HomeMy WebLinkAbout08-11-10-~ REV-1 SOOEx(ot-1o) ~ 1505610143
PA Department of Revenue peons Ivania OFFICIAL USE ONLY
y CaNriy Code Year File Number
Bureau of Individual Taxes OV/JlTMENT OP R[VENUE
Po Box.2lsosol INHERITANCE TAX RETURN 21 10 015 6
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
198 30 0046 11 21 2009 02 15 1907
Decedent's Last Name Suffix Decedent's First Name MI
NIESLEY ELSIE M
(If Applicable) ErMer Surviving Spouse's Information Below
Spouse's Last Name Suffer 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 ^ 5. Federal Estate Tax Return Required
(dale of deeU1 after 12-12$2)
® g. Decedem Died Testate ^ ~, DAecedent Maintained a Uvin9 Tlust ~ 8. Total Number of Safe Deposit Boxes
(Atfadi Copy of wia) (ltadt Copy of Tout)
^ 8. Litlgafbn Proceeds Received ^ 10. Spousal Povem Crest !date d deaM ^ 11. Election to tax under Sec. 9113(A)
hetaeen 1231- 1 and i-1-95> (Attach Sch. 0)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTL4L TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
SCOTT M DINNER ESQ 717 761 5800
First Iine of address
3117 CHESTNUT STREET
Second line of address
City or Post Office
CAMP HILL
State ZIP Code
PA 17011
REGISTER OF WILLS USE ONLY
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Untler penalties of perjury, I declare that I have examined this return, inrJuding accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, oorr~ct and complete. Dedaraty~ of preparer other than the personal representative is based on all information of which preparer has arty knowledge.
~,b ~ l ~ ~i~i,l ~n Carol E. Rohrer ~1' ~ 7 ' ~~
ADDRESS
324 Cr7ndlelight Drive, Mechanicsburg, PA 17055
SIGNAT OF P ~~~ RE ENT q DATE
Scott M Dinner Es AUG 0 6 2010
3117 Chestnut Street, Camp Hill, PA 17011
Side 1
1505610143 1505610143
1
f
1505610243
REV-1500 EX
Decedent's Social Security Number
oecetlenrs Name: NIESLEY, ELSIE M 198 30 0046
RECAPITULATION
1. Real Estate (Schedub A) ......................................................................................... . 1.
2. Stocks and Bonds (Schedule B) .............................................................................. . 2.
3. Closet' 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. 3 6 0 . 0 0
6. Jointy Owned Properly (Schedule F) ^ Separate Billing Requested ............ . 6. 12 , 3 8 4.41
7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested ............
. 7. 3 0 8 3 6. 1 1
~
8. Total Grass Assets (total Lines 1-7) ...................................................................... . 8. 4 3, 5 8 0. 5 2
9. Funeral Expenses & Administrative Costs (Schedule H) ........................................ . 9. 4 , 0 2 5 . 0 0
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedu~ I) .............................. .. 10.
11. Total Deductions (total Lines 9 & 10) .................................................................... .. 11. 4 , 0 2 5 . 0 0
12. Net Value of Estate (Line 8 minus Line 11) ........................................................... .. 12. 3 9 , 5 5 5 . 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. 3 9 , 5 5 5 . 5 2
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 3 9, 5 5 5. 5 2
16.
1, 7 8 0. 0 0
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. 1, 7 8 0. 0 0
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
1505610243 1505610243 J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21 - 10 - 0156
Niesley, Elsie M
STREET ADDRESS
324 Candlelight Drive
CITY
Mechanicsburg STATE
PA ZIP
17055
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19) (1) 1,780.00
2. CreditslPayments
A. Prior Payments 1, 7 0 0.0 0
B. Discount 89.00
Total Credits (A +B) (2) 1,789.00
3. Interest (3) 0.00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) 9.00
Check qox 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. (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
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 wkhout
receiving adequate consideration? ....................................................................................................................... ^ ^x
3. Did decedent own an "in trust for or payable upon death bank account or security al his or her death?......... ^x ^
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 13 YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after JuN 1, 1994 and before Jan. 1, 1995, the tax rate impose° on me ner value or ~ransre~s ~u v~ w~ u~~ u,~ ~~ ~~~a ~~~•~•~~~a
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 imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
p2 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 re{{um 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 ears of age or younger at death to or for the use of a natural parent, an
adoptive parent, or a stepparont of the child is 0 percent p2 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 p2 P.S. 69116 (a) (1.3) . A
sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, w ether y bl or adoption.
SCHEDULE E
CASH, BANK DEPOSITS, 8r MISC.
°O"MAON1"'~"`TMOFPEN"$`'"'""" PERSONAL PROPERTY
MHERRANCE TA%RETURN
RESIDEM DECEDENT
FILE NUMBER
ESTATE OF Niesley, Elsie M 21 - 10 - 0156
Include the proceeds of litigation and the date the proceeds were received by the estate. All property Jointly-0wned with the right of
survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE OF
NUMBER DESCRIPTION DEATH
1 miscellaneous personal property 360.00
TOTAL (Also enter on Line 5, Recapitulation) ~ 360.00
SCHEDULE F
COMMNHERIT~ANCEO AX RETURN ANIA JOINTLY-0WNED PROPERTY
ESTATE OF FILE NUMBER
Niesley, Elsie M 21 - 10 - 0156
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 I ADDRESS I RELATIONSHIP TO DECEDENT
A
324 Candlelight Drive
Mechanicsburg, PA 17055
JOINTLY OWNED PROPERTY:
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT Include name o nanclal Ins wn an ban account number
r similar identifying number. Attach deed forjointy-held real
SYaf@. DATE OF DEATH
VALUE OF ASSET % ~F
DECD'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENTS INTEREST
1 A 01/19/2007 Americhoice FCU checking account 24,226.04 50% 12,113.02
(see attached letter from B. Sharpe of
Americhoice FCU)
2 A 01/19/2007 Americhoice FCU savings account 542.78 50% 271.39
(see attached letter from B. Sharpe
of Americhoice FCU)
TOTAL (Also enter on line 6, Recapitulation) I 12,384.41
COMMONWEALTH OF PENNSYLVANIA SCHEDULE G
INHERITANCE TAX RETURN INTER-VIVOS TRANSFERS ~
RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY
ESTATE OF Niesley, Elsie M
FILE NUMBER
21 - 10 - 0156
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
InUude the ntuns of ux Vanstefee, tlteir rala4oheNP to oeudeM
antl the dale d hansfer. Atlarh a mpy of d~a deed far red estate- DATE OF DEATH
VALUE OF ASSET % OF
DECD'S
INTEREST EXCLUSION
(tF APPLICABLE)
TAXABLE VALUE
1 Ameriprise Fin'I. cert. Acct. # 080448685 6 001 30,836.11 100% 30,836.11
[see attached Itr. dated 11/25109]
T.O.D. in equal shares to daughtedson
TOTAL (Also enter on line 7, Recapitulation) I 30,838.11
SCFEDU.E H
DOMAONVYEALTN OF PENN6VLVANN r611~
IHI/ERITANCE TA7(RETURN AI"1~~~+T~A71~ IC /Y~-"tY~
RESIDENT DECEDENT /7~~~~7 ~ IM ~ ~~G VW ~ J
FILE NUMBER
ESTATE OF Niesley, Elsie M 21 - 10 - 0156
Debts of decedent must be reported on Schedule 1.
ITEM
NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT
A.
B.
1
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
Cily State Zip
Year(s) Commission paid
2. Anomey's Fees Scott M. Dinner, Esq.
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant Carol E. Rohrer
Street Address 324 Candlelight Drive
city Mechanicsburg state PA zip 17055
Relationship of Claimant to peoedent daughter
4. Probate Fees
5. Accountant's Fees
6. Tax Retum Preparer's Fees
7. Other Administrative Costs
1
525.00
3, 500.00
TOTAL (Also enter on line 9, Recapitulation) 4,025.00
0::17%201(1 tt'ED ;~0:~9 b:4,t; :i91y6:i5 Pr~C3'S ,~„~~:„~.
AmeriCi~ice
~FEOERAL CREDIT UNION
Building AelatlanshJps Far Life
February 17, 2010
Scott M. Dinner, Esquire
3117 Chestnut Street
Camp HiII, PA 1701 l
RE: Estate of E?sie M. Niesley
Scott,
The following is the information that you requested in your correspondence. The
decedent held a checking and savings account with Americhaice Federal Credit Union.
Accaunt r_umber 40363 titled Elsie M, Niesley or Carol E. Rohrer:
Date of death balance is as fallo-tvs:
Savings-$542.78
Checking-$24,226.04
There was no change of ownership on either account within the one year period. If you
have any more questions concerning this account, please contact the at ?17-591-9690.
Sincerely,
Becky harpe
Head MSR
Sporting Green Branch
Silver Spring Commons Office: 2G Sporting Green Drive• Meehan+csburc,. PP. t 7050• Phorre; 1?17) 591-9690• fax; (7171 591-9695
_l Weilsite: www ameriehoica.org ~o~yr~~,~,
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FPR-12--1~+ 01:38 PM RENK'7 ~lIGH FIND fe550t:~IATE~ tlT"7614Lt3 "r.' Y.t~l
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Debra MacKlnnonlGoryIAMPF To Thomas F [3enlcovichlField/AeNPF~AMPF
11/25/2009 01 A8 PM ~
Daeauk custom expiration date of ~
02/2 312 0 1 0 Subitsct 10931022 700'
ELSE M NIESLEY
ESTATE SETTLEMENT REGjU1REMENTS
PLEASE DO NOT DELETE
Rlwr9ouru LMs Insurance Company
Rlwr3oures Funds
AmsrlprRs Grtktusts Company
aurtsriprbs aroksrapr
10100 AtmApASa Finsneial Gntsr
M[nnupolls, ARN tiag4
November 23.20J9
THOMAS F SENKOVICH
Ak1ERiPR1SE FINANC[AL SEFtv[t:.ES
4661 TRINDLE RD
STE A
CAMP HILL, PA I~01 I-SG03
Dear THOMAS F BENKOVICH:
We have received notification of EL SIE M NIESLEY's death, The deceased's name appears on the fopowutg
accounts. Account values as of 1 !: ~1 X2009 are listed bebw. At the end of this letter, you wil! ftnd a fist of
beneficiaries shown in our initial review ofthe accounts
Account Information
Certlf[cata
Acrount Numbgr wn i
00804486830 ti 001 [ndivfduai • TOD
Certitica~es
Accjyunt Numbt~ otaT I Vatur
0080486830 G 001 130836.11
The date of death values provided are f.~r estate tax purposes and are no; a tafue to be paid. Accounts may be
subjtxt to market fluctuation as governed by each produa. Please: note that the values indi+:ated for tut Life
truepance products with the insured deceased reflex the grcas death benefit at date of death and not thqq cash value.
Values indicated for Life Insurance products with only the owtter det:eased reelect the cash value as ofitte date of
deat-t. Values for any proprietary mutual funds include accrued dividends as applicable. Ya!ues prov~d for
brokerage products are manually calculated, and should bt used as estimates only i'he prices used to rovide
values are estimates obtained freer outside sources believed to bt reliable. 4meriprise Financial provi~es then
values ss a service to its clients. Actual values used in preparation of ute rc:ums or for planning purpo;es should be
verified by your Icgal and accounting advisors.
Acti:oapt D~posltioa
Actpttm t>•<sposition isbtssed on how tut account is owned (the ownership rypel. The following inforrt{atiun wiN,
help you understand the procass that will bs used to settle the recounts. Accounts may be sabject to market
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i ' fluctuation as governed by each product.
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Disposition for Individual - TOD ownership 4'i?
Uppn the death ot'the owner, ull accounts registered as individual-transfer un death pass w the nantcd;beneficiaries.
Alt~tough the assets do not become part ofthe estate for distribution
we
d
t
d th
h
ld '
,
un
ers
<ut
ey s
ou
be irt~;udetl for
inheritance andlor estate tax purpi,ses.
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Required Doctlmeats i
In order to take appropriate steps to settle the accounts we will need these Cacuments_ €
Certifieq Death Certitkue ~s
(For accounts: 008(1t486850 6 001) rf
The death ceRifieate must be an original document that bears ceRifica;ion from the health department pr local
registrar and includes the cause ofdcattt. ~'
. Estate Sl'ttlcttnent Form (3248j s<
fFot accounts: OOti04d8C850 6 00! ; ~'
Tu process a settlement on a htutual Fund, Certificate or Brokerage account, tech ~.laimant must xrn~-ete an Estate
SeNament Fam (Form 3248). This form includes separate sections for qualified and nor.•quaiified arxounts as 'i'
d'ry'
well as sectioas at the end of the form to be Signed and dated by all new account holders fur alt accou s. The ~ `
account lean! suitability intarmstion requested on the form is required if you intend to retain the Tnveertts you
receive through this process, If suitability informaton is inwmpletr will not delay settlement, howev activity
allowed on arty accounts created throu
h srttiement will b
li
i
d
i fi.,
g
e
m
te
to l
quidation only. We wilt not.;q-ttactyou to
con~+lete the suitability information. Instructions for completion of the Estate Settlement Form err available as ~'.
Fortrt 3248•ltr'ST. Both forms are available through an Arneriprise Financial Advisor or onfiae at ; ~,~
http;~/www,ameriprise.com/amp!giobalr'customer-service/account-seraice.asp under the list heading "1=state ~'
Settlement".
R;S
.
An obituary or Slatemeat iisting a!I children of the decedent t:.
(For accounts: 00$04386850 6001) i~'
~
9e.~tust the brnefici deli .~
ary gelation is living lawful children or children per s trprs, we reyuire eithe
obituary or ~
f
r
a statement signed by either the advisor or an aduq child, listing all children of the decedent (troth livi and
deceased). if a child is deceased, we require a eeRified co
of his or her d
th
rtif
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ddi
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py
ea
cc
cater
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t
on,to this, other
requirements may be needed. '
Request for Waiver or Notice of Transfer (Posstbk} (PA) Form REV-516 E1 a.
(For accounts: 00804486850 6 OO I) ~ ~,`'
Thig document verifies that the state tax bureau is consenting to the transfer of the assets. Form REv:+~l6 should be I "
:orr{pleted by the beneficiary and mailed se the Pennsylvania Department of Revenue. A waiver will he sent to ~`~'
Ameriprise Financial stating that the assets can be released. '`"
In older to be compliant with fair claims practices of many states we will be immediately corrcspondit~g with the i;
beneficiaries liskd for any Life and Annuity accounts held by the deceased client. Similarly we wi!I by
;, ; corresponding with rho beneficiaries ar claimants of al! accounts held by the decedent within a minimgtn of six
mogths of the date of this latter. Plrase contact us if you wish to tee a copy of these correspondences.
W'e.alse rcquestagy information ytw stray have that may facilitate cur efforts to contact other beneficiaries nn tke i1
accquntsinvolving the deceased, ""
~4
If ypu wish Eo complete settlement prior to the end of the 2009 tas year, alt requirements must br recs[ved by
lkcember 14
.009
W'
i r(1
s
.
,
e w
ll put forth our best efforts tc handle all requests before year-end even if rt~eived after
that date. however, we cannot guars^tet that processing will be cotrpleted for the 2009 tat year,
In all etfori to improve our process, we invdte you tc share your feedback with us by sending a Lotus Note rot Life
Events Mailbox.
More information regarding the Estate Settlement process is available on the Ameriprise.com website.yTo view the ~~
'
"Estate Settlement Frequently Asked Questions" page or, the website, type "Estate Settlement FAQs" ih ihr search _
field on the website homepage, Dross tht "Enter" key end select the first item on the "GLOBaL" list. ~ ~ '
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Sincerely, °~
Jint 19attawta by dm
Depth Stttlemrnts Processing Team
70140 Ameriprise Financial Center ' fit'
h4igneapolis, hiP! 55474 ~ x
Cloth Settlements Processing Team: 800-297.6663, PIN, say Death Settlements '
Life Insurance Claims: 800-297-6663, PIN,sny Life Clsi;ns ;. ;
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Attachment: Beneficiary infonnatien
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Benetkian~ lnfortaation
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We have the following beneficiaries en record ftx the deceased's accounts.
' Account Number: 0('804~i858S0 6 001
', De~inatibn: .
PRl;MARY BENFF-ClARY
L-VMG, LAWFUL CH:LDRE'~ IN EQOAL SHARES 100.00.6
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SCOTT M. DINNER,
TEL: (717) 761'5900
FAX: (717) 761'5008
3717 CHESTNUT STREET
CAMP HILL, PA 1701 1
August 9, 2010
Glenda Fanner Strasbaugh hans' Court
Register of Wills and Clerk of the Orp
1 Courthouse Square
Carlisle, PA 17013
Re: Estate of Elsie M. Niesley ("Estate")
#21-10-0156
The following items are being submitted on behalf of the Estate:
1. REV-1500 Inheritance Tax Return Resident Decedent [2 copies).
2. A check for $I5. ding fees) payable to 'Register of Wills'.
Thank ou. j
Scott M. Dinner, Esquire
enclosures (3)
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