HomeMy WebLinkAbout09-13-1015056],01,40
REV-1500 EX (01-10)
PA Department of Revenue
Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number
PO BOX 280601 2 ], D ~I 1 1, 6 1
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
2 0 6 1, 0 8 4 4 2 1, 2 1, 3 2 0 0 9 1, 0 2 9 1, 9 2 0
Decedent's Last Name Suffix Decedent's First Name MI
A L L E N S A R A ~
(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 OVALS BELOW
1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required
death after 12-12-82)
OX 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
{Attach Copy of Will) (Attach Copy of Trust)
9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
D A V I D H S T O N E E S Q U I R E 7 1, 7 ~7 4 7 3 5 ,.,.
~~ ~~ ~
REGISTE~` F~hl'~S USB'1rItJLY ~,',~> t
First line of address 1 ~~ ~ 4 ~ {L, _.-,"
4 L 4 B R I D G E S T R E E T ~ ,, _, , _~ R _,_..i. ;-
Second line of address i -~- ~~a ~~- ~:1 y'
~ . , .~{ ,.. ~ ~ ~--t
~~~ ~ ,
«..~ C_ )
~~ i`
I I
Cit or Post Office DATE FILED _'
Y State ZIP Code ~- - - _ __ _ _ _
N E W C U f1 B E R L A N D P A 1, 7 0 7 0
Correspondent's a-mail address: D S T O N E a~ S T O N E L A W• N E T
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of nny 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.
-S~TUR~` OF PERSO E PONSIB E FOR FILING RETURN DATE
ADDRESS
811, F TL K IDLE ROAD MECHANICSBURG PA 1,7055
IGN URE O RE R R T ER THAN REPRESENTATIVE DF~TE
ADDR ~ ~I ~ ~
41,4 BRIDGE ST EET NEW CUMBERLAND PA 1,707D
PLEASE USE ORIGINAL FORM ONLY
Side 1
1,505610140 1,50561,0140 J
J
1,50561,0240
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: SARA J. ALLEN 2 0 6 1 0 8 4 4 2
RECAPITULATION
1. Real Estate (Schedule A) ......................................... .. 1. •
2. Stocks and Bonds Schedule B 2. 2 5 6 0 4. 0 ],
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. •
4. Mortgages and Notes Receivable (Schedule D) ........................ .. 4. •
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. ~ 0 J, ~ 7 • 1 8
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ..... .. 6. •
7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested ..... .. 7. 5 2 J, ]a 9 . 4 ~
8. Total Gross Assets (total Lines 1 through 7) ......................... .. 8. 8 ? 8 6 0 • 6 6
9. Funeral Expenses and Administrative Costs (Schedule H) ......... ....... .. 9. 6 3 6 0 . 2 3
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .... ....... .. 10. 4 ], 8 ®• 9 L
11. Total Deductions (total Lines 9 and 10) ...................... ....... .. 11. 1 0 5 4 L . L 4
12. Net Value of Estate (Line 8 minus Line 11) ................... ....... .. 12. 7 7 .~ L 9 . 5 2
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 ? :~ 1r 9 . 5 2
TAX CALCULATION -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 .0 0 0 0 15. 0. 0 0
16. Amount of Line 14 taxable
at lineal rate x• 0 4 5 7 7 3 1 9. 5 2 16. 3 ~I 7 9. 0 B
17. Amount of Line 14 taxable
at sibling rate X .12 0 0 0 17. 0. 0 0
18. Amount of Line 14 taxable
at collateral rate X .15 0 0 0 18. 0. 0 0
19. TAX DUE ............................................. ....... .. 19. 3 4 9 3 8
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
15056]0240 1505610240
REV-1500 EX Page 3 File Number
Decedent's Complete Address: 21 09 1161
DECEDENT'S NAME
SARA J. ALLEN
~ STREET ADDRESS
811 FLINTLOCK RIDGE ROAD
__
__
CITY ~ __ - - -_
STATE I ZIP
MECHANICSBURG ; PA 17055-
Tax Payments and Credits:
~. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments 3,400.00
B, Discount 178.95
3, Interest
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.
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(1) 3,479.38
Total Credits (A + B) (2) 3, 578.95
(3) 0.00
(4)
(5)
Make check payable to; REGISTER OF WILLS, AGENT
99.57
0.00
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; ............................... ^ Q
c. retain a reversionary interest; or ................................................................................................ ^ 0
d. receive the promise for life of either payments, benefits or care? ....................................................... ^ Q
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 "intrust for" orpayable-upon-death bank account or security at his or her death? ......... ^ Q
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.
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
3 percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after Jan. 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 statute does not exempt a transfer to a surviving spouse from tax, and the statutory requiremenf:s 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)]. Asibling is defined, undE
Section 9102, as an individual who has at {east one parent in common with the decedent, whether by blood or adoption,
REV-1503 EX + (6-98)
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
SARA J. ALLEN 21 09 1161
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
~ 2537.563 shares LPL Financial-Non Retirement Acct @ $10.090 each 25,604.01
#66886802 - MFS Ser Tr IX Research Bd Fd CI B
TOTAL (Also enter on line 2, Recapitulation) I $ 25,604.01
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
SARA J. ALLEN 21 09 1161
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
~, Camp Hill Emergency Physicians-refund 22.69
2 FNB Corp-Cent of Deposit #100230259 10,000.00
Princ. $10,000, Int. $14.49 William F. Allen predeceased decedent on 9-7-09
3 FNB Corp-Cent of Deposit #100230259 -Accrued Interest 14.49
4 Miscellaneous personal property 100.00
TOTAL (A{so enter on fine 5, Recapitulation) I $ 10,137.18
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX+ (08-09)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS AND
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
SARA J. ALLEN 21 09 1161
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 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 Citizens Bank-Checking Acct #6100744698 4,952.20 100.00 3,000.00 1,952.20
Joint w/Marlena L. Houser on 11-05-09 (w/in one
year of death)
2 Principal Financial Group-Annuity #8584035 50,167.27 100.00 50,167.27
Beneficiary-Marlena L. Houser
TOTAL (Also enter on Line 7, Recapitulation) I $ 52,119 47
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+ (1d-09)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
SARA J. ALLEN 21 09 1161
Decedent's debts must be reported on Schedule 1.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
~. Auer Cremation Services of PA-services rendered 2,185.47
B.
2
3
4
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City State
Year(s) Commission Paid:
Attorney Fees: David H. Stone, Esquire
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
Claimant
Street Address
City State
Relationship of Claimant to Decedent
ZIP
Probate Fees: Register of Wills, Cumberland County
5 Accountant Fees:
6. Tax Return Preparer Fees:
112.50
~. Citizens Bank-check charge 8.35
2 Travelers Insurance-premium due 65.50
3 Citizens Bank-check order fee 25.85
4 Comcast-services rendered 74.32
5 Advertising in 2 newspapers -Cumberland Law Journal & Patriot News Co. 216.24
6 Death certs and short certs 42.00
7 Register of Wills-filing Inh Tax Return and Inventory 30.00
8 Reserve for closing expenses 100.00
TOTAL (Also enter on Line 9, Recapitulation) ~~ 6.360.23
ZIP
3,500.00
If more space is needed, use additional sheets of paper of the same size
REV-1512 EX+ (12-08)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
SARA J. ALLEN 21 09 1161
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimburse~d medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Camp Hill Emergency Physicians-services rendered 22.69
2 East Pennsboro Ambulance Serv.-serve rendered 66.97
3 West Shore EMS-services rendered 112.49
4 Weis Pharmacy-medication 28,62
5 Golden Living-nursing home services 3,950.14
TOTAL (Also enter on Line 10, Recapitulation) I $ 4 1$0.91
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+ (01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
SARA J. ALLEN 21 09 1161
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustees? OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
1 MARLENA L ROUSER Linea 1 62,319.52
811 FLINTLOCK RIDGE ROAD
MECHANICSBURG PA 17055-
2 MORGAN LEE ROUSER Lineal 5,000.00
811 FLINTLOCK RIDGE ROAD
MECHANICSBURG PA 17055-
3 REAGAN CODY ROUSER Lineal 5,000.00
811 FLINTLOCK RIDGE ROAD
MECHANICSBURG PA 17055-
4 LOGAN DALLAS ROUSER Lineal 5,000.00
811 FLINTLOCK RIDGE ROAD
MECHANICSBURG PA 17055-
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS:
.
1. 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 SHEET. ~ $
If more space is needed, use additional sheets of paper of the same size.
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F:\I~CCS\c.P\WILL5`,A1L•~n.~ara.'~+pd ~~~ r' ~~,
LAST WILL AND TESTAMENT
OF
SARA J. ALLEN
I, SARA J. ALLEN, of Upper Allen Township, Cumberland County,
Pennsylvania, declare this to be my last will and revoke any will
previously made by me.
ITEM I: I bequeath my automobiles, household and personal effects
and other tangible personalty of like nature (not including- cash or
securities} together with any existing insurance thereon to MARLENA L.
ROUSER.
ITEM II: I make the following specific bequests:
A. Five Thousand ($5,000.00) dollars to my great
granddaughter, MORGAN LEE ROUSER.
B. Five Thousand ($5, 000.00) dollars to my grf=at grandson,
LOGAN DALLAS ROUSER.
C. Five Thousand ($5,000.00} dollars to my grE~at
granddaughter, REAGAN CODY ROUSER.
ITEM III: I devise and bequeath the residue of my estate of every
nature and wherever situate to MARLENA L. ROUSER.
ITEM IV: I appoint my Executrix and her successors guardian of any
property which passes, either under this will or otherwise, to a minor
and with respect to which I am authorized to appoint a guardian and have
not otherwise specifically done so, provided that this appointment of a
guardian shall not supersede the right of any fiduciary in its
discretion to distribute a share where possible to the minor or to
another for the minor's benefit. Such guardian shall have the power to
use principal as well as income from time to time for the ;~inor's
support and education (including college education, both graduate and
undergrad~.~ate) without regard to his or her parent' s ability to provide
for such supp4~rt ~~nd ed~_~cation, ~~r. to make p,3yment ~~~:~r these purposes, f
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without further responsibility, to the minor or to the minor's parent or
to any person taking care of the minor.
ITEM IV: I appoint MARLENA L. ROUSER, Executrix of this my last
will. Should MARLENA L. ROUSER, fail to qualify or cease to act as
Executrix, I appoint SCOTT B. ROUSER, Executor of this my last will.
ITEM V: I have made no provision in this my Last Will for my
daughter, NANCY MAE MORRIS, as I do not wish her to receive any share of
my estate.
ITEM VT: No fiduciary acting hereunder shall be required to post
bond or enter security for the faithful performance of his or her duties
in any jurisdiction.
IN WITNESS WHEREOF, I, SARA J. ALLEN, have hereunto set my hand and
seal this ~ day of -~p~Pr^~ 2009.
SARA J. ALLY
SIGNED, SEALED, PUBLISHED and DECLARED by SARA J. ALLEN, the
Testatrix above named, as and for her Last Will and Testament, and in
the presence o ~ us, who at her request, in her presence and in the
presence of ~ ac~ other, have subscribed our names as witnesses.
~~~
Witness
414 Bridcte St . , New Cumberland, PA
Address
414 Bridcte St . , New Cumberland, PA
Address
1~ LPL Financial
Attn: Client Services
9785 Towne Centre Drive
San Diego, GA 92121-1968
Law Offices of STONE LaFAVER & SHEKLETSKI
Attn: David H. Stone
414 Bridge Street
Post Office Box E
New Cumberland, PA 17070
January 11, 2010
RE: SARA J ALLEN
811 FLINTLOCK RIDGE RD
MECHANICSBURG PA 17055
DOD: December 13, 2009
To Whom It May Concern:
In regards to your request for the value of assets owned by the decedent at the time of their death with
our investment firm, attached is a portfolio appraisal for Sara's LPL account as of Decerber 13, 2009
for LPL account 66886$02. Also, it appears that the client held a fixed annuity with PFG. The LPL
account (62961134) established at LPL Financial is an outside investment and just a reflection of the
information from that corresponding sponsor. Please contact PFG and they will be better served to
furnish you with a report reflecting the value as of the date of death and other documentation you
require. Both LPL accounts were individual accounts. If you have any questions, please contact us at
the number below.
Sincerely,
LPL Financial Services
800.558.7567
Member FINRA/SIPC
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FN.B. Corpordtlon
Stone, LaFaver & Shekletski
414 Bridge Street
P.O. Box E
New Cumberland, PA 17070
Dear Sir or Madam,
www.fnb-online.com
Telephone Banking 1-800-817-8787
Customer Service 1-800-555-5455
January 14, 2010
RE: ESTATE OF SARA J. ALAN
DOD: 12/ 13/09
SS#: 206-10-8442
As per your request, the following information is provided as of Date of Death:
CD # 100230259
opened 12/21 /04
Titled Sara J. Allen
William F. Allen
Balance $10,000.00
Accrued Interest $14.49
Made Joint When Opened
Account Closed 12/16/09
If you should have any further questions, please do not hesitate to contact me at 724-983-6068.
Very truly yours
FIRST NATIONAL BANK
/rnte~xa~t ~ ;l.7ax~
Debbie Bartosh
~~ Citizens Bank
August 5, 2010
To Whom It May Concern:
2001 Market Street
Philadelphia, PA 19103
This letter is to verify the Date of Death Balance for the account of Sara J Allen. Sara's
date of death was 12-13-2009. The balance at that time was $ 4952.20. At that time, the
account numbered: 6100744698 was jointly held by William F Allen and Sara J .Alen
with Marlena Houser acting on Sara's behalf as Power of Attorney.
On November 5, 2009 Marlena Houser was added to Sara's account as a joint owner.
Due to a back room support error within Citizens Bank, Marlena's name did not show on
the account as joint owner until January 20, 2010. This account was closed with a zero
balance on February 9, 2010.
If there is anything further you may need, don't hesitate to contact me using the
information located below.
Re
Cortney J Sc ffer ""
Assistant B ch Manager
Citizens Bank of Pennsylvania
Phone: 717.795.7652
Fax: 717.795.7657
Email: cortney.schaeffer(~~citizensbank.com
RBS
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f%/JH/1C%a~
Group
January 27, 2010
STONE LAFAVER & SHEKLETSKI
414 BRIDGE STREET
POST OFFICE BOX E
NEW CUMBERLAND, PA 17070
Re: Sara J Allen
Contract No. 8584035
Dear David A Stone:
We recently received your request for information regarding this annuity contract.
Principal life
{nsurance Company
Princor financial
Services Corporation
We have searched our records to verify that this was the only annuity contract that Sara J Allen had
with us. The Date of Death value (12/13/2009) for contract 8584035 was $50,167.27.
Sincerel
~.
- --~" ~
Principal Financial Group
Annuity Services
(800) - 852-4450
BTD
Enc:
Your representative
Jeff Howe
01705-02192
Corporate Center: Des Moines, Iowa 50392-1770 (800- 852-4450
Securities offered through Princor Financial Services Corporation, (800 24T-1 J37, member SIPC.
Principal Life and Princor9are members of the Principal Financial Group, Des Moines, IA 50392.
EE6717-6