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Home My WebLink About04-21-09 (2)1505607120 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code near File Number Po Box.28osoi INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 0 8 10 2 5 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 09 08 2008 03 07 1927 Decedent's Last Name Suffix Decedent's First Name MI KLINE J. F' (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI KLINE ARLENE V Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW X^ 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death prior to 12-13-82) ^ 4. Limited Estate ~ qa, Future Interest Compromise ^ 5. Federal Estate Tax Return Required (date of death after 12.12.82) g. Decedent Died Testate ^ ~ Decedent Maintained a Living Trust 0 8. Total Number of Safe De osit Boxes (Attach Copy of Will) (Attach Copy of Trust) p ^ 9. Litigation Proceeds Received ^ 1 Q, Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A) between 12-31- 1 and 1-1-95) ^ (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JOHN 3 DAVIDSON 717 533 5101 Firm Name (If Applicable) First line of address 320 WEST CHOCOLATE AVENUE Second line of address P.O. BOX 437 City or Post Office HERSHEY State ZIP Code REGISTER OFS USE C~.Y - ~? x~ 1 __ V ~~ t_. ( .rt ftiJ _: c j-1'; ~ :J J ~.~ _ --~- ' _ -~ ~ - ~. ~ ~ -i DA~FILED - -- 3 ~~ Cal PA 17033-0437 Correspondent'se-mail address: yOSt.daVldSOn@verizon.net Under penalties of pery'ury, 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 oreoarer has anv kn~wlartoa Elwood G Kline ADDRESS 334 Walnu treet, Lemoyne, PA 17043 SIGN TURE OF P E ARER OTHER THAN REPRESENTATIVE DATE ~Ly~---~'" John S Davidson ~,~/~ ~ ?, .ZGd~j West Chocolate Avenue, Hershey, PA 17033-0437 Side 1 1505607120 1505607120 J S 1505607220 REV-1500 EX Decedenes Name: J. F I o y d Kline Decedent's Social Security Number RECAPITULATION 1. Real Estate (Schedule A) ..................................................................................... ..... 1. 2. Stocks and Bonds (Schedule B) .......................................................................... ..... 2. 5 0 4, 5 7 0. 5 8 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)..... ..... 3. 4. Mortgages 8 Notes Receivable (Schedule D) ..................................................... ..... 4. 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........... ..... 5. 6 4 9 , 8 6 1 . 3 8 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ........ ..... 6. 1 4 , 6 4 3 . 7 6 7. Inter-Uvos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested ........ ..... 7, 1 4 9, 9 0 9. 4 7 8. Total Gross Assets (total Lines 1-7) .................................................................. ..... 8, 1, 3 1 8, 9 8 5. 1 9 9. Funeral Expenses & Administrative Costs (Schedule H) .................................... ..... 9. 2 4, 3 9 8 5 0 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ........................... ..... 10. 11. Total Deductions (total Lines 9 8 10) ................................................................. ..... 11 • 2 4, 3 9 8 5 0 12• Net Value of Estate (Line 8 minus Line 11) ........................................................ ..... 12. 1 , 2 9 4 , 5 8 6 . 6 9 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) ............................................ ..... 14. 1 , 2 9 4 , 5 8 6 . 6 9 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.00 993, 167 38 15. 16. Amount of Line 14 taxable at lineal rate X .045 3 0 1, 4 1 9. 3 1 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 18. 19. Tax Due .................................................. .................................................................. . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 0.00 13,563.87 0.00 0.00 13,563.87 Side 2 L 1505607220 150560722D REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-08-1025 DECEDENT'S NAME J. Floyd Kline STREET ADDRESS 334 Walnut Street CITY Lemoyne STATE PA ZIP 17043 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable p. Interest E. Penalty 0.00 Total Credits (A + B + C) (1) 13,563.87 Total InteresUPenalty (D + E) 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 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. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (2) 0.00 (3) (4) (5) 13,563.87 (5A) (56> 13,563.87 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 .................................................................................................................. ^ 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? ....................................................................................................................... 0 ^ 3. Did decedent own an "in trust 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? ...................................................................................................................... 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 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)]. 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. Rev-1503 EX+ (8-98) SCHEDULE B STOCKS ~ BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Kline, J. Floyd 21-08-1025 All property Jointly-owned with right of survivorship must tN! disclosed on Schedule F. ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 087509105 500 shares of Bethlehem Steel Corp -common stock - 0 0.00 in bankruptcy, no value 2 s7os721os 1,168 shares of Nuveen PA Investment Qual Municipal 12.445 14,535.76 Fund -common stock 3 687380105 13,230 shares of Orrstown Financial Services, Inc - 30.00 396,900.00 common stock 4 693475105 400 shares of PNC Financial Services Group, Inc. - 76.07 30,428.00 common stock 5 7oso511os 1,000 shares of PPL Corp -common stock 39.68 39,680.00 6 s2os2sa5s 7,800 shares of Shearson Lehman Hutton Unit Tr .05 390.00 7 s45so51os 2,518 shares of Sovereign Bancorp Inc -common 8.99 22,636.82 stock TOTAL (Also enter on Line 2, Recapitulation) 504,570.58 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98) Rev1508 EX+ (&seJ SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF - (FILE NUMBER Kline, J. Floyd 21-08-1025 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 DEATH 1 Belco Commuity Credit Union -certificate of deposit 35,000.00 2 Belco Community Credit Union -certificate of deposit 50,000.00 3 Belco Community Credit Union -regular savings 20.00 4 M&T Bank -certificate of deposit 125,099.76 5 Members 1st Federal Credit Union -regular savings account 3,799.66 6 Members 1st Federal Credit Union -certificate of deposit 100,096.66 7 Orrstown Bank -certificate of deposit 100,257.88 8 PSECU -regular share account 508.86 9 PSECU -certificate of deposit 100,084.58 10 Susquehanna Valley Federal Credit Union -certificate of deposit 100,101.36 11 Susquehanna Valley Federal Credit Union -savings account #3904-00 33,692.62 12 1997 Chevrolet Ventura -van with 80,000 miles -fair condition 1,200.00 TOTAL (Also enter on Line 5, Recapitulation) ~ 649,861.38 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev1509 EX+ (8-98) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Kline, J. Floyd 1 21-08-1025 Man asset was made Joint within one year of the decedents date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Arlene V. Kline 334 Walnut Street Lemoyne, PA 17043 B. Elwood G. Kline 334 Walnut Street Son Lemoyne, PA 17043 C. JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1 B 9/1211997 M8tT Bank -checking account 29,287.51 50.000% 14,643.76 #98175858 TOTAL (Also enter on Line 6, Recapitulation) I 14,643.76 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98) Rev-1510 EX+ (&98) SCHEDULE G INTER-VIVOS TRANSFERS 8~ MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Kline, J. Floyd 21-08-1025 This schedule must be completed and filed 'rf the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DE I E INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 MST Bank -certificate of deposit #48852 55,131.79 100.000 3,000.00 52,131.79 established in the name of decedent and his son on 12/18/2007 2 M8~T Bank IRA -account #35004201002760 97,777.68 100.000 97,777.68 decedent's wife is the named beneficiary TOTAL (Also enter on Line 7, Recapitulation) I 149,909.47 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) REV-1151 Ex+112.99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES ~ ADMINISTRATIVE COSTS ESTATE OF I FILE NUMBER Kline, J. Floyd 21-08-1025 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid 12,559.00 2. Attorney's Fees John S Davidson 7,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3,500.00 Claimant Arlene V. Kline Street Address 334 Walnut Street city Lemoyne State PA zip 17043 Relationship of Claimant to Decedent SpOUSe 4. Probate Fees 477.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 362.50 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 24,398.50 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Kline, J. Floyd 21-08-1025 ITEM NUMBER DESCRIPTION AMOUNT Funeral Exaenses 1 Bonnie Snyder -organist for funeral service 25.00 2 Gingrich Memorials -cemetery marker 665.00 3 Musselman Funeral Home 11,269.00 4 Newport Cemetery -grave opening 500.00 5 Rev. Heather McCallister -funeral honorarium 100.00 H-A Subtotal 12,559.00 Other Administrative Costs 6 Central Penna Abstract Services, Inc. -title abstract for 334 Walnut Street, Lemoyne 150.00 7 Cumberland CountyLaw Journal -estate advertisement 75.00 8 Register of Wills -short certificates 18.00 9 The Sentinel -estate advertisement 119.50 H-B7 Subtotal 362.50 Copyright (c) 2002 form sofiware only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) rt~v-~sta oc. faaol SCHEDULE J COMdONN1EI1LTF1 OF perNSnv~urra ~rrwcE T~z ra:n,rer BENEFICIARIES ESTATE OF FILE NUMBER Kline, J. Floyd 21-0$-1Q 25 NAME AND ADDRESS OF ~ DECmEtJ~l' TO SHARE OF ESTATE NT OF ESTATE NUMBER PERSON(S) RECEMNG PROPERTY Do NatLYtT s (Wong) (yam) I. TAXABLE DISTRIBUTIONS[~aitr e~~ under sec. 9116(ax12)] Arlene V. Kline wife residue of 334 walnut Street estate Lemoyne, PA 17043 Elwood G. Kline Son specific 334 WaMut Street beq~.~sts: Lemoyne, PA 17043 ~ ' see attached statement Total 1,279,942.94 Enter dollar amounts for distributions shown above on pose 5 18, as . on Rev 1500 cove r sheet II. NON-TAXABLE OISIRIBUTIONS: ~ ~ DISIRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT ~ E 8. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOT/11.OF PART h -ENTER TOTAL NON TAXABLE DISTRIBUTIONS ON Ltl~ 13 OF REV 1500 COVER SHEET ' 0.W Copyright (c) ZOOQ tam soltwar+e only The Ladv-er Group. Ma Form PA-1500 Schedule J(Rev.6-98) J. Floyd Kline Estate No 21 - 08 - 1025 Pennsylvania Inheritance Tax Return Attachment to Schedule J -Beneficiaries The decedent's will provides for the following pecuniary bequests to Elwood G. Kline, the decedent's son. Value as Reported 5,000 shares Orrstown Bank common stock $150,000.00 400 shares PNC Bank common stock $ 30,428.00 1,000 shares PP&L common stock $ 39,680.00 All (1,168) shares of Nuveen PA Investment Quality Municipal Fund $ 14,535.76 TOTAL $234,643.76 The decedent's son had a joint interest in an M&T bank account (#98175858) with the decedent, the value of which, as reported is: $ 14,643.76 A The decedent's son was the transferee of an M&T certificate of deposit reported on Schedule G having a taxable value of: $ 52,131.79 TOTAL distributions to decedent's son $301,419.31