HomeMy WebLinkAbout05-12-0815056041147
' REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue County Code Vear File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO 60X.280601 21 0 8 0 3 0 6
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
187 16 5914 02 16 2008 11 02 1922
Decedent's Last Name Suffix Decedent's First Name MI
MORN EDITH I
(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
~_!~ 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate ^ 4a. Future Interest Compromise L~ 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
X g Decedent Died Testate
'~ J (Attach Copy of Will)
I~ ~ Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Trust)
9. Litigation Proceeds Received I~
L
~ 10. Spousal Poverty Credit (date of death I
~ 11. Election to tax under Sec. 9113(A)
between 1231-91 and 1-1-95)
_ _
(Attach SCh. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
RICHARD W. STEWART (717) 761 4540
Firm Name (If Applicable)
JOHNSON DUFFIE
First line of address
301 MARKET ST.
Second line of address
PO BOX 109
City or Post Office
LEMOYNE
I
State ZIP Code
-.,,
ca
REGISTER l'3~~LLS USk`~NLY _:
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DATE FILED '-
PA 17043-0109
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Correspondent's a-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 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.
ADDRESS
Robert T Mohn Jr.
6112 Charing Cross, Mechanicsburg, PA 17050
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE PATE
~~ /~',~~- RICHARD W. STEWART ~ - ~__ v~
ADDRESS
301 Market St., Lemoyne, PA 17043-0109
Side 1
L 15056D41147 15056041147
REV-1500 EX
1505642148
Decedent's Name: E d l t h I M O h n
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) ~ Separate Billing Requested ............. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ~ Separate Billing Requested ............. 7,
8. Total Gross Assets (total Lines 1-7) ....................................................................... 8.
Decedent's Social Security Number
187 16 5914
18,253.45
3,446.65
21,700.10
9. Funeral Expenses & Administrative Costs (Schedule H) .............................. ........... 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ..................... ........... 1t1.
11. Total Deductions (total Lines 9 & 10) ......................................................... .............11.
12. Net Value of Estate (Line 8 minus Line 11) ................................................. ............12.
13. Charitable and Governmental Bequests/Sec 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.
873.00
19.99
892.99
20,807.11
20,807.11
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 .00 0 . 0 0 15.
16. Amount of Line 14 taxable
at lineal rate X .045 1 9, 9 4 5. 4 5 16.
17. Amount of Line 14 taxable
at sibling rate X .12 0 . 0 0 17.
18. Amount of Line 14 taxable
at collateral rate X .15 0 0 0 18.
19. Tax Due ...................................................................................................................19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
0.00
897.55
0.00
0.00
897.55
Side 2
15056042148 15056042148 J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-08-0306
DECEDENT'S NAME
Edith I Mohn
STREET ADDRESS
635 "D" Street
CITY STATE
Enola PA ZIP
17025
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
g. Prior Payments
C. Discount
44.88
(1) 897.55
Total Credits (A + B + C) (2) 44.88
3. InteresUPenalty if applicable
D. Interest
E. Penalty
Total InteresUPenalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
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. (5) 852.67
q. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) $ rj 2.6 7
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 :.................................................................................^
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? ...................................................................................................................~ ^
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. §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 exemot3 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-7508 EX+(6-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF (FILE NUMBER
Mohn, Edith I 21-08-0306
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.
(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-1509 EX+ (6-98)
. SCHEDULE F
1 COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Mohn, Edith I 21-08-0306
If an asset was made joint within one year of the decedents date of death, it must be reported on schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Robert T Mohn 6112 Charing Cross Son
Mechanicsburg, PA 17050
B. Joni M Lightner
C
JOINTLY OWNED PROPERTY:
635 D Street
Enofa, PA 17025
Daughter
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT
NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR
JOINTLY-HELD REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET
o
/o OF
DECD'S
INTEREST
DAVALUE OF TH
DECEDENT'S INTEREST
1 A, B 9/2/1986 Sovereign Bank Checking Account No. 10,339.95 33.333% 3,446.65
0921705174
TOTAL (Also enter on Line 6, Recapitulation) I 3,446.65
(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 F (Rev. 6-98)
REV-1151 EX+(12-99)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Mohn, Edith I 21-08-0306
Debts of decedent must be reported on Schedule I.
ITEM pESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached ~ 145.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City State Zip
Year(s) Commission paid
2. Attorney's Fees Johnson Duffie 350.00
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 108.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 270.00
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 873.00
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
Rev-7502 EX+ (6-981
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H-A
FUNERAL EXPENSES
continued
ESTATE OF (FILE NUMBER
Mohn, Edith f 21-08-0306
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
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN co nti n u e
RESIDENT DECEDENT
ESTATE OF (FILE NUMBER
Mohn, Edith I 21-08-0306
Copyright {c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-95)
Rev-1512 EX+ (8-98)
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF - - FILE NUMBER
Mohn, Edith I 21-08-0306
Include unreimbursed medical expenses.
(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)
C\/.•C1R GVa /OJlfl1
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Mohn, Edith I 21-08-0306
NAME AND ADDRESS OF RELATIONSHIP TO
DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S) RECEIVING PROPERTY
Do Not List Trustee s (Words} ($$$)
I• TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116(a)(1.2)]
Timothy M Leiby Grandchild
2430 S. Market Street
Mechanicsburg, PA 17055
Joni Mohn Lightner Daughter $1000.00 1,000.00
635 D Street Bequest
Enola, PA 17025
Jeffrey T Mohn Son
2270 Old Trail Road
Etters, PA 17319
Robert T Mohn Son
6112 Charing Cross
Mechanicsburg, PA 17050
Total 1,000.00
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropr iate, on Rev 1500 cove r 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 II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS UN LINE 93 Ur Ktv-~5uu uuvtrc Snit ~ v.vv
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98)
ESTATE OF EDITH I. MOHN
SCHED USE OF EXHIBITS
EXHIBIT A Last Will and Testament of Edith I. Mohn, signed and dated April 4rh
2000.
EXHIBIT B Sovereign Bank Date of Death Correspondence for Joint Account.
332327
EXKIBIT
A
I LAST WILL AND TESTAMENT OF
I, ~ 4 ~? , a resident of the STATE OF ~~~~~~_ ,COUNTY OF
being of sound mind and memory, do hereby declare that this is my will. My Social Security
number is:
FLRST: I revoke all former wills and codicils that I have previously made.
SECOND: I give, devise, and bequeath the following money or personal property: '=~ r-
__ ~ -_, _
to:
~u~~ ~~~ t~~`v~r51~
THIRD: I direct all my just
FOURTH: I name CS~tJ7~
(executor) of this will without bond.
as personal representative, Iname _
without bond, instead.
r
....~-~---_ _ ., ~.--- ~ 1 ..-- ~ ~ O
expenses be paid as soon as possible after my ~eath.
~~u
has personal representative
reason fail to qualify or cease to act
_, as personal representative, again
FIFTH: I hereby empower my Executor to sell property, real or personal, for cash or on time, without an
order of Court, at such time and upon such terms and conditions as shall seem best.
HOWEVER, in the event that the above person or persons predeceases me, I give that same money or personal
property to his or her surviving beneficiaries.
If there are no surviving beneficiaries, this money or personal property shall go to:
I, ~ ~~1, ,~ ,the testator, sign my name to this will, consisting of ~ pages,
this _~~_ day of ~~~~ .~„~~~
Being duly sworn, I declare to the undersigned authority that I sign this document as my last will, that I sign it
willingly, and that I execute it as my free and voluntary act for the purposes therein expressed.
I declare that I am of the age and majority or otherwise legally empowered to make a will, and under no
constraint or undue influence.
~~~~ o~
(Signed)
We, the witnesses, sign our name to this document, and we eclare under penalty of perjury, that the forego-
ing is true and correct, this ~_~ay of , lgj2_~~--~
residing at:
residing at: `~~ ~s~/~l~~
~~u. ,. tC/ residing at: 73 ( (/u//~
* FOR NOTARY PUBLIC
THE STATE OF ,COUNTY OF
Subscribed, sworn to and acknowledged before me by
and,
-~~f~ac~ ~ . ~ 70 3 ~-
~~~1~ , ~. ~ ~~~s
L~ n,~lc, t) t _ ~ 7G~5
satisfactory evidence to be the persons), this
SIGNED:
witnesses, personally known to me (or proved to me on the basis of
day of
Official Capacity of Officer
19
and
® S.J.T. Enterprises, Inc.
EXHIBIT B
Sovereign Bank
ESTATE OF Edith I. Mohn
SOCIAL SECURITY #: 187-16-5914
DATE OF DEATH: February 16, 2008
Account #: 0921705174 Type: Checking Open date: 9/2/1986
In the name of: Edith I Mohn or Joni M Mahoney or Robert T Mohn Jr
Date of Death Balance: $10,339.95
Int.(YTD) from 111/2008 to 2/16/2008 $0.00
Accrued interest to date of death: $0.00
Other Info;
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