HomeMy WebLinkAbout04-29-08 (2)
REV-1500 1>.,<. (6-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128.{)601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST. FIRST. AND MIDDLE INITIAL)
GRAHAM
DATE OF DEATH (MM-DD-Year)
RUTH
F_
DATE OF BIRTH (MM-DD-Year)
OFFICIAL USE ONLY
FILE NUMBER
2 1 -0 8 0 4 4 5
""Coij;jTY"CoDE -YEAr- - - NuMsER- -
SOCIAL SECURITY NUMBER
1 60- 1 6 - 0 6 5 2
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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)
THIS SECTION MOST BE COMPLETED.Al..L CORRESPONDENCE AND CONFIOENTIALTAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
ROGER B. IRWIN ESQUIRE 60 WEST POMFRET STREET
FIRM NAME (If Applicable)
IRWIN & McKNIGHT
TELEPHONE NUMBER
717 249-2353 CARLISLE PA 17013
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0.00 X _(15) 0.00
0.00 x .045 (16) 0.00
0.00 X .12 (17) 0.00
0.00 X .15 (18) 0.00
(19) 0.00
01/17/2008 09/30/1919
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST. AND MIDDLE INITIAL)
[X] 1. Original Return
o 4. Limited Estate
[X] 6. Decedent Died Testate (Attach copyofWillj
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12-12-82j
o 7. Decedent Maintained a Living Trust (Attach copy ofTrust)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
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(1)
(2)
(3)
(4)
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
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)
(5)
(6)
(7)
(9)
(10)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
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. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> >iSE SURE Ttl ANSV\lER ALl. QUESTIONS ON REVERSE SIDE AND RECHECK MATHi< <
OFFICIAL USE ONLY
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8,864.58
121 ,449.07
po.;,
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(11)
(12)
(13)
130,313.65
-118,495.42
(14)
-118,495.42
CITY
NEWVILLE
STATE
PA
ZIP
17241
'-
Decedent's Com lete Address:
STREET ADDRESS
210 BIG SPRING AVENUE
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. CreditsfPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
0.00
0.00
Total Credits (A + B + C)
(2)
0.00
3. InterestJPenalty if applicable
D. Interest
E. Penalty
TotallnteresUPenalty ( 0 + 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. (SA)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58)
Make Check to: REGISTER OF WILLS, AGENT
0.00
0.00
0.00
0.00
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; ........................................................................... D 00
b. retain the right to designate who shall use the property transferred or its income; ........................................ D 00
c. retain a reversionary interest; or ...................................................................................................... D 00
d. receive the promise for life of either payments, benefits or care? ............................................................. D 00
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................. D 00
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. D 00
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... D 00
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 preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE F PERSON ~~R FILI\~TURN ./
ADDRESS 10 CH STNUT STREET GREEN SPRING ROAD
NEWVILLE, PA 17241 ILLE, PA 17241
SIGNATURE OF PREPA~THER THAN REPR~TIVE
ADDRESS 60 WES~;; STREE;-
CARLISLE
DATE
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PA 17013
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. 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 0% [72 P.S. S9116 (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. 99116(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. 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 12% [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-1508 EX + (6-98)
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
RUTH
FilE NUMBER
F. 21 08
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.
0445
DESCRIPTION
ITEM
NUMBER
1.
ADAMS COUNTY NATIONAL BANK
SAVINGS ACCOUNT #9639306
2.
ADAMS COUNTY NATIONAL BANK
ESTEEM CHECKING ACCOUNT #117951
3.
ADAMS COUNTY NATIONAL BANK
CERTIFICATE OF DEPOSIT #39910112
VALUE AT DATE
OF DEATH
3,752.25
55.40
8,010.58
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets 01 the same size)
11818.23
REV-1511 EX + (12-99)
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
ESTATE OF
GRAHAM
RUTH
Debts of decedent must be reported on Schedule I.
F.
21
08
0445
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. EGGER FUNERAL HOME, INC. PAID FROM IRREVOCABLE BURIAL FUND (ACNB) 8,010.58
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees IRWIN & McKNIGHT 750.00
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 REGISTER OF WILLS 64.00
5. Accountanfs Fees
6. Tax Return Prepare~s Fees
7. REGISTER OF WILLS, FILING FEE 30.00
8. NOTARY FEES 10.00
TOTAL (Also enter on line 9, Recapitulation) $ 8.864.58
(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
FILE NUMBER
GRAHAM
RUTH
F.
21
08
0445
Include unreimbursed medical expenses.
ITEM
NUMBER. DESCRIPTION
1. DEPARTMENT OF PUBLIC WEFARE CLAIM - SEE ATTACHED
VALUE AT DATE
OF DEATH
121,449.07
TOTAL (Also enter on line 10, Recapitulation) $
121 449.07
(If more space is needed, insert additional sheets of the same size)
R~~"B"'.(*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
,....,.... A I A
NUMBER
I.
SCHEDULE J
BENEFICIARIES
RUTH
F.
FILE NUMBER
21 08
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Lineal
Lineal
0445
AMOUNT OR SHARE
OF ESTATE
1/2 REMAINDER
1/2 REMAINDER
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.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
NANCY LEE BENNETT
10 CHESTNUT STREET
NEWVILLE, PA 17241
JANET L. SINGER
1135 GREEN SPRING ROAD
NEWVILLE, PA 17241
2.
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)
la$t Eill aub Q}t$tamttt!
I, RUTH F. GRAHAM, of the Borough of Newville, Cumberland
County, Pennsylvania, declare this instrument to be my last will and
testament, hereby expressly revoking all wills and codicils heretofore
made by me.
1. I authorize and empower my executrices to sell any realty
owned by me at my death, at either public or private sale, and to
give good and sufficient deeds therefor, in fee simple, as I could do
if living.
2. I give and bequeath all my dishes and household furniture
to my grandchildren but they are to select the same by each taking
an item, according to age, until all items have been selected.
3. I devise and bequeath all the rest, residue and remainder
of my estate of every nature and wherever situate to my two children,
share and share alike, the child or children of any deceased child
taking the share their parent would have taken if living.
4. I nominate and appoint Nancy Lee Bennett and Janet Louise
Singer, to be the executrices of this my last will and testament;
they are to serve as such without bond.
5. I hereby suggest that my personal representative retain the
services of Irwin, Irwin & Irwin, as attorneys in the settlement of
my estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
n
2.,lf day of October, 1984.
GJ.4- .3! ,&~ 4--
RUTH F. GRAHAM
Signed, sealed, published and declared by Ruth F. Graham, the
testatrix above named, as and for her last will and testament, in the
presence of us, who at her request, in her presence and in the presence
of each other have subscribed our names as witnesses hereto.
--n I ,/ A-' /.J
(SEAL)
"
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,'\CKfJO'.'/LEDGP1CU7 ^ lID AFF r DA VI 'L'
He, RUTH F. GRAHJ.llVI
BETZI A. MORRISON
and
SHARON L. SCHWALM
, the t"s tat d x Clnd the "11 tnesses,
respectively, \'Ilh;se names are sicned to t~l(~ r(lrer:oin[~ instrument,
being first dul:l S':ICH"T:, do hereb:; dcclar';' to thn undl:'r~i.r;ned
authority that Lt\(' L('>:;t;JLri/: ~lr~nt'r1 and ""'eu!,('rj 'hc' in;;Lr'ument
as her Last Will and t~at she had si~ned wlllinf]Y, and that she
executed it as her free and vOluntary Ret for the !Jurposes therein
expressed, and that eac~ of t!1C \'l jtncsse~;. in flF' :~Jresence and
hearing of the testatrix, signed tIle \'[ill as a \-11tnes:3 and that
to the best of their knO\'lledr;e the test:;1.1'lx \'Ias at that time
eighteen years 0:' cq:;e or older, of' sound [;ind nrid under no
constraint or undue influence.
~$~
RUTH F. GRAHAM
:JlJD1:th J~ftn
MORRISON '
y:M~ ~0l~~)
, SHARON L. S ADM
CO~1:10!nvEA!JTH OF PE1111SYLVMJIA
5S
COUNTY OF CU:mER!:)^~JD
Subscribed, s"lorn to and acknoN1edfcd before me by
RUTH F. GRAHJ.llVI
, the testc:;Lrix, and subscribed
and sworn to b,?fot'e me to:;
BETZI A. MORRISON
, and
SHARON L. SCHWAlM
, ':1 i 1. n e 5 5 P~; ,
this
-"to
t.\f
day 0 f
October
1984 .
.-IRWIN. NOlAn I'USrn;---
CARL SLE ORC. CUMBERLAND COUNTY
ICClnll rVPlllrc: nrr 1 \GII
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____L
~ ADAMS COUNlY
NATIONAL BANK
February 13, 2008
Irwin & McKnight
Attn: Roger B Irwin
60 W Pomfret St
Carlisle PA 17013
RECEIVED
FEB 1 5 200B
mWiN & McKNIGHt
lAW OFFICES
Re: Estate of Ruth Graham
Dear Mr. Irwin:
The following information is being provided as per your request:
Acct. Type Account No. . Account Accrued Ownership Date
Principal on Interest to Opened
0.0.0. 0.0.0.
Passbook 9639306 $3,752.25 $0.41 Individual 9/18/79
Savings
Account
Esteem 117951 $55.40 $0.00 Individual 2/4/85
Checking
Account
Certificate of 39910112 $8,010.58 $178.22 Irrevocable 6/14/96
Deposit Burial Fund
Inquiries concerning ACNB Corporation stock information should be directed to the Registrar and Transfer
Company at 1-800-368-5948. If you need any additional information, please contact me at (717)339-5122.
Sincerely.
(~vk((;,,- /! tUOc ,<-i/'-
~raJWar r -
Adams Coun : N tional Bank
Deposit Servi Representative II
.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
DIVISION OF THIRD PARTY LIABILITY
ESTATE RECOVERY PROGRAM
PO BOX 8486
HARRISBURG, PA 17105-8486
RECEIVED
February 6, 2008
FEB 0 8 2DDB
IRWIN & MCKNIGHT
ROGER B. IRWIN
WEST POMFRET PROFESSIONAL BUILDING
60 WEST POMFRET STREET
CARLISLE PA 17013
IRWIN & McKNIGHT
lAW OFFICES
Re: RUTH GRAHAM
CIS #: 790176005
SSN: 160-16-0652
Date of Death: 01/17/2008
Dear Mr. Irwin:
Please be advised that the Department of Public Welfare maintains a
claim in the amount of $121,449.07 against the above-mentioned estate. This
claim is for restitution of medical assistance granted on behalf of the
decedent for which the Probate Estate is now responsible to reimburse the
Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as
amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's
itemized statement of claim.
A portion of this medical expense, namely $26,152.57, was incurred
during the last six months of the decedent's life; therefore, it is a Class 3
claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries
Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $95,296.50, is
to be entered as a priority Class 6 claim against the estate.
Please acknowledge receipt of this letter and advise whether the
Commonwealth's claim is admitted and when payment may be expected. If the
estate accounting is complete, please provide a copy. If the estate contains
real estate, please provide copies of the deed, the latest tax assessment,
and a current appraisal, if available.
Sincerely,
~a.~
Susan A. Spracklen
Claims Investigation Agent
717-772-6741
717-772-6553 FAX
Enclosure