HomeMy WebLinkAbout01-22-10 15056051058
REV-15 0 0 EX
06
5
PA Department of Revenue (
-0
) OFFICIAL USE ONLY
Bureau of Individual Taxes
PO BOX 280601 County Code Year File Number
INHERITANCE TAX RETURN
Harrisburg, PA 17128.0601 RESIDENT DECEDENT 21 € ! 09 0262
ENTER DECEDENT INFORMATION BELOW
Social Security Number .Date of Death Date of Birth
202-20-2327 ~ 02/14/2009 ~ ~ 12/24/1928
Decedent's Last Name Suffix Decedent's First Name MI
<------.
Quigley ~".^ ~.. _ ____ ~~ Charlotte ' ~
; W
~
_._._._.__ _ __ _ _
(Ii Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
t """ "'_' ~ ~ ~
_ I
i f
i ~
i i
Spouse's Social Security Number i
" ____ "-~" - -~--
~~ 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
(Attach Co
of Will 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
py
) (Attach Copy of Trust)
9. Litigation Proceeds Received ;~ 10. S ousal Pove Credit date of death
p rtY ( 11. Election to tax under Sec. 9113(A)
• between 12-31-91 and 1-1-95) (Attach Sch. O)
~:UKR
Name
Ronald E. Johnson, Esq
Firm Name (If Applicable)
(717) 243-0123 ,,,~,
REGISTER OF- I LI~$ USE ON ~.
Hf1C7feWS 1Sc JOnnSOn ~ ~ -j -~:?
.. .__..~...~_ _ ._ ~ I I ~ -f
rn a~ m iC ui aaoress
78 West Pomfret Street
Second line of address
City or Post Office State
Carlisle ~ PA
Street, Carlisle, PA 17013
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ZIP Code DATE FILED
17013
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15056051058 Side 1
15056051058
vNDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Daytime Telephone Number
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Correspondent's a-mail address:
Under penalties of perjury, I dedare 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. Dedaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE F ERSON RESPONSIBL FOR FILING RETURN DATE
"- ~-/-/0
ADDRESS
c/o 78 West Pomfret StreP.t Carlisle PA 17013
J
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: Charlotte W Quigley ~ 202-20-2327
RECAPITULATION .~.,,~..,.~ .................~..,~.~..,..,............~
1. Real estate (Schedule A) ............................................. 1.
2. Stocks and Bonds (Schedule B) ....................................... 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3.
4. Mortgages ~ Notes Receivable (Schedule D) ...................... ...... 4.
5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ........ 5.
6. Jointly Owned Property (Schedule F) Separate Billing Requested
7. Inter-Vivos Transfers $ Miscellaneous Non-Probate Property
(Schedule G) ~ Separate Billing Requested.
...... 6.
-- -- -W---m.~...
- ----
8. Total Gross Assets (total Lines 1-7) ........................... 8. 11 38 59
......... ~ 5,4
9. Funeral Expenses 8 Administrative Costs (Schedule H) ..................... 9. ~ 14,028.76
10.
Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ................ i
10. ~
287,416.98
11. Total Deductions (total Lines 9 ~ 10) ...................................
11 • ;
301,445.74
12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. ' -186,007.15
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which -----~-"- - ~°------ -- -~-~------a
an election to tax has not been made (Schedule J) ........................ i
13. ~
0.00
14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. ~ -186,007.15
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATE
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116 ~ --------- -- - ------------~-_______________;
15.
16. Amount of Line 14 taxable ~"~""
at lineal rate X .0 -
'
16.
17. Amount of Line 14 taxable ~ -
at sibling rate X .12
17.'
18 _ _ _ _
Am
u
t
f Li
14 ~'m'°`°°~'°
. o
n
o
ne
taxable
at collateral rate X .15
__--__._..._..._ ..._..__...-_..._..__.__.._._ _.....__.
18.
---~------- ~- ---
~----.._....-
19.
TAX DUE .........................................................
'
19. .._.o...-....e._,....
0.00
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
15056052059
15056052059 Side 2
15056052059
REV 1500 EX Page 3 File Number _ .
Decedent's Complete Address: 21 09 ;0262
M_w....~._,,,.~.. ~.~......,..... ~ :.,..
DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER
Charlotte W Quigley 202-20-2327
STREET ADDRESS
1000 Claremont Road
CITY
Carlisle STATE
PA ZIP
17013
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19) (1)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + B + C) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
FIII in oval on Page 2, Line 20 to request a refund. (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 0.00
Make Check Payable fo: REGISTER OF WILLS, AGENT
......................
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPR OPRIATE 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? ~ ........................................................................................................................ ^ 0
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)j. 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.
,'
LAST WILL AND TESTAMENT
OE
CH.A.RL®TTE W. Q.L.TIGLEY
I, CHARLOTTE W. QUIGLEY, of the Township of Dickinson, County of Cumberland, and
Commonwealth of Pennsylvania, declare this to be my Last Will and revoke any will or codicil
previously made by me.
IT-1: Upon my demise, I direct that my body be buried and not cremated in Lot No.
60(n), Section "E", Row 22 in the Mount Holly Spring Cemetery, Mount Holly Springs, Cumberland
County, Pennsylvania.
I'T'EM 2: I direct that all my just debts and funeral expenses be paid as soon as practical
after my death.
ITEM 3: I direct that all taxes and interest and penalties thereon that may be assessed in
consequence of my death, of whatever nature and by whatever jurisdiction unposed, shall be paid from
a
my residuary estate as a part of the expense of the administration of my Estate.
4: I give, devise and bequeath all the rest, residue and remainder of my estate of
Ew., every nature and wheresoever situate, together with insurance thereon, as follows:
~ A. Seventy percent (70%) to my husband, EDWIN W. QUIGLEY. Should m hu
y sband,
v Edwin W. Quigley, predecease me or fail to survive me for a period of thu-ty (30) days, I
U
give, devise and bequeath his share to my daughter, GWYN ZOOK or her issue.
B. Thirty percent (30%) unto my daughter, GWYN ZOOK, per stapes.
Page 1 of 3
IT_ Until distributed, no gift or beneficial interest shall be subject to anticipation or
voluntary or involuntary alienation.
IT'E_M 6_'. I appoint my daughter, GWYN ZOOK as Executrix of this my Last Will. If my
daugl-jter, OV`JYl`1,~Q0~, prede;.ewses me or elects r~bt to serve as n:y Executrix, I appoint my neighbor,
KIMBERLY A. HAGENBUCH, of 1461 Pine Road, Carlisle, Cumberland County, Penns lvania
Y ,
Executrix of this my Last Will.
I_ 7: I direct that my personal representative or her successor shall not be required to
give bond for the faithful performance of her duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and
Testament, this 1~ day of 2004.
HARLOTTE W. QUIGL
Signed, sealed, published and declared by the above-named Testatrix as and for her Last Will
~.nd Testament in our presence, who, at her request, in her presence and in the presence of each other,
Zave eunto subscribed our name, as esting witnesses. ~- f
1
esiding at - ~
residing at /,~(~ / ~ ~ ~,,(~
Page 2 of 3
COMMONWEALTH OF PENNSYLVANIA )
ss:
COUNTY OF CUMBERLAND )
We, CHARLOTTE W. QUIGLEY, lUl~ t/ ~ ~ and
/7~ v
C'~ k~ ,the Testatrix and the witnesses respectivel ,whose names are
Y
signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the
undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she
had signed willingly, and that she executed it as her free and voluntary act for the purpose therein
expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the will as
witness and that to the best of his or her knowledge, the Testatrix was at the time eighteen (18) years or
older, of sound mind and under no constraint or undue influence.
t '
C. ~.
CHARLOTTE W. QUIGLEY
Witness
~ ~
V~itness ~~ J
J
Subscribed, sworn and acknowledged before me ~~ ~? y ~. ~ -~,~.~ by CHARLOTTE
W. Qf UIGLEY, the Testatrix, and subscribed and sworn to before me by
~~ ' ` v ~ and ~!'~ ~i
~~N ~f ~ ~ ~ ~~~ , the witnesses this
~` day of /~:~ y , 2004.
Notary Public EAL)
.~,;,~._,,sue-g~.~-~~-,,- p_,,~~-pp ,.,e;~,.,wR.,p,,,,«.,,
~ ~ , ettrn~a`~~,G~tl ~ ~O~Cb ~~ fL- 0
Page 3 of 3
SCHEDULE D
MORTGAGES AND NOTES RECEIVABLE
1G~lAl~ur
FILE NUMBER
Charlotte W. Quigley 21 09 0262
All property jointly-owned with Right of Survivorship must be disclosed on Schedule F
ITEM DESCRIPTION VALUE AT DATE
NUMBER OF DEATH
Installment Agreement of Sale dated August 26, 2008 between Charlotte W.
Quigley and Brian Zook for premises situate at 1350 Pine Road, Dickinson
Township, Cumberland County, Pennsylvania. See Instrument No: 200829331
recorded in Cumberland County Recorder of Deeds
Balance due at date of death
$111,920.86
TOTAL (also online 4, Recapitulation) $111,920.86
SCHEDULE E
CASI-~ BANK DEPOSITS AND
MISCELLANIOUS PERSONAL PROPERTY
ESTATE OF
FILE NUMBER
Charlotte W. Quigley 21 09 0262
Include the proceeds of litigation and the date the proceeds were received by the estate
v ~ ru, ~aiso on ime ~, xecaprtulahon) $3, 517.73
the financial IinkTM
ANDREWS & JOHNSON
ATTORNEYS AT LAW
78 W POMFRET ST
CARLISLE, PA 17013
Dear MR JOHNSON:
November 18, 2009
Account # 8071XX~~~X
The following is the status of CHARLOTTE W QUIGLEY's account with PSECU as of the date of death.
Joint Owner's Name NONE
Date of Death 02.14.2009
Date of Birth 12.24.1928
Share Description
S O1 Regular Shares
Open date Balance
08.07.2008 $190.73
Accrued Dividend
$ .06
The dividend earned from January 1, 2009 through the date of death was $1.39. The decedent had no loans with us.
We do not have safe deposit boxes for our members. If you have any questions, please ca11234-8484 in Harrisburg
or our toll-free number, (800) 237-7328. At the menu prompt, enter 6 and then extension 2227.
Sincerely,
r
Jo lbin
Member Service Representative
Finance Support Unit
Pennsylvania State Employees Credit Union
Main Address 1 Credit Union Place, Harrisburg, PA 1 71 1 0-2990 (717) 234-8484 (800) 237-7328
~.,
-" Mailing Address PO Box. 67013, Harrisburg, PA 17106 7013 (717) 777-2100 (TDD) (800) 472-1967 (TDD)
`-~ Savings federally insured up to $100,000 by the National Credit Union Administration W W W. ps e c u . c o m
CHEDULE H
FUNERAL EXPENSES, ADMINISTRATIVE
COSTS AND MISCELLANEOUS EXPENSES
ESTATE OF
FILE NUMBER
Chazlotte W. Quigley 21 09 0262
Debts of decedent must be reported on Schedule I.
A.
B.
i 1 rivt DESCRIPTION
NUMBER AMOUNT
Funeral Ezpenses:
1 Ewing Brothers Funeral Home $1,598.60
2 Cazlisle Memorial $768.07
Administrative Costs:
1 Personal Representive Commissions
Name of Personal Representative(s)Gwyn A. Zook $5,771.93
Social Security Number of Personal Representative:
Street Address: 15C Pfautz Road
City: Duncannon State: PA Zip: 17020
Yeaz(s) commissions paid:
2 Attorney fees to Andrews & Johnson $2,500.00
3 Family Exemption
Claimant
Street:
City: State & Zip
Relationship of Claimant to Decedent:
4 Probate Fees to Register of Wills $298.00
5 Accountant Fees to Patricia Rosendale, CPA
6 Tax Return Prepazer's Fees
7 The Sentinel -estate advertisement $198
16
8 Cumberland Law Journal -estate advertisement .
$75
00
9 Andrews & Johnson, attys -legal services re: reseazch, negotiations, .
prepazation & filing Right of Way Agreement to obtain access of property
situate at 1350 Pine Road, to a public road in order to make property
mazketable $1
757.50
10 Recorder of Deeds -recording fee for Right of Way ,
$96
50
11 Andrews & Johnson, attys -deed preparation & settlement .
$150
00
12 Register of Wills - Pa. Inheritance Tax filing fee .
$15
00
13 Reserve for closing and accounting .
$800.00
TOTAL (also online 9, Recapitulation) $14,028.76
SCHEDULE I
DEBTS OF DECEDENT
MORTGAGE LIABILITIES AND LIENS
~a ~ ti 1 r. yr FILE NUMBER
Charlotte Q. Quigley 21 09 0262
Report debts incurred by the decedent pnor to death which r~emeined unpazd as of the date of death, including unreimbursed nxchcal expenses.
i ~, lam. ~~„~, un ime i~, xecapituianon) $287,416.98
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
DIVISION OF THIRD PARTY LIABILITY
ESTATE RECOVERY PROGRAM
PO BOX 8486
HARRISBURG, PA 17105-8486
.,
ANDREWS & JOHNSON
RONALD E JOHNSON ESQUIRE
78 WEST POMFRET STREET
CARLISLE PA 17013-3216
March 25, 2009
Re: CHARLOTTE QUIGLEY
CIS ##: 710150740
SSN: 202-20-2327
Date of Death: 02/14/2009
Dear Attorney:
Please be advised that the Department of Public Welfare maintains a
claim in the amount of $285,890.04 against the above-mentioned estate. This
claim is for restitution of medical assistance granted on behalf of the
decedent for which the Probate Estate is now responsible to reimburse the
Department according to Act 49, 62 P.S. X412, effective August 15, 1994, as
amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's
itemized statement of claim.
A portion of this medical expense, namely $34,886.83, was incurred
during the last six months of the decedent's life; therefore, it is a Class 3
claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries
Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $251,003.21
is to be entered as a priority <class_tag> claim against the estate.
Please acknowledge receipt of this letter and advise whether the
Commonwealth's claim is admitted and when payment may be expected. If the
estate accounting is complete, please provide a copy. If the estate contains
real estate, please provide copies of the deed, the latest tax assessment,
and a current appraisal, if available.
Sincerely,
Patricia Nace
Claims Investigation Agent
717-772-6616
717-772-6553 FAX
Enclosure
~.,;,.?f
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
TPL SECTION -CASUALTY UNIT
PO BOX 8486
HARRISBURG PA 17105-8486
March 25, 2009
STATEMENT OF CLAIM SUMMARY
NAME Estate of QUIGLEY, CHARLOTTE
ID 710 150 740
MEDICAL- CLASS 3 - CLASS 5.1 ~ TOTAL
INPATIENT .00 .00 .00
OUTPATIENT .00 1.96 1.96
LONG TERM CARE 34,816.23 239,470.94 274,287.17
DRUG 70.60 11,530.31 11,600.91
REIMBURSEMENT TO DPW. _ 34,886.83 251,003.21 285,890.04
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
EIN - 23-6003113
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
Charlotte W. ui le ~ 21-09-0262
ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR SHARE
NUMBER Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal drstributions, ead ~aasfee under Sec, 9116(a)(1.2)]
1 Gwyn A. Zook
15C Pfautz Road, Duncannon, PA 17020 daughter 100%
2
3
4
n
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
Charitable and GovemmenW Bequests:
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (also enter on line 13, Recapitulation) $Q
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