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Home My WebLink About04-06-10 15056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN Po Box 28oso1 RESIDENT DECEDENT 21 10 0240 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Date of Birth Social Security Number Date of Death 180-10-5701 01 /10/2010 10/28/1918 Suffix Decedent's First Name MI Decedent's Last Name Paull Ivy A (If Applicable) Enter Surviving Spouse's Information Below MI Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW Remainder Return (date of death 3 1. Original Return . 2. Supplemental Return prior to 12-13-82) Future Interest Compromise (date of 5. Federal Estate Tax Return Required 4a 4. Limited Estate . death after 12-12-82) Decedent Died Testate 6 7. Decedent Maintained a Living Trust 1 8. Total Number of Safe Deposit Boxes . (Attach Copy of Will) d (Attach Copy of Trust) Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A) 10 9. Litigation Proceeds Receive . between 12-31-91 and 1-1-95) (Attach Sch. O) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: CORRESPONDENT - Daytime Telephone Number Name ~'' ~' (717) 737-0464n -n Lisa Marie Coyne, Esq. ~ - Firm Name (If Applicable) ,. _,... _ :v REGISTER O~ ~L~S USE {}NCSC? , Coyne & Coyne, P.C. ~!~~ ~ ~ -U=~ l First line of address 3901 Market Street Y ~} ~, -w t_~= _. ~ -' Second line of address - -T- ~ ., - > ~~`) , rV - a DA"IE FILED City or Post Office State ZIP Code - PA 17011-4227 Camp Hill Correspondent's a-mail address: IISa@COyneandCOyne.COm 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, a y kno ledge. other than the personal representative is based on all information of which prepay it is true, correct and complete. Dec lion of pre rer DATE SIGNAT E F PERSON RESP BLE FO I NG RETURN ~ / i V ADDRE Ge rge a Jan s, 145 Ewe Road, Mechanicsbur PA 17055 __ __ _ _ __ _ _ 9, -_ - - ----- -- __ _ DATE ---- - SIGNA OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 ~) 15056052059 REV-1500 EX Decedent's Social Security Number Icy A Paull 180-10-5701 Decedents Name: RECAPITULATION - - 1. Real estate (Schedule A) . ........................................... . L 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. 233,136.29 6. Jointly Owned Property (Schedule F) Separate Billing Requested ...... . 6. 38,041.28 Inter-Vivos Transfers & Miscellaneous Non-Probate Property 7 . (Schedule G) 'Separate Billing Requested....... . 7. 8. Total Gross Assets (total Lines 1-7) ............................ ..... .. 8. 271,177.57 . _. 9. Funeral Expenses & Administrative Costs (Schedule H) ................... .. 9. 20,907.50 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .. 10. 1,739.00 11. Total Deductions (total Lines 9 & 10) ................................. .. 11. 22,646.50 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 248,531.07 Charitable and Governmental Bequests/Sec 9113 Trusts for which 13 . an election to tax has not been made (Schedule J) ...................... .. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. 248,531.07., TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or - transfers under Sec. 9116 15. (a)(1.2) X .0_ 16. Amount of Line 14 taxable 248,531.00 at lineal rate X .0 45 1s. 11,184.00 17. Amount of line 14 taxable 17 at sibling rate X .12 18. Amount of Line 14 taxable 18 at collateral rate X .15 11,184.00 19. TAX DUE ...................................................... ...19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 REV-1500 EX Page 3 File Number 71 4f1 ':'..rl')drl ueceaenrs t,.ompieie f+-caurGSa. DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER ivy A Paull 180-10-5701 __ _ __ _ __ STREET ADDRESS 145 Ewe Road -_ - -- - - - CITY - _ _ _ __ _ _ _ _ STATE ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 11,184.00 2. CreditslPayments A. Spousal Poverty Credit - _.- B. Prior Payments __ - C. Discount 559.00 -- -- - - - Total Credits (A + B + C) (2) 559.00 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. Fill 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) 10,625.00 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 10,625.00 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? .............................................................................................................. ^ 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)]. 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)J. 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. i SCHEDULE E CASH, BpANK DEPOpSITS,p&~MISC. COMMONWEALTH OF PENNSYLVANIA ',. PERSONAL PROPERT 1 ' INHERITANCE TAX RETURN RESIDENT DECEDENT _ -. __ _- - -_ ESTATE OF ' FILE NUMBER PAULL, IVY A. 21 - 2010 - 0240 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. __. - - ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH __. - 1 Citizens Bank Acct. No. XXXXX5513 (In trust for daughter) 2 First National Bank Checking Acct. XXXXX4796 3 First National Bank Cert. of Deposit Noe XXXXX4028 4 First National Bank Cert of Deposit No. XXXXX5969 S Wachovia Bank Cert of Deposit No. XXXXX9628 (In trust for daughter) 6 Graystone Bank Savings Acct. No. XXXXXX2308 7 Misc. Personal Property and Effects 8 PNC Bank Cert of Deposit No. XXXXX6580 (In trust for daughter) 9 PNC Bank Money Market Acct No. XXXXX 7556 (In trust for daughter) - - - -- TOTAL (Also enter on Line 5, Recapitulation) 52,309.00 7,106.00 7,772.00 12,753.00 28,489.00 1,000.00 47,730.00 45,274.00 233,136.00 ~' ~ ~~ Account Number 6255985513 Account Title IVY PAULL TTEE FOR GEORGENE JANTOS Date O ened 3/31/2009 Account Type Time Deposits Principal Balance as of DOD $30673.23 Interest from Last Posting to DOD $29.85 . Account Balance as of DOD $30703.08 YTD Interest to DOD $ .00 W ,w ~ a ~s a r or ~ ~P ®B r` ~~ Coyne & Coyne 3901 Market Street Camp Hill, PA 17011-4227 Dear Sir or Madam, March 17, 2010 ~ ~~ ~ ~'~~ ~ _ " y ~z Qj~ RE: ESTATE OF NY A. PAULL ~ SSN: 180-10-5701 ~,,,~ DOD: 1/10/10 www.fnb-online.com Info-Line 1-800-817-8787 Customer Service 1-800-555-5455 As per your request, the following information is provided as of Date of Death: Checking # 97014796 Opened 7/14/09 Titled Ivy Paull Georgene Jantos, Tstee Balance $52,308.95 Accrued Interest $11.46 CD # 101034028 Opened 11/21/07 Titled Ivy Paull Georgene Jantos, Tstee Balance $7,106.04 Accrued Interest $4.09 CD # 101035969 Opened 11/29/07 Titled Ivy Paull Georgene Jantos, Tstee Balance $7,772.22 Accrued Interest $2.77 ***Georgene Jantos, Trustee is a "signer only" on all accounts If you should have any further questions, please do not hesitate to contact me at 724-983-6068. Very truly yours FIRST NATIONAL BANK Deborah L. Bartosh Transmission 3/1712010 9.23;46 AM PAGE 1/001 Fax server Reference ID: 2980232 Wachovia Bank N.A. Balance Confirmation Services P O Sax 40028 Roanoke, VA 2A022-7313 March 17, 2010 COYi~iE & CQYNE ** SUBJECT: Verification / Canfirtnatian of Account and Balance Infarination provided for. Castomer:lVY A PAULL (SSN# XJQC-XX-5701) Date of Death: January 10, 2010 pit Accasl~t Information Accaurt Account Date ofDeath Average Date Maturity Lrt~~est Accrued YTD Date 1~pe Numlxr Balance Balance` Opcnerl Date Rate Ir3erest Inlernt Paid Clonal CERTIFICATE OF ha~.'~628 1112,73284 3/212008 3/28012 516.00 50.00 DEPOSIT LEGALT[TLE: IVY PAULL 1TF GEORGENE JAN'I'+OS "Date of death balance does not include accrued interest. If date of death oecurrs on a weekend or a holiday, date of death balance does not include arty transactions that were made during.that time period. ~y~. 3s+~ Jemrifer Straub Servicenter Assoaate Phone:(SAO)5b3-7323 ,)~ja Checking Accounts: Number: Date Opened: Balance at Date of Death: Name of Joint Owner, if any: Savings Accounts: Number: f~~"~U~~~ Date Opened: l~ - ~--~. ~~ Balance at Date ~ ~~ ~~~ ~ of Death: ~ ~ Name of Joint Owner, if any: Certificates of De posit: Number: Date Opened: Name of Joint Owner, if any: Balance at Date of Death: Maturity Date: Interest Rate: Interest Paid Quarterly, Semi-Annual, etc. Debts: Estate of: Ivy A. Paull Date of Death: January 10, 2010 Name of Bank: Graystone Bank `~~~ Signature of Ba Savings Assoc. Official ~ ~ D ~ ~': Qa o N O_ O ~1 II~~~~JJc---~ ~)~ SCHEDULE F COMMONWEALTH OF PENNSYLVANIA ~ JO~NTLY'OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ~ - - -- _ - - _ - - -. - _ __ - _ _ -_ ESTATE OF 1 FILE NUMBER PAULL, IVY A. 21 - 2010 - 0240 __ __ ___ If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. - _ SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT _ _ - _ ___ _ -- - __ A Georgene Jantos Daug ter JOINTLY OWNED PROPERTY: - _- _ _ _ DESCRIPTION OF PROPERTY o DATE OF DEATH LETTER ITEM DATE Include name of financial institution and bank account numbe r] DATE OF DEATH VALUE OF ~, FOR JOINT NUMBER . MADE 'or similar identifying number. Attach deed for jointly-held real VALUE OF ASSET INTERESTi DECEDENT'S INTEREST TENANT JOINT estate - _ --_ . _ .. -- T - -- ~_ _ _ _ 1 A 'Susquehanna Bank 03/05/2008 15 606.74 ° 50 /° 7,803. ', 'Checking Account No. XXXXX8025 2 A 04/03/2009 i Centric Bank 35,696.99!, 50%'~ 17,848.50 Roll-over CD. No. XXXXX2393 3 A 11/30/2005 ~, Affinity Bank 24,778.811 50%j 12,389.41 Savings Acct. No. XXXXX2866 i ~, -_ _ -- - - - ___ _- _ ___ ~ - e 6, Recapitulation) 38,041.28 TOTAL Also enter on lin Checking Accounts: Number: Date Opened: Balance at Date of Death: Name of Joint Owner, if any: Savings Accounts: Number: ~ I~ Date Opened: Balance at Date of Death: Name of Joint Owner, if any: Certificates of Deposit: Number: ~Q Z Z 3 ~ 3 Date Opened: //3 Q Name of Joint Owner, if any: 1~ ~~ ~ Zti~ /}/L~I~`P Balance at Date of Death: c3~ro9~~ / Maturity Date: 7 /3/~~ Interest Rate: .2. 6 ~ Q Interest Paid Quarterl y, Semi-Annual, eta Debts: Estate of: y A. Paul Nam f Bank: ~ entr°c Bank ~. Date of Death: a ~T6, 2010 Signature of Bank or Savings Assoc. Official ~~ ~9~ ~ o~ ~o ~ 1 Checking Accounts: Number: Date Opened: Balance at Date of Death: Name of Joint Owner, if any: Savings Accounts: Number: '~oaagc~c~ Date Opened: ~ ~ I ~~ "`" Balance at Date h ~ n i ~, j ~.~G ~ I ( `'( 0 of Deat : p Name of Joint if any: Owner ~~ ~ ~~ , Certificates of Dep osit: Number: Date Opened: Name of Joint Owner, if any: Balance at Date of Death: Maturity Date: Interest Rate: Interest Paid Quarterly, Semi-Annual, etc. Debts: Estate of: Ivy A. Paull Date of Death: January 10, 2010 ame of Bank: Affinit Bank ~ ~~ ~} J~ ~ U~~ ~ T1 V ignature of Bank or Savings ssoc. Official SWSquehanna Susquehanna Bank March 22, 2010 -Corrected Estate Letter LISA MARIE COYNE, ESQUIRE 3901 MARKET ST CAMP HILL, PA 1 701 1-4227 RE: Iva A. Paull Estate SS#: 180-10-5701 DOD: January 10, 2010 To Whom It May Concern: ~j MAR 2 5 2010 26 North Cedar Street P.o. Box 1000 Lititz, PA 17543-7000 Toll free 800.311.3182 In response to your letter of March 10, 2010, here is the above customer account information as of January 10, 2010. Account #1 • Account Title: Ivy Paull Georgene Jantos • Account Type/# Ckg/10004338025 • Date Opened /Maturity ,3/5/08 Opened Joint • Interest Rate: .15% • Account Balance*: 15,606.74 • Accrued Interest: 1.08 Ivy's name :~~as removec-. from the • YTD Interest: .00 Ckg, acct. and SDBox on 2/18/10. *Account balance does not include accrued interest. There is a safe deposit box in the names of Ivy Paull &Georgene Jantos located at the Camp Hill Office, 201 St. Johns Church RD., Camp Hill, PA 1701 1. If I can be of further assistance, please feel free to call. Sincerely, Dawn M. Berrier Support Services Lead 1-717-625-6546 DMB/ SCHEDULE H FUNERAL E)~ENSES & COMMONWEALTH OF PENNSYLVANIA Ary~A'N~C•~'fl /~TT/C INHERITANCE TAX RETURN CYJIY~ h7 ~ w'1~ ~Y~ RESIDENT DECEDENT ESTATE OF PAULL, IVY A. Debts of decedent must be reported on Schedule I. __ --- -- -_ ITEM DESCRIPTION NUMBER _ - _ __ __ __ - __. A. FUNERAL EXPENSES: L Klee Funeral Home 2. Reception 3. Flowers 4. Memorial Services g, ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): 250.00 786.00 Street Address City State Zip Year(s) Commission paid 3,000.00 2. Attorney's Fees Coyne & Coyne, P.C. 3,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Georgene E. Jantos Street Address 145 Ewe Road Cit Mechanicsburg State Pa Zip 17055 Y Relationship of Claimant to Decedent Daughter Cumberland County Register of Wills 76.50 4. Probate Fees 5. Accountant's Fees g. Tax Return Preparer's Fees 7. Other Administrative Costs $8.00 1 Postage 180.00 2 Patriot News-- Legal Advetisement Total of Continuation Schedule(s) 3,718.00 _. ---.--- _. TOTAL (Also enter on line 9, Recapitulation) 20,907. ~ FILE NUMBER 21 - 2010 - 0240 __ __ - _ __ __ AMOUNT 8,760.00 549.00 Schedule H COMMONWEALTH OF PENNSYLVANIA ~ /~~,,,~~ ~,,,,.,,~y{,~..~./,,,..,,~~ /^~,~.,,,.,~,,, M.,,~,~ INHERITANCE TAX RETURN F~~ I gI11.7UQYVG l~{.J~ ~I ll.l~l RESIDENT DECEDENT ESTATE OF pAULL, IVY A. 3 Cumberland Law Journal-- Legal Advertisement 4 Carey & Associates-- Income Tax Preparations 5 Reserves 6 Inheritance Tax Return Filing Fee 7 Thank',~lotes 8 Mileage for Executrix @$.585/mile 9 Van Rental 10 Cleaning and Trash Remval, Cleaning Supplies 11 Missed Work for Executrix FILE NUMBER 21 - 2010 - 0240 75.00 300.00 2,000.00 15.00 25.00 192.00 131.00 500.00 480.00 Page 2 of Schedule H SCHEDULEI ~~ r _ DEBTS OF DECEDENT, MORTGAGE 'il COMMONWEALTH OF PENNSYLVANIA '~, LIABILITIES, & LIENS INHERITANCE TAX RETURN i ~. _ RESIDENT DECEDENT - - - - - - - - - - FILE NUMBER - - ESTATE OF pAULL, IVY A. I 21 - 2010 - 0240 Include unreimbursed medical expenses. - -- -_ - -. - - _ _ _ -- ITEM DESCRIPTION AMOUNT NUMBER -- - - - - - -- - - -- - 240.00 - - - _ --- _ - 1 Preventive Healthcare 866.00 2 Home Instead, Senior Care 630.00 3 Uncleared Checks 3.00 4 Commonwealth of Pennsylvania - - -- _ -_ - TOTAL (Also enter on Line 10, Recapitulation) 1,739.00 REV-1513 EX+ (9A0) SCHEDULE J p /~ p ~+ OF PENNSYLVANIA BENEFICIARIES COMMONWEALTH INHERITANCE TAX RETURN _ _ - _L_- - _- __ -- -__ RESIDENT DECEDENT- -- _ --- - __ _ - - - - i FILE NUMBS ESTATE OF pAULL, IVY A. 21 - 2010 - 0240 -- _-_ -- ___--. __ - - ~ RELATIONSHIP TO AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY - ~i DECEDENT OF ESTATE ~--_DO NOLLisiTnasl~e(s~_ -- -- - - - --- --. - i I~ TAXABLE DISTRIBUTIONS (include outright spousal distributions 'i Daughter ~~ 100% of Residual 1 Geeorgene E. Jantos Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet III NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE ' B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET