Loading...
HomeMy WebLinkAbout03-11-101505bD7121 ~' REV-1500 EX (06-05) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number Po sox 2aosol INHERITANCE TAX RETURN Harrisbum PA 17128-0601 RESIDENT DECEDENT '~- ~ I O ~~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 8 8 2 0 5 6 9 9 1 0 2 9 2 0 0 9 1 2 0 5 1 9 2 b Decedent's Last Name Suffix Decedent's First Name MI W A K E F I E L D M A R Y J A N E (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL INAPPROPRIATE OVALS BELOW Q 1. Original Return 4. Limited Estate 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) {Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND GONFNEN f IAL I AX INFURMAI IUN SHUULU tlt UIKtG I tU I U: Name Daytime Telephone Number G R E G O R Y R R E E D 7 1 7 2 3 8 0 4 3 4 Firm Name (If Applicable) First line of address 3 1 2 0 P A R K V I E W Second line of address City or Post Office H A R R I S B U R G Correspondent's a-mail address: LAWOFFICE~EPIX.NET State ZIP Code P A 1 7 1 1 1 ~7 -C7~'~ r-r't C 7 S~ ' ~ a "z.'I ~ C:,.' I-~" r "`` ~ 1 ~~ ~.a REGISTER OF 4.L3 USE ON ~~ o ~ ~~n ~ ~ ~ ~~x ~... ca c~~Q ~ G` -~-I . DAI~ILED . 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 belief, tt is true, correct and complete. Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge. SI ~TURE OF,p~SON R PONSIBLE R FILING RETURN DATE ~.!?o ~1,~.~. ~u/Ja~~~rpv'-pry-- 3/i~/~o~o SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505607121 15D5b07121 L A N E ~~. J 1505607221 REV-1500 EX Decedent's Social Security Number oecedent'sName: MARY JANE WAKEFIELD 1 8 8 2 0 5 6 9 9 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 5 2 7 • 4 0 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous N n-Probate Property h l S d G ~] 2 9 0 0 5 0 ( c e u e ) Separate Billing Requested ....... 7. . 8. Total Gross Assets (total Lines 1-7) ........................... 8. 7 4 2 7. 9 0 9. Funeral Ex enses 8 Administrative Costs Schedule H P ( ) ........... 9. ..... 1 6 6 6. 5 0 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ....... ..... 10. 1 0 4 7 1 1 • 7 1 11. Total Deductions (total Lines 9& 10) ...................... ..... 11. 1 0 6 3 7 8. 2 1 12. Net Value of Estate (Line 8 minus Line 11) .................... ..... 12. - 9 8 9 5 0 . 3 1 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. 9 8 9 5 0. 3 1 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.0 _ 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. Amount of Line 14 taxable at collateral rate X .15 1 g. 19. Tax Due ............................................ ....19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505607221 1505607221 REV-7500 EX, Page 3 Decedent's Complete Address: File Number 0 ~ DECEDENT'S NAME MARY JANE WAKEFIELD STREET ADDRESS CITY STATE ZIP 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 InterestlPenalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fiil 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) 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; ............................... ^ ^ 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? ......... ^ ^ 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 transfers to or for the use of the surviving spouse is three (3) percent (72 P.S. §9116 (a) (1.1) (i)j. 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 p2 P.S. §9116 (a) (1.1) (ii)J. The statute does not exemat a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are stil- 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)]. 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, 1 REV-1508 E,X + (B-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. IN RES DENTEDECEDENTRN PERSONAL PROPERTY ESTATE OF FILE NUMBER MARY JANE WAKEFIELD 0 0 Include the proceeds of litigation and the date the proceeds were received by the estate. All properly jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. IRS Refund (not yet received) 500.00 2. Members 1st Federal Credit Union 245.91 Checking Account 3. Members 1st Federal Credit Union 719.49 Savings Account 4. Guardian Elder Care in Carlisle (refunded to Agent) 3,019.00 5. CRX Railroad (refund) 10.00 6. MetLife -husband's pension plan (widow's benefit) 33.00 7. Stainless steel old-English ring initialed "R", 0.00 referred to in ITEM THIRD of Decedent's Last Will & Testament, never found or located. TOTAL (Also enter on line 5, Recapitulation) S 4 527.40 (If more space is needed, insert additional sheets of the same size) REV-1510 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF SCHEDULE G INTER•VIVOS TRANSFERS 8~ MISC. NON-PROBATE PROPERTY FILE MARY JANE WAKEFIELD 0 0 This schedule must be completed and filed 'rf the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER.ATTACHACOPYOFTHEDEEDFORRFALESTATE. DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST EXCLUSION (IFAPPLICABLE) TAXABLE VALUE 1. Prudential common stock -issued over the years to Decedent 2,900.50 2,900.50 in lieu of dividend. Received by son at her death because he was beneficiary of very small life insurance policy that was liquidated prior to her death to pay nursing home bill. This was not a probate asset. (see documentation attached hereto and marked Exhibit "1") TOTAL (Also enter on line 7 Recapitulation) ~ ~ 2 900 50 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (10-06) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER MARY JANE WAKEF{ELD 0 0 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Funeral (pre-paid) $8,000 B. ADMINISTRATIVE COSTS: 1. Personal Representakive's Commissions Name of Personal Representative {s) Cheryl D. Musselman Street Address City State Zip Year(s) Commission Paid: 2 Attorney Fees Gregory R. Reed 3, Family Exemption: (If decedent's address is not the same as claimants, attach explanation) Claimant NOT APPLICABLE Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Register of Wills 5 Acxountanrs Fees 6, Tax Return Preparers Fees 7, Income tax preparation -Crystal U. Hackett, CPA 750.00 i 750.00 76.50 90.00 TOTAL (Also enter on line 9, Recapitulation) ~ S ~ (If more space is needed, insert additional sheets of the same size) REV-1512 la(* (12-03J COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & DENS ESTATE OF hlLt NUMI3tK MARY JANE WAKEFIELD 0 0 Report debts incurred by the decedent priorto death which remained unpaid as of the date of death, including unrelmbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Commonwealth of Pennsylvania, Department of Public Welfare 104,711.71 (see copy of letter attached hereto and marked Exhibit"2") TOTAL (Also enter on line 10, Recapitulation) I S 1 (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (i1-08) pennsylvania SCHEDULE ] DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER 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 [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. Cheryl D. Musselman, 706 Front Street, Enola, PA 17025 Daughter 50% of residue 2. Donald D. Wakefield, 866 Flook Road, Jersey Shore, PA 17740 Son 50% of residue ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV•1500 COVER SHEET, A S APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. # If more space is needed, insert additional sheets of the same size. hiblt 1 Ex Prudential IMPORTANT TAX RETURN DOCUMENT ENCLOSED 001632 IIII'Illll'IIIIIIIIIrIJrIIIIIIIIrLlnlllllllllll'1111'1""ll'I Recipient DONALD D WAKEFIELD 866 FLOOK RD JERSEY SHORE PA 17740 Holder Account Number 00030982029 I N D T SSNfrIN Certified Yes Symbol PRU Ct:sip 744320102 ODICS0007.SAL.C.REG.D.L.CI5.051749 2731/001632/00163211 Prudential Financial, Inc. -Sale Advice 12010 Tax Form 1099-B Corrected (if checked} Copy B -For Recipient Form 1099-B -Proceeds from Broker and Barter Exchange Transactions 2010 This is important taz information and is being famished to the Internal Reverale Service. If you are required fp file a return, a negligence penalty or other sanction may be imposed on you'rf this income is taxable and the IRS detennines that it has not been reported. DONALD D WAKEFIELD Recipient 866 FLOOK RD JERSEY SHORE PA 17740 Account Number 0030982029 Recipient's ID no. 183440462 Payers FederallD No. 43-1912740 OMB No. 1545-0715 Deoanment of the Treasury -Internal Revenue Serv ce ta- Date of Sale '~ p Stocks, Gross Proceeds or Exchange CUSIP No. I Bonds, etc. ($) Reported to IRS Payer's Derails 11 Jan 2010 744320102 2,915.91 Yes COMPUTERSHARE P.O. BOX 43010 FEDERAL INCOME ' - --De4er~tier~- ----Nerve-af Is~;oar - ---- ---- --- --- - .Tt2r~sackon .. _ _-- ._ . _.. -- --- T~v ItITLI LIGI fl /[1 0.00 PRUDENTIAL FINANCIAL INC Sale - 001 NOTE: Computershare will report the amount in Box 2 to the IRS. The difference between the gross proceeds amount in Box 2 and the net proceeds you received represents any fees, charges, or withholding taxes you may have paid. Form 1099-B (fceep for your recorast Summary This advice is a result of the sale of Plan andlor Direct Registration shares. Trade ' ShareslUnits Price Per Gross Amount Deduction I Deduction Net Amount ~ Transaction Description I Sold I SharelUnit $ I of Sales $) I Amount $) DatelTime i {) ( ( Type of Sale ($) 01111!201014:01 Sale 55.000000 53.016557 2,915.91 15.40 Transaction Fee 2,900.51 Computershare Trust Company, NA., as agent, upon written request, will provide the name of the executing broker dealer associated with the transaction(s), end within a reasonable amount of time will disclose the source and amount of wmpensaGon received from third parties in connection wIN the transac0on(s), i(any. If trade time is not included above, it may be available upon written request. ~' 71 UTX ~,omputershare Computershare Trust Company, N.A- PO Box 43033 Providence, Rhode Island 02940-3033 Within USA, US territories 6 Canada 800 305 9404 Outside USA, US territories b Canada 732 512 3781 v~v11w. computersha re.com/investor PRU 'I" `~~~~~ ~~-~~~~ OOHX2E{FT) PLFASECASHNEPOSITTHISCHECKPROMPTLY. hlblt z Ex R ' COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF PROGRAM INTEGRITY DIVISION Of THIRD PARTY LIABILITY ESTATE RECOVERY PROGRAM PO BOX 8486 HARRISBURG, PA 17105-8486 February 22, 2010 GREGORY R REED ESQUIRE 3120 PARKVIEW LANE HARRISBURG PA 17111 Re: Mary Wakefield CIS #: 580197303 SSN: ###-##-5699 Date of Death: 1OJ29/2009 Dear Attorney Reed: Please be advised that the Department of Public Welfare maintains a claim in the amount of $104,711.71 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. 1412, 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 $37,769.97, 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 $66,941.74, is to be entered as a priority Class 5.1 claim against the estate. Please acknowledge receipt of this letter and advise whether the Commonwealth's claim is admitted and when payment may be expected. If the estate accounting is complete, please provide a copy. If the estate contains real estate, please provide copies of the deed, the latest tax assessment, and a current appraisal, if available. S' cerely, aren H. Peterson Claims Investigation Agent 717-772-6615 717-772-6553 FAX Enclosure LAST WILL AND TESTAMENT OF MARY JANE WAKEFIELD KNOW ALL MEN BY THESE PRESENTS, That I, MARY JANE WAKEFIELD, of the Borough of West Fairview, County of Dauphin and State of Pennsylvania, do make, publish and declare this instrument to be my Last Will and Testament, hereby revoking and making void any and all former Wills by me at any time heretofore made. FIRST - I direct the Executor or Executrix hereof to pay all my just debts, funeral expenses and costs of administration as soon as conveniently may be done after my death. I further direct the Executor or Executrix hereof to pay all inheritance, estate, transfer and succession taxes which may be levied or assessed upon any property which is included as part of my gross estate for the purpose of any such tax. SECOND - I give, devise and bequeath all the rest, residue and remainder of my estate, both real and personal, to my husband, RAYMOND L. WAKEFIELD. THIRD - If my said husband fails to survive me, then I give and bequeath my husband's stainless steel old-English ring, initialed "R", to my granddaughter, REBEKAH WALTZ. FOURTH - If my said husband fails to survive me, then I give, devise and bequeath all the rest, residue and remainder of my Estate, both real and personal, as follows: (a) Fifty (50$) percent thereof to my daughter, CHERYL D. MUSSELMAN, or if she fails to survive me, to her issue per stirpes; and ,, '. `; r, (b) Fifty (50%) percent thereof to my son, DONALD D. WAKEFIELD, or if he fails to survive me, to his issue per stirpes. FIFTH - I appoint my said husband, RAYMOND L. WAKEFIELD, to be the Executor of this, my Last Will and Testament. In the event of the death, resignation, renunciation or inability to act of my said husband, then I appoint my said son, DONALD D. WAKEFIELD, Executor hereof. In the event of the death, resignation, renunciation or inability to act of my said husband and my said son, then I appoint my said daughter, CHERYL D. MUSSELMAN, Executrix hereof. I do hereby give to the Executor or Executrix hereof full power, discretion and authority at any time or times to sell, at private or public sale, mortgage, lease, pledge, exchange or otherwise deal with or dispose of the property comprising my estate upon such terms as deemed best, to settle and compound any and all claims in favor of or against my estate as deemed best and, for any of the foregoing purposes, to make, execute and delivery any and all deeds, mortgages, contracts, leases, bills of sale or other instruments necessary or desirable therefor. LASTLY - I direct that no fiduciary appointed by this, my Last Will and Testament, shall be required to give Bond and that if, notwithstanding this direction, any Bond is required by any law, statute or rule of court, no Surety shall be required thereon. ~ , ~/ IN WITNESS WHEREOF, I have set my hand and seal to this, my Last Will and Testament, consisting of three (3) pages on the margin of which (except this page) I have affixed my initials this ~'" day of :~/t"2~`r~~1~rt~^ A. D. 2002. ,~ j~/ ~:(. ~~ ` •;• ~ ~~ /1~" c:r~,j~-rte t.C~ (SEAL ) Signed, sealed, published and declared by MARY JANE WAKEFIELD, the above named Testatrix, as and for her Last Will and Testament, in the presence of us and each of us, who at her request, and in her presence, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. ~f Jam,'' ; ..- ,~' .,- ,~'~~ ~~: s ~.ry•ti ACKNOWLEDGMENT STATE OF PENNSYLVANIA COUNTY OF DAUPHIN :ss I, MARY JANE WAKEFIELD, the testatrix 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 the instrument as my Last Will; and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. Sworn to or affirmed and acknowledged before me by MARY JANE WAKEFIELD, the testatrix, this ~~ day of November, 2002. ~', ~ ,. L1: ,. MARY ,' E WAKEFIELD - Testatrix Notary Publ'c NOTARIAL SEAL CARA J. VJENGER, Notary Public City of Harrisburg, Dauphin County My Commission Expires Feb. 24, 2003 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN :ss We, Gregory R. Reed and Susan F. Reed, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the testatrix sign and execute the instrument as her Last Will; that the testatrix signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the testatrix signed the will as a witness; and that to the best of our knowledge the testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn to or affirmed and subscribed to before me by Gregory R. Reed and Susan F. Reed, witnesses, this lst day of November 2002. ~:~ Witness Witness G ~ / ~ Notary Publi NOTARIAL SEAL CARA J. WENGER, Notary Public City of Harrisburg, Dauphin County My Commission Expires Feb. 24, 2003