HomeMy WebLinkAbout12-13-06
REV-1500 EX + (6-00)
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
OFFICIAL USE ONLY
FILE NUMBER
21 -0 6 0 0 8 0
""COuNTYCOoE ---YEA~ - - NUMBER- -
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Har ster Sara E
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
12/24/2005 5/15/1919
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
1 62- 1 2 - 1 102
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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[Xl 1. Original Return
o 4. Limited Estate
[Xl 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date 01 death after 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copy oITrust)
o 10. Spousal Poverty Credit (date 01 death between 12-31-91 and 1-1-95)
o 3. Remainder Return (date of 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) (Attach Sch 0)
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THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE ANIJ CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
Forest N M ers Es . 137 Park Place West
FIRM NAME (If Applicable)
Law Office Forest N M ers
TELEPHONE NUMBER
7175329046 Shi PA 17257
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(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Ciosely 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)
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)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
OFFICIAL USE ONLY
6,702.90
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14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable atthe spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
19. Tax Due
X _(15)
-18,203.08 X _ (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. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
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6,702.90
956.50
23,949.48
(11)
(12)
(13)
24,905.98
-18,203.08
(14)
-18,203.08
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ece en s ample e ress:
STREET RDDRESS
700 Walnut Bottom Rd
CITY I STATE I ZIP
Carlisle PA 17013-
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits (A + B + C)
(2)
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.
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
0.00
0.00
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; ........................................................................... 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 00
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 00
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
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
ADDRESS 146 P P ce
ShippensburQ
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
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ADDRESS 137 Park Place est r
ShippensburQ
PA 17257
DATE
1'1.. - S . c/O:::.
PA 17257
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. ~9116 (a) (1.1) (il].
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. ~9116 (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. ~9116(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. ~9116(1.2) [72 P.S. ~9116(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. ~9116(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.
LAST WILL AND TESTAMENT
of
Sara Elizabeth Harpster
I, SARA ELIZABETH HARPSTER, of 1946 Bellemeade Drive, Altoona,
Blair County, Pennsylvania, declare this to be my Will. I revoke
all former wills and Codicils.
ITEM I
I authorize my Co-Executors to pay all the expenses of (1) a
funeral or memorial service;
( 2 )
the interment of my remains,
including the costs of a gravesite, if necessary; and (3) the
installation and inscription of a suitable marker at, and perpetual
care of, the gravesite. I further direct my Co-Executors to pay
all of my debts that my Co-Executors in their sole discretion may
allow as claims against my estate.
ITEM II
I give and bequeath my personal effects, including my jewelry,
wedding rings and personal clothing, to my daughter, KAREN E.
MILES, if she survives me.
If my daughter, KAREN E. MILES, predeceases me, then this gift
shall lapse and become part of the residue of my estate.
ITEM III
I give and bequeath my set of ceramic figurines to my
granddaughter ~:. JENNIFER E. CAPORELLA, if she survives me.
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'IfIIlx.'glJ:-hnddaughter, JENNIFER E. CAPORELLA, predeceases me,
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then this gift shall lapse and become part of the residue of my
estate.
ITEM IV
I give and bequeath my red living room rug to my son, GEORGE
F. HARPSTER, JR., if he survives me.
If my son, GEORGE F. HARPSTER, JR., predeceases me, then this
gift shall lapse and become part of the residue of my estate.
ITEM V
I give, devise and bequeath all of the rest, residue and
remainder of my estate, of whatever kind and wherever situate, in
equal shares, to my children, KAREN E. MILES and GEORGE F.
HARPSTER, JR., if they survive me.
If either of my children predecease me, then I give, devise
and bequeath his or her share of the rest, residue and remainder of
my estate, in equal shares, to his or her issue per stirpes who
survive me.
"Issue" shall include children adopted by my above-named
children, or their issue.
ITEM VI
I appoint my children, KAREN E. MILES and GEORGE F. HARPSTER,
JR., as Co-Executors of this will. If either Co-Executor is unable
__________~~__n_u_~~.1illing to act or continue as Executor, for any reason
whatsoever and whether before or after my death, I direct that the
vacancy not be filled and that the then serving Executor serve as
the sole Executor.
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ITE~l VII
No fiduciary under this will shall be required to give bond or
other security for the faithful performance of the fiduciary's
duties.
Any such fiduciary shall have the following powers, in
addition to those given by law:
To invest in, accept and retain any real or personal
property, including stock of a corporate fiduciary or its
holding company, without restriction to legal investments;
To sell, exchange, partition or lease for any period of
time any real or personal property and to give options
therefor for cash or credit, with or without security;
To borrow money from any person including any fiduciary
acting hereunder, and to mortgage or pledge any real or
personal property;
To hold shares of stock or other securities in nominee
registration form, including that of a clearing corporation
or depository, or in book entry form or unregistered or in
such other form as will pass by delivery;
To engage in litigation and compromise, arbitrate or
abandon claims;
To make distributions in cash, or in kind at current
values, or partly in each, allocating specific assets to
particular distributees on a non-pro rata basis, and for
such purposes to make reasonable determinations of current
values;
To make elections, decisions, concessions and settle-
ments in connection with all income, estate, inheritance,
gift or other tax returns and the payment of such taxes,
without obligation to adjust the distributive share of income
or principal of any person affected thereby; and
To payoff any loans I may have taken against any life
insurance policies owned by me that remain unpaid at the
time of my death.
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IN WITNESS WHEREOF, I have hereunto set my hand and seal to
this my Last will and Testament, this ~day Of~, 1997.
SIGNED, SEALED, PUBLISHED and Declared by the Testatrix above
named, as and for her Last will and Testament, in the presence of
us, who at her request, in her presence and in the presence of each
other, all being present at the same time, have hereunto subscribed
our names as attesting witnesses.
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witness
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Address
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AFFIDAVIT OF TESTATRIX AND WITNESSES
COMMONWEALTH OF PENNSYLVANIA
ss:
COUNTY OF BLAIR
We, Sara Elizabeth Harpster,
J#f4rYh J;:'CanI14'
and L 6 V l . (; . /r;- Ss e / (
,
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
Testatrix signed and executed the instrument as her last will and
that she signed willingly 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
the will as witnesses and that to the best of their knowledge the
Testatrix was at that time eighteen (18) years of age or older, of
sound mind and under no constraint or undue influence.
Subscribed, sworn to and acknowledged before me by Sara
Elizabeth Harpster, the Testatrix, and subscribed and sworn to
before me by
fi-l/, y Y f1 E"' {'t)l1 i1iU"
witnesses, this 31 s t day
and L 6 r / a <
of "J""LL Iv
I
Iri s ~el
,
, 1997.
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My Commission Expires:
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Notarial seal
John A. Ayres, Jr., Notary Public
Clearfield Boro, Clearfield County
My Commission Ex ![es J~~:..~O!__1999
REV-1508 EX + (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Harpster. Sara. E
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
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.
ITEM
NUMBER
1
DESCRIPTION
Orrstown Bank checking #103702552
VALUE AT DATE
OF DEATH
6,702.90
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
6 702.90
-.- FEB 24 2000 11:lSAM
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REV-1511 EX + (12-99)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Hamster. Sara. E
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21
06
0080
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s) George F Harpster, Jr. 469.50
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address 146 Park Place West
City Shippensburg State PA Zip 17257
Year(s) Commission Paid: 2006
2. Attomey Fees Law Office Forest N Myers; Forest N Myers, Esq. 350.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Add ress
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Letters Testamentary; JCP fee; Short Certificates; Inh Tax Ret filing fees 137.00
5. Accountant's Fees
6. Tax Return Pre parer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $ 956.50
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (6-98)
.
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Hamster. Sara. E
FILE NUMBER
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
Pa Dept of Revenue, Dept of Public Welfare claim
VALUE AT DATE
OF DEATH
23,949.48
TOTAL (Also enter on line 10, Recapitulation) $
23 949.48
(If more space is needed, insert additional sheets of the same size)
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
DIVISION OF THIRD PARTY LIABILITY
ESTATE RECOVERY PROGRAM
PO BOX 6466
HARRISBURG. PA 17105-6466
February 15, 2006
FOREST N MYERS ESQUIRE
137 PARK PLACE WEST
SHIPPENSBURG PA 17257
Re: SARA HARPSTER
CIS #: 080175743
SSN: 162-12-1102
Date of Death: 12/24/2005
Dear Mr. Myers:
Please be advised that the Department of Public Welfare maintains a
claim in the amount of $23,949.48 against the above-mentioned estate. This
claim is for restitution of medical assistance granted on behalf of the
decedent for which the Probate Estate is now responsible to reimburse the
Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as
amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's
itemized statement of claim.
A portion of this medical expense, namely $21,258.25, was incurred
during the last six months of the decedent's life; therefore, it is a Class 3
claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries
Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $2,691.23, is
to be entered as a priority Class 6 claim against the estate.
Please acknowledge receipt of this letter and advise whether the
Commonwealth's claim is admitted and when payment may be expected. If the
estate accounting is complete, please provide a copy. If the estate contains
real estate, please provide copies of the deed, the latest tax assessment,
and a current appraisal, if available.
Sincerely,
;J(cCC'<< j /ja-wM6
Nicole L. Lipscomb
TPL Program Investigator
717-772-6606
717-772-6553 FAX
Enclosure
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
S~r~ E= ?1 OR OORO
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. George F Harpster, Jr. Lineal 50.00
146 Park Place West
Shippensburg PA 17257
2 Karen E Miles Li neal 50.00
1799 Lemington Lane
Naples FL 34109-1453
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)
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