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Home My WebLink About07-13-06 (2) REV.1bOO EX (6.00) REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT *' COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 OFFICIAL USE ONLY FILE NUMBER 21 -0 6 0 3 6 7 COuNTY""COOE ----vEA~ - - 'N'UMBER-- DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER .... Z W C W () W C Hollenbau h, Anna K. DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM.DD-Year) 04/18/:Z006 08/22/1916 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) 97- 1 0 - 8 843 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER W I- ::.:: ::;!;en () a:::.:: wQ.() J:oo () a:...J Q.m Q. ct [Xl 1. Original Return D 4. Limited Estate D 6. D'3cedent Died Testate (Mach copy 01 Will) D 9. Liligation Proceeds Received D 2. Supplemental Return D 4a. Future Interest Compromise (date of death aher 12.12.82) D 7. Decedent Maintained a Living Trust (MachcopyofTrust) D 10. Spousal Poverty Credit (date 01 death between 12.31.91 and 1.1.95) D 3. Remainder Return (date of death prior to 12-13-82) D 5. Federal Estate Tax Return Required _ 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (Allach Soh 0) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMA.TlON SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS William A. Addams 27 W. High St. FIRM NAME (If Applicable) I- Z W Cl Z o Q. en w a: a: o () TELEPHONE NUMBER 717 -24:3-7638 Carlisle OFFICIAL USE ONLY 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) (2) (3) (4) (5) PA 17013 z o j:: < ...J ::>> !:: a. < () w a: 3. CloSllly Held Corporation, Partnership or Sole-Proprietorship 4. Mort!)ages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schlldule E) 6. Jointly Owned Property (Schedule F) D Separate Billing Requested 7. Inter.Vivos Transfers & Miscellaneous Non-Probate Property (Sch3dule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 12,676.96 30,636.02 (6) , ~) (7) 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 Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) (8) 30,636.02 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o j:: < .... ::>> a. :E o () >< < .... 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 19. Tax Due X _(15) 17,959.06 X .045 (16) X .12 (17) X .15 (18) (19) 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 20. [J CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT (11) (12) (13) 12,676.96 17,959.06 (14) 17,959.06 808.16 808.16 > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH. < < Decedent's Complete Address: SfREET ADDRESS 29 Parsonage 81. CITY STATE ZIP PA 17241 =d Newville Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 808.16 40.00 Total Credits (A + 8 + C) (2) 40.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/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. (58) Make Check to: REGISTER OF WILLS, AGENT 0.00 768.16 768.16 PLE:ASE 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 [Xl b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 [Xl c. retain a reversionary interest; or ...................................................................................................... 0 [Xl d. receive the promise for life of either payments, benefits or care? ............................................................. 0 [Xl 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?............................................................................................... 0 [Xl 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. 0 [Xl 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... 0 [Xl F THE ANSWEB TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FilE IT AS PART OF THE RETURN. Jnder penalties of pe~ury. I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. leclaration of pre parer other than the personal representative is based on all information of which preparer has any knowledge. ,IGNA,TURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE \DDRESS """". ) l _ lIGNATURE OF ~~A~~ROTt4ER T~ .5a?~y.s~NT~TIVE ./"l;~" <~ ~'~l'!!i/~...'''/ .' "rc.....? _ ,~ t... _'4;. .c-. .;'~~ ,DDRESS 27 W. High St., Carlisle, PA 17013 William A. Addams, Esquire DATE 7/13/06 :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 P.S. 99116 (a) (1.1) (i)]. or 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)]. he 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 1e surviving spouse is the only beneficiary. or dates of death on or after July 1, 2000: he 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, r a stepparent of the child is 0"10 [72 P.S. 99116(a)(1.2)]. he 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. s9116(a)(1)]. 1e 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 dividual 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 Hollenbaugh, Anna K. FILE NUMBER 21 06 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. 0367 ITEM NUMBER 1. DESCRIPTION Checking Account No. 33-05236, F and M Trust Company, Newville, Pa. 2. CD# 15-2954602, F and M Trust Company 3. CD# 2954695, F and M Trust Company 4. Sprint rebate 5. Highmark,Blue Cross/Blue Shield, health insurance refund 6. F and M Bank, interest on checking account 7. VALUE AT DATE OF DEATH 19,343.45 5,047.20 6,035.44 12.72 191 .59 5.62 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 30,636.02 REV-1511 EX+ (1;'-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER ESTATE OF Hollenbaugh. Anna K. ITEM NUMBER A. 1. 2. 3. B. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 21 06 Debts of decedent must be reported on Schedule I. DESCRIPTION FUNERAL EXPENSES: Egger Funeral Home Wayne Noss, flowers Westminister Cemetery, burial plot ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: Attorney Fees William A. Addams Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Shirley A. Heberliq Street Address 29 ParsonaqeSt. City Newville State P A Relationship of Claimant to Decedent dauqhter Zip 17241 Probate Fees Accountant's Fees Tax Return Preparer's Fees Cumberland Law Journal, advertising Valley Times, advertising Evening Sentinel Register of Wills, filing inventory, appraisement and Petition to settle TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0367 AMOUNT 5,967.00 148.40 1,150.00 1,560.00 3,500.00 144.00 75.00 87.56 45.00 12,676.96 REV-1~13 EX + (8-nm SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hollenbauah Anna K NUMBER I. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY T ,II,XABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Shirley A. Heberlig 2B Parsonage 8t. Newville, PA 17241 James C. Hollenbaugh 30 Lebo Rd. Carlisle, PA 17013 2. FILE NUMBER 21 06 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) daughter son 0367 AMOUNT OR SHARE OF ESTATE 1/2 1/2 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: ,II" 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)