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Home My WebLink About07-26-10Ex (01-10> -J REV-1500 1505610143 PA De artment of Revenue ~ OFFICIAL USE ONLY p Pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE Po Box.2soso~ INHERITANCE TAX RETURN 2 1 0 9 10 4 1 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 10 30 2009 O1 20 1920 Decedent's Last Name Suffix Decedent's First Name MI ELRICK EMMA G (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 OPALS BELOW ® 1. Original Return ^ 2. Supplemental Retum ^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of death after 12-12-82) ^ g Decedent Died Testate ^ ~. Decedent Maintained a Living Trust (Attach Copy of Will) (Attach Copy of Trust) ^ 9. Litigation Proceeds Received ^ 1 p. Spousal Poverty Credit (date of death between 12-31-91 and i-1-95) ^ 3, Remainder Retum (date of death prior to 12-13-82) ^ 5. Federal Estate Tax Return Required 1 8. Total Number of Safe Deposit Boxes ^ 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number DAVID C MILLER JR 717 939 9806 First line of address 1100 SPRING GARDEN DR Second line of address SUITE A City or Post Office State ZIP Code MIDDLETOWN PA 17057 Correspondent'se-mail address: davidcmillerjr@verizon.net 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 PER,S(O~N RESPONSIBLE FOR FILING RETURN DATE ~.~d ,~7`~~~yz--- ~~.~~_ REE DEAN ~`"l ~ f~- l C~ ADDRESS / ' 1009 WOODED POND DR, HARRISBURG, PA 17111 SIG R ~ARER O THAN R P ESENTATIVE DATE DAVID C MILLER JR ~~ai ~i~ 1100 SPRING GARDEN DR., MIDDLETOWN, PA 17057 Side 1 L 1505610143 REGISTEI~-QF WILLS U~S' ONLY i ~ ~ ~~ ' ~ C-y ~- rn t~~ i --,, _ ~ +' ?_~~ _.~ ,...INM~ _. 1 ..._ ~ FILED ; .' '::: - -r' ~-- ~' 1505610143 J •`/ ~- J 1505610243 REV-1500 EX Decedent's Social Security Number ~ecedenYs wame: E L R I C K, E M M A GENE RECAPITULATION 1. Real Estate (Schedule A~ ..........................................................._......................... 1. 2. Stocks and Bonds (Schedule B) ................................ ,,.,.,,..,,, 2, 1 8, 7 1 3. 0 0 .............................. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3. 4. Mortgages & Notes Receivable (Schedule D) ............................._......................... 4. 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) .............. 5. 5 5 , 8 4 3.16 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ............. 7, 6 7 3, 8 5 4. 0 0 g, Total Gross Assets (total Lines 1-7) ............................................................._..... 8. 7 4 8, 4 1 0. 1 6 9. .................................... Funeral Expenses & Administrative Costs (Schedule H) 9. 3 1 , 4 2 7 . 0 0 10. 9 9 ( ) .............................. Debts of Decedent Mort a e Liabilities 8~ Liens Schedule I 10. 2 , 19 3.18 11. Total Deductions total Lines 9 & 10 ................................. ( ~ ............................._.. 11. 3 3 , 6 2 0.18 12. Net Value of Estate (Line 8 minus Line 11 ~ .......................................................... 12. 7 1 4 , 7 8 9 . 9 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.. 7 1 4 , 7 8 9 . 9 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. 16. Amount of Line 14 taxable at lineal rate X .045 16. 17. Amount of Line 14 taxable at sibling rate X ,12 17. 18. Amount of Line 14 taxable at collateral rate X .15 7 14 , 7 8 9. 9 8 18. 19. Tax Due ............................................................._................................................. 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 107,218.50 107,218.50 Side 2 1505610243 1505610243 J REV-1500 EX Page 3 Fife Number 21 - 09 - 1041 Decedent's Complete Address: D EDENT' NAME ELRICK, EMMA GENE __ __ ___ _ _____ _ STREET ADDRESS 5225 WILSON LANE _ __ _ __ __ CITY STATE ZIP MECHANICSBURG PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest (1) 107,218.50 102,000.00 5,360.93 Total Credits (A + B) (2) 107,360.93 (3) 0.00 (4) 142.43 (5) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is theOVERPAYMENT. 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 theTAX DUE Make Check Payable to: REGISTER OF WILLS, AGENT. 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 :............................................................................. ] ]x b. retain the right to designate who shall use the property transferred or its income :................................ ] ]x c. retain a reversionary interest; or .............................._.........................................................._................. ^ 0 d. receive the promise for life of either payments, benefits or care? ........................................................... [] 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ..............................._................................................................................. ~~ For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 ears 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 0 percent [72 P.S. §9116 (a) (~.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 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 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 bloo~ or adoption. SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BO N DS INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF ELRICK, EMMA GENE 21 - 09 - 1041 All property jointly-owned with right of survivorship must be disclosed on Schedule F, ITEM NUMBER ~ DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 NOLL FINANCIAL SERVICES -AIB STOCK ACCOUNT 18,713.00 ACCOUNT NO.41 A 046840 3,239 SHARES-AIB BANK STOCK; MONEY MARKET FUND-$607.00 TOTAL (Also enter on line 2, Recapitulation) 18,713.00 I COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER ESTATE OF ELRICK, EMMA GENE 21 - 09 - 1041 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 M&T BANK ` 42,039.36 CHECKING ACCOUNT NO. 98366468 2 MEDCO -REFUND 80.64 3 PINNACLE HEALTH -REFUND 49.18 4 PINNACLE HEALTH -REFUND 18.49 5 PINNACLE HEALTH -REFUND 18.49 6 METLIFE INSURANCE POLICY ASSIGNED TO HALL & STONE FUNERAL HOME 10,177.00 7 MID PENN BANK BURIAL TRUST ACCOUNT 3,460.00 TOTAL (Also enter on Line 5, Recapitulation) ~ 55,843.16 COMMONWEALTH OF PENNSYLVANIA SCHEDULE G INHERITANCE TAX RETURN I~+NTER-VIVOS TRANSFERS & RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY ESTATE OF ELRICK, EMMA GENE FILE NUMBER 21 - 09 - 1041 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY Include the name of the transferee, their relationship to decedent and the date of transfer. Attach a copy of the deed for real estate. DATE OF DEATH VALUE OF ASSET % OF fNTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 AUL ANNUITY 103,012.00 100% 103,012.00 ACCOUNT NO. 20 522 350 50 DATE OF DEATH VALUE-$103,012.00 2 AUL ANNUITY 570,842.00 100% 570,842.00 ACCOUNT NO. 20 523 424 30 DATE OF DEATH VALUE-$570,842.00 i TOTAL (Also enter on line 7, Recapitulation) ~ 673,854.00 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCFE~ULE H wwFU~ERAL. D~'ENSES && /`~r111YG ~I~71 ~ FILE NUMBER ESTATE OF ELRICK, EMMA GENE 21 - 09 - 1041 _ Debts of decedent must be reported on Schedule 1. ITEM -- - - ----i NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT A. 1 HALL & STONE FUNERAL HOME, INC. 13,585.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) REE DEAN 10,000.00 Street Address 1009 WOODED POND DR City HARRISBURG State PA Zip 17111 Year(s) Commission paid 2009 & 2010 2. Attorney's Fees DAVID C. MILLER, JR., SUPREME CT. ID #36504 7,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant 4. 5 Street Address City State Zip Relationship of Claimant to Decedent Probate Fees PROBATE FEES-$165.00; SHORT CERTIFICATES-$24.00; CUMBERLAND LAW JOURNAL-475.00; THE PAXTON HERALD-$48.00; INH. TAX RETURN/INVENTORY-$30.00 Accountant's Fees 6. ~ Tax Return Preparer's Fees 7. Other Administrative Costs 1 342.00 TOTAL (Also enter on line 9, Recapitulation) 31,427.00 SCHEDULEI DEBTS OF DECEDENT, MORTGAGE COMMONWEALTH OF PENNSYLVANIA LIABILITIES & LIENS INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF ELRICK, EMMA GENE 21 - 09 - 1041 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 BETHANY SKILLED NURSING-NURSING HOME-FINAL ILLNESS 504.80 2 EAST PENNSBORO AMBULANCE-FINAL ILLNESS 151.00 3 ~ CONTINUING CARE RX-PRESCRIPTIONS ($1,291.39; $245.99) ~ 1,537.38 TOTAL (Also enter on Line 10, Recapitulation) ~ 2,193.18 REV-1513 EX+ (11-08) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ELRICK, EMMA GENE FILE NUMBER 21 -09- 1041 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) SHARE OF ESTATE (Words) AMOUNT OF ESTATE ($$$) I~ TAXABLE DISTRIBUTIONS[include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 REE DEAN Friend ONE-THIRD OF 1009 WOODED POND DRIVE REST, RESIDUE & HARRISBURG, PA 17111 REMAINDER 2 GRACE ANN GORNIK Friend ONE-THIRD OF 2090 SUNSET DRIVE REST, RESIDUE & CAMP HILL, PA 17011 REMAINDER 3 JAMES L. SNYDER Friend ONE-HALF OF 637 GLENBROOK DRIVE ONE-THIRD OF HARRISBURG, PA 17111 REST, RESIDUE & REMAINDER Enter dollar amounts for distributions shown above on lines 1 5 through 18 on Rev 1500 cove r sheet, as appropriate. III NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX iS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE~f 0.00 REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES continued INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ELRICK, EMMA GENE FILE NUMBER __ __ _ _ _ 21 - 09 - 1041 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) RECEIVING PROPERTY Do Not List Trustee(s) I TAXABLE DISTRIBUTIONS[include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 4 THELMA SNYDER 9 ANDREW COURT HANOVER, PA 17331 Friend ONE-HALF OF ONE-THIRD OF REST, RESIDUE AND REMAINDER Page 2 of Schedule J ~~~ ~AV~~~ ~. MILLER, )~. July 23, 2010 Glenda Farner, Register of Wills CUMBERLAND COUNTY COURTHOUSE 1 Courthouse Square Carlisle, PA 17013 RE: Estate of Emma Gene Elrick File No.: 21-09-1041 Dear Ms. Farner: Atn~rne~~ ut Lai~~ -; ~~. o >> .-:~. ~ < ~ . w~ %•\ ~. ~~ ~ ~. - ~° ~- .~ Enclosed please find and original (without attachments) and one copy of the Pennsylvania Inheritance Tax Return. Also enclosed are an original and one (1) copy of an Inventory. Check Numbers 1015 and 1016, each in the amount of $15.00, are also enclosed as payment of the filing fee for the Pennsylvania Inheritance Tax Return and Inventory. Please time-stamp the extra copy of the first page of the Inheritance Tax Return and the copy of the Inventory and Appraisement and return them to me, along with a receipt for the payment of the filing fees. Aself-addressed and stamped envelope is enclosed for your use. If you have any questions regarding this matter, please contact me. Thank you for your assistance. Respectfully, `~ ~ ~~ ... David C. Miller, Jr. ~ DCM/blw Enclosures: Pa. Inheritance Tax Return -original (wio attachments) and 1 copy of Return Pa. Inheritance Tax Return - copy of Page 1 only Inventory -original and 1 copy Check Nos. 1015 and 1016 (each $15.00) Return Envelope cc: Ree Dean, Executrix (w/o encl.) /,'ill: ti/~rin~ (,:r; <<~~; i'~rirc~..Stritr ,1 • ,~~Jt<Ic/l~~lutirn. P,•1 /7(14i • Pltunc~: i!7-y39-~44Ob • F~u.~: 7l ~'-y3y-?79<<' • f~-~~~ui(: Ucn~i~t(~;11illt~r.lr(u ~~c~r~(~r>rt.ne~t