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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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I DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
. Hershey, John 0
rDATE OF [lEA TH (MM-D[l--YEAR) --. DATE OF BIRTH (M-M:OO:YEAR)
! 02/20/2006 02/20/1916
(IF API'lICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
_-+--.. Hers~~y,~ona
! ~ 1. Original Return
I 0 4. Lirnited Estate
: 181
o
2. Supplemental Return
OFFiCiAL USE: ONL.Y
FILE NUMBER
21
CpUNTY CODE
06 0429
YEARNLJM~ER.
SOCIAL SECURITY NUMBER
191-26-6752
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
6. Decedent Died Testate (Attach copy
o/Will)
Litigation Proceeds Received
4a. Future Interest Compromise (date of death after
12-12-82)
7. Decedent Maintained a Living Trust (Attach
copy of TruSI)
10. Spousal Poverty Credit (date 01 death between
o 3. Remainder Return (date 01 death prior 10 12-13-82)
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
AME
cil ~ I Thomas J, Ahrens
l:i g: ~IRMr;IAME(lf appli~~bie)- --
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8 ~ Ahrens Law Firm, P.C.
~ELEPHONE NUMBER
, 717/697-1800
--r--
! 1. Real Estate (Schedule A)
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2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
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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, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
5521 Carlisle Pike
Mechanicsburg, PA 17050
(1 ) None
(2) None
(3) None
(4) None
(5) None
(6) None
(7) 296,262.21
(8)
(9) 14,962.70
(10) 3,019.00
OFF~CiJ\l., U~;E:."CNLY
296,262.21
(11 )
17,981.70
278,280.51
255,831.01
22,449.50
(12)
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)
(13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14)
1,010.23
20. 181
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
1,010.23
Copyright 2000 form software only The Lackner Group, Inc.
15.Amount of Line 14 taxable at the spousal tax rate, x .00 (15)
or transfers under Sec. 9116(a)(1.2)
z 22,449.50 .045 (16)
0 16.Amount of Line 14 taxable at lineal rate x
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0.. 17. Amount of Line 14 taxable at sibling rate x .12 (17)
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~ I 18. Amount of Line 14 taxable at collateral rate x .15 (18)
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19. Tax Due (19)
Form REV-1500 EX (Rev. 6-00)
~ecedent's Complete Address:
STREET ADDRESS
775 Oak Oval
CITY
i STATE PA
ZIP 17055
Mechanicsburg
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1) 1,010.23
1,000.00
50.51
Total Credits (A + B + C)
(2)
1,050.51
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. (4)
Check box on Page 1 Line 20 to request a refund
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)
0.00
40.28
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 reversionary interest; or. ........... ..................... .................................. .......... ........... ........ ........... .......
d. receive the promise for life of either payments, benefits or care?..............................................................
:2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?.......... ............ ............................. ....................,.....................,
:3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?.................................................... ........................................ ...............
Yes No
~ I
D ~
D ~
~ D
IF THE AIIISWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penaltie,; 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. Declaration of
prepa",,-,,the-'-tt1.anthe p_ersol1a~representative is ba.sedon~nformation of WhiCh pre.!"'r"rtla.s any knowled~e
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS
.J(at.llln.n:F.. .' ZiegIe.7.. -J. ......... ,l.., \ 583 S. Oneida Way
~LL\ttllQi..'Yll . GA-l4.t.J/U Denver, CO 80224
sRl'-NATURE,ClF pERsON RESPONSI~JFOR FILlNGRETURN-- ADDRESS
DATE
'") ! .'] () Cc
DATE
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
Thomas J. Ahrens
ADDRESS
DATE
A d. 5521 Carlisle Pike /
rj l ( Mechanicsburg, PA 17050 7 - /8, tJ (0
.-+ n. _.--- =: I'F ,; ":' iT ~1)llilWlilll1iWi''TI ;,~t" .~-- ll>Il1W~ .
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. 9~1116 (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.
""
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHEI':ITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Hershey, John a
ITEM
NUMBER
FILE NUMBER
21-06-0429
DESCRIPTION OF PROPERTY
Include the name of the transferee, their relationship to decedent
and the date of transfer. Attach a copy of the deed for real estate
DATE OF DEATH
VALUE OF ASSET
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
--.- - -..--
EXCLUSION
(IF APPLICABLE)
%OF
DECD'S
INTEREST
John a. Hershey Living Trust, dated 2/4/2002, see
attached printout for list of assets and DaD values
273,812.71 100%
2
Annuity Contract # A008200692S with SunAmerica
Life Insurance Co.
22,449.50 100%
TOTAL (Also enter on line 7, Recapitulation)
TAXABLE VALUE
273,812.71
22,449.50
296,262.21
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Hershey, John 0
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
21 - 06 - 0429
Debt~. of decedent must be reported on Schedule I.
ITEM
NUMBER FUNERAL EXPENSES:
--------
Hoover Funeral Home
A.
1
2
Minister
B.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
1.
DESCRIPTION
AMOUNT
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City
2.
Year(s) Commission paid
Attorney's Fees Ahrens Law Firm, P.C.
State
Zip
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
4. Probate Fees
State
Zip
5. Accountant's Fees
6.
Tax Return Preparer's Fees 2005 tax returns
2006 estimated tax return
7. Other Administrative Costs
1
Long distance phone calls, postage, etc.
Total of Continuation Schedule(s)
TOTAL (Also enter on line 9, Recapitulation)
2,342.20
200.00
10,000.00
892.50
300.00
250.00
978.00
14,962.70
Schedule H
FLI1eI'aI Expenses &
Administrative Costs continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Hershey, John 0
FILE NUMBER
21 - 06 - 0429
2
Trustee travel expenses
978.00
Page 2 of Schedule H
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Hershey, John 0
Include unrl~imbursed medical expenses.
ITEM
NUMBER
1
2
3
DESCRIPTION
Fields Family Dentistry - final bill
2005 Pennsylvania income tax due
2005 Federal Income tax due
FILE NUMBER
21 - 06 - 0429
TOTAL (Also enter on Line 10, Recapitulation)
AMOUNT
2,400.00
109.00
510.00
3,019.00
REV-1513 EX+ (g-OO)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Hershey, John 0
FILE NUMBER
21 - 06 - 0429
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
RELATIONSHIP TO
DECEDENT
Do Not List Trustee(s)
AMOUNT OR SHARE
OF ESTATE
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1
John O. Hershey Beneficiary Trust, FBO Kathleen C. Ziegler,
daughter of decedent.
583 S. Oneida Way, Denver, CO
i
!Trust
255,831.01
2
Irrevocable Agreement of Trust, executed on May 6, 1992, FBO Joan Trust
Hershey, daughter of decedent. 583 S. Oneida Way, Denver, CO
16,837.13
3
Kathleen C. Ziegler
583 S. Oneida Way, Denver, CO
Daughter
5,612.37
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriale, 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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
Messiah College
85,277.01
Taylor University
85,277.00
Messiah Village
85,277.00
TOTAL OF PART" - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
255,831.01
*'
REV-1647 EX+ (9-00)
SCHEDULEM
FUTURE INTEREST COMPROMISE
(Check Box4a on Rev-1500 CoverShee1)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
______ RESIDENT DE;CEDEi'JT
ESTATE OF
FILE NUMBER
21 - 06 - 0429
Hershey, John 0
This schedule is appropriate only for Estates of decedents dying after December 12,1982.
This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession and 02
enjoyment cannot be established with certainty.
Indicate below the type of instrument which created the future interest and attach a copy to the tax return
o Will 181 Trust 0 Other
I. Benl!ficiaries
AGE TO
NEARESTBRTHOAY
61
58
NAME OF BENEFICIARY RELATIONSHIP
i - ---- ------
11. __________!~!~I~:~_c:::___Zi~~ler Daughter
2. Joan H. Pruett Daughter
I 3. ------ -KifessiahCollege Charity
I_~.--- ~~ylo~~nive-rslty _______ _ ..~ Charity
~ Messiah Village I Charity
For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within 9
months of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse
exercises such withdrawal rillb,t.
________bJ Unl!~Jte~tright o~withdrawaL q bi~itE!d right of withdrawal
Explanation of Compromise Offer:
DATE OF BIRTH
07/23/1945
06/03/1948
Cl
II.
III.
IV. Summary of Compromise Offer:
1. Amount of Future Interest:
2. Value of Line 1 exempt from tax as amount passing to charities, etc.
(also include as part of total shown on Line 13 of Cover Sheet)
3. Value of Line 1 passing to spouse at appropriate tax rate
Check One 0 6% 0 3% 0 0%
(also include as part of total shown on Line 15 of Cover Sheet)
4. Value of Line 1 taxable at lineal rate
06% 04.5%
(also include as part of total shown on Line 16 of Cover Sheet)
5. Value of Line 1 taxable at sibling rate (12%)
(also include as part of total shown on Line 17 of Cover Sheet)
6. Value of Line 1 taxable at collateral rate (15%)
(also include as part of total shown on Line 18 of Cover Sheet)
7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1)
255,831.01
255,831.01
255,831.01
Schedule M
Estate of John O. Hershey
Explanation of Compromise Offer
Decedent bequeathed the residue of his estate to his trustee, in trust, and
directed the payment of the net income and principal for the benefit of Kathleen C.
Ziegler (age 61 at decedent's death), his daughter, for her health, education and
maintenance, as the trustee deems advisable. Any net income not distributed shall
be added to the principal. The trustee is instructed in Article Nine, Section 2.3 of
the trust to be mindful of any additional sources of income and principal available
to her. Upon the death of Kathleen C. Ziegler, ifher sister, Joan H. Pruett (age 58
at decedent's death) is still living, the trust is to be made available to, but not
merged with, the Irrevocable Agreement of Trust established on May 6, 1992 for
the special needs of Joan H. Pruett. Upon the death of Joan H. Pruett, the balance
of the trust property will be distributed equally to Messiah College, Taylor
University and Messiah Village. If, upon the death of Kathleen C. Ziegler, Joan H.
Pruett is deceased, the balance of the trust property will be distributed equally to
Messiah College, Taylor University and Messiah Village. The life estates are
taxable at 4.5%; the remainder, if any, is taxable at 0%.
The trustee believes that it is unlikely that the principal of this trust will be
invaded for Kathleen C. Ziegler's health, education or maintenance or the special
needs of Joan H. Pruett. The life tenant, Kathleen C. Ziegler is currently in good
health, married with no children, working, and has another trust available for her
health, education and maintenance with a balance of over $850,000. The other life
tenant, Joan H. Pruett, has no children and is currently on Social Security
Disability. Her residence is owned by her and is free of any liens. The Irrevocable
Agreement of Trust currently provides Joan with approximately $15,000 per year
to supplement her Social Security Disability income of $12,000 per year. The
current balance of the Irrevocable Agreement of Trust is over $745,000. The
Irrevocable Agreement of Trust also receives annually 6% of a Charitable
Remainder Trust with a current balance of over $135,000. The trustee believes that
it is unlikely that the Irrevocable Agreement of Trust will be depleted in providing
for the special needs of Joan H. Pruett, and therefore the trust will not be invaded
for her needs.
For the above reasons, the trustee believes it is unlikely that either life
tenant will invade any of the principal of the trust. Therefore she proposes that the
entire trust ($255,831.01) be taxed at the charity rate of 0%