HomeMy WebLinkAbout09-27-101505610101
REV-1500 Ex ~o~_~o,~~
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania
Bureau of Individual Taxes °~Paa,"E"? °` NE°`"°E County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN
Harrisburg, PA x'7128-0601 RESIDENT DECEDENT ~ , ~ ~ ~ ~' ~ ~
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
197-05-7081 06/08/2010 12/18/1917
Decedent's Last Name Suffix Decedent's First Name MI
Carey Doris p
(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
C~ 1. Original Return
O 4. Limited Estate
~ 6. Decedent Died Testate
(Attach Copy of Will)
O 9. Litigation Proceeds Received
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
O 2. Supplemental Return
O 4a. Future Interest Compromise (date of
death after 12-12-82)
O 7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
O 10. Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95)
O 3. Remainder Return (date of death
prior to 12-13-82)
O 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
O 11. Election to tax under Sec. 9113(A)
(Attach Sch. O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
Edmund J. Berger, Esq. (717) 920-8900
First line of address
2104 Market Street
Second line of address
City or Post Office
Camp Hill
Correspondent's a-mail address: tbergerCa~bergerlawfirm.net
State ZIP Code
PA 17011
REGISTER OF WILLS USE ONLY
~y
r-~
~-? __.._
'° -~
' C13
'~ M
i
C~
- ~ rl N
`
~ ;, -~-
,
-~, ,.--,
~_.1
3'a®
~ 1
DATE `FIL'ED ~r
-~
^ !1~i „~
-~ _ r ~Z
- ---,
- . , =-,_ ~
_., ~
~_,~
' :..: ~'f
__-'7 ~
uT.~
Under penalties of per]UN" 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, cor and complete. eclaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATU E OF PERSON R P0N E NG RET DATE
~- J` ~ ~ /a
ADDRESS
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610101 1505610101, J
J
1505610105
REV-1500 EX
Decedent's Social Security Number
Decedent's Nacre: Doris D. Carey 197-05-7081
RECAPITULATION
1. Real Estate (Schedule A) ........................................... .. 1. 0.00
2. Stocks and Bonds (Schedule B)
..................................... 2.
.. 0.00
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 0.00
4. Mortgages and Notes Receivable (Schedule D) ....... . ................. .. 4. 0.00
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. 1,821.26
6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. 194,863.00
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested...... .. 7. 46,557.07
8. Total Gross Assets (total Lines 1 through 7) ........................... .. 8. 243,241.33
9. Funeral Expenses and Administrative Costs (Schedule H) . ....... .......... 9. 19,985.39
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .... .......... 10. 3,488.00
11. Total Deductions (total Lines 9 and 10) ............... ....... .......... 11. 23,473.39
12. Net Value of Estate (Line 8 minus Line 11) .................... .......... 12. 219,767.94
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. 219,767.94
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_ 15.
16. Amount of Line 14 taxable
at lineal rate X .0 45 219,767.94 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.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
1505610105 1505610105
9,889.56
9,889.56
O
J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number '~ ~ ~ ~ ~ (,~~ (y
DECEDENT'S NAME
Doris D. Carey
STREET ADDRESS
Country Meadows Retirement Center
4837 E Trindle Rd
CITY
Mechanicsburg STATE
PA ZIP
17050-3680
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments 7 267.50
A. Prior Payments
B. Discount 382.49
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) 9, 889.56
Total Credits (A + B) (2) 7,649.99
(3)
(4)
(5) 2,239.57
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 : ...................................... ...... ^ ^Q
c. retain a reversionary interest; or .................................................................................................................... ...... ^
d. receive the promise for life of either payments, benefits or care? ................................................................ ...... ^ ^x
2. If death occurred after Dec. 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? ........ ...... ^
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 is
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 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)]. Asibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1502 EX+ {11-08)
~ pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Doris D. Carey 21-10-0926
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property
would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F.
If more space is needed, insert additional sheets of the same size.
REV-1503 EX+ (6-98)
~ 7
SCHEDULE B
COMMONWEALTH OF PENNSYLVAN{A STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Doris D Carey 21-10-0926
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
(If more space is needed, insert additional sheets of the same size)
REV-1504 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C
CLOSELY-HELD CORPORATION,
PARTNERSHIP OR
SOLE-PROPRIETORSHIP
ESTATE OF FILE NUMBER
Doris D. Carey 21-10-0926
Schedule C-1 or G-2 (including all supporting information) must be attached for each closely-held corporationlpartnership interest of the decedent, other than a
sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships.
(If more space is needed, insert additional sheets of the same size)
REV-1507 EX+ (6-98)
SCHEDULE D
~-
COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES
INHERITANCE TAX RETURN RECEIVABLE
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Doris D. Carey 21-10-0926
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
(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
Doris D. Carey 21-10-0926
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.
(If more space is needed, insert additional sheets of the same size)
REV-i5og EX+ (os-io)
~ pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
]OINTLY-OWNED PROPERTY
ESTATE OF: FILE NUMBER:
Doris D. Carey 21-10-0926
JOINTLY OWNED PROPERTY:
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR
IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY HELD REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET % OF
DECEDENT'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENT'S INTEREST
1. A. 05I08I08 Merrill Lynch Wealth Management Account No: 882-10617 182,446.42 50 91,223.21
2 A. 05I21I08 Citizens Bank Acct. 610117-455-0 63.01 50 31.51
3 A 05/21/08 Citizens Bank Acct. 622594-611-3 204,152.85 50 102,076.43
4 A 05/21/08 Citizens Bank Acct. 610094-134-5 3,063,70 50 1,531.85
TOTAL (Also enter on Line 6, Recapitulation) I $ 194,863.00
If more space is needed, use additional sheets of paper of the same size.
If an asset became iointly owned within one year of the decedent's date of death, it must be reported on Schedule G.
REV-1510 EX+ (08-09)
;; pennsylvania SCHEDULE G
DEPARTMENT aF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Doris D. Carey 21-10-0926
This schedule must be completed and fi{ed 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
jIF APPLICABLE)
TAXABLE
VALUE
1. PNC Bank Account No. 000009001224699 26,617.36 100 3,000.00 23,617.36
Established 6/11/09 with David Carey, son
Citizens Bank Acct 622594-628-8 22,939.71 100 22,939.71
Established 3/10/10 with David Carey, son
TOTAL (Also enter on Line 7, Recapitulation) $ ~ 46,557.07
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+ (10-09)
~ pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Doris D. Carey 21-10-0926
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER
DESCRIPTION
AMOUNT
A. FUNERAL EXPENSES:
1' Richard H. Disque Funeral Home 5,358.50
2 Chapel Lawn Memorial Park 1,295.00
3 Lodging and Meals for Out of Town Family 327.49
4 Church Service Charges--Peter Uritz--Organist; Rev. Charles Grube; Rev. Dr. William D. Lewis 400.00
5 Church Custodian 70.00
s Castle Inn--Funeral Dinner 428.00
z Evans Fing Floral--Funeral Flowers 233.20
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City State ZIP
Year(s) Commission Paid: _
11,400.00
2. Attorney Fees:
3. Family Exemption; (If decedent's address is not the same as claimant's, attach explanation.)
Claimant
Street Address
4.
5.
6,
7.
s
City ~ State _
Relationship of Claimant to Decedent
Probate Fees:
Accountant Fees:
Tax Return Preparer Fees:
Cumberland County Law Journal--Estate Notice
Patriot News--Estate Notice
ZIP
107.50
75.00
290.70
TOTAL (Also enter on Line 9, Recapitulation) `$ 19,985.39
If more space is needed, use additional sheets of paper of the same size.
REV-1512 EX+ (1.2-08)
~ pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
Doris D. Carey 21-10-0926
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+ (01-10)
~ pennsylvania SCHEDULE ~
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Doris D. Carey 21-10-0926
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• ~ David C. Carey, 322 Somerset Dr., Shiremanstown, PA 1701 I Son I 100%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF 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:
1
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. f $
If more space is needed, use additional sheets of paper of the same size.
LAST WILL AND TESTAMENT
OF
DORIS D. CAREY
I, DORIS D. CAREY, of the Borough of Dallas, County of Luzerne and Commonwealth
of Pennsylvania, being of sound and disposing mind, memory and understanding, do make,
publish and declare this as and for my Last Will and Testament, hereby revolving and making
void any and all Wills, Codicils or other documents in the nature of testamentary disposition at
any time heretofore made by me.
ITEM I: I order and direct my personal representative hereinafter named to pay all my
funeral expenses and costs of administration as soon as may be practicable after my death.
ITEM II: I give, devise and bequeath all the rest, residue and remainder of my estate,
whether real, personal or mixed, of whatsoever kind and wheresoever situate, to my husband,
ROBERT L. CAREY, if he shall survive me by thirty (30) days.
4
ITEM III: If my husband, ROBERT L.. CAREY, shall predecease me or fail to survive
me by thirty (30) days, then and in that event I give, devise, and bequeath all the rest, and
remainder of my aforesaid estate to my son, DAVID C. CAREY.
ITEM IV: If my son, DAVID C. CAREY, also shall predecease me, then and in that
event, I give, devise and bequeath all the rest, residue and remainder of my aforesaid estate as
follows:
(a) One-third (1/3) thereof to THE BACK MOUNTAIN MEMORIAL LIBRARY, of
Dallas, Pennsylvania; and
1
(b) One-third (1/3) thereof to THE DALLAS UNITED METHODIST CHURCH, of
Dallas, Pennsylvania; and
(c) One-third (1/3) thereof to THE FORTY FORT UNITED METHODIST
CHURCH, of Forty Fort, Pennsylvania.
ITEM V: All inheritance, estate or other death taxes, and any interest or penalties
thereon, payable by reason of my death with respect to property or interests forming a part of my
estate for purposes of calculating such taxes, and whether passing under my Will or Codicil, or
otherwise, including jointly-held and other non-testamentary property shall not be apportioned,
but shall be paid out of the principal of my residuary estate before its division into shares as if
such taxes were administration expenses and without reimbursement from the beneficiaries, at
such times as my personal representative shall deem advisable.
ITEM VI: I hereby nominate, constitute and appoint my husband, ROBERT L. CAREY,
as Executor of this, my Last Will and Testament. In the event that my said husband, ROBERT
L. CAREY, shall fail to qualify or cease to act as such Executor, I nominate, constitute and
appoint my son, DAVID C. CAREY, as Executor, of this, my Last Will and Testament. I
direct that my personal representatives shall not be required to give bond for the faithful
performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I, the said DORIS D. CAREY, have to this, my Last
Will and Testament, contained in this and the preceding one (1) page and preceding one (1) page
signed in the margins thereof for purposes of identification only, set my hand and seal this
day of ,two thousand seven (2007).
DORIS. D. C Y
2
Signed, sealed, published and declared by DORIS D. CAREY, the Testatrix
above-named, as and for her Last Will and Testament, in our presence, who, in her presence, at
her request and in the presence of each other, have hereunto subscribed our names as attesting
witnesses this ~G ~ day of _~ ,,/~ , , 2007.
__ residing at ~.~ ~~
~.~~ ~r~~: residin at ~~. ~ `~'~'~
,~
3