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Home My WebLink About03-13-07 (2) REV-15dO fi(6-co) I ' ~.. OFFICIAL USE ONLY COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ~L COUNTY CODE ~L 0609___ YEAR NUMBER I- Z W C W () W C DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) Si e Jane DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 6/30/2006 1/10/1920 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 160-16-0740 TIllS RETURN MUST BE FILED IN DUPLICATE WITH THE w REGISTER OF WILLS SOCIAL SECURITY NUMBER ~ [X] 1, Original Retum ll:::!U) D <J D::ll:: 4, Limited Estate w l1.<J :r:: 00 t.;l <J D::.J LAJ 6, Decedent Died Testate (Attach copy 01 Will) l1.111 ~ D 9, Litigation Proceeds Received D 2, Supplemental Retum D 3, Remainder Retum (date 01 death prior to 12-13-82) D 4a, Future Interest Compromise (date 01 death after 12-12-82) D 5, Federal Estate Tax Return Required D 7, Decedent Maintained a Living Trust (Attach copy 01 Trust) L 8, Total Number of Safe Deposit Boxes D 10, Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) D 11, Election to tax under See, 9113(A)(Attach Sch 0) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS I- Z W o Z o lL III W II: II: o o 17 South Second Street Brid et M. Whitle , Es FIRM NAME (If Applicable) Skarlotos & Zonarich, LLP TELEPHONE NUMBER Harrisburg, PA 17101-2039 717-233-1000 1, Real Estate (Schedule A) (1) c"",:\ - ~ICIAL USE CJI>I[~ - _' J .J 2, Stocks and Bonds (Schedule B) (2) .-:..J 3, Closely Held Corporation, Partnership or Sole-Proprietorship (3) w 4, Mortgages & Notes Receivable (Schedule D) 5, Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (4) ----, (5) r,,) z o i= :5 :J l- ii: <C () w 0::: 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) 4,245 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) 22,862 (18,617) 2,609 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 Subjectto Tax (Line 12 minus Line 13) (21,226) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15, Amount of Line 14 taxable at the spousal tax Z rate, or transfers under See, 9116 (a)(1 ,2) o ~ 16, Amount of Line 14 taxable at lineal rate I- :::l !i 17, Amount of Line 14 taxable at sibling rate o <J 18, Amount of Line 14 taxable at collateral rate >< ~ 19, Tax Due 20,0 o o o 0 x ,0 ~(15) 0 x ,0 45 (16) 0 x ,12 (17) 0 x.15 (18) (19) o o CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWERALL QUESTIONS ON REVERSE SIDE AND RECHECKI\IlATH < < 3W46451,000 DeQedent's Com lete Address: STREET AIilDRESS Bethan Villa e #60 5230 Wilson Cumberland Count CI1Y Mechanicsbur STATE PA ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) o o o o Total Credits (A + B + C) (2) o 3. Interest/Penalty if applicable D. Interest E. Penalty o o Total Interest/Penalty (D + E) (3) 0 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 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0 A. Enter the interest on the tax due. (5A) 0 B. Enter the total of Line 5 + 5A. This is the BALANCE (5B) 0 Make Check PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: 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; . D c. retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . . D d. receive the promise for life of either payments. benefits or care? . . . . . . . . . D 2. If death occurred after December 12. 1982. did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . .. D 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? D 4. Did decedent own an Individual Retirement Account. annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D C1a 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. Yes No ~ ~ ~ ~ ~ ~ SIGNATURE OF PERSON RESPONSIBLE FOR FILING REnJRN Sharon M. Garcia, Executor ADDRESS P.O. Box 274 SIGNAnJRE OF PREPARER OTHER THAN REPRESENTATl Brid et ADDRESS DATE & Camp Hill, PA 17001-0274 DATE 3/ r- PA 17101 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. 9 9916 (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. 99116 (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 ~ 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, 99116(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. 99116(1,2) [72 P.S. 99116(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. 9 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. 3W4646 1.000 RE\'.1508 EX. (6.98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Jane W. Sipe. FILE NUMBER 21 06 0609 Include the proceeds of litigation and the date the proceeds were received by the estate. All property joinUy-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Boscov's Gift Cards in possession of decedent 300 2 Citizen's Bank Checking Account # 61-00683192 40 3 Citizen's Green Savings Select Account #6247-569330 Interest accrued to 6/30/2006 2,006 3 4 Citizen's Money Market Account #610090-133-5 290 5 Credit Balance at Kaplans Cleaners 253 6 Cumberland County Veterans Benefit Payment 100 7 East Pennsboro Ambulance Refund 219 8 Hershey Medical Center refund of medical expenses covered by Access card 124 9 Patriot News Subscription Refund 76 10 Personal Property Sold at Haar's Auction Sale price $401.24 less commission $160.50 11 Stone & Murray Funeral Home refund of unused pre-need funeral account 12 US Treasury - income tax refund due on 2006 1040 return for Jane W. Sipe 241 125 468 3W46AD 1.000 TOTAL (Also enter on line 5 RecaDitulation) $ (If more space is needed, insert additional sheets of the same size) 4,245 REV-1511 E;x + (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Jane W. Sipe, SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21 06 0609 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Decedent had a pre-need funeral arrangement with Stone and Murray Funeral Home B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 212 Name of Personal Representative(s) Sharon M. Garcia Social Security Number(s) I EIN Number of Personal Representative(s) Street Address P.O. Box 274 City Camp Hill State PA Zip 17001-0274 Year(s) Commission Paid: 2007 2. Attorney Fees 1,000 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 76 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Citizen's Bank Service Fee 10 2 Cumberland County Law Journal advertise estate 75 Total from continuation schedules 262 TOTAL (Also enter on line 9, Recapitulation) $ 1 635 Debts of decedent must be reported on Schedule I. 3W46AG 1.000 (If more space is needed, insert additional sheets of the same size) Estate of: Jane W. Sipe, 160-16-0740 Schedule H Part 7 (Page 2) 3 Cumberland County Register of Wills administrative expense 50 4 James D Bogar, Esq. witness affidavit fee 75 5 The Sentinel advertise Estate 137 Total (Carry forward to main schedule) 262 REV, .1512 EX + (1~..03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Jane W. Sipe. SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21 06 0609 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH Bethany Village skilled nursing care balance 8,732 2 Commonwealth of PA, Dept of Public Welfare Balance due to Medical Assistance for Decedent 12,494 3 PA Dept of Revenue 2006 PA-40 Balance due on final tax return for decedent 1 3W46AH 2.000 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 21.227 RE'V-1513 EX+ (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Jane w. Sine 21 06 0609 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)] 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 Commonwealth of Pennsylvania, Department of Public Welfare Debt for Decedent's medical assistance benefits- 59% of residue 1,539 TOTAL OF PART II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 2,609 3W46AI 1.000 (If more space is needed, insert additional sheets of the same size) 160-16-0740 Estate of: Jane W. Sipe, Item No. 2 Schedule J Part 2 (Page 2) Description Amount Bethany Village Balance due for skilled nursing care to Decedent- 41% of residue 1,070 KI Citizens Bank'N 525 William Penn Place Suite 153-2618 Pittsburgh, P A 15219 August 25, 2006 SHARON M GARCIA PO BOX 274 CAMP HILL PA 17001-0274 Estate of JANE W SIPE Date of Death: Jun 30, 2006 SSN: 160-16-0740 Dear Sir/Madam: In accordance with your request, the attached information sheet has been provided in the above decedent's name as of his/her date of death. For IL or LC accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries, please call 888-999-6884. Sincerely, Daniel Peters Operations Services ~~ Citizens Bankw Account Number 6100683192 Account Title JANE W SIPE Date Opened 6/6/1966 Account Type Checking Principal Balance as ofDOD $40.00 Interest from Last Posting to DOD $.00 Account Balance as of DOD $40.00 YTD Interest to DOD $.00 a Citizens Bank" Account Number 6100901335 Account Title JANE W SIPE Date Opened 4/18/1994 Account Type Checking Principal Balance as ofDOD $290.00 Interest from Last Posting to DOD $.00 Account Balance as of DOD $290.00 YTD Interest to DOD $6.40 .~~ Citizens Bankm Account Number 6247569330 Account Title JANE W SIPE Date Opened 4/11/2006 Account Type Savings Principal Balance as ofDOD $2006.08 Interest from Last Posting to DOD $2.94 Account Balance as of DOD $2009.02 YTD Interest to DOD $6.08 Date: 07-14-2006 V~~\IV\I. hi::la'r-'s. COlli Gett 1 €~ment ~~i f:' 11 e \"": Lj, E~7 1+ Item HAAR'S AUCTION SERVICE JANE [...1 S I PE EST 1. SHA rWN Gr.1 RC I A PO DC! X '1,;~:7 ii' CAMP HILL PA 17001-0274 Descr~i.ption Pi. ct I.\l'~e SnOWm2l.n Box lot Cc:d;s meow lot 'Tl-'e e, bii:\ s k et [,1""'0 C I-< !\j",l.t; i v it Y Cup Angels SIn Dwm en Car-'o 1 el'~ Glass an!;;I€:\l Car~O 1 er Snow !;;Ilobe Caro 1 fn~ Cup and saucer lot Car~O 1 er~ Shali er-"~; Ci.H~O 1 er~ C2I.'r~O 1 er" Ci.'lts Papen'Je i !;;Iht Bi:.~sket, cont ent s Bowl Moo~>e, vas!:! !:")ant ':<1 Music box Pi l!;jf'im Pict m~e Chi,na b2\sl,{et Chair Tr.:\ble li!;;lht Pedestal H2\mper" Li.~mp st,:\T1d Wing bacl-< chair~ Dr~ e sse l^'--1fI i r~r~ 0 r~ Re fy' i 1;;1 ~r-'2\t Or~ Commission at 40.0001. Items: @ 717--A,3f~--8f~f1f=, J:)r~ i. ce :38 Amol.mt: 1 E,0. ~:;i0 Less adjustments: Net due to seller: Qty P2\!;! f..\ : :l Tot,;.l 1. 1. l :I. 1 1 1. 1 1 :I. 1. 1. 1 1 1 :I. 1 1. 1 1 l 1 l 1 1 1. 1, 1 1 1 i 1. 1. 1 1. 1. 1 1. :::S Ill. Q) III 121. 501210 0. j:~51Z1121 ,3. 0~~1 C:~. 75 Lj. 0tZI ~.5. Q)lZi 0. 5(~100 el. 251210 Ill. 7500 ;~: 8. 1211Z! 1. . 0121 i::: Ii). Iti 121 :5. 0121 ;;?'It). III 121 121. c~~,;00 ;:5. IlliZi 121. 50eu21 ;:::5. euZl 25. el0 0. 2~)IZiIZl l a i.::5 121. 50lZUZI ;:~.. 121121 1.75 7.00 2. Q)lZI 7.1210 ILl. ~j tZlti.) III 121. .:::';00 ~3. 0121 f:::,). 0121 .1.1.. @ZI :~. 121 121 lHZt. 121 lZl ;:;:121. 0121 .I.~ 5.. 1i.)IZ! L~ 121" 1211Z1 li.lZ/ l t1 ;:~ ~:;.; .,_. :[ C Ii.)" 'j III j::: AI!.). '7 ~:5 Date: 07-14-21211216 www.haa....s.com Settlement Selle.,.': 4274 ..1'.".' ~.~.~,.... ...... _ .--",~ rn It em HAAR'S AUCTION SERVICE JANE W SIPE EST 1- SHARON GARCIA PO BOX 4274 CAMP HILL PA 1712101-121274 Desc'r'iption Pi ct !.ll"'e Sn oltman Box lot CatE. meo\.'J lot T'r'ee, basket Cl"ock j\ at i v i t i CI.lp Angels Snowmen Ca,ro 1 et' Glass angel Cat'O 1 er Snow !;Ilobe Ca'r"'o 1 e'r' Cup and saucer lot Cat'O 1 e'r' Shak et'S Ca.,.' 0 1 et' Ca',"0 1 e'r' Cats P;:\pet'ltJe i ght :Ba.sket:, c::Jnt ent s BC\<>Jl !'rioose, '1Cl.se Santa j;11.lSic b(:;;.< Pilgr'im Pi ct !.we China bc..sket Ch a i t' Table light Pedestal Ham pe'r" Lamp st,:Hld ItJi ng back chai t' D.,.'esse","-m i (",'0(' Re f'r' i 9 e('at Ot' Commission at 40.012101- Items: @ 717-432-8246 p.,., ice 38 f-hnount: 150.5121 Less adjus~ments: Net due to seller: 1-~C.ClR' q I~I IrTTn"J qr-RU Tr:r- Qt Y Page: 1 Total 1 1 1 1. 1 1. 3121.0121 121.5121121121 121.250121 .3.00 .-. 7C" a::.. ,...J 4.iZ10 ; .. 5. !LULi 1 1 1. 1. 1 1. 1 1 1. 1 1 1. 1 1. 121.51210121 0.251210 0.751210 28.0121 1. 1210 20.IZlI21 5.00 20.00 ill. 2500 25. 01;;) 121.5000 i:::5. ell;;) 25.00 0. 2'500 1 .J. 1 .-, C" .J. .. C.-1 1. 121. 5121 QHe 2.00 . J. 1 1 1. 1. 1 1. 1 1 1. 1. 04 -'I:- .l.... i ,_' 7.00 2. t;~~0 7.iZ10 IZl. 51211210 0.2500 5. 0121 .:::5. '210 ,,;.. @Z! 2.:.. !lilt) 1 ... .40 II tZllZt 1 1. 1. 20.00 L~5. 00 4'21. 00 lHZ! 1 . 2~j ....11:; IZ!. '5121 c~"+0. 75 7l7-.li.32-82l~E. r .1.11"1..'.'_.I.l....I,.I::I~..:.I:11.1..::II..I.....;;:I::Il..JI.,.,_:1::I'.\..."J=-:l.,:.I:I:.'.....:..',II....I.I:I-II....::::I..:I.I:I.):::I. .,,;t';~~ , ..~~ HAAR'S, INC. 185 LOGAN ROAD DILLS BURG, PA 17019 (717) 432-8246 t: CITIZENS BANK 3-76'_ ~ 7084 /'1 I C260 ~ 7S $ ;;2CfD~ ;Ill'" -r;Av "'1"" ... -..;' - .. ..-,,, .i1lI1. ""...: ~..~ ....., .,.... ~ J' l1 E S U ~ ~ .~!:.:i~ . 001.8 :' ,,) .. TOTHE~ ORDER ,{)F ~- l' 01~~ ~ ~r~r, _ G'~.pb""~f....' ~ .. .:"'.....(.(...1 'l::In..(lu.'I.,I~~:I::r.,...'"'t;:l..J:1.."j::llI..I:~I.I.I":..1:.:.I:I:::t....,.....:;;I:::I:I~.I:II..h'.r.'(fl::llIIt....,..,:.1:1:r.,.~'.'.I":.:I::r.' II-ODD rOB ~II- I:O:li bO? b .501: b 200:li ~ 2:1i :liB II- ~r" Estate of Jane Sipe c/o Sharyn Garcia P. O. Box 274 Camp Hill, PA 17001-0274 Sharyn Garcia RE: Estate Administration TOTAL PROFESSIONAL FEES Skarlatos and Zonarich LLP 17 S Second St, 6th Floor Harrisburg Pennsylvania 17101 Telephone (717) 233-1000 Fax (717) 233-6740 INVOICE SUMMARY TOTAL EXPENSES MADE TO YOUR ACCOUNT TAXES PAYMENTS AND CREDITS PREVIOUS BALANCE TOTAL BILL AMOUNT FOR INVOICE # 40993 INTEREST ON OVERDUE BALANCE PLEASE PAY THIS AMOUNT (Please see attached invoice detail) January 25, 2007 File #: SIPEJ0601 Inv #: 40993 $112.50 $0.00 $0.00 $0.00 $112.50 $856.56 $0.00 $969.06 A I 1/12% PER MONTH REBILLING CHARGE WHICH IS AN ANNUAL RATE OF 18% WILL BE APPLIED AFTER 30 DAYS. FEDERAL I.D. #25-1839294 PLEASE INDICATE YOUR INVOICE NUMBER ON YOUR REMITTANCE INVOICE DETAIL Estate of Jane Sipe c/o Sharyn Garcia P. O. Box 274 Camp Hill, PA 17001-0274 Attention: Sharyn Garcia RE: Estate Administration DATE DESCRIPTION HOURS RATE SIPEJ060 1 40993 2 AMOUNT Sep-15-06 BMW Review of accounting and draft tax return; call to executor to review changes 0.50 Professional Fees EXPENSES: Total Expenses Total Taxes Charged Total due this invoice Previous Balance Payments received on previous balance Interest due on overdue balance Please Pay This Amount $225.00 $112.50 A 11/2% PER MONTH REBILLING CHARGE WHICH IS AN ANNUAL RA TE OF 18% WILL BE APPLIED AFTER 30 DA YS. FEDERAL I.D. #25-1839294 SIPEJ0601 PLEASE SEE PREVIOUS PAGE FOR YOUR BALANCE DUE. $112.50 $0.00 $0.00 $112.50 $856.56 $0.00 $0.00 $969.06 ------------ ---------- ... ~ ~ -- , .~ ~ -- , .~ ~ .-. , P l.....'_-"< C::i _ (".-- r c.:5 l' , ce' .~ ~ .---- .-.. ;.,. .~: ..... =:< - ... - :- --- --- -= .. - - - - - -. - :: - :: .. - - .. .. - ::::: ' - - ~ - - ~ I)' .~ '" -~ ; ...... w N 0... M O::~ c;::.:...... :l:~ 0-'- [L ee Ci c r-- c::::> = C'.l ... 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