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Home My WebLink About01-25-10 (3)15056051058 REV-15 0 0 EX (06-05) OFFICIAL USE ONLY PA De rtment of Revenue INHERITANCE TAX RETURN Coun Bureau of Individual Taxes 2 ty Co PO BOX 280601 de Year File Number Hamsburg, PA 17128-0601 RESIDENT DECEDENT 1 09 1113 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth j 168-26-2502 '~ 11/12/2009 ! 10/01/1932 _ __ _... Decedent's Last Name Suffix Decedent's First Name MI Tenta _ _ _ _ i .._ _.. I ~ Dorothy..... _ _. A (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI __ _ _ __ _ i Spouse's Social Security ..Number _. _. _ . _ _ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE '; __ _ RESISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW Cllr 1. Original Return ~ 2. Supplemental Retum c,~~„~ 3. Remainder Return (date of death prior to 12-13-82) ~;.7 4. Limited Estate C:~ 4a. Future Interest Compromise (date of C"::~:~ 5. Federal Estate Tax Return Required death after 12-12-82) C~J 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 00 - 8. Total Number of Safe Deposit Boxes (Attach Copy of WII) (Attach Copy of Trust) ~ 9. Litigation Proceeds Received C~7 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 Wiliam L. Adler..... _ i (717) 234-3289 __ Firm Name (If Applicable) __ __ _ _ _. _ REGISTER t~WILLS USE ADLER &ADLER ~ -- ~ Q .._._ ~, .. _ First line of address __ ! _ ~ , --~ , ..__ , , 125 Locust Street . ~~ ' ~ } '"- ~ : -' ( p Second line of address _ _ _ ~ _ f ,. -_,, -;: _... ~ City or Post OfFce _ _ _ _ _.. i C~LED State ZIP Code _....... _ t ...___. ,~- -- .. _, ~ ` .~ ; - +.Y ~ _ Harrisburg _ . . . ~ PA 17101 .._.. '-- __ ,~ `'' ` -' ~' _ _. _ _ ~ ~ Correspondent's a-mail address: unaer 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. SIGNA~UR~ Q~ PERSOAI nNSIBLE FOR FILING RETURN D/~-tTE NUURG.7.7 - ~ ~ ~ ` ~ ~ e I f y ~~ ~ X--~'~yy«~Hu i ri i riA EPRESENTATIVE ~ DATE !~ --- ~7Tfi~Zo~o AD RESS - -- --- o o ~ ~ l'~a .. s s u M ~ mac. o ~! ~ .~ , , 5 I'''~ ~ ~ ~ c-~0 S C3 t~l Rte, n /~ l ~ ~ 5' ~ PLEASE USE OR161NAL FORM ONLY Side 1 15056051058 15056051058 L REV 1500 EX Decedent's Name: DOrOthy RECAPITULATION ___ 1. Real estate (Schedule A) . ............................................ 1, 2. Stocks and Bonds (Schedule B) ....................................... 2. j ~' 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages & Notes Receivable (Schedule D) ............................. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ 5., 28,756.91 6. Jointly Owned Property (Schedule F) C~ Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property "" °"°° `°°'° • ••° •• (Schedule G) C. k7 Separate Billing Requested........ 8. Total Gross Assets (total Lines 1-7) .................................... 8. 28,756.91 p ( ) .....,. . ~,...,., .,...,. , ... 9. Funeral Ex enses & Administrative Costs Schedule H ..................... 9. 10 50 0 42 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................ 10. 11. Total Deductions (total Lines 9 & 10) ................................... 11. 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ................... . .... 13. 7. 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. 12,667.54 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES ,. _..__~..~..~..w,...M....~..~...............~..~..~...,..,~..~..........~....w....-..... 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 __. _ _. _., _ _ _ _ __ (a)(1.2) X .0 _ 15. ~ 16. Amount of Line 14 taxable ...., ...... ......... ....,.... ,_ ...... ,....,... .... ~... ..o.,...., . at lineal rate X .0 _ ~ 16. 17. ...,.. ......... . ...... ..,... ,.,..,..m. .,.,.._ ..,~, Amount of Line 14 taxable .""""a ., ° . • ,.° . ~ ° . at sibling rate X .12 12,667.54' ,. 17 520 00 , 18. ,, ...... ,...v..a .. ~..,..., _.v.......__... v,...- Amount of Line 14 taxable .. , .,.... .............:... .... . .. at collateral rate X .15 18. 19. TAX DUE ......................................................... 19. 1,520.00 __ ___ 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 A Tenta Decedent's Social Security Number 168-26-2502 15056052059 Side 2 15056052059 REV 1500 EX Page 3 Decedent's Complete Address: .v.,,. ~Ell~..tY,gl~-a~Rtr»~ ~...~. ...,,. ~~. 21,.,.._ ~.._..09 ~ ~ 1113 -_..w.........._..,~ a_..-..,...__, ~ ^ . +^~ ^DECEDENTS SOCIAL S DECEDENTS NAME ECURITY NUMBER Dorothy A Tenta __ 168-26-2502 STREET ADDRESS - -- - -- - - -- 121 Walnut Bottom Road CITY STATE ZIP Shippensburg PA 17257 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit _ __ B. Prior Payments _ 1,400.00 C. Discount 74.00 3. Interest/Penalty if applicable D. Interest E. Penalty -- - --- ---- (1) Total Credits (A + B + C) (2) Total Interest/Penalty (D + E ) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. tf 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. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) (4) (5) (5A) (56) 1,520.00 1,474.00 46.00 46.00 Make Check Payable to: REGISTER OF WILLS, AGENT ..., . .. . h .. 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? .............................................................................................................. 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. ^ ^ 0 ^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. Jul 1 1 ~ , ...., . , n For dates of death on or after y 994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the survlvmg 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. SCHEDULE "E" CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY Estate of Dorothy A. Tenta File Number 2009-0113 ITEM NUMBER DESCRIPTION VALUE AT DEATH Members Union, First . account Federal Credit 12928-00 $108.08 Members First, account 12928-11 $11,608.47 Members First, account 12928-05 $8,825.16 M&T Bank, account 985-155-4932 $8,215.20 TOTAL CASH, BANK DEPOSITS, MISC. $28,756.91 SCHEDULE "H" FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES Estate of Dorothy A. Tenta File Number 2009-0113 ITEM NUMBER DESCRIPTION AMOUNT 1. Funeral Expense Weideman Fackler Funeral Home $7,375.55 2. Personal Representative Commission, Robert Tenta $1,000.00 3. Social Security Number 4. Year Commission Paid 2010 5. Attorneys' Fees $1,350.00 6. Family Exemption Claimant, Relationship to Deceased 7. Address of Claimant at Decedent's Death 8. Probate Fees $130.00 9. Advertising estate $75.00 10. Reserve $175.00 Funeral Lunch paid to Robert Tenta for reimbursement for cost advanced $394.87 $10,500.42 SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS Estate of Dorothy A. Tenta File Number 2009-0113 ITEM NUMBER DESCRIPTION AMOUNT Shippensburg Health Care Center, nursing home $5,326.00 Pharmacare Pharmacy, Cumberland MD $262.95 $5,588.95 SCHEDULE J BENEFICIARIES Estate of Dorothy A. Tenta File No. 2009-0113 ITEM NUMBER NAME AND RELATIONSHIP AMOUNT OR ADDRESS OF TO DECEDENT SHARE OF BENEFICIARY ESTATE A . Taxable Bequests Robert M. Tenta 10061 Possum Hollow Rd. brother 5 0 Shippensburg, PA 17257 Joseph F . Tenta 894 US Highway brother 5 0 0 129 Ray City, GA 31645 ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY AMOUNT OR SHARE OF ESTATE A. Charitable and Governmental Bequests ~;:' .~ t~,' .. t' `I #' .~t ~,~ II. I give the remainder of my propert to y my brothers, Joseph F. _.~i t Tent3, of Lake Park, t3eorgia, and Robert M. Tanta, of ~~~ t; Mechanicsburg, PA, in equal shares, provided they survive me. In ~~~:~ ~: the event either of ~' my brothers fails to survive me, I give the ~ ~' remainder of estate to I~_ mY my brother who survives me. ~- . ~;~ ~, f~ t-i III. All taxes and interest and penalties thereon payable by ~~ reason of my death with respect to property comprising mY gross '~ ~~ -~. -Z- '~1 :, :~ .,~ :~~ :; ':~ Lt .: .~'k. ,,,:, ';,r'. ,: taxable estate, whether or not pissing under this Will, shall be ~~ paid from the principal of residua estat ~,-,1~ mY Z'y e . 1 I IV. I appoint mY brother, Robert M. Testa, as 8xecutor of this, my ~. ~~., Last Will and Testament. No fiduciary acting hereunder shall be -+ ` I required to poet bond or eater security is any ~urisdictfon. . ~.~ :~> ,~:~ i~,~'j v. For the purposes of this Will, in determining whether a person ~.((, ~,..;7 ;'.~~~ .. has survived me or survived another ereon, the P person shall not be , ~ `~~' ::~.~ L.. .~ deemed to have survived if he or she dies within thirt y (30) days ~~~{ ~~ o mY death or of the death of the other person. i ~; ~.. , ,! ~, ,~ vI . In all references herein to "Executor" orTestator" the use i ~' ,' :. . . of any particular gender or plural or singular cumber is intended , . ~.', ~~ , to include the appropriate gender or number as the text of the ~~~ ~~ within instrument may require. `'~~ ~~.~ ~i ~. ~~ ~= IN WITNESS W88REOF, I, Dorothy Testa, h®reunto set mcy hand ~: '~ and seal this ~ day of •~c.~:~_•~, 7"' 1997 to this :;; ~'~ mY Laet Will and Testament which consists of four (4) typewritten '~ ~ pages . ~ ~~~i -GJ ~ .."' ,~- E.~ Dorothy T a ~•+ SIGNED, SEALED, PIISLISBED AND DECLAR$D, by Dorothy Tents, ;~ r -~ ~~ ~• - 2 - :~ ,; :, ,.. ~~, E~~ ; a . .~ ,..r. _ .... _ ~.. _ _ the Testator above named, as and_for the Testator's Last Will and __ ~~ Testament, and in the presenc® of us, who, at the Testator's request, in the Testator's presence and in the presence of each ~-~ other have subscribed our names as witnesses. ~ _ ~~ D r r ~~ Witness ~~ ~ ~; Address .i ~ , Witn®s Address ~~ ;. ..~ ,; cornrsoNWEALTH of PENNSxzvANIA ) s ss.: COUNTY OF DAIIPHIN ) I, Dorothy Tents, 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 this instrument as mY Last Will, that I signed it willingly and that I signed it as mY fre® and voluntary act for the purposes therein contained. ~~ Dorothy Ten a sworn or affirmed to and ac]azowledged before me by Dorothy Tanta, the Testator, this ~-~ ~{~ day of `~ Wk , 1997. 1dOTA~9Ai. 5~A1 J30Y GOLOR!fiG. wot~r~ PuA+~c Htrrb~Ovey. DauP':M C?unty PJ~ ~- Cammiaion Fxpirzs !to+• 3.1S~i'1 COMMONWEALTH OF P$NN3YLVANIA ) . / . .- 4 N o t a r y P b l i c z ss.: -3- . CO'ONTY OF DAIIPHIN ,..._.,.-..T ~- - -----._^..__ .. __ _.. _ /. ~ the witneBSee whose names are signed to the atta ed 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 fastrumaat as the Testator's Last Willf that the Testator signed willingly sad that the Testator executed it as the Testator's free sad voluntary act for the purposes therein expressed; that each of us is the hearing and eight of the Testator signed the Will as witnesseef and that to the beet of our knowledge, the Testator was at that time ~ighteea or more years of age, of sound mind sad under ao constraint or undue influence. Witness Wi trees ,Sworn or of f irmetd to and subscribed before me by // ~T , f ~ GC and , witnesses, this Z ~ day of ,~cl i1~~ ~+~ 1997. ~ ^ ~ ~~ Notary Public aoTU~~a~ s~~ .~dY 60~lRIKG, No~ry PuDlk MotrMS~~, Osuphln County PA ~- C~armhslon Expires Alov 3.19W -4- 1 ~. c~ ::. ~ ,•,i - - - - •. , ,..~ :,.~ ~~~~ I''L\~ N• n `;;:~ ..~::~ 1' ,' .1 i' ~. ~: ~: ~.~:~ ;~ ~•~ ~' 3 ~~ .i ~~ ; I' .~ . ~~1 •'~ 'i i' ,~ is t~ . I :: ~n ~,_~ qo ~o Pd (¢v a~ A~ n '~ o0 ~ ag5a.