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Home My WebLink About01-18-06 (2) REV-1500 EX + (6-00) *' w :.:~Ul (JII::': UllL(J :1:00 (JII:..J lLID lL c( OFFICIAL USE ONLY COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT 0657 NUMBER FILE NUMBER 2..1 05 COUNTY CODE YEAR SOCIAL SECURITY NUMBER I- Z UJ C w () w c DECEDENrs NAME (LAST, FIRST, AND MIDDLE INITIAL) Hosterman, Rose M. DATE OF DEATH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 206-26-8447 DATE OF BIRTH (MM-DD-YEAR) 07-11-2005 05-04-1932 REGISTER OF WILLS SOCIAL SECURITY NUMBER (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) o 1. Original Return o 4. Limited Estate ~ 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received o o o o 2. Supplemental Return o 3. Remainder Return (date of death prior to 12-13-82) o 5. Federal Estate Tax Return Required o 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach copy of Trust) 10 Spousal PovertY Credit (date of death between . 12.31-91 and 1-1-95) !z UI C Z o lL ffl II: II: o (J NAME Jennifer B. Hipp FIRM NAME (If applicable) Bogar and Hipp Law Offices TELEPHONE NUMBER 717-737-8761 COMPLETE MAILING ADDRESS 1 West Main Street Shiremanstown, P~2 '-?011 1. Real Estate (Schedule A) (1) None OFFICIAl: USE ONbY 1.,...".,.) . .. (2) None .', - . (3) None (4) None ..,~) . , (..,~ (5) 1,200.00 (6) 592.01 (7) None (8) 1,792.01 (9) 7,256.36 (10) 4,694.61 2, Stocks and Bonds (Schedule B) 3, Closely Held Corporation, Partnership or Sole-Proprietorship z o i= c( ...J ::J I- D: c( () UJ a: 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) 0 Separate Billing Requested 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. Total Deductions (total Lines 9 & 10) (11 ) 11,950.97 12. Net Value of Estate (Line 8 minus Line 11) (12) insolvent 13. Charitable and Govemmental 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) 0.00 (14) 0.00 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15.Amount of Line 14 taxable at the spousal tax rate, 0.00 x .00 (15) z or transfers under Sec. 9116(a)(1.2) 0 (16) i= 16. Amount of Line 14 taxable at lineal rate 0.00 x .045 ~ ::J D. 17. Amount of Line 14 taxable at sibling rate 0.00 x .12 (17) :E 0 () 18. Amount of Line 14 taxable at collateral rate 0.00 .15 (18) >< x c( I- 19. Tax Due (19) 0.00 0.00 0.00 0.00 0.00 20. D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. >> BE SURE TO ANSWER ALL QUESTIONS ON REVERSe:SIDEANIl RECHEClfMATH <;< Copyright 2002 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00: ~ Decedent's Complete Address: STREET ADDRESS 35 East Gate Drive, Apt. 204 CITY Carlisle I STATE PA jZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 0.00 Total Credits (A + B + C) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + 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 ) 0.00 (2) 0.00 (3) (4) (5) 0.00 (5A) (5B) 0.00 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;................................................................................ 0 [!J b. retain the right to designate who shall use the property transferred or its income;................................... 0 [!Jxx c. retain a reversionary interest; or............................................................................................................... 0 [!J d. receive the promise for life of either payments, benefits or care? ............................................................. 0 [!J 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ......... ......... .................................... ...... ............................ ........... ............ ..... 0 [!J 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 [!] 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 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 RESPONSIBLE FOR FILING RETURN ADDRESS Susan M. Hamm S~'-{Y\. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ~'(v\ 400 Stonehedge Lane Mechanicsburg, PA 17055 ADDRESS DATE o 1- I;;;' - tJ6 DATE SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE Jennifer B. H' ADDRESS DATE 1 West Main Street Shiremanstown, PA 17011 , - f:J- 0(1' For dates of dea h 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. 99116 (a) (1.1) (ii)]. The statute does not exemDt 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. ~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 P.S. ~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.S. ~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. Rev-15D8 EX+ (6-98) . SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Hosterman, Rose M. FILE NUMBER 21-05-0657 ESTATE OF Include the proceeds 01 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. ITEM NUMBER DESCRIPTION 1 Personal Property - Sold at Private Sale VALUE AT DATE OF DEATH 1.200.00 TOTAL (Also enter on Line 5, Recapitulation) 1.200.00 (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-1509 EX+ (6-98) . SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Hosterman, Rose M. FILE NUMBER 21-05-0657 ESTATE OF If an asset was made joint within one year of the decedent's date of death, " must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME A. Susan M. Hamm ADDRESS RELATIONSHIP TO DECEDENT 400 Stonehedge Lane Mechanicsburg, PA 17055 Daughter B. C. JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR VALUE OF ASSET INTEREST DECEDENT'S INTEREST JOINTLY-HELD REAL ESTATE. 1 A 10n/2002 Members 1st Federal Credit Union- 25.00 50.000% 12.50 Savings Account No. 222906-00, date of death value $25.00, accrued interest $0.00 2 A 10n/2002 Members 1 st Federal Credit Union - 1.159.01 50.000% 579.51 Checking Account No. 222906-11, date of death value $1,159.01, accrued interest $0.00 TOTAL (Also enter on Line 6, Recapitulation) 592.01 (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 F (Rev. 6-9B) SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established CHECKING ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established USED VEHICLE LOAN: Account Number/Suffix Date Account Established Principal Balance at Date of Death Collateral Name of Co-Borrower Estate of: ROSE M. HOSTERMAN Date of Death: 07/11/2005 Social Security Number: 206-26-8447 fv1R MEMBERS 1st FEDERAL CREDIT UNION 222906 -00 1 0/02/2002 $25.00 $.00 $25.00 Susan Hamm 10/07/2002 222906 -11 1 0/02/2002 $1,159.01 $.00 $1,159.01 Susan Hamm 1 0/07/2002 222906 -01 10/21/2002 $4,694.61 1993 Dodge Shadow/ Contractual Pledge of Shares None MABERS 1ST F~DERAL CREDIT UNION M;~ A ?tJ~? '-'Denise A. ~If~ "/ - Insurance Services Supervisor November 10, 2005 5000 Louise Drive · P.o. Box 40 · Mechanicsburg, Pennsylvania 17055 · (717) 697-1161 · WWV1.memberslst.org REV-1151 EX+ (12-99) *' SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hosterman, Rose M. Debts of decedent must be reported on Schedule I. FILE NUMBER 21-05-0657 ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached 5,870.30 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip - Year(s) Commission paid 2. Attorney's Fees Bogar and Hipp Law Offices 780.00 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 68.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 538.06 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 7,256.36 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1502 EX+ (6-98) . SCHEDULE H.A FUNERAL EXPENSES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Hosterman, Rose M. FILE NUMBER 21-05-0657 ESTATE OF ITEM NUMBER DESCRIPTION AMOUNT 1 Foster Monuments - Grave Monument 344.00 2 Neill Funeral Home - Funeral 5.526.30 Subtotal 5.870.30 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-98) Rev-1502 EX+ (6-98) . SCHEDULE H.B7 OTHER ADMINISTRATIVE COSTS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Hosterman, Rose M. FILE NUMBER 21-05-0657 ESTATE OF ITEM NUMBER DESCRIPTION AMOUNT 1 Comcast - Cable Bill-Final 8.72 2 RESERVES: - Costs to conclude administration of Estate including filing fee for Pa. Inheritance Tax Return and Inventory; preparation of 2005 personal income tax returns 500.00 3 Sprint - Telephone Bill-Final 29.34 Subtotal 538.06 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA.1500 Schedule H-B7 (Rev. 6-98) Rev-1512 EX+ (6-98) . SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hosterman, Rose M. FILE NUMBER 21-05-0657 Include unrelmbursed medical expenses. ITEM NUMBER DESCRIPTION 1 Members 1 st Federal Credit - Vehicle Loan, Account No. 222906-01 VALUE AT DATE OF DEATH 4.694.61 TOTAL (Also enter on Line 10, Recapitulation) 4,694.61 (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) SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established CHECKING ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established USED VEHICLE LOAN: Account Number/Suffix Date Account Established Principal Balance at Date of Death Collateral Name of Co-Borrower Estate of: ROSE M. HOSTERMAN Date of Death: 07/11/2005 Social Security Number: 206-26-8447 fvlH MEMBERS 1st FEDERAL CREDIT UNION 222906 -00 1 0/02/2002 $25.00 $.00 $25.00 Susan Hamm 10/07/2002 222906 -11 1 0/02/2002 $1,159.01 $.00 $1,159.01 Susan Hamm 1 0/07/2002 222906 -01 10/21/2002 $4,694.61 1993 Dodge Shadow/ Contractual Pledge of Shares None MNBERS 1ST F~DERAL CREDIT UNION ~ /J $fi? ''Denise A. ~If~ T - Insurance Services Supervisor November 10, 2005 5000 Louise Drive · P.o. Box 40 · Mechanicsburg, Pennsylvania 17055 · (717) 697-1161 · www:members1st.org REV 1513 EX... (9-00) *' SCHEDULE .J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT NUMBER Hosterman, Rose M. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal aistributions, and transfers under Sec. 9116(a}(1.2)] RELATIONSHIP TO DECEDENT Do Not Ust Trusteels) FILE NUMBER 21-05-0657 SHARE OF ESTATE AMOUNT OF ESTATE (Words) ($$$) ESTATE OF I. See attached schedule Total Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) SCHEDULE J BEN EFICIARIES (Part I, Taxable Distributions) ESTATE OF: Rose M. Hosterman 206-26-8447 07/11/2005 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (W ords) ($$$) 1 Susan M. Hamm Daughter One-sixth (1/6) of 0.00 400 Stonehedge Lane rest, residue and Mechanicsburg, PA 17055 remainder 2 Deborah Hosterman Daughter One-sixth (116) of 0.00 23 Hillside Trailer Park rest, residue and Lewistown, PA 17044 remainder 3 Lisa Hosterman Daughter One-sixth (1/6) of 0.00 3332 Lockheed Blvd., Apt. 101 rest, residue and Alexandria, V A 22306 remainder 4 Michael Hosterman Son One-sixth (1/6) of 0.00 1352 Back Maitland Road rest, residue and Lewistown, PA 17044 remainder 5 Richard Hosterman Son One-sixth (1/6) of 0.00 39 Henrietta St., Apt. B rest, residue and Lewistown, P A 17044 remainder 6 Kimberly Reigle Daughter One-sixth (1/6) of 0.00 RR5, Box 250 rest, residue and Quigley Road remainder Mifflintown, PA 17059 Total 1 J. E J LAw OFFICES HOUCK & GINGRICH 23 N. WAYNE STREET P.O. BOX 430 lEW/STOWN, PA. 17044 WILL I; ROSE M. HOSTERMAN, currently of'Mifflin county, Pennsylvania, being of sound mind, memory and understanding do make and publish this my Last Will and Testament hereby r~voking and making void all former wills by me at any time hereto ford .made. ITEM ONE: I direct all my debts which may be legally col'lectible, and funeral expenses, be paid by. my Executor hereinafter named. ITEM TWO: All federal, state and other death taxes payable because of my death, with respect to the property forming my gross estate for tax purposes, whether or not passing under this will, including any interest or penalty imposed in connection with such tax, shall be considered a part of the expense of the administration of my estate and shall be paid from my residuary estate under ITEM THREE without apportionment or right of reimbursement. All such taxes on present or future interests shall be paid at such time or times as my Executor may think proper regardles~ of whether such taxes are then due. ITEM THREE: If my husband, GEORGE L. HOSTERMAN, is living on the thirty~first day following my death, I give, devise and bequeath to my said husband all the rest, residue and remainder of my estate, real, personal and mixed, of which I shall die seized and possessed, or to which I shall.beentitl~a at my .~. ! ~-~, ....>;: ';-'~;J~".!'~/:~dbO decease of every nature and wherever situ~at~i~) Y.U316 !"'\ ~~ n 11"f (; 7 -;~r ~nq7 u (,.. ,.u ~-i ~ ~...., Jl \I _,..,-,u :~.' i . ~':'.:'. .~:-'; ~~~~! S~S~h ,> '...,~:;', -;;\ nJ;11 I:J~;;':lj;..j jl,) jJ!jJ!..) u..;\JC" ,,-'.J'~ j In the event my said husband is not living on the thirty-first day following my death, I give, devise and bequeath all the rest, residue and remainder of my estate, real, personal and mixed, of which I shall die seized and possessed or to which :'[ shall be entitled at my decease equally to my children, namely, DEBORAH HOSTERMAN, SUSAN HAMM, RICHARD HOSTERMAN, MICHAEL HOSTERMAN, LISA HOSTERMAN and KIMBERLY FILLER. In the event a said child of mine is not living on the thirty-first day following my death, said deceased child's share shall go to his/her issue per stirpes living on the thirty-first day following my death. ITEM FOUR: I nominate, constitute and appoint my husband, GEORGE L. HOSTERMAN, as Executor of this my Last will and Testament. In the event my said husband fails to act as Executor, I nominate, constitute and appoint my daughter, SUSAN HAMM, as substitute Executrix. In the event my said daughter fails to act as Executrix, I nominate, constitute and appoint my ~ son, RICHARD HOSTERMAN, as second substitute Executor. ITEM FIVE: I direct that my Executor, or his successor, shall not be required to give bond for the faithful performance of their duties in any jurisdiction. LAW OFFICES HOUCK & GINGRICH 23 N. WAYNE STREET P.O. BOX 430 lEWISTOWN, PA. 17044 ITEM SIX: No interest (including, but not limited to all shares of principal and income) of any beneficiary under this will or any Codicil hereto or any trust herein created shall be subject to anticipation or voluntary or involuntary alienation. LAW OFFICES HOUCK & GINGRICH 23 N. WAYNE STREET P.O. BOX 430 LEWISTOWN, PA. 17044 IN WITNESS WHEREO~, I, ROSE M. HOSTERMAN, the Testatrix, have to this my Last will and Testament, set my hand and seal (to . this instrument only) this 1'~ day of December, 1991. R~~ m. \~~EAL Signed, sealed, published and declared by the above-named ROSE M. HOSTERMAN, Testatrix, as and for her Last Will and Testament, in the presence of us who have hereunto subscribed our names at her request thereto in the presence of the said Testatrix and of each other. ~~/~~ o(~~.~