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HomeMy WebLinkAbout08-05-08 15056051058 REV-1500 EX (06-05) PA De artment f R v n OFFICIAL USE ONLY p o e e ue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN . j I Hanisburg, PA 17128-0601 RESIDENT DECEDENT •X __ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 209-12-8395 11 /04/2007 09/16/1923 Decedent's Last Name Suffix Decedent's First Name MI Gardner Mrs Marian L (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 i~ : 1. Original Return ~,`1 2. Supplemental Return ~~ 3. Remainder Return (date of death prior to 12-13-82) C:.:,` 4. Limited Estate __, 4a. Future Interest Compromise (date of ~~ _~ 5. Federal Estate Taa Return Required death after 12-12-82) "• 6. Decedent Died Testate C_~ 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) C~'"= 9. Litigation Proceeds Received ~_=s 10. Spousal Poverty Credit (date of death !~-; 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Michael A. Scherer, Esq (717) 249-6873 Firm Name (If Applicable) - __ _ __ ,___ _. REGISTER OF WILLS USE ONL_Y_ = O'Brien, Baric & Schere l First line of address - ; ~ , -- t 19 W. South Street ~ ; Second line of address ~ -.-~ ~,~ City or Post Office State ZIP Code DATE Ftl_ED ~_ LR Carlisle, PA 17013 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 h~3s any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN D~A^l"E ~• J ' r~ J A RESS 7 Red Tank Road, Boiling Springs, PA 17007 SIGN T OF PR P /FER OTHER THAN REPRESENTATIVE DAl'E ~~ ~~~ ~~' AD S 19 W. South Street, Carlisle, PA 17013 PLEASE USE ORIGINAL FORM ONLY ~~ Side 1 15056051058 150560510~~8 ~~l J 15056052059 REV-1500 EX Decedent's Social Se~~urity Number Decede~rs Name: Marian L Gardner 209-12-8395 __ RECAPITULATION 1. Real estate Schedule A . 1. 228,823.20 2. Stocks and Bonds (Schedule B) .................................... ... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. 4. Mortgages 8~ Notes Receivable (Schedule D) .......................... ... 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ..... ... 5. 102,490.90 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested .... ... 6. 4,574.97 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested..... ... 7. 8. Total Gross Assets (total Lines 1-7) ................................. ... 8. 335,889.07 9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. 21,197.46 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. ... 10. _.. 11. Total Deductions (total Lines 9 & 10) ................................ ... 11. 21,197.46 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. 314,691.61 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. 314,691.61 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 15. 16. Amount of Line 14 taxable at lineal rate X .0 45 16. 14,161.12 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. 14,161.12 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: Pile Number DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER Marian L Gardner 209-12-8395 _ STREET ADDRESS CITY STATE 2IP Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 14,161.12 2. Credits/Payments A. Spousal Poverty Credit e. Prior Payments 9,000.00 C. Discount 450.00 Total Credits (A + B + C) (2) 9,450.00 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. Fill in oval on Page 2, 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) 4,711.12 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 4,711.12 Make Check Payable fo: 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 :................................................................................... ....... ^ ^x b. retain the right to designate who shall use the property transferred or its income : ..................................... ....... ^ ^x 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? ....... ....... ^ 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................................................................................................. ....... 0 ^ 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 they 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)]. 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-1502 EX+ (6-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT E5TATE OF Marian L. Gardner FILE NUMBER 21-071065 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which Is lointlvowned with rinhr of ~~~r„s,,,.~~tii.....,,s• ~... ~t__~___~ __ ~_~_~__~_ .. i~~ nivie space is neeoea, insert aooinonal sheets of the same size) REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, 8~ MISC. PERSONAL PROPERTY Marian L. Gardner FILE NUMBER 21-07-1065 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jolntty-owned Wlth rl0ht Of Survlvorshie must ho dte~lneed ,,., c,.tiea„i., ~ tir more space is neeaed, insert additional sheets of the same size) REV-1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF Marian L. Gardner If an asset was made SURVIVING JOINT TENANT(S) NAME A Linda Mumper B C JOINTLY-OWNED PROPERTY: FILE NUMBER 21-07-1065 within one year of the decedent's date of death, it must be reported on Schedule G ADDRESS RELATIONSHIP TO DECEDENT 57 Red Tank Road, Boiling Springs, PA 17007 I daughter LETTER DATE DESCRIPTION OF PROPERTY ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR / CF DATE OF DEATH NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE DATE OF DEATH DECD'S VALUE OF ~ ~ A . VALUE OF ASSET INTEREST DECEDENT'S INTEREST ' 04118/06 PNC Bank Checking # 5140184369 9,149.93 50 4,574.97 TOTAL (Also enter on line 6 Recapitulation) ~ $ 4,574.97 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Marian L. Gardner SCHEDULE N FUNERAL EXPENSES 8~ ADMINISTRATIVE COSTS FILE NUMBER 21-07-1065 Debts of decedent must be reported on Schedule I. ITEM _ NUMBER DESCRIPTION ~ A. FUNERAL EXPENSES: - ~ Hoffman Roth Funeral Home 8~ Crematory 2. Grave Marker B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)lEIN Number of Personal Representative(s) Street Address City State Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. The Sentinel (legal advertising) B. Cumberland Law Journal (legal advertising) Zip Zip TOTAL (Also enter on line 9, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) 7,200.00 1,200.00 12,000.00 500.00 222.46 75.00 21,197.46 REV•1513 EXr (g-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Marian L. Gardner 21-G7-1065 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE t TAXABLE DISTRIBUTIONS [include outright spousal disVibuGons, and transfers under Sec. 9116 (a) (1.2)) 2• Linda A. Mumper, 57 Red Tank Road, Boiling Springs, PA 17007 daughter 100.00 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET ^ 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 ON LINE 13 OF REV-1500 COVER SHEET I $ 0.00 (Ii more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT ~I, MARIAN S. GARDNER, of South Middleton .Township, Cumberland County, Pennsylsgnig, being of sound mind, memory and understanding, do make, publish and declare this as and for., my Last Will and Testament hereby revoking and making void all former wills by me at any time heretofore made . r:Y ~~~~'~~~`~~`~~'~`FIRST~ ~~I•~-drect~all~' ~ ~ iis~t~~eb~~s'`'aridY`•furi~~a-I-±eip~eisesb~ ~`f'iill ~~ paid and satisfied out of my estate by my personal representative hereinafter named as soon as conveniently may, be done after my decease. SECOND. I give, devise and bequeath all •of my estate, real and personal, to my husband, Andrew B. Gardner, if living, otherwise to my daughter, Linda G. Mumper, or her issue. LASTLY, I nominate, constitute and appoint my husband, Andrep B. Gardner, Executor, if living, otherwise my daughter, -Linda G. Mumper, Executrix, of this my Last Will and Testament. . ~-fi,.,-,,,. ,;•: ~ ..:A~~~ - IN-: i~IITNES$~,:WkIEREOF,:.,I;~i~.ye.,~~reumto~Ys~t.,my hand,. an_d seal this _ '!tea ~ . _ ~ - ,. ___,_`day of ,•'1981. ..~ ~~v : ~ -.: ~,,. ,,., wl (SEAL ) Signed, sealed, published and declared by the above named. ?estatrix, Marian S. Gardner, as. and :.for. her Laat ,W.i.ll ,and Testament, in the presence of~us, who, at her request and in her presence and in the presence of each other, have: ,hereunto subscribed our names as . ~ . witnesses thereto. - TaxDB Result Del:ails Detailed Results for Parce140-29-2484-030. in the 2004 Tax Assessment Database DistrictNo 40 Parcel ID 40-29-2484-030. MapSuffix HouseNo 329 Direction W Street FIRST STREET Ownerl GARDNER, ANDREW B & MARIAN L C/O PropType R PropDesc LivArea 1304 CurLandVal 34060 CurImpVal 94010 CurTotVal 128070 CurPrefVal Acreage .34 CIGrnStat TaxEx 1 SaleAmt 1 SaleMo 07 SaleDa 15 SaleCe 19 SaleYr g 1 DeedBkPage 0029M-00404 YearBlt 1952 HF_File Date 12/22/2004 HF_Approval_Status A http://taxdb.ccpa.net/details.asp?id=40-29-2484-030.&dbselect=l Page 1 of 1 8/1/2008 TaxDB Result Details Detailed Results for Parcel 40-14-0140-019. in the 2004 Tax Assessment Databas~° DistrictNo 40 Parcel_ID 40-14-0140-019. MapSuffix HouseNo Direction Street OLD TOWN ROAD Owned GARDNER, ANDREW B & MARION C/O PropType AS PropDesc LivArea 535 CurLandVal 46640 CurImpVal 44180 CurTotVal 59490 CurPrefVal 15310 Acreage 37.00 C1GrnStat Y TaxEx 1 SaleAmt SaleMo SaleDa SaleCe SaleYr DeedBkPage 0021D-00210 YearBlt 1962 HF File Date 12/29/2005 HF_Approval_Status D http://taxdb.ccpa.net/details.asp?id=40-14-0140-019.&dbselect=l Page 1 of 1 3/31/2008 Nationwide Fin~incial Individual Annuity Service Center PO Box 182021 Columbus, OH X43272-4415 April 19, 2008 Law Offices O'BRIEN, BARK & SCHERER Michael A. Scherer 19 West Sou±h Street Carlisle, PA 17013 Re: Annuity contracts 07-1052850 Marian Gardner -Annuitant Marian Gardner -Owner Dear Sir or Madam: On behalf of Nationwide Financial, thank you for your recent inquiry into the Individual Annuity Service Center. I am writing in response to the inquiry we received regarding the aforementioned contract. Please allow this letter to serve as confirmation that the contract value as of November 4m 2007 was $38,352.78 for the aforementioned contract. Contract# 07-1052850 was anon-qualified annuity. Marian Gardner was the sole owner and Linda Mumper was the sole primary beneficiary. Should you need further assistance you may contact our Annuity Service Center at (800) 848-6331. Our representatives are available to assist you Monday through Friday between the hours of 8:00 am and 8:U0 pm, Est. Sincerely, Nationwide Financial 4- 3- KC Life Insurance 5/1/2008 3:09:21 PM PAGE 1/001 Fax Server KANSAS CITY LIFE INSUIZAI\'CE COMPANY ~..~w~. :~I i i.. ~.ii ?.._.i~h_tieii,:~. L.I.. \Le~~: ~..i : ..__i_h._ ~Ic~l~,..: is-'I. ; -_.i, ~a~-~ 1.2005 ~1ICHAEL A SCHEREK O'BRI1-;'V. BAK[C & SCFIERI-;R I9 WEST SOUTH ST CARLISLE PA 17013 Aimuity 2603655 -IRA Aiuluita~lt Marian Gardner, Deceased Beneficiary Ln1da A ~~lumper Per my letter of December 25, 2007, the amiuity value as of November 4, 2007 was S3,1i2.~9. Your e-mail requested information about the nlitial paperwork to continue payments to Lnida vlumper. If you are referruzg to the Claimant's Statement, it was correctly completed and the appropriate changes were made. If you are referring to the KMDr'A1~~' or the Beneficiary Change sent to you April ~~~~~, those completed forms would have been delivered to our Customer Services Department for handling. Our Customer Services Department called me yesterday regardu1g this amluity. They wanted to be sure claim changes were completed, as they received a request to transfer this aiuluity to a Beneficiary IRA with another company. I advised them the claim is completed and funds are available for Ms. ylumper to transfer to a Beneficiary IRA with Fort De~arbom Life. ll~ you have questions, please call me at SUO-521-6164, extension Si7i. Coiulie J Fifer, ACS, FL~1I Claims Department CJF/c f •.. ~N G ~, ING USA Annuity and Life Insurance Company 909 Locust St, Des Moines, IA 50309 MARIAN GARDNER 329 W 1st St Boiling Springs PA 17007-9744 Contract .Summa Contract Number: Product: Contract Date: Annuitant Name: Total Premium: Non Qualified 518613 USG Flex 3 07/03/1997 MARIAN GARDNER $20,250.00 Starting Accumulation Value Interest Ending Accumulation Value $30,281.77 Additi©nal Information As of 07/03/2007 Cash Surrender Value $30,281.77 Total Premium $20,250.00 Cash Surrender Value -Includes Surrender Charge if applicable. Current interest Rate as of 07/IJ3/2Q07 for Initial Premium Rate Effective Date Current Interest Rate 7 Annual Statement As of 07/03/2007 Your Financial Re~re~sentative ANITA E SOWERS Park Road Plaza 100 Love Rd Reading, PA 19607-9652 (610) 898-8000 Year-to-Date 07/03/2006 - 07/03/2007 $29,399.78 $881.99 If you have any questions about your Statement, please contact your agent or our Annuity Service Consultants at (800)369-5303. For additional information regarding your Contract you can also visit our wek~site at www.ingannuities.com. 003379 0000100004 000200086301000 .. Life Insurance Company of the Southwest (u~~~~n~l~~ull~in~n~~~I~n~nll~~nll~n~nll~~~~u~~n~~ MARIAN GARDNER 329 W FIRST ST BOILING SPRINGS PA 17007-9744 CUSTOMER SERVICES TEL: 800 579-2$78 • FAX: 214 6;8-9162 Annual Individual Retirement Account Report In accordance with Internal Revenue Service regulations this report provides the Fair Market Value of your Individual Retirement Account policy as of Decem~er 31, 2007. Policy Owner Policy Number Fair Market Value Marian Gardner 43fi719X $27,i'03.76 The Fair Market Value is the total value of your policy (not taking into account any early withdrawal penalties). Our records indicate your IRA is subjz<:t ~o the required mirlin-,un; distribution (RMD) rules this year. Generally, the RMD requirements must be met by the end of the calendar year. However, the requirements for the year you attain age 70Z may be met up until April 1 of the fol(owirig year. LSW will provide you with the amount of this year's RMD for this IRA if you contact us at 1-800-579-2878. If you have elected the annual automatic distribution of your RMD amount no further action is required on your part. If you have not elected the annual automatic distribution of your RMD and you prefer, you can wait until you receive our annual notification letter. Under IRS rules, LSW will report to the IRS when your IRA is subject to the required minimum distribution requirement. LIFE INSURANCE COMPANY OF THE SOUTHWEST • 1300 WEST MOC-:INGBIRD LANG • Dnt.us, TX 75247••4921 438719X •FMVL M1 031008342