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Home My WebLink About01-27-09--~ REV-1500 1505607120 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number Po Box.2sosol INHERITANCE TAX RETURN _ Harrisburg, PA 17728-otiol RESIDENT DECEDENT 2 1 0 8 0 0 1 9 8 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 02022008 04161926 Dec:edent's Last Name Suffix Decedent's First Name KIRBY MI ROSE L (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 ® 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death ^ 4. Limited Estate ^ qa Future Interest Compromise prior to 12-13-82) (date of death after 12-12-82) ^ 5. Federal Estate Tax Return Required ^ g Decedent Died Testate ^ ~ Decedent Maintained a Living Trust 1 (Attach Copy of Will) (Attach Copy of Trust) 8. Total Number of Safe Deposit Boxes ^ 9. Litigation Proceeds Received ^ 1 p. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) ^ 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFOR Name MATION SHOULD BE DIRECTED TO: C Ft A I G A . DIEHL , ESQUIRE , CPA Daytime Telephone Number 7177637613 Firm Name (If Applicable) L p-W OFFICES O F CRAIG A . DIEHL REGISTER OF WILLS US~(jNLY First line of address C ~ *-~ _ t=om 7 ~a _,.~ 3464 TRINDLE ROAD = ~- i'. , . ,.,. Second line of address ~ ~~ ~u _ ..,,.1 -`~ - : , ; City or Post Office State t3A't`Fir,FILED "~ ZIP Code CAMP HILL PA 17 011 _T1'- ``~' y. Correspondent'se-mail address: Cdiehl@CadlehllaW.COm 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 trove, correct and complete. Declaration of preparer other than the personal representative is based on all infor ti m SIGN IURE OF PERSON RESPONSIBLE~R FILING RETURN ~ , a on of which preparer has any knowledge. ~ -~'~` ~~s~~-, ~.r.~ ~ ~~1 Georgenna Puliti ADDRESS DAfTE / ~ / ~ I c ~ ( ~ 240ti Paxton Church Road, Harrisburg, PA 17110 SIGNATURE OF PREPAR O ER TH REPRESENTATIVE ` Craig A. Diehl, Esquire, CPA DATE ADDRE:~S 3464 Trindle Road, Camp Hill, PA 17011 Side 1 15056 07120 1505607120 J ~~ 15D56D722D REV-1500 EX Decedent's Social Security Number oecedenrs Name: K I R B Y, R O S E L 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 0 1 , 4 7 2 6 4 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested .......... ... 6 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property . (Schedule G) ^ Separate Billing Requested ........... .. 7. 3 0, 9 3 3 0 7 8. Total Gross Assets (total Lines 1-7) ............................................... ...................... .. $. 132, 405 .71 9. Funeral Expenses & Administrative Costs (Schedule H) ................. ...................... .. 9. 1 7 , 3 4 6 0 1 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. .. 10. 7 9 1 1 7 11. Total Deductions (total Lines 9& 10) .................................................................... .. 11. 1 8, 1 3 7 1 8 12. Net Value of Estate (Line 8 minus Line 11) ........................................................... .. 1P 1 1 4 , 2 6 8 5 3 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) ......................... ..... 1 1 4 2 6 8 5 3 14 ................ Ti4X COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES , ... . 1Ei. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .00 15. 16. Amount of Line 14 taxable at lineal rate x .045 1 14 , 2 6 8. 5 3 16. 5, 14 2 0 8 17. Amount of Line 14 taxable . at sibling rate X •12 17 18. Amount of Line 14 taxable at collateral rate X .15 18 19. Tax Due ............ ........................................................................................................ . 19. 5 , 14 2 . 0 8 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 15D5607220 15D56D7220 J RE.V-1500 EX Page 3 File Number 21 - 08 - 00198 Decedent's Complete Address: _ Kirby, Rose L Sl'REET ADDRESS 2405 Paxton Church Road Harrisburg STATE ZIP ~~ PA 17110 Ta:x Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments (1) 5,142.08 A. Spousal Poverty Credit B. Prior Payments 5,100.00 C. Discount 257.10 3. Interest/Penalty if applicable Total Credits (A + g + C) (2) 5, 357.10 D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 2 Line 20 to request a refund (4) 215.0 2 5. lif 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. (SA) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) ~.QO Make Check Payable to: REGISTER OF WILLS, AGENT ~- r~ ~. .,;.~- - PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS ' 1. Did decedent make a transfer and a. retain the use or income of the property transferred :............................................................................... Yes No b. retain the right to designate who shall use the property transferred or its income :.................................... ~ a c. retain a reversionary interest; or ................................... x 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 x 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 designation? ................ ........................................................... ..................................... 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 A 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 datE:s 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)]. sibeng is definedounder Sect ont9102 as an indi iduaol whothasuat least one patient in colmmon with lthe(decedent,nwhetheSby blo d(or ado)tion. P SCHEDULE E ' CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Kirby, Rose L FILE NUMBER 21 - 08 - 00198 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 NUMBER DESCRIPTION VALUE AT DATE OF 1 M & T Bank (Checking Account No. 51456680) DEATH 26, 771.58 2 MML Investors Services, Inc. - APV-801941 74,018.06 3 Men's Ring (See Attached Appraisal) 45.00 4 Internal Revenue Service -Economic Stimulus Check 300.00 5 Men's Ring (See Attached Appraisal) 85.00 6 Men's Ring (See Attached Appraisal) 125.00 7 Men's Ring (See Attached Appraisal) 90.00 8 Men's Wedding Ring (See Attached Appraisal) 38.00 TOTAL (Also enter on Line 5, Recapitulation) 101,472.64 Murvn JEWELRY APPRAISAL ESTATE ~ FA.IR MARKET T VAT.UE We estimate this value(s) as listed for estate purposes only using fair market value guidelines. The following item(s) have been carefully examined and verified as accurately as possible within the normal and reasonable gemological ranges without the use of gemstone removal or damaging tests. Carat weights are osiimated by volumetric formula unless otherwise noted. Prepared For: Estate of Rose Kirby ].. Iteroq Description: Men's ring, Roadway trucking 15 year safe driver, sterling silver with yellow gold berol, brownish-orange simulated oval gemstone l2 x l Omm. Metal weight 7.0 dwt., size 9 3/.. ):air Market Value of this Item............ ....... $ 45.00 2. Item Description: Men's ring, Roadway trucking, 20 year service, sterling silver with yellow gold bezel, one round shape diamond 'x.10 carat, SI2/H quality, set izt a 14x12mm black onyx gemstone, metal weight 9.3 dwt., size 9 '/. Fair Market Value of this Item............ . $ 85.00 3,. Item Description: Men's ring, Roadway trucking, 25 year safe driver, solid signet style design with a round shape diamond, ',10 carat, SIl /H quality, 1 Ok yellow gold, metal weight 9.2 dwt., size 9 3/~. Fair Market Value of this Item ................... $ 125.00 4. Item Description: Men's ring, Blue ststr sapphire, oval shape cabochon cut, 8.Sx5.Smm B quality, lOk white gold mounting, bezel setting. Gold weight: 3.1 dvvt., size 8. 1203 Market S Fair Market V aluE of this Item . . .. . . . . . ... . . $ 90.L1®+n oyn e, DA 1. 5. Item Description: Men's wedding ring, traditional style, polished finish, Smm width, metal weight 1.9 dwt., sine 8'h. Fair Market Value of this Item........,. .... $ 38.00 f'7) 7 Date of Appraisal(s): December 29, 2008 ax 1~~~) 1-8721-~D t~ _ -~ i~, Co feted by; Christopher C. Munn ' 1 ~~~ # { . { ' ; i ~. Nol:e: Precious metal market price: 5854.00/oz('17 t'latinum $805.00/oa.('D +uolass n wt;igbt is estimated by formula, no stone removal. Value excludes tax. Photo of. rte ~~ oragitral document_ 'I'bis is not an offer co purchase or replace articles. ~». ,- h:. ..I , ~'N h ~ ui COMMONWEALTH OF PENNSYLVANIA SCHEDULE G INHERITANCE TAX RETURN INTER-VIVOS TRANSFERS & - RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY ESTATE C1F Kirby, Rose L ITEM NUMBER FILE NUMBER 21 08 00198 rhts schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. 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. AIG Annuity Insurance Company Account No. AN200378 2 Central PA Teamsters Pensions Fund -Retirement DATE OF DEATH VALUE OF ASSET % OF EXCLUSION DECD'S INTEREST (IF APPLICABLE) 30,153.07 100% 780.00 ~ 100% TAXABLE VALUE 30,153.07 780.00 TOTAL (Also enter on line 7, Recapitulation) j 30,933.07 CHEDULE H COMMONWEALTH OF PENNSYLVANIA r~J~rGJViL INHERITANCE TAX RETURN ~~~~~ RESIDENT DECEDENT ESTATE OF Kirby, Rose L nphr~ ,.s .r,. „a__.._ ADMINISTRATIVE COSTS: Personal Representative's Commissions Georgenna Puliti Social Security Number(s) / EIN Number of Personal Representative(s): 168-36-6316 Street Address 2405 Paxton Church Road - -- ------••• •••~~• ~~ ~cNvriea on acnedule I. ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION A• 1 i Neil Funeral Home -Funeral Bill 2 3 4 5 B. 1. I 2. 3. 4. 5. 6. 7. 1 FILE NUMBER '~~ no nnw.,., ~~ AMOUNT 7,584.72 5,000.00 ~IIy rlarrlsburg state PA zip 17110 Year(s) Commission paid ~ Attorne 's Fees y Craig A. Diehl, Esquire Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 4,000.00 Claimant Street Address City State Zip Relationship of Claimant to Decedent Probate Fees Register of Wills -Probate Fees 260.00 Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs -the Sentinel -Estate Advertising Costs 174.58 TOTAL (Also enter on line 9, Recapitulation) ~- 17,346.01 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE c~F Kirby, Rose L Schedule H Funeral Experues & Administrativle Costs continued 2 ~ Cumberland Law Journal -Estate Advertisement 3 ~ Law Offices of Craig A. Diehl -Reimbursement of Certified Mail fee 4 i M&T Bank -Safe Deposit Box Register of Wills -Filing Fee for Family Settlement Agreement 6 Munn's Diamond Galary, Ltd. -Jewelry Appraisal FILE NUMBER 21 - 08 - 00198 ~ 75.00 ~ 5.21 21.50 25.00 200.00 Page 2 of Schedule H SCHEDULEI DEBTS OF DECEDENT, MORTGAGE COMMONWEALTH OF PENNSYLVANIA LIABILITIES, & LIENS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Kirby, Rose L FILE NUMBER 21 - 08 - 00198 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 ManorCare -Nursing Home 425.44 2 Heartland -Prescriptions 324.14 3 Janet L. Miller, Tax Collector -Personal Tax 4.90 4 Michael Sams, D.O. -Physician Bill 36.69 TOTAL (Also enter on Line 10, Recapitulation) 791.17 REV-1513 EX+ (9.00) COMMONWEALTH OF PENNSYLVANIA SCHEDULE J INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATEI~F Kirby, Rose L NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I, (TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] '1 Georgenna Pulitti 2405 Paxton Church Rd. Harrisburg, PA 17110 FILE NUMBER ~ 21 - 08 - 00198 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE DECEDENT (Words) Do Not List Trustee(s) ($$$) Daughter I Fifty 2 Arthur Kirby Son 333 West Caracas Ave., Rear Fifty Hershey, PA 17033 I I Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet II, 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 0.00