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Home My WebLink About11-20-09..J REV-1500 15as6a712a EX (06-05) OFFICIAL USE ONLY PA Department Of Revenue county coca Yer Nunber Bureau of tndividuai Taxes INHERITANCE TAX RETURN 21 0 9 0 5 4 6 Pa eox.zsosol Harrisburg, PA ~~~2t3-oso~ RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 074180949 05012009 07221924 Decedent's Last Name Suffix Decedent's First Name MI SNYDER JANE E (If Applkable) 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 F{LED iN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OYALS BELOW ® 1. Original Return ^ 2. Supplemerthal Return ^ 3. Remainder R~dtm (date ~ death prior tD 12-13+82) ^ 4. limited F_state ^ ^ 5. Federal Estate Tax Return Required 4a. ~~ ~ ~ ~ t ® g. Decedent Dkd Testate ^ 7, At ~ Maakdd ~~ uvhOT~ 8. Total rhnnbel' of Sate Depaeit Boxes i ~r t~h mar a vuN ^ 9. Litigation Proceeds Received ^ 10. 121,- ~~ loath ^ 11. Eiectfott tD ta% under Sec. 9113(Ai (Attach Sch. p) ESPONDENI' -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL 7AX INF SHOULD BE DIRECTED TO: R C OR e a n NN Da~yi~rte Teleiphbne Number JEAN D SEIBERT 7172369301 Firm Name (tf Applicable) REt313TER OF WILLS USE ONLY WION, ZULLI AND SEIBERT ~, First IMe of address C'p °w ` ~ 109 LOCUST STREET r inn ~ c; ~ ~~~ 5scond Itne of address City or Post Office HARRISBURG _' t'~ ~ N i'%_ C~J Qr,. a_ ~ ~.' ,...i ?" X17 ~~ t~ _:~:' t:_.:i State ZIP Code PA 17101 ~. ~ -' CorraspondeM'se~rlaitaddress: wzsf~mindspring.com Under. pentitlos d perjtx~r, l dadare lhat i tyre e~tnkteM this return, kttA~ng acoompEaryln~p sdteduies and and to the of my krtoMVledge and belief, it is Uuis correct and corrtplete• Dedaratbn or preperer other than the personal raprdvb is based on a6 'ot which has any knowledge. S. Walters 72TS Union Deposk Road, Hummedtown, PA 1T0S6 Jean D Seibert 109 Locust Street, Hat'risburg, PA 17101 Side 1 ~, 1505607120 1505607120 J 1505607220 REV-1500 EX Decedent's Social Security Number Decedents name: S N Y D E R, JANE E. 0 7 418 0 9 4 9 RECAPITULATION 1. Real Estate (Schedule A) .......................................................................................... 1. 2. Stocks and Bonds (Schedule B) ............................................................................... 2. 1 6 3, 2 5 5. 0 9 3. Closely Held Corporation, Partnership or So{e-Proprietorship (Schedule C).......... 3. 4. Mortgages & Notes Receivable (Schedule D) .......................................................... 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ................ 5. 2 9 , 8 0 1 . 8 4 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............. 6. 12 , 7 7 8 . 6 5 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ............. 7, 8 2 , 1 8 0 . 5 9 8. Total Gross Assets (total Lines 1-7) ....................................................................... 8. ~ 8 8 , 016.17 9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9. 1 9 , 0 8 9 . 7 8 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10. 7 , 4 0 5 . 4 2 11. Total Deductions (total Lines 9 & 10) ...................................................................... 11, 2 6 , 4 9 5 . 2 0 12. Net Value of Estate (Line 8 minus Line 11) ............................................................. 12. ~ 6 1 , 5 2 0 . 9 7 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. 2 6 1 , 5 2 0 . 9 7 TAX COMPUTATION -SEE {NSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .00 15. 16. Amount of Line 14 taxable at lineal rate X .045 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 2 61 , 5 2 0. 9 7 18. 3 9, 2 2 8.15 19. Tax Due ..................................................................................................................... 19. 3 9 , 2 2 8.15 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ Side 2 1505607220 150560720 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 - 09 - 0546 A Snyder, Jane E. STREET ADDRESS 5225 Wilson Lane, Apt. 222 CITY Mechanicsburg STATE PA ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 39,228.15 2. CreditsJPayments A. Spousal Poverty Credit B, PriarPayments 37,156.00 C. Discount 1,955.58 Total Credits (A + B + C) (2) 3 9 ,111.5 8 3. Interest/Penalty if applicable p, Interest E, Penalty Total Interest/Penalty (D + E) (3) 0.0 0 4. if Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) 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. (5) 116.57 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE, (5B) 116.5 7 Make Check Payable to: REGISTER OF WILLS, AGEWT 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 .................................................................................................................. x d. receive the promise for life of either payments, benefits or care? .............................................................. 0 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 "intrust for" or payable upon death bank account or security at his or her death?......... ^ 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ...................................................................................................................... ~ ^ 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 (O) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exemot 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, whethr3r by blood or adoption. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS FILE NUMBER ESTATE OF Snyder, Jane E. 21 - 09 - 0546 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 Wells Fargo Advisors Account consisted of below: 2 2,249.2370 Shares of Calvert Income Fund @ $14.14 per share 14.14 31,804.21 3 181.7850 Shares of Capital Income Builder @ $42.95 per share 42.95 7,807.66 4 2,761.1560 Shares of Evergreen Asset Alloc @ $9.82 per share 9.82 27,114.55 5 2,039.3520 Shares of First Eagle Overseas @ $17.18 per share 17.18 35,036.06 6 280.8200 Shares of First Eagle Global @ $34.96 per share 34.96 9,817.47 7 3,585.0840 Shares of Loomis Sayls @ $10.40 per share 10.40 37,284.87 8 1,409.4290 Shares of Pimco RL Return @ $10.21 per share 10.21 14,390.27 TOTAL (Also enter on line 2, Recapitulation) 163,255.09 SCHEDULE E CASH, BANK DEPOSITS, & MISC. coI~M10NWEALTHOFPENNSYLVANIA PERSONAL PROPERTY INHERRANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF Snyder, Jane E. 21 - 09 - 0546 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 DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 Wells Fargo Money Market Account 10,875.26 2 M8~T Bank Checking Account No. 80460208 13,604.08 Accrued Interest 0.51 3 M&T Bank Savings Account No. 15004205996729 1,011.06 Accrued Interest 0.01 4 2 Rings -Appraised value 725.00 5 Social Secuirty Deposit 6-3-09 1,234.40 6 :Refund from Capital Blue Cross 149.52 7 .Refund from Erie Insurance 55.00 8 Refund from Bethany Village 2,147.00 TOTAL (Also enter on Line 5, Recapitulation) ~ 29,801.84 SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN ESTATE OF Sn der, Jane E. FILE NWMSER Y 21 - D9 - 0546 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedwle G. 7276 Union Deposit Road Hummelstown, PA 17036 RELATIONSHIP TO DECEDENT ADDRESS SURVIVING JOINT TENANT(S) NAME Sally S. Walters A IOINTLY OWNED PROPERTY: Second Cousin ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT C~F~S lP ,10~ F PRO RTkY Include name o Inanclal Ins I u Ion an ban account number or similar identifying number. Attach deed forjointly-held real estate. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST 1 A 03/05/2007 M&T Bank Savings Account No. 10,180.84 50% 5,090.42 15004214960195 A Accrued Interest 0.38 50% 0.19 2 A 03/05/2007 M8~T Bank Certificate of Deposit No. 15,000.00 50% 7,500.00 31003919238294 Accrued Interest 376.08 50% 188.04 TOTAL (Also enter on line 6, Recapitulation) I 12,778.65 COMMONWEALTH OF PENNSYLVANIA SCHEDULE G INHERITANCE TAX RETURN INTER-VIVOS TRANSFERS & RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY ESTATE OF Snyder, Jane E. I FILE NUMBER 21 - 09 - 0546 This schedule must be completed and filed if the answer to any of questions 1 through 4 an page 2 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY Include the name of the transferee, their relationship to decedent and the date of transfer. Attach a copy of the deed for real estate. DATE OF DEATH VALUE OF ASSET u~ OF DECD'S INTEREST EXCLUSION (IF APPLfCABLE) TAXABLE VALUE 1 Prudential Annuity, ~,.~, ,,~ ~~ 76,128.77 76,128.77 2 Wells Fargo (RA, 616.2750 Shares of Evergreen 6,051.82 6,051.82 Asset Alloc @ $9.82 per share, Beneficiary is Sally Walters, her second cousin TOTAL (Also enter on line 7, Recapitulation) ', ~ 82,180.59 S(~Dl~ H FUNERAL D(PENSES & COMMONWEALTH OF PENNSYLVANIA ~w p/~ ~+ INHERRANCE TAX RETURN ~~~Tf WTI Y G ~ 1 ~7 RESIDENT DECEDENT FILE NUMBER ESTATE OF Snyder, Jane E. 21 - 09 - 0546 Debts of decedent must be reported on Schedule I. ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT A. 1 Memorial Service 250.00 2 Orchard Hill Cemetery 100.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Sally S. Walters Social Security Number(s) / EIN Number of Personal Representative(s): Street Address 7276 Union Deposit Road city Hummelstown state PA zip 17036 Year(s) Commission paid 2. Attorney's Fees Wion, Zulli 8~ Seibert 3, Family Exemption: {!f 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 Register of Wills 5. Accountant's Fees 6. Tax Return Preparer's Fees ~. Other Administrative Costs 1 Cumberland County Law Journal -Advertising 10,965.00 7,000.00 352.00 75.00 TOTAL (Also enter on line 9, Recapitulation) 19,089.78 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Snyder, Jane E. Sd,e H A,,~.,F~,u~n,~er~a,~NEx^pen~ses & /"ICY 1 ~11R4auY~ ~+~JO~ 2 ~ The Sentinel -Advertising 3 ~ The Jeweler's Bench -Ring appraisal 4 ~ Postage to mail rings FILE NUMBER 21 - 09 - 0546 208.78 114.00 25.00 Page 2 df Schedule H SCHEDULEI DEBTS OF DECEDENT, MORTGAGE conMONwEUTHOFaENNSVI_vnNw LIABILITIES & LIENS INHERRANCE TN(RETURN 7 RESIDENT DECEDENT FILE NUMBER ESTATE OF Snyder, Jane E. 21 - 09 - 0546 Include unreimbursed medical expenses. ITEM DESCRIPTION AMOUNT NUMBER 1 Outstanding checks from date of death balance ($94.00, 94.00, 117.40, 395.00, 47.00 and 794.40 47.00) 2 ~ Money Financial Reclaim Deposit made on 6-1-09 ~ 509.17 3 ~ Bethany Village Rent ~ 4,953.00 4 ~ Phone Bill I 146.53 5 ~ Comcast Cable k 5.88 6 ~ West Shore EMS ~ 896.44 7 ~ Pa Department of Revenue -Estimated 3rd Qtr Income Tax ~. 100.00 TOTAL (Also enter on Line 10, Recapltulatlon) ~ 7,405.42 REV-1613 EX+ (9-00) SCHEDULE) COMMONWE4LTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF I FILE NUMBER Snyder, Jane E. 21 - 09 - 0546 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) SHARE OF ESTATE (Words) AMOUNT OF ESTATE ($$$) I~ TAXABLE DISTRIBUTIONS [include outright spousal distributions and transfers under Sec. X116 (a) (1.2)] 1 Sally S. Walters Cousin 75 % of Residue 7276 Union Deposit Road Hummelstown, PA 17036 2 Barbara Chervanik Cousin 25 % of Residue 2664 Nestlebrook Trail Virginia Beach, VA 23456 3 Michael Hartsock Cousin Ring 5612-D Tumbleweed Circle Richmond, VA 23228 Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropriate, on Rev 1500 cover sheet ~ NON-TAXABLE DISTRIBUTIONS: ~ A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 REV-1613 F,t+ (9.00) ~ SCHEDULE J COMM ANIA R A D BENEFICIARIES continued NHE NCE TAXRETURN RESIDENT DECEDENT ESTATE OF I Snyder, Jane E. FILE NUMBER 21 - 09 - 0546 NUMBER NAME AND ADDRESS OF PERSON(S) RELATIONSHIP TO DECEDENT SHARE OF ESTATE (Words) AMOUNT OF ESTATE ($$$) RECEIVING PROPERTY oo Not ust Trustee(s) I~ TAXABLE DISTRIBUTIONS [include outright spousal distributions and transfers under Sec. X116 (a) (1.2)] 4 Steven Hartsock Cousin Ring 7208 Hazel Avenue Upper Darby, PA 19082 Pegg 2 of Schedule J