HomeMy WebLinkAbout02-22-10 (3)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 y.~ ~ I ~ I ,,,7/
Harrisbu , PA 17128-0601 RESIDENT DECEDENT o~-
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
1 9 6 1 4 0 9 6 1 1 2 1 1 2 0 0 9 0 1 0 3 1 9 2 5
Decedent's Last Name Suffix Decedent's First Name
MI
U R B A N C H A R L O T T E H
(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 OyALS BELOW
0 1. Original Retum ~ 2. Supplemental Retum ~ 3. Remainder Retum (date of death
4. Limited Estate
~
4a. Future Interest Compromise (date of prior to 12-13-82)
~ 5. Federal Estate Tax Retum Required
O
6
D
d
t Di death after 12-12-82)
.
ece
en
ed Testate
(Attach Copy of Will) ~ 7. Decedent Maintained a Living Trust
(Attach Copy of Trust) 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 CONFIDE NTIAL TAX INFORMATION SHOULD BE DIRECTED TO
Name :
Daytime Telephone Number
J A N L B R O W N 7 1 7 5 ~-~I 1 5 ~; 5 0
Firm Name (If Applicable)
~17
p
J A N L B R O W
N
& A S S O C REGISTER pFj IA~LS USE ¢pLY -
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First line of address , ~
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A S C T S T E 1
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Second line of address ~ -- ~ ~
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City or Post Office
State ZIP Code
DATE FILED N ~~
H A R R I S B U R G P A 1 71 0 9
c:orrespond~L=rte address: BRENDAJLB@VERIZON.NET
Under penalti of perjury; f declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
itpsfR+e,co nd complete. Declaration of pre rer other than the personal representative is based on all information of which preparer has any knowledge.
SI~NATUR~ RSON R SPON OR FILI JYTU DATE
~~ ~ ~ 2/19/2011
ennooec
501 COUNTRY CLUB RD CAMP HILL PA 17011
SIGNATURE OF PRE R O AN REPRESENTATIVE DATE
ADDRESS ~ -"" 2 / 19 / 2 010
845 SIR ~~1AS CT STE 12 HARRISBURG PA 17109
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505607121 1505607121 J
1505607221
REV-1500 EX
Decedent's Social Security Number
Dacedent'aNarta3: CHARLOTTE H- URBAN 1 9 6 1 4 0 9 6 1
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 & Miscellaneous Personal Property (Schedule E) ....... 5. 4 8 7 5 , 0 0
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 1 1 8 0 6 6 , 3 4
7. Inter-Vivos Transfers & Miscellaneous N n-Probate Property
(Schedule G) [~ S
t
Bill
3
0
0
epara
e
ing Requested ....... 7. 0 , 0 0
8. Total Gross Assets (total Lines 1-7) ........................... 8. 1 2 5 9 4 1, 3 4
9. Funeral Expenses & Administrative Costs (Schedule H) ................ 9. 2 5 3 8 , 7 2
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............ 10. 1 1 4 7 , 3 7
11. Total Deductions (total Lines 9 & 10) ........................... 11. 3 6 8 6 . 0 9
12. Net Value of Estate (Line 8 minus Line 11) ......................... 12. 1 2 2 2 5 5 , 2 5
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) .......... ........ 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) .......... ........ 14. 1 2 2 2 5 5 , 2 5
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 _ 0. 0 0 15. 0. 0 0
16. Amount of Line 14 taxable
at lineal rate x .045 1 2 2 2 5 5. 2 5 16. 5 5 0 1. 4 9
17. Amount of Line 14 taxable
at sibling rate X .12 0. 0 0 17, 0. 0 0
18. Amount of Line 14 taxable
at collateral rate X .15 0 0 0 1 g, 0, 0 0
19. Tax Due ................................................19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
1505607221
5 5 0 1. 4 9
1505607221 J
REV-1500 EX Page 3 File Number
Decedent's Complete Address: 0 0
DECEDENTS NAME
CHARLOTTE H. URBAN
STREET ADDRESS
20 Ardmore Circle
CITY STATE
New Cumberland PA
Tax Payments and Credits:
~~ Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. InteresUPenalty if applicable
D. Interest
E. Penalty
ZIP
17070
(1) 5 501.49
275.07
Total Credits (A + g + C) (2) 275 07
4. 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. 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.
(3) 0 00
(4) 0 00
(5) 5,226.42
(5A)
B. Enter the total of Line 5 +SA. This is the BALANCE DUE. (56) 5,226.42
Make Check Payable to: 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 : ........................
..............................................
b. retain the right to designate who shall use the property transferred or its income; ...........
....................
o
^
a
^
X
c. retain a reversionary interest; or ................................................................................................
d. receive the promise for life of either payments, benefits or care? .................................................. ^
^ ^X
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 'intrust for' or payable upon death bank account or security at his or her death? ......... ^X
^ ^
^X
4. Did decedent own an Individual Retirement Aa;ount, 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 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-0ne 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.
Total Interest/Penalty (D + E )
REV-1508 EX + (6-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, ~ MISC.
IN RESIDENTEDECEDENT N PERSONAL PROPERTY
ESTATE OF
FILE NUMBER
CHARLOTTE H. URBAN 0 0
All property jointly- wnedwi h right of surv' orshirms t be disc used on Sched tle F.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
1. 1997 Toyota Camry; VIN 4T1 BG22KXVU151700; fair condition OF DEATH
Value based upon Kelley Blue Book 1,850.00
2 United States Treasury; 2009 1040 overpayment refund 3,025.00
TOTAL (Also enter on line 5, Recapitulation) 13 4 8
(If more space is needed, insert additional sheets of the same size)
REV-1509 EX + (g_98)
SCHEDULE F
COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
CHARLOTTE H. URBAN 0 0
ff an asset was made joint within one year of the decedents date of death, tt must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Susan E Williard 501 Country Club Road daughter
Camp Hill PA 17011
B
C
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANGAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 1976 PSECU Savings; Account 8007235446 - S1 322.49 50. 161.25
2 A 1976 PSECU Checking; Account 8007235446 - S4 3,734.95 50. 1,867.48
3 A 1992 PSECU Savings; Account 8007235446 - S7 24,075.21 50. 12,037.61
4 A 2007 Real estate situate at 20 Ardmore Circle, 208,000.00 50. 104,000.00
New Cumberland, PA 17070
Value based upon RE/MAX Realty Assoc market analysis
TOTAL (Also enter on line 6, Recapitulation) I S ~ ~ R naa ad
(If more space is needed, insert addfional sheets of the same size)
REV-1510 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OF
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE
CHARLOTTE H. URBAN 0 0
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
NUMBER INq.UDETHENMIEDFTHETRANSFEREE,THEIRREUITIDNSHIPTOCECEDENTAND
THE DATE OF TRANSFER.ATTACHACOPYDFTHEDEEDFDRREALESTATE. DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
VALUE OF ASSET INTEREST
QFAF?LICA~E)
VALUE
1. Transfer/gift in May 2009 from decedent to 6,000.00 100. 3,000.00 3
000
00
Susan E Williard, daughter ,
.
TOTAL (Also enter on line 7 Recapitulation) ( S 3 000 00
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (10-06)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
"""' ` ~~ FILE NUMBER
CHARLOTTE H. URBAN 0 0
Detrts of decedent must be reported on schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Funeral luncheon 1,066.20
2 The Patriot-News; obituary 241.52
3 Honorariums for priest and organist 150.00
4 Funeral flowers 265.00
B.
State Zip
Year(s) Commission Paid:
2, Attorney Fees Jan L Brown & Associates 750.00
3. Family Exemption: (If decedenfs address is not the same as claimants, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4• Probate Fees
5 Accountants Fees
6. Tax Return Preparers Fees
7. PennDOT; replacement title and transfer title fees 51.00
8 Cumberland County Register of Wills; filing fee Inher Tax Return 15.00
TOTAL (Also enter on line 9, Recapitulation) I :
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Street Address
City
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
OF
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
NUMBER
CHARLOTTE H. URBAN 0 0
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
1. Pennsylvania State Employees' Retirement System 1,034.11
Reimbursement of overpayment for period 12/12/09 - 12/30/09
2 Allianz; reimbursement of 12/26/09 payment 113.26
TOTAL (Also enter on line 10, Recapitulation) I S
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX + (9-00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
CHARLOTTE H. URBAN n n
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS (indude outrig ~ spousal distributions, and transfers under
Sec. 9116 a) 1.2
1. Susan E Williard, daughter Lineal
501 Country Club Road, Camp Hill, PA 17011 100%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
1. 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 ~
(It more space is needed, insert additional sheets of the same size)
From: JOHN A ESSER
Date: Friday, January 29, 2010
Subject: 20 Ardmore Circle, New Cumberland, PA 17070
The following link is of a few comparatites with a price range from $187,000 - $217,000.
http://cpml.fnismis.com/publink/default aspx~GUID=2ccf8013 3162 4296 8287
17013 eb4c5 86&Report=Yes
John A. Esser, Realtor®
RE/MAX Realty Associates, Inc.
3425 Market Street
Camp Hill, Pa 17011
Direct: 717.648.3737
Office: 717.761.6300 x3142
Fax: 717.730.5595
E-Mail: iohnesser(a,remax.net
Website: www.midpennhomes.com
~~~~ J ~~~ 23 i~;i1 1~ 55
~ eeb ~ ~ _
THIS INDENTURE, made the ~ day of c~0.r`},l,~Q,rt , in the year Two Thousand
Seven (2007).
,., ., ,~ ...,~.._,~~E W,jJ~1~C~iQRLOTTE H. URBAN and EDWARD J. URBAN, deceased, of the
~$o~roitgb~of ewumerland, Cumberland County, Pennsylvania, GRANTOR
A
N
D
CHARLOTTE H. URBAN, of the Borough of New Cumberland, Cumberland County,
Pennsylvania, and SUSAN E. WILLIARD, of the Borough of Camp HiII, Cumberland County,
Pennsylvania, as joint tenants with the right of survivorship, GRANTEES.
W I T N E S S E T H, That in consideration of the sum of One (1.00) Dollar, in hand paid,
the receipt whereof is hereby acknowledged, the said Grantors do hereby grant and convey to the said
Grantees, their heirs and assigns,
ALL THAT CERTAIN piece or parcel of land situate in the Borough of New Cumberland,
Cumberland County, Commonwealth of Pennsylvania, more particularly bounded and described as
follows:
B E G I N N I N G at a point on the westerly line of Ardmore Circle, said point being located
at the southerly line of Lot Numbered two (2), in block "G", on the hereinafter mentioned Plan of
Lots, the property now or late of Robert Troutman; thence along the latter lot westwardly one
hundred twenty (120) feet to a point; thence along line of lands of William Lynch Murray and wife,
southeastwardly eighty-five (85) feet to a point; thence northeastwardly along the line of lot
numbered four (4), in block "G" on said Plan, one hundred twenty (120) feet to a point on the
westerly line of Ardmore Circle; thence along the latter in a northwesterly direction eighty-five (85)
feet to the place of beginning.
BEING lot numbered three (3), in block "G", on the Plan of a portion of Section 2, Highland
Park Hills and Drexel Hills, said Plan being recorded in Cumberland County, in Plan Book 8, Page 9.
HAVING erected thereon a brick, L-shaped, ranch type dwelling house known and numbered
as No. 20 Ardmore Circle.
B E I N G the same premises which Clarence M. Detweiler and Helen I. Detweiler, by their
Deed dated September 11, 1963, and recorded in the Recorder of Deeds in and for Cumberland
County, Pennsylvania, on September 13, 1963 in Deed Book Z, Volume 20, Page 135, granted and
conveyed unto Edward J. Urban and Charlotte H. Urban, the Grantors herein.
The said Edward J. Urban died on October 22, 1994, thereby vesting title solely in the said
Charlotte H. Urban, as surviving tenant by the entireties, Grantor herein.
T O G E T H E R with all and singular the buildings, improvements, ways, woods, waters,
watercourses, rights, liberties, privileges, hereditaments and appurtenances to the same belonging or
in anywise appertaining; and the reversion and reversions, remainder and remainders, rents, issues
and profits thereof, and of every part and parcel thereof; and also all the estate, right, title, interest,
use, possession, property, claim and demand whatsoever of the Grantors both in law and in equity,
of, in and to the premises herein described and everypart and parcel thereof with the appurtenances.
To have and to hold all and singular the premises herein described together with the hereditaments
and appurtenances unto the Grantee and to Grantees' proper use and benefit forever.
AND the said Grantors do hereby covenant to and with the said Grantees that they shall and
will warrant and forever defend the herein above described premises, with the hereditaments and
appurtenances, unto the said Grantees and assigns, against the said Grantors and against every other
person lawfully claiming or who shall hereafter claim the same or any part thereof, by, from or under
any of them.
THIS TRANSFER IS EXEMPT FROM TRANSFER TAX AS A TRANSFER FROM A
PARENT TO A CHILD.
IN WITNESS WHEREOF, the said Grantors have caused these presents to be duly
executed the day and year first above written.
Signed Sealed and
Delivered in the Presence of
~` ~' ! f S l ~ ~ 'f L~~/ SEAL
tness CHARLOTTE H. URBAN.
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF DAUPHIN
SS.
~.
On this, the oZ ~ day of V1. 2007, before me the
undersigned officer, personally appeared Charlotte .Urban, known to me (or satisfactorily
proven) to be the person whose name is subscribed to the within instrument, and acknowledged that
she executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and notarial seal.
N' tary ublic
COMMONWEALTH OF PENNSYLVANIA
I hereb veri that the recise address of the antee herein is: NoTaRIAI sEAI
y ~ p ~ )ACOUELINE A. KELLY, NOTARY PUBLIC
LOWER PAXTON TWP., DAUPHIN COUNTY
20 Ardmore Circle MY COMMISSION EXPIRES DEC.17, 2007
New Cumberland, PA 17070
I
n Be If of Grantees
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF CUMBERLAND
Recorded in the Office for Recording of Deeds in and for
Cumberland County, Pennsylvania, in Record Book ,Page
Witness my hand and seal of Office this day of ,
Anno Domini, 2007.
Recorder