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Home My WebLink About02-20-08 (2) ---1 REV-1500 EX(06-05) PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 15056041158 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year 21 07 File Number 0542 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 207-34-6322 05172007 09061945 Decedent's Last Name Suffix Decedent's First Name KEEFE SHARON MI A (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last 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 BOXES BELOW [K] 1, Original Return D 4, Limited Estate D 6, Decedent Died Testate (Attach Copy of Will) D 9. Litigation Proceeds Received Future Interest Compromise (date of death after 12-12-82) Decedent Maintained a Living Trust D- 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust) Spousal Poverty Credit (date of death 0 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO; Name Daytime Telephone Number 02. 04a. 07. 010. 5. Federal Estate Tax Return Required Supplemental Return o o 3. Remainder Return (date of death prior to 12-13-82) RICHARD C. SNELBAKER, ESQUIRE 717-697-85\~ O~;;O REGISTER OF Vi ' N <::) Firm Name (If Applicable) SNELBAKER & BRENNEMAN, P.C. First line of address 44 WEST MAIN STREET :r-.. Second line of address -.... CD c...~ 0'\ P.O. BOX 318 City or Post Office State ZIP Code DATE FILED MECHANICSBURG PA 17055 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 beiief, 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. PONSIBLE FOR FILING RETURN DATE <:::J - ').() 0 MILISAVIC OTHER THAN REPRESENTATIVE <..(-< 79 CENTER STREET, C. SNELBAKER, ESQUIRE 44 WEST MAIN STREET, MECHANICSBURG, PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056041158 6M4647 3000 15056041158 -.J ~ .--I 15056042159 REV-1500 EX Decedent's Name:K E E F E S H A RON RECAPITULATION 1. Real estate (Schedule A) . 1. 2. Stocks and Bonds (Schedule B) . . 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . ~. 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 Subjectto 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, or transfers under Sec. 9116 (a)(1.2) X .0D- 0 .00 16. Amount of Line 14 taxable at lineal rate X .0':L5 52628 . 61 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 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056042159 6M4648 2.000 Decedent's Social Security Number 207-34-6322 A 0.00 0.00 0.00 0.00 16421.84 23961.19 24404.25 64787.28 7794.40 4364.27 12158.67 52628.61 0.00 52628.61 15. 0.00 16. 2368.29 17. 0.00 18. 0.00 19. 2368.29 [Xl 15056042159 --.J REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME KEEFE SlREET ADDRESS File Number 0542 SHARON A MONROE TWP, CUM ERLAND COUNTY CITY MECHANICSBURG STATE Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1 ) 2368.29 0.00 0.00 0.00 Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty 0.00 0.00 0.00 Total InterestlPenatty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, 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) 2368.29 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 2368.29 0.00 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: a. retain the use or income of the property transferred; . . . . . . . . . . . . . . b. retain the right to designate who shall use the property transferred or its income; c. retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . . d. receive the promise for life of either payments, benefits or care? ........ 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? . 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes o o o o o o [K] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. o No [K] [K] [K] 00 [K] [K] 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 statute does not exempt 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. F or 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 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. 6M4671 1.000 REV-1508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Sharon A. Keefe FILE NUMBER 21 07 0542 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 NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 1980 Fruehuf Trailer appraised value 100.00 2 1992 Royal Voyager Camper appraised value 100.00 3 1994 Dodge Caravan ~nivan Kelly Blue book value (see attached appraisal) 1,150.00 4 E-Trade Securities, LLC account #6088-6450 consisting of 91 shares of Ross Store, Inc. common stock valued at $3,083.99 and a cash account with a balance of $17.39 3,101.38 5 Members First Federal Credit Union checking account, #107243-11 2,363.81 6 Members First Federal Credit Union savings account, #107243-00 733.81 7 Memers First Federal Credit Union investment savings account, #107243-05 7,615.46 8 ReIman Publications magazine subscription refund 22.90 9 1,219.78 Ross Stores, Inc. wages due the decedent 10 State Farm Insurance refund due the decedent on auto insurance policy 14.70 3W46AD 1.000 TOTAL (Also enter on line 5, RecaDitulation\ $ (If more space is needed, insert additional sheets of the same size) 16,421. 84 Kelley Blue Book - Trade-In Pricing Report - Dodge, Caravan Kelley Blue Book THE TltUSTfP IU50t)RCf. . c~cc"'c",-'~c_-,,,c'--"''''Ulllll '. O. % FOR 72, c,. c MONTllS~' APR .{)d :''''(r.d FIHAt/&IIIG CC ' 11'1 "04"'", Page 1 of: adv0.rtisclTient O~l! OR 54,000 I'lItAlICtHG! COi!'SlIli\tj! CASH _ 11. ~ol'ffils 4LUJ\Ii!~IIf.~, -!>l.US- $1.0001.0YALlYCA5Ht Search Used Car Listings Quick Dealer Price Quote 1994 Dodge Caravan Minivan Trade-In Value BLUE BOOK' TRADE-U4 VALUE NO PHOTO AVAilABLE l~b~':"~~:O~' NEXT STEPS: List Your Car for Sale .~..._DPII~w~.fd~t1t~;::_,(' lJSED CA.RS "'l.i~H;:fllj;~d~~~'~;:._'l~tlr~~lf~I~'itTl'l;ht:[*a_~IlJJ;:;tH'a~~.l~'_._,~r~'l'~riii1~l~,;~l~:f;l.t~lLl1'{;J. ~ > Used Cars> 1994 > ~ > Caravan> Minivan> Equipment Print This Page' Private Party Value Suggested Retail Value Photo Callery Compare Vehicles "EO'>! Blue 1300k Review Consumer Ratings Find Your Next Car Specifications qS;~'t Shopping Tools Free CARFAX Record Check Auto Loan from 5.99% APR Compare Insurance Rates payment Calculator SELL YOUR USED CAR on Blue Book Classifieds™ Reach millions of shoppers on kbb.com, Cars.com, and other popular sites, Find out more, Click BUY A USED CA.R on Blue Book Classifieds™ Dodge Caravan 30 Miles or less ZIP Code 17055 To View Ads, Click mE CAR Compare Used vs. New Under $5,000 Both New and Used Van/Minivan Condition Value Excellent GOiCH.i Fair $1,625 $1,150 Get Pricing on New Vehicles Sell Your Van/Minivan Average Consumer Rating (2 Reviews) Read Reviews 3.5 out of 5 Review This Vehicle Check Out Our 10 Most Researched Van/Minivans 2007 Toyota Sienna 2007 Kia Sedona 2008 Dodge Caravan Grand 2008 Mazda MAZDAS 2007 Dodge Caravan http://WVv-w.kbb.com/KB BID sed Cars/PricingReport.aspx?Manufacturer Id= 13 & Y earl d= 1994& V eh i c I eC'.l ~ R!l7nnn7 2007 Honda Odyssey 2008 Chrysler Town &: Country 2007 Nissan Quest 2007 Hyundai Entourage 2008 Chevrolet Uplander Vehicle Highlights Mileage: 52,353 REV-1509 EX + (6-98) SCHEDULE F JOINTLY-OWNED PROPERTY COIVMONWEAL TH OF PENNSY LV ANIA It-HERITANCE TAX RETURN RESIDENT DECBJENT ESTATE OF FILE NUMBER Sharon A. Keefe 21 07 0542 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT T8'lANT(S) NAME ADDRESS RELA TIONSHIP TO DECEDENT A Danko, Betty Mother B Gilbert, Jack Brother JOINTL Y..QWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DA TE OF DEA TH ITEM FOR JOIN MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECO'S VALUE OF NUMBER JOINT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR VALUE OF ASSET INTEREST DECEDENT'S INTEREST TENANT JOINTLY-HELD REAL ESTATE. 1 AB 11/12/1993 Members First Federal Credit Union 60,866.55 33.3300 20,288.85 investment savings account, #100762-05. Primary owner is Betty Danko with Jack Gilbert and Decedent as co-owners 2 AB 11/12/1993 Members First Federal Credit Union 10,882.55 33.3300 3,627.52 checking account, #100762-11. Primary owner is Betty Danko with Jack Gilbert and Decedent as co-owners 3 AB 11/12/1993 Members First Fedral Credit Union 134.47 33.3300 44.82 sav~ngs account, #100762-00. Betty Danko is primary owner with Jack Gilbert and Decedent as co-owners TOTAL (Also ent..r on lin" f\ Re""nitulation) !t 23,961.19 (if more space is needed, insert additional sheets of the sarre size) 3W46AE 1.000 REV-1510 EX + (6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Sharon A. Keefe FILE NUMBER 21 07 0542 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM NUMBER 1. It'O...LDE T1-E NlWE OF Tl-E TRANSFEREE, THEIR RELA TIONSHlP TO DECEDENT AN) ll-E DATE OF TRANSFER. AITACHACQPV OF Tt-E DEED FOR REAL ESTATE, DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION IF APPLICABLE) TAXABLE VALUE Members First Federal Credit Union IRA account, #107243-15. (Benficiary is decedent's son) 9,892.49 100.0000 0.00 9,892.49 2 Ross Stores 401K plan with Ross Stores (Beneficiaries were decedent's grandchildren) 14,511.76 100.0000 0.00 14,511.76 TOT AL (Also enter on line 7, Recapitulation) $ 24 404.25 (If more space is needed, insert additional sheets of the same size) 3W46AF 1.000 REV-1511 EX+ (10-06) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Sharon A. Keefe FILE NUMBER 21 07 0542 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. FUNERAL EXPENSES 1. Myers Funeral Home, Inc. funeral services DESCRIPTION AMOUNT 3,135. 00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees Snelbaker & Brenneman, P.C. 3,250.00 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 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 PA Dept of Motor Vehicles obain duplicate title for vehicle destroyed in auto accident 22.50 Total from continuation schedules 1,386.90 7W46AG 1.000 TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) $ 7 794.40 Estate of: Sharon A. Keefe 207-34-6322 Schedule H Part 7 (Page 2) 2 Register of Wills filing fee for Inheritance Tax Return 15.00 3 Register of Wills short certificates 28.00 4 Snelbaker & Brenneman, P.C. reimbursement for probate fees and advertising for Administrator notice's 343.90 5 Reserve for filing fees, accounting fees and other costs associated with the administration of the Decedent's estate 1,000.00 Total (Carry forward to main schedule) 1,386.90 REV-1512 EX + (12-03) COMMONVVEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Sharon A. Keefe SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21 07 0542 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH American Express credit card debt 180.63 2 AT&T/Cingular Wireless phone service 131. 73 3 Boore's Towing towing expense to remove auto from accident scene 200.00 4 Chase Card Services credit card debt 1,400.41 5 DCM Services, LLC credit card debt 229.24 6 Discover Card credit card debt 197.12 7 Embarq phone service 97.47 8 FIA Card Services credit card debt 753.97 9 Lanc HMA Phys Mgmt Cent Pen medical expense 183.00 10 Philips and Cohen Associates credit card debt (Citibank) 289.22 11 Walmart credit card debt 140.29 12 WTNNB-Domestications credit card debt 116.19 13 Western Village RV Park storage fees for Royal Voyager Camper 445.00 3W46AH 2.000 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 4 364.27 REV-151~ EX+ (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYL VANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Sharon A Keefe NUMBER I NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers underSe~ 9116(~~.2n 1 Betty Danko 2 Jack Gilbert 3 Nicholas S. ~lisavic General Bequests: 7,255.88 4 Thomas ~lisavic, Jr. General Bequests: 7,255.88 5 Thomas W. ~lisavic 79 Center Street Pittston, PA 18640 All of Residue: 38,116.85 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) FILE NUMBER 21 07 0542 AMOUNT OR SHARE OF ESTATE Mother Brother Grandson Grandson Son 0.00 0.00 7,255.88 7,255.88 38,116.85 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 3W46AI 1.000 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) $ 0.00