HomeMy WebLinkAbout06-07-10 (2)J 15056071120
REV-1500 EX (OS-05)
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
Po Box.2soso~ INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 10 02 7 0
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
194 12 7400 03 04 2010 03 24 1924
Decedent's Last Name Suffix Decedent's First Name MI
SHOVER THERESA A
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social 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 Retum (date of death
prior to 12-13-82)
^ 4. Limited Estate ^ qa, Future Interest Compromise ^ 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
g. Decedent Died Testate
(Attach Copy of Will) ^ ~ Decedent Maintained a Living Trust
(Attach Copy of Trust) ~ 8. Total Number of Safe Deposit Boxes
9. Litigation Proceeds Received ^ 10. Sppousal PovertY Credit (date of death 11, Election to tax under Sec. 9113 A
b9tween 12-31 z31 and T-1-95) ^
( )
(Attach SCh. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
EDWARD P SEEBER 717 533 3280 n
y~
Firm Name (If Applicable)
JAMES, SMITH, DIETTERICK &
First line of address
SUITE C-400, 555 GETTYSBURG PIKE
Second line of address
City or Post Office State ZIP Code
N~CHANICSBURG pA
Correspondent's a-mail address: eP$G,!$dc.C01'1'1
REGISTER LS US~IVLY
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unaer penalties of peryury, 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.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ATE
~ ~ ~ Charlotte A. Houck 0
ADDRESS
1264 Pe Drive Hummelstown PA 17036
SIGNATUR F OTHER THAN REPRESENTATIVE DATE
~~'''~- Edward P Seeber ~ ~,t ~ ~ v
Suite C-400, 555 Gettysburg Pike, Mechanicsburg, PA
Side 1
L. 15056071120
15056071120 J
J
15056072120
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: Theresa A. Shover 194 12 7 4 0 0
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 8~ Notes Receivable (Schedule D) ........................................................ 4.
5• Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ............... 5. 2 9 , 0 81.4 9
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers & Miscellaneous f~q Probate Property
(Schedule G) u S
t
Billi
R
epara
e
ng
equested............ 7. 11, 32 0 .2 6
8. Total Gross Assets (total Lines 1-7) ............................................
.........................
8. 4 0 , 4 01.7 5
9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 12 ,195.43
10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) .............................. 10. 2 , 7 4 7 . 5 4
11. Total Deductions (total Lines 9 8 10) ................................................................... 11. 14 , 942.97
12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 2 5 , 4 5 8 . 7 8
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. 2 5 , 4 5 8. 7 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)(1.2) X .00 15. 0 . 0 0
16. Amount of Line 14 taxable
at lineal rate X .045 25 , 458.78 1s. 1,145.65
17. Amount of Line 14 taxable
at sibling rate X .12 0, 0 0 17• 0. 0 0
18. Amount of Line 14 taxable
at collateral rate X .15 0. 0 0 18' 0. 0 0
19. Tax Due .................................................................................................................. 19. 1 ,145.65
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^
15056072120
Side 2
15056072120 J
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
Theresa A. Shover
STREET ADDRESS
33 Buttonwood Lane
CITY STATE ZIP
Carlisle PA 17015
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. Interest/Penalty if applicable
p. Interest
E. Penalty
1,088.37
57.28
File Number 21-10-0270
Total Credits (A + B + C)
Total Interest/Penalty (D + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 2 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B, Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS. AGENT
(1) 1,145.65
(2> 1,145.65
(3)
(4)
(5) 0.00
(5A)
(5B) 0.0~
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? .................................................................................................................... ^ ^x
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.
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)].
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)]. A
sibling 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-1608 EX+ (g_88)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Shover, Theresa A.
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property JolMly-owned with !b~ rlpht of survlvorshlp must b• dlsclos~d on sch~dul• F.
FILE NUMBER
21-10-0270
ITEM
NUMBER
DESCRIPTION VALUE AT DATE
OF DEATH
1 MStiT Bank Checking Account No. 9841239669 -valued per letter dated 3/25/10 16.897.66
2 MSiT Bank Savings Account No. 15004211781289 -valued per letter dated 3/25/10 11.223.72
3 1976 mobile home -valued per sales price since cost for removal would be $3,000 0.00
4 1994 Ford Tempo GL Sedan -valued per Kelley Blue Book 150.00
5 Miscellaneous personal property -valued per Kelley Blue Book 200.00
6 AEGIS Security Insurance -mobile home insurance premium refund 69.00
7 Comcast Cable -refund 4.85
8 Patriot News -refund 15.50
9 United States Treasury - 2009 income tax refund 320.00
10 Valley Rural Electric Cooperative -refund 200.76
TOTAL (Also enter on Line 5, Recapitulation) 29.081.49
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
R°v-1610 EX+ (g.88)
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Shover, Theresa A.
FILE NUMBER
21-10-0270
This schedule must be completed and filed if 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
THE DATE OF TRANSFERSATTACIi A COPY OF TIRE DEED FOR REAL ESTATE. DATE OF DEATH
VALUE OF ASSET % OF DECD'S
INTEREST EXCLUSION
(IF APPLICABLE) TAXABLE
VALUE
1 M&T Bank IRA No. 35004202555932 - 11.320.26 100.000% 0.00 11.320.26
beneficiaries are daughter & son-in-law; valued
per letter dated 3/25/10
TOTAL (Also enter on Line 7, Recapitulation) 11.320.26
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule G (Rev. 6-98)
REV-1161 EX+ (10-06)
COMMNHEgITAN~ OTF P R~T~RN ANIA
RE IDEN DECED N
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Shover, Theresa A. 21-10-0270
- -'-- -- -----'--._ ...__. .... ...'.... ~.... .... VV..~.M M~~i ~.
ITEM
DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
See continuation schedule(s) attached
5,964.82
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zio
Year(sl Commission oaid
2. Attorney's Fees James, Smith, Dietterick 8c Connelly, LLP 5,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zio
Relationshio of Claimant to Decedent
4. Probate Fees 149.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 1,081.11
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 12,195.43
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Shover, Theresa A. 21-10-0270
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Exoe,+nses
1 Charlie Browns -funeral luncheon 132.82
2 Hoover Funeral Home -funeral services 5.832.00
H-A 5.964.82
3 Other Administrative Costs
Cumberland Law Journal -estate notice advertisement fee
75.00
4 James, Smith, Dietterick ~ Connelly, LLP -reservation for estate administration 200.00
closing
5 Jan Brown, Esquire -Will review 337.00
6 MST Bank -checkbook order fee 12.87
7 PennDOT -duplicate title & title transfer fees 45.00
8 PPL -electric service for home 3.50
9 Progressive Insurance -insurance premium 51.33
10 Register of Wills, Cumberland County -filing fee for Return 8< Inventory 30.00
11 Register of Wills, Cumberland County -short certificates 16.00
12 The Sentinel -estate notice advertisement fee 208.75
13 UGI -gas service for home 90.90
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Shover, Theresa A. 21-10-0270
ITEM
NUMBER DESCRIPTION AMOUNT
14 UGI -gas service for home 5.04
15 US Postmaster -postage 5.72
H-B7 1.081.11
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
Rev-1612 EX+ (12-08)
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Shover, Theresa A. 21-10-0270
Report d~bta Incurred by th• d~c~d~M prior to death that nmaln~d unpaid at the date of death, Including unnimbursad m~dlcal ~xp~na~s.
ITEM
NUMBER
DESCRIPTION VALUE AT DATE
OF DEATH
1 East Pennsboro Ambulance Service - unreimbursed ambulance bill 311.25
2 Kantor & Tkatch PC - unreimbursed medical bill 95.25
3 Manor Care Nursing & Rehab - unreimbursed nursing home bill 1.533.00
4 Moffitt Heart Sz Vascular - unreimbursed medical bill 59.75
5 Penny G. Davis, Tax Collector - 2010 county/township real estate taxes 11.26
6 PPL -electric service for home 27.71
7 PPL -electric service for home 34.52
8 Progressive Insurance -insurance premium 51.33
9 Trust Ambulance Service - unreimbursed ambulance bill 398.50
10 UGI -gas service for home 156.01
11 West Shore EMS - unreimbursed ambulance bill 68.96
TOTAL (Also enter on Line 10, Recapitulation) I 2 747,54
(If more space is needed, additional pages of the same size)
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08)
REV-1613 EX+ (11-08)
COMMO ~WEALT~i OF PENNSYLVANIA
INH ITAN E T RET RN
R IDEN DE DEN
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUMBER
Shover, Theresa A. 21-10-0270
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$)
I TAXABLE DISTRIBUTIONS [include outright spousal
' distributions, and transfers
under Sec. 9116 a 1.2
1 Charlotte A. Houck Daughter 50% of IRA ~ 12,729.39
1264 Peggy Drive residue
Hummelstown, PA 17036
2 Thomas Vonnieda Son-in-Law 50% of IRA ~ 12,729.39
1214 Cherringtown Drive residue
Harrisburg, PA 17110
~ ~ Total
Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet as a ro ~
NON-TAXABLE DISTRIBUTIONS:
II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
25,458.78
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08)
JAMES SMITH DIETTIIZIQC & CONNELLY LLP
June 4, 2010 P.O. BOX 650
HERSHEY, PA 17033
Courier Address:
134 SIPE AVENUE
HUMMELSTOWN, PA 17036
Register of Wills
Glenda Farner Strasbaugh
, TEL 717.533.3280
Cumberland County Courthouse
1 Courthouse Square WWW.JSDC.COM
Carlisle, PA 17013
Re: Estate of Theresa A. Shover
File No. 21-10-0270
Cheryl L. Baker, CP
Certified Paralegal
clb@jsdc.com
Dear Ms. Farner Strasbaugh:
Enclosed are the followin documents to be filed in the above-referenced Estate:
g GARY L. JAMES
MAX J. SMITH, JR.
JOHN ~. CONNELLY, JR.
1. Ari original and two (2) copies of the Pennsylvania Inheritance Tax Return. SCOTT A. DIETTERICK
JAMES F. SPADE
2. Ari original and one (1) copy of the Inventory. NEILrW. YARN BAL, ~~~
3. A check in the amount of $1,088.37 made payable to the "Register of Wills BER
P
~
, uS N M
K D
S
Agent" for the Pennsylvania inheritance tax due during the discount period JARAD W. HANDELMAN
.
4. A check in the amount of $30.00 made payable t0 the "Register of Wills, COURTNEY K. POWELL
KIMBERLY A. BONNER
Cumberland Count "for the filin fee of the Return and Invento
Y g ~• JEFFREY M. MCCORMICK
KAREN N. CONNELLY
JOHN M. HYAMS
Please time-stamp the extra copies and return them to me in the enclosed self-addressed, CHRISTINE T. BRANN
stamped envelope. GREGORY K.. RICHARDS
BERNARD A. RYAN, JR.
If you have any questions, please feel free to contact me.
Very truly yours,
JAMES, SMITHS DIETTERICK & CONNELLY, LLP c,
}
~.. ir~ r~
~J,{
C ry L. Baker CP
erti d Paralegal
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Enclosures
ca ~~~ ~
cc: Charlotte A. Houck, Executrix
Reply to: Suite C-400
555 Gettysburg Pike
Mechanicsburg, PA 17055
Direct Dial: 717-298-2094
Direct Fax: 717-298-2095