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Home My WebLink About02-22-06 REv-l500 ElIl&-OOl REV-1500 '* COMMONWEALTH OF PENNSYLVANIA . DEPARTMENT OF REVENUE . DEPT. 280601 HARRISBURG, PA 17128-0601 QF~ICtl-~L :JS= 'JN~~Y INHERITANCE TAX RETURN FILENUMBER 1L - 0 5 RESIDENT DECEDENT COUNTYCOOE -YEAA- NUMBER I- Z W Q W o w Q DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAl) Haas, Drusilla W. DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 01/27/2005 04/10/1918 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) n/a o 2 6 5 SOCIAL SECURITY NUMBER 177 - 16 ~343 THIS RETURN MUST BE ALEO IN DUPUCATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER w ~~(I) UO:~ wo.g 3:~..J uo.II2 0. < 00 1. Original Return o 4. Umited Estate o 6. Decedent Died Testate (AIIadl copy of WII) o 9. Utigation Proceeds Received o 2. SuppJeri,ental Return o 4a. Future Interest Compromise (cI8le 01 dea\tI after 12-12-82) o 7. Decedent Maintained a Living Trust (AItacI\copy ofTIUSl) D 10. Spousal Poverty Credit (dale d death between 12-31-91 and 1-1-95) :-_.,,;:~ ',': ':'," ..~ o 3. Remainder Return (dale of death priOr III 12-13-82) o 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes o 11, Election to tax under Sec. 9113{A) (AIIach Sell 0) .' "":": etj,:- ' ......... ':, ;..' ~ z w c z ~ tI) W 0: 0: o (J NAME COMPLETE MAILING ADDRESS (1 ) (2) (3) (4) (5) $350.00 (6) $6,302.11 (7) $6,652.11 (8) (9) $5,646.77 (10) Samuel L. Andes ARM NAME (If Applicable) TELEPHONE NUMBER (717) 761-5361 z o ~ ;:) l- ii: c( u w ~ 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or SoIe-Proprietorship 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, & Uens (Schedule I) 11. Total Deductions (total lines 9 & 10) 12. Net Value of Estate (Une 8 minus Line 11) 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 (Une 12 minus Una 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPUCABLE RATES z o ~ ~ ;:) t1. :E o u ~ 15. Amount of Une 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(11) $1,005.34 16. Amount of Une 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20.0 525 North 12th Street Lemoyne, PA 17043 OFFICIAL lJ.S;~ ONLY (11) $5,646.77 (12) $1,005.34 (13) (14) $1,005.34 x.o_ (15) x.O_ (16) $45.24 x .12 (17) x .15 (18) (19) $45.24 ~:~i',".:h;:.if4~~~t~f.;;'?y~ry'if~~~~.,~:~~;$.1t.:,:'" " ~f":. CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT .~ . ~~t8~-~~~t:~f~:~~:.~~~:.~t:~~:~~~.':.;:-',{:.'~~~~J~' ~.:,~.,:. . .' .~. "~'<,~...~<."" '..,i;.' ~:or Decedent's Complete Address: STREET ADDRESS 5:Jt:f ;Y'\ar;'~f S kt'(:,+ CITY IJt.W C LA yY1 8 eR. c..A f\JD 1 STATE Pr) I ZIP /7070 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 'fs, 2 'f Total Credits (A + B + C) (2) 3. InteresUPenalty if applicable D. Interest E. Penalty TotallnterestlPenalty (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 (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 'IS, 2- '1 A. Enter the interest on the tax due. (SA) 8. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58) 4' S, z'1 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSVVER THE FOLLOVVlNG QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes a. retain the use or income of the property transferred; ........................................ 0 b. retain the right to designate who shall use the property transferred or its income; . . . . . . . . . . . . . . . . . .. 0 c. retain a reversionary interest; or " . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0 d. receive the promise for life of either payments, benefits or care? ... . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0 ~ IF THE ANSWER TO Am 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, inc ding accompanying schedules and statements, and to the best of my knowledge and belief, it is true, corred and complete. Declaration of ar thal the personal representative is sed all information of which preparer has any knowledge. SIGN RE PER ON RESPONSIBLE FOR G ETURN c~~b~ l~ f \'"')O/Q ADDRESS .\1. 12~ ~ -h<..e.e.t Le,.~,.oy r-IC. ! A- l7oYj' No ~ B! ~ << ~ DATE DATE F or 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. 99116 (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. 99116(a)(1.2)]. The tax rate imposed on the net value oftransfers to orfor the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. ~9116(a)(1)]. The tax rate imposed on the net value of transfers to orfor the use of the decedent's siblings is 12% [72 P.S. 99116(a)(1.3)}. A sibling is defined, under Section 9102, as an ind\v\dua\ who has at least one parent in common with the decedent, whether by blood or adoption. STF PA42021F.2 RfV.1508 EX . (1-97) . SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERIT ANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Drusilla W. Haas FILE NUMBER 21-05-0265 Include the proceeds of litigation and the date the proceeds were received by the estate. An property jolntly-owned with the right of survivorship must be dilcklsed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Miscellaneous items of clothing and personal effects $350.00 TOTAL (Also enter on line 5. Recapitulation) $ 350.00 (If more space is needed. Insert additional sheets of the same size) REV. I. EX . (1-97) *' SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Drusilla W. Haas FILE NUMBER 21-05-0265 If In asset wal ....d. joint within on. year of the decedent's datt of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RElATIONSHIP TO DECEDENT A. Norman William Haas 519 Market Street New Cumberland, PA 17070 son B. c. JOINTLY -OWNED PROPERTY: lETTER DATE DESCRIPTION Of PROPERTY %Of DATE OF DEATH ITEM FOR JOINT MADE Include nsne of financial institution lIId balk account number or similei' identifying number. Attach DATE OF DEATH DECD'S VAlUE OF NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT"S INTEREST 1. A. 2000 or Account No. 51-4007-2746 with PNC Bank $12,604.22 50% $6,302.11 before TOTAL (Also enter on line 6, Recapitulation) $ 6,302.11 (If more space is needed, insert additional sheets of the same size) Premium Plan Account Statement PNC Bank For the period 01/07/2005 to 02/04/2005 M DRUSILLA HAAS NORMAN WILLIAM HAAS 519 MARKET ST NEW CUMBERLAND PA 17070-1938 Primary account number: 51-4007-2746 Page 1 of 2 Number of enclosures: 21 .Q For 24-hour banking, customer service and transaction or interest rate information, 1t sign-on to Account Link @ by Web on pncbank.com or call 1-888-PNC-BANK Para servicio en espanol, 1-866-HOLA-PNC Moving? Please contact us at 1-888-PNC-BANK ~ Write to: Customer Service PO Box 609 Pittsburgh PA 15230-9738 Q Visit us at pncbank.com I TOO terminal: 1-800-531-1648 For hearing impaired clients only For more information on exciting offers and promotions for our free Online Bill Payment service, stop by any PNC Bank office, visit pncbank.com, or call1-800-PNC-BANK for further details. Premium Plan Interest Checking Account Summary Account number: 51-4007-2746 Drusilla Haas Norman William Haas Balance Summary Please see the Activity Detail section for additional information. Beginning balance Deposits and other additions Checks and other deductions 8,475.89 7,590.23 3,988.06 Average monthly balance 12,085.76 Ending balance 12,078.06 Charges and fees 20.00 Transaction Summary Checks paidJ withdrawals Check Card pas signed transactions Check Card/Bankcard pas PIN transactions 21 o Total ATM transactions PNC Bank A TM transactions Other Bank A TM transactions o o As of 02/04, a total of $2.46 in interest was earned this year. Interest Summary Annual Percentage Yield Earned (APYE) Number of days in interest period Average collected balance for APYE 0.17% 29 11,837.04 Activity Detail Deposits and Other Additions Date 01/10 01/12 01/18 01/28 02/03 Amount Description Deposit Reference No. 027366711 Deposit Reference No. 025144186 Deposit Reference No. 024907827 Deposit Reference No. 026790904 Direct Deposit - Soc See US Treasury 303 Xxxxx1343A Interest Payment 5,378.43 392.34 419.57 444.31 954.00 02/04 1.58 o o Interest Earned this period 1.58 There were 6 Deposits and Other Additions totaling $7,590.23 Premium Plan Account Statement fa For 24-hour customer service information, sign-on to Account Link by Web on pncbank.com or call1-888-PNC-BANK Account number: 51-4007-2746 - continued Checks and Substitute Checks @ For the period 01/07/2005 to 02/04/2005 DRUSILLA HAAS Primary account number: 51-4007-2746 Page 2 of 2 Check Date Reference number Amount paid number 2434 356.05 02/01 027487975 2439 ... 77.60 01/10 027385585 2440 20.00 01/11 028257137 2441 29.10 01/13 E094217443 2442 200.00 01/07 027032507 2443 146.72 01/10 027237811 2444 67.93 01/11 028133133 2445 200.00 01/11 028140075 2446 37.50 01/13 027744645 2448 ... 41.37 01/12 026002411 2450 ... T 20.00 01/10 027366395 ... Gap in check sequence "T" Teller Cashed Check Check number 2451 2453 ... 2455 ... 2456 2458 ... 2460 ... 2462 ... 2463 2467 ... 2468 T Date Reference Amount paid number 1,000.00 01/11 028103090 53.03 01/21 E094221382 10.00 01/18 027581491 20.00 01/24 026702326 25.00 01/21 E094237527 25.00 02/04 024128143 100.00 02/01 027316483 1,000.00 01/31 027064996 300.00 02/04 025291853 125.00 02/02 027061007 T There were 21 checks listed totaling $3,854.30 . There were 2 Online or Electronic Banking Deductions totaling $113.76 . Online and Electronic Banking Deductions Date Amount Description 01/21 81.00 Direct Payment - Slico Prem Shen Life Ins Co Xxxxx7019 01/25 32.76 Payment.E-Check Check Pymt Home Depot/Expo 2459 02/04 Amount Description 20.00 Service Charge There was 1 Other Deduction totaling $20.00 . Other Deductions Date Daily Balance Detail Date Balance Date Balance Date Balance Date Balance 01/07 8,275.89 01/13 12,406.44 01/25 12,604.22 02/02 11.467.48 01/10 13,410.00 01/18 12,816.01 01/28 13,048.53 02/03 12,421.48 01/11 12,122.07 01/21 12,656.98 01/31 12,048.53 02/04 12,078.06 01/12 12,473.04 01/24 12,636.98 02/01 11,592.48 PREMIUM PLAN - Service Charge Explanation Account type Regular Checking Interest Checking Certificate(s) of Deposit Account number 51-4007-3941 51-4007-2746 2001006099 Balance type This Cycle Avg Balance This Cycle Avg Balance Current Value As of 02/04 02/05 02/03 Balance 366.97 12,086.45 1,784.76 These accounts were reviewed to meet the balance requirements of your Premium Plan Account. Since balance requirements were not met this month, a $20.00 fee was deducted from this account. ARE YOUR MONTHLY BILLS GETTING OUT OF CONTROL? Now's the time to consolidate your debts into one lower monthly payment with a debt consolidation loan at PNC. If you own a home, you can take advantage of a home equity loan or line of credit to payoff your outstanding credit cards, auto loans, or other installment loans at a lower rate than you're probably paying now. And with a home equity loan, the interest you pay may be tax deductible (consult your tax advisor about the deductibility of interest) - saving you even more money in the long run. If you're not a homeowner, you can still consolidate your debt with a Personal loan or line of credit. Call us today and ask for details at 1-888-PNC-BANK or visit us on the web at pncbank.com Don t delay - take control of your finances today. Get your taxes done right. Get your refund fast when you e-file. Save 15% on Intuit s TurboTax@ for the WebSM service. Visit pncbank.com/offersmw for more information. You can also use this link to access our Tax Center to learn more about taxes, taxwise investing and how you can maximize your deductions. REV-'SH EX+ ('2-99)_ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Drusilla W. Haas FILE NUMBER 21-05-0265 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: Stone & Murray Funeral Home $1,374.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)JEIN Number of Personal Representative(s) Street Address City State _ Zip Year(s) Commission Paid: 2. Attorney Fees Samuel L. Andes $1,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Norman William Haas Street Address 519 Market Street City New Cumberland $3,000.00 State P A Zip 17070 Relationship of Claimant to Decedent son 4. Probate Fees Register of Wills $68.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. The Sentinel (advertising) Cumberland Law Journal (advertising) $129.77 $75.00 TOTAL (Also enter on line 9, Recapitulation) $ 5,646.77 (If more space is needed, insert additional sheets of the same size) o -1 };. r o -n ?: In JJ o I :P Z o (f) m (f) 111 r rn () -i m o ~ (n \J~ Dr )> ~ ""0 0~C ~''i,m y ~: ) D 3 }>> t/) loc (Do.o .., 0 ::) g.m~ tsl'"tJ !Q,~ f CD ~g ';TC/l ~CD [ f.~ t ~ o 0 ~ o ii) ro S- 3 3 ~ g ~ :J ~ c 0: :J ro ij) :~~ " '< . (1) .' .-, , 0 :1 a (J) :IJ p ro 0 to T in' :J ~ ~ OJ co o D- o to T 3 ro ~ o III a. (J) () c: (i) .., cn c:: =::1. ~ () o ::> or 5' <tl ...., }: ( o ) o--fUJ o 0 tll ~ ~ ~ rO-l m III III ~ g} ::< -i)>- o a. III -i ~ :T r (1) ~ 0 ;:;: co "i1 (t) (t) 0 g 6 )> -:.;.. c ~ Q )> o ~ ~ )> (J) Z (t) 0 :< m 0' (J) ~ ~ 5' o 0- W :i' S' co r t~ ~ ~ --fen ~C ~:s: ~s: ~)> ~:o ~- m II o ::u S III :D o :J: )> Z CJ Ui m CJ) rn r rn (1 .; m o o ill 3 ill ro ~ CDo.Pl=PlPlU=OO =:-n a ~ ~~:g g ~ * :: \- l>> S. 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TOTAL OF PART n. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET 1$ (If more space is needed. insert additional. sheets of the same size)