Loading...
HomeMy WebLinkAbout01-22-10C 15056041158 REV-1500 EX (08-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Indfvldual Taxes County Code Year File Number PO BOX 280801 INHERRANCE TAX RETURN 21 09 0765 Harrisburg, PA 17128.0801 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 195-16-3240 07122009 11191922 Decedent's Last Name MOSHER Suffix Decedent's First Name VIRGINIA (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MOSHER FRANK Spouse's Social Security Number FILL IN APPROPRU\TE BOXES BELOW THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS MI B MI A ^X 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death prior to 12-13-82) ^ 4 Li it d E t t ^ 4 F t I i C f ^ 5 . m e s a e a. ure nterest omprom u se (date o . Federal Estate Tax Return Required 6. Decedent Died Testate ^ 7. death after 12-12-82) Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty CredR (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 HOWELL C• METTE, ESQUIRE 717-232-5000 ~ Firm Name (If Applicable) METTE, EVANS & WOODSIDE First line of address 3401 NORTH FRONT STREET Second line of address PO BOX 5950 City or Post Office State ZIP Cade .: _~ .. _~ "c~ ~I; 7 ,_., ;~ _, , ~; _.~ _ ,. 1 HARRISBURG PA 17110-0950 Correspondent's e-mail address: L J K N O D E a1 M E T T E• C O M Under penalties of perjury, I declare that I have a mined this return, including accompanying Schedubs and statements, and to the heat of my knowledge and belief, it is true, correct and complete. Declaration of prepa~r otl~lr than the personal reprea~rNgEve is based on all Information of which preparer has any knowledge. FRANK A• MO 70 )~ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE E HOWELL C. METTE, ESQUIRE ADDRESS 34 1 N• FRONT STREET, P 950 ARR SB RG, PA 171 950 PLEASE USE ORIGINAL FORM ONLY Side 1 15056041158 BM48473.000 15056041158 ~v W~ 15056042159 REV-1500 EX Decedent's Social Security Number 195-16-3240 Decedent's Namel"10 S H E R V R G I N I A B RECAPITULATION 1. Real estate (Schedule A) . ... ..... ... . ...... ..... ... .. 1. 0 • 0 0 2. Stocks and Bonds (ScheduleB) .... ....... ............... 2. 25006.03 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) • 3. 3 3 512 9 • 6 5 4. Mortgages 8 Notes Receivable (Schedule D). .. 4. 0 , 0 0 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E). 5. 16631 • 12 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested 6. 0 , 0 0 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested 7. 0 • 00 e. Total Gross Assets (total lines 1-7). • 6. 3 7 6 7 6 6. 8 0 9. Funeral Expenses 8 Administrative Costs (Schedule H). 9. 23853 • $8 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)....... ... . 10. 6461 • 39 11. Total Deductions (total Lines 9 & 10) ...................... 11. 3 O 314 • 9 7 12. Net value of Estate (Line a minus Line 11) ................... 12. 346451 • 83 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............ • .. 13. 3 4 O 9 51 • 8 3 14. Net Value Subject to Tax (Line 12 minus Line 13) 14. 5500 • 00 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.o 5500.00 15• 0.00 16. Amount of Line 14 taxable at lineal rate X .045 0 , 00 16• 0 , 00 17. Amount of Line 14 taxable at sibling rateX.12 0 , 00 17. 0 • 00 16. Amount of Line 14 taxable at collateral rate X .15 0, 0 0 18• 0, 0 0 19. TAX DUE 19. 0 • 0 0 20. FILL IN THE BOX IF YOU ARE REWESTING A REFUND OF AN OVERPAYMENT Side 2 15056042159 BM48482.000 15056042159 REV-1500 EX Pape 3 Fiq Number Decedent's Com late Address: 21 0 9 0 7 6 5 DECEDENTS NAME STREET ADDRESS CITY STATE LP Tax Payments and Credits: 1. Tax Dua (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit Q . Q Q B. Prior Payments _ Q . Q Q C. Discount Q . Q Q (1) _ ~ • ~~ Tolal Credits (A + B + C) (2) Q • Q Q 3. InteresUPenalty if applicable D. Interest Q . Q Q E. Penalty Q . ~ Q Total InteresUPenalty (D + E) (3) _ Q . Q Q 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Lina ZO to request a refund. (4) Q • Q Q 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) Q • Q Q A. Enter the interest on the tax due. (5A) Q • Q Q B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) Q . Q Q Make Check Payable fo: REGISTER OF WILLS, AGENT 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; ^ 0 b. retain the right to designate who shall use the property transferred or ks income; .... ^ X c. retain a reversionary interest; or ........ ^ X d. receive the promise for Iffe 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 Aeeount, annuity or other non-probate property which , contains a beneficiary designation? ............. .. ~ ^ IF THE ANSWER TO ANY OF THE A80VE 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 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. §9118(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. BM4871 1.000 REV-1503'EX*(6-96) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS S BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT NUMBER I Virginia B. Mosher 21 09 0765 All property jointly-owned with right of survNorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE oFDEaT>i t. 200 Shares BHP Billiton Ltd Sponsored ADR - 200 aharos common stock CUSIP: 088606108 10,117.50 Held in Kistler Tiffany Account #KTA-001754 2 122 Shares Cameco Corp. - 122 shares common stock CUSIP: 13321L108 2,835.59 Held in Kistler Tiffany Account #KTA-001754 Dividend accrued on 7/12/2009 6.57 3 66 Shares Valero Energy Corporation - 66 shares common stock CUSIP: 91913Y100 1,042.14 Held in Kistler Tiffany Account #KTA-001754 4 11,000 Par U.S. Treasury Note D-2010 0.875'k; 04/15/10 B/E DTD 10/15/04 10,981.09 Held in Kistler Tiffany Account #KTA-001754 Interest accrued to 7/12/2009 23.14 TOTAL (Also enter on line 2, Recapitulation) I $ 25, 006 03 3W4696 1.000 (If more space is needed, insert additional sheets of the same size) REV-1504 EX+(G99) SCHEDULE C COMMONWEALTH OF PENNSYLVANIA CLOSELY-HELD CORPORATION, INHERITANCE TAX RETURN PARTNERSHIP OR SOLE-PROPRIETORSHIP I Vircinia B. Mosher 2109 0765 Schedule C-1 or C-2 (including all suppporting information) must be attached for each closely-held caporationlpartnership interact of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for ade-proprietorships. ITEM VALUE AT NUMBER DESCRIPTION DATE OF DEATH ~~ 5,820 Shares 5,820 shares common stock, Security Savings Syatema, Inc., a Pennsylvania closely held corporation 335,129.65 Voting shares common stock - 1,562 Non-voting shares common stock - 4,238 Decedent owned a 14.7081$ interest in the corporation. See attached business valuation. TOTAL (Also enter on line 3 Recapitulation) ~ $ 335,129 65 3W4097 1.000 (If more space is needed, Insert additional sheets of the same sine) REV-1505 EX + (8-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE C-1 CLOSELY-HELD CORPORATE STOCK INFORMATION REPORT FILE NUMBER Virginia B. Moaher 21 09 0765 1. Name of Corporation Security Savings Systems, Inc. State of Incorporation pennaylvania Address 901 Market Streot Date of Incorporation 5/19/1999 City New Cumberland State pA Zip Code 17070 Total Number of Shareholders 2. Federal Empbyer I.D. Number 23-1302079 Business Reporting Year 12/31/2008 3. Type of Business printinq Product/Service Financial forms 4 STOCK TYPE TOTAL NUMBER OF NUMBF~R OF SHARES VALUE OF THE VotingMon-Voting SHARES OUTSTANDING PAR VALUE OWNED BV THE DECEDENT DECEDENTS STOCK Provide all rights and restrictions pertaining to each class of stock. 5. Was the decedent employed by the Corporation? , , , , , , , , , , , , , , , , , . , ... ^ Yes 0 No If yes, Position Annual Salary $ 0.00 Time Devoted to Business 6. Was the Corporation indebted to the decedent? ......................... ^ Yes X^ No If yes, provide amount of indebtedness $ 0 00 7. Was there life insurance payable to the corporation upon the death of the decedent?, ^ Yes ^X No If yes, Cash Surrender Value $ 0.00 Net proceeds payable $ 0.00 Owner of the policy 8. Did the decedent sell or transfer any stock in this company within one year prior to death or within two years if the date of death was prior to 12-31-827 ^ Yes ®No If yes, ^ Transfer ^ Sale Number of Shares 0 Transferee or Purchaser Consideration $ 0.00 Date Attach a separate sheet for additional Vansters and/or sales. 9. Was there a written shareholder's agreement in effect at the time of the decedent's death?, ^X Yes ^ No If yes, provide a copy of the agreement. 10. Was the decedent's stock sold? .................................. ^ Yes ®No If yes, provide a copy of the agreement of sale, etc. 11. Was the corporation dissolved or liquidated after the decedent's death? ............ ^ Yes ®No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 12. Did the corporation have an interest in other corporations or partnerships? , , , , , , , ,^ Yes ~ No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. A. Detailed calculations used in the valuation of the decedent's stock. B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years. C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair market values. If real estate appraisals have been secured, attach copies. D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent. E List of officers, their salaries, bonuses and any other benefits received from the corporation. F, Statement of dividends paid each year. List those declared and unpaid. G Any other information relating to the valuation of the decedent's stock. (If more space is needed, insert additional sheets of the same size) 4Wd898 1.000 I REV-0508 EX ~ (&98) SCHEDULE E COM~AONWEALTHOFPENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERRANCE TAX RETURN IiESIDEMfTDECEDENT PERSONAL PROPERTY ESTATE OF FILE NUMBER Virvinia B. Mosher 21 09 0765 Include the proceeds of litigation and the dale the proceeds were received by the estate. All property JolnSyowned with the right of wrvivorshlp must be disclowd on Seheduk F. ITEM VALUE AT DATE NUMBER ~~.qi~~u OF DEATH 1 2001 Mercury Sable, VIN 1M6FM5JU11A605136 2 Highmark -refund of health insurance premium 3 Kistler Tiffany Brokerage Money Market Account #KTA001754 4 Miscellaneous items of personal property 5 PNC Checking Account #5140092691 3,500.00 279.14 656.59 2,000.00 10,195.39 TOTAL (Also enter on line 5 Recapkulation) $ ~ 16 631 12 3W48AD t.occ (If more space is needed, insert edditbnal sheets of the same size) ftEV-1510 EX ~ (8-99) COMAAONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER VIVOS TRANSFERS 8r MISC. NON-PROBATE PROPERTY Virginia B. Mosher 21 09 0765 This schedule must be completed and filed If the answer to any d questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBS DESCRIPTION OF PROPERTY IfAIDETEW/AE0F7/E7r7~NSFEREE,TIEIRRELAilON9HGTODECEOEMMD irEbttEaFTRRISFERAITPOIACOPYOFTlEOEEOFORREPLE9TArE. pATEOFDEATH VALUE OF ASSET %OFDECD'S INTEREST EXCLUSION APPLICABLE TAXABLE VALUE ~ Metropolitan Life Retirement Annuity Account #86195163240; benefits ceased at death. 0.00 100.0000 0.00 0.00 FOR INFORMATIONAL PURPOSES ONLY TOTAL (Also enter on line 7, Recapitulation) ~ $ (It more space is needed, insert additional sheets of the same size) 3W48AF 1.000 REV-151TEX+(10-051. COMMONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES 8r ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Vircinia B. Mosher 21 09 0765 Debts of decedent must be reporbd on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~. Parthemore Funeral Hotae, NesP Cumberland, PA 9,540.84 B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address City Year(s) Commission Paid: State Zip 2. 3. Attorney Fees Family Exemption: (If decedent's address Is not the same as claimant's, attach explanation) Claimant Frank A. Mosher 10, 000.00 3 , 500.00 Street Address 5245 Magnolia Court City Mechanicsburg State PA zip 17055 Relationship of Claimant to Decedent SPOUSE 4. Probate Fees 444.00 5. Accountant's Fees 6. Tax Return Preparers Fees 7. 1 Cumberland Laa Journal Legal notice 75.00 2 Estate Valuation Valuation of securities 6.20 Total from continuation schedules 287.54 7W46AG 1.000 TOTAL (Also enter on line 9, Ri (If more space is needed, insert addhional sheets of the same size) 853.58 REV-1512 EX ~ (12-05) Pennsylvania SCHEDULE I DEPARThENrOF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Virginia B. Mosher 21 09 0765 Report debts Incurred by the decedent prior to death that remained unpaid at the date of death, Including unreimbureed medical expenses. 8W45AH 2.000 If more space is needed, insert add'Rional sheets Of the same size. REV-1513 EX+(11-08) Pennsylvania OEPARTG£NTOF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES FILE NUMBER Vir inia B. Mosher 21 09 0765 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY Do Not Liet Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS (inGude outright spousal distributions, and transfers under Sec. 2116 (a) (1.2).] 1. Frank A. Mosher 5245 Magnolia Court Mechanicsburg, PA 17055 2001 Mercury Sable, VIN 1MEFM5JU11A605136 Inventory Value: 3,500.00 Miscellaneous items of personal property Inventory Value: 2,000.00 Surviving Spouse 5,500.00 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1 8 OF REV-1500 COVER SHEET, AS APP ROPRIATE. II NON-TAXABLE DISTRIBUTIONS: A SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN t See Attached 1 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTONS 1. TOTAL OF PART II -ENTER TOTAL NONTAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. S 340 951.83 BWO6AI 2.000 Ir more space IS neeOeO, Insert aOOltlOnal sheets Ot the saRle 81Ze. REV-1849 EXt (688) SCHEDULE O COMMONWEALTH OF PENNSYLVANIA ELECTION UNDER SEC. 911 INHERITANCE TAX RETURN RF~IDENrDECEDENr (SPOUSAL DISTRIBUTION ESTATE OF FILE NUMBER Virginia B. Mosher 21 09 076 Do not complete this schedule unless the estate is making the election to tax assets under Ssetion 9113(A) of the Inheritance 8 Estate Tax Aet If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust. This election applies to the Trust A U/~, Credit Trust Trust (marital, residual, A, B, By-pass, Unified Credit, etc.) If a trust or similar arrangement meets the requirements of Section 97 73(A), end: a. The treat or similar arrangement is listed in Schedule O, end b. The value of the trust or similar arrangement is entered in whole or in pert as an asset on Schedule O, then the transferor's personal representatve may specifically identity the trust (all or a fractional portion or perc~tage) to be included in the electron to have such trust or sim- ilar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property Is Included as a taxable transfer on Schedule O, the personal representative shall be considered to have made the election only as to a haction of the trust or similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar arrangement included as a taxable asset on Schedule O. The denominator is equal to the total value of the Wat or similar arrenoement. PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's surviving spouse under a Section 9113(A) trust or similar arrangement. to more space rs neeeea, mean addltlonal sheets of the same size) 3W48E2 2.000 C -~ o I/'!~N h > VVV~,~ L O z~~0 ~ de} -' a ~RIQ-~ o ~ q~ I o ~_~ ~ N ~Q J N° a d~11Nfi o o g ~l.4lseguro~ IleW ~7l~ol~d m 0 S u7 m ti 0 0 0 0 O O N W A F W ~ W o p~3F o Oo~.on `S~O~Q ~~ v~~~ca ~~zWz~~~ W~ooOw,~ ~" ., W P, M ~~d° ~ ~~ C7 H ~yy~ppd~~M ~aOfaAO yam ~ 3 Q y ~ a~o +~°" ~'~~~a a~ N U H a f"'~ METTE~ EVAN13 ~ WOODSIDE A PROFE69IONAL CORPORATION ATTORNEYEi AT LAW 9401 NORTH FRONT 9TRRET P.O. BO% 5950 HARRISRURO, PA 17110-0930 HOWELL C. METTE t$6 No. za•losaoos TELEPHONE FAX (717) 88E-6000 (717) 888.1618 BTTPJIN'M M'.M8TT8.ppH January 21, 2010 VIA CERTIFIED MAIL RETURNRECEIPT REQUESTED Glenda Farner Strasbaugh n d Register of Wills ~ ~ ~ ;;- Cumberland County Courthouse `~ -° c -> ~ ~ '~~ ` One Courthouse Square . t-- t C~~m rv . ^`7 ~ ~ :~, Carlisle PA 17013 ~_, ~ ~~`'''~` ~' , -" ``~' , -~ ,- _._ l~1!-_ ~1 ~ _ r-.r _ ~ Re: Estate of Virginia B. Mosher -~ ' © ~'''~? File No.: 2009-00765 Dear Ms. Strasbaugh: Enclosed for filing are the following: I . Original and one copy of an Inventory; 2. Original and one (1) copy of a Pennsylvania Inheritance Tax Return, plus a copy of the cover page of the tax return; 3. A check payable to your office in the amount of $30.00 in payment of your filing fees; and 4. Aself-addressed, postage prepaid envelope for return mail. Please file the original Inventory and Inheritance Tax Return. Please forward the copy of the Inheritance Tax Return to the Pennsylvania Department of Revenue. Please return adate- stamped copy of the Inventory and the cover page of the tax return to my attention in the enclosed envelope, along with a receipt for the filing fees. Wyomissing Ottice ~ 1105 Berkshire Boulevard, Suite 320 ~ Wyomissing, PA 19610 ~ Telephone (610) 374-1135 ~ Facsimile (610) 371-9510 1 _« ~ .: r~~ _ ~ ~: January 21, 2010 Page 2 Please do not hesitate to call with any questions. Thank you for your assistance. Very truly yours, v~~ ~~o~' Lisa J. Kn e Paralegal to owell C. Mette LJK: Enclosures 523695v1