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Home My WebLink About01-23-09 5056051058 -~ REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN Po sox 28oso1 RESIDENT DECEDENT 21 08 0667 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 196-18-7184 06/05/2008 03/26/1924 Decedent's Last Name Suffix Decedent's First Name MI Wertz Catherine A (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Wertz William J Spouse's Soaal Secunty Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE ~Gf~'-,~y ~~Z ~, REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return :-_. 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) Limited Estate _._. 4 4a. Future Interest Compromise (date of ,.~: 5. Federal Estate Tax Return Required . death after 12-12-82) 6. Decedent Died Testate 7. Decedent Maintained a Living Trust _.1_ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) Litigation Proceeds Received __.,, 9 10. Spousal Poverty Credit (date of death under Sec. 9113(A) ax -- . 1L n . __ between 12-31-91 and 1-1-95) O Sch Attach ( ) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRec~EU lu: Daytime Telephone Number Name (717) 243-0123 r~ Ronald E. Johnson . ° --, .~ ~ n ~ Firm Name (If Applicable) =' ' REGISTER S usE o 1([~LY , Andrews & Johnson ~ -~-, ~• ~=~ ~ ~ `: _ _ ~ rrt N r , _ r ; First line of address ='~~ C.J -- '--3 c ~ - -> 78 West Pomfret Street E_ ~- % '~ Second line of address _ ? ~;~ N ~` - _ --~ ~ '. ' ~,. W ::; DATE FILED o..f City or Post Office- -----_ State ZIP Code - - - __ Cariisie -- _ - PA 17013 Correspondent's a-mail address: rejOhnSOn@pa.net 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 tru ,correct and complete. Declaration of preparer other than the personal represen five is based o II inf ation of which preparer has any knowledge. SI ATURE OF PE SOt~RESP NSIBLE FO FILING RETURN DATE ~s '/~3l ~ E,7 (.~idac, vrt~-v~.- ~/t~i,~~ ~~ 3 ~ ~ ?w .f / 21 ~ 9 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 15056052059 REV-1500 EX Decedent's Social Security Number Catherine A Wertz 196-18-7184 _ _ _ _ Decedent's Name: _ _ _ 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 8~ Notes Receivable (Schedule D) ............................ . 4. 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ....... . 5. 10,729.90 6. Jointly Owned Property (Schedule F) -- Separate Billing Requested ...... . 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 7 (Schedule G) =-=~~ Separate Billing Requested....... . . $ 10,729.90 8. Total Gross Assets (total Lines 1-7) ............................ ... ..w___ r_~ . ...,__ -. __ 9. Funeral Expenses & Administrative Costs (Schedule H)...... ... . . g. 5,140.92 10. Debts of Decedent, Mortgage Liabilities, i~ Liens (Schedule I) .............. .. 10. 51.18 11. Total Deductions (total Lines 9 & 10) ................................. .. 11. 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 5,537.80 13 Charitable and Governmental Bequests/Sec 9113 Trusts for which . an election to tax has not been made (Schedule J) ...................... .. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... a ~~ e~ 14. . . 5,537.80 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or _ ___ __ - - -- _. transfers under Sec. 9116 2 768.90. 15. 0.00 (a)(1.2) X .0_ 16 . Amount of Line 14 taxable 2 768 90 at lineal rate X .0 45 1 s 124.60 17 . Amount of Line 14 taxable 17 at sibling rate X .12 i8 . Amount of Line i4 taxable 18 at collateral rate X .15 __ __. ___ _ 124.60 19 . TAX DUE ...................................................... ...19. __. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT -- 15056052059 Side2 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: 21 File Number 08 0667 Tax Payments and Credits: (1) 124.60 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total InterestlPenalty (D + E) (3) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. 4 . Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 124.60 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 124.60 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 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? ................................................................ ...... If death occurced after December 12, 1982, did decedent transfer property within one year of death 2 . without receiving adequate consideration? ........................................................................................................ ? ...... ^ ^ ........ 3. Did decedent own an "in truss for" or payable upon death bank account or security at his or her death ...... Did decedent own an Individual Retirement Account, annuity, or other non-probate property which 4 . 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. 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. SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANIOUS PERSONAL PROPERTY FILE NUMBER ESTATE OF Catherine A. Wertz 21-08-0667 Include the proceeds of litigation and the date the proceeds were received by the estate All property jointly-owned with Right of Survivorship must be disclosed on Schedule F VALUE AT DATE ITEM DESCRIPTION OF DEATH NUMBER $762.50 I Cash 2 Certificate of Deposit no. 31003911181269-M&T Bank (see attached) $2,881.86 3 Certificate of Deposit no. 31003913463053-M&T Bank (see attached) $5,558.94 4 Savings Account/Holiday Club Account no. 2500492012581 - M & T Bank (see attached) $320.16 5 Outdoor wooden shed -sale proceeds $50.00 6 1987 Chevrolet Cavalier automobile $200.00 ~ Suburban Propane -refund $566.57 g Ohio Casualty Ins Co -car insurance refund $50.46 9 PP&L -refund $21.41 10 Warranty activation headquarters -refund $318.00 TOTAL (also online 5, Recapitulation) $10,729.90 M&Tgank 499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB_12 Andrews & Johnson attorneys At Law ~ West Po><nfret Street ~ari;<sle, Pennsylvania 17013 Re.• Estate Catherine Social Securi -` A- Wertz Date o ~ 196-18-71 g¢ Chan ed to 266_54- Death.• June OS 2008 6371 Phone (888) 502-4349 Fax (302) 934-2955 September 16, 2008 Deal'Sir or Madam. Per your inquiry dated September 10 depositWith this bad the following: ' 2008' please be advised that at the time of death, the above-named decedent had o 1 ' TYPe ofAccount n Account N Checking Account umber Ownershi 542687 P (Names ofd C'atherine,Q Wertz* opening Date William JWertz* Balance o n D 6/1/77 ate ofDeath A~cruedlnt $168.87 erest Total ~ 0.00 -- ---------- $168.87 -_-_----------- ---------------------- T; -`~"e ~~-`.'ccutmt Ac'=punt Number u.~,t Ownership (Na 1J004200577871 mes ofd Catherine A Wertz* Opening Date William JWertz* Balance on Date ofDeath 8/19/97 Accruea'hzterest ~ 6, 676.47 Total $ 0 -!7 $ 6, 676.94 ....................... ....... __ .. _..... __ .... . _ _ 3. Type of Account Certificate of Deposit Account Number 31003911181269 Ownership (Names o~ Catherine A Wertz* Opening Date 8/19/97 Closed 9/11/08 Balance on Date of Death $ 2, 799.67 Accrued Interest $ 82.19 Total $ 2,881.86 4. Type of Account Certificate of Deposit Account Number 31003913463053 Ownership (Names ofJ CatherineA Wertz* Opening Date 11/1/04 Closed 9/11/08 Balance on Date of Death $ 5, 543.85 Accrued Interest $ 15.09 Total ----------------------------------- $ S, 558.94 5. Type of Account Savings Account/Holiday Club Account Number 25004920125851 Ownership (Names o~ CatherineA Wertz* Opening Date 11/8/83 Closed 9/11/08 Balance on Date of Death $ 320.09 Accrued Interest $ 0.07 Total $ 320.16 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 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 High Street Carlisle Office # 717-240-4536. Sinc rely, ~ .~~1,%l.C~ ~t;'~.'U Tracie Hare Records Management SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES ESTATE OF FILE NUMBER Catherine A. Wertz 21-08-0667 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT MBER NU A. Funeral Expenses: Hoffman-Roth Funeral Home-balance due after prepaid funeral plan $141.31 1 2 B. Administrative Costs: 1 Personal Representive Commissions Name of Personal Representative(s) Social Security Number of Personal Representative: Street Address: City: State: Zip: Year(s) commissions paid: 2 Attorney fees to Andrews & Johnson $2,000.00 3 Family Exemption Claimant Street: City: State & Zip Relationship of Claimant to Decedent: 4 Probate Fees to Register of Wills $100.00 5 Accountant Fees to Patricia Rosendale, CPA 6 Tax Return Preparer's Fees '7 Pequed Salvaage Co -demolition and removal of delapidated mobile home on $1,950.00 leased land 35 $382 g Interstate Waste -large dumpster rental for above . 9 Carlisle Regional Medical Center $300.00 $13.86 10 Cordia Telephone 00 $10 11 M&T Bank -cost for lost safe deposit box key . 12 Kenneth Lupp -reimbursement for misc. expenses incurred as Executor $28.40 13 Register of Wills -Inheritance Tax Return filing fee $15.00 14 Reserve for closing and accounting $200.00 TOTAL (also on line 9, Recapitulation) $$,140.92 SCHEDULEI DEBTS OF DECEDENT MORTGAGE LIABILITIES AND LIENS FILE NUMBER ESTATE OF 21-08-0667 Catherine A. Wertz _ . .. .~_ _ ~___.,e....,..... «., dearh which remained unpaid as of the date of death, including unreimbursed medical expenses. '1 U7 AL (also on une r u, ttwaynwauvi.~ SCHEDULE) BENEFICIARIES FILE NUMBER ESTATE OF 21-08-0667 Catherine A. Wertz NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR SHARE ITEM Do Not List Trustee(s) OF ESTATE NUMBER I and lransfas under Scc. 9116(a)Q.2)] TAXABLE DISTRIBUTIONS [indudc outright spousal distributions, 1 William J. Wertz, Forest Park Nursing Home, husband 50% 700 Walnut Bottom Road, Carlisle, PA 17013 2 Kenneth A. Lupp 1765 Chase Pointe Circle #1137, Virginia Beach, VA 23454 son 25% 3 Harold R. Lupp 1732 Landisburg Road, Landisburg, PA 17040 son 25% NON-TAXABLE DISTRIBUTIONS: II A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. Charitable and Governmental Bequests: $0 TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (also enter on line 13, Recapitulation)