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Home My WebLink About08-18-06 -I 15056051047 REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year File Number Date of Birth Decedent's Last Name Suffix Decedent's First Name MI (If Applicable) Enter Surviving Spouse's Information Below Last Name Suffix MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW _ 1. Original Return C) 2. Supplemental Return C) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required C) 4. Limited Estate C) - C) 4a. Future Interest Compromise (date of death after 12-12-82) C) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) C) 10. Spousal Poverty Credit (date of death C) 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received o 8. Total Number of Safe Deposit Boxes C) C L Y D E R BOMGARDNER 7174362119 Firm Name (If Applicable) REGISTER OF WILLS U3~NLY City or Post Office State ZIP Code DAT~ FILED d' First line of address 1 0 SOU T H M A IN S T Second line of address P 0 BOX 1 6 6 MIFFLINTOWN P A 17059 J ~-., Correspondent's e-mail address: EXECUTRIX 06 DATE 08 06 PO BOX 1 MIFFLINTOWN, PA 17059 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051047 15056051047 -..J -I 15056052048 REV-1500 EX Decedent's Name: Decedent's Social Security Number L8...4 26 51 4 2 RECAPITULATION 1. Real estate (Schedule A). . . . . . . . . .. 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . ...... ... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3. 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. 6. Jointly Owned Property (Schedule F) C) Separate Billing Requested . . . . 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) C) Separate Billing Requested. . . 7. Total Gross Assets 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . . . . . 10. 11. Total Deductions (total Lines 9 & 10)..... ............................. 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. Net Value to Tax TAX COMPUTATION - SEE 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 16. Amount of Line 14 taxable at lineal rate X.O_ 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 . . (4 8 6.1 3) 19. TAX DUE. . . . . . . . . . . . . . . . . .. . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056052048 8. 15. 16. 17. 18. o o 0 o o 0 c::> 15056052048 -..J REV-1500 EX Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME FLORENCE H. WEBER STREET ADDRESS 1006 ROBERT STREET CITY MECHANI CS BURG STATE ZIP PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 0.00 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. InteresVPenalty if applicable D. Interest E. Penalty Total Credits ( A + B + C ) (2) TotallnteresVPenalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, 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 A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (5B) 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: Yes No a. retain the use or income of the property transferred;...................................................................................... D rKJ b. retain the right to designate who shall use the property transferred or its income; ........................................ D IKJ c. retain a reversionary interest; or........................................................................................................................ D [:KJ d. receive the promise for life of either payments, benefits or care? .................................................................... D [Xl 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. D rKJ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ............. D [KJ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ D rKJ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 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 three (3) percent [72 P.S. S9116 (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 zero (0) percent [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 zero (0) percent [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 four and one-half (4.5) percent, except as noted in 72 P.S. S9116(1.2) [72 P.S. s9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. s9116(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. -~~.,'" .. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF WEBER FLORENCE H FILE NUMBER 06 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 Specific cash bequest from the Anna M. Smith Estate under the provisions of the third paragraph of her Last Will and Testament in the amount of VALUE AT DATE OF DEATH 4,000.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 4,000.00 ~""".,," '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF WEBER FLORENCE H FILE NUMBER 06 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Food for funeral meal 100.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Mary Anne Hostetter, Executrix 0.00 Social Security Number(s) / EIN Number of Personal Representative(s) Street Address R. R. 1, Box 60-A City Thompsontown State P A Zip 17094 Yea~s) Commission Paid: 2. Attomey Fees Clyde R. Bomgardner 375.00 3. Family Exemption: (If decedenfs address is not the same as cfaimanfs, attach explanation) Claimant Not Applicable Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Cumberland County Register of Wills - Paid and Reserved 150.00 5. Accountanfs Fees 6. Tax Retum Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ 625.00 (If more space is needed, insert additional sheets of the same size) ~,~"."., '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF WEBER FLORENCE H FILE NUMBER 06 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. Medical: A. Home Care: (1) Linda Goldhart - (2) Beverly Haulman - (3) Nancy Morris - (4) Kathleen Kirsh - (5) Connie Mott - $807.35 799.75 537.50 129.00 +108.50 = $2,382.10 B. Griswold Special Care- C. American Home Patient - equipment rental 639.50 + 91.64 3,113.24 2. Richard Wanadav - Apartment rental 276.24 3. Apartment Utilities: A. Lester W. Erb, Jr. - fuel (heating oil) B. Verizon - telephone service C. PP & L - electric service 324.70 75.42 + 71.53 471.65 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 3,861.13 ~''''a."", . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER FI H 06 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S} RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE 1. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1. Henry B. Hostetter, Jr. Nephew Estate Residue Mary Anne Hostetter Nephew's wife (If Any) R. R. 1, Box 60-A Thompsontown, PA 17094 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, 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. Not Applicable B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. None 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) ---- - funst Ifill ttltU {[[.esmm.ent OF FLORENCE H. WEBER BE IT REMEMBERED, that I, FLORENCE H. WEBER, of 1006 Robert Street, Mechanicsburg, Cumberland County, Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making null and void any and all Wills and Testaments and writings in the nature thereof by me at any time heretofore made. ITEM 1: I direct that all my just debts and funeral expenses be paid as soon after my demise as may be convenient. ITEM 2: All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, whether it be real, personal or mixed, including property over which I have a power of appointment, I give, devise and bequeath unto HENRY B. HOSTETTER, JR. and MARY ANNE HOSTETTER, his wife, or the survivor of them. ITEM 3: I direct my hereinafter named Executor to pay all inheri- tance, estate, succession and legacy taxes of whatsoever nature and kind, to which my Estate or the transfer of any property passing hereunder or otherwise passing by reason of my demise, may be subject and to charge such taxes against my residuary estate, it being my intention that none of the aforesaid taxes, either federal or state, on any property required to be included in my gross estate, under the provisions ~f any state or federal law now in force or hereafter enacted, shall be prorated among the persons interested in my Estate to whom such property is or may be transferred or to whom any benefit accrues. ITEM 4: I appoint HENRY B. HOSTETTER, JR. and MARY ANNE HOSTETTER \.">---.., UA "-<;-,~~<>/'\;.~ (;~ ~l~ c:.'.-(=.. ./ " 'C-;' c2.. t.. L( SEAL) FLORENCE H. WEBER as Co-Executors of this my Last Will and Testament. ITEM 5: I direct that my Executor, guardian or their successors shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 5~ day of~(\ (>-1j1;YY\ L'-...i:.A ,1990. ITNESS: -, ..' \ 1 ~u.., '-~. G--' JL..-, ~~~' . .~,,,-;:: /' . ) " ';..0'. _ /' ~. i -4l/..",..;.. ...;{./ / .,. //'.'; ISEAL) ~:,>-:?,l:.-Y.> /i. '...;./"-- ,/ l : ...j/ >J.....1_~~~.-cL...1. FLORENCE H. WEBER 1 COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF YORK We, FLORENCE H. WEBER, JAN M. WILEY, ESQUIRE and PATRICIA A. OGG, the Testatrix and the witnesses respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testa- trix signed and executed the instrument as her Last Will and Testament and that she had willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed this Last Will and Testament as witness and that to the best of their knowledge the Testa- trix was at the time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. /. . ,./ . ,..;' '. / )<' ,/~/ \} / / ..- /> "', I .(.-.. ,"-"/ ./, /. .f/' ;: )//{ ('/) </' '{/it: ;, i j;" _/(~f(/-,c _ . -' .-1:- .~ 1 ~ ,.._ ~ ,/ _. . FLORENCE H. WEBER (.'.\.. ~~ me . WITNESS - i -\11 ci"" ~ -WITNES Sworn to and subscribed ~ vI before me this ~)~' day of-f\_~..\ k( 'vv-,- \ U '\ , 1990. ..::::; ~IJ..'V\ (~~0...d.+_.Q._Q. b :1 NOTARY PUBLIC 1 MY COMMISSION EXPIRES: Nota!ialSeaJ S Dawn G!OOielter, Notary Public , DiUsbiJ;g Bora, YolI< County My CommissiOn Expires May 17, 1993 Member, Pennsylvania Assodation of Notarles