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HomeMy WebLinkAbout10-20-10J 1505607121 REV-1500 EX (06-05) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisbu PA 17128-0601 RESIDENT DECEDENT 2 1 1 0 0 8 1 6 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 9 1 1 8 3 4 0 1 0 8 0 8 2 0 1 0 0 9 2 6 1 9 2 2 Decedent's Last Name Suffix Decedent's First Name MI R Y N A R D M A R Y E L L E N (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 0 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) QX 6. decedent Died Testate ~ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe De osit Boxes (Attach Copy of WiII) (Attach Copy of Trust) p 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 H U B E R T X G I L R O Y 71 7 2 4 3 3 3 4 1 Firm Name (If Applicable) M A R T S O N First line of address 1 0 E A S T Second line of address City or Post Office C A R L I S L E State ZIP Code P A Correspondent's a-mail address: H G I L R O Y a M A R T S O N L A W• C O M REGISTFB OF WILLS U~NLI C. n ~ r ; -v c-n c~ _ f T C7 _...I rn ~ ~ , _ .i .~. ~E FILE D G3 - ~, _ _ Lis _~ .~ .~ t'; 1 7 0 1 3 ~.' __' ' Under penalties of perjury, 1 declare that 1 have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparnr other than the personal representative is based on all information of which preparer has any knowledge. SI AT R OF PERS RES ONSIBLE FO I G RETU DATE ADDRESS -~ _f 15 ST P K TREET CARLISLE PA 171D3 SI A R A R H N REPRESENTATIVE ,DATE 10 EAST HIGH STR T 1505607121 L A W O F F I C E S H I G H S T R E E T CARLISLE PLEASE USE ORIGINAL FORM ONLY Side 1 PA 17013 1505607121 J REV-1500 EX 1505607221 Decedent's Social Security Number oecedent'sName: MARY ELLEN RYNARD 1 9 1 1 8 3 4 0 1, RECAPITULATION 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 & Notes Receivable (Schedule D) ,, , , , , , , , , , , , , , , 4. , 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 5, 7 6 6 6 , 4 2 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested .... 6. .. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property . (Schedule G) ^ Separate Billing Requested .... ... 7. 8. Total Gross Assets (total Lines 1-7) , , , , , , , , , , ,, , 8 7 6 6 6 , 4 2 9. Funeral Expenses & Administrative Costs (Schedule H) ............. . . . 9. 5 5 9 8 , 2 4 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ... , , , , , , , , . 10. 5 8 3 9 5 , 4 9 11. Total Deductions (total Lines 9 & 10) ........................ ... 11. 6 3 9 9 3 , 7 3 12. Net Value of Estate (Line 8 minus Line 11) ...................... ... 12. - 5 6 3 2 7 , 3 1 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. - 5 6 3 2 7 , 3 1 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 .0 - 15. 16. Amount of Line 14 taxable at lineal rate X .0 , - 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 1505607221 1505607221 J REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME MARY ELLEN RYNARD _ -_ _ -- STREETADDRESS 250 Walnut Bottom Road - -- - __ CITY - _ _ - - - Carlisle Tax Payments and Credits: ~ Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit _ B. Prior Payments C. Discount 3. Interest/Penalty if applicable D. Interest E. Penalty File Number 21 10 0816 _, STATE PA (1) Total Credits (A + 8 + C) (2) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.Total Interest/Penalty (D + E) (3) Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT ZIP 17013 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; .......................................................... ^ a ...:........ b. retain the right to designate who shall use the property transferred or its income; ^ X^ ............................. c. retain a reversionary interest; or ..................................... ........................................................... ^ a d. receive the promise for life of either payments, benefits or care? ............................................. ^ .......... 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................................................. ^ ...................... 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ......... ^ 0 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 January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (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 zero (O) percent (72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exemot 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 twenty-one 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 zero (O) 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 four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) X72 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 twelve (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-1508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY MARY ELLEN RYNARD FILE NUMBER 21 10 0816 Include the proceeds oflitigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. 1 TEM NUMBER DESCRIPTION 1. Sovereign Bank checking 2891043375 (see attached) Cash VALUE AT DATE OF DEATH 7,210.00 4 ti 6.42 TOTAL (Also enter on line 5, Recapitulation) I $ 7 666 42 (If more space is needed, insert adddiona/ sheets of the same see) REV-1511 EX + (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEnFNT ESTATE OF MARY ELLEN RYNARD SCHED ULE H FUNERAL EXPENSES & ADMINISTR,4TIVEOOSTS FILE NUMBER 21 1n nQ~~ Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION A• FUNERAL EXPENSES: 1. Ewing Brothers Funeral Home, Carlisle, PA 2• Cumberland Valley Memorial Gardens B. ADMINISTRATIVE COSTS: ~• Personal Representative's Commissions Name of Personal Representafive (s) Betty Mullen StreetAddress 155 East Park Street Cffy Carlisle State PA Zip 17013 Year(s) Commission Paid: 2010 AMOUNT 1,305.00 2,280.00 ~8~.00 2. AttomeyFees MARTSON LAW OFFICES (estimated) 1, X00.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Gaimant Street Address Crfy State Zip Relationship of Gaimant to Decedent 4. Probate Fees Cumberland County Register of Wills 92.ti0 5 Accountant's Fees 6• Tax Retum Preparer's Fees 7. Filing Fee, Inheritance Tax return 8• Certified mailing, Department of Public Welfare 1 x.00 9• Additional Probate fee ~ 74 1 x.00 TOTAL (Also enter on line 9, Recapitulation) I $ > >9~ 24 (If more space is needed, insert adddional sheets of the same sneJ REV-1512 EX +.(12_03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS MARY ELLEN RYNARD FILE NUMBER 21 10 0816 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. 1 TEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH Commonwealth of Pennsylvania, Department of Public Welfare, medical assistance claim 58. 9>.49 #750156023 TOTAL (Also enter on line 10, Recapitulation) I $ 58 ;9~ 49 (If more space is needed, insert adddional sheets of the same size) I, MARY ELLEN RYNARD, of South Middleton Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my Last Will and Testament, hereby revoking and making void all previous Wills and Codicils heretofore made by me. FIRST I order and direct my personal representative hereinafter named to pay all of my `, just debts, funeral expenses and expenses involved or connected with the administration j v ~of my estate as soon after my death as is reasonable possible. However, my personal ~' ~ representative need not accelerate and pay those unmatured obligations which, in his, ---~ her or its opinion, it might be proper and more advantageous to retain or renew and ~~ pay as they become due and payable. If I do not own a burial plot or a grave marker at ~~ the time of m death, I authorize m y y personal representative, in his, her or its sole discretion, to purchase a burial plot and to erect a suitable grave marker at my grave, ,ti and to expend sums from my estate for this purpose. .._-~ SECOND I give, devise and bequeath the rest, residue and remainder of my estate, together with all insurance proceeds thereon, of whatever nature and wheresoever situate in equal shares to my friends Georgiana Love, Betty Mullen and Kirk Love who survive me by sixty (60) days per stirpes. It is further my desire that my personal PAGE 1 OF 6 LAST WILL AND TESTAMENT OF MARY ELLEN RYNARD representative, after consultation with any heir or heirs of mine who survive me, and in his, her or its own discretion, choose such articles from my tangible and intangible personal property as he, she or it believes will be useful to such heir or heirs or desirable for him or her or them to have, either from a sentimental point of view or otherwise, and to deliver such articles to such heir or heirs or among such heirs in equal or unequal shares as determined by the further exercise of his, her or its discretion, provided no other heir objects to the distribution. All tangible personal property not so distributed is to be sold, either publicly or privately, by my personal representative, adding the proceeds of such sale or sales to my residuary estate to be disposed of in equal shares among my surviving heirs after payment of my estate debts, ,.~ taking into account the tangible personal property otherwise provided to them. THIRD ti ~~ I grant my personal representative the following powers in addition to and not in t `~.___-~ limitation of such powers as my personal representative shall hold by law: (a) To retain all property received, including the stock of any corporate ~~ fiduciary acting hereunder, provided such property remains productive; (b) To join in any corporation, partnership, . recapitalization, merger, reorganization or voting trust plan; to delegate authority with respect thereto; to deposit J investments under agreements and pay assessments; and generally to exercised all rights _ of investors, including but not limited to, the voting of shares; (c) To manage, operate, repair, improve, mortgage or lease on reasonable terms any real estate held or owned by my estate; (d) To operate any business that I may own at my death; PAGE 2 OF 6 LAST WILL AND TESTAMENT OF MARY ELLEN RYNARD (e) To invest any funds of my estate in any stocks, bonds, notes or other securities or property, real or personal, without regard to the principle of diversification in his, her or its absolute discretion, it being my intention to give my personal representative the broadest investment powers possible, providing such investments do not unnecessarily prevent the prompt settlement of my estate; (f) To sell or otherwise dispose of any property, real or personal, tangible or intangible, at any time forming a part of my estate in any manner and on such terms and conditions as my personal representative shall see fit in his, her or its absolute discretion; (g) To borrow money for the payment of taxes or for any other proper purposes ~ in the administration of my estate, and to mortgage or pledge estate assets as security; ~; (h) To compromise claims without court approval, including, but not limited v to, any controversies with the United States of America or the Commonwealth of ~ J `--~ Pennsylvania concerning estate and inheritance taxes on any interests that my pass under this my Last Will and Testament; ~~ ~~ (i) To distribute in cash or in kind upon any division or distribution of my estate; ~' (j) To undertake any and all acts deemed necessary and proper by my personal n representative for the proper, advantageous and prompt management of the settlement l~ of my estate; (k) In general, to exercise all powers in the management of my estate which any individual could exercise in the management of similar property owned in his own right, upon such terms and conditions as to him, her or it may seem best and to execute PAGE 3 OF 6 LAST WILL AND TESTAMENT OF MARY ELLEN RYNARD and deliver all instruments and to do all acts which he, she or it deems necessary or proper to carry out the purposes of this my Last Will and Testament. FOURTH No interest of any beneficiary of my estate either in income or in principal, shall be subject to anticipation or pledge, assignment, sale or transfer in any manner, nor shall any beneficiary have the power in any manner to charge or encumber his interest either in income or principal, nor shall the interest of any beneficiary be liable or subject in any manner while in the possession of my personal representative for the liability of such beneficiary. FIFTH I nominate, constitute and appoint my friends, Georgiana Love, Betty Mullen and Kirk Love as Executors of this my Last Will and Testament, or the survivor(s) of them. I direct that my personal representative shall not be required to give or post bond for the faithful performance of his, her or its duties in this or any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand to this my Last Will and Testament this %s; day of ~.A,,,y,~,~.y , 2Q02. WITNESS: ~~. -~ \ pp ~ _~. ! ' - ~ MARY E EN RYNARD ~- PAGE 4 OF 6 LAST WILL AND TESTAMENT OF MARY ELLEN RYNARD COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND . ss. I, MARY ELLEN RYNARD, the Testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly, and that I signed it as my free and voluntary act for the purpose therein expressed. 1 f i` ,? ~ F L .` Z'' 1. ~L-^~- r~ MARY EL EN RYNARD Sworn or affirm and acknowledged before me by MARY ELLEN RYNARD the Testatrix this -~~~ day of ~~ 2002. err ~aooiairv, v~ ~ OTARY ~dY ~t E~PIRES,RlLY 18, P006 PAGE 5 OF 6 LAST WILL AND TESTAMENT OF MARY ELLEN RYNARD COMMONWEALTH OF PENNSYLVANIA . ss. COUNTY OF CUMBERLAND : ~ ,p We, ~~~ cs ~ _ % a~~ and ~'~'~lt-C-ir'~iYl ~ +~,~Z f C/~ the witnesses whose names are attached to the foregoing document, being duly qualified according to law, do depose and say that we were present and saw Testatrix sign and execute the instrument as her signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testatrix signed the Last Will and Testament as witnesses and that to the best of our knowledge the Testatrix was at the time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. .,-~ ., ;;• ~~ /' 1 ~'~ Sworn or affirmed and subscribed before me by ~~~ ~'~' ~ `~~1J-~S and Ltli~~l/,4yLt ~, ~OZ~~this~~~day of o-,u._t , 2002. Norar~sea. ~ , susnN~. o~ow. Nar~wrPU~c ti ~ M14' WOLLY SPRI+lGS 6080. CIMN~EAIM1DCOdIRY. PA „ . ari ~ E~+IREB JI~Y ~ ~ NOTARY PAGE 6 OF 6 ~- ~ , ~ r~ s ~e iy ©~ c. car ~~A =j C'.,. ( r~--h~ ~~;.~ r-- ~ ~ ~ ~~ ~ ni I ^~ "~'~'11 C' .5 ~~ ~ ~..:_~ C.t;' f' ~i 1 '~«'Y~ %~} ~ CJ y~ ~ (7'Y~ :~ _,~ ... ~. __. --> ... ;;-; _, ' _,-, _ -, -- '_~ ~ : j ~_ _- ~5 Printer Friendly Page 1 of 2 Today is: 08/1 312 0 1 0 User: dswanger Name: Debra E Swan er 9 End Customer Session Customer Profile Mid Atlantic (so17) « Back to Search Name: MARY ELLEN Address: 940 WALNUT BOTTOM RD RM RYNARD S 207 Customer Service History: SN/TIN: 191-18-3401 CARLISLE PA 17015-6926 At-a-Glance (Last 180 Days) Email: Home Phone: (717) 249-2957 Birth Date: 09126/1922 Re o ed Problems 0 Work Phone: Mother's Maiden: Pending Requests 0 Cell Phone: Portfolio Code: 00289R102P Customer Notes 0 Fax Phone: Portfolio Manager: Westover, Denise A ID Protector. All Existing History » Fiserv Notes Certified W9: YES Certified on: 11/07/2001 B1 Notice: 62 Notice: Received C Notice: NO Financial Summary DDA!__ Savinox Certifica_te~of pgpp¢it Bank Card Loans Other Account FINANCIAL SUMMARY (Balance from prior day) Ending Ledger Balance Available Ba lance Total Accounts Total Certificates of Deposit $7 210 00 $7,210.00 $0.00 $0.00 Total Deposits $7 21000 $7,210.00 Total Outstanding Loans $0 00 . $0.00 Total Available Credit $0 00 . $0.00 DDA/SAVINGS ACCOUNTS Account Account Number Type Account Status Tax Endin Led er Open Date Re orter g g Available P Relationship Balance Balance Statement 2891043375 Checking with I Open YES Primary $7 210 00 nterest , , 11/02/2001 $7,210.00 Stand Alane CERTIFICATES OF DEPOSIT Account Status Tax Ending Ledger Available Interest Account Number Open Date Reporter Relationship Balance Balance Rate Maturity Date No current accounts on record. BANK CARDS Account Status Card Number Open Date Card Type 4328450090260971 Closed Sovereign CheckCard 04/04/2005 LOANS Account Status Available Account Number Application Open Date Net Principal Gross Princi al P Balance Interest Rate No current accounts on record. OTHER ACCOUNTS Account Status http://middleware.soverei nban~o ' ~ °~""" ~ - g m/pnnt rien$ly.~s ?needSi -no p g 8/13/2010 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF PROGRAM INTEGRITY DIVISION OF THIRD PARTY LIABILITY ESTATE RECOVERY PROGRAM PO BOX 8486 HARRISBURG, PA 17105-8486 September 3, 2010 MARTSON DEARDORFF WILLIAMS OTTO GILROY & FALLER HUBERT X GILROY ESQUIRE 10 EAST HIGH STREET CARLISLE PA 17013 Re: Maryellen Rynard CIS #: 750156023 SSN: ###-##-3401 Date of Death: 08/08/2010 Dear Attorney: Please be advised that the Department of Public Welfare maintains a claim in the amount of $58,395.49 against the above-mentioned estate. This claim is for restitution of medical assistance granted on behalf of the decedent for which the Probate Estate is now responsible to reimburse the Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's itemized statement of claim. A portion of this medical expense, namely $25,094.04, was incurred during the last six months of the decedent's life; therefore, it is a Class 3 claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $33,301.45, is to be entered as a priority Class 5.1 claim against the estate. Please acknowledge receipt of this letter and advise whether the Commonwealth's claim is admitted and when payment may be expected. If the estate accounting is complete, please provide a copy. If the estate contains real estate, please provide copies of the deed, the latest tax assessment, and a current appraisal, if available. Sincerely, Patricia Nace Claims Investigation Agent 717-772-6616 717-772-6553 FAX Enclosure