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Home My WebLink About08-21-08- J 15056051058 REV-1500 EX (06-05) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes PO BOX 280601 County Code Year File Number INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 07 0690 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 174-40-9388 05/29/2007 06/21 /1947 Decedent's Last Name Suffix Decedent's First Name WALSH MI KATHRI'N A (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name WALSH MI JAMES L Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER CIF WILLS FILL IN APPROPRIATE OVALS BELOW • 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death 4. Limited Estate prior to 12-13-82) 4a. Future Interest Com romise date of p ( 5. Federal Estate Tax Return Required death after l2-12-82) 6. Decedent Died Testate (Attach Copy of Will) 7. Decedent Maintained a Livin Trust g 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust) 9. Litigation Proceeds Received 10. Spousal Pove Credit date of death ~ ( 11. Election to tax under Sec. 9113(A) b etween 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENi'IAL TAX INFORMATION SHOULD B N ame E DIRECTED T0: Daytime Telephone Number STEVE C. NICHOLAS, ESQ. (717) 540-7746 Firm Name (If Applicable) NICHOLAS LAW OFFICES PC REGISTER ~ yu+4LS uSE t7tVtY First line of address ,,; ; 2215 FOREST HILLS DRIVE _~ Second line of address - SUITE 37 """ City or Post Office _, State ZIP Code OATE~FILEO c-,,) HARRISBURG PA 17112-1099 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 ,correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. ~SIGNA URE OF PER N PONSI~LE FjBR FILI RETURN v L L~,7 ~ d .a J(` DATE <1~ ~ _ /~- 08/20/08 ADD ESS _ - - _ _ j4,3~GOLFVIEI/~ ROAD, CAMP HILL, PA 17011-203. 6 IGNATU F _ _ _ _ - E TH Ft THAN REP SEN TIVE .,- ~ /~~ ~` DATE ADDRESS - _ _ _ _ _ _ 08/20/08 2215 FOREST HILLS DRIVE, SUITE 37, HARRISBURG, PA 17112-1099 PLEASE USE ORIGINAL FORM ONLY 15056051058 Side 1 L 15056051058 ~~ ' .J REV-1500 EX 15056052059 Decedent's Social Security Number Decedent's Name: KATHRYN A WALSH _-_ , _~___, ~.__~___ ___.,~, _. ~._.~.. ~._~____._,,,__w.~_._ . 174-40-9388 _ ,,,_._,~,~ _~__._._.~,..__ .~~, _.____...__.._ . 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. 70,159.76 6. Jointly Owned Property (Schedule F) C:~:~a Separate Billing Requested .... ... 6. 3 731 19 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property , . - - (Schedule G) r Separate Billing Requested..... ... 7. 8. Total Gross Assets (total Lines 1-7) .. ,~.~_ ..~~ ~,, ~m.m_~.~~- _~.-..~ ~ .. .,_ ..~~.~A_ _ u~- , e~_~~ 8 73,890.95 Funeral Expenses & Administrative Costs (Schedule H) ... . " ' ~ ~ 14,119.75 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. ... 10. 11. Total Deductions (total Lines 9 & 10) ... .. ............................. ... 11. 14,119.75 i 12. Net Value of Estate (Line 8 minus Line 11) ......... . ................. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which ... 12. 59,771.20 an election to tax has not been made (Schedule J) ...................... .. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) _. .. ...................... __.,~__ ~ ~_. _._ __. _.._,_.. _...~, _._,__ .~.__.___,~-_._ ___.,,~._~_ .............~-. _ ~ ._._,.,,~ ~..__~ TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES . . 14. ,....~,.,_._., _. _. _. __ _._ 59, 771.20 ~-._ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 -- -- - - - - (8)(1.2) X .0 0 3,586.27 15 16. Amount of Line 14 taxable •- . 0.00 __ at lineal rate X .0 17. Amount of Line 14 taxable 16. at sibling rate X .12 2,988.56 17 '' 358 63 18. Amount of Line 14 taxable - . - at collateral rate X .15 .53,196.37 18 7,979.46 19. TAX DUE ... _ _ .... ..................................................... . 19. 8,338.09 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~~:;. L. 15056052059 Side 2 15056052059 REV-1500 EX Page 3 decedent's Complete Address: . , _. _.. _,,, Flle Number ' 21 07 ;06:90 KATHRYN A WALSH STREET ADDRESS --- 43 GOLFVIEW ROAD cITY CAMP HILL Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit __ B. Prior Payments C. Discount 3. InteresUPenalty if applicable D. Interest E. Penalty DECEDENT'S SOCIAL SECURITY NUMBER ___ _ _ 174-40-9388 STATE PA ~ziP -- _ 17011-2036 (1) 8,338.09 ,620.00 559.00 Total Credits (A + B + C) (2) 11,179.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.tal InteresUPenalty (D + E) (3) Fill in oval on Page 2, Line 20 to request a refund. (4) 2,840, 91 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1 D'd d i ecedent 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 pa ments b f t . ^ .. y , ene i s or care? .................................................................... 2. If death occurced after December 12, 1982, did decedent transfer property within one year of death .. ^ without receiving adequate considerations .. 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 SCHE~IULE 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 .x mot a transfer to a surviving spouse from tax, and tihe 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. Walsh Kitty Schedule E scn/est SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY Estate of Kathryn A. Walsh File Number: 2107-0690 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with [Ihe right of survivorship must be disclosed on Schedule F. Item # Description Amount L M&T Bank a. #38315408 $ 191.29 b. #015004213033688 $ 4,314.97 2. Nationwide Insurance Non-Qualified Annuity $65,653.50 Contract Number 07-1085337 payable to Matthew Scheffey (nephew) Total $70,159.76 M&T Bank 499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12 Phone (888) 502-4349 Fax (302)934-2955 August 8, 2007 Nicholas Law Offices PC Attorneys At Law Northwood Office Center 2215 Forest Hills Drive, Suite 37 Harrisburg, Pennsylvania 17112-1099 Re: E_ state of Katlz;yn A Walsh Social Security: 174-40-9388 Date of Death: May 29 2007 Dear Sir or Madam: Per your inquiry dated August 02, 2007, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: . 1. Type of Account Checkz'ngAccount Account Number 38315408 Ownership (Names o, f} Kathryn A Walsh Opening Date 06/28/84 Balance on Date ofDeczth $191.29 Accnced Interest $ 0.00 Total _. __ -_------___-- -- _ $191.29 - --- -- ----------____-. _. _ 2. Type of Account Savings Aceount Account Number 015004213033688 Ownership (Names o~ Kathryn A Walsh Opening Date 06/15/06 Balance on Date of Death $4, 314.14 Accrued Interest $ 0.83 Total __.. _..._. __._. _ _ _ $4 314.97 _ __.. _.. . 3. Type of Account Certificate of Deposit Account Number 031003914382286 Ownership (Names of) Mary Ellen Endrizzi Kathryn A Walsh Opening Date 07/15/88 Balance on Date of Death $4,343.85 Accrued Interest $ 75.58 Total ---.. __. __._.. _..__.. . $4,419.43 4. Type of Account Certificate of Deposit Account Number 031003914382327 Ownership (Names o, f} Mary Ellen Endrizzi Kathryn A Walsh Opening Date 04/14/84 Balance on Date of Death $1,000.00 Accrued Interest $ 3.65 Total _. ___ _... __. $1, 003.65 S. Type of Account Certificate of Deposit Account Number 031003914382335 Ownership (Names o~ Mary Ellen Endrizzi _ - --- - -- Kathryn AWalsh * _ Opening Date 07/07/84 Balance on Date of Death $1,000.00 Accrued Interest $ 35.63 Total __ .. _..._ _. ............ ............... $1 035.63 Please be advised, there was no safe deposit box found for the above decedent. * If upon reviewing the information above, you believe there are additional accounts not referenced, please provide us with an account number and/or the name of any possible joint account holder. For any additional information on the above accounts, including ownership and any changes, closures and/or reimbursement of funds, please call the West Shore Plaza Office # 717- 255-2271. Sincerely, L~/ L~ Nancy Clagett Records Management J.t~N-Of,-'?008 13:23 FROM: ' 1 t1e uug i1, ,t~; ~~;aa ~u~r €i f fQ ~~ . zc ~t :i3 Yi . a...-....._~. T0: 7175411527 P.4~4 n~f.i,an4,lUF; 4,Tf: iua. rase a ~, ., Quarterly Statement Apr 1, 2Q07 to Jun 30, 2007 Contract Number: b7-i 085337 1~'tty welt? Gt:t your tnfom,etton when you•want It, sign trp for eDelivery at natiottwide.corti/lopin. It's slrttple, falgt, it's 5ecun5, Contract Vaiuf: is ~, Customer KATHRYN A W/y SH Yovr Inveslrnent Prufassional JOMV BUGGY 49GOLFVIEW R0 CAPdpHILL PA 17011-2(136 CGO6+h'E~IUENI'SERVIf;ESCt~RP FIXED 2N/AIAINST MECMaIVtCSBURG PA 17()55-6?3' Account inl'artnatlon ConVad Number. 07-108,,337 Convect Is.~?ve DaDe: 02!26x'2002 Natbnwide life and Annuky . P O Sax 182029 ~~... ~l?lan;•1~ype;- ~ Cnlfmtrfa pH 43218-2(121 24hr Autorttatatl IntormAtkxi Line: {800)846-6331 Cu9fomerSrtvice: (900 848-6331 Noarng hnpatr+ed: (B00; 2:38-3036 Intemek ~aww.natonwide.com/togln Account Summary 60guming date Quarter-To-Date 04f0112007 Bagfinninp Contract Yalus 565 172 92 Purchase Paymerrt5 $ 00 Withdtawa Is/ChargQs . Annuity Performance E742.~ Ending Contract Valuq eg of OB/30/2007 b65,915.64 Beneflt Election Suimmalry Death Benefit -Stancferd Cantrad Value Death Beneflt Value Fixed Account Sufr+rnary Year of Purchase Purchase PsygKryt Vlithdrswals Sinrp R~rehase Payment Amount Paymern 2002 S61,u88.24 Fund Total RRti2N~/1066337 D70Bnnrf)DDQ4 Year-To•-Date Incoptlon-To-D: ouo~noo7 ozrzsrzaa2 $64,41'3.58 $.00 551,588.24 $.00 $.oo 1 sa~2.oe -.~~~ s1a.32~.ao ¢65,915,64 $85,913.64 lie of 06730/2007 565.915.64 no Valuo n In trot Rafe 6uarah~ d OtfrsazDOr Througfi 566,015.Frt 4.6596 02!25/2008 ;65,915.E4 Page 2 pf 3 :'~ t ,F a` t~1.1Ca-21-2007 03:24PM ~'qX: IDt PACa'E:902 R=90X :~]N-05'008 13:23 FROM: T0: 7175411527 P.2~4 Tue Aug 21 15:26;42 2007 Nationtride Life Ins. Page 3 of 3 Quarterly Sk2tement Apr 1, 2007 to Jun 30, 2007 Contract Number: 07-1085337 5 Purchase Payments/Credits from 04101/2407 through 06/30J'2007 Transaction Oo1larAmaurrt Credited 9aseRate bate Typo Interest Date Guaranteed Through Nn TWW5AC71ONS Withdrawals/Charges from 04!0112007 through p6/30/2007 ~~ Trerlsaotion Dollar Amount Date Typo NO TRANSACTIONS Get ONino. Got things dono Gel beck to lir6. The days erg getting longer, Gut d'S atAl hard to fit evFrything in. 7nal's writ' we give yrxr a~ssy arrtl secure w•~ys to view and mgna8e your actouni& wilh0ul 1110 Paperwork. o0alrvcry option To recniva'vttrxmation from us taster and reduce rose, you can sign up to oDelivery from Natianwitle. This faalure allows you to hsvs access to your intprrrt~tipn whAn you want it Wo smlply nofrfy you M' a-matl wean your documents (statements, prospetlusAS and othor important docurnents~ are ready for you to rehievf-51~m a,r shwre sarvor. 'I'o ctloose this option; just visit nahortmde.cornllogin and idlow 1h~e steps t CIidS on A4anage Prot7A 2. In A9a1ny Proferences. enter an r.-maB address Change doarmnntmaling preference b a-med. Thafs it. To fnUrnv your aontraot balaru;ea. our clWrnel aria. nal~omvide comdogin find ar sutomsted Anrh,rty Information System, 9-Boo-84D-133:11, are avaiabk+ 24 hours a day, 7 days a week fa your cunvenrence. Our Annuity SerYte>a t,(lrusr Repre~santativas are dvalabl9 hlonUay lfuuvugh Friday 8:00 ? m to 8:00 p.m. Eastern Tmw. please reviyl- the nfarnation n Ihis r:talemertl fatefully Writ' ateslirlns nr «vredinrw must ba roparlaJ to Nafiornvida Irr'Imediateiy to arruue proper aedihna to your conRxt Mnuigea 'are NOT assured by 111a FDIC or any federal government agrfnry 'ere NO7 depnrpta or nhtigatirxls of, guarenleArl bbyy. rX irtrSUrec1 by. your dapo~ilory institution or easy of iW affiliates 'irwolva ir.aslrtlt3N risk. includ'wtg pussd~le loss o(value Ra aN nn Fr a~rrub:raz moa0o600oG~8 Page 3 of 3 nn.incnn.Trnnun;i v3 rirn~x a; mom A1J~-21-2007 03: 25FM FAX: ID: PACE t @03 R=90%t Walsh Kitty Schedule F scn/est SCHEDULE F JOINTLY-OWNED PROPERTY Estate of Kathryn A. Walsh File Number: 2107-0690 Joint Tenant(s): Name/Address Relationship to Decedent A. Mary Ellen Endrizzi Sister 1305 Mallard Road. Camp Hill, PA 17011 B. Jointly-Owned Property: ITEM # Letter for Date Made Description Tota] Value Joint Tenant Joint of Property of Asset 1. A 07/15/1988 M&T Bank $4,419.43 #031003914382286 2. A 04/14/1984 M&T Bank $1,003.65 #031003914382327 3. A 07/07/1984 M&T Bank $1,035.63 #031003914382335 Decd's°ro Int Dollar Value Int. of Decd's Int 50% $2,209.72 50% $1,003.65 50% $ 517.82 'TOTAL $3,731.19 Walsh Kitty Schedule H scn/est SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Estate of Kathryn A. Walsh File Number: 2107-0690 Debts o! decedent [oust be reported on Schedule I. A. FUNERI~L EXPENSES: 1. Parthemore Funeral Home -Funeral $5,720.17 2. Northumberland Memorial Park -Grave opening $ 575.00 3. Northumberland Memorial Park -Memorial Marker $2,950.00 B. ADMINISTRATNE COSTS: 1. Personal Representative's Commissions: Name of Personal Representative(s): $ Social Security Number(s) of Personal Representative(s): Address: Year(s) Commission Paid: 2. Attorney Fees: NICHOLAS LAW OFFICES, PC $1,000.00 3. Family Exemption: (If decedent's address is not the $3,500.00 same as claimant's, attach explanation) Claimant: James L. Walsh Address: 43 Golfview Road, Camp Hill, PA 17011 Relationship of Claimant to Decedent: Husband 4. Probate Fee: Register of Wills of Cumberland County $ 100.00 5. Advertising: Cumberland Law Journal $ 75.00 6. Advertising: The Sentinel $ 174.58 7. Postage, Copies, Notary: NICHOLAS LAW OFFICES PC $ 25 00 , . TOTAL $14,119.75 Walsh Kitty Schedule J scn/est SCHEDULE J BENEFICIARIES Estate of Kathryn A. Walsh File Number: 2107-0690 A• Taxable Distributions No. Name /Address of Beneficiar Relationship Amount or Share of Estate 1 • James L. Walsh 43 Golfview Road Husband Residue Camp Hill, PA 17011 2• Matthew Scheffey Nephew 1100 Saint David's Road Proceeds of Nationwide Williamsport, PA 17701 Insurance Non-Qualified Annuity Contract Number 07-1085337 (Sch E) 3 • Mary Ellen Endrizzi Sister 1305 Mallard Road Jointly owned property (Sch F~ Camp Hill, PA 17011 B• Nontaxable Distributions No. Name /Address of Beneficiar Amount or ~~hare of Estate 1 • Charitable and Governmental Distributions