HomeMy WebLinkAbout08-13-08 (2)i
J 15056051047
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO BOX 280601
Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 0 8 0 0 2 8 6
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
0 2 2 6 2 0 0 8 1 0 0, 3 1 9 2 7
Decedent's Last Name Suffix Decedent's First Name MI
U R.B A N P A T R I C I A A
(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 C 3. Remainder Retum (date of death
prior to 12-13-82)
C :'? 4. Limited Estate C 4a. Future Interest Compromise (date of C 5. Federal Estate Tax Return Required
death after 12-12-82) 0
~~r 6. Decedent Died Testate C=..) 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
C 9. Litigation Proceeds Received C~ 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 TO:
Name Daytime Telephone Number
KEITH 0. B R E N N E M A N 7 1 7 6 9 7 8 5 2 8
Firm Name (If Applicable) ~- - - - - +~-~
RECISTEC~-fjlF WILLS USE;~ULY
S N E L B A K E R & B R E N N E M A N P C ~ ~:_~ `~' ~~-
_.
First line of address .
c. ~ 1
4 4 WEST MAIN S I R E 'E T _ ~--
c..~
Second line of address ~ ;t `
-~
-~ ,~
City or Post Office
State ZIP Code i ~ -, ? ~ i
P~Ti"~[LED
%~
M E C H A N I C S B U R G P A 1 7 0 5 5 `'
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 tru correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SI ATU OF,.PERSON RESPONSIBLE FOR FIL G RETURN DATE
~_. ~~ /.,~~c^-~.~ ~~. ~!~~''~e.,v r.N~ D , Executrix (~'~l ~ ~f/ g
ADDRESS iI
101 N. 36th Street, Camp Hilly PA 17011
SIGNA ~U PREPARER OTHER THAN REPRESENTATIVE ~/ / ~T~ O a
ADDRESS ~
44 West Main Street, Mechanicsburg, PA 17055
~~ ~~ PLEASE USE ORIGINAL FORM ONLY ~.
Side 1
15056051047 15D56051047
J
15056052048
REV-1500 EX Decedent's Social Security Number
Patricia A. Urban
Deceaent'sName:
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. 3 2 , 3 0 0 • ~ 1
6. Jointly Owned Property (Schedule F) C'~ Separate Billing Requested ..... .. 6. •
7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property
2
S
3
5
5
7
9
(Schedule G) c.~ Separate Billing Requested...... .. 7. , •
8. Total Gross Assets (total lines 1-7) .................................. .. 8. 5 7 6 5 8 •' 3 0
9. Funeral Expenses ii<Administrative Costs (Schedule H) ................... .. 9. 4, 3 8 2 • 3 6
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .. 10. 1 4 ~ • S 9
11. Total Deductions (total Lines 9 & 10) ............. . ................... .. 11. !+, 5 2 9 • 9 5
12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 5 3
~ 1 2 8 • 3 5
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. 5 3 , 1 2 8 . 3 5
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
16. Amount of Line 14 taxable
at lineal rate x .o ~,,5 5 3, 1 2 8. 3 5 1 s. 2, 3 9 0. 7 8
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. 2, 3 9 0. 7 8
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT C
Side 2
15056052048 15056052048 J
REV-1500 EX Page 3 Frte Number
Decedent's Complete Address: 21-08-00286
DECEDENT'S NAME
Patricia A. Urban
STREET ADDRESS i
3305 Market Street _
CITY STATE ZIP
Camp Hill PA 17011
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1) 2 , 390.78
Total Credits (A + g + C) (2)
3. InteresUPenalty if applicable
D. Interest
E. Penalty
Total InteresUPenalty (D + E )
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.
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.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3)
(4)
(5) 2 , 390.78
(5A)
(5B) 2 , 390.78
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, 19a2, did decedent transfer property within one year of death
~
^
without receiving adequate consideration? ........................................................................................................ ......
3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ........ ...... ^
4. Did decedent own an Individua{ 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, 1894 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 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)J.
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-1508 EX+ (8-98)
SCHEDULE E
p
BANK DEPOSITS, $c MISC.
CASH
COMMONWEALTH OF PENNSYLVANIA ,
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Patricia A. Urban 21-08-00286
Indude 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.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Members 1st Federal Credit Union:
a. Savings account No. 169975-00: $ 974.37
b. Checking account No. 169975-11: 7,065.66
c. Money Management account No. 169975-05: 7,561.24
d. Certificate of Deposit,
account No. 169975-4: 15,500.15
Total: $31,092.42
2. Miscellaneous personalty, furniture and furnishings 900.00
3. Patriot News -subscription refund 6.48
4. Commonwealth of Pennsylvania retirement fund payment 301.81
TOTAL (Also enter on line 5, Recapitulation) 5 132 , 300.71
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
Patricia A. Urban 21-08-00286
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM
NUMBE DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THE TRANSFEREE, THEIR REUTIONSHIP TO DECEDENTAND
THE DATE OF TRANSFER. ATTACH ACOPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH
VALUE OF ASSET % OF DECD'S
INTEREST EXCLUSION
(IF APPLICABLE) TAXABLE
VALUE
~~ Gift of proceeds from sale of real estate 5,357.59 100 -0- 25,357.5'
April 30, 2007. Transferee: Patricia A.
Savidge, decedent's daughter. Date of
transfer: April 30, 2007
TOTAL (Also enter on line 7 Recapitulation) 5 125 , 357 .59
(If more space is needed, insert additional sheets of the same size
REV-1511 EX+ (10-06)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Patricia A. Urban 21-08-00286
Debts of decedent must be reported on Schedule L
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
Malpezzi Funeral Home -balance due $ 493.36
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s) waived
Street Address
Gity State __ Zip
Year(s) Commission Paid:
2. AttomeyFees to Snelbaker & Brenneman, P. C.
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 to Register of Wills: $95.00; additional probate
fee: $45.00
s. Accountant'sFees ~ miscellaneous probate expenses, reserve
s. ~~~~~ Advertise grant of letters:
~~ a. Cumberland Law Journal $ 75.00
b. The Sentinel 174.00
Total:
2,500.00
140.00
1,000.00
249.00
TOTAL (Also enter on fine 9, Recapitulation) ` $ 4, 382.36
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX+ (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE 1
DEBTS Of DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
Patricia A. Urban 21-08-00286
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX+ {9-0O)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Patricia A. Urban 21-08-00286
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 distributions, and transfers under
Sec. 9116 (a) (1.2)]
Barbara A. Sans, 355 Storer Avenue, Akron, Daughter 1/6 of Estate
OH 44302-1156
2, Carol A. Crupi, 3502 Delwood Drive, Daughter 1/6 of Estate
Mechanicsburg, PA 17050
3• Leonore Lujanac, 225 East Main Street, Daughter 1/6 of Estate
Apt. G, Shiremanstown, PA 17011
4. Daniel T. Urban, 2121 Creek Road, Son 1/6 of Estate
Camp Hill, PA 17011
5• Patricia A. Savidge, 101 North 36th Street, Daughter 1/6 of Estate
Camp Hill, PA 17011
6. Leigh Ann Urban, 411 Mountain Street, Granddaughter 1/12 of Estate
Summerdale, PA 17093
7. Taylor Urban, 1811 Rudy Road, Granddaughter 1/12 of Estate
Harrisburg, PA 17104
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THRO UGH 18, AS APPROPRIATE, ON RE V-1500 COVER SHEET
I[ NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELEGTION 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 S
(If more space is needed, insert additional sheets of the same size)
! LAST WILL AND TESTAMENT
II
', OF
i
PATRICIA A. iJRBAN
;}
;: ~a ...
~' I, PATRICIA A. URBAN, of the Borough of Camp Hill,
Cumberland County, Pennsylvania, being of sound and dispos.i.ng
mi^.d, :^emory and ~znderstanding, do hereby mare, publish and
~~ declare this as and for my Last Will and Testament, hereby
• :i
`~ revoking and making void any and all wills by me at any time
~~ heretofore made.
1. I direct that all my debts and funeral. expenses be paid
as soap as practical after my death by my Executrix hereinafter
named.
I direct that ai.l taxes that may be assessed as a
consequence of my death shall be paid from my residuary estate as
part of the expenses of the administration of my estate.
~. I aired that all. my r.ersona property and housei-cold
furnishings be divided equally among my children, BARBARA A.
SANS, CAROL A. CRUPI, PATRICIA A. SAVIDGE, LEONORE LUSANTC,
STEPIIEN M. URI3AN and DANIEL T. URBAI~~, as they can al.l agree and
in the event they cannot agree, then those items of persona].
property and household furnishings which the aforementioned
beneficiaries cannot agree to divide among themselves be sold at
public auction by my Executrix or Executor, whichever the case
i
may be, hereinafter named with the proceeds of such sale to be
distributed as part of the residue of my estate.
3. All the rest, residue and remainder of my estate, real.,.
personal and mixed, and wheresoever the same may be situate, I
„~~~~ES give, devise and be ueath in e ual shares to my chi_ldre:n, BARBARA
3i;~-ra ri[hinN
;; s,~..w¢e A. SANS, CAROI A. CRUPI, PATRICIA A. SAVIDGE, LEONORE LUJANIC,
~STEPFIEN M. URBAN and DAIITEL T. URBAN, absolutely.
Iri the event any of my children above named. sha].1.
predecease me, I direct: that the share such deceased child would
have received shall be given to his or her issue surviving me per
stirpes and if there shall be no such issue, then such share
Ilshall. lapse.
4. I hereby nominate, constitute and appoint my daughter,
PA'PRICIA A. SAVIDGE, as Executrix of this my last Wi11 and
Testament, but should she predecease me or fail to qualify, then
in such event, I nominate, constitute and appoint my daughter,
(CAROL A. CRUPI, as Executrix of this my Last Will and 'Pestament.
I further direct that no person serving as Executrix
ihareunder shall be required to post any bond to secLire the
(Yai.thful performance of her duties in the Commonwealth of
~Pennsyl.vania or in any other jurisdiction.
IN WITNESS WHEREOF', I have hereunto set any hand and seal i:o
this my Last Will and Testament written on Two (2) pages this
(24th day of March, 1998.
'%' ~ (SEAL)
- 7 ~ ~ '-mot , /'_,. ~ " .F-~~
_. ,.-
Patricia A. Urban
Si-geed, sealed, published and declared by PATRIC'7 A A. TJRFSAP7,
the Testatri}: above named, as and for her Last Wi:LI. and
'testament, in our presence, who, in her presence, at her request,
and i.n the presence of each other, have hereunto subscr.i_bed our
names as attesting witnesses.
`` l
~nw orFic es
SNELp AIC ER.
HRENNEIv1AN
& SPARE
~' i
'~ 1'
-z-
. ~ ~~ I
COMMONI^1EA:LTII OI' PliNIdSYLVA1Ql A)
SS.
COUIdTY OF CLIMBERLAAID)
We, PATRICTA A. URBAN, KEITH O. BRENNEMA2d, ESQUIRE and SUSAN
L. LYCH, the Testatrix and the witnesses, respectively, whose
names are signed to the attached or foregoing instrument, being i
first duly sworn, do hereby declare to the ur_dersigned authority
I
that the Testatrix signed. and executed the instrument as her Last ~
Will and Testament and that she had signed willingly, and that
she executed it as her free and voluntary act :far- the purposes
therein expressed, and that each of the witnesses, in the
{ presence and hearing of the Testatrix, signed the Will as witness
and that to the best of his or her knowledge the Testatrix was at
that time eighteen years of age or older, of sound mind and under
no constraint or undue influence.
,, r i~ ., :_-le f ~.,
/ Testatrix~~
' /~S : -~
Witness ~ ~
Wit>~ESS%
Subscribed, sworn to and acknowledged before me by PATRICIA A. {
URBAN, Testatrix, and subscribed and sworn to before me by KEII'II ~I
O. BRErrNEMAN, ESQUIRE and SUSAN L. 2YCH, witnesses, this 24th day
of March, 1998.
I
~~~1 l~'~1,~~'~1~~-~, ~
Notary Public
iJFF.CES ~i...-"-='e....... ~fV~ZI~~I S3a~
p~~,. s' _
J Lf3AI~ER. **11
L3 (=NIJ EI~.IAN ~ (21r1$CIfi~2 V~'7 ~~~r11t@ Y~l7td P° 1-u~l1i,
sl=a1zE e~4achanlcsbury t}uro C.Llmb~r(anci t vunP~
f41y C omrnlsslo. Exhirr~ . i 201} .~
I pJlomber Pennsylvania Association of PJotaries
r
I