HomeMy WebLinkAbout01-12-0915056051047
06-05)
REV-1500 EX
( 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 1 0 0 4
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
1 8 3 1 2 2 4 0 2 0 7 0 9 2 0 0 8 0 2 1 8 1 9 2 4
Decedent's Last Name Suffix Decedents Firs t Name MI
A L L E M A N D O R O T H Y M
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouses Social Security Number
FILL IN APPROPRIATE OVALS BELOW
~ 1. Original Return
O 4. Limited Estate
O 6. Decedent Died Testate
(Attach Copy of Will)
O 9. Litigation Proceeds Received
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
O 2. Supplemental Return
O 4a. Future Interest Compromise (date of
death after 12-12-82)
O 7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
O 10. Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95)
O 3. Remainder Return (date of death
prior to 12-13-82)
O 5. Federal Estate Tax Return Required
~ 8. Total Number of Safe Deposit Boxes
O 11. Election to tax under Sec. 9113(A)
(Attach Sch. O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
J O S E P H A M A C A L U S 0 7 1 7 `5 3'2 4 8 3 2
r.~
Firm Name (If Applicable) aFrasTFk.AF wu i s usiGAw Y
First tine of address
_.-
9 6 1 4 R 0 W E R U N L 0 0 P ~ y
- -_~ -
Second line of address ~ _ ' I ~ ,
___
-I .. ;
<-,
BATE FILED .. .,_
City or Post Office State ZIP Code
S H I P P E N S B U R G P A 1 7 2 5 7
Correspondent's a-mail address
,,
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i
r;
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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 the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSO SPONSIBL OR I RETURN ? ~. DATE
ADDRESS 204 Sou nd Road 27 Heberlig Road
Kn[~t•f-G T~1 and, NC ~7A5O Newvi 1 1 P, PA 1 7741 -R5t1~
SIGNATURE O REPARER OVER TH~A, N REP~~'TA~ E / D(`j _rl Lf
ADDRESS ` I g~! `2 ~-~ ~ U H / _ t C/ ~ ~ ~j~- I ,7 Zc,S-7
\ PLEASE USE ORIGINAL FORM ONLY
Side 1
15056051047 15056051047 J
`~b
Decedent's Social Security Number
Decedent's Name: Dorothy M. Alleman 1 8 3 1 2 2 4 0 2
RECAPITULATION
1. Real estate (Schedule A) . .......................................... .. 1. 0 •
2. Stocks and Bonds (Schedule B) ..................................... .. 2. 0 .
3 Closaiy Held Corporation, Partnership or Sole-Proprietorship (Schedule C} ... .. 3. 0 .
4. Mortgages & Notes Receivable (Schedule D) ........................... .. 4. 0 .
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ...... .. 5. 0 ,
6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. 1 9 . 1 2 1 9 . 8 0
7. Infer-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested...... .. 7. 0 ,
8. Total Gross Assets (total Lines 1-7) ............. .................... .. 8. 1 9 1 2 1 9. 8 0
9. Funeral Expenses & Administrative Costs (Schedule H) ................... .. 9. 2 1 2 3 . 7 5
10. Debts of Decedent, P~lortgage Liabilities, & Liens (Schedule 1) .............. .. 10. 3 0 9 6 . 1 5
11. Total Deductions (total Lines 9 & 10) ................................. .. 11. 5 2 1 g . 9 0
12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 1 8 5 9 9 9 . 9 0
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ...................... .. 13. 0 .
14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. 1 8 5 9 9 9 , 9 0 -
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 . 15. 0
16. Amount of Line 14 taxable
at lineal rate X .04.5_. 1 8 5, 9 9 9' 9 0 16. ? 8 3 7 0. 0 0
1 7. Amount of Line 14 taxable
at sibling rate X .12 0 17. 0 ,
18. Amount of Line 14 taxable
at collateral rate X .15 Q 18. - Q •
19. TAX DUE ............................. ......................... ..19. _ `$ ~ ,7 0.0 0_"
REV-1500 EX
15056052048
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
~J
~~
15056052048
Side 2
15056052048
O
REV-1500 EX Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
Dorothy M. Alleman
STREET ADDRESS
27 Heberlig Road
CITY STATE ZIP
Newville PA 17241
Tax Payments and Credits:
1. Tax Due (Page 2 ~~ine 19} (1 } _8 , 3 7 0 . 0 0 ____
2. Credits!Payments
A. Spousal Poverty Credit 0
B Prior Payments 7 , 9 3 0.19
C. Discount 4.17.4 6 -
Total Credits (A + B + C) (2) `8 , 3 4 7.6 5
3. InterestlPenalty if applicable
D. Interest
E. Penalty
Total InterestlPenalty (D + E) (3) p
4 If amine 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. (4'I
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE, (5) __ 2 y . 3 5 _____~_
A. Enter the interest on the tax due. (5A) __ ~
B. Enter the tokal of Line 5 + 5A. This is the BALANCE DUE. (5B) ~ 2 - '~ 5 -
Make Check Payable fo: 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 .................................................................................................................... ...... ^
tl. 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 conslderation? .......................................................................................................
....... ^ -,
~~
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her tleaih? ....... ....... ^~
4. Did decedent own an Individual Retirement Account, annuiy; or other non-probate property which
........................................................................
contains a beneficiary designation? ........................................
....... r
I ~
1F THE ANSWER TO ANY OF THE ABOVE QUESTIONS 1S 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(x)(1.2)].
Tt~e tax rate imposed or, 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(x)(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. §9116i;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.
u~v.,sou a.l~•an
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT _
ESTATE OF
SCHEDULEF~
JOINTLY•OWNED PROPERTY
FILE NUMBER
Dorothy M. Alleman
If an asset wa: made joint within one year of the decedents date of death, k must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS
A. See attached Continuation Schedule
B.
C.
InwTl Y.nWNFD PROPERTY:
RELATIONSHIP TO D"cCE`Jch?
ITEM
NUMBER LETTER
FOR JOWT
TENANT DATE
hUDE
JOINT OESCRIPTIONOFPROPERTY
Include name Of Handal InatlhltlOfl and bank mount number Or aiMler identlfylnp number. Attach
deed fOr jointly-held real estate.
DATE OF DEATH
VALUE OF ASSET %OF
DECD~S
INTEREST DATE OFDEAT~-.
vALUE o~
DECEDENT'S IN?EKES i
1. A.
I
.,.
i
TOTAL (Also enter on line 6, Recapitulation) S 191 , 219.8 0
~~ of more space Is needed. lnselt additional sheets of the same size)
PENNSYLVANIA INHERITANCE TAX RETURN
Re: Dorothy M. Alleman
SCHEDULE F
CONTINUATION SCHEDULE -PAGE 1
JOINTLY-OWNED PROPERTY
If an asset was joint within one year of the decedent's date of death, it must be reported on Scheduie G.
Surviving Joint
Tenant's Name
A. Peggy L. Chaney
B. Helen Ann Niclde
Jointly-Owned Propertv
Address
204 South End Rd.
Knotts Island, NC 27950
Relationship to Decedent
daughter
27 Heberlig Rd. daughter
Newvi{le, PA 17241-8503
Date % of
Item Letter for made Description Date of Death Decedent's
Number Joint Tenant Joint of Propertv Value of Asset Interest
1. A and B 10-3-96 checking account $478,373.42 1/3
No. 176249
Adams County National Bank
P.O. Box 3129
Gettysburg, PA 17325
See attached statement
2. A 3-10-06 checking account $62,530.76 1/2
No. 930999
Chartway Federal Credit Union
160 Newtown Rd.
Virginia Beach, VA 23462-2415
See attached statement
Date
of death
value of
Decedent' s
Interest
$159,441.86
$31, 265.38
PENNSYLVANIA INHERITANCE TAX RETURN
Re: Dorothy M. Alleman
SCHEDULEF
CONTINUATION SCHEDULE -PAGE 2
JOINTLY-OWNED PROPERTY
If an asset was joint within one year of the decedent's date of death, it must be reported on Schedule G.
Surviving Joint
Tenant's Name
A. Peggy L. Chaney
B. Helen Ann Nickle
Address
204 South End Rd.
Knotts Island, NC 27950
Relationship to Decedent
daughter
27 Heberlig Rd. daughter
Newville, PA 17241-8503
Jointly-Owned Property (continued)
Item Letter for
Number Joint Tenant
3. A
Date
made Description
Joint of Property
3-10-06 savings account
No. 930999
of
Date of Death Decedent's
Value of Asset Interest
$1,025.12 1/2
Chartway Federal Credit Union
160 Newtown Rd.
Virginia Beach, VA 23462-2415
See attached statement
Date
of death
value of
Decedent' s
Interest
$ 512.56
TOTAL $191,219.80
G~
~~~~/~
COI:~`~IY
NATIONAL BANK
October 9, 2008
Joseph A Macalubo
Attorney at Law
9614 Rowe Run Loop
Shippensburg PA 17257
Re: Estate of Dorothy M. Alleman
Dear Mr. Macaluso:
The following information is being provided as per your request:
Acct. Type Account No. Account Accrued Ownership
Principal on Interest to
D.O.D. D.O.D.
Checking 176249 $478,368.17 $5.25 Jt. w/ Peggy
Chaney and
Helen A Nickle
Date Joint
10/3/96
Inquiries concerning ACNB Corporation stock information should be directed to the Registrar and Transfer
Company at 1-800-368-5948. If you need any additional information, please contact me at (717)339-51 16.
Sincerely, 1 r
Lois A Kime
Deposit Services
PO B~?~ 3129, Ge1Tt'S~uRG, PA 17325 ~ viwve 7173343161 ~ rou. raee 888334.2262 ~ www.acnb.cont
CHARTWA Y
FEDERAL CREDIT C'.~'LO:~' . ~
~- --
\u~~u,t I ~'. 2UU8
1~~ ~~~Ilun~ ft ~~(a~~ ~~uncern:
~lrs. L~oroth~~ ,~l .~~Ileman has an account ~~ith ~'hart~~~ay Federal Credit l:nion. ~~~11~~~)~l.
~~ h]Ch ale a ~CI~~III~~S ~lllC~ a C~lt'.Ck1R~~ aCCOLiRL Hof aCCOL111T W~1S l:St~lbllShe(~ .~~lal'Ch 1 U,
2UU6. The account i5 a joint account Frith Pe~~~~y L Chaney. The balance of the sa~~in~~~
~~ a~ S I O?~.1 ~ and checl:in~u ~~as S6?>3U.76 as of July 9, 2008.
(~thcrc arc an~~ questions ~~lease contact Chartwav Federal Credit pinion at (~~ ;) »~-
IUUI) or (8UU) 6?8-87(~~.
~inccrel~~-
Maureen S. I'ri~vo
\Icinbcr 8~~ecialist
~~hart~~~a~~ Federal Credit ~;nion
160 \e~~~to~~~n Koad, ~'ir~;ini~a E3earh, A%irginia ?3+62-Zal~
(?>~) >j2-1000 • (h00) 6'8-~i%6> • w~~w.chartwav.coni
NCUA
REV-1511 EX+ ~ 12-99)
Y' ~
,~ SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Dorothy M. Alleman
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
See attached Continuation Schedule
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City ------- --- State -----Zip
Year(s) Commission Paid:
2. ~ Attorney Fees
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. I Probate Fees
5. I Accountant's Fees
6. ~ Tax Return Preparer's Fees
7
TOTAL (Also enter on line 9, Recapitulation) $ 2 , 123.75
(If more space is needed, insert additional sheets of the same size)
PENNSYLVANIA INHERITANCE TAX RETURN
Re: Dorothy M. Alleman
SCHEDULE H
CONTINUATION SCHEDULE -PAGE 1
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES
1. Prepaid
Total Funeral Expenses N/A
B. ADMINISTRATIVE COSTS
1. Personal Representative's Commission N/A
Personal Representative N/A
Social security number:
Street Address:
City:
State: Zip:
Year Commission Paid:
2. Attorneys fees/postage/copying $2,108.75
Joseph A. Macaluso, Esq.
3. Family Exemption -0-
PENNSYLVANIA INHERITANCE TAX RETURN
Re: Dorothy M. Alleman
SCHEDULE H
CONTINUATION SCHEDULE -PAGE 2
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
ITEM
NUMBER DESCRIPTION
B. ADMINISTRATIVE COSTS (continued)
4. Probate fees:
(Cumberland County Register of Wills)
Filing fee -
AMOUNT
15.00
TOTAL FUNERAL AND ADMINISTRATIVE EXPENSES $2,123.75
R_V-1512E%'!1 9'j ~~
~~~~~,~~~ SCHEDULE
.~,~ ~=
ccr~~MO~~~wEa~THOFPEr;NSVwaNir; DEBTS ~F ~ECE~ENT,
ir~H~ai~..NCE rA~ REruRr, MORTGAGE LIABILITIES & LIENS _ __
RFs!~ENT ~ECE~Er,r ,
ESTATE OF FILE NUMBER
Dorothy M. Alleman
Include unreimbursed medical expenses.
STEM ----- ---
NUMBER ~ DESCRIPTION AMGUNT
See attached Continuation Schedule
TOTAL (Also enter on line ?C, Recap~tuiationj I S 3 , 096.1 5
!If more space is needed, insert additional sheets of the same size)
PENNSYLVANIA INHERITANCE TAX RETURN
Re: Dorothy M. Alleman
SCHEDULEI
CONTINUATION SCHEDULE -PAGE 1
DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS
ITEM
NUMBER DESCRIPTION AMOUNT
Debts
1. Millenium Pharmacy $367.66
(prescriptions) 245.02
$ 612.68
2. West Shore EMS $88.60
(ambulance) 227.85
316.45
3. Sarah A. Todd Memorial Home 2,167.02
(nursing home)
TOTAL $3,096.15
RE`/-1513 EX + (1-97)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
ESTATE OF
Dorothy M. Alleman
FILE NUMBER
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1. See attached Continuation Schedule
100% of estate
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINE S 15 THROUGH 17, AS APPROPRIAT E, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ -0 -
(If more space is needed, insert additional sheets of the same size)
PENNSYLVANIA INHERITANCE TAX RETURN
Re: Dorothy M. Alleman
SCHEDULE J
CONTINUATION SCHEDULE -PAGE 1
BENEFICIARIES
AMOUNT OR
NAME AND ADDRESS OF RELATIONSHIP SHARE OF
NUMBER RECEIVING PROPERTY TO DECEDENT ESTATE
TAXABLE DISTRIBUTIONS
1. Peggy L. Chaney daughter surviving joint
204 South End Rd. owner of
Knotts island, NC 27950 bank accounts
2. Helen Ann Nickle daughter surviving joint
27 Heberlig Rd. owner of
Newville, PA 17241-8503 bank accounts
TOTAL OF PART I. 100% of estate
PENNSYLVANIA INHERITANCE TAX RETURN
Re: Dorothy M. Alleman
SCHEDULE J
CONTINUATION SCHEDULE -PAGE 2
BENEFICIARIES
II. NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 -0-
FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS -0-
TOTAL OF PART I1. -0-
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