HomeMy WebLinkAbout09-04-08J 15056041147
REV-1500 Fx (os-05) OFFICIAL USE ONLY
PA Department of Revenue County Code veer File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
Po Box.28oso1 21 0 8 0 5 4 5
Harrisburg, PA 17128-O6D1 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
201 18 1262 04 07 2008 07 04 1925
Decedent's Last Name Suffix Decedent's First Name MI
MOWERY MARY 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
XI^ 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
,.,... .,....,....,»e. ,~ ,~ Ate.
8 Decedent pied Testate ^ 7 (Alt ~ C ~ i~ Tmed)a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy oT WII)
9. Litigation Proceeds Received 1 p. Spousal PoveAy Credit (date of death ^ 11. Election to tax under Sec. 9113(A)
^ ^ between 1231-91 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
JERRY A. WEIGLE ESQUIRE 717 532 7388
r..~
Firrn Name (If Applicable)
WEIGLE ~ ASSOCIATES, P.C.
First line of address
126 EAST RING STREET
Second line of address
City or Post Office
SHIPPENSBURG
Correspondent's e-mail address:
State ZIP Code
PA 17257
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REGISTER fhl±ltOLLS USE~BTVLY
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Under penalties of perjury, I deGare that 1 have examined this return, inGuding 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 has any knowledge.
SIGNATURE F PERSON RESP SIBL - FILING RETURN DATE
~~ Karen Bodde ~--~~ -Q~
.~-~%1.~,~ ~
18yQugh Drive, Shippensburg,~A X7257
S19NA R F PR ARER OTHER T N P SENT TI ATE
// _ ~ r- Jerry A. Weigle Esquire ~ -- "~ -D~f
DR S
12 East King Street, Shippers rg, PA 17257
Side 1
L,~, 15056041147 15056fl41147 J
___I 1505642148
REV-1500 EX
oecedenYs Name: M 8 ry A . Mowery
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 ii< 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 8~ Miscellaneous Non-Probate Properly
(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 8~ 10) ...................................................................... 11.
12. Net Value of Estate (Line 8 minus Line 11) ............................................................. 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 Sub}ect to Tax (tine 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 0 . 0 0 15.
16. Amount of Line 14 taxable
at lineal rate X .045 0 . 0 0 16.
17. Amount of Line 14 taxable
at sibling rate X .12 0 . 0 0 17.
18. Amount of Line 14 taxable
at collateral rate X .15 0 . 0 0 18.
19. Tax Due ...................................................................... ............................................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Decedent's Social Security Number
201 18 1262
6,742.83
6,742.83
1,164.54
129,366.58
130,531.12
-123,788.29
-123,788.29
0.00
0.00
0.00
0.00
0.00
0
Side 2
15056042148 15056042148
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-08-0545
DECEDENT'S NAME
Mary A. Mowery
STREET ADDRESS
Green Ridge Village
210 Big Spring Road
STATE
cITY
Newville ~ PA ~ 17241
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1) 0.00
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments 600.00
C. Discount 0.0 0
Total Credits (A + B + C) (2) 600.00
3. Interest/Penalty ffapplicable
p. Interest
E. Penalty
Total Interest/Penaity (D + E) (3)
d. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4} 600.00
Check box 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. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
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 tfie use or income of the property transferred :.................................................................................. ^
b. retain the right to designate who shalt use the property transferred or its income :.................................... ^ '~
c. retain a reversionary interest; or .................................................................................................................. ^
d. receive the promise for Irfe of eitfier 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?......... ^ U
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ...................................................................................................................... ^
1F 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 the use of the
surviving spouse is three (3) percent p2 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 p2 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)]. 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.
COMMONWEALTH OF PENNSYLVANIA
INHERRANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Mowery, Mary A. 21-08-0545
All property jointly-owned with the right of survivorship must be disclosed on sctnsdule F.
ITEM
NUMBER
DESCRIPTION VALUE AT DATE
OF DEATH
1 Blue Cross/Blue Shield -refund 430.29
2 First Church of God -money received toward funeral expenses 1,000.00
3 M8tT Bank Checking Acct. #42709733 2,158.57
Accrued interest on Item 3 through date of death 0.02
4 M&T Bank Savings Acct. #4217687861 2,852.60
Accrued interest on Item 4 through date of death 1.35
5 U. S. Treasury - 2008 Economic Stimulus payment 300.00
TOTAL (Also enter on Line 5, Recapitulation) I 6.742.83
(lf more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
REV-1151 E7(+ (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES 8~
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Mowery, Mary A. 21-08-0545
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION
NUMBER AMOUNT
A. FUNERAL EXPENSES:
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Karen Bodde
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address 181 Pugh Drive
City Shippensburg state PA Z;p 17257
Years} Commission paid 2008
2. Attorneys Fees Weigle 8 Associates, 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
350.00
450.00
4. Probate Fees Cumberland County Register of Wills 84.00
5. Accountant's Fees
6. Tax Return Preparers Fees
7. Other Administrative Costs 280.54
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation} 1,164.54
Copyright (c) 2002 form software only The Lackner Group, Inc.
Fonn PA-1500 Schedule H (Rev. 6-98)
Rev-1502 E7(+ 16-98)
SCHEDULE H-B7
OTHER
ADMINISTRATIVE COSTS
COM~ADNWEALTH OF PENNSYLVANIA continued
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF (FILE NUMBER
Mowery, Mary A. 21-08-0545
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Reve 6-98)
Rev-15.12 FJ(+ (6-98)
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, 8~ LIENS
COfrBdONWFJLLTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF IFILE NUMBER
Mowery, Mary A. _ 21-08-0545
Include unreimbursed medical expenses.
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule 1 (Rev. 6-98)
REV-1513 EX+ (9-0O)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Mowery, Mary A. 21-08-0545
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S) RECEIVING PROPERTY Da ~E
D~NT (Words) ($$$)
~
$
oo
I. TAXABLE DISTRIBUTIONS [include outright spousal
di
i
i
str
but
ons, and transfers
under Sec. 9116(a)(1.2)]
1 Karen A. Bodde Niece 0
181 Pugh Drive
Shippensburg, PA 17257
2 Robert A. Plumb Nephew 0
12970 Lower Horse Valley Rd.
Orrstown, PA 17244
Total
Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropri ate, on Rev 1500 cove r sheet
III 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 L 0.00
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98)
LAST WILL AND TESTAMENT
I, MARY A. MOWERY, of the Borough of Shippensburg, Cumberland County,
Pennsylvania, declare this to be my Last Will and Testament and revoke any Will or Codicil
previously made by me.
ITEM I: I direct that all my just debts (except as may be barred by a Statute of Limitations)
and my funeral expenses (including my gravemazker and expenses of my last illness) shall be paid
from my residuary estate as soon as practicable after my decease as a part of the administration of
my estate.
ITEM II: I bequeath those articles of my household furniture and furnishings and those
articles of my personal effects and personal property as set forth in a sepazate memorandum (which
is signed by me, dated and makes specific reference to this Will and memorandum, which I shall
place with my Will or deposit with my attorney), to the persons therein designated.
ITEM III: I devise and bequeath the residue of my estate of every nature and wherever
situate in equal shares to such of my nephew and niece, ROBERT A. PLUMB and KAREN A.
BODDE, as shall survive me by thirty (30) days.
ITEM IV: Should either my nephew, ROBERT A. PLUMB, or my niece, KAREN A.
BODDE, predecease me or die on or before the thirtieth day following my death but leaving
descendants who so survive me, such descendants shall receive, per stirpes, the share that such
predeceased nephew or niece would have received had he or she so survived me.
ITEM V: If any property passes outright (either under this Will or otherwise) to a minor
(which shall be defined as anyone under twenty-one (21) years of age) and with respect to which I
am authorized to appoint a guardian and have not otherwise specifically done so, I decline to
appoint a guardian but instead authorize my Executor to distribute such property to a Custodian
selected by my Executor (and my Executor may act as such Custodian) as Custodian for the minor
under the Pennsylvania Uniform Transfers to Minors Act. Provided, however, that this appointment
shall not supersede the right of any fiduciary to distribute a share where possible to the minor or to
another for the minor's benefit.
ITEM VI: I direct that all taxes that may be assessed in consequence of my death, of
whatever nature and by whatever jurisdiction imposed, shall be paid from the non-charitable portion
of my residuary estate as part of the expenses of the administration of my estate.
ITEM VII: I appoint my nephew, ROBERT A. PLUMB, and my niece, KAREN A.
BODDE, co-Executors of this my Last Will.
ITEM VIII: I direct that my Executors, custodians or their successors shall not be required
to give bond for the faithful performance of their duties in any jurisdiction.
ITEM IX: The interests of the beneficiaries hereunder shall not be subject to anticipation
2
or to voluntary or involuntary alienation.
IN WITNESS WHEREOF, I hereunto set my hand and seal to this my Last Will and
~` ,---
Testament, written on four (4) sheets of paper, dated this ~(~~day of ~;-`, 2001.
~,~-°~,~
~. (SEAL)
MARY . MOWERY
The preceding instnunent, consisting of this and three (3) other typewritten pages, each
identified by the signature or initials of the Testatrix, was on the day and date thereof signed,
published and declared by the Testatrix therein named, as and for her Last Will, in the presence of
us, who, at her request, in her presence, and in the presence of each other have subscribed our
names as witnesses hereto.
~,.t.
-~x•-,.., residing at ~~a!3~~1,~C~
~~ ~~~Y ~--~ residing at J ~ J~~SU C~ `' ~~i
3
COMMONWEALTH OF PENNSYLVANIA
. ss.
COUNTY OF CUMBERLAND
I, MARY A. MOWERY, the Testatrix whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, do hereby acknowledge that I signed and
executed the instrument as my Last Will; and that I signed it willingly and as my free and voluntary
act for the purposes therein expressed.
(SEAL)
MAR A. MOWERY
Sworn to or affix ed an acl owledged
before me by 0~ the
T tatrix, this c~ day of
2001.
Notary Pub c
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Nichols J. Keilert, Notary Public
Sh nstwrg eoro, CUm!» and County
My mmisslon Expires Aug. 18, 2003
. ss.
COUNTY OF CUMBERLAND
We, %~~~/ ~~YL ~ ~~45 and ~~~~ ;~ ' 6', lJ-s~, the witness whose names
are signed to the attached or foregoing instrument, being duly qualified according to law, do depose
and say that we were present and saw the Testatrix sign and execute the instrumment as her Last Will;
that the Testatrix signed willingly and executed it as her free and voluntary act for the purposes
therein expressed; that each subscribing witness in the hearing and sight of the Testatrix signed the
Will as a witness; and that to the best of our knowledge the Testatrix was at that time eighteen (18)
or more years of age and of sound mind and under na'constraint or undue influence.
~,
Sworn to or affirmed and subscribed to
before me by 1 ' ~ . /.fit. viS and Notarial seal
-~ • Nic~tole J. Keltert, Notary Public
~c-cSQi~ . ~j~ ~D witiresseS, Shippansburg Boro, CUmberiand County
this lk '~-d~Y of ~~~~ , 200 MY Commission Expires Aug, 18, 2003
Notary Public
4
PERSONAL PROPERTY MEMORANDUM TO
ACCOMPANY WILL OF MARY A. MOWERY
As provided in ITEM II of my Will, I hereby designate that the following listed property shall go
to the persons whose names are designated hereon.
ITEM NAME
DATED: SIGNED:
MARY A. MOWERY
Q MSTBank
499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12 Phone (888) 502-4349
Fax (302) 934-2955
June 26, 2008
Weigle & Associates PC
Attorneys At Law
126 East King Street
Shippensburg, Pennsylvania 17257-1397
Re: Estate o : Marv A Mowery
Social Security: 201-18-1262
Date of Death: April 07. 2008
Dear Sir or Madam:
Per your inquiry dated June 20, 2008, 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 Checking Account
Account Number 42709733
Ownership (Names o~ Mary A Mowery
Opening Date 01/28/87 Closed 06/17/08
Balance on Date of Death $2,158.57
Accrued Interest $ 0.02
Total $2,158.59
2. Type of Account
Account Number
Ownership (Names o~
Opening Date
Balance on Date of Death
Accrued Interest
Total
Savings Account
015004217687861
Mary A Mowery
DI/14/08 Closed 06/17/08
$2, 852.60
$ 1.35
$2, 853.95
Type of Account
Account Number
Ownership (Names o, f}
Opening Date
Balance on Date of Death
Savings Account
015004215335529
Mary A Mowery
70/10/07 Closed 01/14108
$ 0.00 * * Closed prior to the date of death
Please be advised, there was no safe deposit box found for the above decedent.
** Please contact the King Street Branch for all additional information on accounts closed prior to the date of death.
* If upon reviewing the information above, you believe there are additional accounts not referenced, please
provide us with an account number and/or 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, etc., please contact our King Street Branch at 35-39 East King Street, Shippensburg, PA 17257, or #
717-532-4132.
Sincerely,
-`~%~~
Nancy Clagett
Records Management
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
June 24, 2008
WEIGLE & ASSOCIATES
JERRY A WEIGLE ESQUIRE
126 EAST KING STREET
SHIPPENSBURG PA 17257
Re: MARY MOWERY
CIS #: 930178423
SSN: 201-18-1262
Date of Death: 04/07/2008
Dear Attorney Weigle:
Please be advised that the Department of Public Welfare maintains a
claim in the amount of $128,287.28 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 $29,032.01, 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 $99,255.27, 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 contains
real estate, please provide copies of the deed, the latest tax assessment,
and a current appraisal, if available.
Sincerely,
~~..
Elizabeth D. James
TPL Program Investigator
717-772-6397
717-772-6553 FAX
Enclosure