HomeMy WebLinkAbout04-0360 COMMO.W~*LT, OFPENNSYLV*.,* INHERITANCE TAX RETURN FILENUMBER
oE.T 2soe0, RESIDENT DECEDENT I 21
HARRISB_URG, PA 171.2~:0601 __. i COUNTY CODE YEAR NUMBER
DEC~E)EN~'S NAME (LASTi FIRST, AND MIDDLE INI:'i;IAL) ' ~ SOCIAL SECURITY NUMBER
Sutton, Margaret E. ~ 187- l 0- 8354
DATE oF 6~ATH iMM-DD-YEAR) ' - bATE OF BI~R (Mk, I-DD:YEAR) ....
i THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
12/18/2003 . 06/04/1915 REGISTER OF WILLS
IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE iNITIAL) SOCIAL SECURITY NUMBER
~ 1. Original Return [] 2. -~upplemer~talFlet~;n D 3. ~mainde~R~turnidat~0f~eat~p;i0¢toi~:i3_-82)
[] 4. Limited Estate [] 4a. Future Interest Compromise (date of death after
12-12-82) [] 5. Federal Estate Tax Return Required
[] 6. Decedent Died Testate (Attach copy [] 7. Decedent Maintained a Living Trust (Attach 0 8. Total Number of Safe Deposit Boxes
of Will) copy of Trust) '
[] 9. Litigation Proceeds Received [] 10. Spousal Poverty Credit (date of death between [] 11.Election to tax under Sec. 9113(A) (Attach Sch O)
12-31-91 and 1-1-95)
~ SECTtON MU~BE coMPEE*EO: ~LL COI~REsPoNDE~cE AND ~0~FIDENTIAE TA~I~ORMA~ION SHOULD BE
~AME ........................ ~PLET~ M,'~ILING ADDRESS
Stephen L. Bloom
~:IRM NAME (If app cab e) I
/ StephenL. Bloom Esquire ! 2~100 Longs Gap Road
~E ' ' ' ~.arlisle, PA 17013
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
[] Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
~on~.I:
ri:'/
None-)
Non/
559.37
None.} r-,,~
6,513.18 i
(8) 7,072.55
7,046.00
43,262.42
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15.Amount of Line 14 taxable at the spousal tax rate,
or transfers under Sec. 9116(a)(1.2)
x .00
r~ 16. Amount of Line 14 taxable at lineal rate x
= x .12
o
o
~ x .15
17.Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20. []
(11) 50,308.42
(12) insolvent
(13)
(14)
(15)
(16)
(17)
(18)
(19)
Copyright 2000 form sofb~are only The Lackner Group, Inc, Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
I 442 Walnut Bottom Road
I® Carlisle '- ]-~TA T~- p~ i Z1P
' I 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits (A + B + C)
Total Interest/Penalty (D + E)
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
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.
Make Check Payable to: REGISTER OF WILLS, AGENT
(1)
(2) 0.00
(3)
(4)
(5)
(5A)
(5B)
0.00
q.o o
0.00
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. rece ve the prom se for fe of ether payments, benefits or care? ..............................................................
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate considerat on? ........................... [] []
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 SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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 !he personal represen_tative is based on all i?~om~ation of which preparer has any knowle_dge
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS DATE
Carlisle, PA 17013
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS DATE
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
Stephen L. Bloor
ADDRESS
DATE
2100 Lonas Gap Road
Carlisle, P'A 17013
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)]. 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 0% [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 4.5%, 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 12% [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.
.~ SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
CO~MO"WEALT, O~ PE,,SVLVANIA PERSONAL PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Sutton, Margaret E.
FILE NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM ~-~T DATE OF
NUMBER DESCRIPTION DEATH
1 United Church of Christ Homes (Thomwald Home) - Resident Refund 559137
TOTAL (Aisc enter on Line 5, Recapitulation)
559.37
~ SCHEDULE G
INTER-VIVOS TRANSFERS &
COMMONWEALTH OF PENNSYLVANIA
,N,ER,T^NCE TA× RETURN MISC. NON-PROBATE PROPERTY '
RESIDENT DECEDENT '
ESTATE OF i FILE NUMBER
Sutton, Margaret E. ! 21 - -
This schedule must be completed and ill_ed if the answer tO an)/of questions 1 through 4 on page 21is )/es.
ITEM
NUMBER
1
DESCRIPTION OF PROPERTY
Include the name of the transferee, their relationship to decedent and the date of transfer.
Attach a copy of the deed for real estate.
Pre-Paid Funeral Arrangements - MiCrodata Systems, Inc. ---' 5,481.84i
Payable directly to Hoffman-Roth Funeral Home, Inc., as
non-probate transfer ($410.84 overpayment subsequently
paid by Hoffman-Roth Funeral Home, Inc., directly to Linda!
L. Sutton, daughter of decedent, as non-probate transfer)
F&M Trust - Checking Account #34-12717 (balance paid
directly to Linda L. Sutton, daughter of decedent, as
non-probate transfer)
F&M Trust - Money Management Account #70-74913
(balance paid directly to Linda L. Sutton, daughter of
decedent, as non-probate transfer)
DATE OF DEATH % OF i i
VALUE OFASSET DECD'S i EXCLUSION, TAXABLE VALUE
INTEREST 0F APPLICABLE) I
100% 5,481.84
237.80
793
100%
100%
237.80
793.54
~ I _ 61~13.18
TOTAL {Also enter on line 7, Recapitulation)
ESTATE OF
Sutton, Margaret E.
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION
A. I FUNERAL EXPENSES:
1 ' Hoffman-Roth Funeral Home, Inc. - Acct. #14182~245
FILE NUMBER2]--
AMOUNT
5,071.00
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City State Zip
Year(s) Commission paid
Attorney's Fees Stephen L. Bloom, Esquire
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
Probate Fees
State Zip
Accountant's Fees
Tax Return Preparer's Fees
Other Administrative Costs
Phil Huntzinger
1,850.00
125.00
TOTAL (Also enter on line 9, Recapitulation) 7,046.00
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
COMMO"W~T. OF.ENNSVLVAN,^ LIABILITIES, & LIENS i
ESTATE OF i NUMBER
Sutton, Margaret E 'FILE
Include unreimbumed medical expenses.
ITEM
NUMBER
1
DESCRIPTION
Pennsylvania Department of Public Welfare, Estate Recovery Program - Claim for Restitution of Medical
Assistance to Decedent - CIS #370156231
TOTAL (Also enter on Line 10, Recapitulation)
AMOUNT
43,262.42
43,262.42
LAST WILL AND TESTAMENT
I, MARGARET E. SUTTON, of the Borough of Carlisle,
Cumberland County, Pennsylvania, being of sound and disposing
mind and memory, do hereby make, publish and declare this to
be my Last Will and Testament, hereby revoking any and all
former Wills or Codicils by me made.
1.
I direct that all my just debts, funeral expenses,
testamentary expenses and all inheritance taxes shall be paid
from my residuary estate as soon as practicable after my decease
and as part of the administration of my estate.
2.
Ail the rest, residue and remainder of my estate, both
real and personal property, I give, devise and bequeath unto
my husband, RICHARD L. SUTTON, absolutely, and I hereby appoint
my said husband as Executor of my estate.
3.
In the event my said husband shall predecease or fail to
survive me, then I give, devise and bequeath all of my estate,
both real and personal property, unto my daughter, LINDA L.
SUTTON, absolutely, and I appoint my said daughter as Executrix
of my estate.
IN WITNESS WHEREOF I have hereunto set my hand and seal
t is
Ma'rgm~et E. Sutton
SIGNED, SEALED, PUBLISHED AND DECLARED by the above named
Testatrix MARGARET E. SUTTON as and for her Last Will and
COMMONWEALTH OF PENNSYLVANIA )
: SS.
COUNTY OF CUMBERLAND )
I, MARGARET E. SUTTON 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; that I signed it willingly; and that I signed it as
my free and voluntary act for the purposes therein expressed.
Margare~ E. Sutt
Sworn or affirmed to and acknowledged before me ~
, the Testatrix, this/~ day
Margaret E. Sutton
of ~~ , 1977.
COMMONWEALTH OF PENNSYLVANIA )
: SS.
COUNTY OF CUMBERLAND )
the witnesses whose names are signed to the attached or fore-
going instrument, being duly qualified according to law, do
depose and say that we were present and saw Margaret E. Sutton
, Testatrix, sign and execute the instrument
as her Last Will; that Margaret E. Sutton
signed willingly and that Margaret E. Sutton
executed it as her free and voluntary act for the purposes
therein expressed; that each of us in the hearing and sight of
Margaret E. Sutton , Testatrix, signed the
Will as witnesses; and that to the best of our knowledge the
Testatrix was at that time 18 or more years of age, of sound
mind and under no constraint or undue influence.
Address ~5-//-~9~
ic.United Church of Christ Homes
30 North 31st Street
Fulton Bank
60-142
010549
Camp Hill, PA 17011
(717) 303.-1502 DATE CHECK NO.
01/21/2004 10549
LANCASTER, PA 17604
313
AMOUNT
$559.37***
PAY
TO THE
;ORDER
OF
FIVE HUNDRED FIFTY-NINE AND 37/100 DOLLARS
Estate of Margaret Sutton
c/o Linda Sutton
246 South Pitt Street
Carlisle, PA 17013
TWO SIGNATURES REQUIRED IF: $50,000 OR MORE
NOT VALID AFTER 90 DAYS
,'O &O S~qll" ~:03&%O&~,22~: 22~ct ~,E~.R&,.
Funeral Home, Inc.
219 North Hanover St.
Carlisle, Pennsylvania 17013
(717) 243-4511
William E. Hoffman
Supervisor
January 14, 2004
Linda L. Sutton
246 South Pitt St.
Carlisle, PA 17013
Dear Mrs. Sutton;
Enclosed you will find check # 22761 in the amount of $410.84 which represents
the overpayment of funeral expenses for Margaret E. Sutton.
We received a check in the amount of $5481.84 from Microdata Systems, Inc. The
funeral bill has been paid in full and we wish to reimburse you for this amount.
We wish to express our sincere thanks for the friendship and good-will you have
accorded us.
It is our purpose at all times to render a considerate and thoughtful service that
may continue to merit your highest esteem.
Sincerely,
Robert A. Filbum
dk
Enclosures
ORIGINAL 286 J ~1~% ACCT. NO, '
Funeral Services ~~)~ :., . :,, _ , ,__ -.
Name of Deceased
[] CREDIT
CARD
[~OTHER
LAST BALANCE
[~INTEREST
[ LATE PAYMENT
CHARGE
SUB TOTAL
CREDITS
9583
TRUST
CHAMBERSBURG
BOLLING SPRINGS
MARION
MONT ALTO
NEWVlLLE
SHIPPENSBURG
WAYNESBORO
CARLISLE
**********************-***** 170
1946 0.4150 AB O. 301 13 I 90
MARGARET E SU'I-rON
% LTNDA L SuI-rON POA
246 S PITT ST
CARLISLE PA 17013-3813
0022 0017 4237 Y
STATEMENT OF ACCOUNTS
34-12717
STATEMENT
FROM
12-11-03
PAGE
PERIOD
THROUGH
1-11-04 0
i OF i
0 ENCLOSURES
GO CLUB REGULAR CHECKING
ACCOUNT: 34-12717
PREVIOUS DEPOSZTS/
STATEMENT BALANCE CREDITS 0
237.80 .00
CHECKS/ SERVICE
DEBZTS 0 FEES
.00 .00
SERVICE FEE BALANCE INFORMATION FROM 12-11-03 THROUGH 1-11-04
AVERAGE LEDGER BALANCE 237.80 AVERAGE COLLECTED BALANCE
MINIMUM LEDGER BALANCE 237.80 MINIMUM COLLECTED BALANCE
ONLINE BILL PAY - COMING SOON. ~ZTH ONLINE BILL PAY YOU CAN
PAY BILLS CONVENIENTLY AND EASILY FROM YOUR F&M TRUST
CHECKING ACCOUNT. NO MORE WRITING CHECKS, LICKING ENVELOPES
OR APPLYING STAMPS. WATCH FOR DETAILS. COMING FEBRUARY
20O4
ENDING
BALANCE
237.80
237.80
237.80
Farmers and Merchants Trust Co
DIRECT
INQUIRIES TO:
TELEPHONE:
RITNER HIGHWAY
1901 RITNER HIGHWAY
CARLISLE, PA 17013
717-960-1400
CHAMBERSBURG
BOLLING SPRINGS
MARION
MONT ALTO
NEWVILLE
SHIPPENSBURG
WAYNESBORO
CARLISLE
**********************-***** 170
1964 0.5420 AB 0.301 14 I 90
MARGARET E SUTTON
% LTNDA L SUTTON POA
246 S PZTT ST
CARL:ZSLE PA 17013-3813
0022 0017 4146 Y
STATEMENT OF ACCOUNTS
34-12717
STATEMENT PERZOD
FROM THROUGH
11-12-03 12-10-03
PAGE
0 ENCLOSURES
Eli
j
PREV"ZOUS DEPOSZTS/ CHECKS/ SERVZCE
STATEMENTBALANCE CREDZTS 0 DEBZTS 0 FEES
237.80 .00 .00 .00
SERVZCE FEE BALANCE ZNFORMATZON FROM 11-12-03 THROUGH 12-10-03
AVERAGE LEDGER BALANCE 237.80 AVERAGE COLLECTED BALANCE
MZNZMUM LEDGER BALANCE 237.80 MZNZMUM COLLECTED BALANCE
HAPPYHOLZDAYS FRON ALL OF THE EMPLOYEES
AND DZRECTORS OF ~ TRUST.
ENDZNG
BALANCE
237.80
237.80
237.80
DZRECT RZTNER HZGHk/AY
ZNC~UZRZES TO: lg01 ~ER HZGHliAY
CARLZSLE, PA 17013
TELEPHONE: 717-g60'1400
TRUST
CHAMBERSBURG
BOLLING SPRINGS
MARION
MONT ALTO
NEWVILLE
SHIPPENSBURG
WAYNESBORO
CARLISLE
**********************-***** 170
1954 0.4150 AB 0.301 13 I 98
MARGARET E SUq-rON
% LINDA L SUTTON POA
246 S PITT ST
CARLISLE PA 17013-3813
0022 0017 5210 Y
STATEMENT OF ACCOUNTS
70-74913
STATEMENT
FROM
12-11-03
PAGE
PERIOD
THROUGH
1-11-04 0
1 OF 1
0 ENCLOSURES
~ONEY MANAGEMENT ACCOUNT
ACCOUNT: 70-74913
PREVIOUS DEPOSITS/
STATEMENT BALANCE CREDITS 0
793.54 .00
CHECKS/ SERVICE
DEBITS 0 FEES
.00 .00
SERVICE FEE BALANCE INFORMATION FROM 12-11-03 THROUGH 1-11-04
AVERAGE LEDGER BALANCE 793.54 AVERAGE COLLECTED BALANCE
MINIMUM LEDGER BALANCE 793.54 MINIMUM COLLECTED BALANCE
ONLINE BILL PAY - COMING SOON. ~ITH ONLINE BILL PAY YOU CAN
PAY BILLS CONVENIENTLY AND EASILY FROM YOUR F~M TRUST
CHECKING ACCOUNT. NO MORE WRITING CHECKS, LICKING ENVELOPES
OR APPLYING STAMPS. WATCH FOR DETAILS. COMING FEBRUARY
2004
ENDING
BALANCE
793.54
793.54
793.54
DIRECT
INQUIRIES TO:
TELEPHONE:
RITNER HIGHWAY
1901 RITNER HIGHWAY
CARLISLE, PA 17013
7~7-960-1400
CHAMBERSBURG
BOILING SPRINGS
MARION
MONT ALTO
NEWVILLE
SHIPPENSBURG
WAYNESBORO
CARLISLE
I,,,111,,,111,,,,,,!1,,11,,,11,1,,I,,,,11,,11,,I,,I,I1,,,,11,1
1972 0.7000 AB O. 301 14 I 98
MARGARET E SUTTON
· ; LTNDA L SUTTON POA
246 S PZTT ST
CARLTSLE PA 17013-3813
0022 0017 5118 Y
STATEMENT OF ACCOUNTS
70-74913
STATEMENT PERZOD
FROM TH ROUGH
11-12-03 12-10-O3
PAGE I OF I
ENCLOSURES
PREV]:OUS DEPOSZTS/
STATEMENT BALANCE CREDZTS 0
1,093.54 .00
CHECKS/
DEBZTS
SERVICE
i FEES
300.00 .00
DATE AC'T'ZV"ZTY DESCRZPTZON REFERENCE
11-:L2 BEGZNNZNG BALANCE
12-02 MMAlir~THDRA~AL
12-10 ENDZNG BALANCE
DEPOSZTS/ CHECKS/
CREDITS DEBZTS
00600601595 300.00
SERV]:CE FEE BALANCE ZNFORMATZON FROM 11-12-03 THROUGH ],2-10-O3
AVERAGE LEDGER BALANCE 1,000.43 AVERAGE COLLECTED BALANCE
MZNZMUN LEDGER BALANCE 793.54 MZNZMUM COLLECTED BALANCE
HAPPY HOLZDAYS FROM ALL OF THE EMPLOYEES
AND DZRECTORS OF F&M TRUST.
ENDZNG
BALANCE
793.54
BALANCE
1,093.54
793.54
793.54
1,000.43
793.54
DZRECT
ZNO. UZRZES TO:
TELEPHONE:
R.I:TNER HZGHI~AY
1901 RZTNER HZGHWAY
CARLZSLE, PA 17013
717-960-1400
January 14, 2004
Linda L. Sutton
246 South Pitt St.
Carlisle, PA 17013-
Hoffman-Roth Funeral Home, Inc.
219 North Hanover Street
Carlisle, PA 17013
(717)243-4511
The Funeral Service for Margaret E. Sutton
14182-245
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can.
feel free to contact us if you have any questions in regard to this statement.
THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT,
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
OUR SERVICE:
Traditional Funeral Service Package .................. $3590.00
FUNERAL HOME SERVICE CHARGES ............ $3590.00
SELECTED MERCHANDISE:
Coleman Casket
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE
THAT YOU HAVE SELECTED ...............
$1435.00
$5025.00
Cash Advances
Certified Copies of Death Certificates ..................
Hairdresser ..........................
TOTAL CASH ADVANCES AND SPECIAL CHARGES ........
$16.00
$30.00
$46.00
Please
Total
Total Cost ..........................
History
01/14/2004 Linda L. Sutton CK# 22761 .................
01/14/2004 Microdata Systems, Inc ...................
TOTAL AMOUNT DUE ..................
$5071.00
$410.84
$-5481.84
$0.00
This statement is net and payable in full within 30 days of receipt.
Please return this portion with your Remittance
$ Amount Enclosed Service ID # 14182-245
Margaret E. Sutton
STEPHEN L. BLOOM
A'I'Tf)RN I'~Y .\NI) C(~I~NSI.~I,I,()R .\T ],.\\V
WWW PI(ACTICAI, Ci)IINSI(I. ('()M
'l'hl.l..l'll()NI; -I-~ 2-19-7717
l: :\ (~'4 I NIl I.l( 71'?-249-v257
T()I.I, J"l{I.l~ 8''~ 5-18-()61)2
Invoice submitted to:
Sutton, Mar§aret E Estate
c/o 246 South Pitt Street
Carlisle PA 17013
Linda L Sutton, Executrix
April 06, 2004
In Reference To: Estate Administration
Invoice #1395
Professional Services
12/31/2003 SLB
11612004 SLB
Preparation for and attend conference with Executrix;
Preliminary estate administration matters
Administrative matters
2/18/2004 SLB
2/19/2004 SLB
2~20~2004 SLB
Administrative and estate accounting matters; Review and
analysis of documents and information; Correspondence with
Department of Public Welfare (Estates Recovery Program) re
status of Medical Assistance Estate Recovery Lien; Review
financial institution account information; Prepare and file Office
of Personnel Management Annuitant Death Notices and
documentation; Prepare and file Metropolitan Life Insurance
Claim and documentation; Prepare Federal Employees' Group
Life Insurance Program Claim for Death Benefits and
documentation; Submit Report of Death of Annuitant to FEGLI;
Telephone conference with Executrix/Beneficiary
Final assembly of FEGLI Claim for Death Benefits and
correspondence with Executrix re same; Telephone conferences
with Thornwald Home re status of Social Security
payment/refund; Telephone conference with F&M Trust
Telephone consultation with client
2~28~2OO4 SLB
Hrs/Rate Amount
1.57 291.07
185.00/hr
0.08 15.42
185.00/hr
3.86 713.23
185.00/hr
1.36 250.68
185.00Ih r
0.08 15.52
185.00/hr
Administrative matters; Review correspondence from F&M Trust O. 17
re date of death account valuation information; Review 185.00/hr
information re Estate refund from United Church of Christ Homes
30.94
I) RACTICAI. ('.()t!NSI':I. ,I, CIIRISTiAN PI.:RSI) I((:TIVI.:
Sutton, Margaret E Estate
3/4/2004 SLB Telephone conference with F&M Trust
3/12/2004 SLB Review documents and information
3/30/2004 SLB
4~6~2004 SLB
Administrative and estate accounting matters; Review
correspondence and proof of claim from Department of Public
Welfare, Estate Recovery Program; Review documentation of
Assets and Liabilities; Preparation of Pennsylvania Inheritance
Tax Return and Schedules
Correspondence with Executrix re review and execution of
Inheritance Tax Return and miscellaneous matters; Prepare and
assemble Estate Information Document, Inheritance Tax Return,
Schedules and Exhibits for filing; Filing of same at Register of
Wills Office; Reserve for final correspondence re same and
correspondence with Department of Public Welfare
For professional services rendered
Page 2
Hrs/Rate Amount
0.08 15.42
185.00/hr
0.11 19.48
185.00/hr
1.77 326.83
185.00/hr
0.93 171.43
185.00/hr
1001 $1,850.02
Balance due
$1,850.02
PAYABLE UPON RECEIPT - THANK YOU
Bill for Tax Preparation
Margaret Sutton
246 S. Pitt Street
Carlisle, PA 17013
$125.00
Billed by:
Phil Huntzinger
STEPHEN L BLOOM ESQUIRE
2100 LONGS GAP ROAD
CARLISLE PA 17013
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
March 30, 2004
Re: MARGARET SUTTON
CIS #: 370156231
SSN: 187-10-8354
Date of Death: 12/18/2003
Dear Attorney Bloom:
Please be advised that the Department of Public Welfare maintains a
claim in the amount of $43,262.42 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 rein%burse 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 $14,073.76, 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 $29,188.66, 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,
Sandi L. Sral
TPL Program Investigator
717-772-6238
717-772-6553 FD~X
Enclosure
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
TPL SECTION - CASUALTY UNIT
PO BOX 8486
HARRISBURG PA 17105-8486
March 26, 2004
STATEMENT OF CLAIM SUMMARY
NAME Estate of SUTTON, MARGARET
ID 370 156 231
MEDICAL CLASS 3 CLASS 6 TOTAL
INPATIENT .00 .00 .00
OUTPATI E NT 6.34 25.90 32.24
LONG TERM CARE 13,103.72 27,452.27 40,555.99
DRUG 963.70 1,710.49 2,674.19
REIMBURSEMENT TODPW 14,073.76 29,188.66 43,262.42
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
EIN 23-6003113
his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
P 9898890
No.
~i~// ::~ : Lo---cai Registra"----~7 --
,. DEC Z 9 2003
~.; EN~ ,,,,,,
~ Date
H10S.143 Rev. 2/87 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDs
.R,.T CERTIFICATE OF DEATH ,~ '~ ~ :
~1 NAMEOFDECEDENT(F~;~; List) SEX SOC~LS Rt~N E ~[~MBER
~,~,T ~ ...... "---- I ~CU U~E,
~AGE(kaslBi~ay) { UNDE~IY~R [ UNDER]pAy DATE OF BIRTH [ 81RTHP~CE(C~and PLACE OF D~TH Check o,N one seeinst~i~s~olbgr}i~)
~ COUN~OFD~TH CIW. BORO,~POFO~TN FACILI~ NAME (I nO ns u on, gvestreetandnum~t WASOECEDENTOFHISPANCORGN?
DECEDENTS USUAL ~CUPATION KIND OF BUSINESS I iNDUSTRY AS DECEDENT EVER IN DECEDENTS EDU~T ~ ' TM ~RIT~ STA~S Ma~ i ' SURVlVlN P
~ DECEDENTS ~ k NG ADDRESS (S~t CiW~ 'State Zip ~e n=o=n=~,~e ' ~ I ' I J · J 15.
I ~2 Walnut ~tt~ Rd. I(U.~...~o.. .... INeina ~ NO dec.entliv ~
~ FATHE~E (~t,~i~k .... J MOTHER'S N~E (Fi~t M~,. ~. S .... ) --
J ~__~_ ~ ~..~____ J INFOR~N~S ~ILING ~DRES~ (Strut, Ci~, State, Z~ ~e)
~2o~ ~.~ ~. ~uuuon 2o~. 246 ~Uth P~tt St., ~rlisle, PA 17013
~ MET.D0 ~ O~SPOS~N ~ ~ [ DATE OF ~SPOSmON P~CE OF DIS~mO~- N.~ d Ct~, C~t~ [LOCATION -
~2,.. _~.(S~) __~ .O U]2,b. ~C. 22, 2~3 ]2~,Me~rial ~rdens ~ 12,. ~rlisle, PA 17013
~ S~GN}T)~ ~ ~E~ S~'~C~S~E ~N ACT,.S AS SUC. L,C~.S~ NUUBE, ~ .~UE A.~ ADD,ESS OF ~C,L,W Hof f~n-Roth ~eral
~=~~ ~~~ tnb. 010343 L ]2~:. 219 No~h Hanover St., ~rlisle, Pa 17013
~ ~ ~ 23e~ ~ ~ ~ ~ ~To me ~st o~ my~n~edge, death ~cu~ed a he I ~. date a.d ~a~ smi~, [ LICENSE NUMBER [DATE S GNED
~AUSE (Disease o~ it~ju~ c.
~ul~g o, deem ) LAST d. "
OF O~? ~ ~ ] Yes ~ N- ~
ye.~ NO~ ~y ~ ~ ISu~de ~ ~130.. 130b. ~ 130c. 130d.
LICENSE NU~ DATE SIG~ED [~, Day. Year
DATE FILED (Month, Day, Year)
34. ~----"'~ ,
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 180601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLO#ANCE OR DZSALLO#ANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
STEPHEN L BLOOM ESQ
2100 LONGS GAP RD
CARLISLE
'(]4 hl~¥ ~, 8
PA
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
?~;~OUNTY
ACN
05-$1-2004
SUTTON MARGARET E
12-18-2005
21 04-0560
CUMBERLAND
101
Amoun~ Remi~ed I
NAKE CHECK PAYADLE AND RENZT PAYNENT TO:
REGISTER OF NILLS
CUNBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THZS LINE 1~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP (01-03) NOTZCE OF ZNHERZTANCE TAX APPRAISEMENT, ALLOWANCE OR
D~SALLONANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF SUTTON HARGARET E FILE NO. 21 04-0360 ACN 101 DATE 05-31-2004
TAX RETURN #AS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE ZNTEREST - SEE REVERSF.
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Es~a~a (Schedule A) (1)
2. S~ocks and Bonds (Schedule B) (2)
3. Closely Held S~ock/Par~nershlp Zn~eras~ (Schedule C) (3)
~. Nor~gages/No~as Race/vable (Schedule D)
$. Cash/Bank Depos/~s/Nisc. Personal Proper~y (Schedule E) (E)
6. Jo/n~ly Owned Propar~y (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. To,al Asse~s
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Cos~s/N/sc. Expenses (Schedule H) (9)
10. Dob~s/Hor~gage L/ab/1/~ias/Lians (Schedule 1) (10)
11. To,al Deduc~/ons
12. Ne~ Value of Tax Ra~urn
559.37
.00 NOTE: To /nsura proper
.00 cred/~ ~o your account,
.00 submi~ ~ha upper por~Lon
.00 of ~his form wi~h your
~ax payment.
.00
6~513.18
(8) 7,072.55
7,046.00
15.
1~.
NOTE:
ASSESSMENT OF TAX:
1.;. Amoun~ of L/ne lr~ a~ Spousal ra~e
16. Amoun~ of L/ne lr, ~axable a~ Lineal/Class A ra~e
17. Amoun~ of L/ne lr~ a~ Sibl/ng ra~e
16. Amoun~ of L/ne 1~ ~axable a~ Collar:oral/Class B ra~e
19. Pr/ncipal Tax Due
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+)
DATE NUHBER TNTEREST/PEN PATD (-)
43~262.42
(11) 5e.308.42
(12} 43,235.87-
Char/~able/Govarnman~al Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00
Ne'l: Value of Es~a~:e Sub.~ec~ ~o Tax (1~*) 43,235.87-
Zf an assessment ~as lssued previously, 11nas 1~, 15 and/or 16, 17, 18 and 19 ~11
reflect figures that include the total of ALL returns assessed to date.
(15), .00 x O0 = .00
(16) .00 x 045 = .00
(17) .00 x 12 = .00
(18) .00 x 15 = .00
(19)= . O0
ZF PAID AFTER DATE ~NDZCATED~ SEE REVERSE
FOR CALCULAT/ON OF ADDITIONAL INTEREST.
AMOUNT PAID
TOTAL TAX CREDZT
BALANCE OF TAX DUE]
INTEREST AND PEN.
TOTAL DUE
.00
.00
.00
.00
( .rF TOTAL DUE ZS LESS THAN $1, NO PAYNENT 'rs REI~U'rRED.
'rF TOTAL DUE TS REFLECTED AS A 'CRED'rT' (CR), YOU NAY BE DUE
A REFUND. SEE REVERSE S'rDE OF TH'rS FORH FOR I'NSTRUCT.rONS. )
RESERVATION: Estates of decedents dying on or before December 1Z, lgDZ -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the laeful Class B (collatmral) rate on any such future interest.
PURPOSE OF
NOTICE: To fulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (72 P.S.
Section 9140).
PAYHENT: Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side.
--Hake check or money order payable to: REGISTER OF HILLS, AGENT
REFUND (CR): A refund of a tax credit, which was not requested an the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Xnharitance and Estate Tax" (REV-1315). Applications are available at the Office
of the Register of Hills, any of the Z3 Revenue District Offices, or by ceiling the special Z4-hour
answering service for forms ordering: X-800-36Z-Z050; services for taxpayers with special hearing and / or
speaking needs: 1-800-447-3020 (TT onXy).
OBJECTXONS: Any party in interest not satisfied with the appraisement, allowance, or disaXXowance of deductions, or assessment
of tax (incXuding discount or interest) as shown on this Notice oust object eithin sixty (60) days of receipt of
this Notice by:
--erittmn protest to the PA Department of Revenue, Board of AppeaXs, Dept. ZDXOZZ, Harrisburg, PA 171ZD-XOZX, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
ADMIN-
ISTRATIVE
CORRECTIONS: Factual errors discovered on this assessment should be addressed in eriting to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Reviee Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601
Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-IS01) far an explanation of administratively correctable errors.
DISCOUNT: Xf any tax due is paid within three (3) calendar months after the decedant's death, a five percent (SI) discount of
the tax paid is aIIowed.
PENALTY: The 1SI tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January Ia, 1996, the first day after the and of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same tiaa period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (l) day from the date of
death, to the date of payment. Taxes which became delinquent before January l, 198Z bear interest at the rate of
six (6Z) percent per annum calculated at a daily rate of .000164. AIl taxes which became delinquent on and after
January l, 198Z ail[ bear interest at a rate mhich will vary free calendar year to calendar year aith that rate
announced by the PA Department of Revenue. The applicable interest rates for 19aZ through Z004 are:
Interest DaiXy Interest DaiXy Interest
Daily
Year Rate Factor Year Rate Factor Year Rate Factor
~ 202 .00054D 19D&-1991 11Z gO00SO1 ~ 9X .000Z47
1983 16Z .000438 199Z 9Z .000Z47 ZOOZ 6Z .000164
1984 XXZ .OOO$Ol 1993-1994 7Z .O00leZ 2003 52 .000137
1985 132 .000356 1995-1998 92 .000247 2004 4Z .O00110
1986 lOX .000Z74 1999 72 .O0019Z
1987 lOX .000274 ZOO0 7Z .00019Z
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELIN{IUENT X DAXL¥ INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessaent. Xf payment is made after the interest computation date sheen on tho
Notice, additional interest must be calculated.