The URL can be used to link to this page

Home My WebLink About03-12-07 -.J 15056041147 REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes PO BOX.280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code vear File Number .. INHERITANCE TAX RETURN RESIDENT DECEDENT 2 1 0 5 0838 Date of Birth 193129434 07072005 12031920 Decedent's Last Name Suffix Decedent's First Name RICHARDSON JACK MI W (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 [!J 1. Original Return D 2. Supplemental Return D 3. Remainder Return (date of death prior to 12-13-82) D 4. Limited Estate D 4a. Future Interest Compromise D 5. Federal Estate Tax Return Required (date of death after 12-12-82) [R] 6. Decedent Died Testate [!] 7. Decedent Maintained a Living Trust 1 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) D 9. Litigation Proceeds Received D 1 0 Spousal Poverty Credit (date of death D 11. Election to tax under Sec. 9113(A) . between 12-31.91 and 1-1-95} (Attach Sch. 0) ~ORRESPONDENT . THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: ame Daytime Telephone Number DONNA M. MULLIN ESQ. 7175333280 Firm Name (If Applicable) JAMES, SMITH, DIETTERICK & (") r".) "-, REGISTER OF:wJLLS USe:-ONL Y -- ,., " . ~.'."'" :':::! First line of address 134 SIPE AVENUE -r, Second line of address r,) HUMMELSTOWN State PA DATE FILED co City or Post Office ZIP Code 17036 Correspondent's e.mail address: d m m @j s d c. com James W. Richardson 3--q.c) I ADDRESS 51 Tuscany Court, Camp Hill, PA 17011 SIGNA RE OF PREPA?Jn~T~E ADDRESS Donna M. Mullin Esq. DATE 3- q-c.l7 134 Sipe Avenue ,Hummelstown, PA 17036 L Side 1 15056041147 15056041147 -.J~ --.I 1505b042148 REV-1500 EX Decedent's Name: J a c k W. R i c h a r d son Decedent's Social Security Number 193129434 RECAPITULATION 1. Real Estate (Schedule A).......................................................................................... 1. 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. 8. Total Gross Assets (total Lines 1-7)....................................................................... 8. 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. 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. 14. Net Value Subject to Tax (Line 12 minus Line 13)................................................. 14. TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, of transfers under Sec. 9116 (a)(1.2) X .00 16. Amount of Line 14 taxable at lineal rate X .045 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 15. 786,133.93 16. o . 00 17. o . 0 0 18. 19. Tax Due.............................. ...... ................................................................................. 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. L Side 2 15[]5b[]42148 11,065.36 796,169.17 807,234.53 14,967.00 6,133.60 21,100.60 786,133.93 786,133.93 o . 0 0 35,376.03 0.00 o . 0 0 35,376.03 D 15[]5b[]42148 --.I REV-1500 EX Page 3 Decedent's Complete Address: File Number 2005-00838 DECEDENT'S NAME Jack W. Richardson STREET ADDRESS 20 North 12th Street, Apt. 104 Essex House CITY I STATE IZIP lemoyne PA 17043 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 35,376.03 0.00 3. InteresUPenalty if applicable D. Interest E. Penalty Total Credits (A + B + C) (2) 0.00 TotallnteresUPenalty (D + E) 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 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) (4) (5) (5A) (5B) 35,376.03 35,376.03 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS [!] [!] D [!] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 1. Did decedent make a transfer and: a. retain the use or income of the property transferred;.................................................................................. b. retain the right to designate who shall use the property transferred or its income;.................................... c. retain a reversionary interest; or.................................................................................................................. d. receive the promise for life of either payments, benefits or care?.............................................................. 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.... .................................................................................................................. Yes [!] [!] [!] [!] No D D D D 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?........ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ............................................ ........................ .................................................. D D 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 exemot 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-1508 EX+ (6.98) *' SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Richardson, Jack W. FILE NUMBER 2005-00838 ESTATE OF Include the proceeds of litigation and the date the proceeds were received by the estate. All property ]olntly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION 1 Coins - valued per letter dated 03/17/06 VALUE AT DATE OF DEATH 666.20 2 1999 Dodge Caravan SE - valued per sales price 5.600.00 3 Conway National Bank account - valued per letter dated 9/7/05 201.57 4 Pinnacle Health Emergency Dept. - refund of patient account 40.41 5 Pinnacle Health System - refund of patient account 36.45 6 PNC Bank Checking Account No. 514024941 - valued per letter dated 8/15/05 4,520.73 TOTAL (Also enter on Line 5, Recapitulation) 11.065.36 (If more space is needed. additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-1510 EX+ (6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Richardson, Jack W. FILE NUMBER 2005-00838 ESTATE OF This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. 1 Matthew Richardson - cash gift on 01/24/05 5.000.00 3.000.00 2.000.00 2 Janney Montgomery Scott Account No. 405.622.77 100.000 0.00 405.622.77 3183-7817 - titled in the Jack W. Richardson Irrevocable Trust dated 2/23/2005 - valued per date of transfer (6/22/05) 3 Janney Montgomery Scott Account No. 328.614.69 100.000 0.00 328.614.69 6967-4257. titled in the Jack W. Richardson Living Trust dated 7/29/1997 - valued per letter dated 8/1/05 4 Sale proceeds of real estate located at 774 59.931.71 100.000 0.00 59.931.71 Allenview Drive, Upper Allen Township, Cumberland County, PA. 1/2 interest titled in the Jack W. Richardson Living Trust dated 7/29/1997 - sale was on 6/14/05 (less expenses to repair property); proceeds check not cashed at death TOTAL (Also enter on Line 7, Recapitulation) 796.169.17 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA.1500 Schedule G (Rev. 6-98) 'r-,f~'~1t:''':!:''''''~~~~ REV-1151 EX+ (12-99) . SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Richardson, Jack W. Debts of decedent must be reported on Schedule I. FILE NUMBER 2005-00838 ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached 6,650.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) I EIN Number of Personal Representative(s): Street Address City State Zip - Year(s) Commission paid 2. Attorney's Fees James, Smith, Oietterick & Connelly 8,000.00 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 87.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 230.00 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 14,967.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1502 EX+ (6-98) . SCHEDULE H.A FUNERAL EXPENSES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Richardson, Jack W. FILE NUMBER 2005-00838 ITEM NUMBER DESCRIPTION AMOUNT 1 Richardson Funeral Home, Inc. - funeral services 6.650.00 Subtotal 6.650.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-98) Rev-1502 EX+ {6-9B} *' SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Richardson, Jack W. FILE NUMBER 2005-00838 ITEM NUMBER DESCRIPTION AMOUNT 1 James, Smith, Dietterick & Connelly, LLP - reservation for estate/trust adminsitration closing costs 200.00 2 Register of Wills, Cumberland County - filing fee for Inventory and Return 30.00 Subtotal 230.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) Rev-1512 EX+ (6-98) '* SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Richardson, Jack W. FILE NUMBER 2005-00838 Include unreimbursed medical expenses. ITEM . NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 AAA Financial Services - credit card bill - medications 1.026.13 2 AARP Health Care 141.25 3 AARP Health Care 141.25 4 Associated Cardiologists, PC - unreimbursed medical bill 160.00 5 Department of Veterans Affairs - unreimbursed medical bill 21.00 6 Essex House Independent Senior Living - monthly rent 3.090.00 7 James W. Richardson - reimbursement for power assist lift chair 1.045.00 8 Kim Hershey - payment for medical assistance 140.00 9 Kim Hershey - payment for medical assistance 280.00 10 Verizon Wireless - final cellular service bill 88.97 TOTAL (Also enter on Line 10, Recapitulation) 6,133.60 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV 1513 EX+ (9~O) . SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT El?TATE OF NUMBER Richardson, Jack W. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] 1 Sophie Clair Dimich Step-grandchild Specific 1,000.00 C/O Gregory Dimich bequest from 1932 Overland Ave., Apt. 201 Jack W. Los Angeles, CA 90025 Richardson 2 Philip K. Hensel IV Step-grandchild Specific 1,000.00 C/O Alexandra Hensel bequest from 1627 Green Street Jack W. Harrisburg, PA 17102 Richardson 3 Emily Potts Granddaughter Specific 90,000.00 9A Richland Lane bequest from Apt # 203 gift to Jack W. Camp Hill, PA 17011 Richardson 4 Jeremy E. Hensel Step-grandchild Specific 1,000.00 C/O Alexandra Hensel Bequest from 1627 Green Street Jack W. Harrisburg, PA 17102 Richardson 5 James Potts Grandson Specific 90,000.00 3748 Keystone Avenue bequest from Apt #203 gift to Jack W. Los Anaeles. CA 90034 Richardson See continuation schedule attached Continuation 603,133.93 Total 786,133.93 Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet FILE NUMBER 2005-00838 RELATIONSHIP TO DECEDENT Do Not List Trustee/sl SHARE OF ESTATE AMOUNT OF ESTATE (Words) ($$$) I. II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) SCHEDULE .. BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Jack W. Richardson 193-12-9434 07/07/2005 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) 6 Adam Richardson Grandson Specific bequest 30,000.00 1054 W. Barre Street from gift to Jack W. Baltimore, MD 21230 Richardson Irrevocable Trust dated 2/23/05 7 James W. Richardson Son 100% Residue of 543,133.93 51 Tuscany Court Estate/Living Trust Camp Hill, PA 17011 and Irrevocable Trust 8 Matthew Richardson Grandson Specific bequest 30,000.00 41 E. Randall Street from gift to Jack W. Baltimore, MD 21230 Richardson Irrevocable Trust dated 2/23/05 Total 603,133.93 1 INVENTORY REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA COMMONWEALTH OF PENNSYLVANIA COUNTY OF Cumberland James W. Richardson Personal Representative(s) of the Estate of } SS } File Number 2005-00838 Jack W. Richardson deceased, depose(s) and say(s) that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in ttie 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 outsidecof the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. ~~~, ..-J (~) I verify that the statements made in this Inven- } tory are true and correct. I understand that false state- ments herein are made subject to the penalties of 18 Pa.C.S. S 4904 relating to unsworn falsification to } authorities. . :.:_) . .',! ) ...c....l James W. Richardson i-' P'.J ~; 1"') ....1.... Attorney -- (Name) (Firm) (Address) (Telephone) Donna M. Mullin Esq. James, Smith, Dietterick & Connelly 134 Sipe Avenue 717 -533-3280 OJ (Supreme Court J.D. No.) 30392 DATE OF DEATH 07/07/2005 LAST RESIDENCE 20 North 12th Street, Apt. 104 Lemoyne, PA 17043 FIGURES MUST BE TOTALED DECEDENT'S SOC. SEC. NO. 193-12-9434 Personal Property Cash............................................................................................... Personal Property. ... ............ .................. ... ........ ........... ... ... ... ........ Stocks/Listed. ... ... ... ... ... ...... ...... ...... ...... ... ........ ... ........ ... ... ... .......... Stocks/Closely Held ... '" ... ...... ...... ...... ... .... .... ... ........ ................. .... Bonds.. ...... ... ... ............ ...... .... ... ... ...... ........ ... ........ ........... ...... ... ... ... Partnerships and Sole Proprietorships ..................................... Mortgages and Notes Receivable....... ........... ........... ......... ......... All Other Property. ......................................... ............................... 11,065.36 Total Personal Property........... ............. ....... .......... 11,065.36 Total Real Property........... ........ ......... ........ ............ Total Personal and Real Property......................... 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. (See 20 Pa. C.S. !j3301 (b)) Form RW-09 Rev. 10-13-2006 Cb INVENTORY REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA COMMONWEALTH OF PENNSYLVANIA } SS COUNTY OF Cumberland } File Number 2005-00838 DATE OF DEATH 07/07/2005 LAST RESIDENCE 20 North 12th Street, Apt. 104 Lemoyne, PA 17043 DECEDENT'S SOC. SEC. NO. 193-12-9434 Cash 1999 Dodge Caravan SE - valued per sales price 5.600.00 Coins - valued per letter dated 03/17/06 666.20 Conway National Bank account - valued per letter dated 9/7/05 201.57 Pinnacle Health Emergency Dept. - refund of patient account 40.41 Pinnacle Health System - refund of patient account 36.45 PNC Bank Checking Account No. 514024941 - valued per letter dated 8/15/05 4.520.73 Total Cash 11.065.36 (Attach additional sheets if necessary) Total Personal Property and Real Estate 11.065.36 1\\\1"-'-1\11111 1)11 1I11\I(k..\:: ((\".".1111 III' 1,\\ ()rIJ( 1\ J.S.).( March 9,2007 Glenda Farner Strausbaugh Register of Wills & Clerk of Orphans' Court 1 Courthouse Square Carlisle, PA 17013 THE ESTATE SECURITY FORMULA"" RE: ESTATE OF JACK W. RICHARDSON, DECEASED FILE NO. 2005-00838 Georgianna Quayle Paralegal gjq@jsdc.com Dear Ms. Snyder: Enclosed are the following documents to be filed in the above-referenced Estate: 1. An original and two (2) copies of the Pennsylvania Inheritance Tax Return. 2. An original and one (1) copy of the Inventory. 3. A check made payable to the "Register of Wills, Agent" in the amount of Thirty-Five Thousand Three Hundred Seventy-Six and 031100 Dollars ($35,376.03) representing the Pennsylvania Inheritance Tax due. 4. A check made payable to the "Register of Wills, Cumberland County" in the amount of Twenty-five Dollars ($30.00) representing the filing fee. Please time-stamp the additional copies of the Return and Inventory and return them to me in the enclosed self-addressed, stamped envelope. If you have any questions, please feel free to give me a call. Sincerely, JAMES, SMITH, DIETTERICK & CONNELLY, LLP JJLbt#)<~ GeorgiarMa J. Quayle /gjq cc: James W. Richardson 134 SIPE AVENUE HUMMElSTOWN, PA 17036 MAILING ADDRESS PO. BOX 650 HERSHEY, PA 17033 TOll FREE 1.800.942.3660 TEL. 717.533.3280 FAX 717.533.7771 www.jsdc.com Glenda Farner Strasbaugh Register of Wills and Clerk of Orphans' Court Marjorie A. Wevodau First Deputy Ki~S. Sohonage, Esq Solicitor Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX (717)240-7797 INVOICE Bill To: InvoiceN 0: Invoice Date: Estate of: Estate No: 1333 3/12/2007 RIa-IARDSON TACK W 21-05-838 MULLIN DONNA M 134 SIPE AVENUE CJ HUMMELSTOWN, P A 17036- Qty 1 Fee Description Additional Probate Fee Total $15.00 15.00 Total: $15.00 Checks should be made payable to the Register of Wills. Terms: Net 30. Please return one copy of this invoice with your payment. Thank you.