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Home My WebLink About07-14-0915056051058 REV-1500 EX 06 05 ( ) OFFICIAL USE ONLY PA Department of Revenue Coun Code Year File Number Bureau oflndividualTaxes INHERITANCE TAX RETURN tY Po box zsosol 21 ~ 08 i 1112 Harrisburg, PA nt26-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death _ . _ __, _ i _ __ 185-24-7636 10/29/2008 Decedent's Last Name Suffix Kelley (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix ............... Spouse's Social Security Number I FILL IN APPROPRIATE OVALS BELOW ~~ 1. Original Return Date of Birth _ _. ..- 03/24/1932 _ _ _ _,: Decedent's First Name Beatrice __ _ Spouse's First Name __. _ -.. THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS MI O 2. Supplemental Return t~ 3. Remainder Return (date of death prior to 12-13-82) ~ 4. Limited Estate C~ 4a. Future Interest Compromise (date of ;~ 5. Federal Estate Tax Return Required death after 12-12-82) C!u 6. Decedent Died Testate t~ 7. Decedent Maintained a Living Trust _~ 1_ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received C~? 10. 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) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Karen M. Balaban ... _ _ M ... (717) 232-3708 Firm Name (If Applicable) _ .. . _,... ~,. _ _ REGISTER OF WILLS USE ONLY i Karen M. BalabanLLC ~ ^~ I First line of address { i._ ~ ..o - -- ~ ~`-i ~ . _. . -~_. _.... _ _ _ _ SJ C... ~ 223 State Street, Suite ~ x' ~ rte-. ... ' Second line of address ~' ~ ''fi' __ _ ~ _- __ _ _ ~ .I ~ i P O Box 821 ~ ~~ c : 3'" ~ ? .__ . ~-~ .._~_. ~ .._ ~_. .__~. . City or Post Office _ _ _ . _ _ . .. _,._... r ~~__~. ___v _ - . State ZIP Code _ '- .-----_-_-- _ 'D-~'~Ft~ED ~ __ _ ;1 - ~; Harrisburg . `PA ~ 17108-0 _ - ~ y 821 ° ,~ r:t -~, Correspondent's a-mail address: 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 true, correct and complete. DeGaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATUR F PERSON RESPONSIBLE FOR FILING RETURN DATE /~~.,,,,.,,~~ ~~~•~-L.~,~.~-- 07!13/09 ADDRESS P.O. Box 821, Harrisburg, PA 17108-0821 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY 15056051058 Side 1 15056051058 MI fM _ __- `-~` REV-1500 EX Beatrice M Kelley Decedent's Name: 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. Decedent's Social Security Number 185-24-7636 4. Mortgages 8 Notes Receivable (Schedule D) ............................. 4. 5. Cash, Bank Deposits ~ Miscellaneous Personal Property (Schedule E) ........ 5. 6. Jointly Owned Properly (Schedule F) C! Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property `"`° (Schedule G) C=7 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, 8 Liens (Schedule I) ................ 10. i 11. Total Deductions (total Lines 9 & 10) ................................... 11. 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. I! 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or ,.. _ . _. trans ers under Sec. 9116 ~_. v.. ~ _. _ (a)(1.2) X .0_ 15. ,, 0.00 16. Amount of Line 14 taxable °° at lineal rate X .0 _ 16. i ~ 0.00 17. i~,... ~. ... _,... a .~ s.,..~ ... _~ .... ~,..... Amount of Line 14 taxable ~ ~~~~ ; ~~~~"~'~ """ "" ~"' ~ ~~~~~~~ ~ ~ at sibling rate X .12 17. 0.00 18. Amount of Line 14 taxable at collateral rate X .15 18. ! 0.00 19. TAX DUE .........................................................19.; 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~-~ 15056052059 Side 2 15056052059 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: Flle Number , _r ~.. 21 ;i 08~ 1112 DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER Beatrice M Kelley 185-24-7636 STREETADDRESS 28 Country Club Place West CITE' STATE ZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Inten;sUPenalty if applicable D. Interest E. Penalty (1) Total Credits (A + B + C) (2) Total Interest/Penalty (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. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) (4) (5) (5A) (56) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 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 .................................................................................................................... ...... ^ 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 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 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)]. 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. REV-1502 EX+ (11-08) y ~~pennsylvania SCHEDULE A ~7 DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF FILE NUMBER Beatrice M. Kelley 21-08-1112 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant fads. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1' 128 Country Club Place West, East Pennsboro Township, Camp Hill, PA 17011 80,000.00 TOTAL (Also enter on Line 1, Recapitulation.) I; 80,000.00 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. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Beatrice M. Kelley 21-08-1112 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointty-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Discover Bank, P.O. Box 7112, Dover, DE 19903-9955 CD 303-478052-5 2 572.09 , 2 CD 303-472964-6 7 787 37 3 CD 303-487763-5 5,142.75 4 Money Market 300-271011-1 33,558.74 5 PNC Bank, 1400 Camp Hill Shopping Mall, Camp Hill, PA 17011 Checking Acct 5004126527 -47.75 6 Savings Acct 5004384147 110,972.05 7 U.S. Treasury Savings Bonds EE 511670351 47.34 8 EE 45935016 1,191.20 9 EE 46389803 1,167.60 10 Allstate Bank, P.O. Box 8136, Vemon Hills, IL 60061-8136 Regular Savings Acct. 2010028971 7,809.51 11 CD 3120002716 5,151.63 12 Bank of America, NA, P.O. Box 25118, Tampa, FL 33622-5118 Money Market Svgs Acct 2 70061184 68,874.15 13 DCBM Services, LLC, 4150 Olson Memorial Highway, Suite 200, 3 83 ~Ainnnonnlin ~AAI ~.GA 77 AS211 0 . 14 Allstate Insurance reimbursement for damages to home resulting from clean-up after the homicide 9,421.66 15 Family Ford 1993 Ford Escort station wagon 475.00 16 State Employees Retirement System final check 1,203.80 17 State Farm Mutual Automobile Ins Co car insurance refund 94.34 18 Vogelsong Investment Properties reimbursement for pre-paid real estate taxes 784.65 19 Allstate Insurance Company homeowners insurance refund 56.00 20 Leffler Energy healing oil refund 172.00 21 Commonwealth of PA 2007 property tax rebate 250.00 22 U.S. Treasury 2008 income tax refund 464.00 23 Clothing, personal effects, household furnishings, furniture 250.00 TOTAL (Also enter on line 5, Recapitulation) S I 257,401.96 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) SCHEDI~ILE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES 8c INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Beatrice M. Kelley 21-08-1112 Debts of decedent must be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Myers-Hamer Funeral Home Inc. 7,696.00 2• Karen Balaban -reimbursement for post-funeral luncheon 83.76 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 10,500.00 Name of Personal Representative(s) Karen M. Balaban Social Security Number(s)/EIN Number of Personal Representative(s) 25 1892588 Street Address 223 State Street, Suite 200 city Harrisburg .state PA zip 17101 Year(s) Commission Paid: 2008 and 2009 2. Attorney Fees 7,730.00 3. Family Exemption: (If decedent's address is not the same as claimants, attach explanation) Claimant Street Address City State _ Zip Relationship of Claimant to Decedent 4. Probate Fees 306.00 5. Accountant's Fees 0.00 6. Tax Return Preparer's Fees 0.00 ~. Cumberland Law Journal -advertisement of letters 75.00 a. The Sentinel - advertisement of letters 158.62 s. Criterium-Yingst Enginners, Inc. residential inspection & report 425.00 ~ o. Jeff Palkovic new entrance door 401.12 ~ ~ . Jeff Palkovic clean out house 25.00 12. Katie Palkovic clean out house 24.00 ~4~-TOTAL (Also enter on line 9, Recapitulation) $ 27,424.50 (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA SCHEDULE H INHERITANCE TAX RETURN FUNERAL EXPENSES & RESIDENT DECEDENT ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Beatrice M. Kelley ITEM DESCRIPTION NUMBER AMOUNT B. ADMINISTRATIVE EXPENSES (continued from page 1 of Schedule H) 13. Jeff Palkovic materials to shore up basement walls 428.00 14. PAWC water bill 12.99 15. Leffler Energy heating oil 250.54 16. PPL Electric Utilities electric bill 32.39 17. State Farm car insurance 110.99 18. Jeff Palkovic labor and materials to shore-up basement walls 599.88 19. PAWC water bill 12.44 20. PPL Electric Utilities electric bill 16.69 22. Jack Gaughan Realtor ERA real estate closing costs 6,258.65 22. PPL Electric Utilities final electric bill 31.75 23. PAWC final water bill 17.83 24. Jeff Palkovic final clean-up before real estate settlement 80.00 25. Kelley Estate damages to home resulting from clean-up after homicide 9,421.66 26. Register of Wills additional short certificates 16.00 27. Postmaster postage to mail life insurance claims 4.10 28. Vital Statistics additional death certificates 36.00 29. Register of Wills additional probate fee 100.00 Sub-total this page: 17 429.91 Sub-total page 1: 27,424.50 TOTAL $ 44,854.41 REV-1512 EX+ (12-08) i~~ ~ pennsytvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF ~ECE~ENT~ INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF Beatrice M. Kelle FILE NUMBER Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unre mbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. S ears Gold Master Card 2. Leffler Energy 3. Discover Card 4. PAWC 5. Bank of America 6. PPL Electric Utilities 7. East Pennsboro Twp. 8. Phillips & Cohen Associates Ltd credit card charges heating oil credit card charges water bill VISA credit card electric bill sewer and trash bill reserve for disputed Chase Bank, N.A. credit card 87.76 361.98 207.33 60.86 76.53 138.82 211.40 499.28 TOTAL (Also enter on Line 10, Recapitulation) I ~ 1 643 96 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (11-OS) ~;. , ~`~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Beatrice M. Kelley SCHEDULE ~ BENEFICIARIES RELATIONSHIP TO DECEDENT NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. FILE NUMBER 21-08-1112 AMOUNT OR SHARE OF ESTATE ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. I Cumberland County Library System 100% TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I ~ ~o o %~~ If more space is needed, insert additional sheets of the same size.