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HomeMy WebLinkAbout1-12-10 (2)J 15056041114 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 ~j Harrisbur PA 17128-0601 RESIDENT DECEDENT ~ r U ~ CQ d g ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 192-12-4189 05232009 09271920 Decedent's Last Name Suffix Decedent's First Name MI HARKLEROAD MARY (If Applicable) Enter Surviving Spouse's Information Below H Spouse's Last Name Suffix Spouse's First Name MI N/A 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 Return 0 3. Remainder Return (date of death Q 4. Limited Estate 0 prior to 12-13-82) 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required 0 6. Decedent Died Testate ~ death after 12-12-82) 7. Decedent Maintained a Living Trust 0 (Attach Copy of Will) 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust) 9. Litigation Proceeds Received 0 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 PENNIE L. CAVANAUGH, EXECUTRIX 610-777-8769 Firm Name (If Applicable) First line of address 228 BRIAN DRIVE Second line of address City or Post Office ENOLA State ZIP Code PA 17025 REGISTER OF LS USE ONI,'~ ~y ~ >-:Y.. ., ~ ~ ~ ~~~~~ ~ 1t ~~ r~==- r ~ C'r {, ~,.v~ 1 _.t.! DA~ FILED ,. :.~'"? '..~`. ', `, .;'7 r.. ~ ~= r -- -. , : J ~- --,..~ -r~i _ , ~. c~ ~ ;._2 ..,.:.1 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 belie , it is true, correct and complete. Declaratior;of~re~~r other than the personal representative is based on all information of which preparer has any knowled e ~NA~R__slP PERSON R~SP~SIBI[~ F~SR FII INr^ RFri iQN .~ ADDRESS /~ v ~) 228 BRIAN DRIVE, ENOLA, PA. 17025 NATURE OF PREPARER HER THAN REPRESENTATIVE ~ ~~ DATE DDRESS / ~ / /O 401 DORCHESTER AVE., WEST LAWN, PA. 19609 610-777-8769 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056041114 15056041114 J J REV-1500 EX 15056042115 Decedent's Social Security Number Decedent's Name: MARY H . HARKLEROAD .l 9 2 -12 - 418 9 RECAPITULATION 1. Real estate (Schedule A) ........................................... 1. NONE 2. Stocks and Bonds (Schedule B) ...................................... 2. NONE 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. NONE 4. Mortgages 8~ Notes Receivable (Schedule D) ............................ 4. NONE 5. Cash, Bank Deposits ~ Miscellaneous Personal Property (Schedule E) ........ 5. 17 3 3 2 . O O 6. 7. Jointly Owned Property (Schedule F) OSeparate Billing Requested ....... Inter-Vivos Transfers & Miscellaneous Non-Probat P . 6. 3 5 3 9 5 . 0 0 e roperty (Schedule G) Separate Billing Requested ....... . 7~ 19958.00 8. Total Gross Assets (total Lines 1-7) .. ............................... . 8. 7 2 6 8 5. 0 0 9. Funeral Expenses & Administrative Costs (Schedule H) ...... ............ .. 9. 4 O O 2 . 0 O 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 1 .............. . 0. 5 0 7 . 0 0 11. Total Deductions (total Lines 9 & 10) .... ............................ . 11. 4 5 0 9 . O O 12. Net Value of Estate (Line 8 minus Line 11) 13. ....... ............... Charitable and Governmental Bequests/Sec 9113 Trusts for which .12. - 6 8 17 6 . 0 0 an election to tax has not been made (Schedule J) ...... ................ . 13. 0. 0 0 14. Net Value Sub'ect to Tax Line 12 minus Line 13 .... . ............ TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 14. 6 817 6 . O 0 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0 0 16. Amount of Line 14 taxable 15. 0. 0 0 at lineal rate x .0 4 5 6 817 6. 0 0 16. 3 0 6 8 0 0 17. Amount of Line 14 . taxable at sibling rate X • 12 18. Amount of Line 14 taxable 17. 0 . 0 0 at collateral rate X , 15 18 0.00 19. TAX DUE .......................................................19. 3068.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056042115 15056042115 J ,, _ _ _ - - REV-1500 EX Page 3 192-12-4189 File Number Decedent's Complete Address: 21-09-0608 DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER MARY H. HARKLEROAD 192-12-4189 STREET ADDRESS 810 CHARLOTTE WAY, SUITE 204 CITY STATE ZIP ENOLA PA 17025 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments (1) 3068.00 A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + g + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT enalty (D + E) (3) 0.00 Fill in oval on Page 2, Line 20 to request a refund. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 3068.00 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 3068.00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE AP PROPRIATE BLOCKS 1. Did decedent make a transfer and: a. retain the use or income of the property transferred : ....................................... a b. retain the right to designate who shall use the property transferred or its income : ................ X 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 X without receiving adequate consideration? ........ ^ ......................... ^ X 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? .... . ............................................ .... ~ ^ 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 tran the use of the surviving spouse is three 3 [ § () ( ) (i)] sfers to or for ( )percent 72 P.S. 9116 a 1.1 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 . A siblin is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adopt on.), g 217 REV-1508 EX+ (6-98) SCHEDULE E CASH BANK DEPOSITS & MISC COMMONWEALTH OF PENNSYLVANIA ~ ~ INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER MARY H. HARKLEROAD Include the proceeds of litigation and the date the proceeds were received by the estate. 21-09-0608 All roe 'ointl -owned with ri ht of survivorshi must be disclosed on Schedule F ITEM . NUMBER DESCRIPTION VALUE AT DATE OF D EATH 1. M & T BANK: CHECKING ACCOUNT NUMBER 9834692148 2. 2000 CHEVROLET IMPALA 8,808 3. COUNTRY MEADOWS NURSING HOME REFUND 3,500 4. STATE FARM RENTERS INSURANCE REFUND 4,628 5. HIGHMARK HEALTH INSURANCE REFUND 17 6. STATE FARM AUTO INSURANCE REFUND ~ 278 7. COMCAST CABLE BILL REFUND 31 8. OTHER REFUND 27 43 TOTAL (Also enter on line 5, Recapitulation) $ - 17,332 (If more space is needed, insert additional sheets of the same size) 217 REV-1509 EX+ (g-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MA SCHEDULE F JOINTLY-OWNED PROPERTY RY H. HARKLEROAD FILE NUMBER If an asset was made joint within one year of the decedent's date of death - 21-09-0608 SURVIVING JOINT TENANT(S) NAME ~ ~t must be reported on Schedule G. A. PENNIE L. CAVANAUGH ADDRESS RELATIONSHIP TO DECEDENT 228 BRIAN DRIVE ENOLA, PA. 17025 DAUGHTER B. ZENAS E. HARKLEROAD C JOINTLY-OWNED PROPERTY: LETTER DATE ITEM FOR JOINT MADE NUMRFR TCUwu~ .___ _ 1. I A. 1. A, B A, B A, B A,B A, B A,B 519 MT. ROAD LYNDEBORO, NEW HAMPSHIRE 03082 DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. 9/2/03 SMITH BARNEY MUT'L FUND BANK DEPOSIT PROGRAM*** [THIS ACCOUNT WAS FUNDED FROM SMITH BARNEY FUNI 9/2/03 SMITH BARNEY, INCOME FUND OF AMERICA CLASS A*** 12/23/03 SMITH BARNEY, FEDERATED BOND FUND CLASS B*** 7/28~0o LEGG MASON VALUE TRUST FD. CL. C [transferred to S-B *** 9/2/03 SMITH BARNEY AIM CHARTER FUND CLASS A*** ~ 9/2/03 SMITH BARNEY MFS TOTAL RETURN FUND A*** *** ALL OF THE ABOVE WERE PURCHASED BY THE DECEDENT ONLY AND MADE JOINT WITH SURVIVORSHIP ON OR BEFORE SEPTEMBER 2, 2003. THE LAST TWO FUNDS LISTED WERE TRANSFERRED INT THE SMITH BARNEY [S-Bj ACCOUNT ON OR BEFORE IT WA S MADE A JOINT WITH SURVIVORSHIP ACCOUNT BY THE DECEDENT ON OR BEFORE SEPTEMBER 2, 2003. ALL OF THE ABOVE FUNDS AND S-B BANK DEPOSIT PROGRAM AMOUNT WERE IN SMITH BARNEY ACCOUNT NUMBER 75G-01807-16-500. SON OF DATE OF DEATH DATE OF DEATH DECD'S /ALOE OF ASCf=r ,,,,T~„~~_ _ VALUE OF 1,094 33.34% 365 14,875 33.34% 0 24,620 33.34% 4,959 18,113 33.34% 8,208 14,676 33.34% 6,039 32,787 33.34% 4,893 10, 931 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (If more space is needed, insert addit onal sheets of the same sizel' • 217 REV-1510 EX+ (6-98) SCHEDULE G COMMONWEALTH OF PENNSYLVANIA INTER-VIVOS TRANSFERS & INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ~~ i A i t car FILE NUMBER MARY H. HARKLEROAD 21-09-0608 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1. SMITH BARNEY IRA ACCOUNT # 75G-70393-11 19,060 100.00% 0 19,060 2. SMITH BARNEY IRA ACCOUNT BANK ACCOUNT PROGRAM 898 100.00% 0 ggg 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTAL (Also enter on line 7 Recapitulation) $~ 19 958 (If more space Is needed, Insert addltlonal sheets of the same size) ~' REV-1511 EX + (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES 8~ ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER MARY H. HARKLEROAD 21-09-0608 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. WAKE 361 2. FUNERAL 100 3. OBITUARY 144 4. DEATH CERTIFICATES 134 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) PENNIE L. CAVANAUGH Street Address 228 BRIAN DRIVE City ENOLA State PA zip 17025 Year(s) Commission Paid: 0 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant N/A Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. ADVERTISING-LETTERS TESTAMENTARY [HARRISBURG PATRIOT & CUMBERLAND LAW J 8. INHERITANCE TAX FILING FEE 9. DISTRIBUTION EXPENSE 10. POSTAGE EXPENSE 867 945 160 400 500 293 15 71 12 TOTAL (Also enter on line 9, Recapitulation) ~ $ 4,002 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-08) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES 8~ LIENS ESTATE OF FILE NUMBER MARY H. HARKLEROAD 21-09-0608 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. If more space is needed, insert additional sheets of the same size. r~ 217 REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MARY H. HARKLEROAD RI=LATIONSHIP TO DECEDENT NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. PENNIE L. CAVANAUGH, 228 BRIAN DRIVE, ENOLA, PA. 17025 DAUGHTER 2. ZENAS E. HARKLEROAD, 519 MT. ROAD, LYNDEBORO, NH 03082 SON FILE NUMBER 21-09-0608 AMOUNT OR SHARE OF ESTATE I 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 50% 50% TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND estate of MARY H HARKLEROAD SHORT CERTIFICATE I, GLENDA EARNER STRASBAUGH Register for the Probate of Wills and Granting Letters of Administration in and for CUMBERLAND County, do hereby certify that on the 29th day of June, Two Thousand and Nine, Letters TESTAMENTARY in common form were granted by the Register of said County, on the late of EAST PENNSBORO TOWNSH/P (First, Midd/e, Lastl in said county, deceased, to PENNIE L CAVANAUGH (First, Midd/e, Lastl and that same has not since been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of said office a t CARLISLE, PENNSYLVANIA, this 29th day of June Two Thousand and Nine . Fi 1 e No . 2009- 00608 PA Fi 1 e No . 21- 09- 0608 Date of Death 5/23/2009 S . S . ~ # 192-12-4189 NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL LAST WILL AND TESTAMENT OF I, MAR'S H. HAIGti~L.EROAD-, of the Borough of Westmont, County of Cambria, and State of Pennsylvania, being of sound mind and body, do make, publish and declare this as and far my Last Wiii and. Testament, hereby revoking ail. former Wills by me at any time heretofore made, \ ~jRST: I direct that my debts and funeral expenses be aid b m P Y Y 4:~ Executor as soon after my death as conveniently may be done. .~, SECOND: As tom worldl Estate and all the ro e ~~ y Y , p p rty, real, personal or ~~ mixed, of which I shah die seized and possessed, I ,give, devise and bequeath unto my ~~`~~ '~ ~` children ZENAS EDWARD t-i,A.RI~.LEROAI3 AND p-E~,~ LY'I~T CAVANAUGH, to be divided equally share and share like. f~ ,~ T~~IB~. Should. one of my children predecease me, then his or her share in ~'' ~,,,. - ~ my estate shall pass to his or her children, per stirpes. ~~'~. t •~' F'O1TR'lt'H: I nominate, constitute and appoint my daughter, PENNiE L~S.'NN CAVANAtI'GH, as Executrix of this my Last Will and Testament. to serve without bond. '~ C]Ei~ Should my daughtex, PF;NNIE LYNN C,A'Ll"ANAI,IGH, predecease me or be unable to act as Executrix, then I nominate, constitute and appoint, my son, ZENAS EDWARD ~:f A~2T~I,ER©AD, to act as Executor of this my Last WiII and Testament to serve without bond. :: r . ~ ~ _ JOthda o e?'e_e~t:i`_ _`,:;- _.. ,_. .~ \..`~~ ~~~,~. y f November, 1995. Signed, sealed, published and declared b t y he above named Testatrix, h~ARY H> ~KLEROAD, as and for. her Last 'Vt~ill and T estament, Yn the presence of us, who at her request and in her presence and in the presence of each other, have hereunto subscribed our names as witnesses thereto. I,11~1AR Y H. HARI£~..EROAD, Testatri whose fore oin ~ name is signed to the attached or g g h~~tr~urient, having been dul acknowledge that I signed and executed qualified according to law, do hereby that I signed it willin 1 the instrument as my Last Will and Testament; g y~ and that I signed it as my free and voluntary act for the therein expressed. purposes .~royarn or armed to and acknowled ed befo _ HA~'2KI_£t~0..~ the-~`estu l~ re me by .~~1ARY H. this 3€?th day of NQVember, .l q95. w._.- w .,. ~' _. ~ , No Publi ~' STATE 4.F PL.Nl1TS~,v'~A. Notarial seal iGmberry A.1VliHer, Not COUNTY OF CAMBR.IA, SS: ~ Johnstown, Cambria o,+n~ic Y Commission Expires Se t. p 13, 1999 We, D.C, NOKES ---.~~ are signed to the attached or ~rand• LYNN ANN GEISEL, the witnesses whose name do depose and sa g°mg instrument,. bein dui s y that we were present and saw testatrix si y qualified `cording to law, as her Last Will and TeStaYnent; that ~ZARY H.1`~~R~E gn and execute the ~strument that MARY H. HA.R;KI.,EROAD executed it as her ROAD signed willingly and therein expressed; that each of us in the h free and voluntary act for the at that time 1$ or more years of age, of sound m and sight of the testatrix si purposes ind and under no coan ~~ the Will influence. strains or undue _ .. S~v~ car at~.eci to and shhsc~ibed to bef ~. ANN OE.ISE.I:., ui~itnesses, this 3~ rlay dfNovernberr l~e l~.t/. I~TCCII~ES, JR:. and LYNN 995. ~.. Notary P{xblic _ _ ~...~, Notarial Sea! !4t'mbBrfy A. Hitler, Notary Put~lic Johnstown, Cambria County My Commission Expires Sept. 13, 1999