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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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REV-1500
OFFICIAL USE ONLY
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
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COUNTY CODE YEAR NUMBER
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Burke, Jennie C.
DATE OF DEATH (MM-DD-YEAR)
10-29-00
SOCIAL SECURITY NUMBER
194 - 28
8941
DATE OF BIRTH (MM-DD-YEAR)
1-29-27
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
[!] 1. Original Return
o 4. Limited Estate
o 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
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)
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)
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NAME
COMPLETE MAILING ADDRESS
126 East King Street
Shippensburg, PA 17257
Jerry A. Weigle, Esquire
FIRM NAME (lfAPPli~IGLE, PERKINS & ASSOCIATES
TELEPHONE NUMBER
(717) 532-7388
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
(1)
(2)
(3)
(4)
(5)
23,500.00
OFFICIAL USE ONLY
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4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o 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)
(11)
(12)
(13)
34,411.37
(10,737.37)
174.00
(6)
(7)
(8)
23,674.00
(9)
(10)
8,838.10
25,573.27
14. Net Value Subject to Tax (Line 12 minus Line 13)
(14)
(10,737.37)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
x.O_ (15)
x.O_ (16)
x .12 (17)
x .15 (18)
(19) NONE - INSOLVENT
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
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Decedent's Complete Address:
STREET ADDRESS
224 Gettle Avenue
CITY Shippensburg I STATE I ZIP
PA 17257
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + B + C ) (2)
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 Payable to: REGISTER OF WILLS, AGENT
NONE - INSOLVENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred; .......................................................................................... D
b. retain the right to designate who shall use the property transferred or its income; ............................................ D
c. retain a reversionary interest; or.......................................................................................................................... D
d. receive the promise for life of either payments, benefits or care? ...................................................................... D
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. D
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ D
No
[]
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IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Lynn W. Stackfield
PA 17257
Jerry A. Weigle, Esquire
, Shippensburg, PA
17257
DATE I
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DATE 7 0
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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 exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum 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 or for 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-1502 EX+ (12-85)
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SCHEDULE A
REAL ESTATE
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
Jennie C. Burke
(Property jointly-owned with Right of Survivorship must be disclosed on Schedule F) All real estate should be reported at fair market value
which 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.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
Real Estate at 224 Gettle Avenue, Borough of Shippensburg,
Cumberland County, PA, one-half interest ($47,000.00 x 1/2)
23,500.00
TOTAL (Also enter on line 1, Recapitulation)
(If more space is needed, insert additional sheets of same size.)
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23,500.00
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Sailhamer Real Estate
494 East King Street
Shippensburg, PA 17257
(717) 532-6059
Fax: (717) 530-5181
June 14, 2001
.,
The Law Office of
Weigle, Perkins and Associates
126 East King Street
Shippensburg, PA, 17257
Dear Mr. Wei gle:
This analysis has not been performed in accordanoe ,,6th the uniform standards of
professional practice which requir~s valuers to a~t as unbiased, di~interested
third parti es with impartiality, objectivity and independence and 1".ithout
accommodation of personal interest, it is not to be contrued as an appraisal and
may not be used as such for any purpose.
In responne to your request for a compareb1e market ene1ysis of re~l e~tete of
the Estate of Jennie Burke, I am sending you my opinion of current market value.
The pro perty is located in the Borough of Shipnensburg, Cumberland County and
is known as 224 S,outh Gett 1e Avenue, Shippenn burg, Pennsylvania end is more fully
described in Cumberland County Recorder of Deeds Book 191, Page 575. The lot is
served by public water end public sewer.
The lot is improved with a two story frame dwelling that has 'been covered with
vinyl siding.- !he dwelling contains approximately 1662 square feet of living
space. There is a partial basement under the dwelling, flooring being of dirt.
!he main level contains a living room, dining room, kitchen, and bath with
shower, no tub. The second level contains three bedrooms, one of which is not
finished, and full bath with tub and shower. There is a floored attic above the
second level., Roofing material is of standing seam metal. The heet1ng system is
an oil-fired hot ,':e'ter boiler. '
The location of the subject property is within easy driving distance to major
highways, and is within walking dis'tance to the Shippensburg sho?ping dis trict.
The neighborhood consists of similar type single family housing, and single and
double unit rentals. !he overall condition of the pro?erty appears to be good.
Based. upon my inves,tigetion and findings, it is my opinion that a comparable
merket analysis would indicate a current market value of FORTY SEVEN THOUSA1ID
. DOLLARS ($47,000.00).
Respectfully, ,
~~~~~ -
Ronald L. Sai1hamer .
Broker of Real Estate
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, . REV-150B EX + (2-B7)
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
Please Print or Type
FILE NUMBER
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Jennie C. Burke
(All property jointly-owned with the Right of Survivorship must be disclosed on Schedule F)
ITEM
NUMBER
DESCRIPTION
VALUE AT
DATE OF DEATH
l.
2.
Household Contents
Allfirst Bank checking account
150.00
24.00
TOTAL (Also enter on line 5, Recapitulation) $
174.00
(Attach additional BY," x 11" sheets if more space is needed.)
REV-151~ EX+ (7-881
ESTATE OF
ITEM
NUMBER
A.
1.
B.
1.
2.
3.
4.
C.
1.
2.
3.
4.
5.
6.
7.
8.
.
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
Please Print or Type
FILE NUMBER
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Jennie C. Burke
DESCRIPTION
AMOUNT
Funeral Expenses:
Fogelsanger-Bricker Funeral Home
4,728.10
Administrative Costs:
Personal Representative Commissions
Social Security Number of Personal Representative:
Year Commissions paid
Attorney Fees Weigle, Perkins & Associates
500.00
Family Exemption
Claimant Lynn W. Stackfield
Relationship
Daughter!
3,500.00
Address of Claimant at decedent's death
Street Address 224 Gettle Avenue
City
Shippensburg,
Zip Code
17257
State P A
Probate Fees
Miscellaneous Expenses:
Register of Wills, Cumberland County - filing Insolvent PA
Inheritance Tax Return
Sailhamer Real Estate - appraisal fee
10.00
100.00
TOTAL (Also enter on line 9, Recapitulation)
$
8,838.10
(If more space is needed, insert additional sheets of same size.)
REV.1512 EX. 11.93)
ESTATE OF
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SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES AND LIENS
Please Print or Type
I FILE NUMBER
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Jennie C. Burke
DESCRIPTION
AMOUNT
ITEM
NUMBER
1.
24,408.56
2.
3.
4.
5.
6.
7.
8.
9.
10.
American General Finance - mortgage loan ($48,817.11 x 1/2)
Department of the Treasury - balance owed on installment
agreement
339.02
K & W Medical Services, Inc. - 10-17-00 statement
159.00
Chambers burg Area Advanced Life Support - final billings
352.48
Chambers burg ALS - West Shore EMS - service on 8-15-00
35.50
Milton S. Hershey Medical Center - 8-23-00 statement
118.00
Young's Medical Equipment - 10-31-00 statement
.99
Merck/Medco Rx Services - 10-16-00 statement
46.08
Chambers burg Hospital - service 5-22-98
21.20
CPO 2 - 7-31-00 statement
92 .44
TOTAL (Also enter on line 10, Recapitulation)
$ 25,573.27
(If more space is needed, insert additional sheets of same size.)
Account Statement
Ple.,e ,ele, quUI/ons 0' ,equulS 10' money '0 'he edd,ess below. Pleese include
you, neme end eccoun' numbe, on eny correspondence. Phone (717) 263- 8493.
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FINANCE
AMERICAN GENERAL FINANCE
777 WAYNE AVE
CHAMBERSBURG. PA 17201-3801
Statement Date: Oct 28. 2000
Regular Payment: 465.91
Account
Number
l3526999
Current
Amount Due
465.91
Past Due
Amount
0.00
Payment Additional Past Due Charges Accrue
Due Date if Pa nt is Received After
Noy 13 2000
Account Summary
PrevIous Balance............
Paymenl
Date
Amount
Charges or
Interest
Principal
Oct 03 2000
463.28
267.16
196.12
Balance
49013.23
48817 . 11
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IT'S CUSTOMER APPRECIATION DAYS NOV 1-30. STOP BY FRIDAY NOV 17 OR
MONDAY. NOV 20 DURING OUR HOUDAY OPEN HOUSE. WEU HAVE A
LITTLE EXTRA SUGAR AND SPICE AND EVERYTHING NICE TO SPICE UP YOUR
HOLIDAYS. OR POP-IN FOR HOLIDAY DOUGH ANYTIME. TO APPLY CALL (717)
263-8493 TODAY.
Contact us on the internet at www.LoansFast.com
All loans are subject to normal credit policy.
l' Retain this portion for your records
*OOOBKO* L-3827-AG013-016539-01539
DLRP97
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COMMONWEALTH OF P~NNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
Jennie C. Burke
ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR
NUMBER SHARE OF ESTATE
A. Taxable Bequests:
1. Not relevant as probate estate is insolvent.
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
AMOUNT OR
SHARE OF ESTATE
B. Charitable and Governmental Bequests:
1.
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation) S
(If more space is needed, insert additional sheets of same size)
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BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, AllOWANCE OR DISAllOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
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DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
08-13-2001
BURKE
10-29-2000
21 01-0618
CUMBERLAND
101
JERRY A WEIGLE
WEIGLE ETAL
126 EKING ST
SHIPPENSBURG
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REV-15~1 EX AFP n2-IIl
JENNIE
C
Allount Re..itted
PA 1.1257
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV=is4"j-EX-AFP--ri'2':oOY-NOYiCE--OF-YNHEiiiTANCE-YAX-APPRAisEMENT~--Ai.l-owANCE-OR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BURKE JENNIE C FILE NO. 21 01-0618 ACN 101 DATE 08-13-2001
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ~ returns assessed to date.
ASSESSMENT OF TAX:
15. Allount of line 14 at Spousal rate (15)
16. Allount of line 14 taxable at lineal/Class A rate (16)
17. Allount of line 14 at Sibling rate (17)
18. AIIount of line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
U)
(2)
(3)
(4)
(5)
(6)
(7)
23.500.00
.00
.00
.00
174.00
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage liabilities/liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
nO)
8,838.10
25.513.27
Ul)
(2)
(3)
(4)
NOTE:
.00 X
.00 X
.00 X
.00 X
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
23,674.00
34.411 37
10,137.37-
.00
10,137.37-
00 =
045 =
12 =
15 =
.00
.00
.00
.00
.00
(9)=
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS lESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A ""CREDIT"" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
RESERVATION:
Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reServes the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
PURPOSE OF
NOTICE:
To fulfill the requireMents of Section 2140 of the Inheritance and Estate Tax Act, Act Z3 of 2000. (72 P.S.
Section 9140),
PAYMENT:
Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side.
--Make check or money order payabla to: REGISTER OF HILLS J AGENT
REFUND (CR):
A refund of a tax credit, which was not requested on the Tax Return, May be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office
of the Register of Wills, any of the 23 Revenue District Offices, or by calling the special 24-hour
answering service for forms ordaring: 1-800-362-2050; services for taxpayers with special hearing and / or
speaking needs: 1-800-447-3020 (TT only).
OBJECTIONS:
Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or intarest) as shown on this Notice must Object within sixty (60) dayS of receipt of
this Notice by:
--writtan protest to the PA DepartMent of Revanue, Board of Appeals, Dept. 281021, HarriSburg, PA 17128-1021, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
ADMIN-
ISTRATIVE
CORRECTIONS:
Factual errors discovered on this assessment should be addressad in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, HarriSburg, PA 17128-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administrativaly correctable errors.
DISCOUNT:
If any tax due is paid within three (3) calendar Months after the decedent's death, a five percent (57-) discount of
the tax paid is allowed.
PENALTY:
The 157- tax a~esty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty periOd. This non-participation
penalty is appealable in the same manner and in the the same tiMe period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
INTEREST:
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six (67-) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January 1, 1982 will bear interest at a rate which will vary frOM calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2001 are:
Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor
1982 207- .000548 1992 97- .000247
1983 167- .000438 1993-1994 77- .000192
1984 117- .000301 1995-1998 97- .000247
1985 137- .000356 1999 77- .000192
1986 107- .000274 2000 87- .000219
1987 97- .000247 2001 97- .000247
1988-1991 117- .000301
--Intarest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NU"BER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax beCOMes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.