HomeMy WebLinkAbout09-20-07
717-737-3407 SAIDIS SHUFF FLOWER
848 P02
JUN 07 '07 10:55
-I
15D5bDIf:L:L&l7
REY-1100 EX (06-05)
PA Department of Revenue
Bureau of Individual TaXAls~_
PO B0X280801 ~
HarriSburg, PA 17128-0601
ENTER DECEDENT IMFORMA11ON SaLOW
Social Security Number Date of Death
OFFICIAL USE ONLY
county Code YllIlr
INHERITANCE TAX RETURN
RESIDENT DECEDENT 2 1 0 5
FIe NurnI:Hii
0996
Date of Birth
174201560
09182005
0618J.927
Decedent's Last Name
SUffix
DeaecJent's First Name
MAR~
MI
C
MCKILLIP
(If Applicable) Enter Surviving spouse'l$ Information Below
Spouse's L.ast Name
Suffix
spouse's First Name
Ml
spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THe
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
IXI 1. Original Retum I I 2. Supplemental Return I' 1 s. Remainder Retum (date of death
prior 10 12-13-82)
I 4. Limiled e,tate I I 4a FIlIUr9In1er8&I ~ I. I 5. Fede/lll Estete Tax Reil.lm Required
, .J . (da1~ 01 de8llI after 12.12082)
Ixl 6 IJecslle'It 0lI!Id Testate /'''1 7 DecsdentMi~alM1DTIUSI 0 8. Total Number of Safe Dspo&it Boxes
. lA\tiJd'l COPY or W1II) . (A1tlldI COpy of )
] I 9. Litigation F'raceells FleQllivsd 1_ 1 10 S~~C!edl~dal'of~ \ I 11. Election to lax under Sec. 911 $(A)
. ~ 12-31 and .1.95) (A1teoh Sch. 0)
aOftRESPONDENT . THIS SECTION MUST iii! COMPLe1'ED. AlL COAAESPONDENCE AlIID CONFIDENTIAL TAX INFORMATION SHOULD BE DIREClED 10:
ame Daytime Telephone Number
GEORGE F. DOUGLAS III 717243~22 ~~;
,=;o ~
----, ]
Finn Name (If Applicable)
SAlOIS, .Tnnf!ll,
FLOWER &I
lJ N OSA.'f
REGISTER OF~l LIt US~L Y ,-,-'
"I'~ V (
-..m 1".,)
> :/3 ;.l.J 0
First line of addreea
26 WEST HIGH STREET
;- )
-r1
;,j
Second line of addre5$
(,0
..-
DATE FILED
city or Post OI'fIce
CARLISLE
State
PA
ZIP Code
17013
Correspondent's HTlall addl'8lls:
Under penaltles of P.8I1ury, I declel'll thallllave eIQIminscl thiS return, including accom~nying sc:heclulsE and statemen1E. and to the best of my ~ an" belief,
Ills IIW, CllfI9Ct and eomplete. DIIclarallon of preparer olher than II'MI personllll'llpresentallve is b8$8d on all information of which preparer hIlS any knoWledge.
SIGNATURe OF P!;RSON RESPONSIIJU< FOR !"ILlNG RImIRN OA TEl (
~C.~..lJ}fnA..-W, ~~ Lana ProvilZZO 1 E:''lI.Ci!..<':,U\.<!-''''',,, <t '2..9 01
ADOFIeSS ~
::-:-=
26 Old Stone House Road, Carlisle, PA 17013
SIGNATURE OF PREPARER OTHER N FlEPI'tESENTA.TIVE
George F. Douglas III
Df..E
Cf.17-~ {tJ7
26 West High Street, Carlisle, PA 17013
I
'1.. II:nI:LnU'l'1.U"
1505L.DlflJ."?
.-J
j
Side 1
717-737-3407 SAIDIS SHUFF FLOWER
..J
1505'-DII23,1I6
REV-1500 EX
0ecedIlr\I'S NImI; Mary C. M c K III i p
-- --....
RECAPITULA1lON
1. Real Estate (Schedule A).......................................................................................... 1.
2. Stocks and Bonds (Schedule B)............................................................................... 2.
3. Closely Held Corporaaon, Partnership or Sole-Proprietorship (Schedule C).......... 3.
4. Mortgages Be Notes Receivable (Schedule 0).......................................................... 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E)................ 5.
6. JoinUy Owned PrOperty (Schedule F) U Separate BlUing Requested............. 6.
7. Inllar-VIVOS Transfers & Miscellaneous Nol}.Probate Propel'ty
(SChedule G) r I 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 Uabilities. & liens (Schedule I)................................ 10.
11. Total DeduGtiOn5 (total Un~ 9 & 10}...................................................................... 11.
12. Net Value of EstIte (Une 8 minus Une 11)............................................................. 12.
13. Charitable and Governmental BequestslSec 9113 Trusls tor whIch
an election to lax has I'lot been made (Schedule J)................................................. 13.
14. Net Value Subject to Tax (Une 12 minus Line 13)................................................. 14.
...--...-. -- -- --~ .------. .-- ......
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPUCABLE RATES
15. Amount of l.ine 14 taxable
at the spousal lax rate. of
transfers under Sec. 9116
(a)(1.2) X ~
16. Amount of Line 141axl!lble
at lineal rate X .045
17. Amount of Une f4"i8Xable
at sibling rate X .12
18. Amount of Wne 14 taxable
at collateral rate X .15
0.00
15.
0.00
16.
0.00
17.
93,146.24
18.
19. Tax Due...... ..................................... ..................... ..... ................... ........... ........... ....... 19.
20. FILL IN THE OVAl IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
L
J.,SDSl:.OlJ2:L&fA
848 P03
JUN 07 '07 10:56
Decedent's Social Security NUmber
174201560
89,530.00
1,494.30
7,158.00
409.27
98,591.57
4,375.33
1,070.00
5,445.33
931146.24
93,146.24
0.00
0.00
0.00
13,971.94
13,971.94
o
J.SDSbDIfi:!Jrlf6
..J
717-737-3407 SAIDIS SHUFF FLOWER
848 P04
REV.1500 EX PagEl 3
Decedent's Comple~e Address:
DECEDENT'S NAME
Mary C. McKillip
STREet ADORESS . ....
10 BrIan Drive
File Number 21..05-0996
c'rrY
I sTATE PA IZIP'
Tax Payments and Credits:
1. Tax Due (Page 1 Wne 19)
2. CreditsJPayments
A. Spousal Poverty Credit
e. Prior Pa~nts
C. Discount
(1)
14,400.00
0.00
3. Interest/Penalty If applicable
D. Interest
E. Penally
Total Credits (A + B + C)
(2)
TotallnterestJPenalty (0 + E)
4. If Line 2 is greater than Line 1 + Une 3, enter the difference. TI'lis Is the OVERPAYMENT.
Check box on Page 2 LIne 20 to I"eql1e5t a refund
5. If Line 1 + Line 3 is greater than Une 2, enter the difference. This is the TAX DUE.
A. enter !he interest on the tax due.
B. enter the lntal of Line 5 + SA. This is !he BALANCE DUE.
(3)
(4)
(5)
(5A)
(5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
JUN 07 '07 10:56
13,971.94
14,400.00
428.06
PLEASE ANsweR THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a ttansfer and; Yes
a. retain the use or income of the properly lranaferred;.................................................................................. II. I
b. retain the right to designale Who shall use the property transferred or its income:.................................... 1
c.. retain a reverslonary interest; or.................................................................................................................. I. 'l'l
d. receive the promise for life of eittler payments, benefits or C8r8?..............................................................
2. If death occulT8d after December 12. 1982, did deeedent transfer property within one year of death without
receilllng adequate consideratfon?...................................................................................................................... I.]
3. Did dececlent own an "In trust for" or payable upon death bank account or seourlt:y at hiS or her death? ......... I I
4. Did decedent own an Individual RelirementAccounl, annuity, or other non-probate property which
contains a beneficiary designalion?...................................................................................................................... I' j I x'l
IF THE ANSWER TONlY OF THE ABOVE QUEsnONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT M PART OF THE RETURN.
No
Ixl
r x.!
I.~,
IXI
lx/
I x: i
For dales 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 tlpouss is three (3) percent [72 P .S. t9116 (a) (1.1) Q)].
For dates of death on or after January 1, 1995. the tax rate imposed on the net value of transfers to or far the use of the surviving ~pouse is i:ero
(0) percent{72 P.S. fi9116 (a) (1.1) (II)). The statute does potexemota transfer to a SUrviving spouse from tax, and the statutory requirements
for disclosure of assels and fiUng a lax retum are still applicable even if the surviving spouse is the only beneficiary.
For dSle$ of death on Of after July 1. 2000:
The fax ratEllmposEld on the net value of transfers ft'om a deceased child twenty.one )IEIars of age or younger at death to or for tl'le use of fA
natural parent. an adoptive parent. or a .pparent of thea child is zero (0) percent 1.72 P.S. 99116 (8) (1.2)].
The tax rate imposed on the net value of1ransfers to or fer tile use of the decedent's lineal beneficiaries is four and one-half (4.5) percent,
except as noted in 72 P.S. 59116 1.2) {72 p.S. 59116 (a)(1)].
The tax rate Imposed on the net value ofttansfers to or for the U5Et of the deoeclenfs siblings is twelve (12) percentfl2 P.S. 59116 (a) (1.3)]. A
siblina Is defined under Section 9102. as an individual who has at least one parent In common with the decedent, whether by blood or adoption.
717-737-3407 SAIDIS SHUFF FLOWER
848 Pt35
JUN 07 '137 10:56
~5IlZ ex. tMII
'*'
.eMEDULI! A
REAL ESTATE
CllIIMONWSAI.'Itf OF I'ENNliYLvNM
IIIN!M'ANCET~ RE'T1JAN
RliIIlOIHT IlECEIlI!NT
McKillip, Mary C.
PILE NUMBER
21..05-0996
ESTATE OF
A111'8B1 proplJ\l owned IOI11y or illlI ..lit In cammon ~ _11IP0/tlld at air II1lIIMt ......... FelrlllllliGJt VlII\Ie Is IlIIIIned 86lhe pA 1II wlIIcII JllIlPIII\Y would be
~ "'-' ....ei'lQ ~BI1d. wili'lg sener. neIlIler lNlInII ~ 10 buy II' &eI, boll'I ha~1IlI ~ knt,Mtedge tAlIlB reIevlInl ~.
RelI pr..n:v wlllc:lll8 JOIl111y-owned with I'IOhl d aurvlvcll1lhIP nwst lie dIacI/owCI (lfIlleMCIUIe'.
ITEM
NUMBER DESCRIPTION
1 10 Brian Drive, Carlisle Borough, Cumberland Co., PA . valued based on county
tax assessment
VALUE AT DATE
OF DeATH
89.530.00
TOTAL (Also er'lt.r on Una 1, Recapitulation)
89.530.00
(If more 8Pl1QI;I i& 1IEIIIdeCl, additional ~ of tl'Ie same size)
Coovriaht le\ 2002 form software only The Lackner Group,lnc.
Fonn PA-1500 SChedule A (Rev. 6-98)
717-737-3407 SAIDIS SHUFF FLOWER
848 P06
JUN 07 '07 10:57
~5lI3 EX. (....1
.
.eH.DULI 8
STOCKS & BONDS
CQIUlNWEAl. 'I'H OF flall'IllYlvANIII
Nl!RITANCE TAX RETURN
RESIlENT llECEDl!1'IT
ESTATE OF
McKillip, Mary C.
FILE NUMBER
21-05.0998
All ~ jgI~1I8lI WIlli right Of $Ul'V\VllI&hlp "",st Il8 c111lClOAd on SCIIIClIIIe 1'.
ITEM cuSIP DESCRIPTION UNIT VALUE VALUE AT DATE
NUMBER NUMBER OF DEATH
1 30 shares Mat Life Trust at 49.81 per share 1.494.30
TOTAL (Also enter on Una 2, Recapitulation) 1.494.30
or
(If more &pace is needed, IIckfltianal pagN of the same slia)
r.nnvrinhl It:, ~002 form 50ftwilre only The Laelcner Group, Inc.
Form PA-1500 Schedule B (Rev. 6-96)
717-737-3407 SAIDIS SHUFF FLOWER
848 Pla7
JUN 07 '07 10:57
1blv-'I5118 EX. IH'l
'*
aCHEDULE E
CASH, BANK DEPOSITS. & MISC.
PERSONAL PROPERTY
cor.t.1ONWEAI.1M OF f'ENllliYLVNlIA
lNtfiIlTANCE TAX M'tUlN
RESBIT DlCl!IlErfT
McKillip, Mary C.
FILE NUMBER
21.05-0996
ESTATE OF
IncIUlIIllIIe proceeas at IIlIgsDcn in:l tile CIaIe !IIIl proceeds _ rceiYIIl by lhe esIaI8.
All PIVIl4Ifti jQlnIIyoOwllOd wUIIlM r1g1ll: of lul'llvlnhlp nlIJ$t lie dl8cloud on sehtdut. P.
ITEM
NUMBER DESCRIPTION
1 Vanguard Mutual Fund
VAL.UE AT DATE
OF DEATH
1,608.00
2 1996 Jeep, VIN 1~4FJ7856TL247736 - value based on Kelley Blue book value
3.750.00
3 household goods and furnishings
1.800.00
TOTAL (Also enter on Una 5, Recapitulation)
7.158.00
(If more I,Ipace i& needed. additional pages of the same size)
Copyright (0) 2002 fonn software only The Lackner Group, InC.
Form PAw1500 Schedule E (Rev. 6-98)
717-737-3407 SAIDIS SHUFF FLOWER
848 P08
JUN 07 '07 10:57
Rev-1S01 ex.. ,....,
*'
8CHI!DULE F
JOINTLY -OWNED PROPERTY
CQIIlICHWEAL 111 CfII1ENNS'1\VANIA
INHI!l'II'I'ANCt!TAX~
AUrJI!N'\'~
ESTATE OF
FILE NUMBeR
McKillip, Mary C. 21-05-0996
IF 1ft ...wu IIlIct.JGlm ",\11111'10/18 year Ofllle __MIl'5 *'" of dMtII, It muat be reparW CII\~" G.
SURVIVING JOINT TENANT(S) NAME
A. Lana Provazzo
ADDRESS
26 Old Stone House Rd.
Carlisle, PA
RELATIONSHIP TO DECEDENT
cousin
B.
c.
JOIN1'L Y OWNED PROPERlY:
L.Im'ER DATE DESCRIPTION OF PROPERTY %OF o.t. TE OF oeA TH
ITEM FOR JOINT MADE INCLUDE NAMe 01' ,.INANCIAL /NSTI1IJTION AND BANK ACCOUNT ~ATEOFOEA~ DECO'S VALUE OF
NUMBER NUMB&R OR SlMILAI't IDENTIFYING NUMBER. ATTACH oe.eo FOR A1.UE OF ASS Dt;CEDENrS INTEREST
TeNANT JOINT JOlNTL V-HElD REA\, ESTATE. INTEREST
1 A 8/28/2079 M&T Bank, joint checking acct. with 818.54 50.000% 409.27
Lana Provuzo
TOTAL (Also enter on Una 6, Recapitulation) 409.27
(H more &pace is needed. addJtlonlll pBgeS of the same size)
CopyrIght (e) 2002 form software only The Lackner Group, tnc.
Form PM500 Schedule F (Rev. 6-98)
717-737-3407 SAIDIS SHUFF FLOWER
848 P09
rUN 07 '07 10:58
REY-11S1 P+ 1'~oIIII)
.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEAL1H OF PENNSVLVANIA
'T~~
McKillip, Mary C.
Debts of deeectent must be reported on Schedule I.
FILE NUMBER
21-05..0996
ESTATE OF
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSeS:
See continuation schedule(s) attached 875.00
B. ADMINISTRAnVE COSTS:
1. personal Representative's Commissions
SoCial Securtty Nurnber(s) I EIN Number of Personal Representative(s):
SlrHt Address
City State ~ Zip
Year(s) Commission paid
2. Attorneys Fees 3,000.00
See continuation schedule(s) attached
3. Family Exemptioo: (If decedent's acldte6S is not the same as c1aimanfs, attach explanation)
Claimant
Street Address
CIty State Zip
Relationship of Claimant to Oececlent
4. Probate Fees 252.00
See continuation schedule(s} attached
5. Accountanfs Fees
6. Tax Retum Preparer's Fees
7. Other Administrative Costs 248.33
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 4,375.33
Copyright (0) 2002 form software only The Lackner Group, Ino.
Form P,,",1500 Schedule H (Rev. 6-98)
717-737-3407 SAIDIS SHUFF FLOWER
848 P10
JUN 07 '07 10:58
Rav.1soa EX+ (Me)
.
BeM.DULI H-A
FUNERAL EXPENSES
continued
~1HOF PENNSVl.\lANIA
IlIHIiIIITANCETAl(/Ii'l\IflH
REUlENT DECEDENT
ESTATE OF
McKillip, Mary C.
FILE NUMBER
21-05..0996
ITeM
NUMBER DESCRIPTION
1
Eby GranIte Works, marker
AMOUNT
350.00
2
Hoffman..Roth Funeral Home
526.00
Subtotal
875.00
Copyright (0) 2002 fonn software only The Lackner Group, Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
717-737-3407 SAIDIS SHUFF FLOWER
848 P11
JUN 07 '07 10:58
Rev-1&O:1U+ (WI)
.
SCHEDULE H-82
ATTORNEY'S FEES
continued
lXIINJNWEAL1'I1 Of PeHHSYLVIM'I
MI!Illll'ANCl! TAX ftElUIlH
RfSIDENT IlECSllM"
ESTATE OF
McKillip, Milry C.
FILE NUMBER
21..05..0996
ITI!M
NUMBER OeSCRIPTION
1 saidis, Shuff, Flower & Lindsay
AMOUNT
3,000.00
Subtotal
3,000.00
CODvrlaht (0) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B2 (Rev, 6-98)
717-737-3407 S~IDIS SHUFF FLOWER
848 P12
JUN 07 '07 10:58
R8W15fl:l EX+ (WI)
.
SCHEDUU H~"
PROBATE FEES
continued
COMMONWEALTH ~ I'l!NNlYLVANIA
tlERlTANCf TAXRe'I\IRN
IlIiSJlliNT 0ECliI.1liMT
ESTATE OF
McKillip, Mary C.
FILE NUMBER
21-GS-0996
ITEM
NUMBER
1
DESCRIPTION
AMOUNT
Cumberland County Register of Wills
252.00
Subtotal
252.00
Copyright (c) 2002 foIm software only The Lackner Group, Inc.
Form PA-18DO Schedule H-B4 (Rev. 6-98)
717-737-3407 SAIDIS SHUFF FLOWER
848 P13
JUN 07 '07 10:59
""'4_ EX"'IMII
.
.eM.DULI: H.87
OTHER
ADMINISTRATIVE COSTS
continued
COIolhfOHWIiIlLTH C1F _~VANM
IHiRlTANCE TAX RETURN
IlSllIlBIl' .-:eeNT
McKillip, Mary C.
FILE NUMBER
21.05..0996
ESTATE OF
ITEM
NUMBER DESCRIPTION
1 Cumberland Law Journal.. estate ad
AMOUNT
75.00
2 The Sentine .. e.tate ad
173.33
Subtotal
248.33
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA--1500 Schedule H.B7 (Rev. 6-98)
717-737-3407 SAIDIS SHUFF FLOWER
848 P14
JUN 07 '07 10:59
Rtv-1S1Z a.'....,
.
SCHI!DULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COUIONWEAL 1H OF PENNS'I\.VAIlIA
INH/!RIl'NlCI! TAX IlETIJIIN
IWIlCfHl'DfCEl)I!rlIT
ESTATE OF
McKillip, Mary C.
FILE NUMBER
21-05-0996
1ndud9 unNIIIdIunI8d IlI8lIIcaI 8Xp11n$_
ITEM
NUMseR DESCRIPTION
1 Vlaa balance (aect. #4888 6031 3031 4057)
VALUE AT DATE
OF DEATH
1.070.00
TOTAL (Also ent.r on line 10, Recapitulation)
1,070.00
(If more BpIlOe Is needed. additional page& Df the &Sma size)
Copyright (c) 2002 form soflwaI'e only The L.ackner Group, Inc.
FOnn PA.11500 Schedule J (Rev. 6-98)
717-737-3407 S~IDIS SHUFF FLOWER
848 P15
JUN 07 '07 10:59
RSV-l'fnx.. IUD)
.
8CHIIDULE .J
BENEFICIARIES
COMMONWEAlTH OF P&JI/NSYLVAHfA
INHERITANCE TAX RETURN
RliSJO&NT O&C&OENT
ESTATE OF
1
McKillip, Maf'Y C.
NAME AND ADDRESS OF
PERSON(S} RECElVI~G PROPERTY
TAXABLE DISTRIBUTIONS Undud& OUll'lght spousal
itistribuUons and transfers
under Sec. $l116(a)(1.2)]
Lana Provazza
26 Old Sto"e House Rd.
Carlisle, PA 17013
RELATIONSHIP TO
DECEqENT _
DoHotUlt~a)
FILE NUMBER
21.()S-Q996
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
NUMBER
I.
Cousin
entire estate
Total
Enter dollar amouns for disbibutions shown above on lines 5 throuah 18, as SpOroPI ate. on Rev 1500 cover sheet
U. NON-TAXABLE DISTfUSUTIONS;
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- E~R TOTAL NON-TAXABL.E 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. 5w9B)