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HomeMy WebLinkAbout11-30-09-~ REV-1500 15056177120 EX (06-05) OFFICIAL U3E ONiLY PA Department Of Revenue County coos rear Foe Number Bureau of Individual Taxes INHERITANCE TAX RETURN 2 1 0 9 0 3 5 6 PO BOX.280601 Harrisburg, PA X7128-ost)1 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 171285279 03252009 07301928 Decedent's Last Name Suffix Decedent's First Name Mi TARNER RICHARD W (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 Retum ^ 2. Supplemental Retum ^ 3. Remainder Retum (date of death prior to 12-13-82) ^ 4. Limited Estate ^ qa, Future Interest Compromise ^ 5. Federal Estate Tax Retum Required (sate or death aner 1z-lz-sz) 0 ® g Decedent pied Testate (Attach Copy o} wllq [] 9. Litigation Proceeds Received ^ ~ Decedent Makdahed a Living Trust (Attach Copy of Trusq 1 p Spousal PoveM Credit Nate of death ^ belwee~ 12-31- 1 and i-1-95) 8. Total Number of Safe Deposit Boxes ^ 11. Election to tax under Sec. 9113(A) (Attach Sch. O) NameESPONDENT - 7HI3 SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATI N SHOULD BE DIRECTED TO: N Daytime Telephone Number HAMILTON C DAVIS 7175325713 Firrn Name (If Applicable) ZULLINGER DAVIS, PC First line of address 20 EAST BURD STREET, SUITE 6 Second line of address City or Post Office State ZIP Code SHIPPBNSBIIRG PA 17257 REGISTER OF WILLS USE ONLY t""~ rwa c,°. w c~ ~ ~ '`~ C~ ~ C7 ~ •>r- -.~ _ ~~ ~,• ~ ~ © %) DAT~' ~D~ ~ ---. =... --i .. t. -. ~~ 7 ~~`s <`"^1 ^Tk ,~_:, r`-ri ~a fU + Comespondent'se-maiiaddress: HCDaLDhamiitondavislaw.com U sdtrueeo r~ecst aond~~mp ie~ t~daratlon of prep mer~oUter than ttteip~e soul re~premseanta vn9e is~l>~sed on eldl nfortnatio~ri of wti'lochfhpr parer has any kn~o9wleedge.~lief, ,~,~,Q,J HOWARD W. TARNER / / 68 LANTERN LANE, SHIPPENSBURG, PA 17257 SIGNA %~F PREPAR OTHER THAN REPRESENT/~FIVE DATE ~./e ~ (/7i~...----~'° Hamilton CDavis - //z.~'7'U q 20 East Burl Street, Suite 6, Shippensburg, PA 17257 Side 1 1505607120 1505607120 1 1505607220 REV-1500 EX Decedent's Social Security Number oeeeaenra Name: T A R N E R, RICHARD W. 17 12 8 5 2 7 9 RECAPITULATION 1. Real Estate (Schedule A) .......................................................................................... 1. 970.00 2. Stocks and Bonds (Schedule B) ............................................................................... 2. 3. Closet' Held Corporation, Partnership orSole-Proprietorship (Schedule C).......... 3. 4. Mortgages & Notes Receivable (Schedule D) .......................................................... 4. 103,621.50 5• Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ................ 5. 6. Jointy Owned Property (Schedule F) ^ Separate Billing Requested ............. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 0 0 0 (Schedule G) ^ Separate Billing Requested ............. 7, . 8. Total Gross Assets (total Lines 1-7) ....................................................................... g, 1 0 4, 5 9 1. 5 0 4,796.25 9. Funeral Expenses $ Administrative Costs (Schedule H) ......................................... 9. 2 9 . 7 9 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10. 11. Total Deductions (total Lines 9 & 10) ...................................................................... 11. 4,826.04 12• Net Value of Estate (Line 8 minus Line 11) .......................... ................................... 12. 9 9 , 7 6 5 . 4 6 13. Charitable and Govemmentai 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. 99,765.46 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 .00 15. 16. Amount of Line 14 taxable at lineal rate X .045 16. 17. Amount of Line 14 taxable 9 9, 7 6 5. 4 6 at sibling rate X ,12 17• 11 , 9 7 1. 8 6 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. Tax Due ..................................................................................................................... 19. 11 , 9 7 1 . 8 6 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ Side 2 L 1505607220 1505607220 REV-1500 EX Page 3 Decedent's Complete Address: Fite Number 21 - 09 - 0356 TARNER, RICHARD W. STREET ADDRESS 129 WALNUT BOTTOM ROAD CITY SHIPPENSBURG STATE PA ZIP 17257 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 11,971.86 Total Credits (A + B + C) (2) 0.0 0 3. Interest/Penalty ffapplicable p. Interest E. Penalty Total Interest/Penalry (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (q) 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) 11, 971.8 6 q, Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 11, 9 71.8 6 Make Check Payable to: REGISTER OF WILLS, AGEIWT 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? .............................................................. ^ x 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?......... ^ ^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. 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^haN (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. co~oNwEAi.TN of aE-~NSrivANw MlIERRANCE TAX RETURN RESDENf DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF TARNER, RICHARD W. FILE NUMBER 21 - 09 - 0356 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 AGCHOICE FARM CREDIT PREFERRED STOCK 970.00 TOTAL (Also enter on line 2, Recapitulation) 970.00 SCHEDULE E CASH, BANK DEPOSITS, & MISC. cOM~gNNIEALTNOFPENN8TWANw PERSONAL PROPERTY IMIERITANCE TAX RETURN RESX1ENf DECEDENT FILE NUMBER ESTATE OF TARNER, RICHARD W. 21 - 09 - 0356 InGude 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 NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 ADAMS COUNTY NATIONAL BANK CHECKING ACCOUNT NO. 132004 (SEE ATTACHED 16,337.24 VALUATION) 2 ADAMS COUNTY NATIONAL BANK CERTIFICATE OF DEPOSIT NO. 165208 (SEE 28,660.17 ATTACHED VALUATION) 3 ACCRUED INTEREST ON 2 82.15 4 ADAMS COUNTY NATIONAL BANK CERTIFICATE OF DEPOSIT NO. 165209 (SEE 28,631.68 ATTACHED VALUATION) 5 ACCRUED INTEREST ON 4 93.00 6 ADAMS COUNTY NATIONAL BANK CERTIFICATE OF DEPOSIT NO. 165210 (SEE 27,962.39 ATTACHED VALUATION) 7 ACCRUED INTEREST ON 6 619.37 8 SENIOR CARE OPERATIONS HOLDING LLC 972.16 9 HIGHMARK PREMIUM REFUND 263.34 TOTAL (Also enter on Line 5, Recapitulation), I 103,621.50 SCHEDULE G COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN INTER VIVOS TRANSFERS & RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY ESTATE OF TARNER, RICHARD W. F{LE NUMBER 21 - 09 - 0356 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. ITEM NUMBER DESCRIPTION Of PROPERTY Inge °~ ~~ °f ~ ~~~' their relaNonahip to decedent and ttre date Of transfer. Attach a copy Of the deed for roet estate. DATE OF DEATH VALUE OF ASSET % OF INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 PRUDENTIAL LIFE INSURANCE POLICY NO. 4,147.61 0% 0.00 M52619778 PAYABLE TO THE ESTATE AS NAMED BENEFICIARY TOTAL (Also enter on Itne 7, Recapitulation) I 0.00 cawMONwEUTN of vENNSr~vANw INHERRANCE TAX RETURN RESIDENT DECEDENT SCF®U_E H F1~~2ALDff~EJVSES& ADIVeVI:STRATNE OO6TS _.__ FILE NUMBER ESTATE OF TARNER, RICHARD W. 21 - 09 - 0356 Debts of decedent must be reported on Schedule L ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT A. 1 I PRE-PAID B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid 2. Attorney's Fees HAMILTON C. DAVIS, ESQUIRE 4,500.00 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 CUMBERLAND COUNTY REGISTER OF WILLS 100.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 CUMBERLAND COUNTY LEGAL JOURNAL -LEGAL ADVERTISING 75.00 TOTAL (Also enter on line 9, Recapitulation) 4,796.25 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Sd~edule H A~~F.tn~,~e~~alME~en~es 8r, F'1~.~ 1 ~ w.7YAY~ FILE NUMBER ESTATE OF TARNER, RICHARD W. 21 - 09 - 0356 THE NEWS CHRONICLE -LEGAL ADVERTISING I 121.25 Page 2 of Schedule H SCHEDULEI DEBTS OF DECEDENT, MORTGAGE cOMdONVVEALTNOFPE1NSrivaaw LIABILITIES, & LIENS INHERITANCE TNf RETURN RESIDENT DECEDENT ESTATE OF TARNER, RICHARD W. FILE NUMBER 21 - 09 - 0356 Include unreimbun3ed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 CHOICE CRITICAL CARE 29.79 TOTAL (Also enter on Line 10, Recapltulatlon) ~ 29.79 Rev-~a~a ex.ls-oo) COMMONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT SCHEDULE) BENEFICIARIES ESTATE OF TARNER, RICHARD W. I FILE NUMBER 21 - D9 - O35Fi NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustags) SHARE OF ESTATE (Words) AMOUNT OF ESTATE ($$$) I~ TAXABLE DISTRIBUTIONS [include,outright spousal distributions and transfers under Sec. X116 (a) (1.2)] 1 Howard W. Tarner Brother 68 Lantern Lane Shippensburg, PA 17257 Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropriate, on Rev 1500 cover sheet II NON-TAXABLE DISTRIBUTIONS: I A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHELT ~,~~ LAST WILL AND TEBTAMENT I, RICHARD W. TARNER, of North Newton Township, Cumberland County, PA, declare this to be my Last Will and Testament and revoke any Will or Codicil previously made by me. ITEM I: I direct that all my just debts and funeral expenses, including my gravemarker and all expenses of my last illness, shall be paid from my residuary estate as soon as practicable after my decease as a part of the administration of my estate. ITEM II: I devise and bequeath all of my estate of every nature and wherever situate to my brother, HOWARD W. TARNER, providing he shall survive me by thirty (30) days. ITEM IIT: Should my brother, HOWARD W. TARNER, predecease me or die on or before the thirtieth (30th) day following my death, I devise and bequeath all of my estate of every nature and wherever situate to my niece (my brother, HOWARD'S, daughter), ~~~ PAMELA K . MYERS . ITEM IV: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as part of the expenses of the administration of my estate. ITEM V: I appoint my brother, HOWARD W. TARNER, Executor of this my Last Will. Should he fail to qualify or cease to act as Executor, I appoint my sister-in-law, JANICE R. TARNER, Executrix of this my Last Will. ITEM VI: I direct that my Executor or guardian or their successors shall not be required to give bond for the faithful performance of their duties in any jurisdiction. ITEM VII: My individual fiduciary shall be entitled to reasonable compensation for his or her services rendered from time to time unless different compensation has been provided for in a separate letter of agreement. IN WITNESS WHEREOF, I hereunto set my hand aDd seal to this my Last Will and Testament, written on three (3) sheets of paper, dated this l~f~ day of ~~_,~.,¢_._ , 1993. ~,L~t'~l~ ~ Lt,~ ~~yy~.rr~ ( SEAL) RICHARD W. TARNER The preceding instrument, consisting of this and two (2) other typewritten pages, each identified by the signature or initials of the Testator, was on the day and, date thereof signed, published and declared by the Testator therein named, as and for his Last Will, in the presence of us, who, at his request, in his presence, and in the presence of each other have subscribed our names as witnesses hereto. ./ / ,~~ '' residing at /J/cGs~~/• ` Z , ~ ' C~. ~.d.-K.,~'.2-,~..e~c.~ residing at ~~ ' ,2 2 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND . ss. I, RICHARD W. TARNER, the Testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that. I signed and executed the instrument as my Last Will; and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. ~cca~ ~~ (SEAL) RICHARD W. T ER Sworn to or affirmed and acknowledged before me by >P~a~~ w. Ta~~rr , the Testator, this / t~ day of .~ w-. ~_ , 1993 . ........._..._._nicSr~k~N~~SE~:zM VELDA M. SEASi:, I~lotary Public J Shippansburg Boro, Cumberland Co., Pa. v/J i . ~_~_ My Commission Expir~e5 April 16,1994 Notary Public COMMONWEALTH OF PENNSYLVANIA . ss. COUNTY OF CUMBERLAND We, rT~{w•: ' ~ r• DA,~ ~ ~ and ~.n ~ s A - Sd ~~ ~ the witnesses whose names are signed to the a tacked or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testator sign and execute the instrument as his Last Will; that the Testator signed willingly and executed it as his free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testator signed the Will as a witness; and that to the best of our knowledge the Testator was at the time eighteen (18) or more years of age and of sound mind and under no constraint or undue in luen r Sworn to or affirmed and .subscribed to before me b ~'( r~-(~y~ 5 and Loy, .Q~~Sv/~ , witnesses, this 18't~ day o f u n , 19 9 3. NoraRiAt. sEA~ VELDA M. SEriaE, lVoxary ('ufsltc ~_'~( r ~;L~` ShfRaensE:urg 8oro, ~uml;erlanc! Vic,. :~sy C':xnmiasion ' ~' Notary Public ,. ~_.._...._ ~_ ~~t~s,„a~vr~~ i:.~.9c:z..~ 3 OCT 1 :: ~~G9 ~~~~~~ COL;J~JTY NATIONAL BANK October 15, 2009 Hamilton C. Davis, Esquire 20 East Burd 8greet, Suite 6 P. 0. Box 40 Shippensburg, PA 17257 RE: Richard W. Tarner Estate Dear Mr. Hamilotn: Mr. Tarner had the following accounts with this bank, all of which were in his name alone: Checking account 4132004 opened 3/12/1985 with a balance as of March 25, 2009 of $16,337.24. It was a non-interest bearing account. Certificate of deposit 44165208 for $28,660.17 plus $82.15 accrued interest, issued 3/21IE005. Certificate of deposit 44165209 for $28,631,68 plus $93.00 accrued interest, also issued 3/21/2005. Certificate of deposit #165210 for $27,962.39 plus $619.37 accrued interest, also issued 3/21/2005. Sincerely yours ~~~ Carolyn H. Kough PO Box 3129, GETCYSBURG, PA .17325 ~ rHONe 717.334.3161 I ro~.i_ rare 888.334.2262 ~ www.acnb.cotn Prudential HAMILTON C DAVIS PO BOX 40 SHIPPENSBURG PA 17257 Dear Hamilton C Davis: Castomer Service Oifice PO Box 7217 Philadelphia, PA 19176 18001575-7780 www.prudential.com Policyowner: Richard W Tarner Insured: Richard W Tarner Policy Number: M52619778 October 29, 2009 1 am responding to your request for informafion on the above referenced policy number. A claim in the amount of $4,147.61 was paid out to you on August 20, 2009, from policy number M52614778. Listed below is a breakdown of the amount received. Face Amount of Police _____ __ _ __ ___ $_1,006.00 Termination Dividend $21.75 Face Amount of Paid-U Additional Insurance $4,169.51 Claim Interest _ i $41.32 Minus Outstanding Loan and Interest _ _ _ $1,090.97 _ Total Proceeds Paid ( 54,147.61 if you have any questions, please call our customer service office at (800) 575-7780, Monday through Friday, between 8:00 a.m. and 6:00 p.m., Eastern time. If you are using a telecommunications device for the hearing impaired, please call at (800) 778-8633, Monday through Friday, 8:00 a.m. to 6:00 p,m., Eastern time. One of our customer service representatives will be happy to help you. Sincerely, Frances ~ .~fughes Frances E Hughes Customer Service Associate gs Life insurance is issued by The Prudential Insurance Company of America, Pruco Life Insurance Company (except in NY), or Pivco Life Insurance Company of New Jersey (in NY and NJ). LAW OFFICES OF ZULLINGER -DAVIS PROFESSIONAL CORPORATION JOEL R ZULLINGER HANIILTON C. DAVIS 14 North Main Street Dale F. Shughart, Jr. 20 East Burd Street, Suite 6 Suite 200 of counsel P.O. Box 40 Chambersburg, PA 17201 Shippensburg, PA 17257 717-264-6029 717-532-5713 Fax: 717-264-1884 JoelZullin er o,zullingerlaw.com November 25, 2009 Register of Wills Cumberland County Courthouse One Courthouse Square, Room No. 102 Carlisle, PA 17013 RE: Estate of Richazd W. Tamer N O O o ,.' c~ ~ O rn ~ t ~~ ;~~ Est. No. 2009-00356 ~~o© ~ Deaz Sir or Madam: ~ ~' N N Enclosed herewith please find an inheritance tax return, filed in duplicate, and a check in the amount of Eleven Thousand Nine Hundred Seventy-One Dollazs and 86/100 ($11,971.86), as payment for the above estate's inheritance tax. A check for filing fees and costs in the amount of $225.00 is also enclosed. If there are any questions or concerns, please contact me at the Shippensburg office. Thank you. Sincerely yours, ~ C~ Hamilton C. Davis for Zullinger -Davis Professional Corporation HCD/njk Enclosures Fax;717-530-5222 hamiltondavislavv~,comcast.net ~} ~ ,-_.~ S''7=~ _- %:.~~,~ rr ~_ ~~~'l ~.' ~~ Reply to: Hamilton C. Davis P.O. Box 40 Shippensburg, PA 17257