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Home My WebLink About04-14-10 1505607121 C REV-1 WOO Ex os 0 ( - 5) PA Department of Revenue OFFICIAL USE ONLY Bureau of Indnidual Taxes Po eox zttosol INHERITANCE TAX RETURN County Code Year File Number Harristwrl, PA 17128.0601 RESIDENT DECEDENT 2 0 0 9 0 1 0 1 5 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 6 8 1 4 2 2 9 2 0 4 0 3 2 0 0 9 0 2 2 6 1 9 1 9 Decedent's Last Name Suffuc Decedent's First Name MI F E H L J R H A R R Y L (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 Q 1. Original Retum ^ 4. Limited Estate ® 6. Decedent Oied 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 Retum (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required curtrtesPVNDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTUIL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number J O H N A C A R P E N T E R E S Q U I R 5 7 0 2 8 6 7 0 0 0 8. Total Number of Safe Deposit Boxes Firm Name (If Applicable) RE613TER OF WILLS ONLY C A R P E N T E R 8 C A R P E N T E R += ~ o ~y_; ?a ap xw r .-, ~, First line of address r~s7 ..~ ,._.~ , v r~' ~~ ~ cn 1 0 1 N E L E V E N T H S T R E E T m - ~~= ~ Second line of address '/' ~% ~ .C' "l j - ~.,.~ . >iJ-rte'! ~ ~_ i City or Post Office State ZIP Code ~ FILED "- S U N B U R Y P A 1 7 8 0 1 ~ Correspondent's a-mail address: Under penalties of perjury, I dedere that I have examined this return, induding accompanying schedules and statements, and to the best of k it is tNe, Cored and complete, Dedaretbn of preperer other than the personal representative is based on at information of which preparer has anykrlw~rk;dge. ~lx3f, SIGNATURE OF PERS N RESPONSIBLE FOR FILING RETURN _ DATE ~'1~~G1 • ~1-.~ ••,, J~ /(DDRESS ' T S a( V 1095 STRAWBRIDGE ROAD NORTHUMBERLAND PA 17857 SIG U F A OT ER T PRESENTATIVE DATE DRES ~ I D 1 ELEVENTH ST SUNBURY PA 17801 PLEASE USE ORIGINAL FORM ONLY 11. Election to tax under Sec. 9113(A) (Attach Sch. O) Side 1 1505607121 1505607121 J J 15D56D7221 REV-1500 EX Decedent's Social Security Number Decedents Name: HARRY L• F E H L, J R 1 6 8 1 4 2 2 9 2 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. 7 1 7 5 1, 4 2 6. Jointty Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. , 7. Inter-Vivos Transfers & Miscellaneous N -Probate Property (Schedule G) ~ ] Separate Billing Requested ....... 7. S. Total Gross Assets (total Lines1-7) ,,,,,,,,,,,,,,,,,,,, ,,,,,, 8. 7 1 7 5 1, 4 2 9. Funeral Expanses & Administrative Costs (Schedule H) ......... ....... 9. 8 6 5 2 , 1 4 10. Debts of Decedent, Mortgage Liabilities, i£ Liens (Schedule I) ..... ....... 10. 1 1 7 3 , 3 0 11. Total Deductions (total Lines 9 8 10) .................... ....... 11. 9 8 2 5, 4 4 12. Net Value of Estate (Line 8 minus Line 11) .................. ....... 12. 6 1 9 2 5 , 9 8 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........... . . .. . .. 13. 3 D 9 6 , 3 0 14. Net Value Subject to Tax (Line 12 minus Line 13) ............ ...... 14. $ 8 8 2 9 , 6 8 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.z) x.o - D. 0 0 15. D. D D 16. Amount of Line 14 taxable at lineal rate X .045 5 8 8 2 9. 6 8 16. 2 6 4 7. 3 4 17. Amount of Line 14 taxable at sibling rate x .12 D. 0 D 17. D. D D 18. Amount of Line 14 taxable at wllateral rate X .15 D D D 18. D. D D 19. Tax Due ......................................... 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15D56D7221 2 6 4 7. 3 4 15D56O7221 J REV-1500 EX Page 3 File Number Decedent's Complete Address: 20 os 01015 JR NURSING 8~ RE clTr Tax Payments and Credits: t • Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit _ B. Prior Payments C. Discount STATE PA ZIP 17013 (1) 2 647.34 3. InteresUPenalty if applicable Total Credits (A + 6 +C) (2) 0 00 D. Interest 28 54 E. Penalty 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT Total InteresUPenalty (D + E) (3) 28 54 Pill in oval on Page 2, Une 20 m request a refund. (4) 0 00 5. If Une 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 2 675.88 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (56) 2 675.88 Make Check Payable fo: REGISTER OF WILLS, AGENT ,:. i .., .3 , , ~, ~ ~f y: 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 caze? ............................. 2. If death occurred afer December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? ...................... ^ O . ............................................................ . 3. Did decedent own an "in trust 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? .......................... IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ~.T: "r 9 . 5t~:il.' ,~r fi}~m `.' ; ^{~:". A~ ,: Tx Y& z~t5+~`b`3r"..h`sdFs., h.^8 H "i.~vk zzaa}~ z .:. 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 p2 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 adaptive 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 + (e-88) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, ~ MISC. PERSONAL PROPERTY FILE NUN TARRY L. FEHL JR 20 09 Include the proceeds of litigation and the dale the proceeds were received by the estate. All properly jointly~owned wkh right of survivorship must be discbsed on ScheduN F. ITEM NUMBER DESCRIPTION 1. Sovereign Bank, Elysburg, PA, account 1681706342 2- Sovereign Bank, Elysburg, PA, account 1685419671, certificate of deposit 3• Sovereign Bank, Elysburg, PA, account 1925046938 4. Coin collection, proceeds of sale 5• Stamp collection, proceeds of sale 6. Commonwealth of Pennsylvania, two-day retirement due 7• U. S. Treasury, refund 8. Patient account, nursing home 9• Conesco Insurance, nursing policy benefits 10. Commonwealth of Pennsylvania, state retirement 11. Central PA Gas, Inc., refunds 12. Embarg Corp., refund 13. Service Health Ins. Co. of PA, refund 01 VALUE AT DATE OF DEATH 8,436.17 51,161.02 5,033.52 1, 586.23 1,644.00 59.30 6.00 44.08 3,000.00 593.04 67.51 13.24 107.31 TOTAL (Also enter on line 5, Recapitulation) E (If more space is needed, insert additional sheets of the same size) REV-1571 EX+(10-06) COr~gdONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ~~~ ~ FILE NUMBER HARRY L. FEHL JR 20 09 01015 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION A• FUNERAL EXPENSES: 1. Aver-Cremation of Harrisburg, services 2. Greenmont Cemetery, opening and closing vault 3. Rev. Stephen Milton, funeral service 4• Rola Lehman, organist at funeral service 5• Silver Spring Presbyterian Church, luncheon B• ADMINISTRATIVE COSTS: 1 • Personal Representative's Commissions Name of personal R~resentative (s) Cheri A. Little Stieetaddress 1095 Strawbridge Road city Northumberland site PA zip 17857 Year(s) Commissbn Paid: 2010 2. Attorney Fees Carpenter & Carpenter 3. Family Exemption: (If decedents address is not the same as claimants, attach explanation) Claimant Street Address City Relatbnship of Claimant to l~cedent 4• ~ Probate Fees 5, ~ Accountants Fees 6• I Tax Return Preparers Fees State zip 7• Cumberland Law Journal, advertising granting of letters 8. The Sentinel, advertising granting of letters 9• Cheri A. Little, travel expense to pick up cremated remains TOTAL (Also enter on line 9, Recapitulation) AMOUNT i 234.45 265.00 200.00 75.00 150.00 3,588.00 3,588.00 214.00 75.00 187.54 75.15 (If nron; space is needed, insert additional sheets of the same size) REV-1512 EX + (12_03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8 LIENS Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbureed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. Phar-Merica Pharmacy, co-pay for medicine 155.64 2. CSH Insurance Co., insurance premium 112.66 3• IShippensburg Area EMS, ambulance service 4• ICHFE ,two days nursing home care 5• IDr. Kenneth E. Harm, medical services 6• (Special Event Emerg. Medical Services, wheelchair van transport TOTAL (Also enter on line 10 Recapitulation) I ; (Ii more space ~ needed, mseR add~6onal sheets of the same size) 250.00 480.00 100.00 75.00 REV-7573 EX + (g.pp) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE) BENEFICIARIES wr,vrtur HARRY L. FEHL JR FILE NUMBER 20 09 01015 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT AMOUNT OR SHARE I. TAXABLE DISTRIBUTIONS [indude o ht spousal distributions, and transfers under ~ ~ Ust Trustee(s) OF ESTATE Sec. 9116u (a~ (1.2)] 1. Harry K. Fehl Lineal 5737 N. Kenmore Street, Apt. 604 27,866.69 Chicago, IL 60660 2. Cheri A. Little Lineal 1095 Strawbridge Road 30,962.99 Northumberland PA 17857 DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 AS APPROPRIATE ON REV 1500 COVER SHEET WitlLt DISTRIBUTIONS I A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. Silver Spring Presbyterian Church 444 Silver Spring Road 3 , 096.30 Mechanicsburg, PA 17050 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET S (If more space Is needed, Insert addlbonal sheets of the same sizel i v Y sari ~~Cyyl r~ ~k~ V ~'' ~.~ ~ f.1. IY ,~ 2 ~ N '1~ W v~U`n~ u~~Q ~ G 3~~~ ~~~m: ~-zz QOV~i U '-' .-~ ..y f-+ ~ ``: O ~~ .~ U ~ O M ~ p ~ cq c+~ ~ o °" O yU ~ ~ w~O~" ~~~ ~ ~ ~ .~ ~ ~ C7 ~+ U r.t ~'-{ ~9'i ~'~;t v^t e:,y ~•.. .,..~