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Home My WebLink About01-07-09J 1505607121 REV-1500 EX (06-05) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Hamsbu , PA 17128-0601 RESIDENT DECEDENT 2 1 0 8 0 7 0 3 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 9 6 4 8 1 5 1 2 0 6 1 2 2 0 0 8 1 2 1 2 1 9 1 3 Decedent's Last Name Suffix Decedent's First Name W E I T Z E L MI M I L D R E D E (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 FILL IN APPROPRIATE OVALS BELOW REGISTER OF WILLS 1. Original Return ~ 2. Supplemental Return 3 Re i 4 Limit d E . ma nder Return (date of death i . e state ~ 4a. Future Interest Compromise (date of d th pr or to 12-13-82) ~ 5. Federal Estate Tax Ret R OX 6. Decedent Died Testate (Attach Copy of Will) ~ ea after 12-12-82) 7. Decedent Maintained a Livin Trust 9 urn equired 1 8 T 9. Litigation Proceeds Received (Attach Copy of Trust) 10 S l . otal Number of Safe Deposit Boxes . pousa Poverty Credit (date of death between 12-31-91 and 1-1-95) 11. Election to tax under Sec. 9113(A) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFtOR Name S MAT ON HOULD BE DIRECTED T0: M U R R E L R W Daytime Telephone Number r.~ Firm Name (If Applicable) A L T E R S I I I 7 1 7 67 4~ 5 ~- j " '`~ ~~7 Cam. rr !-_~ REGISTER ~ `'' ~ '~ ~F~ RUSE C1tlLY i ±- ':'s"J First line of address ~ . _ r_ ) V ~ ~. 5 4 E A S T M A I N S T R E E T .- / Y , ~ L.. ~.~-Iry~ ~~ ~' _ ~' -.' ~ s Second line of address __= L"'~i ~ c+Q r-r s CJ1 ~' r;'T Cit or P ~ ,r ~ y ost Office State ZIP Code DATE FILED 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 true, correct and comp) te. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. _-.`5~1~1R~OF PE O RESPONSIBLE FOR FILING RETURN ~ Jl DATE ADDRESS DAVID L• YE PINE CHAPEL LN• GREENVILLE SIGNATU P A OT HAN REPRESENTATIVE V A 2 4 .4 0 ADDRE DATE %~ ~2 d~` MURREL WALTERS, III, 54 E MAIN ST MECHANICSBURG PLEASE USE ORIGINAL FORM ONLY PA 17055 Side 1 L 1505607121 1505607121 J ,J 1505607221 REV-1500 EX Decedent's Social Security Number Decedents Name: M I L D R E D E• W E I T Z E L 1 9 6 4 8 1 5 1 2 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. 1 9 8 7 7 5 6 • 1 1 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested 6 ... 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Re uested .... . • q ... .... 7. 8. Total Gross Assets (total Lines 1-7) • ~~~~ ~~~~~~~~~~~~~~~~.. .... 8. 1 9 8 7 7 5 6. 1 1 9. Funeral Expenses & Administrative Costs (Schedule H) . , . . ......... ... s. 1 0 5 3 4 1. 1 7 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ... , .. , .. 10. 9 2 6 6 • 4 1 11. Total Deductions (total Lines 9 & 10) ........................ ... 11. 1 1 4 6 0 7 • 5 8 12. Net Value of Estate (Line 8 minus Line 11) 13 12 1 8 7 3 1 . Charitable and Governmental Bequests/Sec 9113 Trusts for which 4 8 . 5 3 an election to tax has not been made (Schedule J) .. 13 ............. ... . 0 . 0 0 14. Net Value Subject to Tax (Line 12 minus Line 13) ............... 1 8 7 3 1 4 ...1a. 8 5 3 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 _ 0 0 0 16. Amount of Line 14 taxable 15. 0 • 0 0 at lineal rate X . _ 17. Amount of Line 14 taxable 16. at sibling rate X .12 2 0 0 0 0 0. 0 0 18. Amount of Line 14 taxable 17' 2 4 0 0 0• 0 0 at collateral rate x .15 8 7 6 1 4 5. 8 2 18 1 3 1 4 2 1. 8 7 19. Tax Due ............................................... .19. 1 5 5 4 2 1. 8 7 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 1505607221 1505607221 REV-1500 EX~ Page 3 File Number Decedent's Complete Addres s: DECEDENT'S NAME 21 08 0703 MILDRED E. WEITZEL STREETADDRESS 5225 WILSON LANE LOWER ALLEN TOWNSHIP CITY MECHANICSBURG STATE ZIP PA Tax Payments and Credits: 17055 ~ Tax Due (Page 2 Line 19) 2. Credits/Payments (1) A. Spousal Poverty Credit 155 421.87 B. Prior Payments C. Discount 147 650.77 7 771.10 3. InteresUPenalty if applicable Total Credits (A + B + C) (2) D. Interest 155 421.87 E. Penalty Total InteresUPenalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT (3) . Fill in oval on Page 2, Line 20 to request a refund. 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (4) 0.00 A. Enter the interest on the tax due. (5) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (56) 0.00 Make Check Payable to: REGISTER OF WILLS , AGE NT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE 1. Did decedent make a transfer and: APPROPRIATE B LOCKS 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, 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 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary desi n t' ~ Yes No ~~ ^ a :: ^° o ............ ^ 0 g a ion ................................................................................................... 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 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)], 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 ~ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER .,. ITEM NUMBER 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. Include the All property, M&T BANK CERTIFICATE OF DEPOSIT AIM EQUITY FDS, INC. MUTUAL FUND 3665.249 @ 15.920 AIM EQUITY FDS, INC. MUTUAL FUND 733.361 @ 15.260 MASSACHUSETTS INVS GROWTH MUTUAL FUND 3877.865 @ 13.0500 LEBANON COUNTY PA HEALTH 25000 @ 99.53500 4200 BLACKROCK INSD MUN INCOME TR 4200 @ 13.8410 3000 BLACKROCK MUN INCOME 3000 @ 13.9910 1700 BLACKROCK MUNIYIELD PA INSD FD 1700 @ 13.08800 2225 BLACKROCK PA STRATEGIC MUN TR 2225 @ 12.6500 DREYFUS PREMIER ST MUN MUTUAL FUND 4844.631 @ 15.600 EVERGREEN PA MUN BD MUTUAL FUND 8745.214 @ 10.840 FRANKLIN TAX FREE TR MUTUAL FUND 6539.565 @ 10.140 MFS MUN SER TR MUTUAL FUND 9735.586 @ 9.9500 OPPENHEIMER AMT FREE MUNICIPAL MUTUAL FUND 14641.237 @ 8.2800 VAN KAMPEN TAX EXEMPT TR MUTUAL FUND 8473.987 @ 10.10000 EVERGREEN EQUITY TR MUTUAL FUND 6017.541 @ 9.15000 TOTAL (Also enter nn line ~ Ro~~.,~+„i..~,,...~ ~ .. (If more space is needed, insert additional sheets of the same size) Vr„u'y~'v"/ ~ ~~ ~o ~ru of litigation and the date the proceeds were received by the estate. med with right of survivorship must be disclosed on Schedule F. DESCRIPTION VALUE AT DATE OF DEATH 25,054.86 58, 350.76 11,191.09 50,606.14 24,958.75 58,132.20 41,973.00 22,249.60 28,146.26 75,576.24 94, 798.12 66,311.19 96,869.08 121,229.44 85,587.27 55,267.50 7, 756.1 • Continuation of REV-1500 Inheritance Tax Return Resident Decedent MILDRED E. WEITZEL Decedent's Name 21 08 0703 Page 3 File Number Schedule E -Cash, Bank Deposits, ~ Misc. Personal Property ITEM NUMBER DESCRIPTION VALUE AT DATE 17. CASH OF DEATH 23,961.61 18. SOVEREIGN BA NK CERTIFICATE OF DEPOSIT 19. SOVEREIGN BANK CERTIFICATE OF DEPOSIT 20. PNC BANK CERTIFICATE OF DEPOSIT 21 • PNC BANK CERTIFICATE OF DEPOSIT 22. PNC BANK CERTIFICATE OF DEPOSIT 23. PNC BANK CERTIFICATE OF DEPOSIT 24. PNC BANK CERTIFICATE OF DEPOSIT 25. PNC BANK CERTIFICATE OF DEPOSIT 26. PNC BANK CERTIFICATE OF DEPOSIT 27. PNC BANK CHECKING 28. AIG ANNUITY INSURANCE COMPANY ANNUITY -BENEFICIARY: RONALD MEYER 29• M&T BANK FEDERATED PA MUNI CASH CL SS #8 16,451.84 @ 100.00% 30. M&T BANK FEDERATED PA MUNI CASH CL SS #8 14,684.71 @ 100.00% 31 • M&T BANK FEDERATED MUNI UL TRASHORT FD INST. 7,244.88 @ 9.96 SUBTOTAL SCHEDULE E ooc,aoZ.3l ' Continuation of REV-1500 Inheritance Tax Return Resident Decedent MILDRED E. WEITZEL Decedent's Name 21 08 0703 Page 4 File Number Schedule E -Cash, Bank Deposits, & Misc. Personal Property ITEM NUMBER DESCRIPTION VALUE AT DATE 32. M&T BANK HARTFORD FLOATING RATE FD-7 689.263 @ 9.21 33. M&T BANK MTB PA MUNI BOND - INST I-FD #476 15,373.36 @ 9.97 34. M&T BANK RIDGEWORTH SEIX FL RATE HI INC FD-1 1,083.35 @ 9.24 35. M&T BANK VANGUARD SHORT-TERM TAX-EXEMPT #41 4,381.30 @ 15.74 OF DEATH 6,348.11 153,272.43 10,010.11 68,961.65 SUBTOTAL SCHEDULE E 238,592.30 GRAND TOTAL SCHEDULE E $ 1, 987, 756.11 REV-1511 EX t (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MILDRE~ F WFIT7G1 SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER nw ~~ VO V/U3 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION A• FUNERAL EXPENSES: AMOUNT ~ • NEILL FUNERAL HOME -PREPAID 2• TOMB STONE 125.00 B (If more space is needed, insert additional sheets of the same size) ADMINISTRATIVE COSTS: ~ • Personal Representative's Commissions Name of Personal Representative (s) DAVID L. MEYER Street Address 172 PINE CHAPEL LANE 51,253.00 City GREENVILLE State VA Zip 24440 Year(s) Commission Paid: 2009 2. Attorney Fees MURREL R. WALTERS, III 3. Family Exemption: (If decedents address is not the same as claimant's, attach explanation) 51,253.00 Claimant Street Address City State Zip Relationship of Claimant to Decedent 4 Probate Fees REGISTER OF WILLS -CUMBERLAND COUNTY 933.00 5. Accountant's Fees TODD DECKER 450.00 6 Tax Return Preparers Fees ~• ESTATE NOTICE PUBLICATIONS THE PATRIOT-NEWS CUMBERLAND LAW JOURNAL 148 17 8• REGISTER OF WILLS -ADDITIONAL SHORT CERTIFICATES . 75.00 9• REGISTER OF WILLS -FIRST AND FINAL ACCOUNT FILING FEE 24.00 1,080.00 TOTAL (Also enter on line 9, Recapitulation) I $ 17 R-EV-1512 EX + (12.03) SCHEDULE 1 COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, IN RESI DENTEDE EDENT N MORTGAGE LIABILITIES, ~ LIENS ESTATE OF MILDRED E. WEITZEL FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, in ludOng n reimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE ~ ~ BETHANY ASSISTED LIVING OF DEATH RENT 2,481.50 2• UNITED STATES TREASURER 2007 INCOME TAX 155.25 3• TAMEY MEYER NURSING CARE & MISC. FUNERAL EXPENSES 1,125.25 4• CONTINUING CARE RX MEDICAL 875.41 5• CHECK FEE 13.00 6• PA DEPT. OF REVENUE 2008 TAX 370.00 7• U.S. TREASURY 2008 TAX 3,106.00 8• INTERNAL REVENUE SERVICE 2006 FEDERAL INCOME TAX 1,140.00 TOTAL (Also enter on line 10, Recapitulation) I $ (If more space is neederi ~n~prt ~a + ~ ~ 9 266 41 a~ anGCia or me same size) REV-1513 EX ± (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MILDRED E. WEITZEL FILE NUMBER 21 08 0703 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT AMOUNT OR SHARE I. TAXABLE DISTRIBUTIONS [include ouVight spousal distributions, and transfers under Do Not List Trustee(s) OF ESTATE Sec. 9116 (a) (1.2)] 1• HELEN FELTY 406 RICH VALLEY ROAD Collateral 63,000.00 CARLISLE, PA 17013 2. GRACE FELTY ADAMS 1127 BALDWIN STREET Collateral 63,000.00 MECHANICSBURG, PA 17055 3. ELIZABETH HAINES 2855 SPRINGHAVEN PLACE Collateral 33,333.33 MACUNGIE, PA 79105 4. TRACY ROTMAN 1925 MAPLEWOOD LANE Collateral 33,333.33 ALLENTOWN, PA 18103 5. DIANE BRAUN 5280 HANOVER DRIVE Collateral 33,333.33 ALLENTOWN, PA 18103 6. VIOLET M. STOUFFER 246 HARVEY ROAD Sibling 100,000.00 HERSHEY, PA 17033 7• ROBERT MEYER 5400 BERNARD DRIVE, APT. A306 Collateral 100,000.00 ROANOKE, VA 24014 I ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 AS APPROPRI I. NON-TAXABLE DISTRIBUTIONS: , ATE, ON REV -1500 COVER SHEET 1 A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT . BEING MADE 1 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1• LUTHERAN HOME 1075 OLD HARRISBURG ROAD GETTYSBURG, PA 17325 2. SALVATION ARMY 1122 GREEN STREET HARRISBURG, PA 17102 3. VOLUNTEERS OF AMERICA 1404 N. 3RD STREET HARRISBURG, PA 17102 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHFFr (It more space is needed, insert additional sheets of the same size) SCHEDULE J BENEFICIARIES 39,850.14 39,850.14 39,850.14 $ 797.002.7 ' ' ' Continuation of REV-1500 Inheritance Tax Return Resident Decedent MILDRED E. WEITZEL Decedent's Name 21 08 0703 Page 6 File Number Schedule J -Beneficiaries -1 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS (include outright spousal distributions) 8. JAMES MEYER 246 HARVEY ROAD HERSHEY, PA 17033 9. DAVID MEYER 172 PINE CHAPEL LANE GREENVILLE, VA 24440 10. RONALD MEYER 10696 JONESTOWN ROAD ANNVILLE, PA 17003 11. LARRY SMITH 3658 E. 200TH STREET ANDERSON, IN 46017-9726 12. CURTIS SMITH 109 OLD FEDERAL ROAD HARRISBURG, PA 17110 13. JANEL ZAWATSKI 1024 PINE CIRCLE MECHANICSBURG, PA 17055 14. BONNIE BLAUCH 5915 LARUE STREET HARRISBURG, PA 17110 15. ROMAINE SMITH 100 COTTAGE DRIVE PALMYRA, PA 17078 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE Collateral Collateral Collateral Collateral Collateral Collateral Collateral Sibling 100,000.00 100,000.00 250,145.83 25,000.00 25,000.00 25,000.00 25,000.00 100,000.00 ' ' Continuation of REV-1500 Inheritance Tax Return Resident Decedent MILDRED E. WEITZEL Decedent's Name 21 08 0703 Page 7 File Number Schedule J -Beneficiaries - 26 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 4. MECHANICSBURG AREA PUBLIC LIBRARY 16 N. WALNUT STREET 39,850.14 MECHANICSBURG, PA 17055 5. MOUNTAIN VIEW BIBLE CHURCH 34 SIPE AVENUE 103,610.34 HUMMELSTOWN, PA 17036 6. BETHANY VILLAGE 325 WESLEY DRIVE 119,550.40 MECHANICSBURG, PA 17055 7. ST. MARK'S EVANGELICAL LUTHERAN CHURCH 117 W. KELLER STREET 278,950.94 MECHANICSBURG, PA 17055 8. BETHESDA MISSION 611 REILLY STREET 55,790.19 HARRISBURG, PA 17102 9. NEW HOPE MINISTRIES 15 STATE ROAD 39,850.14 MECHANICSBURG, PA 17050 10. MECHANICSBURG AREA SENIOR ADULT CENTER 97 W. PORTLAND STREET 39,850.14 MECHANICSBURG, PA 17055 SUBTOTAL SCHEDULE J-26 I 677,452.29