HomeMy WebLinkAbout05-07-10.,
15056051058
REV-1500 EX
06
0
(
-
5)
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes
Poaox28oso1 County Code Year File Number
.......... . .......... .
INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 10 !'j' f~z,~j
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
180-05-0712 02/28/2010 01/15/1917
Decedent's Last Name
_.. _ ._
Suffix Decedent's First Name
__.
_.
WELKER
_.. EVELYN
_ . M
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name
_ _. Suffix Souse's First Name
P
_ ......
_......
pouse s ocial Security Number
_..
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
__ __ _
__ _ _'
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
"~ 1. Original Return 2. Supplemental Return ~ 3. Remainder Return (date of death
~'.,;~ 4. Limited Estate prior to 12-13-82)
4a. Future Interest Compromise (date of =~ 5. Federal Estate Tax Return Required
death after 12-12-82)
~::"~. 6. Decedent Died Testate
(Attach Co
of Witl) 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
py (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)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name
---- ---- ---
Daytime Telephone Nurnber
HOMAS E. FLOWER
.. .... ........... __
(717) 737-3405
...................................
irm Name (If Applicable)
........ ...............................
_.
SAIDIS, FLOWER, LINDSAY___ __ __ _ REGISTER ~~tgLS usE or ~:~
r {
_..
First Ime of address
,
,., ~ ,
--C
~ t -'r r
.~
2109 MARKET ST _ _..
<~r ~ --I ~'= °..~:~
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Second line of address _ _ ~
"
7 C~ "T~
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.
,
~ ,,_
_ _ :.~
--~t ..
Ity or Post Office DAr~E FILED N
State ZIP Code " ~
CAMP HILL PA :17011
Correspondent's a-mail address: tflOW@f@S7'I-IaW.COCYt
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,
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.
SIGNAT E PERSON~ESPO LE FOR FILING RETURN ...__
ADDRESS ~ v Z~
5395 VEpDALE ROAD, MECHANICSBURG, PA 17050
SI OF PREPARE AN REPRESENTATIVE DATE
enno e ~/Z ~.
SAIDIS, FLOWER & LINDSAY, 2109 MARKET ST., CAMP HILL, PA 17011 ~ r
PLEASE USE ORIGINAL FORM ONLY
1 505605 1 058 Side 1
15056051058
J
15056052059
REV-1500 EX
Decedent's Social Security Number
decedent's Name: EVELYN M WELKER " 180-05-0712
RECAPITULATION ~-°-•~-°~--°-~~
1. Real estate (Schedule A) . ........................................... .
2. Stocks and Bonds (Schedule B) .......................................
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .... .
4. Mortgages & Notes Receivable (Schedule D) ........... .
. .................
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... .
6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ...... .
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ~ Separate Billin Re u t d
1. 0.00
2. 0.00
3. 0.00
4. ' 0.00
5. 7,261.68
6. 0.00
0.00
7,261.68
2,653.43
9 gese........ ~.
."
8. Total Gross Assets (total Lines 1-7) .................................... 8.
". .,. :.
9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................ 10.
4,608.25
11. Total Deductions (total Lines 9 & 10) ............................... .... 11. , 7,261.68
12. Net Value of Estate (Line 8 minus Line 11) ........... 12
13. ...............
Charitable and Governmental Bequests/Sec 9113 Trusts for which ....
.
""~" ° ~ ' ~
0 00
"."..
°°"~ •-°
an election to tax has not been made (Schedule J) .................... .... 13.
0.00
14. Net Value Subject to Tax (Line 12 minus Line 13) .................... .... 14.
0.00
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 0 0 00
: 15.
0 00
16. ." .._.,...,.._......_ ,........"......."",., .~_..,... _" ..
Amount of Line 14 taxable
at lineal rate X .0 _ 0.00 ! 16. ~,' 0.00
17. .,..."..,,...". ~,_,.,. _ " _,.. _~ .w~..,,.." .~.....~~... ,,_, .".."......., ."....~ ~~.
Amount of Line 14 taxable """~
°°~" ~ ""~- - •°
---
^
at sibling rate X .12 0.00 17. ' 0.00
Amount of Line 14 taxable
at collateral rate X .15 0.00 '. 18. ! 0.00
19. TAX DUE ..................................................... .... 19. ` 0.00
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
15056052059 Side 2
15056052059
REV-1500 EX Page 3
FUe..Number
Decedent's Complete Address: ~ 21 10 .0426
DECEDENT'S NAME ,.....F.,H~.._«,_: ....,,.,...~.........
EVELYN M WELKER DECEDEN TS SOCIAL SECURITY NUMBER
STREET ADDRESS 180-05-0712
MANOR CARE HEATH SERVICES
1700 MARKET ST
CITY
STATE
CAMP HILL
ZIP
PA 17011
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments (1) 0.00
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + B + C)
3. Interest/Penalty if applicable (2)
D. Interest
E. Penalty
Total Interest/Penalty (D + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (3)
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)
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
c.
ry
_.
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 :.......................................................................................... ^ 0
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? .............. ^ ^x
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.
"" 'a~ ~ ~. ,;:ram 's,~ ,,. H ° ~~~~a', <~a . ~ ~ ,~ ~ ~~ , .
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 survlvmg 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
(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)j.
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.
REV-1508 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE [~F
SCHEDt~ILE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
EVELYN M. WELKER FILE NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate. 21-10-0426
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION VALUE AT DATE
1 MANOR CARE RESIDENT ACCOUNT of DEATH
1,224.50
2 METRO BANK ACCT. N0.00820022155
6,037.18
TOTAL (Also enter on line 5, Recapitulation) s 7,261.68
(If more space is needed, insert additional sheets of the same size)
EV-1511 EX+ (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
C~IAIt OF
EVELYN M. WELKER
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
21-10-0426
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION
A• FUNERAL EXPENSES: AM(
t. ..MEMORIAL DINNER
2• INSCRIPTION ENGRAVING ON HEADSTONE
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s) .LARRY L. WELKER
Social Security Number(s)/EIN Number of Personal Representative(s) 195-38-9043
Street Address '5395 RIVERDALE RD
City MECHANICSBURG State PA Zip 17050
Year(s) Commission Paid: 2010
2. Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State ,Zip
Relationship of Claimant to Decedent
4. Probate Fees
5• Accountant's Fees
6. Tax Return Preparer's Fees
7. 'REGISTER OF WILLS, .INHERITANCE TAX RETURN FILING FEE
8. THE SENTINEL, PUBLISH ESTATE NOTICE
9. CUMBERLAND LAW JOURNAL, PUBLISH ESTATE NOTICE
TOTAL (Also enter on line 9, Recaoitulatinn- I
(If more space is needed, insert additional sheets of the same size)
NT
105.91
150.00
500.00
1,500.00
77.50
15.00
230.02
75.00
2,653.43
REV-1512 EX+ (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHED~lLE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
EVELYN M. WELKER FILE NUMBER
21-10-0426
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
t. COMMONWEALTH OF PA, DEPT OF WELFARE, MEDICAL ASSISTANCE ESTATE RECOVERY
PARTIAL PAYMENT OF CLAIM
4,608.25
TOTAL (Also enter on tine 10, Recapitulation) S 4,608.25
(If more space is needed, insert additional sheets of the same size
''METRO
BANK
>00489 6259416 X01 0921417
EVELYN M WELKER
5395 RIVENDALE BLVD
MECHANICSBURG PA 17050
Metro Bank
3801 Paxton Street
Harrisburg PA 17111-1418
1-888-937-0004
mymetrobank.com
We're here 7 days a week, 24 hours a day at 1-888-937-0004.
3tatnment3Balartce as ofifl2/09i1d
PWs `Deposits and Other Credits
Less Checks and Other Debits
Plus interest Paid
S~ament~8~ttanoe as of 03/09/10
50 PLUS CHECKING 0082002155
`'$6;031x:49
$0:00 ;
$0:00
$A&9
$6,037.18
7ra~nsactl~r>!s Rv !~?te
Date Description Debit Credit_ Balance
1k3J0$~'~ tN~~`EREST PAYIYFEi-TT $0.69 $6,037.18
Interest Summary
'Beginning .interest Rata
Numbenof Days in this Statement Poriod
interest Earned this Stakement' Period
Annual Percentage Yief+d Earned this Statement Period.{A,PY)
Interest Paid Yeartfl~flate
Fees Summary
o.~~~~
2$
$0`=69
0.#5%
$23i
__~,_:
Overdraft Fees Year to Date ~ $0.00
Retur~tl item Fees thk ,~ nt`P~riwd ' $0:00
Returned Item Fees Year to Date $0.00
The Fees Summary above does not reflect any refunded or waived items credited to your account.
FUNDS AVAILABILITY: Check deposits made before 6 pm are available on the next business day, provided the check is not subject
to a hold. Beginning Feb. 27, 2010, held items will be delayed until the 2nd business day (previously the 5th business day). Under
certain circumstances, funds may be held until the 7th business day (previously the 11th business day). You will be notified if a
hold is placed on your funds for any reason.
FEES & CHARGES: Certain fees will be revised as follows effective April 1, 2010: Cash or Deposit Item Returned - $12.00 per item;
Cashier's Check - $8.00; Closing Account (90 Days) - No charge; Closing Account-Mail Request - $20.00; Collection Items - $20.00
domestic/$50.00 foreign; Dormant Account-Checking/Money Market - $5.00 per month; Dormant Account-Savings - $5.00 per month;
Money Order - $5.00; Wire Transfer Domestic-Outgoing - $20.00.
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LAW OFFICES
SAIDIS, FLOWER & LINDSAY
A PROFESSIONAL CORPORATION
2109 MARKET STREET
JOHN E. SLIKE CAMP HILL, PENNSYLVANIA 17011 CARLISLE OFFICE:
ROBERT C. SAIDIS TELEPHONE: (717) 737-3405 -FACSIMILE: (717) 737-3407 26 WEST HIGH STREET
JAMES D. FLOWER, JR EMAIL: tflower@sfl-law.com CARLISLE, PA 17013
CAROL J. LINDSAY www.sfl-law.com TELEPHONE: (717)243-6222
JOHN B. LAMPI FACSIMILE: (717)243-6486
DANIEL L. SULLIVAN
DEAN E. REYNOSA
THOMAS E. FLOWER
REPLY TO CAMP HILL
MARYLOU MATAS
JASON E. KELSO
May 6, 2010
Office of the Register of Wills
p w
°
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Cumberland County Courthouse ~ ~' ~ ~-~ J ~ ~=;
One Courthouse Square ~
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Room 102 ~
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Carlisle, PA 17013 ~
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Re: Estate of Evelyn Welker
~ ~ ~
r~V ~~~~
~~
File No.: 2010-00426 ,*„i
Dear Sir or Madam:
Enclosed please find one (1) original and two (2) copies of the Inheritance Tax Return
for the Estate of Thelma G. Thrush with payment of the filing fee. I have also enclosed aself-
addressed stamped envelope for the return of atime-stamped copy. Thank you.
If you have any questions, please call.
Very truly yours,
SAIDIS, FLOWER & LINDSAY
`~~'-- c~
Yvonne Sersch, Assistant to
Thomas E. Flower, Esquire
iys
Enclosures
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