HomeMy WebLinkAbout12-12-07
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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
File Number
INHERITANCE TAX RETURN
RESIDENT DECEDENT
21 07
775
Decedent's Last Name
Suffix
Date of Birth
07061932
Decedent's First Name MI
EDWARD A
Spouse's First Name MI
JACQUELINE L
209222215
07272007
BORN
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
BORN
Spouse's Social Security Number
177262433
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
[!] 1. Original Return
n
L-J
4. Limited Estate
D
D
D
D
4a. Future Interest Compromise
(date of death after 12-12-82)
2. Supplemental Return
o
D
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
[KJ
6. Decedent Died Testate
(Attach Copy of Will)
7 Decedent Maintained a Living Trust
. (Attach Copy ofT rust)
8. Total Number of Safe Deposit Boxes
D
9. Litigation Proceeds Received
10 Spousal Poverty Credit (date of death
. between 12-31-91 and; -1-95)
D
11.Election to tax under Sec. 9113(A)
(Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
MICHAEL L. BANGS 7177307310
Firm Name (If Applicable)
1'-.'
REGISTER QfWILLS USE ~~L Y
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First line of address
429 SOUTH 18TH
STREET
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Second line of address
CAMP HILL
State
PA
ZIP Code
17011
DA!l; FliED
City or Post Office
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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 information of which preparer has any knoWledge.
~~TURE OF PERSON RESPON;~BL~~ FI R DATE
Jacqueline L. Born I~ I" "7
4 Sussex Road, Camp Hill, PA 17011
~PREPARER OTH R THAN REPRESENTATIVE
ADDRESS
DATE
Michael L. Bangs
429 South 18th Street, Camp Hill, PA 17011
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Side 1
1SDSbD41147
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15[]5b[]42148
REV-1500 EX
Decedent's Name Edward Anthony Born
Decedent's Social Security Number
209222215
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) D Separate Billing Requested.............. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) D 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 eleetion 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 ~ 4 3 , 5 6 7 . 8 8
15.
16. Amount of Line 14 taxable
at lineal rate X .045 0.00
17. Amount of Line 14 taxable
at sibling rate X .12 0.00
18. Amount of Line 14 taxable
at collateral rate X .15 0.00
16.
17.
18.
19. Tax Due
.............. ................................................................................................
19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
L
Side 2
15D5b[]42148
49,967.06
49,967.06
6,399.18
6,399.18
43,567.88
43,567.88
0.00
0.00
0.00
0.00
0.00
D
15D5b[]42148
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REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
Edward Anthony Born
STREET ADDRESS
4 Sussex Road
FileNumber 21-07-775
CITY
Camp Hill
II STATE
PA
jlZIP
17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
0.00
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits (A + B + C)
(2)
0.00
Total Interest/Penalty (D + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
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 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)
(4)
(5) 0.00
(5A)
(5B) 0.00
Make Check Payable to: REGISTER OF WILLS, AGENT
!!I~'i'i~li~i~'iii!!!;~~ltillll&iI~II~liiiIlilii''''''iiiimil.lliII'liIIilill.liIIilliJ-'''liII!_liIIiIliIIlIiII_..--'r..'ilililllilii!lr-llillliII'lIiIlli...........llilliIIilill!lill!iliiil!lll!!!~lpiili~I~'!ilili"IIl!liii!il':iiIiI:::~li!i~!;
.._..i.L"......Iii....!u!!!O!__. _ .. !!O!!!!._ !!!_mlll!!!!!! ... .liall!l!lll__!IIlI!!l!!tlll_!ll!l iil~.!!!'!IlI!l!ll!!!lIIl1i1i1I!!!." lelill!llI""'!i!lOIl........!!!!llIIL.."',,.IJ!l!ll............Wtmll.........'"
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;..................................................................................... D CJ
b. retain the right to designate who shall use the property transferred or its income;......................................... D CJ
D '''j
c. retain a reversionary interest; or..................................................................................................................... L
d. receive the promise for life of either payments, benefits or care?.................................................................. D CJ
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?.............. ................. ......... ................ ..................... ............. ............... ................ C CJ
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?............... L
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?............. .............. ............. ................. .............. ................... ................ ....... ...... D
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 of the 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-150S EX+ (6-9S)
'* SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Born, Edward Anthony 21-07 -775
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 VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Oppenheimer - Alliance Bernstein Income Closed End Fund 12.330.00
:
2 Oppenheimer - Alliance Bernstein National Tax Free 37.635.52
3 Oppenheimer - Advantage Primary Liquidity Money Market Fund 1.54
TOTAL (Also enter on Line 5, Recapitulation) 49.967.06
(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 E (Rev. 6-98)
REV-1151 EX+ (12-99)
.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Born, Edward Anthony
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-07-775
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 2,069.48
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid
2. Attorney's Fees Michael L. Bangs 4,000.00
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
4. Probate Fees 128.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 201.70
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 6,399.18
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
Rev-1502 EX+ (6-98)
.
SCHEDULE H-A
FUNERAL EXPENSES
continued
COMMONWEALlH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Born, Edward Anthony
FILE NUMBER
21-07-775
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Auer Memorial Home and Cremation Services, Inc.
1,415.00
2
Funeral Luncheon
404.48
3
St. Mary's Church of the Maternity - Grave opening
250.00
Subtotal
2.069.48
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
-
Rev-1502 EX+ (6-98)
*' SCHEDULE H-87
OTHER
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA continued
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Born, Edward Anthony 21-07 -775
ITEM
NUMBER DESCRIPTION AMOUNT
1 Cumberland Law Journal - legal advertising 75.00
2 The Sentinel - legal advertising 126.70
I
Subtotal 201.70
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98)
REV-1 ~13 EX+ (9-00)
*'
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
NUMBER
Born, Edward Anthony
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal
Ctistributions, and transfers
under Sec. 9116(a)(1 .2)]
FILE NUMBER
21-07-775
RELATIONSHIP TO
DECEDENT
Do Not List Trusteelsl
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
I.
1
Jacqueline L. Born
4 Sussex Road
Camp Hill, PA 17011
Spouse
Entire
Total
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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- 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 Schedule J (Rev. 6-98)
OPPENHElME~
Oppenheimer & Co. Inc.
]015 Mumma Road
Wormleyshurg. PA 17043
800-722-2294
Member of All Princip:11 Exchanges
November 27,2007
Michael L. Bangs, Esquire
429 South 18th Street
Camp Hill, PA 17011
RE: Estate of Edward A. Born
Acct #A09-0002781
Dear Mr. Bangs:
In regards to your request for the date of death valuation, please find the closing values
for July 27, 2007 below:
AllianceBernstein Income Closed End Fund
1,500 shares price: 8.220 value: 12,330.00
AllianceBernstein National Tax Free
2,656 shares price: 14.170 value: 37,635.41
Advantage Primary Liquidity Money Market Fund
Value: 1.54
Total Value: $49,969.95
If you have any further questions, please do not hesitate to call our office. We apologize
for the delay in responding to your request.
MBC/hmk
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BE IT Rl!MlM BERED '!'HAT
I, EDWARD A. SORN, of the COunty of CUIllberland and COIllIIIOnwealth of
Pennsylvania, beinq of sound mind, memory and understandinq, do malte, publish and
declare this to be my LAST WILL and TES'l'JIM EN'!', hereby revoltinq and malting null and
void any and all Wills and Codicils, or writings in the nature thereof, at any
time heretofore made by me.
~: As my personal representative, I nominate and appoint my wife,
JACQUELINE L. BORN, to be the Executrix of this LAS'!' WILL. In the event JACQtELINE
L. BORN is unable or ceases to act for any reason whatsoever, I nominate and ap-
point MICHAEL M. SORINSICI to succeed as Executor of this LAST WILL.
~l I direct that my debts and funeral expenses be paid as soon
after my death as is practicable by my Executrix out of my estate, but not from
any assets, funds, death benefits or insurance proceeds which are otherwise ex-
cludable or exempt f_ my qross estate for federal estate valuation or tax
purposes.
THIRD: I direct that all estate, succession, leqacy, inheritance or
other transfer taxes, however designated, that shall become payable by reason of
my death in respect of all property COIIIprising my gross estate for death tax purposes.
whether or not such property passes under this LAST WILL, shall be paid by my
Executrix out of my estate, but not from any assets, funds, death benefits or
insurance proceeds which are otherwise excludable or exempt from my qross estate for
federal tax purposes. _____- "))0 t IUUM~I.l;,j- I - )..'J -'1 I ~
~: ~I;- is my express desire and I hereby authorize and direct my
Executrix to arrange for my thited States Air Rlrce identification tags, my
baseball trophy, and my red wooden shafted golf putter to be buried with me.
.!!!!!!: I give, devise add bequeath all of my estate, both real and
personal, wherever situate, in which I may have any interest at the time of my
death, including any property over which I may have a power of appointment, to
my wife, JACQtELINE A. BORN.
SIXTH: In the event that my wife fails to survive me, then I give,
devise and bequeath all of my estate, both real and personal, wherever situate,
in which I may have any interest at the time of my death, including any property
over which I'may have a power of appointment, to my daughter, CHRISTINE L, BORN,
~EVENTH: In the event my wife and daughter fail to survive me, then I
give, devise and bequeath all my estate, real and personal, wherever situate, to
my descendants per stirpes, their heirs and assigns forever.
EIGHTH: If any part of my estate shall vest in a person under twenty-
one (21) years of age, the Executrix may, with absolute discretion, deliver such
part, or any portion thereof, without bond, to the parent or guardian of such
person to be held for such person until he or she reaches twenty-one (21) years of
age, The receipt of such parent or guardian shall be a complete discharge and
acquitt,ance of the Executrix and shall be final and binding on all persons in interest,
NINTH: If any legatee, beneficiary, or devisee other than my wife shall
fail to survive me by thirty (30) days, I direct that I shall be deemed to have
survived such legatee, beneficiary or devisee and that this LAST WILL and all
its proviSions, except where specifically stated otherwise, shall be construed
on this assumption notwithstanding the provisions ot any law establishing a con-
trary presumption.
TENTH: I direct that no Executrix or Executor nominated and appointed
by the provisions of this LAST WILL shall be required to give any bond or post
any security, and that if, notwithstanding this direction, any bond or security
is required by any law or order of court, no sureties be required thereon.
~LEVF~B,: I direct that my Executrix or Executor, whenever they
may need legal counsel in the settlement of my estate for the purposes ex-
pressed in my LASTW'ILL consult ALBERT Z. BOGERT, ESQUIRE, he having intimate
knowledge of my affairs, ,dews and wishes in many matters t.hat may arise in the
setU.ement of my estate.
IN WITNESS ~niEPBOF, I have subscribed my name and affixed my seal
this
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day of
~7U''-;--
,1979.
CdtiJ /LII<t( II J:;~
EDWARD A. BORN
.
ACKNOI'ILEDGEMENT
CO.MMONw~ALTH OF PENNSYLVANIA
ss.
COUNTY OF CUMBERLAND
I, EDWARD A. BORN, Testator, whose name is signed to the attached
or foregoing instrQ~ent, having been duly qualified according to Law, do hereby
acknowledge that I signed and executed the instrument as my LAST WILL, that I
signed it willingly, and that I signed it as my free and voluntary act for the
purpos€~s therel.n expressed.
&!aJal/f /), J;;~---
EDWARD A. BORN
Sworn or affirmed to and
this /(J~' day
acknowledged before me,
of(::;~~;l~~4-Z'- ,1979.
by EDWARD A. BORN, Testator
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Notary PU]Jlic
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M...-J'~r"ic'i ' .-L,. .,nrj ., fl'e.t.
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AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
We, 4~ 3f,f.r 2. f5cyf-iL1, &, and T~,.obc,t-Ct (J. vI>') L>::.:C
the witnesses whose names are signed to the attached or foregoing instrumcnl:,
be.lng duly qualified according to law', do depose and say that we were present
and saw Testator sign and execute the instrument as his LAST WILL; that EDWARD
A. BORN signed willingly and that he executed it as his free and voluntary act
for the purposes therein expressed; that each of us in the hearing and sight of the
Testator signed the WILL as witnesses; and that to the best of our knowledge tile
Testator was at the time 18 years or more of age, of sound mind and under no cons-
traint or undue influence.
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Sworn or affirmed to and acknowledged before
,'~)-f',X::TA /" (.,,'
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me this i/';' day of
<. .,: .~~. (' ..
,1979.
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Notaxy Pub.Lic
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ANll'A l BOG~,'\T, NiA.,t"V '";~'!e
M"'!:..han;.,~~k)r7' C\F~'berl"lrl.d ':":"'", ".~.
~y Cr-trnniss.i....n hp>!'l.. :'\ug. ?;", J..o:"~.>9/l'/
BANGS LltW OFFICE
429 SOUTH 18TH STREET
CAMP HILL, PA 17011
E-mail: mikehangs@verizon.net
MICHAEL L. BANGS, Attorney-at-Law
WENDY K. STRAUB, Paralegal
December 10, 2007
Glenda Farner Strasbaugh, Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, P A 17013
RE: Estate of Edward A. Born
File No. 21-07-775
Dear Mrs. Strasbaugh:
Enclosed you will find the following:
1. The original Inventory;
2. The original and one copy of the Inheritance Tax Return; and
3. A check in the amount of $30.00 to pay the filing fee.
PHONE: 717-730-7310
FAX: 717-730-7374
WILLIAM E. MILLER, JR.
Of Counsel
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Kindly file the inheritance tax return accordingly and return a filing receipt to me in the enclosed,
stamped, pre-addressed envelope.
If you have any questions or require anything further, please contact me.
Michael L. Bangs
wks
Enclosures
cc: Mrs. Jacqueline L. Born
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