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HomeMy WebLinkAbout09-22-101505610143 REY-1 ~Q~ Ex (o1-to> ^ OFFICIAL USE ONLY PA Department of Revenue Pennsylvania coumy cone veer file Number Buroau of individual Taxes °"""""~"Of"'~"" PO 60X.280801 {NHER{TANCE TAX RETURN 21 09 1170 Harrisburg, PA 1128-0801 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 171 28 2036 10 31 2009 06 30 1937 Decedent's Last Name Suffix Decedents First Name MI BEERS MARTHA J (If Applicable) Enter Surviving Spouse's Informatlon Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICAITE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return ^ 2. Supplemental Return ^ 3' prior to 1~2-13-82) (date of death ^ 4. Limited Estate ^ ~• ~~~ a ~~,°~e~212-8) ^ 5. Federal Estate Tax Return Required © g• Decedent Died Teafate ^ ~• Alta t~i~~)a LiWn9 T~+ ~ 8. Total iVumber of Safe Deposit Boxes (Attach Copy or Will) ^ 9. Litlgation Proceeds Received ^ 10. bg°tw~e~snP2~i ~i nd~t{daB5> de8s' ^ 11.Election ~ jfax under Sec. 9113(A) (Attach Sclp. O) CORRESPONDENT - THI8 SECTION MU8T BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytlme Teleplhons Number EDMARD P SEEKER 717 533 3280 First line of address 555 GETTYSBURG PUCE Second line of address svITE c4oo City or Post Office 1dECHANICSBURG CorrospondeM's e-mail addross• ~ fas{~sa~.cwn REGISTER qF WILLS USE ONLY n ca C~ o i ~ ~ t'TI ~ ~ ~,. '7J rn tV ~- ~~ N ~-~ rr v~ C ~O~ i ~ State ZIP Code PA 17055 c~ w -, <~~' 7 ~'::: c° _. ~~ c~ r -~ r-~, J !._.~ r -~ »- 4'.- _.: ~.~ ~ ~ iUt Is~true~~t a~ d~oanrypbteDeclar~ati Ion off pro~pa~ror tl~thei~personal r~eproo sentatl~veISbased~on eU In'a ~whict~prea ha amrKno~knoaNedgnOe.~~~ SIGNATURE OF PERSON RESPONSIBLE FOR FILI RETURN ~g DATE I~i~o~- ~ ~Rl?i~.l~i._" Debra Beers_ q ~ 1 lt3 ~ 1b ADDRESS Side 1 1505610143 35056101143 1505610243 REV-1500 EX oeceasnrs New: Beers, Martha J. . Decedent's Social Security Number 171 28 2036 RECAPITULATION 40,000.00 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 8 Notes Receivable (Schedule D) ........................................................ 4. 5• Cash, Bank Deposits 8~ Miscellaneous Personal Property (Schedule E) ............... 5. 951.27 8. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 8. 2 , 558.14 7. Inter-Vivos Transfers 8~ Miscellaneous Probate Property ~ Se arate Billin (S h d l G R t d p g c e u e ) eques ............ e 7, 8. Total Gross Assets (total Lines 1-7) ..................................................................... 8, 43 , 50 9.41 9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 10,217.67 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) .............................. 10. 82 ' 8 94 ' 2 8 11. Total Deductions (total Lines 9 ~ 10) ................................................................... 19. 93 ,111.95 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12, -4 9 , 602.54 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............................................... 13. 14. Net Value Subjsct to Tax (Line 12 minus Line 13) ............................................... 14, -4 9 , 602.54 TAX COMPUTATION - 3EE IN3TRUCTION3 FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9118 (a)(1.2) X .00 15. 0.00 16. Amount of Line 14 taxable 0 . 0 0 at lineal rate X .045 18. 0 . 0 0 17. Amount of Line 14 taxable at sibling rate X .12 0.00 17. 0.00 18. Amount of Line 14 taxable at collateral rate X .15 0. 0 0 18. 0. 0 0 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 150561QI243 J REV-1500 EX Page 3 Ftle Number 21-09-1170 Decedent's Complete Addn3ss: DECEDENTS NAME Beers, Martha J. STREET ADDRESS 29 Adams Street CITY Enola STATE PA ZIP 17025 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 0.00 2. Credits/Payments A. Prior Payments e. Discount 0.00 3. Interest Total Credits (A + B) (2) 0.00 (3) q, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2 Llne 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) Q"QQ Make Check Pa able 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; or ............................................................................................................... x 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 writhout receiving adequate consideration? .................................................................................................................... ^ ^x 3. Did decedent own an "intrust 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? .................................................................................................................. ^ 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE 8CHEDULE 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 January 1, 1995, the tax rate im~,posed on the net value of transfers to or for the use of the purviving 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 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 Juy 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 deoedent's siblings is 12 percent (72 P.S. §116 (a) (1.3)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common wkh the decedent, whbther by blood or adoption. Rev1602 EX•t11-0i) SCHEDULE A REAL ESTATE coAweorwvtxTHOf vEnwsv>_vu~an INNEPoTANCE TA7( RETIMN RE81DEHr DECEDENT ESTATE OF IFILE NUMBER Martha 21-09-1170 All real properly owned wlely or p a board In eemmon must be ropeAed at fair marllet valve. Fair market value is dMned as the price st wtNCh properly would be exchanys0 Detwwn a wllllnp buyer and a wflling seller, neither bNrp compelled to buy or Bell, bWh haNnnOg reasonable knowledge of the relevant fact. Real property whlah Is tolrlNyowned riAtlr AOht of wMvowhlp must W dlsebsed on wheduN p. Copyright (c) 2009 form software ony The Lackner Group, Inc. Form PA~1500 Schedule A (Rev. 11-08) (H more apace is needed, additional pages of the same size) Rev-160! EX+ (i•fi) SCHEDULE E CASH, BANK DEPOSITS, 8t MISC. PERSONAL PROPERTY cor~tteorrv~wTN of PENNSrw~uu~ INHERITANCE T/V(RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Beslrs, Martha J. 21-09-1170 InGude fhe ppro~ceeds of IltiOaUon and the date the procsede were received by lha estate. All property Jointlyowned with the AOh! of sarvlverehlp must be dbelosed on sohsdWe f. (K more space is needed, additional pages of the game size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rer-lief EX+t~.fe) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RE81DENiDECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Besrs, Martha J. 21-09-1170 k an asset was mrtde Joint wkhM ens yrar or tM decedent's deb of death, k mwt be sported on eoheduN O. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Mary Beers 29 Adams Street Daughter Enola, PA 17025 B. C. JOINTLY OWNED PROPERTY: ITEM NUMBER FOR JOIN TENANT MADE JOINT DESCRIPTION OF PROPERTY NNUMBER OR SEMILAR DENTIFY NG INUMBERAATDTACH D ED POR JOINTLY-HELD REAL ESTATE. DATE OF DEATH ALOE OF ASSE o~ OF pECD'S INTEREST DATE OF DEATH DECEDENTS NTEREST 1 A 1/28/2002 M8T Bank Checking Account No. 950723106 - 5,116.28 50.000% 2,558.14 valued per bank Better dated 2123110 TOTAL (Also enter on Line 6, Recapitulation) I 2,558.14 (If more space is needed, additional papas of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98) REV-71H EX~(10-0t) SCHEDULE H coM~~~,4~D ,eFNgv~vnNin ADMIN STRATIVE COS S --- ESTATE OF F1LE NUMBER Beers, Martha J. 21-09-1170 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT A. FUNERAL EXPENSES: See continuation schedule(s) attached B. ADMINISTRATIVE C03TS: 1. Personal Represerrtative's Commissions Name of Personal Representative(s) Street Address City State Zio Year(s) Commission paid 2. Attomev's Fees James, Smith, Dietterick 8e Connelly, LLP 3. Famiy 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 2,746.00 5,000.00 4. Probate Fees 268.50 5. Accountant's Fees 6. Tax Retum Preparer's Fees 7. Other Administrative Costs 2,202.17 See continuation schedule(s) attached TOTAL (Also enter. on line 9, Recapitulation) 10,217.67 Copyright (c) 2009 form software ony The Lackner Group, Inc. Fonn PA11500 Schedule H (Rev. 10-06) ~ _ _ _r SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE WUMBER Beers, Martha J. 21.9-1170 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Richardson Funeral Home, Inc. -funeral services 2,746.00 H-A 2,746.00 2 Other Administrative Costs Comcast -cable service for residence 153.25 3 Cumberland Law Journal -estate notice publication fee 75.00 4 East Pennsboro Township - sewer b refuse service for residence 379.50 5 PAWC -water service for residence 118.78 6 PPL -electric service for residence 633.78 7 Register of Wills, Cumberland County - filing fee for Petition 63.50 8 Register of Wills, Cumberland County -filing fee for Return S Inventory 30.00 9 Register of Wllis, Cumberland County • filing fee for accounting 130.00 10 The Sentinel -estate notice publication fee 178.92 11 UGI -gas service for residence 228.17 12 UGI -service agreement for residence 117.25 13 Verizon -telephone service for residence 85.03 H-B7 2,202.17 Copyright (c) 2002 font software ony The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rw-1612 Ex+ (12.06) COMMONWEALTH OF PENNBYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT scNSeu~e ~ DEBTS OF DECEDENT, MORTGAGE LIABILITIES, ~ LIENS ESTATE OF FILE NUMBER Beers, Martha J. 21-08-1170 R~poR d~bb InourT~d by tll~ dSOSdN1t p11or t0 MNh {FISt rwnalmd unpaid d the deb Of dggl, InCIYdlllp unnlmbursOd m~dklN ~Xp~nNS. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Central PA Hema B Med Onc Assoc PC (Account No. 19172) -unreimbureed medical service 15.00 2 Comcast -cable service for residence 116.27 3 Commercial Acceptance Company for East Pennsboro Ambulance (Account No. 5934312) - 50.00 unreimbureed medical service 4 Consolidated Collection Service -West Shore EMS (Account No. 840371) - unreimbureed 177.50 medical service 5 Consolidated Collection Service -West Shore EMS (Account No. 841820) -unreimbureed 922.15 medical service 6 CRA Collections for Holy Spirit Health System (Account No. 0005053197) -unreimbureed 117.00 medical service 7 Cumberland County Tax Claim Bureau - 2008 real estate taxes 767.13 8 Debbie Lupold, Treasurer - 2009 county/township real estate taxes 300.59 9 Debbie Lupold, Treasurer - 2009-10 school real estate taxes 889.98 10 East Pennsboro Township -sewer 8~ refuse service for residence 609.00 11 Heritage Medical Group, LLP (Account No. 365279) -unreimbureed medical service 15.00 12 Holy Spirit (Account No. 34205682) -unreimbureed medical service 20.00 13 Holy Spirit (Account No. 34283226) -unreimbureed medical service 15.00 14 Holy Spirit (Account No. 35041201) -unreimbureed medical service 15.00 15 Holy Spirit (Account No. 35087186) -unreimbureed medical service 15.00 Total of Continuation Schedule see attached page TOTAL (Also enter on Line 10, Recapitulation) 82,894.28 (If more space is needed, additional pages of the same size) Copyright (c) 2009 form software ony The Lackner Group, Inc. Form PA-1ti00 Schedule 1(Rev. 12-08) _~-_ Rw•1612 HX+ (FM) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8 LIENS CO~MIOMNEALTN OF PENN8YWMNA ~T~T,~~nR" continued ~S~~rR~~~rR ESTATE OF FILE NUMBER Beers, Martha J. 21-09-1170 ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 16 Holy Spirit (Account No. 35215326) - unrelmbureed medical service 15.00 17 Holy Spirit (Account No. 35303791) - unreimbureed medical service 15.00 18 HSCS -Holy Spirit (Account No. 34177477) - unreimbureed medical service 30.00 19 HSCS -Holy Spirit (Account No. 35144294) - unrelmbureed medical service 50.00 20 Northwest Consumer Discount Company Loan No. 491-185984-8 -personal loan valued per 2.020.38 payoff provided 21 PAWC -water service for residence 91.49 22 PPL -electric service for residence 666.28 23 Quest Diagnostics - unreimbureed medical service 30.00 24 Revenue Collect -Holy Spirit (Account No. 0005258699) - unreimbursed medical service 30.00 25 Richardson Funeral Home, Inc. -funeral services for husband 3,000.00 26 Sterling Medical Services Account No. 220388 - unreimbursed medical service 38.10 27 UGI -gas service for residence 221.98 28 Verizon -telephone service for residence 107.28 29 Wells Fargo Mortgage No. 0005850012 -valued per statement dated 12/14/09 72,534.17 TOTAL (Also enter on Line 10, Recapitulation) I 82,884.28 Copyright (c) 2002 form software ony The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) _. SCHEDULE J CpMM(~~QF pENNN~'fnt.\'ANIA ~ BENEFICIARIES ESTATE OF FILE NUMBER Beers, Martha J. 21-08-1170 NAME AND ADDRESS OF RELATIONSHIP TO DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(Sl RECEIVING PROPERTY (Words) (S3S) I TAXABLE DISTRIBUTIONS [include outright spousal • distributions, and transfers under Sec. 9116 a 1.2 1 Debra Beers Daughter 4535 Rolio Court Mechanicsburg, PA 17055 2 Mary Beers Daughter clo Rebecca Wetzei, Cumberland Perry MRS Swite 301,16 West High Street Carlisle, PA 17013 3 Val Parr Daughter 233A West Market Street Mechanicsburg, PA 17055 4 Virginia Daughter P.O. Box 224 indiahoma, OK 73552 Total f r doNar amounts for distributions shown above on lines 15 thro h 18 on Rev 15 00 cover ah t as riate. NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOT AL O PART II -ENTER TOTAL NON-TAXAB DISTRIBUTIONS ON LINE 13 OF REV-1 COVER HEE Copyright (c) 2009 form software ony The Lackner Group, Ina Form PA-1500 Schedub J (Rev. 11-08)