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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
FILE NUMBER
INHERITANCE TAX RETURN
RESIDENT DECEDENT
21
05
1079
Year
Number
County Code
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Z
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
HOCKER Jean G.
SOCIAL SECURITY NUMBER
195-07-7778
THIS RETURN MUST BE FILED IN DUPLICATE WITH
DATE OF BIRTH (MM-DD-YEAR)
December 5, 1915
DATE OF DEATH (MM-DD-YEAR)
December 5, 2005
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
N/A
x 1. Original Return
I--
4. Limited Estate
~
x 6. Decedent Died Testate (Attach copy of Will)
I--
9. Litigation Proceeds Received
L.....-
2. Supplemental Return
3. Remainder Return (date of death prior to 12-
I--
5. Federal Estate Tax Return Required
L...-
1 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A)
-
4a. Future Interest Comprise (date of death after 12-12-82)
-
7. Decedent Maintained a Living Trust (Attach a copy of Trust)
-
10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
-
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THIS SECTION MUST BE COMPLETED.
NAME
Jean D. Seibert, Esquire
FIRM NAME (If Applicable)
Wion, Zulli & Seibert
TELEPHONE NUMBER
717-236-9301
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
COMPLETE MAILING ADDRESS
109 Locust Street
Harrisburg, PA 17101
1. Real Estate (Schedule A)
(1 )
(2)
(3)
(4)
(5)
(6)
$0.00
OFFICIAL USE ONLY
$79,128.72 -,
f'-. ,
, - _:~.:..~
)
.-
,0 -.
2. Stocks and Bonds (Schedule B)
( )
$0.00
3. Closely Held Corporation, Partnership or Sole-Proprietorship
~ 4. Mortgages & Notes Receivable (Schedule D)
I-- 5. Cash, Bank Deposits & Misc. Personal Property (Schedule E)
<t:
---l 6. Jointly Owned Property (Schedule F)
~ D Separate Billing Requested
~ 7. Inter-Vivos Transfers & Misc. Non-Probate Property
() (Schedule G or L)
W
0:: 8. Total Gross Assets (total Lines 1-7)
$0.00
ie, )
$18,011.23
t,-;'J
(7)
- 1. --)
$0.00 , . . ':':-:1
1 -. - ri
! - j:~ '11
$33,710.33 L.:::....... ........... !::=........ .'... ~~. ~-:j~i.......
$130,850.28
(8)
$7,159.54
$2,536.28
(11 )
(12)
(13)
(14)
$121,154.46
9. Funeral Expenses & Administrative Costs (Schedule H)
(9)
(10)
10. Debts of Decedent, Mortgage Liabilities & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
$9 695 82
12. Net Value of Estate (Line 8 minus Line 11)
$121,154.46
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
$000
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
Z rate, or transfers under Sec. 9116 (a)(1.2) $68,041.29 x .045 (15)
0 -
j: 16. Amount of line 14 taxable at lineal rate x (16)
x< -
<~ 17. Amount of line 14 taxable at sibling rate $53,113.17 x .12 (17)
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~ 18. Amount of line 14 taxable at collateral rate x .15 (18)
0
() 19. Tax Due
(19)
20. ~
$3,061.86
$0.00
$6,373.58
$000
$9,435.44
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
Decedent's Complete Address:
STREET ADDRESS Bethany Village, 325 Wesley Drive
I .
CITY I ~T ATE IZIP
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 )
$9,435.44
~Q 1~~ n~
~.471 77
Total Credits (A + B + C) (2)
$9 605 42
3. Interest/Penalty if applicable
D. Interest
E. Penalty
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)
$0.00
$169.98
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5A)
(5B)
A. Enter the interest on the tax due.
$0.00
Make Check Payable to: REGISTER OF WILLS, AGENT
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;
b. retain the right to designate who shall use the property transferred or its income;
c. retain a revisionary interest; or
d. receive the promise for life of either payments, benefits or care?
If death occurred after December 12, 1982, did decedent transfer property within on year of death
without receiving adequate consideration?
Did decedent own an "in trust for" or payable upon death bank account or security at his or her
Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
Yes
No
2.
~
E9
;
a
3.
4.
contains a beneficiary designation? [2] c=J
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 j)reparer other than the personal representative is based on all the information of which preparer has any knowledge.
SIGNA TU
'A
LE FOR FILING RETURN
'2A)
TE
.h ( 2 DOb
5730 Covington Circle, Minnetonka, MN 55345
SIG T E OF RE THER THAN REPRESENTATIVE
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 il
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 s
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 adop
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 decedenfs 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 decedenfs 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-1503EX = (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Jean G. Hocker
FILE NUMBER
21-05-1079
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
$19,957.32
918 shares of UGI stock @ $21.74 per share
2.
1,794.7360 shares of Dreyfus Premier Income Fund D @ $10.91 per share
$19,580.57
3.
3,921.0160 shares of Franklin US Govt Securities Fund Class A @ $6.43 per share
$25,212.13
4.
1,381.2390 shares of Columbia Federal Securities Fund A @ $10.41 per share
$14,378.70
TOTAL (Also enter on line 2, Recapitulation)
(If more. space is needed, insert additional sheets of the same size)
$79,128.72
REV-1508 EX + (1-97)(1)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Jean G. Hocker
FILE NUMBER
21-05-1079
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.
ITEM
NUMBER
1.
DESCRIPTION
Certificate of Deposit No. 210010115513 at PNC Bank
Interest accrued to date of death
VALUE AT DATE
OF DEATH
$2,657.00
$1.86
2.
Certificate of Deposit no. 21001015734 at PNC Bank
Interest accrued to date of death
$14,513.85
$11.52
3.
Personal property, clothing, housewares, etc.
$200.00
4.
Refund from Bethany Village
$575.00
5.
Refund from Renters Insurance
$52.00
TOTAL (Also enter on line 5, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$18,011.23
REV-1510 EX + (1-97)(1)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
Jean G. Hocker
FILE NUMBER
21-05-1079
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 % OF DECD'S TAXABLE
ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. DATE OF DEATH INTEREST EXCLUSION VALUE
NUMBER ATTACH A COpy OF THE DEED FOR REAL ESTATE. VALUE OF ASSET (IF APPLICABLE)
1. Met Life Investor Single Premium Deferred Annuity $23,965.13 100.0% $23,965.13
Beneficiary: Sister, Joan Herman
2. Checking Account No. 5080032247 at PNC Bank established $12,745.20 50.0% 3,000.00 $9,745.20
11-29-05, joint with son, George B. Hocker
TOTAL (Also enter on line 7, Recapitulation) $33,710.33
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (1-97)(1)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Jean G. Hocker
FILE NUMBER
21-05-1079
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Myers-Harner Funeral Home $222.00
2. Luncheon $50.00
B. ADMINISTRATIVE COSTS:
1. 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:
2. Attorney Fees - Wion, Zulli & Seibert $4,750.00
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 and oath $284.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Advertising - Cumberland Law Journal $75.00
The Sentinel $181.86
8. G. Benjamin Hocker - reimbursement for travel, hotel, rental car, etc. $1,305.38
9. G. Benjamin Hocker - shipping packages to heirs $33.60
10. G. Benjamin Hocker - postage for documents $53.90
11. G. Benjamin Hocker - office supplies $16.28
12. G. Benjamin Hocker - telephone calls $112.52
13. Reserve for Wion, Zulli & Seibert - mailings, postage, long distance telephone calls, copies $75.00
TOTAL (Also enter on line 9, Recapitulation) $7,159.54
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (1-97)(1)
COMMONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
Jean G. Hocker
FILE NUMBER
21-05-1079
Include unreimbursed medical expenses.
ITEM
NUMBER
1. Bethany Village Nursing Care
DESCRIPTION
AMOUNT
$1,380.00
2.
Holy Spirit Hospital
$50.25
3.
Verizon
$26.68
4.
Alert Pharmacy
$246.97
5.
Sally Aigner, assisted with care, arrangements and travel
$800.48
6.
Software for preparation of final PA income tax return
$31.90
TOTAL (Also enter on line 10, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$2,536.28
REV-1513 EX + (9-00))
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
BENEFICIARIES
21-05-1079
ESTATE OF
Jean G. Hocker
FILE NUMBER
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. Ben Hocker Son 1/3 of estate
5730 Covington Circle
Minnetonka, MN 55345
2. Sally J. Aigner Daughter 1/3 of estate
2735 North Patton Avenue
Arlington Heights, IL 60004
3. Clara Joan Herman Sister 1/3 of estate
26 Almond Drive
Hershey, PA 17033
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 $0.00
(If more space is needed, insert additional sheets of the same size)
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