HomeMy WebLinkAbout12-12-07
LAW OFFICE
FOREST N. MYERS
Shlppensburg, Pennsylvania 17257
137 Park Place West,
717.532.9046
Fax 717.532.8879
fnmyers@embarqmail.com
December 10, 2007
Register of Wills
Cumberland County
One Court House Square"
Carlisle PA 1 7013
Re: Edith R Carbaugh
Estate No.: 21-07-0463
Dear Sir or Madam:
Enclosed please find for filing an original and one copy of the Inheritance Tax
Return in the above-captioned estate along with my check for $15.00 for the filing
fee.
Also enclosed is a file copy for my records. Please time-stamp this copy and
return it to me in the enclosed self-addressed, stamped envelope I have provided.
Sincerely,
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Forest N. Myers
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REV-1500 EX + (6-00)
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
2 1 -0 7 0 4 6 3
COUNTY""COOE ---voor- - - NUMBER- -
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DECEDENrs NAME (LAST, FIRST, AND MIDDLE INITIAL)
Carbau h Edith R
DATE OF DEATH (MM-DD-Year)
SOCIAL SECURITY NUMBER
DATE OF BIRTH (MM-DD-Year)
1 83- 0 7 - 8 4 1 5
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
4/24/2007 11/13/1913
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
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[Xl 1. Original Return
o 4. Limited Estate
[Xl 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copy of Trust)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
o 3. Remainder Return (date of death prior to 12-13-82)
o 5. Federal Estate Tax Return Required
_ 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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NAME COMPLETE MAILING ADDRESS
Forest N M ers Es
FIRM NAME (If Applicable)
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TELEPHONE NUMBER
1. Real Estate (Schedule A)
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)
D 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)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
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(7)
(8)
472.675.59
(9)
(10)
38.829.55
422.71
(11)
(12)
(13)
39,252.26
433,423.33
33.373.60
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14)
400.049.73
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15. Amount of Line 14 taxable at the spousal tax
rate. or transfers under Sec. 9116 (a)(1.2)
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
0.00 X _ (15) 0.00
0.00 X _ (16) 0.00
0.00 X .12 (17) 0.00
400.049.73 X .15 (18) 60.007.46
(19) 60,007.46
20. ~
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
>>...... BSSURE'TOANSWERALt;.QUeSnONSONRWeRSESlDE'ANDREOHECKMATH< ;(
Decedent's Com lete Address:
STREET ADDRESS
Shi
CITY
Shippensburg
5T ATE
PA
ZIP
17257-
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
60.007.46
60.000.00
3.000.37
Total Credits (A + B + C)
(2)
63.000.37
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.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check to: REGISTER OF AGENT
0.00
2,992.91
0.00
0.00
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 00
b. retain the right to designate who shall use the property transferred or its income; ......................................... 0 00
c. retain a reversionary interest; or ...................................................................................................... D 00
d. receive the promise for life of either payments, benefits or care? .. ............... ....... ............................ ......... 0 00
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?. ........ ....... ........................................... ............ ................ ....... D 00
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. D [RJ
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................... ................................................. ........................... D 00
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
ADDRESS aniel Baer, Tru
ShiooensburQ
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
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ADDRESS Forest N Myers, 137 Park Place West
POBox 250
PA 17257
DATE
12.- 10-~"
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. ~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 0% [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 0% [72 P.S. ~9116{a){1.2)).
The tax rate imposed on the net value of transfers to orfor the use of the decedent's lineal beneficiaries is 4.5%, 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 12% [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-1503 EX + (6-98)
..
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
0463
ESTATE OF
Carbaugh Edith R
FILE NUMBER
21 07
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
DESCRIPTION
ITEM
NUMBER
1
Federal Money Market - Int
DaD Balance $1,704.71 plus $6.72 interest
2
Federal Money Market - Pri
DaD Balance $150,133.38 plus $516.72 interest
3
FHBL (5.03)
DaD Balance $24,922.00 plus $540.40 interest
4
FHLB (4.5)
DaD Balance $19,768.80 plus $217.50 interest
5
FFCB
DaD Balance $19,937.60 plus $226.80 interest
6
Tenn Valley Authority
DaD Balance $19,662.40 plus $181.50 interest
7
US Treasury HH Bonds
DaD Balance $43,000.00 plus $539.00 interest
8
Vanguard IT
DaD Balance
9
Vanguard ST
DaD Balance
VALUE AT DATE
OF DEATH
1,711.43
150,650.10
25,462.40
19,986.30
20,164.40
19,843.90
43,539.00
18,770.42
171,243.33
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
471,371.28
ORRSTOWN
FINANCIAL ADVISORS
A Tradition of Excellence
Account: 50000228001 EDITH R CARBAUGH
INVESTMENT HOLDINGS AS OF 4/24/07 (000)
Security Name Shares I Par 000 Value DOD Price Accrued Income
1331 SHS5 FFCB 3.556/29/07 20,000.0000 $19,937.60 99.688 $226.80
133XCG23 FHLB 4.5% 7/27/09 20,000.0000 $19,768.80 98.844 $217.50
133XDNE7 FHLB 5.03 11/17/08 25,000.0000 $24,922.00 99.688 $540.40
0934N625 FED MONEY MKT-PRI 150,133.3800 $150,133.38 1.00 $516.72
0934N621 FED MONEY MKT -INC 1,704.7100 $1.704.71 100 $6.72
9059TBS9 TVA 3.3% 1/15/08 20,000.0000 $19,662.40 98.312 $181.50
22031810 VG IT INVESTGRD ADM 1,921.2300 $18,770.42 9.77
22031836 VG ST INVESTGRD ADM 16,139.8050 $171,243.33 10.61
BOO02994 US SVGS HH 07-01-12 43,000.0000 $43,000.00 100.00 $539.00
$469 142 64 $2 228 64
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REV-1508 EX + (6-98)
. *
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Carbaugh Edith R
FILE NUMBER
21 07
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.
0463
ITEM
NUMBER
1.
DESCRIPTION
Refund; Shippensburg Health Care Center
2.
Refund; Capital Blue Cross
VALUE AT DATE
OF DEATH
1,030.00
. 274.31
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
1 304.31
-REV-1511 EX + (12-99)
*
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Carbaugh Edith. R
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21
07
0463
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s) Orrstown Bank 18,998.00
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
Attorney Fees Forest N Myers 18,998.00
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
1 Probate Fees Cumberland County Courthouse; probate fees: Petition $410.; filing Will $15 456.00
Short Certs $16.; JCP $10.; Auto fee $5.
5. Accountanfs Fees
6. Tax Retum Prepare~s Fees Orrstown Bank; 2006 Tax Return 250.00
1 Shippensburg Sentinel 52.55
2 Cumb Legal Journal 75.00
TOTAL (Also enter on line 9, Recapitulation) $ 38.829.55
(If more space is needed, insert additional sheets of the same size)
-REV-1512 EX + (6-98)
..
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Carbauah. Edith R
FILE NUMBER
21 07
0463
Include unrelmbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1. Millennium Pharmacy Systems; medical
VALUE AT DATE
OF DEATH
422.71
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
422.71
~EV_1513EX+I"
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS pnclude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
FILE NUMBER
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not List Trustee(s) OF ESTATE
Collateral 25,872.67
Collateral 25,872.67
Collateral 25,872.67
Collateral 25,872.67
Collateral 59,116.24
Collateral 59,116.24
Collateral 59,116.24
NUMBER
I.
II.
1.
Donna Schenk
3404 Chestnut Ave
TrevasePA 19057
Thomas Jackson
210 Middle Spring Road
Shippensburg PA 17257
Carol Eckenrode
841 Long Lane
Chambersburg PA 17201
Howard Shuman Jr
1728 Pinehurst Lane
Fossmoor IL 60422
Betty lynch
POBox 263
Shippensburg PA 17257
Doris Kling
59 Locust St
Shippensburg PA 17257
Sandy Weaver
325 Whitmer Road
Shippensburg PA 17257
2.
3.
4.
5.
6.
7.
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18. AS APPROPRIATE, ON REV-1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
Messiah United Methodist Church
38 S Penn Street
Shippensburg PA 17257
33,373.60
TOTAL OF PART II - 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)
$
33 373.60
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Carbaugh, Edith, R
Decedent's Name
Page 1
21 07 0463
File Number
Schedule J - Beneficiaries - 1
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS (include outright spousal distributions)
8. Estate of Rose Jackson, deceased Collateral 59,116.24
325 Whitmer Road
Shippensburg PA 17257
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