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Home My WebLink About07-14-09 (3)15056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 09 0320 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 181-05-7871 01 /16/2009 02/15/1915 Decedent's Last Name Suffix Decedent's First Name MI Walter John H (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 FILL IN APPROPRIATE OVALS BELOW i 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate 4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Oied Testate 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received 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 Peter J. Russo, Esq (717) 591-1755 Firm Name (If Applicable) REGISTER OF wiLL5 USE ONLY Law Ofc Peter Russo '"~' First line of address ( ~~ ~ ~^;! ~ ~ -r~ -~ 7 ' 5006 E. Trindle Road , ; r? ~-• r" 6 ~ C _~ ~ ~ ~ ~ ~.> m ~, _ . _ ~ E_._ ~ Second line of address _r.1 ~~ .~ ='•; ;~'~ Suite 100 ~ x` ;'-.'' -r~ `,~ `= City or Post Office `~B~1FILED State ZIP Code r-i ~ ~-~ ~- b ~ i Mechanicsburg PA 17050 -- s c:~7 - ,, Correspondent's a-mail address: prUSSO@pjr18W.COn1 Under penalties of perjury, 1 declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, corcect and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATU OF PEftSAN RESPONj616LE FQR,FILING RETURN DATE w . -~L/~-4=~ ~/ 9/ o 3 ~ ~o ~ ~ M-~E,, 2,~ V~1 cL.~ v, , ~, ~ 1~Y~ ~ "? c) ~ U PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 15056052059 REV-1500 EX Decedent's Social Security Number John H Walter Decedent's Name: 181-05-7871 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. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ..... ... 5. ` 34,368.66 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. 34,368.66 9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. 2,078.58 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. ... 10. 7,728.77 11. Total Deductions (total Lines 9 & 10) ................................ ... 11. 9,807.35 12. Net Value of Estate (line 8 minus Line 11) ........................... ... 12. 24,561.31 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. 24,561.31 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 .0 45 24,561.31. 15. 1,105.26 16. Amount of Line 14 taxable at lineal rate X .0 _ 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 1 g. 19. TAX DUE ....................................................... ..19. 1,105.26 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 ' 09 ' 0320 DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER John H Walter 181-05-7871 STREET ADDRESS Green Ridge Villiage 210 Big Spring Road CITY STATE ZIP Newville PA 17241 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable D. Interest E. Penalty (1) Total Credits (A + B + C) (2) 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. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) (4) (5) (5A) (56) 1,105.26 0.00 0.00 1,105.26 1,105.26 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 : ............................................ ^ 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 exert 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 isdefined, 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+ (6-98) ~ Y~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER John H. Walter 21-09-0320 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. tir more space is needed, insert additional sheets of the same size) MetLife Investors USA Insurance Company P.O. Box 295 Des Moines, IA 50301-0295 ESTATE OF JOHN WALTER 708 SOMERSET DR MECHANICSBURG, PA 17055 Metl.if a .. Date: 07-01-2009 Check No: O~naA77F~ REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNED~ILE N FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t' Conklin Funeral Home 617 52 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) David J. Walter Social Security Number(s)IEIN Number of Personal Representative(s) Street Address 708 Somerset Drive city Mechanicsburg .State PA zip 17055 Year(s) Commission Paid: 2. Attorney Fees 1,156.06 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. Probate Fees 155.00 5. Accountant's Fees 6. Tax Return Preparer's Fees ~. Preperation and Filing of Rev-1500 150.00 _ TOTAL (Also enter on line 9, Recapitulation) $ 2,07$.58 (If more space is needed, insert additional sheets of the same size) Cocklin Funeral Home ,Inc. 30 N. Chestnut Street Dillsburg, PA 17019 (717)432-5312 May 4, 2009 Mr. David J. Walter 708 Somerset Drive Mechanicsburg, PA 17055- The Funeral Service for Mr. John H. Walter We sincerely appreciate the confidence you have placed in us and will conti nue 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. (A) OUR SERVICE: BASIC SERVICES OF FUNERAL DIRECTOR & STAFF $3725.00 FUNERAL, HOME SERVICE CHARGES - $3723.00 SELECTED MERCHANDISE: Antique Gold . _ $2895.00 Monarch . . . . . . . . . . . . . . . . $990.00 THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED $7610.00 Cash Advances Flowers. _ _ _ $135.68 Certified Copies of the Death Certificate . _ $60.00 Clergy Honorarium $100.00 Cemetery Opening & Closing $750.00 Newspaper Obituaries -Harrisburg _ $279 27 -Carlisle _ _ _ $138.40 Banner. $35.0() Cemetery Equiptment, _ _ _ $150.00 Date of Death Plates . $300.00 TOTAL CASH ADVANCES AND SPECIAL CHARGES • $1948.35 Total Total Cost , $9558.35 SUB-f0'fAL $9558.35 INITIAL PAYMENT /DISCOUNT /CREDITS 8940.83 TOTAL AMOUNT DUE $617.52 'he unpaid balance over 0 days is subjected to a 0.50 % service charge per month - 6.0000 % per annum. Mr. John H. Walter Page 1 ORIGINAL 4C~(~'~ mod. ACCT. NO. F . C~o~ Funeral Services wed ~ Name of Deceased CHECK # ~ oAROIT COCKLIN FUNERAL HOME, I1VTC. ^ OTHER a I ~ ~~. «~.~ LAST BALANCE $ 9~Q 3...) INTEREST U LATE PAYMENT CHARGE 3UB TOTAL CREDITS _ESS PAYMENT / ~~ ~ .-- VEW BALANCE $ ~~~~~ ~ Pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER John H. Walter 21-09-0320 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. It more space is needed, insert additional sheets of the same size. }'~ coMMONwFxTN of PENNSnvANw DEPARTMENTOF PUBLIC WELFARE BUREAU OF FINANCIAL OPERATIONS DMS~N OF THIRD PARTY LNBILIiY ESTATE RECOVERY PROGRAM PO 80X8486 HARRISBURG. PA 171058468 April 15, 2009 LAW OFFICES OF PETER J RUSSO PC PETER J RUSSO ESQUIRE 5006 TRINDLE RD STE 100 MECHANICSBURG PA 17050 Dear Attorney Russo: Re: JOHN WALTER CIS #: 730186276 SSN: 181-05-7871 Date of Death: 01/16/2009 Please be advised that the Department of Public welfare maintains a claim in the amount of $7,728.77 against the above-mentioned estate. This claim is for restitution of medical assistance granted on behalf of the decedent for which the Probate Estate is now responsible to reimburse the Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as amended by Act 20-95, effective June 30, 1995. 8nclosed is the Department's itemized statement of claim. A portion of this medical expense, namely $984.07, was incurred during the last six months of the decedent's life; therefore, it is a Class 3 claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $6,744.70, is to be entered as a priority Class 5.1 claim against the estate. Please acknowledge receipt of this letter and advise whether the Commonwealth's claim is admitted and when payment may be expected. If the estate accounting is complete, please provide a copy. If the estate contains real estate, please provide copies of the deed, the latest tax assessment, and a current appraisal, if available. Sincerely, LL~o Jt! L ~~ Karen P. Georgoulis Claims Investigation Agent 717-214-1283 717-772-6553 FAX Enclosure ~~ PETER J. RUSSO, ESQUIRE ASHLEY R. SIPE, PARALEGAL Register of Wills Cumberland County 1 Courthouse Square Carlisle, PA 17013 LAW OFFICES OF PETER J.RUSSOPC. ATTORNEYS AT LAW Monday, July 13, 2009 ELIZABETH J. SAYLOR, ESQUIRE AMBER L. SOUTHARD, PARALEGAL RE: Estate of John H. Walter, Deceased Dear Sir or Madam: rv c-, ~:~ :~ -~: C ritd 3 ..... r / ~ ~ ~ ~, ~ ~~ f . J L ` ~ ~ _ ~. r t Enclosed please find the original and two (2) copies of the Certification of Notice Under Pa. O.C. Rules 5.6(a) as well as the complete Revenue 1500 for the above mentioned matter as well as a copy. Please file the originals and return a time stamped copy in the envelope provided. I have also enclosed the filing fee and the check for the inheritance tax due. Should you have any questions please feel free to contact our office. Thank you for your assistance in this matter. Very truly yours, ~ 2_ As ley R. S'pe, Para egal i Enclosure 5006 EAST TRINDLE ROAD, SUITE 100, MECHANICSBURG, PA 17050 PHONE: (717) 591-1755 FAX: (717) 591-1756 ~~ ti~ ~~ r a ~ `~ M O f,~ ~ ~ ~ ~ c ~ a i ~ '~ I~,¢ i~~~.~ ~~, ti~~. _~~ ~ ~•. "' ~~ ~~ M_ W ~ ~O - O (q 3~ ~,~ ~~ ~Q o~oa a~ ~ a~ N ~ ~ N .~ ~ O .~ y~U~ ~U~U 0 N N L Q~ ~. a 0 0 T ' •7 O ~~1 ~ Lr ~;~~; y 77Lj 4 ~ ~ ii:,JJ f,,,j ~ Q ~~ °' r i = ~ bid 't 1 ~r1r 6002 ~_ _~