HomeMy WebLinkAbout03-10-08 (2)
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15[]5b[]41147
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 06
RESIDENT DECEDENT
File Number
0366
579 36 5497
12 08 2006
Date of Birth
07 21 1921
Decedent's Last Name
PORT
Suffix
Decedent's First Name
ETTA
MI
L
(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 OVALS BELOW
!!l 1. Original Return
4. Limited Estate
o
o
o
o
4a. Future Interest Compromise
(date of death after 12-12-82)
2. Supplemental Retum
o
o
3. Remainder Retum (date of death
prior to 12-13-82)
5. Federal Estate Tax Retum Required
o
[!]
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
9. 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)
CORRESPONDENT. THIS SECTION MUST BE COMPLETED. All CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
HERBERT P. HENDERSON II 717 367 2800
Firm Name (If Applicable)
PECHT & ASSOCIATES, P.C.
1"'. ."'
REGISTER'OF ~ILLS US~0NL Y
First line of address
55 WEST HIGH STREET
-)
C)
Second line of address
{--
City or Post Office
ELIZABETHTOWN
State
PA
\
DATE FILED
ZIP Code
17022
Correspondent's e-mail address: h hen d e rs 0 n @pec h t I a w . com
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.
:' OF\P;~~ON RESPON. FOR FILING RETURN _ ') ?~ ()O
~'{.( ~ Patrick Port c...J/"- / 0
ADDRESS
15
Herbert P. Henderson, II
7TE
-3 ~ c'r"
55 West High Street, Elizabethtown, PA 17022
Side 1
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15[]5b[]41147
15[]5b[]41147
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15056042148
REV-1500 EX
Decedent's Name: Etta Louise Port
Decedent's Social Security Number
579 36 5497
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 . 0 0
15.
114,015.35
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.
Side 2
L
15056042148
77,741.70
51,886.99
129,628.69
12,486.76
3,126.58
15,613.34
114,015.35
114,015.35
o . 0 0
5,130.69
o . 0 0
o . 0 0
5,130.69
D
15056042148
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REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-06-0366
DECEDENT'S NAME
Etta Louise Port
STREET ADDRESS
CITY I STATE JZIP
lower Allen Township PA
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
5,130.69
1,600.00
84.21
Total Credits (A + B + C)
(2)
1,684.21
3. Interest/Penalty if applicable
D. Interest
E. Penalty
86.95
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) 86.95
(4)
(5) 3,533.43
(5A)
(58) 3,533.43
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;.................................................................................. [!J 0
b. retain the right to designate who shall use the property transferred or its income;.................................... [!J 0
c. retain a reversionary interest; or.................................................................................................................. [!J 0
d. receive the promise for life of either payments, benefits or care?............................................................. D [!J
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?...................................................................................................................... D [!J
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?........ 0 [!J
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?............................ ......................................................................................... D [!J
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 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.
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
COMMONWEAl. TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Port, Etta Louise
FILE NUMBER
21-06-0366
ESTATE OF
Include the proceeds of I~lgalion and the date the proceeds were received by the estate.
All property jalnUy-owned with the right of survivorship must be disclosed on schedule F.
ITEM
NUMBER DESCRIPTION
1 AARP Health Care Options - Refund of payments made beyond cancellation date
VALUE AT DATE
OF DEATH
66.00
2 Carillon Assisted Living - Refund per copy of check
22.767.58
3 Chevy Chase Bank Account # 024-332306-9 - 000 value per statement from bank
1.430.22
4 M & T Bank - Distribution check from Retirement Account # 035-004201531785
100.00
5 M & T Bank Retirement Account # 035-004201531785 - Value as of 9/8/07 close of
account
1.200.00
6 US Series EE Bonds - Redemption value on 9/10/07 per bank Savings Bond
Redemption Summary
6.572.64
7 US Series EE Bonds - Redemption value 9/10/07 per bank Savings Bond
Redemption Summary
38.547.36
8 US Treasury Check - Social Security for INS per copy of check
351.50
9 Wachovia Checking Account # 1010118641751 - 000 value per bank letter
6.706.40
TOTAL (Also enter on Line 5, Recapitulation)
77.741.70
(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.1510 EX+ (6.98)
.
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEAl. TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIOENT OECEOENT
Port, Etta Louise
FILE NUMBER
21-06-0366
ESTATE OF
This schedUle must be completed and filed ~ the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM ..~ y DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE.
1 Wachovia Revocable Trust Checking Account # 18,241.99 18,241.99
1010126443569 - 000 value per bank letter
2 Wachovia Revocable Trust Securities Account # 33,645.00 33,645.00
6856-8187 - 000 value per bank statement
TOTAL (Also enter on Line 7, Recapitulation) 51,886.99
(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 G (Rev. 6-98)
REV-1151 EX+ (12-99)
*'
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Port, Etta Louise
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21 ~06~0366
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 6,997.50
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 Pecht & Associates, PC 4,862.00
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 627.26
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
TOTAL (Also enter on line 9, Recapitulation) 12,486.76
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
COMMONWEALTH OF PENNSYLVANIA
~HERITANCETAXRETURN
RESIOENT DECEDENT
Port, Etta Louise
FILE NUMBER
21-06-0366
ESTATE OF
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Mount Olivet Cemetary - Vault, engraving, opening/closing cemetary plot
2.222.50
2
Peacock-Newnam & White Funeral & Cremation Services - All funeral services and
merchandise
4.775.00
Subtotal
6.997.50
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-82
ATTORNEY'S FEES
continued
COMMONWEAnH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Port, Etta Louise
FILE NUMBER
21-06-0366
ESTATE OF
ITEM
NUMBER
1
DESCRIPTION
Law Offices of Steven J. Hogg - Attorney fees for probate
AMOUNT
662.00
2
Pecht & Associates - Attorney fees for estate administration
4.200.00
Subtotal
4.862.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B2 (Rev. 6-98)
Rev-1502 EX+ (6-98)
*'
SCHEDULE H.84
PROBATE FEES
continued
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Port, Etta Louise
FILE NUMBER
21-06-0366
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Cumberland County Register of Wills - Petition, will, short certificates and fees
286.00
2
Cumberland Law Journal - Estate advertising
75.00
3
The Patriot- News - Estate advertising
253.26
4
Wachovia debit - Estate check charge
13.00
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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
INHERITANCE TAX RETURN 2 1 0 6
RESIDENT DECEDENT
File Number
0366
579 36 5497
12 08 2006
Date of Birth
07 21 1921
Decedent's Last Name
PORT
Suffix
Decedent's First Name
ETTA
MI
L
(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 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
lKJ
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
9. Litigation Proceeds Received
1 O. g~~::~ ~~~~r!gf~n~t ~~f_~5)f death
o
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
HERBERT P. HENDERSON II 717 367 2800
Firm Name (If Applicable)
~. "I
I ___.____,_.L u___
,-'
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"",.,I"I",........I'I'I~,..
Rev-1512 EX+ (6-98)
.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Port, Etta Louise
FILE NUMBER
21-06-0366
ESTATE OF
Include unrelmbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1 Amera-Tech of NC, Inc. - Medical transportation - non-emergency
VALUE AT DATE
OF DEATH
39.30
2 Costal Carolina Pathology - Lab work co/pay
22.87
3 Delaney Radiologists PA - Radiology bill patient responsibility
10.42
4 FIA Credit Card Services - Outstanding credit card bill
1.931.45
5 Howe St Internal Medicine - Medical bill patient responsibility
80.29
6 J.A. Dosher Memorial Hospital - Hospital bill patient responsibility
865.43
7 South port Rescue Squad - Emergency transportation
176.82
TOTAL (Also enter on Line 10, Recapitulation)
3,126.58
(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
NUMBER
Port, Etta Louise
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal
Cfistributions, and transfers
under Sec. 9116(a)(1.2)]
RELATIONSHIP TO
DECEDENT
Do Not Ust Trustee(sl
FILE NUMBER
21-06-0366
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
ESTATE OF
I.
1
Mary E Eaton
PA
Daughter
five percent
5,700.77
3
Patricia L Pak
PA
Daughter
twenty-five
percent
28,503.84
4
Patrick G Port
PA
Son
seventy
percent
79,810.75
Total 114,015.36
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)
Informational Copy
Do Not File
SCHEDULE Y-19A
Inheritance Tax
Paid @ 5% Discount
ESTATE OF
Port, Etta Louise
FILE NUMBER
21-06-0366
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1
Cumberland County Register of Wills - Inheritance Tax Discounted Payment
1.600.00
TOTAL (Also enter on Line 7, Recapitulation)
1.600.00
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.