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Home My WebLink About08-24-06 REV .1500 EX + (6~) W ~ ~:$U) OO::~ WO.O :I:OO oD::-J nolD no <( . OFFICIAL USE ONLY REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 2005 COUNTY CODE YEAR SOCIAL SECURITY NUMBER 00487 NUMBER COMMONWEALTH OF PENNSYLVANIA OEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) HEFFLEFINGER, MARTHA A t- Z W C w fd c DATE OF DEATH (MM-DD- YEAR) DATE OF BIRTH (MM-DD- YEAR) 174-05-0628 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER 3. Remainder Return (date of death prior to 12-13-82) o 4. Limited Estate 0 4a. Future Interest Compromise (date of death 0 5. Federal Estate Tax Return Required after 12-12-82) o 6. Decedent Died Testate (Attach copy 0 7. Decedent Maintained a Living Trust (Attach 8. Total Number of Safe Deposit Boxes of Will) copy of Trust) o 9. Litigation Proceeds Received 0 10. Spousal Poverty Credit (date of death between 0 11.Election to tax under Sec. 9113(A) (Attach Sch 0) 12-31-91 and 1-1-95 jH~$~jl~.aijj~V$tj~i~~lffib~jiUli&iQ$#d~eiije~)~ijQ~~~Piij.?fiiJij~tjilf~6jiiJ)J~tftQtrttmmmmmfmmfmmm)mmmnn:r: AME COMPLETE MAILING ADDRESS Lisa M. Greason P.O. Box 385 Carlisle, PA 17013 (1 ) 101,648.97 (2) 106,066.44 (3) None (4) None (5) 102,702.06 (6) None (7) None OFFICIAL USE ONLY r--.) ,':':l < "') =0 :--; '1 (-) -. :-.:) OS/24/2005 04/26/1912 /-:-) t.:':"i"", (IF APPLICABLE) SURVIVING SPOUSES NAME (LAST, FIRST AND MIDDLE INITIAL) ~ ~~-~-':1 ) .- ;-l ~. ~} ': C~) i =~;J .' ,.. --} L~~~~~~~....~~~~L~~~~~~~'L::~::..~~~"~,,.........i~O.~~~...j .:._~) ~31 0 ,41 i.l1. 7 1. Original Return 2. Supplemental Return (8) (9) 55,524.54 '.... <nz Ww n::c O::z 00 o~ IRM NAME (If applicable) Greason Law Office 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11 . Total Deductions (total Lines 9 & 1 0) (11 ) 55,524.54 254,892.93 (12) (13) 13. Charitable and Governmental Bequests/Sec 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) Copyright 2000 form software only The Lackner Group, Inc. ELEPHONE NUMBER 717/241-3030 z o i= <( ..J ::J .... a:: ~ w a::: 1. Real Estate (Schedule A) 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) 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) 12. Net Value of Estate (Line 8 minus Line 11) (14) 254,892.93 SEe INSTRUCTIONS ON REVERSE sloe FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, x .00 (15) or transfers under Sec. 9116(a)(1.2) z 254,892.93 .045 (16) 0 16. Amount of Line 14 taxable at lineal rate x i= <( .... :;) no 17. Amount of Line 14 taxable at sibling rate x .12 (17) :E 0 0 >< 18. Amount of Line 14 taxable at collateral rate <( x .15 (18) .... 19. Tax Due (19) 11,470.18 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 11,470.18 20. ~ Form REV-1500 EX (Rev. 6-00) v Decedent's Complete Address: STREET ADDRESS 355 W NORTH STREET CITY I STATE PA I ZIP 17013 CARLISLE Tax Payments and Credits: 1 . Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 11,470.18 13,000.00 Total Credits (A + B + C) (2) 13,000.00 3. Interest/Penalty if applicable D. Interest E. Penalty 0.00 Total Interest/Penalty (D + 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. (SA) B. Enter the total of Line S + SA. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 1,529.82 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; .......... .................................................... ....................... D ~ b. retain the right to designate who shall use the property transferred or its income;......................................... 0 ~ c. retain a reversionary interest; or..................................................................................................................... D ~ d. receive the promise for life of either payments, benefits or care?.................................................................. 0 ~ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?............................................................................................................... .......... 0 ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?.............. 0 ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?............................................................ ............ ........................... .................... 0 ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. DATE 115 Airport Drive Carlisle, PA 17013 Y1' 1-3 )ifl& DATE ADDRESS SIGNATURE OF PR~ER OTHER THAN REPRESENTATIVE ~. // ,//{ n ta~ls~e~xP~~7013 ?!JS/JCClfi ! )i!~==:;:;:;:;:;:;:;:;:;:;:;:;:;:;:;:;:;:;:;:;:;:;:;:;:;:;:;:;:::;:;:;:::::::;:;:;:;:;:::;:;:;:;:;:;:;:;:;:;:;::;;:;:;:::::::;:::;:;:;:;:::;:;:;:;::.:':::;:;:;:;::;;:;:::::.,::;:;:::;:;:;:;:;:;:::;:::;:;:;:;:;:;:;:;:;:;:;:;:;:::;:;:;:;:::::;:;:::::~;::~:::;:;:;:;:;:::;:;:;:;:;:;:::;:::::::::;:::;:;:;:::;:::;:::;:::::::::::;:::;:;:;:;:::::;:;:::;:;:::;:;:::;:;:;:;:::;:;:;:;:;:;:;:;:::;:;:;:;:;:;:;:;:;:::;:::::::;:;:;:;:;:;:;:;:;:;:;:;:;:::::;:;:;:;:;:;:;:;:;~:::;:;:;:;:;:::;:::;:::;:;:;:;:;:;:;:;:;:;:;:;:;:;:;:;:;:;:;:;:;:;:;:;:;:;:::::;:;:;:;::::::: . For dates of death on or after July 1, 1994 an efore 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. ~9116 (a) (1.1) (i)]. ADDRESS DATE The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is . 1.2) [72 P .5. 99116 (a) (1 )]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for th~ Ileo ^~ n.._ -..-., . [72 P .S. ~9116 (a) (1.1) (ii)]. The statute does not exemDt a transfer to a surviving spouse from tax, and tl ,... \ of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. ~ ~G 0 MU C/ For dates of death on or after July 1, 2000: ~ r - The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or young~ '7 parent, an adoptive parent, or a stepparent of the child is 0% [72 P .S. ~9116 (a) (1.2)]. ;7 U () --- ~ AIIJ/ (tV 0" {/vv ~ ~ The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.; under Section 9102, as an individual who has at least one parent in common with the decedent, whether by *' SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF HEFFLEFINGER, MARTHA A FILE NUMBER 21 - 2005 - 00487 All real proper1Y owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be excflanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE NUMBER OF DEATH 355 W. North Street, Carlisle, Cumberland County PA 17013, Tax Parcel # 05-20-1798-185. 101.648.97 Value based on sale price. See attached settlement sheet. TOTAL (Also enter on Line 1, Recapitulation) 101,648.97 . SCHEDULE B STOCKS & BONDS COMMOMNEALTH OF PENNSYLVANIA INHERITANCE TAX RETIJRN RESIDENT DECEDENT ESTATE OF HEFFLEFINGER, MARTHA A FILE NUMBER 21 - 2005 - 00487 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 33.787.77 Waddell & Reed Acct # 8182552. WR Advisors New Concepts A (630) 9.13 1 Waddell & Reed Acct # 8182552. WR Advisors Small Cap A (677) 15.29 41,598.04 2 Waddell & Reed Acct # 8182552. WR Advisors Accumulative A (623) 6.28 30,680.63 TOTAL (Also enter on line 2, Recapitulation) 106,066.44 . SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF HEFFLEFINGER, MARTHA A FILE NUMBER 21 - 2005 - 00487 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 DESCRIPTION VALUE AT DATE NUMBER OF DEATH 1 M& T Bank, Aeet # 31003914380735, Certificate of Deposit. Maturity 02/27/2006 27.846.36 2 M& T Bank, Acct # 41984064, Checking Account 10,405.54 3 M& T Bank, Acct # 31003914380751 Certificate of Deposit. Maturity 11/17/2006 9.732.54 4 Wachovia, Acct # 1014135645383, Crown Classic Banking 1.068.54 5 Waehovia, Acet # 300324261904, Premium Savings Account 8.647.68 6 Wachovia, Acet # 247412050834877, Certificate of Deposit. Maturity 7/28/2005 35.000.00 7 Wachovia, Acct # 247412041 096529, Certificate of Deposit. Matu rity 7/28/2005 10.001.40 TOTAL (Also enter on Line 5, Recapitulation) 102,702.06 .~ ~ SCHEDULE H FUNERAL EXPENSES & ADIVIINISTRA TIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF HEFFLEFINGER, MARTHA A Debts of decedent must be reported on Schedule I. FILE NUMBER 21 - 2005 - 00487 ITEM DESCRIPTION AMOUNT NUMBER FUNERAL EXPENSES: A. 1 Ewing Brothers Funeral Home, Inc. 6,987.75 2 Bethany Guild for gathering 300.00 3 Jeffreys Flowers 15.90 4 Ashland Cemetary (opening up gravesite) and foundation for marker 1,286.00 5 Gingrich Mem 3,400.00 B. ADMINISTRAT 1. Personal Repres Martha A. Fr 13,000.00 Social Security N Street Address City Carlisle Year{s) Comm 2. Attorney's Fees 13,000.00 3. Family Exemptio Claimant 3,500.00 Street Add City CA Relationsh 4. Probate Fees 330.00 5. Accountant's Fe 6. Tax Return Prep 7. Other Administra 1 Advertiseme 226.55 ($151.55) orial - grave marker IVE COSTS: entative's Commissions itz umber(s) I EIN Number of Personal Representative(s): 115 Airport Drive State P A Zip 17013 ission paid Greason Law Office n: (If decedent's address is not the same as claimant's, attach explanation) Alan L. Hefflefinger ress 355 W. North Street RLISLE State PA Zip 17013 ip of Claimant to Decedent Child Register of Wills Office es arer's Fees tive Costs nt of Legal Notices, Cumberland Law Journal ($75) & The Sentinel Total of Continuation Schedule(s) 13,478.34 55,524.54 TOTAL (Also enter on line 9, Recapitulation) *' SchecUe H FmeraI ExpeIases & _Cos1scootinJed COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT I FILE NUMBER 21 - 2005 - 00487 ESTATE OF HEFFLEFINGER, MARTHA A 2 CRF Mechanical - Home Matintenance & Repairs 572.64 3 Anne Capozi, Chris Toone, Eric Starner, John Novak - House cleaning, yard maintenance, disposal 3,855.00 4 Metropolitan Life - Homeowner's Insurance 774.97 5 Various - Utilities - Gas, electric, phone 4,992.92 6 Capital Tax Collection Bureau - Property Tax (County $536.54) (School $1241.27) 1.777.81 7 Various - Final non-reimbursed medical expenses 1,505.00 Page 2 of Schedule H REV-1!13 EX+ (9-09) . SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF HEFFLEFINGER, MARTHA A I FILE NUMBER 21 - 2005 - 00487 RELATIONSHIP TO AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE Do Not List Trustee(s) I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 Kenneth Shughart, NW 290 Marin Lane, Florence, MT 59833 son 1/6th of residuary 2 Martha A. Fritz, 115 Airport Drive, Carlisle PA 17013 daughter 1/6th of residuary 3 Thomas Highlands, 14 Spring Loop Circle, Ocala, FL 34472 son 1/6th of residuary 4 Lisa M. Greason, 11 Sheraton Drive, Carlisle, PA 17013 granddaughter 1/6th of residuary 5 Abigail Downs, 8022 Seawood Court, Indianapolis, IN 46268 grandaughter 1/18th of residuary 6 Jennifer Schmidts, 3130 Lindsey Court, Bettendorf, IA 52722 granddaughter 1/18th of residuary 7 Katherine Crane, 5416 Albert Drive, Winter Park, FL 32792 granddaughter 1/18th of residuary See Continuation Schedule(s) attached Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, bn 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 I : I TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET *' SCHEDULE J BENEFICIARIES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF HEFFLEFINGER, MARTHA A I FILE NUMBER 21 - 2005 - 00487 RELATIONSHIP TO AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE Do Not List Trustee{s) I. rTAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] 8 Debra Fisher, 6525 Melbourne Way, Citrus Heights, CA 95621 granddaughter 1 /12th of residuary 9 Don Shughart, 402 Main Street, Oriskany, NY 13424 grandson 1/12th of residuary Page 2 of Schedule J A. SETTLEMENT STATEMENT U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT HUD-1 OMS No. 2502-0265 B. T e f Loan 1. DFHA 2. DFmHA 3. I8lConv. Unins. 4. OVA 5. OConv. Ins. 6. File Number: RE06-70 7. Loan Number: 132323841 8. Mortgage Insurance Case Number: C. NOTE: This fonn is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "(p.o.c.)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. D. Name and Address of Borrower(s): Adam B. Spiegel E. Name and Address of Seller(s): Estate of Martha A. Hefflefinger 46 W South Street 355 W North Street F. Name and Address of Lender: Tri-Star Lending Group 7600 N 16th Street, Suite 205 Phoenix, AZ 85020 Place of Settlement: Irvine Row, Carlisle, PA 17013 G. Property Location: 355 West North Street, Carlisle, Pennsylvania 17013 Carlisle Borough, Cumberland County 05.20-1798-185 H. Name of Settlement Agent: Orchard Settlement Services, LLC I. Settlement Date: 4-27-2006 112 700.00 12-31-2006 364.82 4-27-2006 to 6-30-2006 217_65 8252.50 205. 505. Payoff of second mortgage loan .~".:{70'dj"f'(jfcir:Sale~1Bt()ke(~:t~onitriii~ri~,~,?F:i:!~1J} based on price $ 112700.00 @ % = nivi~inn nf (line 700\ as follows' 701. $ 3304.57 to ERA-NRT Inc. 702. $ 3254.57 to Hooke Hooke & Eckman 703 oaid at C.......I............"'.... 704. Transaction Fee to ERA-NRT Inc. ;:8bO~,ilteh1s~Pli~~bi~iti-'co~ti6IiltWifRjJill'~ii~:. 801. Loan Oriaination Fee % to 802 I n:ln ni~~nllnt % to 803. Aooraisal Fee Larry E. Foote 804. Credit Report 805. Fpp 806. Administration Fee 807. Flood Certification 808, Tax Service Fee 809 Discount to Broker to ~uuv ;-ill<1111~idl Mortaaoe 810. Wire Fee Pinnacle Financial Corp dba Tri-Star Lendino Group 811. Broker Premium to YSP oaid bv Lender to Broker POC $1126.88 812. 813. 814. />Qnn" ,; 901. Interest from 4-27 -2006 to 5- 1-2006 902. Mortaaae insurance premium for 903. Hazard insurance premium for 904 905. :;:'OO(i'Resedies :be6o$ited,With~E'~rid~t:.:;J~f,f~~~la;;;}:Jy~j8;:~;:f;:;;~i~7[~' 1001 H~zard inSUr::lnCA 3 months rfi) $ 4158 oer month 1002. Mortaaae insurance months @ $ cer month 1003. City property taxes months @ $ Der month 1004. County property taxes 3 months (fi) $ 44.75 oer month 100~ mnnth~ tF1J S n~r m~nth 1006. School property taxes 8 months @ $ 103.44 oer month 1007. months ~ $ per month 1 nnR Annre>n:::iltp ~,._.,_. : "1-iOb~:;n:tIE;';Chilr(Je~}':!>' ..' ,. 1101, Settlement or closina fee to 1102. Abstract or title search to 11 03 Title tn 1104. Title insurance binder to 1105. Document preparation to 11nR Nnt:uv fpp~ tn Ca~h 1107. Attorney's fees to Lisa Greason, Esquire (includes above item numbers: ) 1108. Title insurance to Orchard Settlement Services, LLC, Agent for United General Title (in~hlti~~ ~bnVA . . 1101-1104 ) 1109. Lender's coverage $ 90150.00 1110. Owner's coveraae $ 112700.00 1111 - 1 00 300 R 1 tn I -itle 1112. Closina Protection Letter to United General Title 1113.0verniahtJ\IV~~e/~mail ~ee.,t? 9,~c~ar~~.?~ttle~~.ntS~ryi~s ~LC ... ,,' ~~_' '_.",'""..... ".. .."......";..:;'...,..,,,\ .'1~~rt:;!) . ';~ .','.'.,'."~" '..,';:;!';;";''''''if::id~'iR'.;",,::,::,:;,.;;'t:~~Jf(i<:;~~;:1';~~;t~""~~~~~~'1:~1Eg!,tMr.i~l&lf;~[~~_l~~ 1201. Recordina fees: Deed 38.50 MortQaQe 64.50 Release 0.00 1202. City/county tax/stamos: 1203. State tax/stamos: 1204. 1205. ::~;1300.Additioh:ai'Siffi~AA'~ht~h~tdj~}::, ;;;,:8tr~ 1301 -. .- lU 1302. Home Warranty 1303. 1304. 1305. 1400. Total Settlement Charges (enter on lines 103. Section J and 502 Section K\ Paid From Borrowers Funds at Settlement Paid From Seller's Funds at Settlement R ~~~u 4 125.00 .:::: 300.00 Pinnacle Financial Corp dba Tri-Star Lendino Group FDSI ~7!=i nn 795.00 16.50 90150 35.00 ~ $ 18.8327 Idav months to vear(sJ to 75.33 124.74 134.25 827.52 -3501 15.00 POC 923.75 Premium $ Premium $ 923.75 1~ 35.00 60.00 103.00 1 127.00 1 127.00 . ";.,, C~rli!';l~ Bnrolloh AON Home Warranty A~ct 01825A 32.36 409.00 5,963.58 8,252.50 CERTIFICATION : I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my account or by me in this t~~ion. I further certify that I received a copy of the HUD-1 Settlement Statement. /' , Aft" ~ - ~~~-1 ..), /1,/1 ~A d-~? :~,.- y~ 7' J' ) //\ Adam B. g~ . _;,-/ I..e.- \.Estate of Martha A. Heff(efi~e}, Signature of Borrower [1- Signature of Seller "-~ T~l:UD- une Date WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon conviction can include a fine and imprisionment. For details see: Title 18 U.S. Code Section 1001 and Section 1010.