HomeMy WebLinkAbout09-12-06
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
Anna K. Hollenbaugh
Date of Death:
April 18, 2006
Will No.
21-06-0367
Admin. No.
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes x No Family Agreement filed.
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes No x . Family Agreement filed
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk Qi the Orphans' Court and may be attached to this report.
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LDate:.:,-Sept. 31_. 2006 ~,y~~
l L::" . Signat,ure
(",J William A. Addams
Name (Please type or print)
27 W. High St., Carlisle, FA 17013
Address
,
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(717 ) 243-7638
Tel. No.
Capacity:
Personal Representative
x
Counsel for personal
representative
(MAH:rmf/AM3)
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F AMIL Y SETTLEMENT AND FINAL RELEASE
In Re: Estate of ANNA K. HOLLENBAUGH. Deceased
No. 2106 0367
KNOW ALL MEN BY THESE PRESENTS, that
WHEREAS, ANNA K. HOLLENBAUGH, Late of the Borough of Newville,
Cumberland County, Pennsylvania, died testate on April 18, 2006, having first
made her last will and testament, which was duly executed on November 22,
1976, and is duly recorded in Cumberland County, PA, to No. 21-06-0367.
WHEREAS, the said Anna K. Hollenbaugh, by the aforesaid last will and
testament, named James c. Hollenbaugh and Shirley A. Heberlig as Executors of
said last will and testament.
WHEREAS, Letters Testamentary on the estate of the said decedent were duly
issued by the Register of Wills of Cumberland County, P A. to the said Executors
hereinafter called the personal representatives;
WHEREAS, the said personal representatives have gathered the assets of the
estate of the said decedent and the assets consist of cash, for a total value of
$30,636.02, as set forth in the attached inheritance tax return marked Exhibit A.
WHEREAS, the debts and deductions in the amount of $12,676.96, including the
$3,500 family exemption and the payment of inheritance tax in the amount of
$808.57 amount to $13,485.12, thereby leaving a balance for distribution of
$17,150.49 plus the $3,500 family exemption, to both heirs under the will.
WHEREAS, the balance for distribution has been distributed in accordance with
the terms of the last will and testament of the decedent as set forth in the
schedule of distribution evidenced in the attached Exhibit A.
NOW, THEREFORE we, the undersigned Legatees, being all of the legatees of
the said decedent and being those persons entitled to inherit under the last will
and testament of Anna K. Hollenbaugh do hereby, each of us, acknowledge that
we have received from the aforesaid estate, in full satisfaction, the sum or sums
of money set forth above.
AND, each of us does hereby stipulate and agree that in order to avoid the
expense and time involved in he filing of a formal account and schedule of
distribution, we each agree that no account is necessary and we do hereby agree
thabne. do ~onsent:;tB distribution being made without the filing of an account
and s<;b~dl1leof qis,1;ribution, the same to be with the same force and effect as if
they hadJ~~~l}med and confirmed by the Orphans' Court Division of the Court
of Common Pleas of Cumberland County, P A.
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THEREFORE, each of us does hereby remise, release, quitclaim and forever
discharge the said personal representative, her heirs, executors, and
administrators and assigns, of and from the said estate and from all actions, suits,
payments, accounts, reckonings, claims, and demands whatsoever for or by
reason thereof, or for any other use, matter, cause or thing whatsoever touching
upon the estate of the said decedent, and each of us does further hereby covenant
and agree that should any liability come due to the estate of the said decedent
after the signing of this agreement, we and each of us do hereby covenant and
agree with each other that we will contribute pro rata our share of the estate to
satisfy any and all claims, demands, suits, or causes of action which may be
successfully prosecuted against the said estate after signing, sealing and delivery
of this settlement agreement, and final release.
IN~lTNE55 WH~REO("f, we have he:eunto set our hands and seals this
~day of ~' ,20Gb.
Witness: /&7/ ~ /C.
./2;/;:r:*Ue::
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Shirley . eberlig, individuall
And as Executrix of the Estate of
Anna K. Hollenbaugh
a ?'8L ~ ~.
c! ~ L- 11' M~v"-,:;,/ (
vi} ames C. Hollenbaugh, .
individually, And as Executor of
the Estate of Anna K.
Hollenbaugh
Commonwealth of Pennsylvania)
55:,
County of Cumberland )
On this, the ~..J,+- of ~. , 2006, before me, a Notary
Public, the undersigned officer, personally appeared Shirley A. Heberlig,
individually and as Executrix of the Estate of Anna K. Hollenbaugh and James c.
Hollenbaugh, individually and as Executor of the Estate of Anna K.
Hollenbaugh, known to me to be the persons whose name are subscribed to the
within instrument, and acknowledged that they executed the same for the
purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
0-~LL ~
Notary
NoIItIII Seal
Anne .. Cox, Notary Public
Carlise BorougIt, Cumberland County
My ComndIIlon bpi... June 3, 2009
08-28-2006
HOLLENBAUGH
04-18-2006
21 06-0367
CUMBERLAND
101
APPEAL DATE: 10-27-2006
(See reverse side under Objections)
Amount Remitted I I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE --+ RETAIN LOWER PORTION FOR YOUR RECORDS +--
REv:i547-EX-AFP-(03:05)-~OTiCE-oF-iNHERiTANCE-TAX-APPRAIsEMENT:-AiiowANcE-OR---------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ANNA K FILE NO. 21 06-0367 ACN 101
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
WILLIAM A ADDAMS
27 W HIGH ST
CARLISLE
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
PA 17013
ESTATE OF
HOLLENBAUGH
REV-1S47 EX AFP (06-05)
ANNA
K
TAX RETURN WAS: (X) ACCEPTED AS FILED
CHANGED
DATE 08-28-2006
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
30,636.02
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses ISchedule H)
10. Debts/Mortgage Liabilities/Liens ISchedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts ISchedule J)
14. Net Value of Estate Subject to Tax
(9)
(10)
12,676.96
.00
Ill)
(12)
(13)
(14)
I~ an assessment was issued previously, lines
re~lect ~igures that include the total o~ ALL
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate
16. Amount of Line 14 taxable at Lineal/Class A rate
17. Amount of Line 14 at Sibling rate
18. Amount of Line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS.
NOTE:
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
30,636.02
12.676 96
17,959.06
.00
17,959.06
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
.00 X 00 =
17,959.06 X 045=
.00 X 12 =
.00 X 15 =
(19)=
(15)
(16)
117J
(18)
.00
808.16
.00
.00
808.16
.
t'AYMt.NI no." (+J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID 1-)
07-13-2006 CD006964 40.41 768.16
TOTAL TAX CREDIT 808.57
BALANCE OF TAX DUE .41CR
INTEREST AND PEN. .00
TOTAL DUE .41CR
~ IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
I IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR), YOU MAY BE DUE
REV-1500 EX + (6-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Hollenbau h, Anna K.
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
~d_~-<t ,I '3( CYb
OFFICIAL USE ONLY
FILE NUMBER
2 -06 0 3 6 7
COuN"TY"CoiiE -vEA~ - - NUMii"ER- -
SOCIAL SECURITY NUMBER
1 97- 1 0 - 8 843
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Return (date 01 death prior to 12-13-82)
o 5. Federal Estate Tax Return Required
_ 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A} (Atlach Sch 0)
· THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAl:TAX INFORMATION.SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
William A. Addams 27 W. High St.
FIRM NAME (If Applicable)
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04/18/2006 08/22/1916
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST. AND MIDDLE INITIAL)
lliJ 1_ Original Return
o 4. Limited Estate
o 6. Decedent Died Testate (Atlach copy 01 Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12-12.82)
o 7. Decedent Maintained a Living Trust (Atlach copy of Trust)
o 10. Spousal Poverty Credit (date 01 death between 12-31-91 and 1-1-95)
PA 17013
OFFICIAL USE ONLY
30,636.02
(8)
30,636.02
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TELEPHONE NUMBER
717 -243-7638
Carlisle
12,676.96
(11)
(12)
(13)
12,676.96
17,959.06
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
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)
12. Net Value of Estate (Line 8 minus Line 11)
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)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
X _(15)
17,959.06 X .045 (16)
X .12 (17)
X .15 (18)
(19)
(14)
17,959.06
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
19. Tax Due
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
- > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE,S.IDE AND RECHECK MATH < <
808.16
808.16
D
d t' C
I t Add
ece en s omple e ress:
STREET ADDRESS 29 Parsonage St.
CITY I STATE I ZIP
Newville PA 17241
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 + B + 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. (5B)
Make Check to: REGISTER OF WILLS, AGENT
0.00
768.16
768.16
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 00
b. retain the right to designate who shall use the property transferred or its income; ........................................ D 00
c. retain a reversionary interest; or ...................................................................................................... D 00
d. receive the promise for life of either payments, benefits or care? ............................................................. D 00
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................. D 00
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. D 00
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... D 00
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 return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE
ADDRESS
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
DATE
ADDRESS
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. s9116 (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. s9116(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. 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 12% [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.
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 6, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
30,636.02
REV-1511 EX+(12-99)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
ESTATE OF
Hollenbauah. Anna K.
ITEM
NUMBER
A.
1.
2.
3.
B.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
21
06
0367
Debts of decedent must be reported on Schedule I.
DESCRIPTION
AMOUNT
FUNERAL EXPENSES:
Egger Funeral Home
Wayne Noss, flowers
Westminister Cemetery, burial plot
5,967.00
148.40
1,150.00
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 PA
Relationship of Claimant to Decedent dauQhter
1,560.00
3,500.00
Zip 17241
Probate Fees
144.00
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
75.00
87.56
45.00
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
12,676.96
REV-1513 EX + (8-nJ"\\
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Hollenbaunh Anna K
NUMBER
1.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1.
Shirley A. Heberlig
29 Parsonage St.
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:
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 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)