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Home My WebLink About05-30-07 -.J 15056051058 REV-1500 EX (06-05) PA Department of Revenue '* Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0001 ENTER DECEDENT INFORMATION BELOW Social Number Date of Death OFFICIAL USE ONL V ~?~nty(;(xje Year INHERITANCE TAX RETURN RESIDENT DECEDENT File Number 21 07 0216 Date of Birth 175-40-9999 0212612007 1012111947 Decedent's Last Name Suffix Decedent's First Name MI DIETZ BARBARA J (If Applicable) Enter Surviving Spouse's Information Below Last Name First Name MI .Spo~~~'s.~ocial~~CUrityNUrnber THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WillS FILL IN APPROPRIATE OVALS BELOW \:8) 1. Original Retum c::;) 4. Limited Estate c::;) 3. Remainder Retum (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required c::;) 2. Supplemental Return c::;) c::;) c:::> 4a. Future Interest Compromise (date of death after 12-12-82) c:::> 7. Decedent Maintained a Living Trust (Attach Copy of Trust) c::;) 10. Spousal Poverty Credit (date of death c:::> 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 [)aytirne-relep~on~t>I~rn.b~r., ., 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received --~- 8. Total Number of Safe Deposit Boxes c::;) John E. Slike : (717) 737-3405 First line of address l....-..-------..-..--.............--..-.......-.~--' REGISTER OF WILLS USE QNi.v . ~. I ~~ '.~ \ -< I c-.) E o [ i Firm Name SAlOIS, FLOWER & L1NDSA 2109 Market Street Second line of address State ZIP Code DATE FILED ........................;.,.,.......::.:,,4............. cs i ..........J o 17011 , _...~ Correspondent's e-mail address:jeslike@sfl-Iaw.com Under penalties of pe~ury, 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, and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. PERSON ~PONSIB F R FILING RETURN DA} II 7 tket Street, Camp Hill, PA 17011 E OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 ...J L 15056051058 ....J REV-1500 EX Decedent's Name: BARBARA RECAPITULATION 15056052059 Decedent's Social J DIETZ 175-40-9999 1. Real estate (Schedule A). .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 0.00 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. 11,899.90 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . . . 3. 0.00 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. 0.00 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . . . 5. 9,038.91 6. Jointly Owned Property (Schedule F) <=> Separate Billing Requested . . . . . . . 6. 12,516.23 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) <=> Separate Billing Requested. . . . . . . . 7. 0.00 8. Total Gross Assets (total lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 33,455.04 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . . . 9. 3,016.07 10. Debts of Decedent, Mortgage liabilities, & liens (Schedule I). . . . . . . . . . . . . . . . 10. 698.02 11. Total Deductions (total lines 9 & 10). . . . . . .. . . . . . .. . . . . . . . . . . . . .. . . . . . . 11. 3,714.09 12. Net Value of Estate (line 8 minus line 11) . . . . . . . . . . . . . . .. . . . . . . . . . . . .. . 12. 29,740.95 13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. 0.00 14. Net Value Subject to Tax (line 12 minus line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14. 29,740.95 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 .0_ 16. Amount of line 14 taxable at lineal rate X.O 45 17. Amount of line 14 taxable at sibling rate X .12 18. Amount of line 14 taxable at collateral rate X .15 m 15. 16. 1,338.34 17. 18. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 1,338.34 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 '* Side 2 15056052059 --.J REV-1500 EX Page 3 Decedent's Complete Address: DECEDENTS NAME BARBARA J DIETZ STREET ADDRESS 1 LongsdorfWay, Cumberland Crossings DECEDENTS SOCIAL SECURITY NUMBER 175-40-9999 CITY Carlisle STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2 line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 1,338.34 1,291.05 66.92 Total Credits (A + B + C ) (2) 1,357.97 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( 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, Une 20 to request a refund. (4) 19.63 5. If line 1 + line 3 is greater than line 2, enter the difference. This is the TAX DUE. B. Enter the total of line 5 + 5A. This is the BALANCE DUE. (5) (5A) (5B) A. Enter the interest on the tax due. 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;.......................................................................................... 0 [i] b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 [i] c. retain a reversionary interest; or.......................................................................................................................... 0 [i] d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [i] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 [i] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 [i] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 [i] 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 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 ofthe 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+ (6-9* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF Barbara J. Dietz FILE NUMBER 21-07-0216 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 property which Is jolntly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. None. VALUE AT DATE OF DEATH DESCRIPTION TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0.00 REV-1503 EX+ (6-96* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Barbara J. Dietz FILE NUMBER 21-07-0216 All property jolntly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION 85.792 shares of PPL common stock @ 36.5024 per share Vanguard 500 Index Fund, 65.523 shares @ 133.82 per share 2. TOTAL (Also enter on line 2, Recapitulation) (If more space is needed, insert additional sheets of the same size) REV-1507 EX+ (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE ESTATE OF Barbara J. Dietz FILE NUMBER 21-07-0216 ITEM NUMBER All property jolntly-owned with right of survlvol'$hlp must be disclosed on Schedule F. DESCRIPTION None. TOTAL (Also enter on line 4, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0.00 REV-1508 EX+ (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Barbara J. Dietz FILE NUMBER 21-07-0216 Include the proceeds of litigation and the date the proceeds were received by the estate. All property Jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 . Cumberland Crossings - resident's cash fund 167.40 2. Diakon Lutheran Ministries - resident's refund 384.31 3. PA Employee's Benefit Trust Fund 4. Fulton Bank account 6,460.40 2,002.00 5. IRS 2006 Income Tax refund TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-1509 EX+ (6-98. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF Barbara J. Dietz FILE NUMBER 21-07-0216 If an as..t 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. Berniece Dietz 1 LongsdOrfWay, Cumberland Crossings, Carlisle, PA 17013 Mother B. C. JOINTLY-OWNED PROPERTY: DATE OF DEATH VALUE OF ASSET 2. A. DATE MADE JOINT prlor to '05 prior to '05 DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. LETTER ITEM FOR JOINT NUMBER TENANT 1. A. Northeast Investors Trust States Savings Bonds ,719.66 TOTAL (Also enter on line 6, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 12,516.23 REV-1510 EX+ (6-98* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF Barbara J. Dietz FILE NUMBER 21-07-0216 ITEM NUMBE 1. None. 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. DESCRIPTION OF PROPERTY INCLUOE THE NAME Of THE TRANSFEREE. THEIR RELATIONSHIP TO OECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. TAXABLE VALUE EXCLUSION TOTAL (Also enter on line 7 Recapitulation) (If more space is needed, insert additional sheets of the same size) 0.00 REV-1511 EX+ (12-99>. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Barbara J. Dietz FILE NUMBER 21-07-0216 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT 1. FUNERA~ EXPENSES.: Myers-Harner Funeral Home, Camp Hill, PA - balance due B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions 1,000.00 Name of Personal Representative(s) E. Slike Social Security Numbe~s)/EIN Number of Personal Representative(s) Street Address 21 09 Market Street City Camp Hill Year(s) Commission Paid: 2007 (est.) StatePA Zip 17011 2. Attorney Fees - SAIDIS, :FI.CmER & LINDSAY (est.) 1,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent 5. Accountant's Fees 4. Probate Fees (est.) 6. Tax Retum Preparer's Fees - Masland & Barrick 7. Estate notices TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF Barbara J. Dietz FILE NUMBER 21-07-Q216 Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death, Including unrelmbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Lancaster HMA Physicians - medical bill 3. West Shore EMS - transportation 2. Continuing Care RX - prescriptions 4. Philhaven - medical bill 5. Carlisle Neurocare - medical bill 6. MSHMC Physicians - medical bill TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheels of the same size) 698.02 REV-1513 EX+ (9-00) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Barbara J. Dietz NUMBER I NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Berniece Dietz, Cumberland Crossings. Carlisle, PA 17013 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) 1. Mother 2. D. Stoner Dietz, Cumberland Crossings, Carlisle, PA 17013 Father FILE NUMBER 21-07-0216 AMOUNT OR SHARE OF ESTATE 50% + joint property 50% 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 None. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS None. 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)