HomeMy WebLinkAbout06-11-09 (2)J 15D5607120
- 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 Box.zsosol 21 0 9 0 2 21
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
e'36 16 9424 09 18 2008 12 14 1918
Dec;edent's Last Name Suffix Decedent's First Name MI
SPATZER RUTH V
(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
FILIL IN APPROPRIATE OVALS BELOW
XD 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise ~ 5. Federal Estate Tax Return Required
(dale of death after 12-12-82)
g Decedent Died Testate
(Attach Copy of Will) ~ ~ Decedent Maintained a Living Trust 0 s. Total Number of Safe De OSit Boxes
(Attach Copy of Trust) P
9. Litigation Proceeds Received ~ 1 p, Spousal Poverty Credit (date of death 11, Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1 -95) ~
(Attach SCh. O)
COIRRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Narne Daytime Telephone Number
DAVID W DELUGE. 717 761 4540
Firrn Name (If Applicable)
JOHNSON D U F F I E REGISTER OF WILLS USE ONLY
First line of address
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301 MARKET STREET w
Second line of address -
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Correspondent'se-mail address:
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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 lirue, rect and complete. Declaratio ,
n of preparer other than the personal representative Is based on all information of which preparer has any knowledge.
SIGNAT OF PERSON RESPONSIBLE ILING RETURN
/~ PENNSYLVANIA GUARDIANSHIP ASSOCIATIORfT~
~f~---~. / ''~'
rf77ll% Brian Brooks
O. ox 7295
J E OF PR
7604
DAVID W DELUGE
DATE
301 Market Street, Lemoyne, PA 17043
Side 1
L~ 1505607120 1505607120 J
REV-1500 EX
~eoedenYsName: Ruth V SPATZER
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.
Decedent's Social Security Number
236 16 9424
5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............. ... 5. 4 2 , 9 6 9 . 9 0
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. 4 2, 9 6 9. 9 0
9. Funeral Expenses & Administrative Costs (Schedule H) ..................................... .... 9. 5 , 5 2 7 . 2 1
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................. ... 10. 8 8 5 . 5 5
11. Total Deductions (total Lines 9& 10) ................................................................. .....11. 6, 4 1 2 7 6
12. Net Value of Estate (Line 8 minus Line 11) ........................................................ .....12. 3 6 , 5 5 7.14
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) .............................................. ... 13. 3 6 , 2 3 5.14
14. Net Value Subject to Taz (Line 12 minus Line 13) ............................................. .... 14. 3 2 2 . 0 0
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 1, 0 0 0. 0 0 18.
19. Tax Due .................................................... .......................................................... .....19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
L,~ 1505607220 1505607220
1505607220
0.00
0.00
0.00
150.00
150.00
..J
REV-1:i00 EX Page 3
Decedent's Complete Address:
File Number 21-09-0221
DECEDENT'S NAME
Ruth V SPATZER
STREET ADDRESS
Claremont Nursing 8~ Rehab. Center
1000 Claremont Drive
CITY STATE ZIP
Carlisle PA 17013
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
D. Interest
E. Penalty
0.00
Total Credits (A + B + C)
(1) 150.00
(2) 0.00
(3)
(4)
(5> 150.00
(5A)
(5B) 150.00
Total Interest/Penalty (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.
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 :.................................................................................~ 0
b. retain the right to designate who shall use the property transferred or its income :....................................
c. retain a reversionary interest; or ...............................................................................................................~ 0
d. receive the promise for life of either payments, benefits or care? ..............................................................~ a
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?.........
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ...................................................................................................................~ ^x
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 date;; 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 date:> 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:. 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)J.
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-1508 EX+ (8-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF (FILE NUMBER
SPATZER, Ruth V 21-09-0221
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
NUMI3ER
DESCRIPTION VALUE AT DATE
OF DEATH
1 PA Guardianship Custodial Account as Guardian for Decedent 37,304.39
2 Capital BlueCross -Refund 1,172.61
3 Claremont Nursing & Rehabilitation Center 2,990.00
4 Pennsylvania Life Insurance Company -Premium Refund 25.80
5 The Woods At Cedar Run -Refund of Security Deposit 1.477.10
TOTAL (Also enter on Line 5, Recapitulation) I 42,969.90
(If more space is needed, additional pages of the same size)
Copyrigtlt (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
REV-1151 EX+(12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
SPATZER, Rutty V _ 21-09-0221
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION
NUM'~BER AMOUNT
A. FUNERAL EXPENSES:
B.
1
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address P.O. BoX 7295
city Lancaster state PA zip 17604
Year(s) Commission paid 2009
2,150.00
?. Attorney's Fees Johnson Duffle 2,828.00
;;. 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 Decedent
4. Probate Fees 146.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 403.21
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 5,527.21
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
SPATZER, Ruth V 21-09-0221
ITEM
NUMBER DESCRIPTION AMOUNT
Other Administrative Costs
1 Cumberland County Register of Wills Office 15.00
2 Cumberland County Register of Wills Office -Filing fees for Inheritance Tax Return 30.00
and Inventory
3 Pa Vital Records 114.25
4 The Cumberland Law Journal -Notice of Estate Administration 75.00
5 The Patriot News -Notice of Estate Administration 168.96
H-B7 Subtotal 403.21
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
Rev-151:: EX+ (6-98)
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF (FILE NUMBER
SPATZER, Ruth V 21-09-0221
Include unreimbursed medical expenses.
pr more space Is neetletl, 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-151:1 EX+ (g-00)
SCHEDULE J
COM N~ERITANCEOTAXRETURNANIA BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
SPATZER, Ruth V 21-09-0221
NUMBER NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO
DECEDENT SHARE OF ESTATE
(Wo
d AMOUNT OF ESTATE
Do Not List Trustee(s) r
s) ($$$)
I. TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116(a)(1.2)]
'i C Arthur Neal Friend Specefic 1,000.00
Cardinal Drive Bequest of
Etters, PA 17319 $1,000.00
Total 1,000.00
Enter dollar amounts for distributions shown above on lines 15 through 18, as approp riate, on Rev 1500 cov er 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
1 West Virginia Wesleyan College 36,235.14
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE 36,235.14
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98)
ESTATE OF R UTH V. SPATZER
SCHEDULE OF EXHIBITS
EXHIBIT A Copy of Decedent's Last Will and Testament signed and dated on
the 21st day of July, 1994.
367381
~~t~t ~iI1 ~tn~ ~P~~~crrcPnt
OF
RUTH V. SPATZER
I, RU'T'H V. SPATZER, of Lower Allen Township, County of Cumberland and Commonwealth
of Pennsylvania, do make, publish and declare this to be my Last Will and Testament, hereby revoking
and making void any and all former Wills by me at any time heretofore made.
ARTICLE I
I direct the payment of my just debts and funeral expenses as soon after my decease as may be
convenient to my Executor hereinafter named.
ARTICLE II
I give and bequeath the sum of One Thousand ($1,000.00) Dollars unto REVEREND C,
~4RTHUR HEAL, provided he survives me.
ARTICLE III
I give and bequeath my William Rogers & Son, silver service for eight, including five serving
pieces, unto my sister, KATI~EEN POLING, Buckhannon, West Virginia, provided she survives me.
In the event she predeceases me, I give and bequeath the same unto my nephew, THOMAS POLING.
ARTICLE IV
I give, devise and bequeath all the rest, residue and remainder of my Estate, of whatsoever nature
and wheresoever situate, unto WEST VIRGINIA WESLEYAN COLLEGE, Buckhannon, West
Virginia.
ARTICLE V
I direct that all taxes that may be assessed as a consequence of my death be paid from my
residuazy Estate so that the residuary charitable beneficiary shall bear the burden of such taxes.
ARTICLE VI
I name, constitute and appoint DAUPHIN DEPOSIT BANK AND TRUST COMPANY
Executor of this my Last Will and Testament.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and
Testament, thisG.~/..tray of ~t,~' 1994. j'~~'
f
~~ ~ e ~ ~:f,: .~`.~° (SEAL)
,,TRUTH V. SPATZ
Signed, sealed, published and declared by the above-named Testatrix, as and for her Last Will
and Testament, in the presence of us, who at her request, in her presence and in the presence of each
other, have hereunto subscribed our names as witnesses.
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ACKNOWLEDGMENT AND AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF CUMBERLAND
We, RUTH V. SPATZER, ~(Yl ~ C,R~~~`~, ~~„~, ~,.¢~.,~,d -~~~ s~~ ~.~- 4°~ ~( the
Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument,
being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and
executed the instrument as her Last Will and that she had signed willingly and that she executed it as her
free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence
and hearing of the Testatrix, signed the Will as witness and that to the best of her knowledge the Testatrix
was at the time eighteen years of age or older, of sound mind and under- o constraint or undue influence.
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~ iJTH V. SPATZE~ ""
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Witness ~
Witness
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ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF CUMBERLAND
,~,°,e
On this, the ~ ~" day of ~-X1994, before me, the undersigned officer, personally appeared.
Edmund G. Myers, I.D. # 20558, known to me (or satisfactorily proven) to be a member of the bar of
the highest court of Pennsylvania and certified that he was personally present when the foregoing
acknowledgement and affidavit were signed by the Testatrix and witnesses.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
~~
Notary Public ~ ~„ `~ `
NOTARIAL SEAL.
DlArlNELEN(G,:~±~~~sr,; i~;!blic
Lemoyne Borough t~u~rzl;exl~r~ Co.
My Comm9ssio;t Expir=:s'~~c. ~1,1~97
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