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Home My WebLink About03-26-08 z o ~ < ..J :::> .- a: < u w a::: z o ~ <:( .- :::> a. :E o u >< <:( .- REV-1500 EX + (6-00) REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 .- Z W C W U W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Bivens Howard M. DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) 04/02/2006 OS/23/1923 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) W I- ~ :$(1) u a:~ w 15U :I:a:g U a.m a. <( [RJ 1. Original Return o 4. Limited Estate o 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 12-12-62) o 7. Decedent Maintained a Living Trust (Attach copy oITrusl) o 10. Spousal Poverty Credit (date of death between 12.31-91 and 1-1-95) OFFICIAL U SE ONLY FILE NUMBER 2 1 -0 6 0 4 4 3 COONTYCOOE ---YEA~ - - NuMBER- - SOCIAL SECURITY NUMBER 1 6 1 - 4 8 - 4 3 0 2 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 3. Remainder Return (date 01 death pnorto 12-13-62) 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) THIS SECTION MUST BE COMPLEtED. ALL CORRESPONDENCE AND CONFIDENTIAl'TAX, INFORMATION SHOULD BE DIRECTED TO: - NAME COMPLETE MAILING ADDRESS John M. Eakin Market Square Building FIRM NAME (If Applicable) I- Z W o z o a. (I) w a: a: o U TELEPHONE NUMBER 717-766-3172 Mechanicsburg, PA 17055 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscelianeous Personal Property (5) (Scheduie E) 6. Jointly Owned Property (Schedule F) (6) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscelianeous Non-Probate Property (7) (Schedule G or L) 8. T alaI Gross Assets (total Lines 1-7) 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) 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) (8) (11) (12) (13) 20. 0 -- '-.," -':>::>.'.' BE SURE TO'ANSWER',:ALLQUESTIONS dN':RE-VE-RSE;SIDE A'NO RECHECK MATH'l;<<,. 14. Net Value Subjectto Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES (14) 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X _(15) X _(16) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 711.88 X .12 (17) (18) (19) 18. Amount of Line 14 taxable at collateral rate X .15 19. Tax Due I I j I 12,912.02 i OFFICIAL USE ONLY :''',-~ 12,912.02 12,160.00 40.14 12,200.14 711.88 711.88 85.43 85.43 :i-::\!~ d:O"'\'_:\;:i: Add Decedent's Complete ress: . STREET ADDRESS . CITY I STATE I ZIP Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 85.43 3. Total Credits (A + B + C) (2) InteresUPenalty if applicable D. Interest E. Penalty 56.95 4. TotallnteresUPenalty ( 0 + E) 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) 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. (58) Make Check Payable to: REGISTER OF WILLS, AGENT (3) 56.95 5. 0.00 142.38 142.38 PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS No [2SJ [2SJ [2SJ [2SJ 1. Did decedent make a transfer and: Yes a. retain the use or income of the property transferred; ........................................................................... 0 b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 c. retain a reversionary interest; or ...................................................................................................... 0 d. receive the promise for life of either payments, benefits or care? ............................................................. 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ......... .......... .............. .............. ................... ............................ 0 3. Did decedent own an "in trust for' or payable upon death bank account or security at his or her death? ................. 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... 0 [2SJ [2SJ 1KI IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 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 pre parer other than the personal representative is based on all information of which preparer has any knowledge. SIGNAT).\~ OF PERSON RE~~SI8LE FOR FILING RETURN DATE U,,1,(.-o1 "" t: i~4-l.U/l'\n ADDRESS .~ 1 .__ tee L[v-{. '^-<~ I --e^/I.-aL<- HAN REPRESENTATIVE SIGNATURE OF PR J~'A_-t-L-.e,,^- \ ADDRES~ e }' ~,-e /S~ DATi.::;" ) Of f 7C',~' :,' 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. 39116 (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. 39116 (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 0% [72 P.S. 39116(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. 39116(1.2) [72 P.S. 39116(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. 39116(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-1508 EX + (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Bivens. Howard M. ITEM NUMBER 1. FILE NUMBER 21 06 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. 0443 DESCRIPTION M& T Bank Savings Account # 15004200933867, see attached VALUE AT DATE OF DEATH 935.70 2. Citizens Bank Checking Account # 610076-042-1, see attached 375.58 3. PNC Bank Burial Account #5030110086 11,600.74 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 12912.02 - ~ M&I'Bank 15004200933867 M&T PERSONAL SAVINGS MAR.21-APR.20,2006 00 0 04350M NM 017 18264 HOWARD M BIVENS 17 MAURICE RD MT HOLLY SPGS PA 17065-1104 INTEREST PAID YEAR TO DATE 0.52 TRINDLE ROAD OFFICE . ..,B:e:GIl'ml#~ . : : :'ilArJuiiCE;:.. . ACCOUNT SUMMARY ...:::':: .:'l'/~:rllI)~l'/Ar..?Ii()'tIl.:~.. .. ... :::::::::.SUSTRACTioNS:... NO . AMOUNT o 0.20 :..:..:'............J:):e:~()$t.I:SA:.... ::: .:.: :U'I'HE:R::j,ririi'I'iONS:.. NO. AMOUNT o .::.:.....:......!::~I:..:::.:.:.:.::... .. INTERES'I':: PAID::::... 935.70 0.00 0.00 ACCOUNT W(Dl<Al'/ALSt;OTHER .... ...SUB'I'AAC'I'iONS... 03-21-06 BEGINNING BALANCE 04-20-06 INTEREST PAYMENT 0.20 ENDING BALANCE ANNUAL PERCENTAGE YIELD EARNED 0.25 % LOCK IN A GREAT LOAN RATE. UNLOCK THE POSSIBILITIES. WITH M&T CHOICEQUITY, YOU GET THE ABILITY TO LOCK IN A LOAN WITH A GREAT FIXED RATE, AS WELL AS A LINE OF CREDIT - ALL IN ONE ACCOUNT. HOW'S THAT FOR SECURITY AGAINST RISING INTEREST RATES? BEST OF ALL, YOU'LL ONLY HAVE ONE MONTHLY PAYMENT, WITH NO CLOSING COSTS, NO APPLICATION FEE AND NO REAPPLYING. SO WHY WAIT? START ENJOYING THE FLEXIBILITY OF M&T CHOICEQUITY TODAY. TO APPLY, STOP BY ANY M&T BRANCH, VISIT WWW.MANDTBANK.COM, OR CALL THE M&T TELEPHONE BANKING CENTER AT 1-800-724-3222. 1 OF 1 935.90 $935.90 ~~ C"t" B k :It~ I Izens ...an 1-888-910-4100 Call Citizens' PhoneBank anytime for ac~ount information, current rates and answers to your questlons. US259 SR306 2 1 CLARENCE E BIVENS CUST 7800 AVONDALE TER HARRISBURG PA 17112-3806 Checking Account Statement o OF 3 Beginning March 23, 2006 through April 24, 2006 Checking SUMMARY BaLance CaLcuLation Previous Sa lance Checks Withdrawals Deposits & Additions Interest Paid Current BaLance ~ 800.00 - 706.00 - 671.00 + .00 + -459.42 = TRANSACTION DETAilS Checks. There is a break in check sequence Check # Amount Date 505 800.00 04/13 /" WithdrawaLs Other WithdrawaLs Date Amount Description 04/11 671.00 Debit Memo 04/14 35.00 Overdraft Fee (1) Deposits & Additions Date Amount Description 04/03 671. 00 US Treasury 303 SOC Sec 040306 Daily BaLance Date 04/03 04/11 Balance / Date 1,046.58 04/13 375.58 .'~.) Balance Average Daily Balance 401. 67 Interest Current Interest Rate Annual Percentage Yield Earned Number of Days Interest Earned Interest Earned Interest Paid this Year Check # Amount Date A p n I .5 CJu t'f/ Jel-.;,rt'/ '7( Ck Balance -424.42 Date 04/14 Balance -459.42 CLARENCE E BIVENS CUST HOWARD M BIVENS PersonaL Checking with Interest 610076-042-1 .00'10 .OO'!. 33 .00 .00 Previous Balance 375.58 G Total Checks 800.00 G Total Withdrawals 706.00 o o Total Deposits & Additions 671. 00 Current Balance -459.42 ~ o PNC ADVlSORS PO Box 308 Camp Hill PA 17001-0308 (717) 730-2265 July 6, 2006 John M. Eakin Attorney at Lav.J Market Square Building Mechanicsburg P A 17055 Re: Bivens Burial Reserve Account Dear Mr. Eakin: Enclosed you will find our Cashier's check in the amount of$11,600.74 payable to Myers Funeral Home as requested. This check represents the balance in our account #5030110086, Please deliver the check to the funeral home at your convenience. Si~cerely, '. . 'C'", (, ~~~ Linda J. Lundberg Asst. Vice President Estate Administrator Enclosure A member of The PNC Financial Services Group 4242 Carlisle Pike Camp Hill Pennsylvania 17011 REV-1511 EX+(12-99) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Bivens Howard. M. FILE NUMBER 21 06 0443 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Myers Funeral Home, Inc. 8,866.00 2. Gingrich Memorials, grave stone 2,068.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Clarence Bivens 600.00 Social Security Number(s)/EIN Number of Personal Representative(s) 200-24-2027 Street Address 7800 Avondale Terrace City HarrisburQ State P A Zip 17112 Year(s) Commission Paid: 2008 2. Attomey Fees John M. Eakin 400.00 3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Letters Administration 81.00 5. Accountant's Fees 6. Tax Return Prepare(s Fees 7. Register of Wills - filing of bond 15.00 8. Community Banks Insurance Service, Administrator Bond 100.00 9. Register of Wills - Filing Fee 15.00 10. Citizens Bank- Bank Charge 15.00 TOTAL (Also enter on line 9, Recapitulation) $ 12160.00 Debts of decedent must be reported on Schedule I. (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 Bivens. Howard. M. FILE NUMBER 21 06 0443 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1. Alert Pharmacy SeNices, Inc. VALUE AT DATE OF DEATH 40.14 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 40.14 """:~'(. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER RivF'n~ Howarrl M, 21 OR ().14~ RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE 1. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under See, 9116 (a) (1.2)] 1- Mable Hankey Sister 1/7 of net residue Green Acres Nursing Home 595 Biglerville Road, Gettysburg, PA 17325 2, Elizabeth Smee Sister 1/7 of net residue 651 Hilltop Drive New Cumberland, PA 17070 3, Helen Frame Sister 1/7 of net residue 6000 Pelican Bay Blvd, apt. 1402 Naples, FL 34108 4, Clarence Bivens Brother 1/7 of net residue 7800 Avondale Terrace Harrisburg, PA 17112 5, Robert Bivens Brother 1/7 of net residue 246 Jonathan Drive Sherrystown, PA 17344 6, Jean Basehore Sister 1/7 of net residue 6050 Creekview Road Mechanicsburg, PA 17050 7, Beatrice Bivens Sister 1/7 of net residue P,O, Box 55 Grantville, PA 17028 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 1, B, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1- 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)