HomeMy WebLinkAbout04-02-08
...J
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 DO
RESIDENT DECEDENT 2 1 ~
File Number
()2) 0
Date of Birth
05022007
09131953
Decedent's Last Name
Suffix
Decedent's First Name
RIVERA
DEBI
MI
M
(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
Yj 1. Original Return
2. Supplemental Return
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
4. Limited Estate
c_ J
4a. Future Interest Compromise
(date of death after 12-12-82)
6. Decedent Died Testate
(Attach Copy of Will)
7. f,..~f:,g,e~to~:i~:~:;;~>" Living Trust
8. Total Number of Safe Deposit Boxes
1 9. Litigation Proceeds Received
1 O. ~~~::~ ~3~~r!gf~en~t1(~1~~5\,f death
11. Election to tax under Sec. 9113(A}
(Attach Sch. O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
JERRY A. WEIGLE ESQUIRE 7175327388
Firm Name (If Applicable)
WEIGLE & ASSOCIATES P.C.
l-....)
=
SHIPPENSBURG
State
PA
ZIP Code
17257
REGISTE~g.'ILLS U<<ONL 'f:,~
c):J -0 -0 c..' ) .
i ,-II (") ::0 C' ,
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oA;-E FILED 0
-0
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~
First line of address
126 EAST KING STREET
Second line of address
City or Post Office
Correspondent's e-mail address:
Maria E. Figueroa-Snyder
Jerry A. Weigle Esquire
?
DATE ~
-z.?{ -Or
L
Side 1
15056041147
15056041147
...J
?5
--1
15056042148
REV-1500 EX
Decedent's Name Deb i M. Rivera
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)"..""""""
6. Jointly Owned Property (Schedule F) ! Separate Billing Requested.."..""". 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) 'l Separate Billing Requested.."..""". 7.
8. Total Gross Assets (total Lines 1-7)..".."..".."..".."..".."""""""""""..""..".."..".
--- - --- ..-- ..-.. --- --....-- -- --- --._-- ---._- ------- ___...___ _n __.. ___
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.
16.
Amount of Line 14 taxable
at the spousal tax rate, of
transfers under Sec. 9116
(a)(1.2) X~ 0 00
Amount of Line 14 taxable
at lineal rate X .045 0 00
Amount of Line 14ia:Xable
at sibling rate X .12 0 00
Amount of Line 14 taxable
at collateral rate X .15 0 00
18.
15.
17.
16.
18.
17.
19. Tax Due" .."....................... """""" "". "..".."..".."..".."... ".."".... """......... """"""'" 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
L
Side 2
15056042148
-
5.
8.
Decedent's Social Security Number
10,720.37
10720.37
6 337 46
23 915 96
30 253 42
-19 533 05
-19,533.05
o 00
o 00
o 00
o 00
o 00
o
15056042148
--1
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
Debi M. Rivera
STREET ADDRESS
122 Peach Orchard Road
File Number 21--
-- ...- - -- ----, --- -- --, -...-- --- -
CITY
-.. ----.._---- ------ -------- -- '----._-._---
Newville
I STATE
PA
fZIP - -
17241
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
0.00
0.00
3. InteresVPenalty if applicable
D. Interest
E. Penalty
Total Credits (A + 8 + C)
(2)
0.00
TotallnteresVPenalty (0 + 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.
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3)
(4)
(5)
(5A)
(58)
0.00
0.00
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?........ J Ix:
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which___
contains a beneficiary designation?........... .................... ........... ........... ......................... ....................................... I xJ
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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?................................................................................................................. .....
Yes
!
No
xl
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 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. ~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-1508 EX+ (6-98)
*'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Rivera, Debi M.
IFILE NUMBER
21--
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jolntly-owned with the rfght of survivorship must be disclosed on schedule F.
ITEM
NUMBER DESCRIPTION
1 Cornerstone Federal Credit Union Checking Account #23455-07
VALUE AT DATE
OF DEATH
6.34
Accrued interest on Item 1 through date of death
0.51
2
Cornerstone Federal Credit Union Savings Account #23455-01
493.84
Accrued interest on Item 2 through date of death
4.54
3
Cornerstone Federal Credit Union Special Savings Account #23455-09
125.44
Accrued interest on Item 3 through date of death
0.70
4
2003 Ford Escape - average condition
10.089.00
TOTAL (Also enter on Line 5, Recapitulation)
10.720.37
(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
Rivera, Debi M.
Debts of decedent must be reported on Schedule I.
I FILE NUMBER
21--
ESTATE OF
ITEM
NUMBER
A. FUNERAL EXPENSES:
DESCRIPTION
AMOUNT
See continuation schedule(s) attached
2,272.46
B.
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City
Year(s) Commission paid
State Zip
2.
Attorney's Fees
Weigle & Associates, P.C.
500.00
3.
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant Maria E. Figueroa-Snyder
Street Address 122 Peach Orchard Road
City Newville State PA Zip 17241
Relationship of Claimant to Decedent Daughter
3,500.00
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
Other Administrative Costs
See continuation schedule(s) attached
65.00
TOTAL (Also enter on line 9, Recapitulation)
6,337.46
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
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Rivera, Debi M.
IFILE NUMBER
21--
ESTATE OF
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Hoffman-Roth Funeral Home
2.272.46
Subtotal
2.272.46
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-B7
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Rivera, Debi M.
IFILE NUMBER
21--
ESTATE OF
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Register of Wills, Cumberland County - filing Insolvent PA Inheritance Tax Return
15.00
2
Register of Wills, Cumberland County - miscellaneous filing fee (petition)
25.00
3
Weigle & Associates, P.C. - reimbursement for postage, xerox copies, and long
distance telephone calls
25.00
Subtotal
65.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B7 (Rev. 6-98)
Rev-1512 EX+ (6-98)
.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Rivera, Debi M.
IFILE NUMBER
21--
Include unrelmbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1 Capital One Services, Inc. - credit card balance
VALUE AT DATE
OF DEATH
359.14
2 Chase Bank, U.S.A. - credit card balance
4.666.83
3 Ford Credit - auto loan balance
18.157.99
4 G. H. Harris Associates, Inc. - 2006 Big Spring School District per capita tax
29.00
5 Newville Community Ambulance
450.00
6 Penn Credit Corporation - 2004 and 2006 county and township per capita taxes
57.00
7 Sprint
196.00
TOTAL (Also enter on Line 10, Recapitulation)
23,915.96
(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)
~
~",..---.....~... Ir-~r-.-_... .r-
LCJKI"cK~ J UNt
Federal Credit Union
P.O. Box 118/,5 East Gate Drive, Carlisle, PA 17D 15
Telephone (717) 249-1661 FAX (717) 249-8208
www.comerstonefcu.coop
Member founded - Service based
July 10, 2007
JUL 1 1 2UU1
Weigle & Associated, P.c.
126 East King Street
Shippensburg, PA 17257
RE: ESTATE OF DEBRA M. RIVERA
Jerry,
At the time of her death, Debra M. Rivera had a savings, checking and special savings account.
Listed below is the information requested per your letter dated June 29, 2007:
Account Numbers 23455-0 I 23455-07 23455-09
(#1 & #2) Savings Checking Special Savings
(#3) Date Accounts were open I 1 -I - 2006 I I-I - 2006 11-27-2006
(#4) Joint Account No No No
(#5) Balances $493.84 $6.34 $125.44
(#6) Accrued interest $4.54 $0.51 $0.70
If you require any additional information, please do not hesitate to contact me at 717-249-1661
ext 240.
Sincerely,
I
1~>J(j1 i~I~:)lUlld
t r-duer:.::d ("~rdti!t U! ill_:!l
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/~n '/Y~~yV-l
~MBER SAVINGSACCOUNTS FEDERALLY INSURED To $100,000 By THE NATIONAL CREDIT UNION ADMI~
~~,
\~~9l1fcho
Donna J. Mickey
Financial Services Administrator
,~. ~.----_._'-'
UWOI
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LAW OFFICES OF
WELTMAN, WEINBERG & REIS CO., L.P.A.
323 W. Lakeside Avenue, Suite 200
Cleveland, OH 44113
(216) 685-1001 (800) 807-7796
Mon-Thurs 8am-7pm, Fri 8am-5pm, & Sat 8am-12pm EST
May 9, 2007
6017930/CBX/137/5466192/0907
To the Estate of:
DEBI M RIVERA
122 PEACH ORCHARD RD
NEWVILLE, PA 17241
~--- ~ ~
~APITAL O~~)SERVICES, INC.
Account No. 4862362558250554
Balance Due a~ of May 9, 2007: $359.14
Our File No.: 6017930
Dear Personal Representative of the Estate:
Please be advised that this law firm represents the above-captioned
creditor with regard to this account on which the Decedent was liable.
Please accept our condolences during this difficult time.
It would be appreciated if you would contact our office and advise as
to whether an Estate has been or will be filed and if so, the
information pertaining thereto. Also, please advise our office as to
the intentions of the estate with regard to the satisfaction of the
Decedent's outstanding debts. Please also furnish to this office a
copy of the death certificate for the Decedent. The following
toll-free number is available for your convenience: (800) 807-7796.
Your attention to this matter is greatly appreciated.
Sincerely,
Weltman, Weinberg & Reis Co., L.P.A.
Federal law requires us to advise you of the following information:
This law firm is a debt collector attempting to collect this debt for
our client and any information obtained will be used for that purpose.
Unless you disp'lte the validity of this debt, or any portion thereof,
within thirty (10) days of receipt of this letter, we will assume that
this debt is valid. If you notify us in writing within the t'lirty (30)
day period that the debt, or any portion thereof, is disputed, we will
obtain verific&~ion of the debt and mail you a copy. If you request in
writing within the thirty (30) day period, we will provide you with the
name and address of the original creditor if different from the current
creditor.
25X Chapman Rd
Suite 205
'Newark. DE 19702
Return Service Requested
Phillips
06/06/07
Office Hours:
M - Th: 8am - 9pm
Fri: 8am - 6pm
Sat: 8am-12pm
The Estate of:
Debi Rivera
122 PEACH ORCHARD RD
NEWVILLE PA 17241-8947
11111111111111111111111111111111111111111111111111111111111111
258 Chapman Rd
Suite 205
Newark, DE 19702
---------------------------------------------------------
Account #: 5986715
Balance: $4666.83
Re: Client:
Client Acct#:
Our Acct#:
Balance:
*** PLEASE DETACH AND RETURN IN THE ENCLOSED ENVELOPE WITH YOUR PAYMENT ***
~E BA~USA, N.A.
42 41049759309
5986715
$4666.83
To the Estate of Debi Rivera:
Our client CHASE BANK, USA, N.A. recently received notification that Debi Rivera passed away. Initially, on
behalf of our client and our office, please accept our condolences.
As you may already know, at the time of the unfortunate passing of Debi Rivera, the amount of $4666.83 was
owed to CHASE BANK, USA, N.A.. In order to prevent any h\rther collection activity against the Estate of Debi Rivera
and to resolve this matter, please contact this office at the above address. If you have infonnation regarding the Estate of
Debi Rivera, including if there is no Estate, please contact our office by telephone at the above number.
IF YOU HAVE ANY QUESTIONS, YOU MAY CONTACT OUR OFFICE AT THE ABOVE TELEPHONE
NUMBER.
Thank you for your prompt attention to this matter.
Sincerely,
Howard A. Enders
President
** IMPORTANT CONSUMER INFORMATION **
Unless you notify this office within thirty (30) days after receiving this notice that you dispute the validity of this debt or any
portion thereof. this office will assume this debt is valid. If you notify this office in writing within thirty (30) days from receivinl
this notice, this office will: obtain verification of the debt or obtain a copy of a judgment and mail you copy of such verification (
judgment. If you request this office in writing within thirty (30) days of receiving this notice, this office will provide you with th
name and address of the original creditor, if different from the current creditor. This communication is from a debt collector. TI
is an attempt to collect a debt and any information obtained will be used for that purpose.
Phillips & Cohen Associates, Ltd. . 258 Chapman Rd, Suite 205 · Newark, DE 19702 · 800-259-6991
PCAL022
(QESP)40:T035:002419:001.1000:071 57:PUOl :PCAL022:01:
Account Number
Vehicle Description
VIN
041684953
2003 FORD ESCAPE
1 FMCU94153KC85405
0410112007
$18,157.99 04121/2007
1-800-n7-7000
Mon - Sat7am to Bpm CST
www.fonIQ.8dit..com
Statement Date
Payoff Amt Good Thru
CUstomer Service Cantel'
Hours of Operation
Website Address
Refarto back of statement for additional contact information.
~;f:\~~'1~~~{{jW~ii~
DATE
03/2012007
DESCRIPTION
Payment Received - Thank you!
AMOUNT
$ 431.22
Payments received after statement date are not reflected.
~MOUNTIS):BUE' '., ';~.'" " "', .' ',"-
DATE
0412112007
DESCRIPTION
Payment Due
TOTAL AMOUNT DUE
AMOUNT
$ 431.22
$ 431.22
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reference code G5Q or visit us at www.fordcarinsurance.comto see what
we can do for you. And your car.
American Road Services Company, ("AMRa"), a subsidiary of Ford Motor
Company ("FORD"), is the licensed insurance agency supporting the Ford Motor
Company Insurance Services program. Ford Motor Company is not an insurance
company or agent.
...
'"
o
'"
'"
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-
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--
!S
--
-
-
All insurance is underwritten by the following wholly owned subsidiaries of
Ameriprise Financial. Inc.: Ameriprise Insurance Company, AMEX Assurance
Company or IDS Property Casualty Insurance Company, De Pere, WI, or other
insurance companies for whom Ameriprise Auto & Home Insurance Agency is an
agent. Ameriprise Auto & Home Insurance's California license number is 0C41813.
AMRO's California license number is OC02678.
-
--
DETACH AND RETURN REMITTANCE COUPON BELOW FOR EACH ACCOUNT PAID.
...
~
I~l
\. .... -...,-.-.- ... ..
Ford Credit
P,O, Box 542000
Omaha, NE 68154-a000
#BWNKPYC
#00000041684953T#
AS 01 188031 86153 S 622 A
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DEBRA M RIVERA
122 PEACH ORCHARD RD
NEWVILLE PA 17241-8947
6
Account Number
Payment Due Date
TOTAL AMOUNT DUE
041684953
04121/2007
$ 431.22
If Payment Received AFTER
Please Pay
05/01/2007
$ 439.84
,
ENTER TOTAL AMOUNT PAID ABOVE
REMIT TO: 041684953
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Ford Credit
Box 220564
Pittsburgh, PA 15257-2564
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14806300000000000004168495300043122003