HomeMy WebLinkAbout03-10-06
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT, 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
-
OFFICIAL USE ONLY
FILE NUMBER
2 1 -0 5
026 7
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
COUNTY CODE ~~ - - NUMBER- -
SOCIAL SECURITY NUMBER
HERTZLER
DATE OF DEATH (MM-DD-Year)
.lEANNE E.
DATE OF BIRTH (MM-DD-Year)
1 68- 2 4 - 3 064
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WIllS
03/16/2005 07/12/1928
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
o 2. Supplemental Retum
o 4a. Future Interest Compromise (date of death after 12-12-82)
o 7. Decedent Mainta ined a Living Trust (Attach copy ofT rust)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
o 3. Remainder Retum (date of death prior to 12-13-82)
o 5. Federai Estate Tax Retum Required
!.. 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Soh 0)
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NAME
MURREL R. WALTERS III, ESQUIRE
FIRM NAME (If Applicable)
TELEPHONE NUMBER
717-697-4650
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
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-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)
[KJ1. Original Retum
o 4. Limited Estate
[KJ 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
54 EAST MAIN STREET
MECHANICSBURG
PA 17055
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
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(1)
(2)
(3)
(4)
(5)
OFFICIAL USE ONLY
30,214.50
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(6)
12,962.02 '
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1..0
(7)
(8)
43,176.52
(9)
3,200.00
3,079.67
(11)
(12)
(13)
6,279.67
36,896.85
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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(14)
36,896.85
X _(15)
36,896.85 X ~(16)
X .12 (17)
X .15 (18)
(19)
1,660.36
1,660.36
PI.
Decedent's Complete Address:
-
STREET ADDRESS
335 WESLEY DRIVE
APT. 124
CITY T STATE I ZIP
MECHANICSBURG PA 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
1,660.36
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits (A + 8 + C) (2)
Total Interest/Penalty ( 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)
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
1,660.36
1,660.36
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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 00
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 00
c. retain a reversionary interest; or ...................................................................................................... 0 00
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 00
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................. 0 00
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. 0 00
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... 0 00
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 infonnation of which preparer has any knowledge.
SIGNATURE OF P~SPONSIBL OR IL G RETURN DATE
3/8/2006
ADDRESS
PA 17055
DATE
3/8/2006
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. ~9116 (a) (1.1) (i)J.
Fa dat", of death 00 a aft., J,,",ry " 1995, ~'fa< ,~, 'mposed 00 ~, "" ,"'" of f",",f,,, fo a fa ~,"oo of tho ,"".0' 'poooo " 0% ~2 P.S. 19116 (,) (1.1 )(It)].
Th, 'taruf, does oof "'mil! , f""sf., to , ,"N"'O, 'po"5o from f"" ,,' fh, st~"tory ,",,"' ffimon" fo, "scJos"m of assets ,,' fiI'o, , fa> "'"m '" ,W' "",,1t"b1, "" ff
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The fa> ,~, 'mposed 00 tho ",f ,,'"' of f"osf,,, from , ",",'ed ohil' 1we0fy-o", ye", of ". 0' yooo9"< ~ de"" fo 0' fo' ., "50 of , ",f,," P""f, " "'Optf" ",mof,
or a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)J.
Th, fa< "f' imposed on fh, ""f "',, of ""sf", fo '" fm ~e "50 of fh, '''''''''rs liose' ",",rod""es is 4.5%, ""'PI " ""'ed io 72 P.S. 19116(1.2) ~2 P.S. 191'6('X' I).
The fa> ,~, imposed 00 tho ",f ,,'''' of ",,""', fo '" to, ., "50 of tho deoed"r, 'i.'o" ;, 12% 172 P.S. 19116(')(1.3)J. A 'iblio, i, datloed, oode' S""oo 9102, " "
individual who has at least one parent in common with the decedent, whether by blood or adoption.
PA 17055
REV.1508 EX + (6-98)
'*
-
ITEM
NUMBER
1.
I
FILE NUMBER
JEANNE E. 21 5
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.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
HERTZLER
0267
FINANCIAL NETWORK
BROKERAGE ACCOUNT
DESCRIPTION
VALUE AT DATE
OF DEATH
30,214.50
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
30,214.50
REV-.1509 EX + (6-98)
-
.
SCHEDULE F
JOINTL Y-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
HERTZLER
JEANNE
E.
FILE NUMBER
21
5
0267
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A CONNIE J. SMITH
306 BRANDY LANE
MECHANICSBURG, PA 17055
DAUGHTER
B
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JOINTL Y.OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 8/16/99 MEMBERS 1 ST FEDERAL CREDIT UNION 1,610.54 50. 805.27
SAVINGS ACCOUNT
2. A. 8/16/99 MEMBERS 1 ST FEDERAL CREDIT UNION 1,265.18 50. 632.59
CHECKING ACCOUNT
3. A. 7/16/99 MEMBERS 1 ST FEDERAL CREDIT UNION 16,998.66 50. 8,499.33
MONEY MANAGEMENT ACCOUNT
4. A. 9/15/00 MEMBERS 1ST FEDERAL CREDIT UNION 6,049.65 50. 3,024.83
CERTIFICATE OF DEPOSIT
TOTAL (Also enter on line 6, Recapitulation) $ 12,962.02
(If more space is needed, insert additional sheets of the same size)
,
REV,1511 EX + (12-99)
'*
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COMMONWEALTH OF PENNSYL VANIA
INHERITANCE TAX RETURN
RES/DENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
HERTZLER
JEANNE
FILE NUMBER
E.
21
05
0267
ITEM
NUMBER
A
Debts of decedent must be reported on Schedule I.
1.
2.
3.
4.
FUNERAL EXPENSES:
MYERS FUNERAL HOME, INC. - MOSTLY PREPAID
GINGRICH MEMORIAL - INSCRIPTION
EWING BROTHERS - MONUMENT FOUNDATION
AMERICAN LEGION - FUNERAL LUNCHEON
DESCRIPTION
AMOUNT
722.00
100.00
100.00
440.00
B.
1.
ADM/NISTRA TIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) TERRY L. HERTZLER _
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address 2706 E. ROSEGARDEN BLVD.
RENOUNCED
City MECHANICSBURG
State PA
Zip 17055
Year(s) Commission Paid:
2.
3.
Attorney Fees MURREL R. WALTERS III, ESQUIRE
Family Exemption: (If decedenfs address is not the same as daimanfs, attach explanation)
Claimant
Street Address
1,650.00
City
Relationship of Claimant to Decedent
State
Zip
4.
Probate Fees REGISTER OF WILLS - CUMBERLAND COUNTY
5.
Accountant's Fees
188.00
6.
Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
3,200.00
--
REV-~512 EX + (6-98)
.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
HERTZLER
JEANNE
FILE NUMBER
E.
21
05
0267
ITEM
NUMBER
1.
Include unreimbursed medical expenses.
DESCRIPTION
VALUE AT DATE
OF DEATH
CLAREMONT NURSING HOME
RESIDENTIAL CARE
2,925.00
2.
VERIZON
TELEPHONE
68.78
3.
BETHANY TOWERS
25.00
4.
PATHOLOGY ASSOCIATES
MEDICAL
17.89
5.
HARRISBURG HOSPITAL
TELEPHONE
43.00
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
3,079.67
'~~"''''.(.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
HERTZLER
--
SCHEDULE J
BENEFICIARIES
RELA TIONSH/P TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
1. TAXABLE DISTRIBUTIONS pnclude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. TERRY L. HERTZLER SON 1/3
2706 E. ROSEGARDEN BLVD.
MECHANICSBURG, PA 17055
2. CONNIE .I. SMITH DAUGHTER 1/3
306 BRANDY LANE
MECHANICSBURG, PA 17055
3. JEFFREY L. HERTZLER SON 1/3
6014 MOCKINGBIRD DRIVE
MECHANICSBURG, PA 17050
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
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
JEANNE
E
I
FILE NUMBER
21 05
0267
(If more space is needed, insert additional sheets of the same size)