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Home My WebLink About06-26-08nnl:V t~ ~ i (~) COMMONWEALTH OF REV-15 0 0 OFFICIAL USE ONLY PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER DEPT. 280601 HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 2 1- o s o 4 0 8 _ COUNTY CODE YEAR NUMBE2 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER N W GOODHART CLARENCE E. 1 7 4- 0 5- 0 3 4 2 ~ DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE U 03/01 /2008 05/01 /1908 REGISTER OF WILLS Q (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ~ ^X 1.Original Return ^ 2. Supplemental Retum ~ 3. Remainder Retum (date of death prior to 12-13-82) ~ a Y ~ 4. Limited Estate ~ 4a. Future Interest Compromise (dace or death after tz-iz-sz) ~ 5. Federal Estate Tax Retum Required U ~ a m ~ 6. Decedent Died Testate (Ana~h copy otwill) ~ 7. Decedent Maintained a Living Trust (Atracn wpy orrrusc) _ 8. Total Number of Safe Deposit Boxes a ~ 9. Litigation Proceeds Received ~ 1 O. SpOUS81 POVerty Credit (date of death between 12-31-91 and 1-t-95) ~ 11. Election to tax under Sec. 9113(A) (Anach sen of F, > THIS SECTION"MUSTBE GOMPLETEQ. ALL GORRESPONDENGE AN D CONFIDENTIAL TAX INFORMATION SHOULD'BE DIRECTED TOc Z W NAME COMPLETE MAILING ADDRESS o ROGER B. IRWIN ESQUIRE 60 WEST POMFRE T STREET y FIRM NAME (If Applicable) ~ IRWIN 8 McKNIGHT p TELEPHONE NUMBER ~ 717 249-2353 CARLISLE '.. A 17013 1. Real Estate (Schedule A) (1) - ~~ OFFf~tAL USEONLI' 'r? c._. ; -- - ~-- ' 2. Stocks and Bonds (Schedule B) (2) = °~° f`,.7 3. Closely Held Corporation, Partnership orSole- Proprietorship (3) -- . ~' ' -- / 4. Mortgages & Notes Receivable (Schedule D) (4) i - r' ' % ` 5. Cash, Bank Deposits & Miscellaneous Personal Preper!y (5) 4, 245.31 -- _ ,_ ., ~ r~,~ , Z (Schedule E) ~~= c~ . ~ ; 0 6. Jointty Owned Property (Schedule F) (6) ~ Separate Billing Requested ~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) r a V W t5cneawe ~ or L) 8. Total Gross Assets (total Lines 1-7) (8) 4,245.31 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 2,950.92 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) (10) 26,194.01 11. Total Deductions (total Lines 9 810) (11) 29,144.93 12. Net Value of Estate (Line 8 minus Line 11) (12) -24, 899.62 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) -24, 899.62 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES Z Q F- a O V F- 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 0.00 X (15) 0.00 16. Amount of Line 14 taxable at lineal rate 0.00 x .045 (16) 0.00 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 141axable at collateral rate 19. Tax Due 20. << 0.00 x .12 (17) 0.00 0.00 x .15 (18) 0.00 (1 g) 0.00 C. Decedent's Corn Address: I STREET ADDRESS 208 TODD CIRCLE clrr CARLISLE srATE PA ZIP 17013 Tax Payments and Credits: 1• Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. InteresUPenalty if applicable D. Interest E. Penalty (3) Total Credits (A + B + C) (2) O.Oc Total InteresUPenalty (D + E ) 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 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. O.Of 0.0~ (4) O.OC (5) O.OI (5A) B. Enter the total of Line 5+5A. This is the BALANCE DUE. (5g) Make Check Payable fo: REG/ST~R OF WILLS, AG~'NT 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 : ........................................................................... ^ ^X b. retain the right to designate who shall use the property transferred or its income : ........................................ ^ c. retain a reversionary interest; or ...................................................................................................... ^ ^X d. receive the promise for life of either payments, benefits or care? ............................................................. ^ ^X 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? ................. ^ ^X 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 Under penalties of pery'ury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is We, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS 208 TOrSD CIRCLE 9b`6A ALEXANDER SPRING ROAD r CARLISLE, PA 17013 CARLISLE, PA 17013 SIGNATURE 0 EPARER OTHER THAN ¢tEPRESENTATIVE D TE '~ . ~c.._._, G L ~'~, ADDRESS n _ n n 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. §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 0% (72 P.S. §9116 (a) (1.1) (ii)i. 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 childtwenty-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. §9116(a)(1.2)i. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)J. 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. §9116(a)(1.3)1. Asibling 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 E:K + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER i+nnnuno'r CLARENCE E 21 08 0408 Include the proceeds of litigation and the date the proceeds were received by the estate. All propefi/ jointly-owned with right of survivorship must be disclosed on Schedule f. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. MEMBERS 1ST FEDERAL CREDIT UNION -SAVINGS ACCOUNT #158440-00 201.24 2. MEMBERS 1ST FEDERAL CREDIT UNION -CHECKING ACCOUNT #158440-11 2,895.58 3. INVESTMENT SAVINGS ACCOUNT #158440-05 16.34 4. SOCIAL SECURITY 1,074.00 5. THE SENTINEL -REFUND 58.15 TOTAL (Also enter on line 5, Recapitulation) ~ $ 4,245.31 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER GOODHART CLARENCE E 21 08 0408 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. HOLLINGER FUNERAL HOME 406.92 2. MT. ZION UNITED METHODIST CHURCH -DONATION (OUTSTANDING PLEDGE) 1,000.00 B. 1 2. 3. 4. ADMINISTRATIVE COSTS: . Personal Representative's Commissions Name of Persona4 Representative (s) CHARLES D. GOODHART Social Security Number(s)IEIN Number of Personal Representative(s) 168244971 i Street Address 208 TODD CIRCLE City CARLISLE State PA Zip 17013 Year(s) Commission Paid: AttomeyFees 1RWIN & McKNIGHT Family Exemption: (1f decedent's address is not the same as claimant's, attach explanation) Claimant Street Address 350.00 750.00 City State Zip Relationship of Claimant to Decedent Probate Fees REGISTER OF WILLS 64.00 5. I Accountant's Fees 6 7 Tax Return Prepares Fees REGISTER OF WILLS - FLING FEE f 30.00 TOTAL (Also enter on line 9, Recapitulation) f $ .92 (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent GOODHAR"f CLARENCE E. 21 08 0408 Decedent's Name Page 1 File Number Schedule H -Funeral Expenses 8~ Administrative Costs - B1 ITEM NUMBER DESCRIPTION AMOUNT B. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) LEE P. GOODHART 350.00 Social Security Number(s)/EIN Number of Personal Representative(s) 171305386 Street Address 966A ALEXANDER SPRING ROAD City CARLISLE State PA Zip 17013 Year(s) Commission Paid: SUBTOTAL SCHEDULE H-61 ~ 350.00 REV-1512 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS FILE NUMBER GOODHART CLARENCE E 21 08 0408 Include unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. DEPARTMENT OF PUBLIC WELFARE CLAIM 26,194.01 CIS# 970201605 TOTAL (Also enter on line 10, Recapitulation) I S 26 194.01 (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (?-nm SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER A 1 4 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE j TAXABLE DISTRIBUTIONS [nclude outright spousal distributions, and transfers under Sec. 9t 16 (a) (1.2)] 1. CHARLES D. GOODHART Lineal 208 TODD CIRCLE 1/2 REMAINDER CARLISLE, PA 17013 2. LEE P. GOODHART Lineal 966A ALEXANDER SPRING ROAD 1/2 REMAINDER CARLISLE, PA 17013 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET jj, 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) St MEMBERS 1ST FEDERAL CREDIT UNION 7 " REGULAR SAVINGS ACCOUNT: Account Number/ Suffix Date Account Established 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/Suffx Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner INVESTMENT SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Estate of: CLARENCE GOODHART Date of Death: March 1, 2008 Social Security Number: 174-05-0342 158440-00 05/01 /1996 $201.24 $.00 $201.24 None 158440-11 05/01 /1996 $2, 895.58 $.00 $2, 895.58 None 158440-05 02/13/2006 $16.34 $.00 $16.34 None M ERS 1ST FE~D~EkR~AL~CREDIT UNION anielle A. Kline Insurance Services Specialist April 25, 2008 5000 Louise Drive PO. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 w~~~v.memberslst.org F 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 April 21, 2008 IRWIN & MCKNIGHT ROGER B IRWIN ESQUIRE WEST POMFRET PROFESSIONAL BUILDING 60 WEST POMFRET STREET CARLISLE PA 17013 Re: CLARENCE GOODHART CIS #: 970201605 SSN: 174-05-0342 Date of Death: 03/01/2008 Dear Attorney Irwin: Please be advised that the Department of Public Welfare maintains a claim in the amount of $26,194.01 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 $26,194.01, 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 $.00, 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 coatains real estate, please provide copies of the deed, the latest tax assessment, and a current appraisal, if available. Sincerely, C~ ~~'~` Elvetta Knox Claims Investigation Agent 717-772-6613 717-772-6553 FAX Enclosure Hoiiinger Funeral Home & Crematory, Inc. Eric L. Hollinger, Supervisor April 14, 2008 Chuck Goodhart 208 Todd l.irciE Carlisle, PA 17013 The Funeral Service for Clarence E. Goodhart: We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. AT THE TIME FUNERAL ARRANGEMENTS WERE MADE, WE ADVANCED CERTAIN PAYMENTS TO OTHERS AS AN ACCOMMODATION. THE FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES. Cash Advances Newspaper Notices -Patriot-News $243.92 Newspaper Notices -Sentinel 163.00 Current Balance: 406.92 501 NORTH BALTIMORE A'4ENUE • MOLINT HOLLY SPRINGS, PENNSYL\7AN1A 17065 • (z t z) 486-3433 • FAX (717) 486-3215 wwva.hollingerfuneralhome.com