HomeMy WebLinkAbout08-18-10 5056041046
REV-15 0 0 EX (05-04) OFFICIAL USE ONLY _
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes ^ ~ INHERITANCE TAX RETURN
Dept. 280601 r ~ S(
Harrisburg, PA 17128-0601 ~ RESIDENT DECEDENT ~ ~' O) j I "~)
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
1 9 7 4 0 5 0 2 3 1 1 1 0 2 0 0 8 0 5 0 5 1 9 4 8
Decedent's Last Name Suffix Decedent's First Name MI
G e b h a r t P,a t r i o i s A
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
G e b h a r t E d w a r d G
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 O 2. Supplemental Return
O 4. Limited Estate O 4a. Future Interest Compromise (date of
death after 12-12-82)
O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust
(Attach Copy of Will) (Attach Copy of Trust)
O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95)
O 3. Remainder Return (date of death
prior to 12-13-82)
O 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
O 11. Election to tax under Sec. 9113(A)
(Attach Sch. C))
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
R i c h a r d F M a f f'e t t E s q 7 1 7 2 3 3 4 1 6 0
Firm Name (If Applicable)
First line of address
'2 2` 0 1 N S e c o n d S t r e e' t
Second line of address
City or Post Office
H a r ri s b u r g
REGISTE~F WILLS US~NLY
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State ZIP Code
P A 1 7 1 1' 0
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Correspondent's a-mail address: rTl1a f f e t t j r@ a01 . COm
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 comple preparer other than the personafl-epresentative is based on all information of which preparer has any knowledge.
SI ATURE C~'~jRSON~OFILI G -TURN L~{at.0 ~ ~ c~~E~
ADDRESS ".tJCiwarCi G . Gebriart
35 Recency Woods North, Carlisle, PA 17015 _
SIGNATURE F PREPARER OTHER THAN RE RESENTATIVE DATE
ADDRE 1C ar a e , r . , squire
2201 N. Second St., Harrisburg, PA 17110
PLEASE USE ORIGINAL FORM ONLY
Side 1
15056041046 15056041046 J
15056042047
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: G2badrt ~ Patricia A. 1 9 7 4 0 5 0 2 3
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 Personal Property (Schedule E) ........ 5. 1 5 3 7 1. 3 4
6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. •
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested........ 7.
8. Total Gross Assets (total Lines 1-7) .................................... 8. 1 5 3 7 1. 3 4
9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9. rj '] '] ~. '] ~
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................ 10. 4 4 0 6 . 0 1
11. Total Deductions (total Lines 9 & 10) ................................... 11. ~. 0 1 7 9. 8 0
12. Net Value of Estate (Line 8 minus Line 11) .............................. 12 5 1 9 1. 5 4
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. 5 1 9 1 . 5 4
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 .o ~ 2 5 9 5 ,7 7
15.
0.0
0
16. Amount of Line 14 taxable
at lineal rate x .o ~5 2 5 9 5 .7 7
16.
1
1 6. 8
1
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. ~. l 6 * 8 ~-
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~
Side 2
15056042047 15056042047
REV-1500 EX Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
PATRICIA A. GEBHART
STREET ADDRESS
35 Regency Woods North
CITY
STATE PA ZlP 17 O ~. 5
Carlisle
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19) (1) 116.81
2. CreditslPayments
0
A. Spousal Poverty Credit
B. Prior Payments 0
C. Discount 0
0
Total Credits (A + B + C) (2)
3. Interest/Penalty if applicable
D. Interest ~ . 2
E. Penalty 0
Total Interest/Penalty (D + E)
(3)
5 . 2 6
4. 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. (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 1:16.81
A. Enter the interest on the tax due. (5A) _5 . 2 6
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 12 2 . 0 7
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 IVo
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, ditl 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 security at his or her death? ....... ....... ^ ~X
I
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 A,S 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)J. 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 1:he use of a natural parent, an
adoptive parent, or a stepparent of the chid 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 (4.51 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.
Register of Wills of Dauphin County, Pennsylvania
INVENTORY
Estate of
Patricia A. Gebhart
also known as
No. 2008-01157
Date of Death 11/10/08
Deceased Social Security No.
197-•40-5023
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the fallowing inventory include all
of the persona! assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that
the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and
that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum
at the end of this inventory. 1/V1le verify that the statements made in this Inventory are true and correct. 1/We understand that
false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 re{ating to unsworn falsification to
authorities.
Name of
Attorney: Richard F . Maffett, Jr .
I.D. No.: 35539
Address: 2201 N. Second Street
Harrisburg, PA 17110
Telephone: 717-233-4160
Personal Representative:
Edward G. Gebhart
35 Regency Woods North
Ca.r is e,
Dated
RW-13
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include
the value of each item, but such figures should not be extended into the total of the Inventory.
REV-1508 EX+ (t-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
2008-011~i7
PATRICIA A. GEBHART
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 VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
~. N~embers 1st Federal Credit Union $14,371.34
Savings Account No. 229509
2. ~ Personal Property
1,000.00
TOTAL (Also enter on line 5, Recapitulation) $ 15, 371.34
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX + (1.97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
Patricia G. Gebhart 2008-01157
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
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
DECD'S
INTEREST
EXCLUSION
IF APPLICABLE
TAXABLE VALUE
1. Prudential Life Insurance Policy 3,149.46 1000 7'2 P.S. 0
No. 17212918 9~111(d)
Insured: Patricia A. Gebhart
Beneficiary: Edward G. Gebhart
2. Fort Dearborn Life Insurance Company 33,000.00 1000 72 P,S. 0
Policy No. MG16652 9111 (d)
Insured: Patricia A. Gebhart
Beneficiary: Edward G. Gebhart
3 . Con~unerce Bank 918.36 50 0 72 P , S . 0
50 Plus Checking Account 9111 (m)
Owner: Patricia A. Gebhart or Edward G.
Gebhart
Account No. 003 2026478
4. Conar>erce Bank 3, 216.6 3 50 0 7 2 P, S. 0
Personal Statement Savings 9111 (m)
Owner: Patricia A. Gebhart or Edward G.
Gebhart
Account No. 0430017589
5 . 1984 Corru~rxlore Mobile Houle 7,140.00 50 0 7:2 P , S . 0
9:111 (m)
6. 1999 Chevrolet Blazer LS 2,000.00 500 72 P,S. 0
9:111 (m)
7. 2003 GMC Safari AWD 3,500.00 500 7? P.S. 0
9111 (m)
TOTAL (Also enter on line 7, Recapitulation) $ 0
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99) ~
SCHEDULE H
~.
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Patricia A. Gebhart 2008-01157
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT _
A. FUNERAL EXPENSES:
1~ Musse]m~rl Funeral Home & Cremation Services, Inc. $4,560.92
P.O. Box 137, Lemoyne, PA 17043
Professional Services, Facilities, Autos, Flowers, Death
Certificates, Newspaper Death Notice
B.
1
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s) Waived
Social Security Number(s)/EIN Number of Personal Representative(s~
Street Address
2
3
City ___ State Zip
Year(s) Commission Paid:
Attorney Fees Five (5 0) percent of gross estate subject to probate
to Richard F. Maffett, Jr., Esq.
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
4.
5.
6.
~.
8.
Street Address
City ____ State _ Zip
Relationship of Claimant to Decedent
Probate Fees Cumberland County Register of Wills
Accountant's Fees
Tax Return Preparer's Fees Robert Shannon
The Patriot News -Advertisement of Estate
Dauphin County Reporter -Advertisement of Estate
768.57
85.00
75.00
209.30
75.00
TOTAL (Also enter on line 9, Recapitulation) $ 5, 773.79
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX+ (12-03)
Y
COMMONWEALTH OF PENNSYLVANfA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
Patricia A. Gebhart 2008-01157
Re port debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimburseci medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
~ Heritage Medical Group, T,T,p -medical bill $ 336.00
2. Orthopedic Institute of PA -medical bill 243.13
3. Good Hope Family Physicians -medical bill 30.97
4. West Shore EMS 897.53
5. Holy Spirit Hospital 149.80
6. Grandview Surgery & Laser Center 1,920,00
7. Discover Card 379.54
8. AAA Financial Services Account No. 4264296753004826 369.47
9. Verizon Wireless 79.57
TOTAL (Also enter on line 10, Recapitulation) $ ` 4, 406.01
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX+ (9-00)
~.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUMBER
Patricia A. Gebhart 2008-01157
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. Edward G. Gebhart Spouse 500
2. David E. Gebhart Child 250
3. Karen K. Cassell Child 250
II
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON RE:V-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
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $
(If more space is needed, insert additional sheets of the same size)