HomeMy WebLinkAbout04-06-09` ~ 1505607121
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number
PO BOX 280601
Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 0 9 (~3
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
0 8 3 2 2 8 8 3 4 0 1 2 8 2 D D 9 0 3 2 2 1 9 1 7
Decedent's Last Name Suffix Decedent's First Name MI
F I T Z G E R A L D M E R T O N B
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
a 1. Original Return
^ 4. Limited Estate
^ 6. Decedent Died Testate
(Attach Copy of Will)
^ 9. Litigation Proceeds Received
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
^ 2. Supplemental Retum ^
^ 4a. Future Interest Compromise (date of ^
death after 12-12-82)
^ 7. Decedent Maintained a Living Trust _
(Attach Copy of Trust)
^ 10. Spousal Poverty Credit (date of death ^
between 12-31-91 and 1-1-95)
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
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 T0;
Name Daytime Telephone Number
S T E P H E N L B L O O M 7 1 2 4 9 2 3 5 3
raj
Firm Name (If Applicable)
I R W I N & M c K N I G H T P C•
First line of address
6 0 W E S T P O M F R E T S T R E E T
Second line of address
City or Post Office
C A R L I S L E
State ZIP Code
P A 1 7 0 1 3
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Correspondent's e-mail address:
Under penalties of perjury, I declare that I have examined this n3tum, 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.
SIGNA~IRE OF PFrRSON R~ONSIB FOR FILING RETURN DATE
623 OLD YORK ROAD CARLISLE PA 17013
SIGNATURE O~ P RER~E,R THAN REPRESENTATIVE nnTG
60 WEST POMFRET STREET CARLISLE PA 17013
PLEASE USE ORIGINAL FORM ONLY
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REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 09 0
`DECEDENT'S NAME
MERTON B. FITZGERALD
STREET ADDRESS
623 OLD YORK ROAD
CITY
CARLISLE STATE
PA ZIP
17013
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount 17.82
3. InteresUPenalty if applicable
D. Interest
E. Penalty
(1) 356.41
Total Credits (A + g + C) (2) 17.82
Total InteresUPenalty (D + E )
4. If Line 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.
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.
(5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 338.59
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 : ...................................................................... ^ ^X
b. retain the right to designate who shall use the property transferred or its income; ............................... ^ X^
c. retain a reversionary interest; or ................................................................................................ ^
d. receive the promise for life of either payments, benefits or care? ....................................................... ^ X^
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... ^ Q
3. Did decedent own an "intrust for" 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
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 childtwenty-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.
(3) 0.00
(4) 0.00
(5)
338.59
REV-1507 ESC + (6-98)
SCHEDULE D
COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES
INHERITANCE TAX RETURN RECEIVABLE
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MERTON B. FITZGERALD 21 09 0
All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. MORTGAGE NOTE -SANDRA F. SHINE AND ALEXANDER P. SHINE 12,126.42
AMORTIZATION SCHEDULE ATTACHED
TOTAL (Also enter on line 4, Recapitulation) ~ $ 12,126
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX + (6-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
IN RESIDENTEDECEDENT N PERSONAL PROPERTY
ESTATE OF FILE NUMBER
MERTON B. FITZGERALD 21 09 0
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.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. FIVE STAR BANK -CHECKING ACCOUNT #277997089 924.99
2. ~HIGHMARK-REFUND ~ 391.04
CHAPEL POINTE -REFUND I 940.00
TOTAL (Also enter on line 5, Recapitulation) ~ $ 2.256.03
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (10-06)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MERTON B. FITZGERALD 21 09 0
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. EWING BROTHERS FUNERAL HOME, INC. 1,824.00
2. THE DAILY STAR - NY -OBITUARY 126.00
3. BINGHAMTON PRESS & SUN, NY -OBITUARY 197.63
4. FINGER LAKES TIMES - NY -OBITUARY 116.00
5. PASTOR 100.00
6. GUEST PASTOR GIVING EULOGY 100.00
7. GUEST PASTOR TRAVEL EXPENSES FROM ALLENTOWN, PA TO ROMULUS, NY 250.00
8. ORGANIST 50.00
9. MEAL CATERING 200.00
10. FUNERAL LUNCHEON 442.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees IRWIN & McKNIGHT 1,000.00
3, Family Exemption: (If decedents address is not the same as claimants, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees
5 Accountants Fees
6. I Tax Return Preparers Fees
7. REGISTER OF WILLS -FILING FEE
8. NOTARY FEES
9. AIRLINE TICKET FROM ORLANDO, FL TO SYRACUSE, NY
10. FAMILY CODING -TWO NIGHTS/TWO ROOMS
11. TRAVEL EXPENSE -DANIEL FITZGERALD (SON) -1,596 MILES X .55 = $877.80
12. TRAVEL EXPENSE -SANDRA SHINE (DAUGHTER) - 476 MILES X .55 = $261.80
15.00
15.00
274.00
400.00
877.80
261.80
TOTAL (Also enter on line 9, Recapitulation) I $ 6.349.23
(If more space is needed, insert additional sheets of the same size)
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
MERTON B. FITZGERALD 21 09
Decedent's Name Page 1 File Number
Schedule H -Funeral Expenses 8~ Administrative Costs - A.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
11. HEADSTONE ENGRAVING 100.00
SUBTOTAL SCHEDULE H-A I 100.00 1
REV-1512 EX + (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RFCIr1FNT flFrFr1FNT
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF riLt tvum~stK
MERTON B. FITZGERALD 21 09 0
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. PA DEPARTMENT OF REVENUE -STATE INCOME TAX 50.00
2. (MILLENNIUM PHARMACY SYSTEMS EAST -MEDICAL
3. IHIGHMARK BLUE RX -OUTSTANDING CHECK
4. IHIGHMARK BLUE SHIELD -OUTSTANDING CHECK
TOTAL (Also enter on line 10, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
413.86
47.70
351.40
REV-1513 EX + (g-00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
MERTON B. FITZGERALD 21 09 0
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 oufight spousal distributions, and Vansfers under
Sec. 9116 (a) (1.2))
1. SANDRA F. SHINE Lineal 7,920.26
623 WEST OLD YORK ROAD 1/4TH REMAINDER
CARLISLE, PA 17015
2. DANIEL FITZGERALD Lineal
6396 SHAKER TRACT ROAD 1/4TH REMAINDER
NORTH ROSE, NY 14516
3. DAVID FITZGERALD Lineal
230 BAILEY WOODS TRAIL 1/4TH REMAINDER
CHAPIN, SC 29036
4. PETER FITZGERALD Lineal
26 E. MAIN STREET 1/4TH REMAINDER
SIDNEY, NY 13838
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, 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
1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(It more space is needed, insert additional sheets of the same size)
~~ Five Star Bank
55 North Main St., P.O. Box I l0, Warsaw, NY 1 4 569-01 10
MERTON B FITZGERALD 10129
C/0 SANDRA SHINE
623 W OLD YORK RD
CARLISLE PA 17015-9155
~u~~~~ui~~~nnii~~i~i~i~~~nni~~i~i~i~~i~~n~i~n~~~ui~~~
24 HOUR TOUCH TONE BANKING
1-877-882-5782
NetExpress Teller Internet Banking
www.five-stazbank.com
customerservice @ five-stazbank.com
Date 2/09/09 Page 1
Account Number_ 277997089
6
C H E C K I N G A C C O II N T S
MERTON B FITZGERALD
Standard Checking
Account Number
Beginning Balance
Deposits/Credits
6 Checks/Debits
Service Charge
Interest Credited
Ending Balance
277997089
8,696.24
.00
8,202.45
.00
.00
493.79
6
Statement Dates 1/12/09 thru 2/09/09
Days in the Statement Period 29
Average Ledger 1,340.04
Average Collected 1,340.04
CB)3CKS
Date Number Amount Date Number Amount Date Number Amount
1/16 1607 20.00 1/14 1609 7,301.25 2/02 1611 351.40
1/14 1608 450.00 1/30 1610 32.10 2/02 1612 47.70
* INDICATES MISSING CHECK NUMBER
DAILY BALANCE INFORMATION
Date Balance Date Balance Date
1/12 8,696.24 1/1<6 924.9:9 2/02
1/14 944.99 1/30 892.89
E N D O F S T A T E M E N T
Balance
493.79
NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION
Amortization Schedule: 60 months to repay $41600 at 5.0%.
---------------------------------------------------------------
Payment Payment Interest Principal Balance ~ ~- ~ ~_
Number
----------- Amount
--------------- Amount Reduction Due
--------------------------- ~A ~ ~ ~ fly~~'~ ~ # ~
1.
$785.05
$173.33
611.2 ---------
409
.3 ~ ~
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2. $785.05 $170.78 614.26 40374.02 ~ ~ ~ 3a'
168.22 616.82 $39757.19 ,~ o ~ 3
5 165.65 619.39 $39137.80 .s' ~
5. $785.05 $163.07 $621.97 $38515.82 0 .~
85.05 160.48 $624.57
7.
8. 785.05
$785.05 $157.88
$155.27 $627.17
$629.78 $37264.08
$36634.30 ~-
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9. $785.05 $152.64 $632.41 $36001.89
10. $785.05 $150.01 $635.04 $35366.85 ~
11. 785.05 147.36 637.69 34729.16
12. $785.05 $144.70 $640.34 $34088.82 ~.
13. $785.05 142.04 $643.01 $33445.81
14. 285.05 ~ ~ 139.36 $645.69 $32800.11
15. $785.05 $136.67 $648.38 $32151.73
16. $785.05 $133.96 $651.08 $31500.65 ~
17. $785.05 $131.25 $653.80 $30846.85 ~:
1.8. $785.05 $128.53 $656.52 $30190.33 ~ "'
19. 785.05 $125.79 $659.26 $29531.07
20. $785.05 $123.05 $662.00 $28869.07
21. 785.05 120.29 664.76 $28204.30 ~'
22. $785.05 $117.52 $667.53 $27536.77
23.
24. $785.05
$785.05 $114.74
$111.94 $670.31
$673.11 $26866.46
2619 .35
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25. 785.05 109.14 675.91 $25517.44 ~ s` p~ ~ ~
26. $785.05 $106.32 $678.73 $24838.71 _ __ _ _ _ __
:~
27. ~ - $785.05 $103.49 $681.55 $24157.16 -~ ~ y i
28. $785.05 $100.65 $684.39 $23472.76 Za,n
29. $785.05 $97.80 $687.25 2278. ~ ~•
30. $785.05 $94.94 690.11 22095.41 ~ ~
31. $785.05 $92.06 $692.98 $21402.42 ~,
32. 785.05 $89..18 _ _ $695.87 $20706.55
33. $785.05 $86.28 $698.77 $20007.77
34. $785.05 $83.36 $701.68 $19306.09
35. $785.05 $80.44 $704.61 $18601.48 J p
36. 785.05 $77.51 $707.54 $17893.94
37. $785.05 $74.56 $710.49 $17183.45 ~ ~# a~
38. $785.05 $71.60 $713.45 $16469.99 = ~ _
39. $785,05. ~ $68.62 $716.42' ` $15.753.57 ~,,
40. $785:05 $65.64 $719:41; $15034.16 ~, ,0, sa
41. $785.05 $62.64 $722:41 ~ $1431 i .75
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42. .05 9.63 725.42 13586.33 ~a-~ Dc~~e ~ ~
43.
,44.
45. 785.05
785.05
$785.05 $56.61
$53.57
$50.53 $728.44
$731.47
$734.52 $12857.89
$11391.89 ) ~ $ ,~, n
~1 u
46. $785.05 $47.47 $737.58 $10654.31
47. 785.05 $44.39 $740.66 $9913.65
48 $
785
05 $41
. .
. .31 $743.74 $9169.91
49. $785.05 $38.21 $746.84 $8423.07
50. 785.05 35.10 749.95 $7673.11
51. $785.05 $31.97 $753.08 $6920.04
52. $785.05 $28.83 $756.22 $6163.82
53. 785.05 25.68 759.37 54 4.45
4. 2. 2 2 5 4641.92
. 5. 785.05 19.34 765.71 3876.21
7 0 16.15 7 8.90 3107.31
7• 2.95 772.10 2335.21
15 9.89
9. 785.05 $6.50 $778.55 $781.34
60. 784.59 3.25 781.34 $0.00
* Interest calculated at 1/12th of annual interest rate on
the remaining principal amount. (Rounding errors possible)
---------------------------------------------------------------
Ewing Brothers Funeral Home, Inc.
630 South Hanover Street
Carlisle, PA 17013-
(717)243-2421
March 2, 2009
Sandra F. Shine
623 Old York Rd.
Carlisle, PA 17015
The Funeral Service for Merton B. Fitzgerald
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please
feel free to contact us if you have any questions in regard to this statement.
THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT,
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
1. PROFESSIONAL SERVICES
Services of Funeral Director/Staff , $1160.00
3. AUTOMOTIVE EQUIPMENT
Vehicle to transfer remains to Funeral Home, $265.00
FUNERAL HOME SERVICE CHARGES $1425.00
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE
THAT YOU HAVE SELECTED $1425.00
Cash Advances
Certified Copies of the Death Certificate , ,
Crematorium Fee
. . . . . . . . . . . . . . . . . . . . . . . .
Coroner's Authorization Fee
. . . . . . . . . . . . . . . . . . . . .
Cremation Pouch , .
TOTAL CASH ADVANCES AND SPECIAL CHARGES .
Total
Total Cost , ,
SUB-TOTAL
INITIAL PAYMENT /DISCOUNT /CREDITS
TOTAL AMOUNT DUE
The unpaid balance over 30 days is subjected to a 1.50 % service charge per month - 18.0000 % per annum.
~~~
~~
$24.00
$315.00
$25.00
$35.00
$399.00
$1824.00
$1824.00 ~~~QOG~~
1833 7%J'~
$-9.12 , n ,W'~'
.~~`~~~