HomeMy WebLinkAbout09-08-10--~ REV-1500 E"(01-1°) A 1505610143
PA Department of Revenue OFFICIAL USE ONLY
Pennsylvania County Code Year File Number
Bureau of Individual Taxes DEPARTMENT OF REVENUE
PO 60X.280601 INHERITANCE TAX RETURN 2 1 101 0 0 6 9
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
507 42 9387 O1 08 2010
Decedent's Last Name Suffix
WOODWORTH
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's Social Security Number
Date of Birth
02 21 1941
Decedent's First Name MI
KAREN R,
Spouse's First Name MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
® 1. Original Return ^ 2. Supplemental Return
^ 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 1-1-95)
^ 3. Remainder Return (date of death
prior to 12-13-8:?)
^ 5. Federal Estate Tax Return Required
0
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 INFORMATIOIN 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
REGISTER f~j VYILLS US~NLY
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Correspondent'se-mail address: davidcmillerjr@verizon.net
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Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best o~F my knowledge and belief,
it is true, correct and complete. Declar 'on of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATU E PERSON ESPO IBLE F FILING RET RN DATE
~ JUDITH J. VALENTINE
`~~? 1t~
P. O. BOX 15, BOWMANSVIL~L,~, PA 17507
IG UR PARER O~IEf~HAN RE RES NTATIVE
DAVID C MILLER JR
D TE
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ADDRESS V
1100 SPRING GARDEN DR., MIDDLETOWN, PA 17057
Side 1
L 1505610143
1505610143
sr~' t'`~
J
1505610243
REV-1500 EX
Decedent's Social Security Number
DecedenPs Name: W O O D W O R T H, KAREN R. 5 0 7 4 2 9 3 8 7
RECAPITULATION -
1
. Real Estate Schedule A _,,,,,,,,,,,,,,,,,,,,,,,
( ~ ............................................................ 1 18 7, 0 0 0. 0 0
2. Stocks and Bonds (Schedule B) .......................................................................... 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C}......... 3.
4. Mortgages 8~ Notes Receivable (Schedule D) ............................._......................... 4.
5• Cash, Bank De osits & Miscellaneous Personal Pro e
P p rty (Schedule E) ..............
5. 4 1 , 8 0 1 . 1 8
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............. 6. 3 , 2 3 6 . 4 2
7. Inter-~vos Transfers 8~ Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested ............. 7, 8 4 , 17 7 . 2 9
8. Total Gross Assets (total Lines 1-7~ .................................................................. g, 3 1 6, 2 1 4. 8 9
9. Funeral Expenses & Administrative Casts (Schedule H} .............................._....... 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I} ............................... 10.
11. Total Deductions (total Lines 9 & 10) .............................._.................................. 11.
12. Net Value of Estate (Line 8 minus Line 11 ~ .......................................................... 12.
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.
44,275.45
'.18, 171.73
1:2,447.18
1513,767.71
193, 767 .71
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 19 0, 5 3 1. 2 9 16.
17. Amount of Line 14 taxable
at sibling rate X ,12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 3, 2 3 6. 4 2 18.
19. Tax Due ............................................................................................................ ... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
8,573.91
485.46
9,059.37
Side 2
L 1505610243 15D5610243 J
REV-1500 EX Page 3 File Number 21 - 10 - 0069
Decedent's Complete Address:
DECEDENT' NAME
WOODWORTH, KAREN R. _ _ ___ _ __ _____ .______
STREET ADDRESS
503 COLONY DRIVE
CITY STATE ZIP ~_
CAMP HILL PA 17011
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19) (1) 9, 0 59.37
2. Credits/Payments
A. Prior Payments 8 , 4 0 0.0 0
B. Discount 442.11
Total Credits (A + B) (2) 8,842.11
3. Interest (3) 0.00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the(3VERPAYMENT. (4) ~_
Check box on Page 2 Line 20 to request a refund
5. {f Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE (5) 2 ~ 7.2 6
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; ar ............................................................................................................ ^ ^
d. receive the promise for life of either payments, benefits or care? ........................................................... ] ]x
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration? ................................................................................................................. ^
~-, r-,
For dates of death an 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, e:+ccept 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 wrath the decedent, whether by blood' or adoption.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
FILE NUMBER
ESTATE OF WOODWORTH, KAREN R. 21 - 10 - OC-69
All real property owned sole)y or as a tenant in common must be repported at fair market value. Fair market value is defined as the price
at which property would be exchanged between a willing buyer and a wilting seller, neither being compelled to buy- or sell, both having
reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on
schedule F.
Attach a copy of the settlement sheet if the property has been sold.
Include a copy of the deed showing decedent's interest if owned as tenant in common.
ITEM I DESCRIPTION I VALUE AT DATE OF
NUMBER + DEATH
Single-family dwelling located at 503 Colony Dr., Camp Hill, Cumberland Co., PA; transferred to
Decedent on August 31, 1998 by deed recorded in the Office of the Recorder of Deeds of
Cumberland County, Pennsylvania at Deed Book 184, Page 597. Valuation determined as
follows: Sale Value
187, 000.00
TOTAL (Also enter on Line 1, Recapitulation) ~ 987,000.00
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
ESTATE OF WOODWORTH, KAREN R. 21 - 10 - 0069
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
DEATH
NUMBER
1 M&T Bank, Checking Account No. 61238414; date of death balance-$9,052.32; accrued interest 9,052.33
$0.01
2 Fulton Bank, Checking Account No. 3623-51269; date of death balance-$0.00; 0.00
accrued interest $0.00
3 MorganStanfey SmithBarney 20,027.86
Account No. 724-06126-19-002
4 Members 1st Savings Account No. 328341-00; date of death balance $2,543.10; 2,543.10
accrued interest $0.17
5 Members 1st VISA Account No. 467209000029009; Credit Balance 99.98
6 Emergency Medical Services Refund 229.70
7 Vehicle - 1998 Toyota Avalon, Good Condition 4,665.00
8 Personal Property -Private Sale 1, 000.00
9 Real Estate Taxes -Refund (Proration from Settlement Statement) 562.26
10 Sewer -Refund (Proration from Settlement Statement) 79.12
11 Sprint -Refund 33.96
12 UGI -Refund 206.00
13 ExpressScripts-Refund 34.72
14 ADT Security Service-Refund 27.00
TOTAL (Also enter on Line 5, Recapitulation] 41,801.18
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT continued
ESTATE OF WOODWORTH, KAREN R.
FILE NUMBER
21 - 10 - Ot169
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 OF
NUMBER DESCRIPTION DEATH
15 American Water-Refund 13.89
16 GMAC-Refund of Overpayment of Mortgage 1,560.23
17 United States Treasury-Social Security Payment-1 /27/10 1,138.40
18 Morgan Stanley 27.63
19 Pennsylvania Department of Revenue -Property Tax Rebate 500.00
Page 2 of Schedule E
SCHEDULE F
COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT _ _ ___~____~_,_______ __~_,_
ESTATE OF WOODWORTH, KAREN R. FILE NUMBER
21 - 10 - 0069
If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
Judith J. Valentine 503 Colony Drive
q Camp Hill, PA 17011
_InINTI v OwIV1=D PROPERTY:
Friend
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT ~F~SCRIPTIO~ ~?F PR~PEF~TY
Include name o nanclal Ins I u Ion an ban account number
or similar identifying number. Attach deed for jointly-held real
estate.
DATE OF DEATH
VALUE OF ASSET
_ "/o OF
DECD'S
INl"ERES DATE OF DEATH
VALUE OF
DECEDENT'S INTEREST
1 A 11/2004 Fulton Bank, Checking Account No. 2219-63065; 6,472.83 50% 3,236.42.
Date of Death Balance-$6,472.71; accrued
interest-$0.12
TOTAL (Also enter on line 6, Recapitulation) 3,236.42
COMMONWEALTH OF PENNSYLVANIA SCHEDULE G
INHERITANCE TAX RETURN INTER-VIVOS TRANSFERS &
RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY
ESTATE OF WOODWORTH, KAREN R. FILE NUMBER
21 - '10 - 0069
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 °I° OF
I DEEREST EXCLUSION
(IF APPLIG4BLE) TAXABLE VALUE
1 MorganStanley Smith Barney 84,177.29 100% 84,177.29
I IRA Account No. 724-66421-15-002
i --
TOTAL (Also enter on fine 7, Recapitulation) 84,177.29
Sq-~DUI~ H
FUt~Q?AL D~ENSES &
COMMONWEALTH OF PENNSYLVANIA w~A * '~'~~
INHERITANCE TAX RETURN r~rl~'I ~I IYG ~~
RESIDENT DECEDENT
ESTATE OF WOODWORTH, KAREN R. l FILE NUMBER
21 - 10 - 0069
Debts of decedent must be reported on Schedule I.
__
{TEM
NUMBER
FUNERAL EXPENSES: DESCRIPTION
AMOUNT
A. 1 Myers-Harner Funeral Home 3,909.00
2 Georgia Clements, Organist-$50.00; Jim Reitz, Eulogy-$100.00; Blooms By Vickrey, 751.40
Inc.-$456.86; Walmart-Items for Funeral Photographs-$144.54
3 Fantini Monuments -Monument 465.00
4 Coakley's Irish Restaurant-Funeral Luncheon 945.00
5 Our Lady's-Mt. Carmel-$450.00; Father Raymond-$100.00 550.00
B. ADMINISTRATIVE COSTS:
~ , Personal Representative's Commissions
Name of Personal Representative(s)
JUDITH J. VALENTINE 10,000.00
Street Address P. O. BOX 15
City BOWMANSVILLE State PA Zip 17507
Year(s) Commission paid 2010
2. Attorney's Fees DAVID C. MILLER, JR. ESQUIRE, I.D. NO. 36504 8,500.00
3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
4.
5.
6.
7.
1
Street Address
City State Zip
Relationship of Claimant to Decedent
~, Probate Fees Probate Fees ($303.50); Short Certificates ($40.00); The Paxton
~~ Cumberland County Law Journal ($75.00); The Paxton
Herald ($48.00); Additional Probate Fees ($50.00)
Accountant's Fees
Tax Return Preparer's Fees Patricia A. RadonoviCh
Other Administrative Costs
~i BJR Plumbing -Repairs
516.50
350.00
60.00
TOTAL (Also enter on line 9, Recapitulation) 44,275.45
Sdiedule H
Q-
f~ IG7A «
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN /
F~,r•'~'~'~.~Y QY VG ~~ (~~~
RESIDENT DECEDENT
KAREN R.
ESTATE OF WOODWORTH FILE NUMBER
, 21 - 10 - 0039
2 ERA-NRT, LLC -Commission on Sale of Real Estate 11,470.00
3 Recorder of Deeds -Realty Transfer Tax -Sale of Real Estate 1,870.00
4 Christina L. Hershey -Notary Fee -Sale of Real Estate 10.00
5 Secured Land Transfers -Tax Certification Fee -Sale of Real Estate 15.00
6 Secured Land Transfers -Wire Fee for Mortgage Pay-Off 45.00
7 Seller Paid Closing Costs -Sale of Real Estate 4,500.00
8 U.S. Postal Service-Stamps 8.80
9 Central State Distributors-Repair of Garage Door _ 129.75
10 Joe Swartzell-Clean-Out of House prior to Sale 150.00
11 Register of Wills-Filing Fee-Pa. Inheritance Tax Return and Inventory 30.00
Page 2 of Sc:hedule H
SCHEDULEI
DEBTS OF DECEDENT, MORTGAGE
COMMONWEALTH OF PENNSYLVANIA LIABILITIES & LI ENS
INHERITANCE TAX RETURN 7
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF WOODWORTH, KAREN R. 21 - 10 - 0069
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM DESCRIPTION AMOUNT
NUMBER
1 GMAC Mortgage -Account No. 0019094606 70,520.72
2 PA American Water Company ($39.35; $40.94; $43.92; $35.67) 159.88
3 I Fulton Bank VISA Card { 128.39
4 Sprint Telephone 36.52
5 Special Events Emergency Medical Services 254.70
6 Verizon Telephone Services 100.28
7 UGI Gas Services ($125.00; $208.58; $203.42; $206.00; $178.67) 921.67
8 PP&L Electrical Services ($157.00; $156.99; $156.98) 470.97
9 Camp Hill Fire Co. -Ambulance Service 68.35
10 HCR Manor Care 275.00
11 Unitrin (Kemper insurance) -Automobile Insurance ($45.00; $45.00) 90.00
12 Hampton Township-Sewer and Trash 150.00
13 Peak Mobility-Repair Stair Lift 221.75
14 Terry Jones-Lawn Mowing 115.00
15 GMAC-Mortgage Payments-February, March, April and May, 2010 4,658.50
TOTAL (Also enter on Line 10, Recapitulation) I 78,171.73
REV-1513 EX+ (11-08)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF WOODWORTH, KAREN R. FILE NUMBER
21 - 10 - 0069 _
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY Do Not List Trustee(s)
I TAXABLE DISTRIBUTIONS[include outright spousal
distributions, and transfers
under Sec. 9116 (a) (1.2)]
1 Judith J. Valentine Friend Specific Bequest
503 Colony Drive
Camp Hill, PA 17011
2 Angela S. Taylor Daughter Specific BequE~st
2994 Autumnwood Drive ~
State College, PA 16801
3 Joel C. Berrettini Son Specific Bequest
4935 Bayside Cove
Waterford, WI 53185
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet, as appropriate.
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE 0.00
- ------------- ------ - --- --1------ ----- --
REV-1513 EX+ (9-0Q)
~~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF WOODWORTH, KAREN R.
SCHEDULE J
BENEFICIARIES continued
NUMBER NAME AND ADDRESS OF PERSON(S)
RECEIVING PROPERTY
I~ TAXABLE DISTRIBUTIONS[include outright spousal
distributions, and transfers
under Sec. 9116 (a) (1.2)]
4 Robert J. Berrettini
1550 Williams Grove Road, Unit 108
Mechanicsburg, PA 17055
5 Emily Grace Taylor
c/o Angela S. Taylor
2294 Autumnwood Drive
State College, PA 16801
6 Katherine Jane Taylor
c/o Angela S. Taylor
2294 Autumnwood Drive
State College, PA 16801
FILE NUMB'~ER
_ _ 21 - '10 - 0069
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
DECEDENT (Words) ($$$)
Do Not List Trustee(s)
Son Specific Bequest;
50% of Residue
Grandchild 125°l0 of Residue
Grandchild 125% of Residue
Page 2 of Schedule J