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REV.1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21 06
COUNTY CODE YEAR.
.---.-------,-----
SOCIAL SECURITY NUMBER
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 2l106O'
HARRISBURG, PA 17128-0601
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Trees, Edward J.
DATE OF DEATH (MM-DD-YEAR)
DATE OF BIRTH (MM-DD-YEAR)
,06/20/2006 11/17/1924
~PPLlCABlE) SURVIVING SPOUSE'S NAME ( LAST. FIRST AND MIDDLE INITIAL)
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1. Original Return
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ll: ~ 12 i 0 4. Limited Estate
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rh Ii Gregory M Kerwin
~ ~ IRM NAME (If applicable)
8 2 Kerwin & Kerwin
~lEPHONENUMBER.
717/362-3215
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1. Real Estate (Schedule A)
2. Supplemental Return
OFFICIAL USE ONLY
189-18-5315
00571
NUMBER
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF Wt~~~__ _____
SOCIAL SECURITY NUMBER
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3. Remainder Retum (date of death prior to 12-13-82)
6. Decedent Died Testate (Attach copy
of Will)
9. Litigation Proceeds Received
4a. Future Interest Compromise (date of daath
after 12-12-82)
7. Decedent Maintained a Living Trust (Attach
copy of Trust)
10. Spousal Poverty Credit (date of death between
12.31.91 1-1-95
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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2. Stocks and Bonds (Schedule B)
3. Closely 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)
5. Federal Estate Tax Return Required
COMPLETE MAiliNG ADDRESS
4245 Route 209
Elizabethville, P A 17023-9765
OFFICIAL USE ONLY
(1 ) None
(2) None
(3) None
(4) None
(5) 7,455.76
(6) None
(7) 8,286.14
(9) 7,799.00
(10) 15,381.41
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15,741.90
23,180.41
(12)
insolvent
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
I 14. Net Value Subject to Tax (Line 12 minus Line 13)
--t--
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(13)
(14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax rate,
or transfers under Sec. 9116(a)(1.2)
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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
19. Tax Due
x .00
(15)
x .045
(16)
x .12
(17)
x .15
(18)
(19)
CHECK HU~E IF YOU ARE RE QUES T1NG A RFFUND OF AN OVE,RPAYMEN I
20. 0
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Copyright 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
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'Decedent's Complete Address:
STREET ADDRESS
129 Henry Road
CITY
Enola
1STATE PA
I ZIP 17025
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
Total Credits (A + B + C)
(2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (0 + 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 reque.t 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) 0.00
(4)
(5) 0.00
(5A)
(5B) 0.00
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: Ye. No
a. retain the use or income of the property transferred;................................................................................ ~ I
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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?................................................................................................................... ~
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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?.................................................................................................................
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 pene~ies of perjury. I declare that I have examined this retum. Including accompenylng 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.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS
Patrlc:la A. Pay
DATE
3 Elm Street
Enola, P A 17025
-jo-o/
DATE
ADDRESS
ADDRESS
DATE
4245 Route 209
Elizabethville, PA 17023-9765
:$-1 ~007
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. 99116 (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)l. 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 retum 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. 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 .5. 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. 99116 (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.
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-
423 North Enola ROlld. Enolll, fA 17025
7177320765....7177326484
Jamie Myers
M&T Bank
Branch Manager
Swnmerdale Office
03/16/2007
Re: Edward J Trees
3 Elm Dr
Bnola Pa 17025
To Whom It May Concern:
Please note that the date of death balance for Edward J Trees in his M&T checking
account #86264966 as of June 22 2006 was $7455.76. This information was requested
by the ex.ecutrix of the estate accoWlt Patricia A Payne. Attached is the last statement of
Edward J Trees' account which indicates the above noted balance.
Any further questions or concerns feel free to contact me anytime at 717-255-2261.
Thank you for your time and consideration in thi5 matter.
incerely,
./~
Jamie Myer:;
.
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEAlTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIOENT DECEDENT
ESTATE OF T Ed d J
rees, war .
I FILE NUMBER
21 - 06 - 00571
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM
NUMBER
1
DESCRIPTION
VALUE AT DATE
OF DEATH
7,455.76
Checking account at M & T Bank, 86264966
423 North Enola Road, Enola, P A 17025
(see letter dated 3/16/07 attached hereto)
TOTAL (Also enter on Line 5, Recapitulation)
7,455.76
.
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Trees, Edward J.
FILE NUMBER
21 - 06 - 00571
ESTATE OF
ITEM
NUMBER
This schedule must be com
DESCRIPTION OF PROPERTY DATE OF DEATH % OF
Include the name of the transferee. their relationship to decedent and the date of transfer. VALUE OF ASSET DECO'S EXCLUSION TAXABLE VALUE
Allach a copy of the deed for real estate. I INTEREST (IF APPLICABLE)
Cash Value of life insurance policy
Peoples Benefit Life Insurance Company
surrendered 9/2/05; transferree - daughter,
Patricia A. Payne
11,286.14 100%
3,000.00
8,286.14
i
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TOTAL (Also enter on line 7, RecaPltulatlo~!
8,286.14
.
sctEDU.E H
RN:RALEXPENSES&
ADI\IWSTRATlVECOSTS
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I FILE NUMBER
21 - 06 - 00571
ESTATE OF T Ed d J
rees, war .
Debts of decedent must be reported on Schedule I.
ITEM I
NUMBER
A.
B.
DESCRIPTION
AMOUNT
2
FUNERAL EXPENSES:
Richardson Funeral Home - funeral
(prepaid by Patricia A. Payne out of funds listed on Schedule S,
Funeral luncheon - Patricia A. Payne
5,902.00
225.00
750.00
750.00
72.00
100.00
7,799.00
ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Patricia A. Payne
Social Security Number(s) I EIN Number of Personal Representative(s):
2.
Street Address 3 Elm Street
City Enola State P A Zip 17025
Year(s) Commission paid 2007
Attomey's Fees Kerwin & Kerwin -- Gregory M Kerwin
3. Family Exemption: (If decedent's address is not the same as claimant's. attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
State
Zip
4.
Probate Fees
Register of Wills
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
1
Other Administrative Costs
Reserve for closing costs
TOTAL (Also enter on line 9, Recapitulation)
*'
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABiliTIES, & LIENS
COMMONWEAlTH OF PENNSYLVANIA
INHERIT ANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Trees, Edward J.
I FILE NUMBER
, 21 - 06 - 00571
Include unrelmbursed medical expenses.
ITEM
NUMBER
1
DESCRIPTION
AMOUNT
14,940.13
Pennsylvania Department of Public Welfare - claim - see attached letter dated 6/20/06
2
Jewish Home, account payable
441.28
TOTAL (Also enter on Line 10, Recapitulation)
15,381.41
*'
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
DIVISION OF THIRD PARTY LIABILITY
ESTATE RECOVERY PROGRAM
PO BOX 8486
HARRISBURG. PA 17105-8486
August 28, 2006
PATRICIA A PAYNE
3 ELM DR
ENOLA PA 17025
Re: EDWARD TREES
CIS #: 750179496
SSN: 189-18-5315
Date of Death: 06/20/2006
Dear Ms. Payne:
Please be advised that the Department of Public Welfare is attempting to
recover the monetary value of any and all eligible assets in the subject
estate. Although the amount in the estate may be considerably less than that
which is owed to the Department, our cla~ is against the estate, no one
else. Your responsibilities, as the primary next of
kin/administrator/executor, is to advise the Department of any assets in the
estate and to insure that the remaining money, after all funeral and
administrative costs are deducted, is sent to the Department.
The Department of Public Welfare maintains a claim in the amount of
$14,940.13 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 $14,940.13, 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 $.00, is to be
entered as a priority Class 6 claim against the estate. ----
Please acknowledge receipt of this letter and advise 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.
Enclosure
j~:t}lrs~
~Ole L. Lipscomb
TPL Program Investigator
717-772-6606
717-772-6553 FAX
,EV.1513 El+ (9.00)
*'
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Trees, Edward J.
I FILE NUMBER
21 - 06 - 00571
RELATIONSHIP TO
DECEDENT
ft_ ..~
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I TAXABLE DISTRIBUTIONS (include outright spousal distributions)
.
Patricia A. Payne
3 Elm Drive, Enola, P A 17025
Daughter
2 Edward W. Trees
7 Accent Circle, Camp Hill, PA 17011
Son
3 Stephen J. Trees
6166 Spring Knoll Drive, Harrisburg, P A 17111
Son
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover shee
AMOUNT OR SHARE
OF ESTATE
1----------------
one-third
one-third
one-third
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 SHEE
KERWIN & KERWIN
ATTORNEYS AT lAW
4245 ROUTE 209
EUZABETIMUE. PA 11023
(111) 362.3215
(111) 896.9089
FAX (111) 362-4459
E-rn"il: lJ.J@epix.net
Pi....." R"ply To:
GOVERNORS' ROW
21 NORTH FRONT STREET
HARRISBURG, PA 11101
(111) 238-4165
FAX (11 1) 238.8455
PATRICK E. KERWIN (1913-1981)
GREGORYM. KERWIN - GMK@Kerwinlawlinn.com
TERRENCE]. KERWIN - KK@Kerwinl..wfinn.com
JOSEPH D. KERWIN - ]DK@Kerwinlawfinn.com
HOLLY McCLURE KERWIN - KK@Kerwinlawfinn.com
o EUZABETIMUE OFFICE
o HARRISBURG OFFICE
March 30, 2007
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013-3387
Re: The Estate of Edward J. Trees
Date of Death - June 20, 2006
Estate #2006-00571
PA #21-06-0571
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Dear Sir or Madam :
Please find enclosed herewith an Inheritance Tax Return and Inventory with respect to the above-
captioned estate for filing in your office. Also enclosed is a check in the amount of$25.00 for the filing fee.
The estate is insolvent.
Would you kindly time stamp the enclosed file copies and return them to me in the enclosed stamped,
self-addressed envelope?
As always, thank you for your help.
Very truly yours,
GMK:bmk
Enclosures
/~
ORY M. KERWIN
KERWIN & KERWIN
ATTORNEYS AT LAW
4245 ROUTE 209
EUZABETHVIUE, PA 17023
(717) 362-3215
(717) 896-9089
FAX (717) 362-4459
E-mail: lJJ@epix.net
p/tKU" R"p/y To:
GOVERNORS' ROW
27 NORTH FRONT STREET
HARRISBURG, PA 17101
(717) 238-4765
FAX (717) 238-8455
Cl EUZABETHVIUE OFFICE
Cl HARRISBURG OFFICE
PATRICK E. KERWIN (1913-1987)
GREGORYM. KERWIN - GMK@Kerwinl.wfirm.com
TERRENCE J. KERWIN - KK@Kerw;nlawfinn.com
JOSEPH D. KERWIN - JDK@Kenvinl.wfinn.com
HOllYMcCLURE KERWIN - KK@Kenvinl.wfinn.com
April 2, 2007
Register of Wills
Cumberland County Courthouse
Attention: Chris
One Courthouse Square
Carlisle, PA 17013-3387
Re: The Estate of Edward J. Trees
Date of Death. - June 20, 2006
Estate #2006-00571
PA #21-06-0571
Dear Chris :
As per your telephone call of April 2, 2007, please find enclosed herewith a check payable to the
Register of Wills in the amount of $5.00 representing the additional amount due on the above-captioned
estate.
Thank you for your help.
GMK:bmk
Enclosure
Very truly yours,
jI~ ryj^-,
GREGO~ M! KERWIN
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