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Home My WebLink About07-27-0915056051058 REV-1500 EX (O6-OS) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN /~ ~ f~ Harrisburg, PA 17128-0601 RESIDENT DECEDENT ~ ~ ~ V(J~`~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 162-36-8676 03/29/2009 10/29/1946 Decedent's Last Name Suffix Decedent's First Name MI BURNS MERRIAM A (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 • 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 Died Testate 7. Decedent Maintained a Living Trust 0 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 ELIZABETH FEATHER, ESQ. Firm Name (If Applicable) _ . _ .,. REGISTER OF WILLS USE C~jY CALDWELL & KEARNS, P.C. I ~ ° ., First line of address _.. o ~ ." -17 ~_, , ,._ ; ; ~ . 3631 N. FRONT STREET '~ ~ rr t"- 4 ` ~ -; `~ , ~-t r.~ ( ,, Second line of address , ~ _7 t ,: ~ ;c _, ... City or Post Office State ZIP Code _ DAT7=Dl1tED ._ - r=~~~ --f ~, .. HARRISBURG PA 17110 ~ Correspondent's a-mail address: efeatherl~caldwellkearns.com 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, cone and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGN U F PERSO E$PO SIBLE FOR FILING RETURN DATE i a ~i~I~A~CK AD, MECHANICSBURG PA 17055 ' S~NA _ OFD PREP~1REBtOTHEFj THAN REPRESENTATIVE neT~ ADDR ~S 363 N. FRONT STREET, HARRISBURG, PA 17110 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 o~ 15056052059 REV-1500 EX Decedent's Social Security Number ~ecedent•s Name: MERRIAM A BURNS 162-36-8676 RE CAPITULATION _ _ 1. Real estate (Schedule A) . ......................................... ... 1. 0.00 2. Stocks and Bonds (Schedule B) .................................... ... 2. 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. 0.00 4. Mortgages & Notes Receivable (Schedule D) .......................... ... 4. 0.00 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ..... ... 5. 4,587.68 6. Jointly Owned Property (Schedule F) " , Separate Billing Requested .... ... 6. 0.00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) _::.; Separate Billing Requested..... ... 7. 0.00 8. Total Gross Assets (total Lines 1-7) ................................. ... 8. 4,587.68 9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. 4,587.68 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .. 10. 0.00 11. Total Deductions (total lines 9 & 10) ................................ ... 11. 4,587.68 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 0.00 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which ` " an election to tax has not been made (Schedule J) ...................... .. 13. 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. 0.00 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_ 15. 16. Amount of Line 14 taxable at Iineai rate X .0 45 0.00 16. 0.00 17. Amount of Line 14 taxable _ _ _ at sibling rate X .12 17. 18. Amount of Line 14 taxable ` at collateral rate X .15 18. 19. TAX DUE .................................................... .. . .. 19. 0.00 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 DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER MERRIAM A BURNS 162-36-8676 STREET ADDRESS 940 WALNUT BOTTOM ROAD CITY STATE ZIP CARLISLE PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits(Payments A. Spousal Poverty Credit _ B. Prior Payments _ C. Discount 3. Interest/Penalty if applicable D. Interest E. Penalty 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. (1) (3) (4) (5) (5A) (5B) 0.00 Make Check Payable to: REGISTER OF W1LLS, 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? .............. ^ Q 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ ^ ^Q 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-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, 8~ MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER MERRIAM A. BURNS 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, (It more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER MERRIAM A. BURNS Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~ Cocktinfuneral Home, Inc. 3,005.23 2. Stonemor Partners, L.P.-opening of grave and grave marker 1,582.45 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)IEIN Number of Personal Representative(s) Street Address City ,State Zip Year(s) Commission Paid: 2. Attorney Fees 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 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ 4,587.68 (If more space is needed, insert additional sheets of the same size) EXHIBIT -SCHEDULE E ~ • • unum~ May 8, 2009 JEFFERY ZINN ESTATE OF MERRIAM A BURNS 325 HEMLOCK ROAD MECHANICSBURG, PA 17055 Unum Extended disability Benefits PO Box 100158 Columbia, SC 29202-3156 Phone:l-800-822-9103 Fax: t-888-249-2540 www. unum.com ,~r,4~ ~~ ( ~, ~~ G.~~`~' RE: Bums, Merriam A DOB: October 29, 1946 Claim Number: 3462928 Policy Number: 84009 Unum Life Insurance Company of America Dear Mr. Zinn: Please accept our sincere condolences on the loss of your mother. We understand that she passed away on March 29, 2009. This letter concerns her Long Term Disability claim. Under separate cover, we are sending a final benefit check payable to Men-iam Bums for benefits owed prior to her passing, totaling $839.93. This check includes benefits for the period from March 26, 2009 through March 28, 2009, in the amount of $124.93, and a reimbursement for the deduction of social security benefits for the period from March 1, 2009 through March 25, 2009, in the amount of $715.00. A copy of our calculation is enclosed. In addition, this policy includes a Survivor Benefit defined as follows: "WHAT BENEFITS WILL BE PROVIDED TO YOUR FAMILY IF YOU DIE? {Survivor Benefit) When UNUM receives proof that you have died, we will pay your eligible survivor a lump sum benefit equal to 3 months of your gross disability payment if, on the date of your death: - your disability had continued for 180 or more consecutive days; and - you were receiving or were entitled to receive payments under the plan. If you have no eligible survivors, payment will be made to your estate, unless there is none. In this case, no payment will be made. However, we will first apply the survivor benefit to any overpayment which may exist on your claim." "Eligible survivor means your spouse, if living; otherwise your children under age 25." 1242-03 UNUM IS A REGISTERED TRADEMARK AND MARKETING BRAND OF UNUM GROUP AND ITS INSURING SUBSID]ARIES. Claimant Marne: Bettis, Merriam A Claim Number. 3462928 May 8, 2009 Page 2 of 2 Since your mothers Long Term Disability policy contained the above provision, a survivor benefit may be payable. If we can locate a survivor as defined above, we will provide that individual with a benefit in the amount of $3;747.75. If them are multiple eligible survivors, the benefit will be distributed equally between them. If the-•e ar•e no eligible survivor, but an estate exists, we will make this benefit payable to the estate. If we are unable to locate a survivor and no estate exists we vriN be unable to hay a survivor benefit according to the terms of the con tr-act. So that we may determine if a benefit is payable and to whom, please contact us within 30 days of the date you receive this letter if you have any information about an eligible survivor or an estate in the name of Merriam Burns. We require the following information: A capy of Merriam Burns's death certificate; and The name(s), address(es), date of birth(sJ, and Social Security numbers} of any eligible survivor; If there are no eligible survivors, but an estate exists, please provide the estate identification number. Mr. Zinn, if you have any questions, please feel fire to contact me at 1-800-822-9103, extension 56349. Again, we offer our sincere condolences for your loss. Since rely, Linda. ,S'..GZ6C1"~~1. Linda S. Liberty Benefits Center P.epr-esentative Enclosures: Financial: Benefit Calculation Return Envelope -Columbia (18506) CC: HIGHMARK, INC./Lori Caffarella (without enclosures) 05/07/09 Benefit Rep: C1L2L Page 1 Claimant: BURNS,MERRIAM Policyholder: ;009 Recalc ulation for 02/26/2009 - 03/25/2009 LTD benefits were paid as follows: Benefit Begin End Duration Monthly Total Ref Z~Pe Date Date Amount Amount Basic Benefit 02/26/09 - 03/25/09 1 mo $1,249.25 $1,249.25 Primary Soc Sec 02/26/09 - 03/25/09 1 mo $856.00- $858.00- Gross payment without taxes: ~ $391 25 LTD benefits should have been paid as follows: Benefit Begin End Duration Monthly Total Ref ~Pe Date Date Amount Amount Basic Benefit 02/26/09 - 03/28/09 1 mo, 3 d $1,249.25 $1 374.18 Primary Soc Sec 02/26/09 - 02/28/09 5 d $858.00- , $143.00- Total that should have been paid: $1 231.16 Underpayment Information for 02/26/2009 - 03/25/2009 Total amount paid $391.25 Total that should have-been paid $1,231.18 Gross underpayment $839.93- LESS SUI~V=VnR BENEFIT $3,747.75 Net underpayment $4,587 68- UNUM LIFE INSURANCE COMPANY OF AMERICA EXTENDED DISABILITY BENEFITS PO BOX 100158 COLUMBIA, SC 29202-3158 JEFFERY ZINN ESTATE OF MERRIAM A BURNS 325 HEMLOCK ROAD MECHANICSBURG, PA 17055 EXHIBIT -SCHEDULE H Cocklin Funeral Home ,Inc. 30 N. Chestnut Street Dillsburg, PA 17019 (717)432-5312 July 8, 2009 Mr. Jeff S. Zinn 325 Hemlock Road Mechanicsburg, PA 17055- The Funeral Service for Mrs. Merriam A. Burns We sincerely appreciate the confidence you have placed in us a~ld will continue 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: Cremation Option #11 _ _ _ $2490.00 FUNERAL HOME SERVICE CHARGES $2490.00 SELECTED MERCHANDISE: Chasmere Gray _ _ $245.00 THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED $2735.00 Cash Advances Certified Copies of the Death Certificate . , Newspaper Obituary -Harrisburg . _ . - Carlisle . . TOTAL CASH ADVANCES AND SPECIAL CHARGES . Total Total Cost . . SUB-TOTAL INITIAL PAYMENT /DISCOUNT /CREDITS TOTAL AMOUNT DUE ie unpaid balance over 0 days is subjected to a 0.50 % service charge per month - 6.0000 % per annum. $6.00 $170.07 $94.16 $270.23 $3005.23 $3005.23 1011.93 $1993.30 Mrs. Merriam A. Burns Page 1 )~-: ~" -+.. a' .ily~' ... _ ... .. ~' «'. 1~~1~~l~ ~~~4rrtii~~: ~~ J k ~ Cum6ertandvalley ~(emoriatGar'rfens 1921 Ritner Highway Carlisle, PA 17013 `Westminster Cemetery 7ri-~'ouuty .9~femoriatGardens 1159 Newville Road 740 Wyndamere Road Carlisle, PA 17013 Lewisberry, PA 17339 ~2~T 2 ~Nt N ,~;~~~.~~~~~ , ~a , c Ito ss ~ ~. ~-~; ~~ ~p~M~~°~ ~~ ~ ,cno~.cr~ ~ ~ ~ R ~~M ~ . ~~ e~ e,~ 6~ c~c~e. ~ ~ ,5 0 0 ~~x 1e ~~ T~\\h. ~Q ~~l ~' ~~~~ ~~~ ~ ~~~s JAMES R. CLIPPINGER CHARLES J. DEHART, III JAMES L. GOLDSMITH P. DANIEL ALT LAND JEFFREY T. MCGUIRE• STANLEY J. A. LASKOWSKI DOUGLAS K. MARSICO BRETT M. WOODBURN MICHAEL D. REED PAULA J. LEICHT ELIZABETH H. FEATHER KAREN W. MILLER DOUGLAS M. OBERHOLSER •BOARD CERTIFIED CIVIL TRIAL ADVOCATE CALDWELL &KEARNS A PROFESSIONAL CORPORATION ATTORNEYS AT LAW 3631 NORTH FRONT STREET HARRISBURG, PENNSYLVANIA 17110-1533 July 23, 2009 Glenda F. Farner-Strausbaugh, Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013-3387 RE: Estate of Merriam A. Burns Date of Death: March 29, 2009 Dear Ms. Farner-Strasbaugh: OF COUNSEL CARL G. WASS JAMES D. CAMPBELL. JR. THOMAS D. CALDWELL. JR. 119 2 8-2 0011 RICHARD L. KEARNS RETIRED 717-232-7661 FAX: 717 - 232- 2766 thefirm~caldwellkearns.com n . a `~ ~ ' w ,_~ _ ~ : ~~~ rte- `I '"- m N r_ ~i ~:~ ._., - '. _.` "' ~ t - 0 , . cri Enclosed please find the original and two copies of the Pennsylvania Inheritance Tax Return in regard to the above-referenced Estate. Please file the same and return one time- stamped copy to me in the enclosed self-addressed, stamped envelope. Please note that I have not enclosed a check as there is no inheritance tax due. Additionally, after I receive a certificate from your office showing the status of the filing of the Inheritance Tax Return, I will be filing a Petition to Settle a Small Estate, which is why a file has not yet been opened in your office for this matter. If you have any questions, please do not hesitate to contact me. Very truly yours, ~~~~ Elizabeth H. Feather CALDWELL &KEARNS, P.C. ef-eaihcrr~i'c<:tlde~ e1ll.ez~~~l~~;.cc~~>~ EHF:se Encs. ec: Mr. Jeffery Zinn (w/enc.) 09204-001/151261 c4~ ~''~ •; . ~~~~: ~~~'~' ~ ~' J~~~,Nf v r cc;l 7!r' '~` ~ +-~ .-~ y ,~ i '~} ^. ._ ;, „~ _ _ ,~ . _ r,,- (` ~!~ 1 _ „ 0 L ~ ~ O ~ ~ ~ ~ ~M O ~ C'7 p~U~~ ~ >, m o ~ ~ o ~ o ~ Q cLoU ~a ~~o~ L~U~ E°~~~`v ~ ~~U ~ U c~ c a~ W W Q a c~ ~ ~ w "~ w ~ ~ o ~- r z o Q ~ ~ _ ~ ~ ~ ~ ~ O Z cn ~ ~ co Q o'~ _ C~