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HomeMy WebLinkAbout08-30-101505610143 J REV-1500 Ex(°1_,°' ; OFFICIAL USE ONLY PA Department of Revenue Pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE PO 80X.280601 INHERITANCE TAX RETURN 21 10 0 0 3 9 3 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 311 12 5766 03 20 2010 O1 23 1919 Decedent's Last Name Suffix Decedent's First Name MI BECKER FLOYD A (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 Return ^ 4. Limited Estate ^ 6 Decedent Died Testate (Attach Copy of Wili) ^ 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS ® 2. Supplemental Return ^ 4a. Future Interest Compromise (date of death after 12-12-82) ^ ~ Decedent Maintained a Living Trust (Attach Copy of Trust) ^ 10 Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) ^ 3, Remainder Return (date of death prior to 12-13-82) ^ 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes ^ 11. Election to tax under Sec. 9113(A} (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST 8E COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number DEBRA K WALLET 717 737 1300 First line of address 24 NORTH 32ND STREET Second line of address City or Post Office State ZIP Code CAMP HILL PA 17011 3 ~..._, REGISTER Oi*S USE ONLY _, ~ . _ F' _3 l~ 3 ' ~t ~ ~. _~ DdTE FILED --•- c ~~ Correspondent's a-mail address: w a l l e t d e b@ a o l. c o m 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, Corr ct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG U F PERSON RESPONSIBL OR FILI RETURN DATE ~ Jeffrey E. Becker -- ~ - f Q s 101v~Swarthmore Street, New Cumberland, PA 17070 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE I•~Mnv tt . ~J.a+~a- Debra K Wallet Shy ~ 9, ?~ i D ADDRESS 24 North 32nd Street, Camp Hill, PA 17011 Side 1 L 1505610143 1505610143 J 1505610243 REV-1500 EX Decedent's Social Security Number Decedents Name: B E C K E R, F L O Y D A 311 12 5 7 6 6 __ _ ---- 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. 7 , 615.3 8 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ............. 7. 1 , 0 6 9 . 8 0 8. Total Gross Assets (total Lines 1-7) ...................................................................... g. 8 , 6 8 5.18 9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9. 1 , 4 0 4 0 2 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10. 1 5 , 2 6 2 3 4 11. Total Deductions (total Lines 9 & 10) ...................................................................... 11. 1 6 , 6 6 6 . 3 6 12. Net Value of Estate (Line 8 minus Line 11) ............................................................. 12. - 7 , 9 8 1 1 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 , 9 8 1 1 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 0 0 0 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. 0 0 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 L 1505610243 1505610243 REV-1500 EX Page 3 File Number 21 - 10 - 0 0 3 9 3 Decedent's Complete Address: Becker, Floyd A STREET ADDRESS 46 Erford Road __ CITY - STATE 'ZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest 311.91 _._..0.00 4. if Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. 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 the TAX DUE. (1) 0.00 Total Credits (A + B) (2) 311.91 (3> 0.00 (4) 311.91 (5) 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 i _~ b. retain the right to designate who shall use the property transferred or its income :.................................... x ~'~ c. retain a reversionary interest; or .................................................................................................................. ! x d. receive the promise for Gfe of either payments, benefits or care? .............................................................. j x', 2. if death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................................................... ' , x 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... ' x 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ...................................................................................................................... x 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 Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Janua 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The sta~ute 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 21 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 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 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)1. 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. SCHEDULE H FUI~RAL. DCPENSES & COMMONWEALTH OF PENNSYLVAN{A ~~~w ~,. ~~ INHERITANCE TAX RETURN "Vt RESIDENT DECEDENT ESTATE OF Becker, Floyd A Debts of decedent must be reported on Schedule I. __ - - _. ____ ITEM DESCRIPTION NUMBER I FUNERAL EXPENSES: A. 1 1 Auer Cremation Services (over prepaid services) B. I, ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions ~, Name of Personal Representative(s) FILE NUMBER 21 - 10 - 00393 Street Address City State Zip Year(s) Commission paid 2. I'i, Attorney's Fees Law Offices of Debra K. Wallet -- Debra K. Wallet 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. '~ Tax Return Preparer's Fees 7. Other Administrative Costs 1 Postage, photocopies, etc. TOTAL (Also enter on line 9, Recapitulation) AMOUNT 241.42 1,000.00 137.60 25.00 1,404.02 SCHEDULEI ' ~ ~! DEBTS OF DECEDENT, MORTGAGE COMMONWEALTH OF PENNSYLVANIA ~ LIABILITIES, & LIENS INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF Becker, Floyd A 21 - 10 - 00393 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 Department of Public Welfare Claim (see attached) 15,262.34 TOTAL (Also enter on Line 10, Recapitulation) I 15,262.34 JUL ~ 8 2010 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF PROGRAM INTEGRITY DIVISION OF THIRD PARTY LIABILITY ESTATE RECOVERY PROGRAM PO BOX 8486 HARRISBURG, PA 17105-8486 June 30, 2010 JEFFREY E BECHER 1015 SWARTHMORE RD NEW CUMBERLAND PA 17070 Re: Floyd Becker CIS #: 930235911 SSN: ###-##-5766 Date of Death: 03/20/2010 Dear Mr. Becher: Please be advised that the Department of Public Welfare maintains a claim in the amount of $15,262.34 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 $15,262.34, 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 $.00, is to be entered as a priority Class 5.1 claim against the estate. Please acknowledge receipt 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. Sincerely, ~ ~' ~- Tina M. Wise TPL Program Investigator 717-214-1204 717-772-6553 FAX Enclosure NOTICE OF INHERITANCE TAX BUREAU OF INDIVIDUAL TAXES APPRAISEMENT, ALLOWANCE OR DISALLOWANCE INHERITANCE TAX DIVISION OF DEDUCTIONS AND ASSESSMENT OF TAX PO BOX 280601 HARRISBURG PA 17128-0601 DEBRA K WALLET 24 NORTH 32ND STREET CAMP HILL PA 17011 cl) .00 c2) .00 c3) .00 c4) .00 c5) 7,615.38 c6) .00 C7) 1 , 069.80 CUT ALONG THIS LINE _ --~ R_ETA_IN LOWER POR_TION_ FOR YOUR RECORDS E- _ ______________ REV-1547 EX AFP C12-09? NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF: BECKER FLOYD AFILE N0.:21 10-0393 ACN: 101 DATE: 08-23-2010 TAX RETURN WAS: C X) ACCEPTED AS FILED C ) CHANGED APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) RUC 2 7 2010 ~ ~3x t~ pennsylvan~a ~, ~ DEPARTMENT OF REVENUE REV-1547 EX AFP C12-09) NOTE: To ensure proper credit to your account, submit the upper portion of this form with your tax payment. c8) 8 , 685.18 C9? 1 , 389.02 clo) .00 11 . Total Deductions C11) 1 , 389.02 12. Net Value of Tax Return C12) 7,296.16 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) C13) .0 0 14. Net Value of Estate Subject to Tax C14) 7,296.16 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate C15) .0 0 X 0 0 = .0 0 16. Amount of Line 14 taxable at Lineal/Class A rate C16) 7.?96.16 x 045 = 328.33 17. Amount of Line 14 at Sibling rate C17) .0 0 X 12 = .0 0 18. Amount of Line 14 taxable at Collateral/Class B ra te C18) .0 0 X 15 = .0 0 19. Principal Tax Due C19)= 328.33 TAX CREDITS: PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID 06-14-2010 CD012923 16.42 311.91 DATE 08-23-2010 ESTATE OF BECKER FLOYD A DATE OF DEATH 03-20-2010 FILE NUMBER 21 10-0393 COUNTY CUMBERLAND ACN 101 APPEAL DATE: 10-22-2010 (See reverse side under Objections) Amount Remitted) MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TOTAL TAX PAYMENT 328.33 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.