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Home My WebLink About02-01-07 ~ 15056041125 REV-1500 EX (06-05) PA Department of Revenue '* Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year 2 1 0 6 File Number o 0 6 8 6 Date of Birth 166149069 o 4 182 0 0 6 11141919 Decedent's Last Name Suffix Decedent's First Name PHI L LIP S ELEANOR MI C (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW [g] 1. Original Return o 4. Limited Estate [g] o 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death 0 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 o o o 8. Total Number of Safe Deposit Boxes 2. Supplemental Return o o o 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required S USA N H CON F A I R 717 7C;f)3 1~383 ~~.:~;: Q --.J I-REGISTER 0; ~~~lJSE e;v' Firrn Name (If Applicable) REA G ERA D L E R P C First line of address 233 1 MAR K E T S T R E E T =~~ Second line of address 01 City or Post Office State ZIP Code DATE FILED C AMP H ILL P A 17011 Correspondent's e-mail address: Under penalties of perjury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of pre parer other than the personal representative is based on all information of which pre parer has any knowledge. SIGNATUREj>F)'ERSON RESPO}JSI~ FOWFILlN..@RETURN DATE A.4uA/~ ~. 4<..td...4:C II;},,; 07 ADDRESS ' 16 Hummel Avenue Camp Hill PA 17011 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056041125 15056041125 ~ ~ -I 15056042126 REV-1500 EX Decedent's Social Security Number Decedent's Name: Eleanor c. Phillips RECAPITULATION 166149069 1. Real estate (Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 2650000 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) D Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) D Separate Billing Requested. . . . . .. 7. 874226 8. Total Gross Assets (total Lines 1-7) ........................... 8. 3524226 1557016 144399 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. 1701415 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. 1822811 14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . 14. 1 8 2 2 8 1 1 TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X.O _ 0 0 0 15. 0 0 0 16. Amount of Line 14 taxable at lineal rate X .O~ 1 8 2 2 8 1 1 16. 8 2 0 2 6 17. Amount of Line 14 taxable 0 0 0 at sibling rate X .12 17. 0 0 0 18. Amount of Line 14 taxable 0 0 0 at collateral rate X .15 18. 0 0 0 19. Tax Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 8 2 0 2 6 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT D Side 2 L 15056042126 15056042126 -I Decedent's Complete Address: DECEDENT'S NAME Elean(.")rJ:;___Ph imps_ STREET ADDRESS 135 Biddle Street File Number 00686 REV-1500 EX Page 3 CITY West Fairview i STATE . PA -;ZIP --------- I 17025 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 820.26 Total Credits (A + B + C) (2) 3. InteresUPenalty if applicable D. Interest E. Penalty 0.00 TotallnteresUPenalty ( 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) 0.00 0.00 820.26 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. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (5B) 820.26 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 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. 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. ~9116 (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. ~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 zero (0) percent [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 four and one-half (4.5) percent, 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 twelve (12) percent [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. REV-1502 EX + (6-98) SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Eleanor C. Phillips 00686 All real property 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 exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real orooertv which is iointlv-owned with riaht of survivorshio must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION Real property located at 135 Biddle Street West Fairview, PA 17025 see attached HUD Settlement Sheet VALUE AT DATE OF DEATH 26,500.00 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 26500.00 REV-1509 EX + (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF Eleanor C. Phillips FILE NUMBER 00686 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Sherry Deibert 16 Hummel Avenue Camp Hill, PA 17011 daughter B c JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY '10 OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FORJOINTL Y-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 6/1995 M& T Bank checking account 17,484.51 50. 8,742.26 TOTAL (Also enter on line 6, Recapitulation) $ 8742.26 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (12-99) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Eleanor C. Phillips FILE NUMBER 00686 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Rolling Green Cemetery 3,470.25 2. Funeral Luncheon 150.00 3. Musselmans Funeral Home 6,604.90 B. ADMINISTRATIVE COSTS: 1. 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: 2. Attorney Fees Reager & Adler, P.C. 875.00 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 Cumberland County Register of Wills 140.00 5. Accountanfs Fees 6. Tax Return Prepare~s Fees 7. Homeowner's Insurance - Aegis Insurance 155.00 6. East Pennsboro Township - Sewer & Trash 230.00 7. East Pennsboro Twp - Property taxes 305.01 8. Cumberland Law Journal 75.00 9. Yard maintenance prior to sale of home 100.00 10. Realty Transfer Tax 265.00 11. Real Estate Commission 3,000.00 12. Transaction Fee - Century 21 at the Helm 125.00 13. Deed Preparation 75.00 TOTAL (Also enter on line 9, Recapitulation) $ 15570.16 (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (12-03) '* SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Eleanor C. Phillips FILE NUMBER 00686 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Jackson Gastroenterology 124.00 2. Dr. Piffer - DPM 33.00 3. Quantum Imaging 5.88 4. West Shore EMS 37.11 5. Holy Spirit Hospital 229.51 6 PP&L Electric - May 2006 - December 2006 122.86 7. Amerigas - May 2006 - December 2006 811.00 8. PA American Water - May 2006 - August 2006 65.09 9. AT&T 15.54 TOTAL (Also enter on line 10, Recapitulation) $ 1 443.99 (If more space is needed, insert additional sheets of the same size) ,,,,.n,, 8<. ". COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF C h'lI SCHEDULE J BENEFICIARIES FILE NUMBER Eleanor .P I iDS 00686 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. Sherry L. Deibert Lineal 4,557.02 16 Hummel Avenue Camp Hill, PA 17011 2. Florence Fultz Lineal 4,557.03 502 Magaro Road Enola, PA 17025 3. Patricia Magaro Lineal 4,557.03 816 S. Humer Street Enola, PA 17025 4. Melva Gingrich Lineal 4,557.03 13 Meadowbrook Drive Schuylkill Haven, PA 17972 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) INVENTORY Estate of ELEANOR C. PHILLIPS No.21 06 00686 . Deceased Date of Death 4/18/2006 Social Security No. 166149069 also known as Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We verify that the statements made in this inventory are true and correct. I/We understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Personal Representative: Name of Attorney: Susan H. Confair S~rt./ -tDd-d Dated ~/<>7~/t?/)' I.D. No.: 70241 Address: 2331 Market Street Camp Hill Telephone: 7177631383 PA 17011 ~~~ Description ,-"".., -'"' .:. "T-'1 Vafu~ _ -,,-.---. J Stocks & Bonds -rJ I; Closely-Held Corporation, Partnership or Sole-Proprietorship -~ (_n Mortgages & Notes Receivable Cash, Bank Deposits, & Misc. Personal Property Real Estate Real property located at 135 Biddle Street West Fairview, PA 17025 see attached HUD Settlement Sheet 26,500.00 Total 26,500.00 (Attach Additional Sheets if necessary) NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW-4 \ ~ COMMONWEALc""H OF PF'INSYlVANIA DEPARTMENT OFiifVENUE BUREAU OF INDIVIDUAL TAXES DEPTc 280601 HARRISBURG, PA 17128,0601 REV,1162 EX(11,96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT DEIBERT SHERRY l 16 HUMMEL AVENUE CAMP Hill, PA 17011 --- fold ESTATE INFORMATION: SSN: 166-14-9069 FILE NUMBER: 2106-0686 DECEDENT NAME: PHilLIPS ELEANOR C DA TE OF PAYMENT: 02/01/2007 POSTMARK DATE: 02/01/2007 COUNTY: CUMBERLAND DA TE OF DEATH: 04/18/2006 NO. CD 007764 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $820.26 I I I I I I I I TOTAL AMOUNT PAID: $820.26 REMARKS: ESTATE OF ELEANOR PHilLIPS EXEC SHERRY DEIBERT CH ECI(# 1001 SEAL INITIALS: AJW RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WillS