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Home My WebLink About05-21-0815056D41147 REV-150 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue 'county code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO 80X.280601 2 1 0 7 0 112 4 Harrisburg, PA 17128-0(101 - RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 196141031 10152007 01311923 Decedent's Last Name Suffix Decedent's First Name MI WARNER MILDRE.D L (1f Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Netme MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OIF 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 ^ 5. Federal Estate Tax Return Required (date of death after 12-12-82) g Decedent Died Testate 7, Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes ^ (Attach Copy of W ill) ^ (Attach Copy of Trust) ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (date of death ~ between 1231-91 and 1-1-95) 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 WILLIAM R. BUNT, ESQ. ;175828195 ~,,, r__ ~ r,~ r~ __~~ Firm Name (If Applicable) - .. -~~ WILLSIiONLY; j REGISTERO ~ LAW OFFICE OF WILLIAM R. BUNT , , First line of address ~ ~ PJ `j 109 SOUTH CARLISLE STREET ~ ~ .~ , ~-> ',_ ; ; Second line of address C7 _.'i r-,? - P . 0 . BOX 3 3 6 `' ,,. - `~ . : :, DATE FILED City or Post Office State ZIP Code NEW BLOOMFIELD PA 17068 W r b~ p a. n e t ' Correspondent s a-mail address: Under penalties of perjury, 1 declare that f 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 th n the personal representative Is based on all information of which preparer has any knowledge. SIGNATURE ERS RESPON LE FOR FILING RETUR " DATE ' -,~~ Charles M. Warner, Jr. mil / ~ ,Oa ADDRESS P.O. Box 1 , Millerstown, PA 17062 SIGNATURE OF E THE THAN REPRESENTATIVE ATE William R. Bunt, Esq. Q)Q~ ADDRESS 109 South Carlisle Street, New Bloomfield, PA 17068 Side 1 15056D41147 1,5056041147 J 15056042148 REV-1500 EX Decedents Name: B A R N E R, M I L D R E D L. 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, 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 1 i} ............................................................. 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. 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 15. 16. Amount of Line 14 taxable 1, 7 3 2 4 1 at lineal rate X .045 16. 17. Amount of Line 14 taxable at sibling rate X .12 17 18. Amount of Line 14 taxable at collateral rate X .15 18 19. Tax Due ..................................................................................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Decedent's Social Security Number 196141031 6,203.43 6,203.43 4,471.02 4,471.02 1,732.41 1,732.41 77.96 77.96 Side 2 15056042148 15056042148 REV-1500 EX Page 3 Decedent's Complete Address: File Number 2'I - 07 - 01124 CEDENT S NAME Barney, Mildred L. STREET ADDRESS 310 Bridge Street CITY New Cumberland STATE PA ZIP 17070 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 77.96 Total Credits (A + B + c) (2) 0.00 3. InteresUPenalty if applicable p, Interest E. Penalty Total Interest/Penalty I;D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page 1 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) 7 7.9 6 A, Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. {5B) 7 7 , 9 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 ::.................................... ^ x x c. retain a reve rsionary interest; or....... .. ..................................................................................................... p p y d. receive the romise for life of either a ments, benefits or care? ............................................................. ^ x ^ 2, If death occurred after December 12, 1982, did decedent transfer property within ore 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?......... ^ ^x 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation7 ..................................................................................................................... ^ 1F THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE 1T AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and betore January 1, 1995, the tax rate imposed on the net v,~lue 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 b~=_neficiary. 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. SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Garner, Mildred L. FILE NUMBER 21 -07-01124 Include the proceeds of litigation and the date the proceeds were received by the estate. A!I property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 Members First-account no. 41997-00 1,047.43 See attached letter 2 Members First-account no. 41997-11 4,119.37 See attached letter 3 Proceeds from the sale of a 1994 Nissan sedan 500.00 4 Commonwealth of Pennsylvania-rent rebate 450.32 5 Community Banks Insurance Services-anticipated car insurance refund 45.06 6 Readers Digest-refund 13.49 7 Patriot News-refund 27.76 TOTAL (Also enter on Line 5, Recapitulation) I 6,203.43 Sti MEMBERS 1St FEDERAL CREDIT UPfION REGULAR SAVINGS ACCOUNT: Account Number! Suffix Date Account Estabiished Principal Balance at date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner CHECKING ACCOUNT: Account NUmber/SUffiX Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Oeath Total Principal and Accrued Interest Name of Joint Owner Estate of: MILDRED GARNER Date of Death: October 15, 2007 Social Security Number: 196-14-1031 41997-00 03/25/1985 $1,047.03 $.40 $1,047.43 None 41997-11 10113/2004 $4,118.94 $,43 $4,119.37 None f vIBERS 1s~ FEDERAL~~R~E~:DIT UNION Danielle A. Kline Insurance Services Specialist April 24, 2008 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 wwwmemberslst.org SCHEDULE H FUNERAL EXPENSES & COMMONWEALTH OF PENNSYLVANIA ADMINI~TRATNE COSTS INHERITANCE TAx RETURN RESIDENT DECEDENT ESTATE OF Barner, Mildred L. ~ FILE NUMBER 21 -07-01124 Debts of decedent must be reported on Schedule 1. ITEM DESCRIPTION AMOUNT NUMBER ~ FUNERAL EXPENSES: A. 1 F Myers Funeral Home-funeral 2,931.22 2 ,Bill Beasom-organist 75.00 B 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address 2. 3. City State Zip Year(s) Commission paid Attorney's Fees William R. Bunt Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant a 5. 6. 7. 1 Street Address City State Zip Relationship of Claimant to Decedent Probate Fees Register of Wills Carlisle Sentinel Cumberland County Law Journal Accountant's Fees Tax Return Preparer's Fees Thomas Clark-income tax preparation Other Administrative Costs Register of Wills 850.00 71.00 199.92 75.00 50.00 3.00 TOTAL (Also enter on line 9, Recapitulation;) 4,471.02 C Schedule H COMMONWEALTH OF PENNSYLVANIA Funeral INHERITANCE TAX RETURN Administrable Costs COnhnued RESIDENT DECEDENT ESTATE OF Barner, Mildred L. FILE NUMBER 21 -07-01124 2 '; Verizon 134.12 3 Comcast 1.60 4 PPL 40.16 5 ~ Register of Wills-additonal probate and filing fees 40.00 Page 2 of Schedule H REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Barner, Mildred L. 21 -07-01124 ~ NAME AND ADDRESS OF PERSON(S) RELATIONSHIP TO DECEDENT SHARE OF ESTATE (Words) AMOUNT OF ESTATE ($$$) NUMBER RECEIVING PROPERTY Do Not List Trustee(s) ~~ TAXABLE DISTRIBUTIONS[include outright spousal distributions, and transfers ~ under Sec. 9116 (a) (1.2)] 1 ~ Karla Levy daughter one-fifth I P.O. Box 5082 Scottsdale, AR 85261 2 11 Trudy Sharf daughter one-fifth 2012 Deer Path Rd. Harrisburg, PA 17110 I 3 ~ David R. Barner son one-fifth 15809 Milton Dr. Harrisburg, PA 17112 A I Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropriate, on Rev 1500 cover sheet I~~ NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX 15. NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET O.OO REV-1513 EX+ (9-DO) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES continued INHERITANCE TAX RETURN RESIpEN7 DECEDENT ESTATE OF FILE NUMBER Barner, Mildred L. 21 -07-01124 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER 1 NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) RECEIVING PROPERTY Oo Not List Trustee(s) I~ i TAXABLE DISTRIBUTIONS [include outright spousal d t f ib i rans ers distr ut ons, an under Sec. 9116 (a) (1.2)] 4 Wendy Miller daughter one-fifth 614 North 4th St. New Cumberland, PA 17070 5 Charles M. Barner, Jr. son one-fifth I P O. Box 147 i i 1 I i . Millerstown, PA 17062 I I I i l I i Page 2 of Schedule J " ~ ~ . ~ ~ ~' `~~ 202 ~~~~~' 2 i ~r7 tip: ~ ~ ~. ~~ v., ~r'~ w. r-.. .~ ~ ~ ~ ~ ~ 0 (0 L ..Q ~ ~ O ~ ~ ~ N C !/~ M ~' ~ ~'- L. O N ~ LL U ~ r O C ~ ~ ~- L O N ~ (~ ~ ~ U _ ~ ~ 'L ~ ~ ~ ~ ~~UOU ~ ~ m co 0 ~ _ti m a~i Q _- ~ a _~ 3 ~, a o.~M °' vroc~~ V o 0 O~jmm ~o~ a~i J ~ A 7