust (Attach copy ofTrust) L B. Total Number of Safe Deposrt Boxes o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) 0 11. Election to tax under Sec. 9113(A) (Altaoh Soh 0) Decedent Died Testate (Attach copy of 'Mil) Litigation Proceeds Received THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS I- Z w C Z o ll. en W a:: a:: o o Richard C. Snelbaker FIRM NAME (If Applicable) Snelbaker & Brenneman, P.C. TELEPHONE NUMBER 44 West Main Street Mechanicsburg, PA 17055 717-697-8528 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) Z 6. Jointly Owned Property (Schedule F) (6) 0 D Separate Billing Requested i= ::5 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) ::) (Schedule G or L) l- ii: 8. Total Gross Assets (total Lines 1-7) <( U W 9. Funeral Expenses & Administrative Costs (Schedule H) (9) n:: 10. Debts of Decedent, Mortgage Liabilrties, & Liens (Schedule I) (10) 11 Total Deductions (total Lines 9 & 10) 0.00 9,066.06 0.00 '."+j ,.-, OFFICiAll. USE ONLY: _co. 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 0.00 7,107.64 0.00 C) , i 167,477.91 (8) 9,034.53 260.00 183,651.61 (13) 9,294.53 174,357.08 0.00 (11) 12 Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) (12) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 174,357.08 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16 Amount of Line 14 taxable at lineal rate 0.00 0.00 x.O ~(15) X.o 45 (16) z o i= <( I- :::l 11. :E o u >< <( I- 17. Amount of Line 14 taxable at sibling rate 0.00 174,357.08 x .12 (17) 0.00 0.00 0.00 18. Amount of Line 14 taxable at collateral rate 20. [KJ CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT (19) 26,153.56 26,153.56 x .15 (18) 19. Tax Due > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < 3W4645 1000 Dece,dent's Complete Address: SIREET ADDRESS 295 Old Stone House Road, South Monroe Twp., Cumberland County CI1Y 1 STATE I ZIP Mechanicsburg PA 17055- Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1 ) 26,153.56 0.00 20,000.00 1,000.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + 8 + C) (2) 21,000.00 0.00 0.00 Total Interest/Penalty (0 + E) (3) 0.00 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) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 5,153.56 A. Enter the interest on the tax due. (SA) 0.00 8. Enter the total of Line 5 + SA. This is the BALANCE (58) Make Check 5,153.56 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;. . . . . . . . . . . . . . . D b. retain the right to designate who shall use the property transferred or its income; . D c. retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . . D d. receive the promise for life of either payments, benefits or care? . . . . . . . . . D 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " IX] 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. Under penalties of perjury, I declare that I have examined this retum. 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 is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RE Yes No ~ ~ ~ ~ ~ og ADDRESS 'J.OC/J .; 295 Old Stone House Rd., South, PA ADDRESS Richard C. Snelbaker, Esquire 44 West Main St., Mechanicsburg, PA 17055 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 P'S.9 9916 (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. 99116 (a) (1.1) (ii)] The statute does not exempt 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 dates 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 stepparent of the child is 0% [72 P.S. 9 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 4.5%, except as noted in 72 ps. 9 9116(1.2) (72 P.S. 9 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.S. 9 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. 3W4646 1000 ~EV-1503 EX ~ (5-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE 8 STOCKS & BONDS FILE NUMBER Helen W. Hendley 21 05 0120 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTlON VALUE AT DATE OF DEATH 9,066.06 1.Manulife Financial Corporation 206 shares of common stock valued at $44.01 per share 3W4696 1000 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 9,066.06 REV-1508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Helen W. Hendley Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. FILE NUMBER 21 05 0120 ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Citizens Bank savings account # 6140277523 188.27 2 Citizens Bank checking account #6100631648 5,243.27 3 PA Employee Benefit Trust Fund (PEBTF) refund on medical benefit plan 482.10 4 U.S. Treasury Social Security Benefit 797.00 5 U.S. Treasury refund on 2004 Individual Income Tax Returns 397.00 3W46AD 1.000 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 7,107.64 REV-1510 EX + (5-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYL VANIA INHERITANCE TAX RETURN RESIDENT DECEDENT EST ATE OF Helen W. Hendley FILE NUMBER 21 05 0120 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM IN:.LLOE TI-E NOME OF TI-E TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT MI) DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER T1-EOATE OFTRMSFER ATTACHAGOPV OF Tl-E DEED FOR REAL ESTATE VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1. MetLife 59,909.89 100.0000 0.00 59,909.89 annuity #073443770AB 2 MetLife 107,568.02 100.0000 0.00 107,568.02 annuity # 073005809AB TOTAL (Also enter on line 7, Recapitulation) $ 167 477.91 (If more space is needed, insert additional sheets of the same size) 3W46AF 1.000 REV-1511 EX+ (;2-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Helen W. Hendley ITEM NUMBER A. B. 2. 4. Debts of decedent must be reported on Schedule I. DESCRIPTION FUNERAL EXPENSES: 1. Ewing Brothers Funeral Home funeral services 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: Attorney Fees Snelbaker & Brenneman, P.C. 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 5. Accountant's Fees Probate Fees 7. 6. Tax Return Preparer's Fees 1 3W46AG 1.000 Citizens Bank maintenance fee on estate checking account Total from continuation schedules TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) FILE NUMBER 21 05 0120 $ AMOUNT 6,057.26 1,500.00 83.00 15.00 1,379.27 9,034.53 Estate of: Helen W. Hendley 196-05-3727 Schedule H Part 7 (Page 2) 2 Cohick & Associates preparation of 2004 Individual Income Taxes 140.00 3 Cumberland Law Journal advertising Executor Notice 75.00 4 Register of Wills Short Certificates 8.00 5 Register of Wills filing fee for Inheritance Tax Return and Inventory 30.00 6 The Patriot-News advertising Executor notice 126.27 7 Reserve for filing fees, accounting fees and other costs associated with the administration of Decedent's estate 1,000.00 Total (Carry forward to main schedule) 1,379.27 REV-1512 EX + (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Helen W. Hendley SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21 05 0120 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH Andorra Radiology Assoc., P.C. medical services 160.00 2 Belvedere Medical Corp. medical expenses 57.64 3 Cumberland Goodwill Fire Rescue ambulance service 42.36 3W46AH 2.000 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 260.00 . , REV-1513 EX+ (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Helen W Hendl~ FILE NUMBER 21 05 0120 1 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Raymond C. Smith, Jr. 295 Old Stonehouse Road, South Mechanicsburg, PA 17055 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE NUMBER I 100% Residue: 174,357.08 None 174,357.08 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET /I 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 II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET (If more space IS needed, Insert additional sheets of the same size) $ 0.00 3W46AI 1 000 lllll: "_.- ~:: LAST WILL AND TEST AMENT I, HELEN W. HENDLEY, of the Township of Monroe, County of Cumberland, and Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void all former wills and codicils by me at anytime heretofore made. FIRST. I order and direct that all my just debts and funeral expenseS be paid by my Executor or Executrix, as the case may be, hereinafter named, as soon as conveniently may be done after my decease. SECOND. I give, devise and bequeath all the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situated, unto RAYMOND C. SMITH, JR., absolutely and in fee simple, ifhe survives me. If the said RAYMOND C. SMITH, JR. does not survive me, then and in that event, I give devise and bequeath all the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situated unto JUDITH D. SMITH, absolutely and in fee simple. LASTLY. I nominate, constitute and appoint RAYMOND C. SMITH, JR., to be the Executor of this, my Last Will and Testament, but if for any reason he should fail to qualify as such Executor or cease so to serve, then and in that event, I nominate, constitute and appoint JUDITH D. SMITH to be the Executrix, hereof, each and both to serve without bond or olher security as a condition of qualification hereunder. IN WITNESS WHEREOF, I, HELEN W. HENDLEY, have hereunto set my hand and seal to this my Last Will and Testament, which consists of One (1) typewritten pages to which I have affixed my signature this 23rd day of April, A.D., Two Thousand Three (2003). .1/~~-v If:' JJe.~J-~AL) Helen W. Hendley LAW OFFICES SNELBAKER. BRENNEMAN & SPARE The preceding instrurnent~ consisting of this and two (2) other typewritten pages, each identified by the signature of the Testatrix, was on the date thereof signed, sealed, published and declared by HELEN W. HENDLEY, the Testatrix therein named, as and for her Last Will and Testament, in the presence of us, who, at her request, in her prese d in the presence of each other, have subscribed our names as witnesses hereto. ~~.~ , . COMMONWEALTH OF PENNSYLVANIA) SS. COUNTY OF CUMBERLAND ) We, HELEN W. HENDLEY, RICHARD C. SNELBAKER and JANE J. COONEY, the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament and that she had signed willingly, 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 a witness and that to the best of his or her knowledge, the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. 'J~, ~/~~ ~x . k4" ss JV7i!S~ Subscribed, sworn to and acknowledged before me by HELEN W. HENDLEY, the Testatrix, and subscribed and sworn to before me by RICHARD C. SNELBAKER and JANE J. COONEY, the witnesses, this 23rd day of April, 2003. ^ Jb ~< . Notary PUbli~ .. - LAW OFFICES SNELBAKER. BRENNEMAN Be SPARE Not.maJ:~. M~L~~~. I My~.Jen Nov. 24, am '~'.~ ,~~~t ~.I': ~1.~~ .::.;..a.~~~). ..I......~:;,f"/~.. .,jff;~ er ,,~t.J.' '~~-G ....