HomeMy WebLinkAbout06-22-10
1,5056071,2],
REV- ~ ~ O O EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue Coun Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN ~
Po Box 28oso1 ~ 2 1 1 D
Hamsburg, PA 17128-0601 RESIDENT DECEDENT ~C.Q~o~
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
1 9 6 1 4 1 4 0 8 0 2 0 9 2 0 1, 0 0 3 0 6 1, 9 2 6
Decedent's Last Name Suffix Decedent's First Name MI
R E E D J O H N E
(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
1. Original Retum ^ 2. Supplemental Return ® 3. Remainder Return (date of death
prior to 12-13-82)
^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of ^ 5. Federal Estate Tax Return Required
death after 12-12-82)
^ 6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of ~fl) (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 Number
R O G E R B I
F' f R W I N, E S Q U I R E 7 1 7 2 4 9 2 3 5 3
THIS RETURN MUST BE FILED IN DUPLICATE VNITH THE
REGISTER OF WILLS
irm Name (I Applicable)
I R W I N & M c K N I G H T P C•
First line of address .
6 0 W E S T P O M F R E T S T R E E T
Second line of address
City or Post Office
C A R L I S L E
State
P A
REGISTER OF WILLS USE ONLY
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Correspondent's a-mail address:
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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.
SIGNATURE OF SON RESPONSIBLE FOR FILING RETUR DATE
D
ADDRESS
53 PARKER ROAD NEWVILLE PA 17241
SIGNATURE OF PREPA THER THAN; EPRESE TATIVE G ~L(~lv
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60 WEST POMFRE'~_~STRE_ET
CARLISLE
PA 1,701,3
PLEASE USE ORIGINAL FORM ONLY
Side 1
15056071,21 15056071,21, J
~'1)
J
1505607221
REV-1500 EX Decedent's Social Security Number
Decedent':Name:. JOHN E• REED 1 9 6 1 4 1 4 0 8
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. •
6 6 8 ? . 4 9
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5.
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6•
7. Inter-Vivos Transfers 8~ Miscellaneous t~Probate Property
Billin
Re
uested
at
Se
7 7 6 7 0 . 6 6
.......
g
q
par
e
(Sdtedule G) u .
8. Total Gross Assets (total Lines 1-7) ........................... s. 1 4 3 5 8. 1 5
9. Funeral Expenses 8 Administrative Costs (Schedule H) ......... ....... 9. 9 5 3 1. 8 7
10. Debts of Decedent, Mort a Liabilities, & Liens Schedule I
9 9e ( ) .....
....... 10. 1 7 3 ^ 9 1 . 6 9
11. Total Deductions (total Lines 9 8~ 10) .................... ....... 11. ~ 1 8 2 6 2 3. 5 6
12. Net value of Estate (Line 8 minus Line 11) ......................... 12. - 1 6 8 2 6 5. 4 1
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. - 1 6 8. 2 6 .5. 4 1
TAX COMPUTATION =SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
0
0
0
1~
0.
0
0
.
(ax1.2) x.o .
16. Amount of Line 14 taxable
^ ^
^
~ •
~
0
at lineal rate X .045 16.
17. Amount of Line 14 taxable 0 . 0 ~ 17 0 . 0 0
at sibling rate X .12 .
18. Amount of Line 14 taxable
^ ^
^
^ '
0
^
at collateral rate X .15 18.
19. Tax Due ........................................ ........ 19. 0 . 0 0
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
L 1505607221
Side 2
D
1505607221 J
raw- i.+vv cn r'dy~
pecedent's Complete Address:
File Number
21 10 0
DECEDENT'S NAME
JOHN E. REED
STREET ADDRESS
121 WALNUT BOTTOM ROAD
CITY STATE ZIP
SHIPPENSBURG PA 17257
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. interestlPenalty if applicable
D.lnterest
E. Penalty
4.
5.
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.
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.
(4) 0.00
0.00
(5A)
(5B) 0.00
Make Check Payable fo: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPR{ATE 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? ...............:....................................... ^ a
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? .................................................................................................. ^
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.
(1) 0.00
Total Credits (A + B + C) (2) 0.00
Total Interest/Penalty (D + E) (3) 0.00
(5)
REV-1508 ~X + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
JOHN E. REED 21 10 0
include the proceeds of litigation and the date the proceeds were recenred by the estate.
All aropertv iointly-owned with right of survivorshia must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. ORRSTOWN BANK -CHECKING ACCOUNT #619930 6,687.49
TOTAL (Also enter on line 5, Recapitulation) ~ $ 6,687.49
(If more space is needed, insert additional sheets of the same size)
REV-1510 Ek + (6-98)
SCHEDULE G
INTER-VIVOS TRANSFERS &
COM INHERITANCE TAX RETURNANIA MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
JOHN E. REED 21 10 0
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.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME of THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (iF APPLICABLE) VALUE
1. ORRSTOWN BANK -BURIAL FUND 7,670.66 100. 7,670.66
TOTAL (Also enter on line 7 Recapitulation) ~ $ 7,670.66
(If more space is needed, insert additional sheets of the same size)
REV-1511' EX + (10-06)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
IN RESIDENT DECEDENTRN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
JOHN E. REED 21 10 0
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. FOGELSANGER-BRICKER FUNERAL HOME, INC. 8,316.87
B
1
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Street Address
City
Year(s) Commission Paid:
State Zip
2, Attorney Fees IRWIN & McKNIGHT, P.C.
3, Family Exemption: (If decedent's address is not the same as claimants, attach explanation)
Claimant
1,200.00
Street Address
City State Zip
Relationship of Claimant to Decedent
4. I Probate Fees
5 Acxountan~s Fees
6. Tax Return Preparer's Fees
7. REGISTER OF WILLS -FILING FEE 15.00
TOTAL (Also enter on line 9, Recapitulation) , $ 9,531.
(If more space is needed, insert additional sheets of the same size)
PEV-1512 EX + (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
JOHN E. REED 21 10 0
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. DEPARTMENT OF PUBLIC WELFARE -CIS#160184112 173,091.69
TOTAL (Also enter on line 10, Recapitulation) , $ 173,091.69
(If more space is needed, insert additional sheets of the same size)
REV-1513 EY. + (g-00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
JOHN E. REED ~~ ~ n n
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 [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. DEBORAH J. MIXWELL Lineal
53 PARKER ROAD 1/3 REMAINDER
NEWVILLE, PA 17241
2. MICHAEL E. REED Lineal
456 E. KING STREET 1/3 REMAINDER
SH{PPENSBURG, PA 17257
3. CHRIS E. REED Lineal
PO BOX 417 1i3 REMAINDER
SHIPPENSBURG, PA 17257
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(if more space is needed, insert additional sheets of the same size)
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0601
my-1543 Ex AFP COB-0e)
~1\1"VR17Al tVPI PIUI tVG
AND FILE N0. 21
TAXPAYER RESPONSE ACN 10117615
DATE 03-23-2010
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MINERVA REED `~
45 PARKER RD~
NEWVILLE ~~ PA 17241
EST. OF JOHN E REED
SSN 196-14-1408
DATE OF DEATH 02-09-2010
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SgUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
~p~~~
C~1.~ ~ Q~ib
0 RRST OWN BANK provided the Department with the information below, which has been used in calculating the
potential tax due. Records indicate that at the .death of the above-named decedent, You were a 5oint owner/beneficiary of this account.
If you feel the information is incorrect, please obtain written correction .from the financial institution, attach a copy to this form
and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of
Pennsylvania. Please call 0717) 787-8327 with questions.
COMPLETE PART 1 BELOW ~ SEE 'REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 619930 Date 07-24-1985 To ensure proper credit to the account, two
Established copies of this notice must accompany
payment to the Register of Wills. Make check
Account Balance $ 6, 687.49 payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax $ 3, 343.75 months of the decedent's date of death,
Tax Rate ~( ~ j, r~ deduct a 5 percent discount on the tax due.
Any Inheritance Tax due will become delinquent
Potential Tax Due $ 501 .56 nine months after the date of death.
PART TAXPAYER RESPONSE
1
A. ~ The above information and tax due is correct.
Remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or check box "A" and return this notice to the Register of
CHECK Wills and an official assessment will be issued by the PA Department of Revenue.
ONE
B L 0 C K B. The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
ONLY to be filed by the estate representative. ~~~ ~?'Q~/~S
C. ~ The above informs ion is incorrect and/or debts and deductions were paid.
Complete PART 2~ and/or PART 3LJ below.
PART If indicating a different tax rate, please state
relationship to decedent:
TAX RETURN - COMPUTATION
LINE 1. Bate Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
OF TAX ON JOINT/TRUST ACCOUNTS
1
2 $
3 X
4 $
5
6 $
7 X
8 $
PART DEBTS AND DEDUCTIONS CLAIMED
0
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete o the best of my knowledge and belief. HOME C )
WORK t )
TAXPAYER S NATURE TELEPHONE NUMBER DATE
TOTAL CEnter on Line 5 of Tax Computation) ~
[~ p /~ ~ T~ 60-1503 DATE ~1~
P. O. BOX 230 SHIPPENSBURG. PA 117257 313
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il'06069911' ~:0 3 i 3 ~ 50 36~: i0 3 00460 211'
ORIGINAL 4110
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HECK # ~ v
CREDIT
CARD
OTHER
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ACCT. NO.
C~ i G
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Name of Deceased.
FOGELSANGER-BRICKER
FUNERAL HOME, INC.
~~'~~ ~:
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LAST BALANCE $
Q INTEREST
4ATE PAYMENT
CHARGE
SUB TOTAL
Qi~.rc
CREDIT'S ~~ ~ T
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LESS PAYMENT `~i ~ ~ 6 6
NEW BALANCE $ ~~
07413
A
PAY TO THE ~:~~~
ORDER OF $
I
~~~~~~~~ ~ SIX ~ ~ Si ~ W/ I{~ ~ DOLLARS
~ VO{D AFTER 6 NTHS
CASHIER S CHECK
Remitter ~• ~ "~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF PROGRAM INTEGRITY
DIVISION OF THtt2D PARTY LIABILITY
ESTATE RECOVERY PROGRAM
PO BOX 8486
HARRISBURG, PA 17105-8486 ~~
February 25, 2010
IRWIN & MCKNIGHT PC ~ ~E~ 2 ~ ~~~~
ROGER B IRWIN ESQUIRE
WEST POMFRET PROFESSIONAL BUILDING IRWIN & ~fcKN{GHf
60 WEST POMFRET STREET LAW ~JFFICES
CARLISLE PA 17013-3222
Re: John Reed
CIS #: 160184112
SSN: ###-##-1408
Date of Death: 02/09/2010
Dear Attorney Irwin:
Please be advised that the Department of Public Welfare maintains a
claim in the amount of $173,091.69 against the above-mentioned estate. This
claim is for restitution of medical assistance granted on behalf of the
decedent for which the Probate Estate is now responsible to reimburse the
Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as
amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's
itemized statement of claim.
A portion of this medical expense, namely $28,627.16, was incurred
during the last six months of the decedent's life; therefore, it is a Class 3
claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries
Code, 20 Pa. C.S.A. 3392(3}. The balance of the claim, namely $144,464.53,
is to be entered as a priority Class 5.1 claim against the estate.
Please acknowledge receigt of this letter and advise whether the
Commonwealth's claim is admitted and when payment may be expected. If the
estate accounting is complete, please provide a copy. If the estate contains
real estate, please provide copies of the deed, the latest tax assessment,
and a current appraisal, if available.
L / f
wren H. Peterson
Claims Investigation Agent
717-772-6615
717-772-6553 FAX
Enclosure