HomeMy WebLinkAbout01-24-07
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REV-1500 EX (~)
COMMONWEALTH OF
PENNSYlVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV.1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NU~ER
~L
COLNTY CODE
~L 0426___
YEAR NUM3ER
DECEOENT'S NAAE (LAST, FIRST, AND MIDDLE INIl1AL)
~ Houde.hel Helen
~ DATE OF DEATH (MM-OD-YEAR) DATE OF BIRTH (MM-OD-YEAR)
~ 5/2/2006 2/20/19l3
W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INmAL)
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SOCIAL SECURnYNUMBER
196-03-4820
THIS RETURN MUST BE FilED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURnY NUMBER
t [i] 1. Original Retum
~~ D 4. Limited Estate
Woo r=l
5 ~ L.A..J 6. Decedent Died Testate (Attach copy of Will)
~ D 9. Litigation Proceeds ReceiYed
D 2. Supplemental Retum D 3. Remainder Retum (date of death prior to 12-13-82)
D 4a. Fu1ure Interest Compromise (date of death after 12-12-82) D 5. Federal Estate Tax Retum Required
D 7. Decedent Maintained a Living Trust (Attach copy of Trust) L 8. Total Num bar of Safg DeposIt Boxes
D 10. Spousal POY8Ity Credit (data of death Mtwee" 12-31-01811I1-1-85) D 11. Election to tax under Sec. 9113(A)(AtlachSchO)
THIS SECTION MlJSTBt; COIllPLETED;ALL CORRESPONbENCE AND CoNFIDEtmAL TAX INFoRMAtioNSHOuLDSE[)I~CTED TO:
NAME COM='LETE MAILING ADDRESS
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P.O. Box 308
Linda Lundber
FIRM NAME (If AppHcable)
Pile Wealth MaDa _ent
TELEPHOfIE MJMBER
717-730-2265
Camp Hill, PA 17001-0308
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
(1 )
(2)
0.00
0.00
0.00
0.00
63,306.06
0.00
3. Closely Held CorporatIon, Partnership or SoIe-ProprIetorshlp (3)
4. Mortgages & Noles Receivable (Schedule D) (4)
5. Cash, Bank DeposIts & Miscellaneous Personal Property
(Schedule E) (5)
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6. J~ Owned Property (Schedule F)
U Separate BOling Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Properly (7)
(Schedule G or L)
(6)
0.00
8. Total Gross Assets (total Lines 1-7)
(8)
5,030.62
2,574.41
9. Funeral Expenses & AdministratlYe 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)
1 3. Charitable and Governmental Bequests/See 9113 Trusts br which an election to tax has not been
made (Schedule J)
(12)
(13)
o OFFICIAL USE cliiY
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63,306.06
7,605.03
55,701.03
0.00
14. Net Value Subjed to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPUCABLE RATES
(14)
55,701. 03
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
0.00
X.O L (15)
x.O ~ (16)
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55,701.03
0.00
0.00
17. Amount of Line 14 taxable at sl>lng rate
x.12 (17)
x.15 (18)
18. Amount of Line 14 taxable at coIlaterall'8te
19. Tax Due
(19)
20. D
CHE(~K HERE if 'ou t'RE REQUE: riNG 6, RU'UND OF AN OVERPAYMENT
0.00
2,506.55
0.00
0.00
2,506.55
. > >.BE SURE TO ,ANSWER Al....QtJESTIONS oNR~RSESIPEANDREC.tlEC;KMA,....<<
3W4645 1.000
d "sC
I t Add
Dace ent ompl8 e ress:
STREET ADDRESS
824 LisburD Road
CUmberland
CIlY I STATE I ZIP
CIUlLD Bill PA 17001-0308
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
2,506.55
0.00
1.615.00
85.00
Total Credits (A + B + C) (2)
1,700.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
0.00
0.00
Total Interest/Penalty (0 + E) (3)
0.00
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)
0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(5)
806.55
A. Enter the interest on the tax due.
(5A)
0.00
(5B)
806.55
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 [j
b. retain the right to designate who shall use the property transferred or its income;. . . D [j
c. retain a r8ll8f'SIonary interest; or ...... . . . . . . . . . . . . . . . . . . . . D [iI
d. receive the promise for life of either payments, benefits or care? . . . . . . . . . . . D [jj
2. If death occurred after December 12. 1982. did decedent transfer property within one year of death
without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . .. D [j
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? D [JI
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D [j
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 ~ pllljury, IlclllA t'al1Jur. ltl ndum, Indudlng 8CCOmP8nylng lChedules 8'1d statements, and to ltle best of my knowledge and belief, ilia true, correct and complete.
Declaration of preparer 0 NlIP.~ baled on a111nformal1on of which P'II*er h. any knowledge.
FOR FILl
SlGNATl.R: OF PREPARER OlHER THAN REPRESENTATIVE
DATE
AOORESS
-hf-
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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.!i 9916 (a) (1.1)(1)].
For dates of death on or after January 1, 1995. the tax rate imposed on the net value of transfers to or fer the use of the suNNing spouse is 0% [72 P.S. ~ 9116 (a) (1.1) (Ii)]
The statute doe. not exemDt a transfer to a surviving spouse from tax. and the statutory Alqulr8ments for disclosure of assets and filing a tax retum are stili appllcable even if
the surviving spouse is the only benellclary.
For dates of death on or after July 1, 2000:
The tax rate Imposed on the net value of transfers from a deceased chid twenty-one years of age or younger at death to or for the use of a natural parent, an adoptille parent,
or a stepparent of the child is 0% [72 P.S. S 9116(aX1.2)].
The tax rate imposed on the net value of transfers to orbrthe use of the dececlenfs lineal beneliclaries 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 fer the use of the decedenfsslb&ngs is 12% (72 P.S. ~ 9116(a)(1.3)). A sibling Is dellned, under Section 9102, assn
Individual who has at least one parent in common with the decedent, whether by blood or adoption.
3W4646 1.000
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REV-1508 EX+ (&-98)
COWAONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAl.. PROPERTY
ESTATE OF
Belen L. Boudeshel
FILE NUMBER
21 06 0426
I nclude the proceeds of litigation and the date the proceeds were receiYed by the estate.
All olntlv-owned with the right of survivorship must be disclosed on Schedule F.
VALUE AT DATE
OF DEATH
ITEM
NUMBER DESCRIPTION
1 Commonwealth of PA
Pro rated benefit to date of death
86.75
2 Social Security Administration
Pinal benefit
887.00
3 Sovereign Bank
Money Market Account
.1681727048
Balance as of 5/2/06
(Includes accrued interest
See letter attached)
39,055.18
4 Sovereign Bank
Checking Account
'1681717476
Balance as of 5/2/06
(See letter attached)
1,359.75
5 Penn Treaty Insurance Co
Long Ter.m Care Policy '76507
Benefits
18,007.32
6 Penn Treaty Insurance Co
Long Ter.m Care Policy .217742
Benefits
2,080.06
7 Penn Treaty Insurance Co
Long ter.m Care Policy .269834
Benefits
.780.00
8 Tangible personal property
Appraised by Claude C. Wolfe
(Copy of Appraisal attached)
1,050.00
3W46AD 1.000
TOTAl. (Also enter on line 5 RecaDitulation) $
(If more space is needed, insert additional sheets of the same size)
63,306.06
REV-1511 E4< + (12-99) ,
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INtERlTANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Belen L. Boudeshel
ITEM
NUMBER
A.
B.
3W46AG 1.000
1.
Debts of decedent must be reported on Schedule I.
DESCRIPTION
FUNERAL EXPENSES:
Rone
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s) PRC Bank. R .A.
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address 4242 Carlisle Pike
City Camp Bill
State PA
Zip 17011
Year(s) Commission Paid:
2.
Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
State
Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
1
Register of Wills
Filing fee for Inventory and Inheritance tax return
Total from continuation 8chedu1es . . . . . . . . .
FILE NUMBER
21 06 0426
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
"
AMOUNT
2,532.00
2,000.00
30.00
468.62
5,030.62
Estate ofl Belen L. Boudeshel
196-03-4820
Schedule B Part 7 (Page 2)
2
Chart One Inc
Pee for copies of medical records from Boly Spirit
Bospital
22.42
3
Claude C. Wolfe & Associates
Appraisal fee
75.00
4
Murrell R. Walters, III
Reimbursement of probate fees
140.00
5
Murrell R. Walters, III
Reimbursement for Legal advertising
211.20
6
Register of Wills
Short certificates
20.00
Total (Carry forward to main schedule)
468.62
..
REV-1512 EX + (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Helen La Houd..h.l
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
21 06 0426
R.port d.bts Incurred by the d.c.d.nt prior to d.ath which r.malned unpaid as of the date of death, Including unrelmbursed medical .xpen....
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Beverly Bealthcare - Blue Ridge
Rursing Bame care 4/22/06 - 5/1/06 1,973.38
2 Metro Med Services
Balance due for services on 3/29/06 60.10
3 R. Lynn McGargle MD
Medical services rendered on 3/13/06 38.73
4 The Woods at Cedar Run
Balance due 502.20
3W46AH 2.000
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
2,574.41
REV.1013 EX+ (9-ro)
.
SCNIDULI ..
BENEFICIARIES
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERlY
I TAXABLE DISTRIBUTIONS pnclude outright spousal distributions. and transfers under
Sec. 9116 (a) (1.2)]
RELATIONSHIP TO DECEDENT
Do Not List Trustee{I)
AMOUNT OR SHARE
OF ESTATE
1 Patrick R. Souder
Step Grandson
100% of estate
739 Girard Street
Harrisburg, PA 17104-2428
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18. AS APPROPRIATE, ON REV-1500 COVER SHEET
n NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- 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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BB IT RBMBMBERBD THAT
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I, BBLBN L. HOUDBSHEL, a resid.nt of CUlaberland County,
P.nnsyl vania, being of sound and disposing .ind, .eaory and
understanding, do aake, publish'.nd decl.re this to be .y LAST
fiLL and TBSTAMBNT, hereby revoking any .nd .11 Wills and
Codicils previously ..de by ...
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I d.clare that I .. not .arried, JIY beloved husband, SPURGEON
M. HOUDESHEL, having predece.sed M.
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I dir.ct th.t all wry just d.bts and tuner.l expens_ sh.ll be
paid froa wry residuary e.tat. as soon as pr.cticable after lilY
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dec.....
III
I direct that. .11 taxes that _y be a..e-.cs in consequence
of .y death, of whatever nature and by whatever jurisdiction
iJIposed, shall be paid froa JIY re.iduary ..t.te as a part of th.
expense of the .dJdni.tration of -.y e.t.te.
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I give, devi.e and bequeath all wry property, whether real or
per.onal, wheraver situata, includinq .ny property over which I
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..y bave a power of .ppointaent to .y .tepgrand.on,
RICHARD SOUDER, per stirpes.
PATRICK
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I n01linate, constitute and appoint PRe JiAHK a. Executor of
this LAST WILL, to serve without bond.
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ACDJOII'LBDGBKD'l'
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
ss.
I, HELEN L. HOUDESHEL, Testatrix, whose n_e is signed to
the attached or foregoing in_truaent, havinq been duly qualified
according to law, do hereby acknowledge that I signed and executed
the instrmaent as 1IY LAST WILL; that I signed it aa my free and
voluntary act for the purpos.. therein expressed.
-ta~ L'. J'~-, /
HBLEH L. HOUDBSHBL
SWOrn or affiraed to and a~owledgad before .. by HELEN L.
HOUDESHEL, Testatrix, this ('7 day of f14,{ 'f ,1999.
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Rotary Pu lic
Ul'XIaVX'.!
NotaMI Seal
DIIne M. SmIIh. Nofaty PutIIIc
I ~. CumblifIlIll1 Counlv
My EJCpInts June 22. 200CJ
COIOIONWBAL'1'H OF PENNSYLVANIA
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cotJN'1'Y OP CUMBERLAHD
. We, H~tl. 12 W4(.,(l:'72/"0I. and ~'1~~ ,
the wi tnes.e. whose' naaea are srqDed to tlie attached or .foregoing
instrUlUlllt being duly qualified according to law, do depOse and
say that we were present and .aw Testatrix sign and execute the
instrwaent as her LAST WILL; that HELEN L. HOUDBSHBL signed
willingly and that .he executed it a. her free and voluntary act
for the purpose. therein expr....d; that each of u. in the heari .
and sight of the Testauix .igned the Will a. witnes.e.; and t
to the be.t of our knowledge, the Ter/jtau wa_ at the ti 18
years of age or more, of sound .ind'- d Dde 7/Jcons;') or
undue influence. ;I'~(_
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SWorn or affiraed to and acknowledged before
.. this /31#.. day of m~ 1999.
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DIane M. SmI1h'~rIal'lCl CountY
~&xPirt. June 22, 2000
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Sovereign Bank
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RECEIVED
PNC ADVISORS
MAY 3 1 2006
ESTATE OF
SOCIAL SECURITY #:
DATE OF DEATH:
Helen L. Houdeshel
196-03-4820
May 2, 2006
Account#: 1681717476 Type:
In the name of: Helen L. Houdeshel
Date of Death Balance:
Int.(YTD) from 1/112006 to
Accrued interest to date of death:
Other Info: Closed 5/19/06
Checking
Open date: 6/29/1996
$1,359.75
4/23/2006
$0.01
: $0.21
. .
Account #: 1681727048 Type:
In the name of: Helen L. Houdeshel
Date of Death Balance:
Int.(YTD) from 1/112006 to
Accrued interest to date of death:
Other Info: Closed 5/19/06
Money Market Savings
Open date: 1/31/1995
539,055.18
4/30/2006
$1.39
$,80.98
I
Page 1 of 1
,.
ClAUDE C. WOLFE & ASSOCIATES'
AUcnoNEERS & APPRAISERS
FAMILY OWNED SINCE /9/0
2009 LINCOLN STREET · CAMP HILL, PA 17011
717.737.0734
Appraisal ror the Estate or Helen Houdeshel
do PNC Bank, 4242 Carlisle Pike, Camp Hill, PA 17011
ROOM ITEMS
Chest over chest
3-Drawer cabinet
Floral motif wing back chair
Drop leaf table & 2 chairs
Dresser with mirror
Desk with ladder back chair
Battery operated cart/scooter
RECEIVED
PNC ADVISORS
JUN ., 9 LtJ06
June 5, 2006
250.00
100.00
35.00
75.00
125.00
65.00
400.00
APPRAISAL TOTAL S 1,050.00
This Fair Market Value appraisal is true and correct to the best of my ability as an
auctioneer and appraiser with 35 years experience.
. Member: Certified Appraisers Guild of America
\.J.\.L.~ &.~I-
w. K. Dusty Chapman, CAGA