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Home My WebLink About07-01-10J 1505610143 REV-1500 Ex(°'_'°) PA Department of Revenue OFFICIAL USE ONLY Bureau Of Individual Taxes Pes~ucrr 8iaosvairc~x~ County code Year File Number Po Box.2soso~ INHERITANCE TAX RETURN Harrisburg, PA 1712s-0601 RESIDENT DECEDENT 21 0~ 1020 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 158 16 2246 10 05 2009 09 12 1925 Decedent's Last Name Suffix Decedent's First Name DANDY ~, MI DANIEL ', ly (If Applicable) Enter Surviving Spouse's Information Below I' Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number ', THIS RETURN MUST BE FILED IN DUPLICAfi~ WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW X^ 1. Original Return ^ p, Supplemental Return ^ 3. Remainder Re )ttm (date of death ^ pnorto 12-13 4. limited Estate ^ ~. Future Interest Ca~rom ise (date of death after 12-12-82) ^ 5. Federal Estet~ ) Tax Return Required 6. DecederH Disd Testate t Mai Wed a Livi Trust 0 (Wreath Copy orwu) ^ ~• qtt ~epY "o~tist) r'o 8. Total Number ~ Of Safe Deposit Boxes ^ 9. Litigation Proceeds Received ^ 10, S~aus l P~f end t1-95~ deeMr ^ 11. Eledion to tax ( under Sec. 9113(A) (Attach Sch. CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMA Nam e SHOULD BE DIRECTED TO: Daytime Teleplt MARCI S MILLER Number 717 540, 4332 REGISTEFi~ r~ ILLS U~ONLI(-~-) > ~ C First line of address ' '"`' '---. -. n ~ r , , :~ 2000 LINGLESTOi~N ROAD ~ ' t/ ~ +, 7 k ~ ~ `~' ~'~' Second line of address C ~ ~ ~ ~~' l ~ SUITE 202 `~~° ~ . - "~ City or Post Office DATE (LED ~ `•" ~ State ZIP Code HARRISBURG ~ ~ v PA 17110 corresipondent's a-mail address: mmiiler a~hazenelderiaw.com Under penalties of perjury, I dedare that I have examined this return, indudin atxxxn n it is true, correct and txmtPlete. Declaration of preparer other than the g ~)nn9 schedules and statements. and to the SIGNATURE OF PERSON R aonu_caar c cno n. ~~,. ~~~ ..... personal representative is based On all information Of which pl knowledge and belief, any knowledge. 2000 Linglestown Road, Hamburg, PA 17110 Side 1 1505610143 150561014 J - _ - - __ - ~ %~ "-~' Daniel J Dandy ~ I~~ q ~ ~ CJ ADDRESS (/ REV-1500 EX 15056102.43 °eCed°'n's""~^°~ Dandy, Daniel A 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 Per,~onal Property (S~~ule E) ............... 5. 8. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ g. 7. Inter-Vrvos Transfers 8 Miscellaneous lynq Probate Property (Schedule G) (~J Separate Billing Requested............ 7. 8. Total Gross assets (total Lines 1-7) .............. 9. Funeral Expenses & Administrative Costs (Schedule H)............•..•..• .............•..••.. 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule 1) .............................. 10. 1 i . Total Deductions (total Lines 9 8 10) ................................................................... 11. 12. Net Value of Estate (Line 8 minus Line 11) ........................ . 13. Charitable and Governmental ................................. 12. BeQuests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............................................... 13. 14. Net Value Sul~Ject to Tax (Line 12 minus Line 13) ............................................... 14. 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 16. Amount of Line 14 taxable 15. at lineal rate X .045 19 , 985.07 1s. 17. Amount of Line 14 taxable at sibling rate X .12 0 . 0 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 n n n _ _ 19. Tax Due .................................................................................................................. 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 1505610243 Side 2 Decedent's }social Security Number 158 L'~6 2246 !, 365.50 45,058.15 45,423.65 20,610.21 4,828.37 25,438.58 19,985.07 19,985.07 0.00 '' 899.33 0.00 0.00 ', 899.33 1505610241 J ill REV-15(10 EX Page 3 Decedent's Comp DECEDENT'S NAME Dandy, Daniel A STREETADDRESS looo west south st. cmr Carlyle Tax Payments and Credits 1 • Tax Due (Page 2, Line 19) 2• CreditsJPayrnents A. Prior PaY---ents B. Discount 3. Interest 4,300.00 44 97 File Number 21-09-1020 4. If Line 2 is greater than Line 1 + Line 3, enter the di}ferenoe This ~ the OVERPAYMENT. CMck box on Page 2 Uns ZO to roqusst a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the dgferenoe. This is the TAX DUE. Make Check Payable to: STATE !, ZIP PA 17013 ~i, (1) _ 899.33 Total Credits (A + B) ~(2) ~3) ~) t~) 4,344.87 PLEASE gNSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN TH E APPROP 2. Did decedent make a transfer and: b. r~~ ~ use or incxmre of the property transferred;... ..................................... right to designate who shall use the ...................... c• retain a reverakma Property transferred ................. ry inMrest; or. or its income :.................. ', d. receive the .................. ................ ..................... Promise for life of either ....................................................................... ~~ ff death oaxrrned attar Payments, benefits or care? ...................... . December 12, 1982, did decedent transfer ................................... sdequate conaideratbn? .............. Property within one year of death without .................... . .................. 3' ~ deOSdeM own an 'in trust for' or Payabb upon death bank account or security at his or her death?....... 4. ~ decbent own an Individual Retirement Account, annudy, or other non-probate prope-ty which cartains a IF THE ANStNER TO ANY ~sfidary ~si9r-atlon? ............... ..................... THE ~~ QUESTIONS IS YES. YOU MUST COMPLETE SCHE ..,.....•.,•. 3,445.64 1ATE BLOCKS Yes No ^ Qx DOLE G AND FILE IT ^ O For dates of death on or after Asi ART OF THE RETURN. spouse is 3 Peroent (72 P.S. ~~ 1' 1 ~ and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for t use of For dates of depth on or $9118 (pj (1.1) (i)j. alter January 1, 1995, the tax rate im the surviving [72 P.S. §9118 (a) (1.1) (ujj The s Posed on the net value of transfers to or for the use of the survivi' assets and flung a tax return aro ~ tatub does not exempt a transfer to a survving spouse from Fo- dates of death on or aPPiicabb even if the survivi ~, and the statuto spouse is 0 percent posed after Juy 1.2000: ^9 spouse is the only beneficiary. ry requiremb for disclosure of • hrs Pa+ent, °r astepPprsnt of ~ of ~nafers from a deceased child 21 yyeears of child is 0 Percent [72 P.S. §9118 (a) (1.2)j, age or younger at death to or for the uaie a natural ~ The ~ rats imposed on the net v~ua of jof [72 P.S. §9118 (a) (1)j. 72 P.S. §9118 1.2 transfers to or for the use of the decedent's lineal beneficiaries is 4.5 Parent, an ~~ t ~~ Posed on the net yplue of trpnsfera to or for the use of the ~~nt, except ~s noted in ~ ~~ under Sectbn 9102, as an i decedent's siblf ndividual who has at bast one parent in ~ ~ 12 ~fOQnt (72 P.S. §9118 (a) (~.3)] q common with the decadent, whether by blood or adoption. II Address; Rw-150.1 IX+ (!~) 1 ~~ ~~ ESTATE OF SCHEDULE B STOCKS & BONDS Daniel A FILE iN 21 ~ ProPsrty la~tlY-0~d wNh right or surWv~~P must b~ p~ ~~~ R ITEM CUSIP NUMBER NUMBER DESCRIPTION 1 10 shares of MetLife insurance Company UNIT VALUE AT DATE OF DEATH 365.50 TOTAL (Also enter on Line 2. Recapitulation) (M more apace Is needed, additional 365.50 Copyright (c) 2002 form soRware ony The Lackner Group, Inc. PeOas of the name size) Font PA-150q ~5ohadule B (Rev. g.gg) rtw-~aoe ac+ls.~l SCHEDULE E CASH, BANK DEPOSITS, & MISC. ~~ PERSONAL PROPERTY ESTATE OF Dand Daniel A FILE Nt~JMBER 21-09 1020 ~ Y s_ proa,d.~~w ~ ~ a "',~.vw«sM ~ aao..~„ms °'a~.. la sclNduls F. ITEM NUMBER DESCRIPTION ' VALUE AT DATE 1 Cash on hand OF DEATH 2 Refund from C '' 140.80 enturyTel Inc. -overpayment of telephone utility 3 Members 1st Federal Credit Union -checking acct. #32740 19.79 4 Members 1st Federal Credit Union -sayings acct. III32740 10,408.52 5 MidPenn Bank Acct. x•30092700 -Money market account 12.874.74 21,614.30 TOTAL (Also enter on Line 5, Recapitulation) CopY~9ht (c) 2002 form ~ (K none °P°0° ~ "°~~. addiNona~ ' 45.058.15 soBware on The Lackner Group, Inc. Psees ~ ~ ~~ ~~ Form PA-1600 Sc~edule E (Rev. 6-98) REV-1151 EX+ (10-08) COM~~i~~-.~2~~~~ra ESTATE OF Dandy Da..ie~ e SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTs 21-08-1020 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT A. FUNERAL EXPENSES: See continuation schedule(s) attached 11,131.81 B• ADMINISTRATIVE COSTS: t • Personal Representative's Cwnmissions Name of Personal Representative(s) Daniel J Dandy street Address 333 North Mountain Rd. City Newvilie state PA Zio 17241 Year(sl Commission oaid 2010 - 2011 3,100.00 2. Attomev's Fees Hazen Elder Law 5,250.00 3. Fatuity Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claim ant to Deced ent 4• Probate Fees Register of Wllls 106.00 5• Accountant's Fees Mark J. Wetzel, CPA - preparation of personal and fid ' uciary 350,00 6• Tax Retum Preparer's Fees ~• Other Administrative Costs See continuation schedule(s) attached 672.40 TOTAL (Also enter on line 9. Recsnlt~dss:....- Copyright (c) 2009 form software only The Lackner Group, Inc. ~-~.-^ Form PA-1500 20,610.21 ~......~ H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF Dand Daniel A FILE NI 21-0 ITEM NUMBER DESCRIPTION 1 American Monume~rt Co. -lettering for tombstone 2 Bartlett Greenhouses & Florist -funeral flowers 3 Edible Arrangements _ funeral luncheon 4 Mario's Restaurant -funeral meal 5 Quinlan Funeral dome 8 St. Mary -church for funeral services ~iACli111t1I1lt[ative Ca is 7 Cumberland Law Journal -estate notice 8 NJMJ Newspaper _ obituary for decedent 9 Sentinel -estate notice CoPy-ight (c) 2002 form soArvare only The Lackner Group, Inc. AMOUNT 425.00 374.50 278.78 553.53 8.000.00 1.500.00 H-A 11.131.81 75.00 378.00 219.40 H-B7 672.40 Form PA-1tf00 ~CFrodub H (Rev. 6-98) I rtw-~a~2 Dk« fu.oal scNS~u~E ~ DEBTS OF DECEDENT , ~TM~~A~A MORTGAGE LIABILITIES, ~ LIENS M AERITMICE TAX RETtfitN R~ID01T tlEC~OEl~{ ESTATE OF Dan Daniel A FILE NI~MBER 21-09 1020 a.bes mwrw nr aw Wc~k per, to d.an tlrt ~w,w,,.d ww.w ak a~ wa or ITEM d"n'~ ~'~h~0 unrNnW~rY~d NIHNBER DESCRIPTION VALUE AT DATE 1 Carlisle HMA Physician -medical expense ' OF DEATH 2 Cumberland-Goodwill FireRescue -ambulance services ii 10.00 3 Embarq Telephone -final phone bill 55.94 4 Millennium Pharmacy Systems East 58.50 5 Sarah Todd Memorial Home -final nursing home bill 12.90 ' 6 Special Event ER Medical 3ervlcea -medical expense 3.182.95 7 West Shore EMS -ambulance costs I' 61.61 1.446.47 TOTAL (Also enter on Lies 10, Recapitulation) 4,828.37 DopYr18M (c) 2009 form software on The (M moro sPsoe is ,~ t of the same atze) IY Lackner Group, Inc. Form PA-1600 S~hedub 1(Rev. 12-08) REV-1513 EXr (11-08) SCHEDULE J k:orN ~~~a BENEFICIARIES ESTATE OF Dand ,Daniel A NUMBER PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [indude outright spousal • distributions, and transfers 1 under Sec. 9116 a 1.2 Gina Dandy 42216 Ten'auo Ter. Apt. 405 Stone Ridge, VA 20105 2 Daniel J Dandy 333 North Mountain Rd. Newville, PA 17241 FILE jNUMBER 21-0 -1020 RELATIONSHIP TO SHARE OF ESTAITE AMOUNT OF ESTATE DECEDENT (Words) ($SS) Daughter 50% of the residue Son 50°~ of the residue traer tlollar amounts for distributions shown above on lines 15 thro h 18 on Rev 1500 c~o~r shy ~ II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT B. CHARITABLE AND GOVERNMENT,4L DISTRIBUTIONS - r~ucr u - en r tK TOTAL NON-TAXAB Copyright (c) 2009 form software only The Lackner Group, Inc. 1500 OVER SHE Form PA-1t500 S I J (Rev. 11-08) o ~\ ~ ~ ° ~ O o - O O Q~ O ~ ~ O a-- I r- N ~ a m } M 1I) ~ ~ C ~ O r C a c 'O ~ o t ~ C ' ~ M M .r.. C ~ ~ _ v .- ~ ~ N N L7f o ~ ~'? Q V ~ .- ~ .. ~ N ~ ~ ~ N ^ ~ Q ~ d O O ° ~+ o .- C d ~+ N C m v '~' f;, C ~ ~ a ~3 Q m ~ c~ •~ .. ~ :Q ~ ° C Q H U " ~ ~UQ • eo K ~ m ~ ,'. . m ~ ~ .~ ~ ~ m :a ~ W ~' O F - U v ~ ~ ~ v o ~ a ~ ~ ~k ~' M M y ~ ~ V N N MEMBERS 1st FEDERALCREpI'I' UNION s~viNCS AccouNT• Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner CHECKINt3 ACCgUNT• Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Int®rest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Estate of: DANtE~ A. DANDY Date of Dead: 10/1?J2009 Social Security Number: 158-16-2246 327240-00 04/07/2008 $12,874.74 $2.12 $12,876.86 None 327240-11 04/07/2008 $10,408.52 $.51 $10,409.03 None MBERS 1~ FEDERAL CRE[~IT UNION Danielle .Kline Insurance Services Specialist November 24, 2009 ~J/ 3 0 2009 ---...._..:~.:.~_uv 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 • 1 st.org " "'"J` ` ~~ ~W An Estate Planning Elder Law and S ecial Nee P ds Plannrng Law Fire: 2000 Linglestown Road, Suite 202 Harrisburg, PA 17110 www.HazenElderLaw.com Ta: (71'?7 540-4332 Muielle F. Hazen, CF.LA' Fnx: (717) 540313 M~rd S. Miller, Associate June 30, 2010 - ra e~ Q -~:; ter; ~,,,, ~ ~ ~~ ~,_~ ~ CERTIFIED MAIL ~ ~ ~-<~ ~ `~' ' ' ' Register of Wills ~ ~ ~ sue` Cumberland County Courthouse r~ ~ One Courthouse Square ~`, ~ `~;~ `t"' Carlisle, PA 17013-3387 ~ ~' Re: Estate of Daniel J. Dandy File No.: 21-09-1020 Social Security No.: 158-16-2246 Inheritance Taa Return To: The Register of Wills: Enclosed for filing please find the original and one copy of the abovq-ueferenced Inheritance Tax Return and Inventory, along with a copy of the first plage of the Inheritance Tax Return. Please date stamp the first page of the return and a irppy of the Inventory and return them to my office in the enclosed self-addressed envelgp@. Also enclosed is a check for the filing fee in the amount of $30.00. If you have any questions or require any additional information, pl~,ase do not hesitate to contact me. Sincerely, C A Q c~~t~"°ris(~ Corinne Eggers Woodhousle Enclosures Paralegal cc: Daniel A. Dandy, Ex. *Certified Elder Law Attorney by the Nations/ E/der Law Foundation as authorized by the Pennsylvania SupreiPre Court _ _ _. I