HomeMy WebLinkAbout03-16-06
REV.1500 EX + (6.00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Hakes,Per ,L
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
OFFICIAL USE ONLY
FILE NUMBER
2 -05 0 9 4 4
COuNTYCcii5E ----vEA~ - - NUMBER- -
SOCIAL SECURITY NUMBER
99- 0 7 - 8 5 0 7
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 3. Remainder Return (date of death prior 10 12.13.82)
D 5. Federal Estate Tax Return Required
_ 8. Total Nurnber of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Allach Sch 0)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
David H. Stone, Es uire 414 Bridge Street
FIRM NAME (If Applicable)
Stone LaFaver & Shekletski
TELEPHONE NUMBER
717 774-7435 New Cumberland PA 17070-
~ OFFICIAL USE ONLY
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0.00 X (15) 0.00
0.00 x .045 (16) 0.00
0.00 X .12 (17) 0.00
0.00 X .15 (18) 0.00
(19) 0.00
9/6/2005 10/25/1926
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
[Xl 1. Original Return
D 4. Limited Estate
[Xl 6. Decedent Died Testate (AllachcopyofWill)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (date of death after 12.12.82)
D 7. Decedent Maintained a Living Trust (Attach copy of Trust)
D 10. Spousal Poverty Credit (date of death between 12.31.91 and 1.1.95)
15,469.55
(8)
15,469.55
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1. Real Estate (Schedule A)
(1)
(2)
(3)
(4)
(5)
13,214.46
23,760.54
(11)
(12)
(13)
36,975.00
-21,505.45
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)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
(6)
(7)
(14)
-21,505.45
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
(9)
(10)
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
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)
14. Net Value Subject to Tax (Line 12 minus Line 13)
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
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
d
I C
I t Add
Dece ents ompl e e ress:
STREET ADDRESS 120 S. Filbert Street
CITY I 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 )
0.00
Total Credits (A + B + C)
(2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
T otallnterest/Penalty ( D + 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. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
0.00
0.00
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 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
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
ADDRESS
DATE
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PA 17319
DATE
J..l1--o
ADDRESS
PA 17070
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. 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 of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(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. 99116(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-15G8 EX + (6-98)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Hakes. Perrv. L
FILE NUMBER
21 05
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.
0944
ITEM
NUMBER
1.
DESCRIPTION
$50 EE US Savings Bond dated May 51992
VALUE AT DATE
OF DEATH
52.88
2
Bankers Fidelity Life Ins.-short term care benefit
4,900.00
3
Miscellaneous deposit
166.22
4
Parthemore Funeral Home-Reimb. on services rend.
344.12
5
Sovereign Bank-Checking Accl. #0571130488
joint w/Nancy R. Hakes (predeceased), Prine. $10,006.10, Inl. $.23
10,006.33
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
15,469.55
REV-1511 EX +(12-99)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Hakes. Perrv. L
FILE NUMBER
21
05
0944
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
2
3
FUNERAL EXPENSES:
Rollling Green Cemetery-services rendered
Parthemore Funeral Home-funeral expenses
Parthemore Funeral Home-funeral expenses
995.00
1 52.30
8,925.16
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) Christine Jo Hakes
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address 595 Old Trail Ct.
1,250.00
B.
210-40-0419
City Etters
Year(s) Commission Paid: 2006
State PA
Zip 17319
2.
3.
Attorney Fees David H. Stone, Esquire
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
1,250.00
Street Address
City
State
Zip
Relationship of Claimant to Decedent
4.
Probate Fees
74.00
5.
Accountant's Fees
6.
Tax Return Preparer's Fees
7.
8.
9.
Register of Wills-filing Return and Inventory
Bankers Fidelity Ins-Reimb of benefit
Reserve for closing expenses
30.00
438.00
100.00
TOTAL (Also enter on line 9, Recapitulation) $
13,214.46
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (6-98)
'*
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Hakes. Perry. L
FILE NUMBER
21
05
0944
Include unreimbursed medical expenses.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
5,685.37
Pinnacle Health-services rendered
2.
Harrisburg Postmaster-services rendered
37.49
3.
Department of Public Welfare-statement of claim
18,037.68
TOTAL (Also enter on line 10, Recapitulation) $
23,760.54
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX + (8-nO\
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
Hakes Perrv L 21 05 0944
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Christine Jo Hakes Lineal 0.00
595 Old Trail Ct.
Etters, PA 17319
2. Michael P. Hakes Lineal 0.00
1403 Letchworth Road
Camp Hill, PA 17011
3. Kathy H. Mehring Lineal 0.00
623 Old Quaker Road, #6
Lewisberry, PA 17339
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 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)
LAST WILL AND TESTAMENT
OF
PERRY L. HAKES
I, PERRY L. HAKES, of Lower Allen Township, Cumberland County,
Pennsylvania, declare this to be my last will and revoke any will
previously made by me.
ITEM I: I direct that my Executrix hereinafter named shall pay
all my just debts and funeral expenses as soon as conveniently may be
done after my decease.
ITEM II: I devise and bequeath all the rest, residue and remain-
der of my estate, of every nature and wherever situate, in equal
shares to such of my children, MICHAEL PERRY HAKES, CHRISTINE JO
HAKES, and KATHY MEHRING, as survive me. Should any of my children
predecease me, I devise and bequeath the share of such child to his or
her issue, per stirpes; and should any such child of mine leave no
such issue living following my death, I devise and bequeath the share
of such child to my issue, per stirpes.
ITEM III: I appoint my Executrix and her successors guardian of
any property which passes" either under this will or otherwise, to a
minor and with respect to which I am authorized to appoint a guardian
Page 1 of 3
and have not otherwise specifically done so, provided that this ap-
pointment of a guardian shall not supersede the right of any fiduciary
in its discretion to distribute a share where possible to the minor or
to another for the minor's benefit. Such guardian shall have the
power to use principal as well as income from time to time for the
minor's support and education (including college education, both
graduate and undergraduate) without regard to his or her parent's
ability to provide for such support and education, or to make paYment
for these purposes, without further responsibility, to the minor or to
the minor's parent or to any person taking care of the minor.
ITEM IV: I appoint my daughter, CHRISTINE JO HAKES, Executrix of
this my last will.
ITEM V: No fiduciary acting hereunder shall be required to post
bond or enter security for the faithful performance of her duties in
any jurisdiction.
IN WITNESS WHE~~~_ I, PERRY L. HAKES, have hereunto set my hand
and seal this =7(0 day of , 1999.
.................................::> /~
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Page 2 of 3
SIGNED, SEALED, PUBLISHED and DECLARED by PERRY L. HAKES, the
Testator above named, as and for his Last Will and Testament, and in
the presence of us, who at his request, in his presence and in the
other, have subscribed our names as witnesses.
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ddress
Page 3 of 3
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Court Ordered Processing / MA I MB3 02-10
P.O. Box 841005
Boston, MA 02284
February 6, 2006
Stone LaFaver & Shekletski
Attorneys at Law
P.O. BoxE
New Cumberland, P A 17070
RE: Estate of: Perry L. Hakes
Date of Death: September 6, 2005
Dear Mr. Stone:
Per your request, enclosed please find the account information as of date of death for the
above-named decedent. Please note the balances do not include accrued interest.
If you should have any further questions, please do not hesitate to call.
Very truly yours,
Linda Spavento
OAG Team Leader
(617) 533-1789
(617) 533-1931-fax
Sovereign Bank
ESTATE OF
SOCIAL SECURITY #:
DATE OF DEATH:
Perry L Hakes
199-07 -8507
September 6, 2005
Account #: 0571130488 Type: Checking
In the name of: Perry L Hakes or Nancy R Hakes
Date of Death Balance: $10,006.10
Int.(YTD) from 1/1/2005 to 8/21/2005
Accrued interest to date of death: $0.23
Other Info:
Open date: 8/22/1997
$5.64
Page 1 of 1
*'
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
DIVISION OF THIRD PARTY LIABILITY
ESTATE RECOVERY PROGRAM
PO BOX 8486
HARRISBURG, PA 17105-8486
January 17, 2006
STONE LAFAVER & SHEKLETSKI
DAVID H STONE ESQUIRE
414 BRIDGE ST
PO BOX E
NEW CUMBERLAND PA 17070
Re: PERRY HAKES
CIS #: 810178013
SSN: 199-07-8507
Date of Death: 9/6/2005
Dear Attorney Stone:
Please be advised that the Department of Public Welfare maintains a
claim in the amount of $18,037.68 against the above-mentioned estate. This
claim is for restitution of medical assistance granted on behalf of the
decedent for which the Probate Estate is now responsible to reimburse the
Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as
amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's
itemized statement of claim.
A portion of this medical expense, namely $18,037.68, was incurred
during the last six months of the decedent's life; therefore, it is a Class 3
claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries
Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $.00, is to be
entered as a priority Class 6 claim against the estate. ----
Please acknowledge receipt of this letter and advise whether the
Commonwealth's claim is admitted and when payment may be expected. If the
estate accounting is complete, please provide a copy. If the estate contains
real estate, please provide copies of the deed, the latest tax assessment,
and a current appraisal, if available.
Sincerely,
Snober V. Ketty
Claims Investigation Agent
717-772-6608
717-705-8150 FAX
Enclosure
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
INVENTORY
Estate of Perry L Hakes
also known as
, Deceased
No.21
05
0944
Date of Death 9/6/2005
Social Security No. 199-07-8507
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the
personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation
placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no
real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We
verify that the statements made in this inventory are true and correct. I/We understand that false statements herein made are subject to the
penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Name of
Attorney:
David H. Stone, Esquire
I.D. No.: 39785
Address: 414 Bridge Street
New Cumberland
PA 17070-
Telephone: (717) 774-7435
pe~~e~
Christine Jo Hakes
595 Old Trail Ct., Etters, PA 17319
,J-/3-Dtp
Dated
Value
Description
$50 EE US Savings Bond dated May 5 1992
Bankers Fidelity Life Ins.-short term care benefit
Miscellaneous deposit
Parthemore Funeral Home-Reimb. on services rend.
Sovereign Bank-Checking Acct. #0571130488
joint w/Nancy R. Hakes (predeceased), Prine. $10,006.10, Int. $.23
(Attach Additional Sheets if necessary)
52.88
4,900.00
166.22
344.12
10,006.33
Total
15,469.55
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
include the value of each item, but such figures should not be extended into the total of the Inventory.
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