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HomeMy WebLinkAbout03-09-10 (2) 1505607121 REV-1500 EX 06 05 ( - ) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes Po Box asosol INHERITANCE TAX RETURN County Code Year File Number Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 1 0 0 0 2 7 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 9 6 1 4 4 2 3 0 1 2 2 8 2 0 0 9 1 2 0 2 1 9 2 1 Decedent's Last Name Suffix Decedent's First Name MI L I L L E Y J O S E P H X (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS © 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ prior to 12-13-82) 5. Federal Estate Tax Return Required ® s Decedent Died Testate ~ death after 12-12-82) 7 D d . . ece ent 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 Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) µ I....,_ ~~:) ,~ City or Post Office State ZIP Code ``D/~,`~FnED -p c_ -; `.~. .-•~ ..~.. C A R L I S L E P A 1 7 0 1 3 ~`~ --~ ~ ~ ~~~ r-~~ '~Ly. ~ ~ } ~`~, ~wr- 4.x.'•1 ,,, ,r..f Correspondent's a-mail address: Under penalties of perjury, I declare that I have examined this return, including acx:ompanying 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. S URE F PERS N RESP~~ OR FILING RETURN ~~Y/d' CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number D O U G L A S G M I L L E R 7 1 7 2 4 9 2 3 5 3 Firm Name (If Applicable) REGISTER OF WILLS USE ONLY I R W I N & M c K N I G H T P C• First line of address n -,-, 6 0 W E S T P O M F R E T S T R E E T ~ -~ ,~-, - ~~ _: '~ ~'~? Second line of address ~_ ~ ~~ ~~ ~_, ~ ~ 60 WEST POMFRET STREET CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY 1505607],21 1505607121 nvvr~~aJ -/ ~ - 60 WE T POMFRET STREET CARLISLE PA 17013 SIC~IQasl IRG (IC~RCGACCG l1TUtC Tuww~ ocnorc~r~~rwrni~ r 'C22Z095~54 'C22Z09S054 Z aP!S a 1N3WJlVd?l3A0 Ned ~O dNf1~321 d JNIlS3f1D321 321~d flOJl ~I lt/AO 3Hl NI lll~ 'OZ '66 ................................................ ana xel'66 0 0 ~ O 0 0 ' 0 8 6 0 5 6' X a}e~ !era}e!!oo }e 0 0 algexe} ~ ~ au!l }o }unowy •g ~ 0 0 ' 0 L 6 0 Z 6' X a}e~ 6u!!q!s }e 0' 0 algexe} ~ ~ au!l }o }unowy •L ~ 0 0 ' 0 g 6 0 . 0• X a}e~ !eau!! }e 0 0 algexe} b 6 au!l }o }unowy •g ~ 0 0 ' 0 'S ~ 0 0. 0 0' x (Z' 6)(e) • oaS ~apun spa}sues} g ~ 66 ~o `a}e~ xe} !esnods ay} }e algexe} ~ ~ awl }o }unowy .5 ~ S31V21 319b~~lldd~d 210 SNOIl~f1211SN1 33S - NOIlH1f1dW0~ Xdl .~~ .................. 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(d alnPayoS) a}e}sa leas ' 6 1VOlldlfllldV~321 Jl 31-I I 1 ' X H d 3 S 0 I' :aweN s,;uapaoaa O E 2 h h 2 9 6 2 aagwnN i(}!~noaS le!ooS s,}uapaoaa X3 0056-n32i 'C22G09505'C REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 10 0027 DECEDENT'S NAME JOSEPH X. LILLEY STREET ADDRESS 801 NORTH HANOVER STREET CITY CARLISLE STATE PA ZIP 17013 Tax Payments and Credits: ~. Tax Due (Page 2 Line 19) (1) 0.00 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 0.00 Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 0.00 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. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 0.00 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? ....................................................................................... ^ Q 3. Did decedent own an "intrust 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-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. REV-1508 EX + (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. IN RESIIDENT D EDEN RN PERSONAL PROPERTY ESTATE OF FILE NUMBER JOSEPH X. LILLEY 21 10 0027 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PNC BANK -CHECKING ACCOUNT #5004737264 7,015.07 2. LINCOLN BENEFIT LIFE COMPANY -ANNUITY CONTRACT NO. LBCA135027 189,407.43 BENEFICIARY: THE ESTATE OF JOSEPH X. LILLEY 3. PERSONAL PROPERTY -GUITAR 500.00 TOTAL (Also enter on line 5, Recapitulation) ~ ~ 196,922.50 (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 JOSEPH X. LILLEY 21 10 0027 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. AVER CREMATION SERVICES OF PENNSYLVANIA 299.50 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) DOUGLAS G. MILLER Street Address 60 WEST POMFRET STREET City CARLISLE State PA Zip 17013 Year(s) Commission Paid: 2, Attorney Fees IRWIN & McKNIGHT, P.C. 3. Family Exemption: (If decedents address is not the same as claimants, attach explanation) Claimant 4. Street Address City State Zip Relationship of Claimant to Decedent Probate Fees REGISTER OF WILLS 5. I Acx:ountanYs Fees 6. Tax Return Preparers Fees PATRICIA A. ROSENDALE, CPA FIDUCIARY AND INCOME TAX RETURNS 7. REGISTER OF WILLS -FILING FEE 8. 1-800 GOT JUNK -TRASH REMOVAL 9. THE SENTINEL -ESTATE NOTICE 10. CUMBERLAND LAW JOURNAL -ESTATE NOTICE 11. NOTARY FEES 12. REGISTER OF WILLS -SHORT CERTIFICATES 8,900.00 9,600.00 177.50 465.00 30.00 406.00 176.92 75.00 25.00 12.00 TOTAL (Also enter on line 9, Recapitulation) I $ 20.166.92 (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (12-03) SCHEDULE 1 COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ~ ESTATE OF FILE NUMBER JOSEPH X. LILLEY 21 10 0027 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. CARLISLE RENT ASPACE -STORAGE 208.40 2. WEST SHORE EMS -AMBULANCE 70.67 3. WATERSHED UROLOGY -MEDICAL 7.15 4. CARLISLE REGIONAL MEDICAL CENTER -MEDICAL 151.11 5. REIMBURSEMENT OF SOCIAL SECURITY PAYMENT 1,129.00 6. KINETIC IMAGING -MEDICAL 14.68 7. CONTINUING CARE -MEDICAL 744.03 8. STOKEN OPHTHALMOLOGY -MEDICAL 20.00 9. PHILHAVEN -NURSING 10.75 10. DARRYL K. GUISTWITE -MEDICAL 34.55 11. CUMBERLAND-GOODWILL -AMBULANCE 547.08 12. CHURCH OF GOD HOME -NURSING 18,784.54 13. ALEXANDER SPRING EMER PHYS -MEDICAL 22.69 TOTAL (Also enter on line 10, Recapitulation) I ~ 21, 744.65 (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER JOSEPH X. LILLEY ~~ ~ n nn~~ 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 [nclude outright spousal distributions, and transfers under 1, Sec. 9116 (a) (1.2)] ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. IN TOUCH MINISTRIES 77,505.47 PO BOX 7900 ATLANTA, GA 30357 2. CHURCH OF GOD HOME, INC. 77,505.46 801 N. HANOVER STREET CARLISLE, PA 17013 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ~ 155 010.93 ~Ir more space Is needed, insert additional sheets of the same size) Lincoln Benefit Life Company P.O. Box 94212 Palatine, IL X0094-4212 Telephone: (877) 499-6418 Facsinule: (866) 635-4523 February 11, 2010 Douglas G. Miller West Pomfret Professional Building 60 West Pomfret Street Carlisle, PA 17013-3222 Re: Joseph X Lilley Contract No: LBCA135027 Dear Mr. Miller: I~E~ `~ ~ ~~~~~~ 1RUVIN & I'NcKliiiGl! p~W OFFlCE~ We received a request to complete IRS Form 712 for the above referenced contract. The purpose of Form 712 is to provide an estate or donor with the value of a life insurance contract or its proceeds as of a certain date (usually the owner's date of death or date of transfer of the contract). Because this contract is an annuity, it is not reportable on IRS Form 712. I can, however, provide the following information for estate purposes: Contract Date: November 29, 2006 Date of Death: December 28, 2009 Annuity Value as of Date of Death: $ 189,407.43 Cost Basis: $ 177,298.58 Named Beneficiary: Joseph X. Lilley Estate *The actual amount paid may differ due to Market Value Adjustments and/or any applicable Surrender Charges. If you have any questions, please contact me at 1-877-499-6418 Ext. 86489. Sincerely, LINCaLN BENEFIT LIFE AM ALL8TATE COMPAI~IY Crystal J. Parish Sr. Claim Examiner ~ ~ u~ ~. Lulu I I . JUnivi i iu~ unlun ~h i L I UJ-L l `t l ~~~ LEADUI6THEWAY Febiuttry 5, 2010 Douglas G Miller, Esq. Irwin & McKnight P.C. West Pomfret Prof Bldg 60 W Pomfret St Carlisle, PA 17413-3222 RE: Joseph X Lilley SSN: 196-14-4230 DOD: 12-28-2009 Dear Mr. Miller: IV U, UL7J r, I/ i In response to your xequest fox Date of Death (DOD) balances for the customer noted above, vur records show the fallowing: Checking Account Account.# 5004737264 Established: 09-23-2005 yOSEPH X LILLEY DOD balance: $ 7,014.97 + 0.10 accnied interest ' Interest paid O 1-01-2009 thru 12-28-2009 $ 56.20 Yl'D PIease note that this office. provides date'of death balances for deposit accounts (IltAs, CDs, Checking and Savings). We do not proce99 any financial traasaction9 ~or provide ~9tatenwent9. Lf you need assistance with any of these items, please call 1-888-PNC-BANK (1-885-762 2265) or stop by your local PNC Bank branch office. Sincerely, National Financial Services Center PNC Bank, N.A. Member FDIC `~ I i f Paae 1 of 1 /,. f i ~'1, f~°raTabl'e, ~l~j', Usrd Guitars and Ads ~~ ,., f ~ ~~ HOURS: ! ~~~~.~.~. - ,I~.fl ~ D~+ Mon & Tues --11-5 r ` ~ ; ski Wed & Thurs -11-7 % .'+ ~ ~ ~t Friday -11- 5:30 i •~ - '~n~ Saturday --10-4 •~; ;' r "~'' Closed -Sunday :F: i ~ .:~` ~ _ South 3rd Street - .. .~ ~~ ~717~ 97 17043 ~ ~ i ( ) 52385 ~~ ~- Dat C.7 .Z ©/ ~ ~~ Name. .:~~~~ ~: ~l'i.,v~ ~ ~~, rri ~ City ~; ~~ State ~~ Zip ~ i~l~i/ Qh' Descriptio Price COI~IIVIENTS: 525.00 Charge oa all returned checks NO Cash refunds - in store credit Pa sales tax Only if made within 3 days TOtal 60 Day layaway with 25% down Item must be paid in full within 60 DepOSlt Days or deposit will not be refunded Balance Signature ~~ ~x ~(no <n~ ~,, :n~ !~ P i~ ~ c~ ~290~