HomeMy WebLinkAbout04-0611COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-O601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 004099
ROJOHN EDITH L
5029 WOODBOX LANE
MECHANICSBURG, PA
17055
........ fold
ESTATE INFORMATION: SSN: 189-26-7931
FILE NUMBER: 2104-061 1
DECEDENT NAME: KRIEN EDITH L
DATE OF PAYMENT: 06/30/2004
POSTMARK DATE: 06/28/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 05/05/2004
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $2,895.65
TOTAL AMOUNT PAID-
92,895.65
REMARKS:
SEAL
CHECK#422
INITIALS' JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
~,~y & Co., ClmA's
~ ~ 12~l N. ~est Ave.,
Walnuq~ PA 1~088
jLJ ,~
~00~
2 {-.) ,n. 4
Cumberland Courthouse
1 Courthouse Sq.
Carlisle, PA 17013-3387
I'" C':
REV-1500' EX
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
COLIN~' CODE YEAR
NLMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
Z KRIEN, EDITH L 189-26-7931
t'"l DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPUCA'rE WITH THE
O 05-05-2004 12-15-1914 REGISTER OF VVlLLS
LLI (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
[] 1. OdginalRetum [] 2. SupplementalRetum [] 3. RemainderReturn(dateofdeathpriorto12-13-82)
[] 4. Limited Estate [] 4a. Future Interest Compromise (dale of death after 12-12-82) [] 5. Federal Estate Tax Retum Required
~lr-] 6. DecedentDiedTestate(Attachcopyof~ll) [] 7. DecedentMaintainedalivingTrust(Attachco~wofTrust) __ 8. Total Number of Safe Deposit Boxes
Ir'--] 9. Litigation Proceeds Received [] 10. SpousalPovertyCredit(daleofdeath~ween12-3~-Sland~.1.~ [] 11. Election to tax under Sec. 9113(A)(~achSchO)
NAME COMPLETE MAILING ADDRESS ,
GARY A. FREY 121 N. BEST AVE
FIRM NAME (if App~cable)
SUITE 2
FREY & CO , CPA'S
'
TELEPHONE NUMBER WALNUT PORT, PA 18088
610-760-8920
I. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Propriatorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
[] Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Properly (7)
(Schedule G or L)
8. Total Gross Asse~s (total Lines 1 - 7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Ne{ Vat ue of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Ne{ Value Subject to Tax (Line 12 minus Une 13)
64,428.00
12,379.50
OFFICIAL USE ONLY
(6) 76,807.50
6,960.00
2,113.00
(11) 9,073. O0
(12) 67,734.50
(13)
(14) 67,734.50
SEE INSTRUCTIONS FOR APPUCABLE RATES
15. Amount o~ Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2) X .0 (15)
16. Amount of Line14 taxable at lineal rate 67, 734. 50 X .0 45 (16)
17. Amount of Line 14 taxable at sibling rate X .12 (17)
18. Amount of Line 14 taxable at collateral rate X .15 (18)
19. Tax Due (19)
20.
STF PA42021F.1
3,048.05
3,048.05
[] CHEEK; HERE IFYOU~E REQOE~TiNG~ ~E~UNDO~:~:O¥~'RPAYMEN
>= >;BE SURE TO ~SWER ALE QUESTIONS:ON: REV~E SiDE AND :RE~E~ MATH ~ ~
Dec~edent's Complete Address:
ISTREET ADDRESS 5029 WOODBOX LANE
CiTY MECHANICSBURG
I STATEpA
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Pdor Payments
C. Discount
17055
(1)
152.40
3,048.05
Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits (A + B + C) (2)
Total Interest/Penalty (D + E) (3)
If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page '1 Line 20 to request a refund (4)
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. (SA)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE, (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
152.40
0.00
2,895.65
2,895.65
PLEASE ANSVVER 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 dght 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 secudty at his or her death? ..... [] []
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.
DUnd,er p. enalti.es of perju~Czt~clare that I have, examined this return, including accempanying schedu es and statements, and to the best of my knowledge and belief, it is true, correct and complete.
eclaration o~ pre(~3~l~ other tl'~n the persona~ representative is based on all inforr~ation of which preparer has any knowledge.
SIG~URp~ R_ESPONSL~f~OR~ET_ U~
ADDRESS
5029 WOODBOX LANE, MECHANICSBURG, PA 17055
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
121 N. BEST AVE, SUITE 2, WALNUTPORT, PA 18088
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 3%
[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 0% [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 disc osure of assets and filing a tax return are still applicable even
if the su~ving 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 0% [72 P.S. §9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedenrs lineal beneficiaries is 4.5%, 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 decedenrs siblings is 12% [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.
STFPA42021F.2
RE~/-1508 EX + (1-97) (I)
SCHEDULE E I
COMMO,~ALTHOFPENNSY,VAN~ CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN
RES,~ENTDECEDENT PERSONAL PROPERTY
ESTATE OF FILE NUMBER
EDITH L KRIEN
Include the proceed s of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of sup/ivorship must be di~!__nsed on Schedule F.
ITEM
NUMBER DESCRIPTION
1. FEDERAL INCOME TAX REFUND
2. AMERICAN EXPRESS FINANCIAL ADVISORS
ANNUITIES -POST 1985
ACCT %930030169849004
TOTAL (Also enter on line 5, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
STF PA42021F.9
VALUE AT DATE
OF DEATH
405
64,023
$ 64,428.00
RE~/-1509 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA SCHEDULE F
INHERITANCE TAX RETURN JOINTLY-OWNEDPROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
EDITH L KRIEN
If an asset was made joint within one year of the decedeflt's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A.PATRICIA ROJOHN DAUGHTER
5029 WOODBOX LANE
MECHANICSBURG, PA 17055
JOINTLY-OWNED PROPERTY:
L~-~-~ DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of finandal institution and ba~ accomt number or similar identifying n~rnber. DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT Attach deed forjoin~.held real eslale. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 4/22/9l AMERICAN EXPRESS FINANCIAL ADVISORS 1, 568 50 784.00
CERTIFICATE ACCT#008044417338001
2. A 4?22?9 M&T BANK CHECKING ACCT#950945307 23,191 50 11,595.50
TOTAL (Also enter on line 6, Recapitulation)$ 12,3 7 9.5 0
(If more space ~s needed, insert additional sheets of the same size)
STF PA42021F, 10
RE'~-1511 EX + (1-97)(I)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
EDITH L KRIEN
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
2.
3.
4.
5.
6.
7.
5.
6.
7.
FUNERALEXPENSES:
JOHN BUTLER HOUSE - BED & BREAKFAST
ORGANIST, SOLOIST, MINISTER & PIPER
MOUNT VERNON CEMETARY
GILBERT FUNERAL HOME - OBIT IN PAPER
GREENOCK METHODIST CHURCH
EXECUTIVE CHEF CATERER
POSTMASTER - STAMPS
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Social Secunty Number(s) / EIN Number of Personal Representative(s)
Street Address
City State
Year(s) Commission Paid:
Attorney Fees
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant PATRICIA ROJOHN
Zip
Str~Address5029 WOODBOX LANE
CityMECHANICSBURG
Relationship of Claimant to Decedent DAU G H T E R
State PA Zip. 17 0 5 5
Probate Fees
Accountant's Fees
Tax Re~um Preparer's Fees
TOTAL (Also enter on line 9, Recapitulation) $
342
605
300
116
1,000
660
37
3,500
200
2O0
6, 960.00
(If more space is needed, insert additional sheets of the same size)
STF PA42021F. 12
RE~/-1512 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
EDITH L KRIEN
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
I
FILE NUMBER
Include unreimbursed medical expenses.
ITEM
NUMBER
2.
3.
4.
5.
6.
7.
DESCRIPTION
VERIZON
AT&T WIRELESS
SUS. INTERNAL MEDICINE
EKG ASSOCIATES
WEST SHORT EMS AMBULANCE
SEIDLE MEMORIAL HOSPITAL
LESHER EMS
TOTAL (Also enter on line 10, Recapitulation) $
AMOUNT
69
120
100
35
84
1,651
54
2,113.00
(If more space is needed, inse~ additional sheets of the same size)
STFPA42021F. 13
REV-1513 EX + (9-00)
COMMONWEALTH OF PENNSYLVANIA SCHEDULE J I
INHER'TANOE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
EDITH L KRIEN
NUMBER
I.
S'rF PA42021F. 14
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
AMOUNT OR SHARE
OF ESTATE
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outfight spousal distributions, and transfers
under Sec. 9116 (a) (1.2)]
PATRICIA ROJOHN
5029 WOODBOX LANE
MECHANICSBURG, PA 17055 DAUGHTER ENTIRE RESIDUE
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
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 INDTVIDUAL TAXES
/NHERITANCE TAX D/VIS/ON
DEPT. Z80601
HARRTSBURG, PA 171Z8-0601
COMMONNEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLO#ANCE OR DZSALLO#ANCE
OF DEDUCT/OHS AND ASSESSMENT OF TAX
GARY A FREY
FREY & CO
121N BEST u~VE STE 2
NAL~UTPORT.~r. ~:*P~ 18088
DATE
ESTATE OF
DATE OF DEATH
FILE NUHBER
COUNTY
ACN
08-23-200q
KRIEN
05-05-200q
21 0q-0611
CUMBERLAND
101
Aeoun'~ Raei~:*ed
RE¥-1547 EX AFP (01-05)
EDITH L
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF HILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG~.~_~:~"Z$ .... L~IE__.______ --------..'~" RETAIN LONER PORTION FOR YOUR RECORDS ~
~:-V-:~,-7-~E~~:RFP (~Ol-O~I'-~IOTZCE OF ZNHERZTANCE TAX APPRAISEMENTs ALLONANCE OR
'~ -- .C:::::) ~SALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF KRTEN :L)(~ EDITH L FILE NO. 21 0q-0611 ACH 101 DATE 08-25-200q
TAX RETURN NAS: (X) ACCEPTED AS FTLED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Es~a~a (Schedule A) (1)
2. S~ocks and Bonds (Schedule B) (2)
$. Closely Held S~ock/Par~nership Zn~eras~ (Schedule C) ($).
q. Mor~gages/No~as Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Propar*y (Schedule E) (5)
6. Jointly Owned Proper~y (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. To*al Asse~s
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expanses/Ada. Costs/Misc. Expanses (Schedule H) (9)
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10)
11. To,al Deductions
12. Na~ Value of Tax Ra~urn
6q~qZ8.00
12z$79.50
.00
.00 NOTE: To insure proper
.00 credi~ ~o your account,
.00 submi~ ~he upper portion
.00 of ~h~s fore wi*h your
~ax payment.
2,115.00
(11) 9.07~. 00
(12) 67,75q.50
1F PAID AFTER DATE ZNDZCATED~ SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
TAX CREDITS:
PAYMENT
DATE
06-28-200q
15.
lq.
NOTE:
ASSESSMENT OF TAX:
15. Amoun'~ of Line lq a~ Spousal ra~e (15).
16. Amoun* of Line lq ~axable a~ Lineal/Class A ra~e (16)
17. Amoun'l: of L/ne lq i~ Sibling ra~a (17)
18. Amount of L/ne lq ~axabla a* Collateral/Class B ra*e (18)
19. Principal Tax Due
RECEIPT
NUMBER
CDOOq099
DI$COUNT
INTEREST/PEN PAID (-)
152.qO
reflect figures that include the total of ALL returns assessed to date.
· O0 x O0 = . O0
67,75~,.50 x Oq5= $,0q8.05
· O0 x 12 = .00
· O0 x 15 = .00
(19)= $, Oq8.05
AMOUNT PAID
2,895.65
Chari~abla/govarneen~al Bequests; Non-elected 911S Trusts (Schedule J)
Ne* Value of Es*a~a SubSec~ ~o Tax (lq)
Zf an assesseent was ~ssued prevAously, iAnes 1~, 15 and/or 16, ~7,
18 and 19 will
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
$,0q8.05
.00
.00
.00
( TF TOTAL DUE ZS LESS THAN $1, NO PAYMENT 'rs RE{IUTRED.
.rF TOTAL DUE .rS REFLECTED AS A "CRED.rT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE S.rDE OF TH'rS FORM FOR 'rNSTRUCTTONS.)
76,807.50
.00
67,73q.50
(8)
6,960.00
RESERVATION:
Estates of decedents dying on or before December II, 1982 -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decadent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
PURPOSE OF
NOTICE:
PAYMENT:
REFUND (CR):
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
To fulfill the requirements of Section ZI~O of the Inheritance and Estate Tax Act, Act Z3 of ZOOO. (7Z P.S.
Section 91q0).
Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side.
--Make check or money order payable to: REGISTER OF HILLS, AGENT
A refund of a tax credit, ahich was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications ara available at the Office
of the Register of Nills, any of the 23 Revenue District Offices, or by calling the special Zq-hour
answering service for forms ordering: 1-&OO-36Z-ZO50; services for taxpayers with special hearing and / or
speaking needs: 1-800-qq7-3OZO (TT only).
Any party in interest not satisfied aith the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals~ Dept. Z810Z1, Harrisburg, PA 171[B-lO[I, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes~ ATTN: Post Assessment Review Unit, Dept. [BO601, Harrisburg, PA 171ZB-0601
Phone (717) 787-6505. Sam page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
If any tax due is paid within three (33 calendar months after the decadant's death, a five percent (SX) discount
the tax paid is allowed.
The 1SI tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning aith first day of delinquency, or nine (9) months and one [1) day from the date of
death, to the date of payment. Taxes which became delinquent before January l, 19SI bear interest at the rate of
six (6X) percent per annum calculated at a daily rate of .00016q. All taxes which became delinquent on and after
January 1, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOOq ara:
Interest Daily Interest Daily Interest
Year Rate Factor Year Rate Factor Year Rate Factor
198Z 20Z .OO05qB 1988-1991 llZ .000301 ZOO1 9X .O00Zq7
1983 16Z .OOOq38 199Z 9Z .O00Z~7 ZOOZ 6Z .OOOl6~
198q iIX .000301 1993-199~ 7Z .O0019Z 2003 5Z .000137
1985 13Z .000356 1995-1998 9Z .OOOZ~7 ZOOq qZ .OO011O
1986 lOX .OOOZTq 1999 7Z .O0019Z
1987 lOX .00027q ZOO0 7Z .OOOXgZ
--Interest is calculated
as follows:
INTEREST = BALANCE OF TAX UNPATD X NUNBER OF DAYS DELINQUENT X DA/LY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (lS) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Natice~ additional interest must be calculated.