HomeMy WebLinkAbout11-24-09
J 1505607121
REV-1500 EX (06-05)
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN
Harrisbu PA 17128-0601 RESIDENT DECEDENT 2 1 0 9 0 8 2 2
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
Date of Birth
2 0 5 5 0 9 3 6 1 0 3 2 9 2 0 0 9 1 0 2 8 1 9 5 7
Decedent's Last Name Suffix
Decedent's First Name MI
W I N G A R D M A U R I N D A
C
(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
Q 1. Original Return ~ 2. Supplemental Retum
3. Remainder Retum (date of death
4. Limited Estate ~ prior to 12-13-82)
4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Retum Required
death after 12-12-82)
6. Decedent Died Testate ~ 7. Decedent Maintained a Livin Trust
(Attach Copy of Will) (Attach Copy of Trust) g 8. Total Number of Safe Deposit Boxes
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 T0:
Name
Daytime Telephone Number
S T E P H E N L B L O O M 7 1 7 2 4 9 2 3 5 3
Firm Name (If Applicable)
I R W I N & M c K N I G H T p C ~ REGISTEI~F WILLS USB'i1NLY
~~ ~
First line of address "~. `° ;r7
6 0 W E S T P O M F R E T S T R E E T ~J •'? `~' -~c -'~~
Second line of address .~~' ~ ra ~ ,~ f-r~ ~ ~''
• 7 ~ •,.
City or Post Office ~ -~ =°= ~ •-'
State ZIP Code •~t.~CfE FILED N ,_~:~-,:_ :~:
C A R L I S L E P A 1 7 0 1 3 ~ t. ~? ~~~
Correspondent's a-mail address:
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.
SIGNATURt'~ OF PER~N ~POI~jIBI.~E FOR (LING RETURN
SIGNATURE OF P P THE H REPRESENTATIVE
DATE
ESS ~ZC~
~ ~D ~~, s~
~ ~~
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505607121 1505
607121
REV-1500 Ei( Page 3
File Number
C~ecedent's Complete Address: 21 09 os22
DECEDENT'S NAME
MAURINDA C. WINGARD
STREET ADDRESS
396 GREASON ROAD
CITY
CARLISLE STATE
PA
Tax Payments and Credits:
~ ~ Tax Due (Page 2 Line 19)
2. Credits/Payments
A, Spousal Poverty Credit
B. Prior Payments
C. Discount
3. Interest/Penalty if applicable Total Credits (A + B + C )
D. Interest
E. Penalty
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT Total Interest/Penalty (D + E )
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.
ZIP
17015
(1) 0.00
(2) 0.00
(3) 0.00
(4)
0.00
(5) 0.00
(5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
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? ...... ^
................................................................................. ^ X
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 (0) 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)]. 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
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
MAURINDA C. WINGARD 21 09 0822
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.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
7. USABLE LIFE -SHORT TERM DISABILITY BENEFITS OF DEATH
6,251.37
TOTAL (Also enter on line 5, Recapitulation) I $ 6 251 37
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (10-06)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
IN R SIIDAENT DECEDENTRN ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
MAURINDA C. WINGARD
21 09 0822
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION
A• FUNERAL EXPENSES: AMOUNT
1•
B, ADMINISTRATIVE COSTS:
1 • Personal Representative's Commissions
Name of Personal Representative (s)
Street Address
City State Zip
Year(s) Commission Paid:
2, Attorney Fees IRWIN & McKNIGHT, P.C. 750.00
3. Family Exemption: (If decedent's address is not the same as claimants, attach explanation)
Claimant
Street Address
City State __ Zip
Relationship of Claimant to Decedent
4• Probate Fees REGISTER OF WILLS
64.00
5• Accountants Fees
6• Tax Return Preparers Fees
7. I REGISTER OF WILLS, FILING FEE
30.00
TOTAL (Also enter on line 9, Recapitulation) I $
844
(If more space is needed, insert addiiaonal sheets of the same size)
REV-1513 EX+ (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
CCTATe nr
SCHEDULE J
BENEFICIARIES
MAURINDA C. WINGARD
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
j TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. WENDELL C. WINGARD
396 GREASON ROAD
CARLISLE, PA 17015
FILE NUMBER
21 09 082;
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Spousal
AMOUNT OR SHARE
OF ESTATE
5,407.37
REMAINDER
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET a
(If more space is needed, insert additional sheets of the same size)
usa~ urn
July 27, 2009
Mr. Wendell Wingard
3 96 Greason Rd.
Cazlisle, PA 17015
RE: Maurinda Wendell, Deceased
Claim No: 7608-09
Short Term Disability Benefits
Lear Mr. ~~~ingazd:
We are sorry to heaz of the death of your wife, Ms. Maurinda Wingazd, and wish to
express our deepest sympathy to you and your family for your loss.
At the time of her death, Ms. Wingazd was covered by a short term disability policy. Our
records indicate that we currently have a payment pending for approximately $6,251.37.
Because Ms. Wingazd is deceased, the benefits are payable to her estate. In order to issue
the benefits due, we will need the following information:
~ A Court certified copy of Ms. Wingazd's estate documents. This can be either:
o Letters of Administration/Testamentary if Ms. Wingazd's estate is being
probated. Probate requires the services of an attorney and a Court order.
If Ms. Wingazd's estate, including the approximate $6,251.37 payable by
USAble Life exceeds $11,000, we suggest you contact your personal legal
counsel for assistance; or
o An Affidavit for Collection of Small Estate, if the total of the assets owned
individually by Ms. Wingazd at her death is small (under $11,000).
A return envelope is enclosed for your use in submitting this information. Please feel
free to call me if you have any questions.
Sincerely,
USABLE LIFE
Suzanne Bilello, Legal & Regulatory Affairs
Tel. 1-800-648-0271 ext. 8885
Enclosures
P.O. Box 1650 Little Rock, Arkansas 72203-1650 (501) 375-7200 (800) 648-0271 www.usablelife.c
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