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Home My WebLink About03-20-09J 1505607120 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue coonry cme Year Fita Namoer Bureau of Individual Taxes INHERITANCE TAX RETURN Po eox.zaosol 2 1 0 8 0 6 9 2 Harrisburg, PA 17128-osol RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 204 14 4602 05 24 2008 06 19 1923 Decedent's Last Name Suffix Decedent's First Name MI LUDWIG DORIS 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 ; X~ 2. Supplemental Return '_ ~ 3. Remainder Return (tlate of death - prior to 12-13-62) ~~ 4. Limited Estate -_ qa, Future mtarest compromise ', 5. Federal Eslale Tax Return Requiretl (date of death aver 12-t2-92) ~X r~ s oewdenc Died testate 7 Decedent Maimained a Living Trust 0 B. Total Number of Safe Deposit Boxes (Attach Copy of Will) (AttaM Copy o/ Trust) ' 9. Litigation Proceeds Receivetl - ~i 10 spousal Poveny credit (date or death '~. -' 11. Election to tax under Sec. 9113(A) __.. - - between t2-31-91 and t-1-95) - (Adach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAx INFORMATION SHOULD 6E DIRECTED TO: Name Daytime Telephone Number MARIELLE F HAZEN 717 590 4332 Firm Name (If Applicable) HAZEN ELDER LAW First line of address 2000 LINGLESTOWN RD Second line of address SUITE 202 City or Post Office State ZIP Code HARRISBURG PA 17110 N t~ REGISTEF~F,ydILLS USE'ONLY _ ~o ~_ r ~ Z - N r- O :,~~ yU~n 'D `~ ~ S _ ~ fV SATE FILED tv Correspondent's a-mail address: Untler 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 ail information of which preparer has any knowledge. Jeffrey P. 2639 Amanda Dr., Harrisburg, PA 17112 IGN4T}IRE OF PR B R OTHER THAN REPRESENTATIVE Marielle F Hazen 2000 Linglestown Rd., Harrisburg, PA 17110 Side 1 1505607120 15()5607120 J ~\^ y~ 1- J 155607220 REV-1500 EX Decedent's Social Security Number oe~eaem'sNeme DOrIS L. Ludwig 2 0 4 1 9 4 6 0 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. 6. Jointly Owned Property (Schedule F) Separate Billing Requested ......... .... 6 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property . (Schedule G) -Separate Billing Requested ......... .... 7. 8. Total Gross Assets (total Lines 1-7) ......... ........................................................... _-- - ... 8. 9. Funeral Expenses & Administrative Costs (Schedule H) ...................................... ... 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................. ... 10. 11. Total Deductions (total Lines 9 8 10) ................ ................................................... ... it. 12. Net Value of Estate (Line 8 minus Line 11) .... ...................................... ................ 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which ... 12. an election to tax has not been made (Schedule J) ......... ...................................... .. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13)... ......._ ....................._....._..... ---___ - 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 .00 0 0 0 15. 16. Amount of Line 14 taxable at lineal rate X .045 0 0 0 16. 17. Amount of Line 14 taxable at sibling rate X .12 0 0 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 0 0 0 1 B. 19. Tax Due ........................................................................................................._.......... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. L. Side 2 1505607220 2, 291 ,39 2, 291 .39 2, 186 .20 155, 89 2, 392. 04 -50. 65 -50.65 0.00 0.00 0.00 0.00 0.00 1505607220 REV-1500 EX Page 3 File Number 21-08-0642 Decedent's Complete Address: DECEDENT'S NAME Doris L. Ludwig - -- STREETADDRESS - - _ - Bethany Village 5225 Wilson Lane .. - -- McChanlCSbUrg STATE - ~jp ~-- PA 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments (1) __ - _ _ _ 0.00 A. Spousal Poverty Credit -B. Prior Payments C. Discount _._ 3. InteresVPenalty if applicable Total Credits (A + g + C) (2) D. Interest 0.0 0 - E. Penalty --- - - Total lnterest/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 Llne 20 to request arefund (4) -- 5. 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 (5) -- - 0.00 ------------- . (SA) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE -- ~ - - -- . (58) ~.0~ Make Check Payable to: REGISTER OF W/LLS, 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 :............_......_........................................................__ `~ U b. retain the right to designate who shall use the property transferred or its income :.............................. 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 receiving adequate consideration?......._...._ [] .................................................... 3. Did decedent own an "in trust foi' or payable upon death bank account or security at his or her death?..... _.. ~ x 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which _~ L? contains a beneficiary designation? ..................... ~ -~ _...._......... ~x~ ~ I ..................................... . 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 exemot 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 taz rate imposed on the net vdlue 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)]. 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. Rev4510 EXi (6.981 COMMONWEALTH OF PENN9nVPNIA INHERRPNCE TAX RETURN RESIDENT DECEDENT ESTATE OF Doris L. LE NUMBER 21-08-0642 This schetlule mugl be compleletl antl filetl rt the answer to any o/Questions 1 Through q on the reverse side of the REV-1500 COVER SHEET is yes. NUMBER INCLUDE NAME OF TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH %oF DecD's EXCLUSION TAXABLE THE DATE OF TRANSFER. ATTACHACOPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1 John Hancock annuity contract #727556 -Jeffrey 2,291.39 100.000 2,291.39 P. Ludwig, son and beneficiary TOTAL (Also enter on Line 7, Recapitulation) I 2 291 39 (If more space is needeq additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY REV-1161 E%. (12-891 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES 8r w~u..........~. ~.. ._ ___-_ ESTATE OF Doris L. z~-tis-osai Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT c ... 1 ...,.".„~ cnrcrvaca: B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission paid 2. I Attorney s Fees Hazen Elder Law -additional estate administration legal fees I 1,922.00 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 Decetlent a. I Probate Fees Cumberland Co. Register of Wills -additional probate fees I 10.00 5. ~ Accountant's Fees 6. I Tax Return Preparer's Fees 7. Other Administrative Costs 254.20 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 2,786.20 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-7500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF Doris L. LE NUMBER 21-08-0642 NUMBER DESCRIPTION AMOUNT Other Administrative Costs U-Haul Storage -expense to store decedent's personal property until it could be 254.20 disposed of and/or donated H-B7 Subtotal 254.20 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1612 EX~(6-98) COMMONWEP1iM OF PENNSYLVgNN INHERRgNCE TqX 0.ENRN RE610ENi DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Ludwig, Doris L. 21-08-0642 Inclutla unrelmDUrsetl metlical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Continuing Care Rx -medical expense 25.71 2 East Pennsboro Ambulance Service -medical expense 70.00 3 Mobile X-Ray Imaging -medical expense 13.42 4 Quantum Imaging -medical expense 1.71 5 South Central EMS -medical expense 45.00 TOTAL (Also enter on Line 10, Recapitulation) I 155.84 (If more space is needed, atltlitional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV 1513 EXt (900) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE) BENEFICIARIES FILE NUMBER Ludwig, Doris L. 21-08-0642 NUMBER NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$) TAXABLE DISTRIBUTIONS linClude outright snnusal oo Not Lint Tmstee s) I. Jeffrey P. Ludwig 2639 Amanda Dr. Harrisburg, PA 17112 Son ~ 100% of estate Total Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET 0 00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) =C~ ~i ~i ~ ti i. G~ £~ i l hQ l •i: ~ \~ ~~ U ~, d y ~~,` '? .m ~~. r .D 0' ~- 0 u7 a O O O O 0 ~, 0 m 0 0 N 3 N O N a~+ .~ b Y N b0 ~_ a 0 0 0 N Q /W/''~~ L~ a W LTa x 0 ~_ ^~ w ,D .~ x O F O 0 U Y U b N 3 W O N .~ x ~~ ~ M ~ M ~M ti O ~ ~ O ~ U y ~~ ov HazF.ty F.~.n~ Law An Estate Planning and Elder Law Firm 2000 Linglestown Road, Suite 202 Harrisburg, PA 17110 Ter.: (71'7) 540.4332 eAx: (717) 5404313 March 19, 2009 CERTIFIED MAIL Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013-3387 Re: Estate of Doris L. Ludwig File No.: 21-08-0642 Social Security No.: 204-14-4602 Supplemental Inheritance Tax Return To: The Register of Wills: www.HazenElderlaw.com Marielle F. Hazen, CELA* Marci S. Miller, Associate n c ~~ a c O .~, ~n ,~c~ ~ .` rT '" V~ ~~ ~ N ~ I j~~ ~ f :'~ ~ ~ ~ _ _ N N N Enclosed for filing please find the original and one copy of the above-referenced Supplemental Inheritance Tax Return, along with a copy of the ftrst page of the Inheritance Tax Return. Please date stamp the first page of the return and return it to my office in the enclosed self-addressed envelope. Also enclosed is a check for the filing fee in the amount of $15.00. If you have any questions or require any additional information, please do not hesitate to contact me. Sincerely, Enclosures cc: Jeff Ludwig L~n+ti-P iGQF~F-~~ l°V'~ Corinne Eggers6A OWoodhouse Paralegal 'Certified Elder Lam Attorney by the National Elder Lain Foundation ¢s outhor¢ed by the PerzmiyL~ania Supreme Court