Loading...
HomeMy WebLinkAbout07-14-09 (2) J 150560712D 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.28oso1 2 1 0 8 1 2 0 5 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 11 11 2008 Decedent's Last Name Suffix PETERSaN (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number Date of Birth 12 06 1929 Decedent's First Name MI PEARL E Spouse's First Name MI 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 ~ j ! --~ 4a, Future Interest Compromise (date of death after 12-12-82) ~ 5. Federal Estate Tax Return Required ~~ g. Decedent Died Testate (Attach Copy of III) ^ ~• (Attach Copy Hof Trust)a Living Trust Q 8. Total Number of Safe Deposit Boxes ~i 9. Litigation Proceeds Received ^~ ^ 1 Q, Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) (~ 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 TO: Name Daytime Telephone Number T 1~MF'C Tl T-TiTC~'t-TFC F'~C~ ~ 7 ~ 7 2 4 9 6 3 3 Firm Name (If Applicable) SALZMANN HUGHES PC First line of address 354 ALEXANDER SPRING ROAD, SUITE 1 Second line of address City or Post Office State ZIP Code CARLISLE PA 17015 Correspondent's a-mail address: j h u g h e s @s a l z m a n n h u g h e s. c o m 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. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. 354 Alexar~er Spring Road, Suite 1, Carlisle, PA 17015 Side 1 150560712U REGISTER ~,iA US1LY ~.i fY, ' ~ ,~ ~~ ~ ~~ 1.'~. :S .~7 ,.~+~ 0.~ • • ~ ' ~a ~ . ~,,,~ DATE FILED ~.~;7 .~ , -t F,~ ~~ r'' w]~ t"~~ i ~~.7 - 1505607120 J 30 pyre echanicsbur , PA 10755 SI ATURE RE HER THAN REPRESENTATIVE DA ~,,._ James D. Hughes Esq. ~ g O J 1505607220 REV-1500 EX Decedent's Social Security Number Decedents Name: P e a r I E. Peterson REC APITULATION 1. Real Estate (Schedule A) .......................................................................................... 1. 2 432, 830. 75 2. Stocks and Bonds (Schedule B) ............................................................................... 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3. 4. Mortgages 8 Notes Receivable (Schedule D) .......................................................... 4. 1 7 7 2 6 3 7 5• Cash, Bank Deposits 8~ 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. 4 5 0 5 5 7 1 2 3 8 1 1 7 4 7 9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9. ~ 10. Debts of Decedent, Mortgage Liabilities, 8~ Liens (Schedule I) ................................ 10. ~ ~ 3 ~ 6 2 11. ' Total Deductions (total Lines 9 8 10) ...................................................................... 11. 40. 057. 09 12. ............................. Net Value of Estate (Line 8 minus Line 11) ...............................: 12. ~ 4 1 0 5 0 0 0 3 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which ~ 2 O 5 2 5 0 0 1 an election to tax has not been made (Schedule J) ................................................. 13. , 14. Net Value Subject to Tax (Line 12 minus Line 13) ..............................................:.. 14. ~ 2 0 5 2 5 0 0 2 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 0 0 0 15. 0 0 0 (a)(1.2) x .00 16. Amount of Line 14 taxable 0 0 0 • 16. 0 0 0 at lineal rate X .045 17. Amount of Line 14 taxable 0 0 0 17. 0 0 0 at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate x .15 2 0 5, 2 5 0 0 2 18. 3 0, 7 8 7 5 0 19. Tax Due ..................................................................................................................... 19. 3 0 7 8 7 5 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505607220 1505607220 J REV-1500 EX Page 3 rle~nrlont~c (_mm~latp Or~r~rPCC' File Number 21-08-1205 DECEDENT'S NAME Pearl E. Peterson STREET ADDRESS Bethany Village, 325 Wesley Drive CITY STATE Mechanicsburg ~ PA ZIP 10755 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 27,000.00 1,421.05 Total Credits (A + B + C) (1) 30,787.50 (2) 28,421.05 (3) (4) (5) 2,366.45 (5A) (56) 2,366.45 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 :.................................................................................. x 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? .............................................................. j~ Ox 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without ~~11 receiving adequate consideration? ....................................................................................................................... ~ I"J 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? ...................................................................................................................... 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. „z.~._, .8r.~e1~ ~,cuu-roi jai,",...s~~iiX.:.n~..S..+~:.~~:.~a'~s2.~~t`.~=tai..sC~e~`'s~' ~ ~. For dates of death on or afte~ uly~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. • Rev1503 EX+ (g.98) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Peterson, Pearl E. 21-08-1205 All property jointly-owned with right of survivonshlp must be disclosed on Schedule F. ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH Edward Jones Account #377-10162 1 1,595.373 shares of American Funds Short Term Bond 9.77 15,586.79 Fund of America -Class A; ASBAX 2 257.685 shares of Capital Income Builder Fund -Class 40.85 10,526.43 A; CAIBX 3 211,822 shares of Cash Management Trust of America 1 211,822.00 -Class A; CTZXX 4 548.718 shares of Dodge 8~ Cox Income Fund - DODIX 11.38 6,244.41 5 3,861.235 shares of Franklin Income F~rnd -Class A; 1.69 6,525.49 FKINX 6 150,266 shares of Franklin Money Fund -Class A; 1 150,266.00 FMFXX 7 377.783 shares of Franklin Mutual Shares Fund -Class 15.51 5,859.41 O• TFCIY 8 869.584 shares of Income Fund of America Fund - 13.05 11,348.07 Class A; AMECX 9 836.497 shares of Templeton Global Bond Fund - 11.16 9,335.31 Class A; TPINX 10 406.486 shares of Templeton Growth Fund -Class A; 13.08 5,316.84 TEPLX TOTAL (Also enter on Line 2, Recapitulation) 432,830.75 (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) • Rev-1608 EX+ (8-98) ,. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Peterson, Pearl E. 21-08-1205 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 dlscloaed on schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Edward Jones Money Market Account #377-10162 1.07 2 PNC Bank, N.A., Checking Account #5140189629 9,035.23 3 Asbury Communities, Inc. -refund of credit ~ 2,241.56 4 Commonwealth of Pennsylvania - 2005, PA40 income tax refund 635.53 5 Commonwealth of Pennsylvania - 2007, PA40 income tax refund 907.17 6 Commonwealth of Pennsylvania - 2008, PA40 income tax refund 271.00 7 FIA Card -refund of credit ~ - .. 4.72 8 State of NY -refund of unearned, premium 496.26 9 Union Fidelity Life Insurance Co. -refund of unearned premium ~ 11.00 10 United Healthcare Insurance Company -refund 33.82 11 United Healthcare Insurance Company -refund 8.30 12 United Healthcare Insurance Company -refund 9.01 13 United Healthcare Insurance Company -refund 1.37 14 United Healthcare Insurance Company -refund 1.37 15 United Healthcare Insurance Company -refund 393.96 Total of Continuation Schedule See attached page TOTAL (Also enter on Line 5, Recapitulation) 17,726.37 (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) • Rev-1508 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA continue d INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Peterson, Pearl E. 21-08-1205 REV•1151 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Peterson, Pearl E. 21-08-1205 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Tracy L. Olson Social Security Number(s) / EIN Number of Personal Representative(s): street Address ~ 302 Empire Circle - - - city Mechanicsburg state PA zip 10755 Year(s) Commission paid 2. Attorney's Fees SALZMt4NN HUGHES PC 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 Decedent 4,594.87 16,515.00 16,265.00 4. Probate Fees 486.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 256.60 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 38,117.47 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 Peterson, Pearl E. 21-08-1205 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Ewing Brothers Funeral Home, Inc. -funeral services 4,594.87 H-A subtotal 4,594.87 Other Administrative Costs 2 Cumberland Law Journal -Legal advertising 75.00 3 Edward Jones -wire transfer fee ~ 15.00 4 The Sentinel -Legal advertising ~ 166.60 . ~ H-87 Subtotal 256.60 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev1512 EX+ (8-98) 1 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Peterson, Pearl E. 21-08-1205 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Bethany Village -balance due on account 43.88 2 Camp Hill Emergency Physicians -balance due on account 33.46 3 Continuing Care RX -balance due for prescription drugs 1.95 4 Continuing Care RX -prescription drugs 122.41 5 Continuing Care RX -prescription drugs 12.59 6 East Pennsboro Ambulance Service, Inc. -transport service on 10/1/2008 35.00 7 Flagship Rehab -balance due on account ~ 14.21 8 Hampden Physician Associates -balance due on account 865.55 9 1-In~it~no IUeaiiii-~I rrn~in 1 I P _ i-~I~nra~ ri~~o fnr morli~-~I conii~-oc 5$'92 10 Holy Spirt Hospital -balance due for medical service on 8/22108 37.05 11 Holy Spirt Hospital -balance due for medical service 60.00 12 Howard Roy Cohen, M.D. -balance due for medical service 28.60 13 Lower Allen EMS -balance due for medical transport on 9126/2008 69.84 14 Lower Allen EMS -balance due for medical transport on 10/08/2008 68.53 15 Lower Allen EMS -balance due for medical transport on 01/11/2007 66.22 16 Mobile X Ray Imaging Inc. -balance due on account 40.27 17 Nephrology Associates of Central Pennsylvania Inc. -balance due on account 42.90 Total of Continuation Schedule See attached page TOTAL (Also enter on Line 10, Recapitulation) 1,939.62 (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 I (Rev. 6-98) Rev-1512 EX+ (6-98) SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA continued INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Peterson, Pearl E. 21-08-1205 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV-1b13 EX+ (9-00) SCHEDULE J ANIA COMM T BENEFICIARIES NHERI ANCE TTAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Peterson, Pearl E. 21-08-1205 NAME AND ADDRESS OF RELATIONSHIP TO DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY Do Not List Trustee s (Words) ($$$) I • TAXABLE DISTRIBUTIONS [include outright spousal and transfers distributions , under Sec. 9116(a)(1.2)] 1 Tracy L Olson Niece 1/2 residue as 205,250.02 302 Empire Circle per Four. A. of Mechanicsburg, PA 17055 the Will Total 205,250.02 Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropr iate, on Rev 1500 cove r sheet TI. 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 The Salvation Army 68,416.67 2 Disabled American Veterans 68,416.67 3 Helen Krause Animal Foundation, Inc. 68,416.67 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ~ Z05,Z50.0'I Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) Jan. 22, 2009 2:32PM PNC BANK 412-1.05-2747 .~~~ No. /Uj~ r. I/ I pPtvc January 22, 2009 7a~aes D Hughes, Esq. Salzmann Hughes, F.C. 3 54 Alexander Spring Rd Ste I Carlisle, PA 17015 RE: Pearl E Petersen SSN: 081-24-3385 DOD: 11-11-2008 .Dear M.r. Hughes: ~ ~ . In response to your request for Date of Death (DOD) balances for the customer noted above, our records show the following: Checking Account . - ~ Accoux-t # S 140189629 ~ ~ ~ Established: 07-OI-1973 PEARL E PETERSEN DOD balance: $ 9,035.23 non interest bearing ~ . ' Please note that this ofl~ce provides date of death balances for deposit accounts (IRAs, CDs, Checking and . Savings). We do not process any financial transactions or provide statements, If you need assistance with any of these items, please call 1-888-PNC-BANS. (1-888-~62-2265) or stop by Your local PNC dank branch office. Sincerely, Natipnal Financial Services Center PI~TC Baa~1c, N.A. Member FDIC - Fage 1 of 1 .~ d C O b W N O tr? ...y a .. ~ ° z ti ~ ~ L G O ~ •~ O 0 r ~ O Q ~ ~ ~ ~ ~ ~ ~ _ ~ ~ ~ ~ a ~ ~, ~ a ~ ~ w ~ w m i~ ~ ~ ~ N W a c`x° ° ~ '~ ~ 'S ~ ~ oa M ~ ~ ~ ~ ~ U 'D t V to C th '~ ~ ~~ ~ y ~ V ~~ H C ~ ~ •J Qy 7+ ~ .~ ~ ~ ~ U ~ ~ Yo o ~ g ~~ ~ a. ~~ s` ~~ ~O ~m. •~m ~ ~~~ ~ ~~ .y . ~ ~ -~~ ~°. ~~ `°- v ~ `° ~ ~ ~i ~- '~ oNa, ~ r. cad ao_ °°- ~ ~ ;' o ~. m ~ ~v ~ .~ ~ ~ ~ apo ao E ~ °' $, ~ N N ~ ~ ~ --- ~ ~ r `'"' ~ ~ ~` r ~ Cy ~ <fl ifi EA 69 ~ ~ i!3 ~ ~ ~ dg ~ ~ Z ~ ~ ~ to +~ U m ., ~ ~ ~ o 'a -v c ~ ~ a t. G .~y C ~ 'b ; ~ ~ ~i `~ ~ ~ ''~~ ~ ~ ~ ~ ~ c ~ m ~ o ~ ~ ~ ~ c chi a~ '$ O ~ c ~ r; N O M ^~ iri cp ~ t~ o~ vi ° ~ ~ v[~a^~~,~ m U a w~ ~ a CZtZO 3Jad S3NOL' ~~IaMQ3 ZZZ068LLZZ Lb ~ZL 600Z/50/Z0 h C O d?~ Q C `~ C a R /L~ `r •. v W mm $~ cv . p • a 1A ~ ~ a~ ~ -~ ~ a t p p . o ~~~ ~~ ~ w ,~ ,~ ~p ~ O ~ ac y, ~ ~ y C ~ ~ ~L iA~ dd@~ Ef3 6f3 (A 6~ d3 ~ EA 6F} c~ ~ ty '~ tp ~G tG ~ ~ ~ ~ ~ aD ~ ~ ~ ~ ~ N ~ ~ t~ p ~ ~O ~ ~ ~= C] ~ N ~ $ ~ ~ ~ ~ ~ ~ ~ .~ ~ ~ ~ N ~- ~ '~ a F- il'! b9~ ~ t~ 4!~ ~A E~ Ei~ ~ tf3 E9 t,R t~ ER tR ~ ~ ~ ~ ~ ~ '~, ~. ~ o ~ c~ co~ © ~ ue co o ~ ,~ ~ N .~' ~ ~ Qi C~ r s - ~ r ~ -' ~ ~ '~ C ~ ~ ~ O - ~ . m ~' #A 4f3 Efl E~? ~ ~ ~ H O ~ .~ m A d a - ~~ ~ v ~ ~.. ~~ ~ ~ ° . ~ w _ Q~ a. ~ .~ ~ ~ . d. o N a ~ ~ ~+ ~ ~ ~ C ~ N ~ im m ~ cA ~ w ? J .c ~ . ~ ~ ~ V ! 4 ~ i. ~-' ~ ~ ~ - ~' •~ o F- `. d ,"~ ~ .r• ~ t~. ~ ~ r m ~ ~ U ~ o c ~ C~ ~, c r ~ LL ~ ~ ~ 8 5 c~ ~U {i. T2 °d ~2 `Zn C ~ (3 ~1 ~ O ~ C ~ ~TQ~ = W v~ ~ ~ ~ ~ ~~j s ~ ~ ~ ~ a m ~ C ~j li '~~' (~ ~y ~ C F- k-+ ~ 0 1 a ~ c ~, ~ ~ g ~ O ~ ~ ~„~ ~ st ~ ~ "_ ~ as ~ ~ as ~ ~,' ~ ~l~-, ~ m `!~~ ~ * c a~i r ~ ~ r N ~ ~} OD W S "~ ~~! ~ ~ T ~ a7 7 r ~ r N RJ et' LC1 CO P~ C7D ~ O r Nam„ ~ r T ~ ,~' E W~ 0 t /L0 3Jtid S3NOr Q~J'~MQS ttZ068LLtZ Lb=Zt 600Z~50/ZO