HomeMy WebLinkAbout11-19-07
~
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 Year
INHERITANCE TAX RETURN 21 07
RESIDENT DECEDENT
File Number
0752
207037999
07162007
Date of Birth
07151909
Decedent's Last Name
WATSON
Suffix
Decedent's First Name
MARY
MI
K
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's L'3st 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
4. Limited Estate
o
o
o
o
4a. Future Interest Compromise
(date of death after 12-12-82)
2. Supplemental Return
o
o
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
o
[R]
o
6. Decedent Died Testate
(Attach Copy of Will)
7 Decedent Maintained a Living Trust
. (Attach Copy of Trust)
8. Total Number of Safe Deposit Boxes
g. Litigation Proceeds Received
10 Spousal Poverty Credit (date of death
. between 12-31-91 and 1-1-95)
o
11.Election to tax under Sec. 9113(A)
(Attach Sch. 0)
~ORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
ame Daytime Telephone Number
JERRY A. WEIGLE ESQUIRE 7175327388
Firm Name (If Applicable)
WEIGLE & ASSOCIATES, P.C.
126 EAST KING STREET
REGISTER OF WILLS USE.:PNL Y
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City or Post Office
SHIPPENSBURG
State
PA
ZIP Code
17257
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First line of address
Second line of address
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Correspondent's e-mail address:
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 infomnation of which preparer has any knowledge. '
SIGNATURE OF PERSON RESPON ISLE FOR FILING RETURN DATE
Phyllis W. Jumper
Jerry A. Weigle Esquire
L
Side 1
15056041147
15056041147
-.J
-1
15(]56(]42148
REV-1500 EX
Decedent's Name: Mary K. Watson
Decedent's Social Security Number
207037999
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) 0 Separate Billing Requested............. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) 0 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 ~
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
o . 00
15.
3,380.51
16.
o . 00
17.
o . 00
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
16,223.90
16,223.90
9,820.79
3,022.60
12,843.39
3,380.51
3,380.51
o . 00
152.12
o . 00
o . 00
152.12
D
15(]5b(]42148
-1
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-07 -0752
DECEDENT'S NAME
Mary K. Watson
STREET ADDRESS
122 Stillstown Road
CITY I STATE /ZIP
Newville PA 17241
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1 )
152.12
0.00
3. InteresVPenalty if applicable
D. Interest
E. Penalty
Total Credits (A + 8 + C)
(2)
0.00
TotallnteresVPenalty (0 + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is thEOVERPAYMENT.
Check box on Page 2 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE.
A. Enter the interest on the tax due.
8. Enter the total of Line 5 + 5A. This is theBALANCE DUE.
(3)
(4)
(5) 152.12
(5A)
(58) 152.12
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 ~
b. retain the right to designate who shall use the property transferred or its income;................................ 0 ~
c. retain a reversionary interest; or..........................................................................................__................ 0 ~
d. receive the promise for life of either payments, benefits or care?........................................................... 0 ~
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?.... .......... ..... ...................... ... .......... ..... .... .................. ............ ...... ....... ...... 0 ~
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... 0 ~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?..........................................................................................__.................... 0 ~
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. 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 zero
(0) percent [72 P.S. 99116 (a) (1.1) (ii)]. The statuta:foes not exemota 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. 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 four and one-half (4.5) percent,
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 twelve (12) percent [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.
Rev-15G8 EX+ (6-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Watson, Mary K.
FILE NUMBER
21-07-0752
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 DESCRIPTION VALUE AT DATE
NUMBER OF DEATH
1 Farmers National Bank of Newville Certificate of Deposit #162600 3.268.54
Accrued interest on Item 1 through date of death 121.05
2 Farmers National Bank of Newville Certificate of Deposit #172542 1.800.00
Accrued interest on Item 2 through date of death 33.30
3 Farmers National Bank of Newville Checking Acct. #183237 8.500.50
Accrued interest on Item 3 through date of death 0.51
4 1999 Ford Taurus stationwagon 2.500.00
TOTAL (Also enter on Line 5, Recapitulation)
16.223.90
(If more space is needed. additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 SCheduleE (Rev. 6-98)
REV-1151 EX+ (12-99)
*'
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRA TIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Watson, Mary K.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-07-0752
ITEM
NUMBER
A. FUNERAL EXPENSES:
DESCRIPTION
AMOUNT
See continuation schedule(s) attached
4,991.50
B.
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City
Year(s) Commission paid
State Zip
2.
Attorney's Fees
Weigle & Associates, P.C.
850.00
3.
Family Exemption: (If decedent's address is not the same as claimant's. attach explanation)
Claimant Phyllis W. Jumper
Street Address 122 Stillstown Road
City Newville
Relationship of Claimant to Decedent
3,500.00
State
daughter
PA
Zip
17241
4.
Probate Fees
Register of Wills, Cumberland County
98.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
Other Administrative Costs
See continuation schedule(s) attached
381 .29
TOTAL (Also enter on line 9, Recapitulation)
9,820.79
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 ScheduleH (Rev. 6-98)
Rev-1502 EX+ (6-98)
.
SCHEDULE H-A
FUNERAL EXPENSES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Watson, Mary K.
FILE NUMBER
21-07-0752
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Egger Funeral Home
4.991.50
Subtotal
4.991.50
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 ScheduleH-A (Rev. 6-98)
Rev-1502 EX+ (6-98)
.
SCHEDULE H-B7
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Watson, Mary K.
FILE NUMBER
21-07-0752
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Cumberland County Register of Wills - Family Settlement Agreement filing
75.00
2
Cumberland County Register of Wills - PA Inheritance Tax Return filing
15.00
3
Cumberland Law Journal - estate advertising
75.00
4
The Sentinel - estate advertising
190.54
5
Weigle & Associates, P.C. - miscellaneous postage, phone calls, etc.
15.75
6
Weigle & Associates, P.C. - Notary fee
10.00
Subtotal
381.29
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA.1500 ScheduleH-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
Watson, Mary K.
FILE NUMBER
21-07-0752
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1 Department of Public Welfare - lien against estate
VALUE AT DATE
OF DEATH
3.022.60
TOTAL (Also enter on Line 10, Recapitulation)
3,022.60
(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+ (9-00)
SCHEDULE ..
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
NUMBER
Watson, Mary K.
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal
oistributions, and transfers
under Sec. 9116(a)(1.2)]
RELATIONSHIP TO
DECEDENT
Do Not List Trustee s
FILE NUMBER
21-07-0752
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
I.
1
Phyllis W. Jumper
122 Steelstown Road
Newville, PA 17241
Daughter
100%
3,380.51
Total 3,380.51
Enter dollar amounts for distributions shown above on lines 5 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
TOTAL OF PART II- 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 ScheduleJ (Rev. 6-98)
*'
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
September 25, 2007
WEIGLE & ASSOCIATES
JERRY A WEIGLE ESQUIRE
126 EAST KING STREET
SHIPPENSBURG PA 17257
Re: MARY WATSON
CIS #: 330158761
SSN: 207-03-7999
Date of Death: 07/16/2007
Dear Attorney Weigle:
Please be advised that the Department of Public Welfare maintains a
claim in the amount of $3,022.60 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 $3,022.60, 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 whether the
Commonwealth's claim is admitted and 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.
Sincerely,
&~l\l.~
Elizabeth M. Wilson
TPL Program Investigator
717-214-1868
717-772-6553 FAX
Enclosure
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ADAMS
COUNIY
NATIONAL BANK
October 5,2007
WEIGLE & ASSOCIATES PC
ATTORNEYS AT LAW
ATTN: JERRY A WEIGLE
126 EKING ST
SHIPPENSBURG P A 17257
Re: Estate of MARY K WATSON
Dear Mr. Weigle:
The following information is being provided as per your request:
Acct. Type Account No. Account Accrued Ownership Date
Principal on Interest to Opened
D.O.D. D.O.D.
Esteem 183237 $8,500.50 $0.51 Individual 06/06/978
Checking
Account
Certificate of 162600 $3,268.54 $121.05 Irrevocable 08/11/03
Deposit Burial Fund
Certificate of 172542 $1800.00 $33.30 Irrevocable 01/17/07
Deposit Burial Fund
Inquiries concerning ACNB Corporation stock information should be directed to the Registrar and Transfer
Company at 1-800-368-5948. If you need any additional information, please contact me at (717)339-5122.
S~inCerelY; ~.,nl
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~' .l(lmir;..; . L(b"lL,----
i Baroara I'Warnti .
Adams County ional Bank
Deposit Services Representative II
PO Box 3129, GETTYSBURG, PA 17325 I PHONE 717.334.3161 I TOLL FREE 888.334.2262 I www.acnb.com