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Home My WebLink About11-03-10~ 1505610101 REV-1 s oo Ex ~ol_io, OFFICIAL USE ONLY PA Department of Revenue Pennsylvania 'JS ~AKIMI:KI 01'fli'.~i'NUf County Code Year File Numbe Bureau of Individual Taxes INHERITANCE TAX RETURN l PO BOX 28o6oi (,,11 Harrisburg, PA i~izE-o6oi RESIDENT DECEDENT , ENTER DECEDENT INFORMATION BELOW Sociaf Security Number Date ofi Death MMDDYYYY Date of Birth MMDDYYYY 175-34-8005 04!14(2009 02/14/1917 Decedent's Last Name Suffix Decedent's First Name MI RHOADS MABEL R (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 O O 4. Limited Estate O O 6. Decedent Died Testate O (Attach Copy of Will) O 9. Litigation Proceeds Received O 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82} 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 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 Ta:K 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 T0: Name Daytime Telephone Number JAMES D. FLOWER, JR. (717) 243-5513 First line of address FLOWER LAW, LLC Second line of address 10 W. HIGH ST City or Post Office State ZIP Cade CARLISLE PA 17013 REGISTER OF WILLS USEL.Y ~- c~ ', t ~ ~ ~ -, ~' ~ ~ ~ , t i c , , ~ ,. ' ~-~ -~ ~ ` W - :~ c.~ s -,~ , ~-~~ c:.~. i DA;T"EJ EA: D -- ""'" Correspondent's a-mail address: JIMi~FLOWER-LAW.COM ^"_: _ .,,, 1 . _~ N -- •, .._ r~.... Ste.' .A ~t. Under penalties of perjury, 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, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. /3j+6'fS+aTURE OF RSON RESPONSIBL R FIL~N TURN C DATI~ o ~ ~~ a ADDRESS CAROLYN MCQUILLIN, 1044 PINE RD, CARLISLE, PA 17015 SIG U OF PREPAR H HAN REPRESENTATIVE DATI= re 2z_ ,o _ ADD SS FLOWER LAW, LLC, 10 W. HIGH ST, CARLISLE, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 150561D101 ~~ J 1505610105 REV-1500 EX Decedent's Social Security Number Decedent's Name: MABEL R. RHOADS 175-34-8005 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 and Notes Receivable (Schedule D} ........................... 4. 5. Cash, Bank Deposits and MisceNaneous Personal Property (Schedule E)....... 5. 5,532.09 6. Jointly Owned Property {Schedule F} O Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers $~ Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1 through 7} ............................. 8. 5,532.09 9. Funeral Expenses and Administrative Costs (Schedule H} ............ ....... 9. 2,865.25 ; 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I} ....... ....... 10. 191,053.51 11. Total Deductions (total Lines 9 and 10} .......................... ....... 11. 193,918.76 12. Net Value of Estate (Line 8 minus Line 11 } ....................... ...... . 12. 0.00 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. 0.00 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 ~ 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. 0.00! 20. FELL 1N THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610105 1505610105 J REV-1500 EX Page 3 e~___r_~~~_ n_._...~I..a.. w.,f.J.....,... File Number MABEL R. RHOADS STREET ADDRESS 770 SOUTH HANOVER ST. C~CARLISLE STATE ZIP PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) ~ 0.00 2. Credits/Payments A. Prior Payments B. Discount Total Credits (A + B) (2) 3. Interest (3) 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. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 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 :.......................................................................................... ^ b. retain the right to designate who shall use the property transferred or its income : ............................................ ^ c. retain a reversionary interest; or .......................................................................................................................... ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 0 3. Did decedent own an "intrust 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 ar 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 impased an 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 tlisclasure 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 an 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-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER MABEL R. RHOADS 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) High Performance Money Market ~~~ 01 1010071396839 752 30 0 5 1,239 WACHOVIA 00000320 01 AV 0.335 O1 5DG 2 I~~~III,~~lll~~„~~11~1~1~1~1....II.I...l~~ll~~l~~l~l~~l~ll~~l ~~ MABEL R RNOADS ~~~ CAROLYN R MCQUILLEN POA PB ~~ PAUL R RHOADS POA 1044 PINE RD CARLISLE PA 17015-9373 High Performance Money Market 4110/x009 thru 5/08/209 Account number: 1010071396839 Account owner(s): MABEL R RHOADS CAROLYN R MCQUILLEN PUA PAUL R RHOADS POA Account Summary Opening balance 4/10 $3,744.21 {nterest paid _ 0.06 + Closing balance Sl08 $3,744.27 Deposits and Other Credits Date Amount Description 5/08 0.06 INTEREST FROM 04/10/2009 THROUGH 05/0812009 Total 0.06 Interest Number of days this statement period 29 Annual percentage yield earned 0.02% {nterest earned this statement period $0.06 Interest paid this statement period $0.06 interest paid this year $0.50 Wachovia is number one in customer satisfaction -for eight years straight. How do you get to be first in satisfaction? By putting customers first. Are you with Wachovia? Based on 4th quarter, 2008 American Customer Satisfaction Index (ACS/) results of the largest U.S, retail banks. Wachovia Bank, N.A. and Wachovia Bank of Delaware, N.A. are Members FDIC. WACHOVIA BANK, N.A. , CARLISLE page 1 of 2 ,;... _. ~.,,. yvveSWUr~kgA"~F ,. ~'Mfire,e I i ~, ~ M&T Barak ~ ~~~ r ~ ~~t ~=~ ACCOUNT N0. ACCOUNT TYPE 433926 CLASSIC CHECKING 00 0 04319M NM 017 EARL R RNOADS MABEL R RHOADS 1044 PINE RD CARLISLE PA 17015-9373 errniiAlT CIIMMAOV STATEMENT PERIOD PAGE APR.24-MAY.22,2009 1 OF 1 HIGH STREET-CARLISLE: BEGINNING BALANCE DEPOSITS 8 OTHER ADDITIONS CHECKS PAID OTHER SUBTRACTIONS CURRENT INTEREST PD ENDING BALANCE N0. AMOUNT N0. AMOUNT N0. AMOUNT 856.71 0 0,00 0 0.00 0 0.00 0.00 856.71 Arrni~uT ArTTVTTV POSTING DATE TRANSACTION DESCRIPTION DEPOSITS,INTEREST & OTHER ADDITIONS CHECKS 8 OTHER SUBTRACTIONS DAILY BALANCE 04-24-09 BEGINNING BALANCE 5856.71 ENDING BALANCE S856.71 L008A (6I0~ 63489 M&T - - ~~ ~ x ~ ~ ~. ~,. ~. 4~ r ~."'_ ~ , ., ~>4 ^ . . ACCOUNT NO. ACCOUNT TYPE 433926 CLASSIC CHECKING 00 0 04319M NM I17 5508 EARL R RHOADS MABEL R RHOADS 1044 PINE RD CARLISLE PA 17015-9373 Ar`f`(111{JT C{IMMARV STATEMENT PERIOD PAGE MAR.24-APR.23,2009 1 OF 2 HIGH STREET-CARLISLE BEGINNING BALANCE DEPOSITS & OTHER ADDITIONS CHECKS PAID OTHER SUBTRACTIONS CURRENT INTEREST PD ENDING BALANCE N0. AMOUNT N0. AMOUNT N0. AMOUNT 836.71 1 1,450.00 1 1,430.00 0 0.00 0.00 856.71 Af Cf111NT ~f:T T V T TY POSTING DATE TRANSACTION DESCRIPTION DEPOSITS,INTEREST 6 OTHER ADDITIONS CHECKS R OTHER SUBTRACTIONS DAILY BALANCE 03-24-09 BEGINNING BALANCE 1836.71 04-03-09 US TREASURY 303 SOC SEC 1,450.00 2,286.71 04-07-09 CHECK NUMBER 4856 1,430.00 856.71 ENDING BALANCE 5856.71 CHECKS PAID SUMMARY 4856 04-07-09 1,430.00 MgT PARTICIPATES IN THE FDIC'S TRANSACTION ACCOUNT GUARANTEE PROGRAM (TAG), UNDER NHICH ALL BALANCES IN NON-INTEREST-BEARING TRANSACTION ACCOUNTS ARE FULI'Y GUARANTEED BY THE FDIC THROUGH 12/31/09. TAG COVERAGE IS IN ADDITION TO AND SEPARATE FROM THE COVERAGE AVAILABLE UNDER THE GENERAL FDIC DEPOSIT INSURANCE RULES. M&T MILL ALSO MAKE ALL CONSUMER NON ACCOUNTS (OTHER THAN POKER CHECKING) ELIGIBLE FOR COVERAGE UNDER TAG BUT TO DO S0, THE FDIC REQUIRES MgT TO COMMIT TO PAY NO MORE THAN .50% INTEREST THROUGH 12/31/09. THUS, MiT HILL PAY NO MORE THAN .50% INTEREST ON SUCH ACCOUNTS (OTHER THAN POWER CHECKING) THROUGH 12/31/09. LooBn lsro~) ;., .,:': .« .. .~ ,,~+ ~~~ el Pointe at Carlisle 770 S. HANOVER STREET, CARLISLE, PA 17013 RH~ADS, MABEL R CARULYN R. MCQUILLEN 1044 PINE RD. CARLISLE, PA 17015 Trust Fund t?uarterly Statement Statement Date: 04/01/2009 Reporting Period: 01/01/2009 To 03/31/2009 ID: 12857 Trans. Date Descriptian ~ Comment Reference Deposit Withdrawal Vendor Fund: RTF Resident Trust Fund O1/0112009 Be inning Balance 874.67 01/22lZ009 Interest to 1st Party 0300000413 -2.53 Chapel Pointe at Carlisle Rhoads, Mabel R 01/31!2009 Interest Income 0.07 02/12/2009 Interest to 1st Party 0300000427 -2.53 Chapel Pointe at Carlisle Rhoads, Mabel -Feb Int 02/Z8/2009 Interest Income 0.06 03/05/2009 Interest to 1st Party 0300000445 •2.53 Chapel Pointe at Carlisle Rhoads, Mabel March Int 03131/2009 Interest Income 0.06 Totals -Number of Transactions 6 0.19 -7.59 03f31/2009 Ending Balance 867,27 ~~ ~ ~ ~ u HOLD DOCUMENT UP TO THE LIGHT TO VIEW TRUE WATERMARK i~ '~ r°" ~ HOLG DOCUMENT UP TD THE LIGHT TO VIEW TRUE WATERMARK . ~• ---- - -- --- - - - - - -- r 0 ~ M&TBanlc - -- - -- - - 200026708- 2 ~ - ~ Manufacturers and Traders Trust Company BUFFALO, N.Y. 14240 10-4/220 ~ ~' DATE Secunty J REMITTER ~ Geaa+ls on r back. PAY TO THE ORDER OF - $ ii TWO AUTHORIZED SIGNATURES REQUIRED FOR AMOUNTS $10,000.60 & OVER ~ ~ ~._ ~ __ Np AUTHORIZED SIuNATURE ~ _.~._~.___.._._~,.__...____-~__.-.__..-...._._e.~.~~-.___ AU.T.tiO ig?FD Sli:;p~A ~ _~_.________a_._._~_~__ _ TiJ~F ___-_ II' 2000 26 708~~' ':0 ~ 2000046: 1 700 20 L99 2604 7~~' ~~v-~s~~ ~x+ (~o-o~) • ~~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER MABEL R. RHOADS Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' HOFFMAN ROTH FUNERAL HOME, SERVICES EQUIPMENT & MERCHANDISE $7,710.00 OBITUARY NOTICE, SENTINEL 120.12 OBITUARY NOTICE, PATRIOT 298.82 ORGANIST & CLERGY HONORARIA 300.00 DEATH CERTIFICATES, FLOWERS & HAIR DRESSER 223.00 LESS PREPAYMENT AND DISCOUNT (7,854.00) 797.94 CLOTHING (12.59) AND FUNERAL LUNCHEON (208.92) 221.51 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 275.00 Name(s) of Personal Representative(s) CAROLYN R. MCQUILLEN Street Address 1044 PINE ROAD City _CARLISLE State PA ZIP 17015 Year(s) Commission Paid: 2010 2• Attorney Fees: 1, 500.00 3• Family 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 4• Probate Fees: 5• Accountant Fees: 6• Tax Return Preparer Fees: ~• INHERITANCE TAX RETURN FILING FEE 15.00 8. THE SENTINEL, CLASSIFIED AD r~u~p~-2,tua¢~ ~5~~ ~oZ~- 55.80 TOTAL (Also enter on Line 9, Recapitulation) $ 2,865.25 If more space is needed, use additional sheets of paper of the same size. Hoffman-Roth Funeral Home & Crematory, Inc. 219 North Hanover Street - Carlisle, PA 17013 (717)243-4511 ' May 5, 2009 Carolyn McQuillen • 1044 Pine Road Carlisle, PA 17013 The Funeral Service for Mabel R. Rhoads 15603-92 We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. OUR SERVICE: Traditional Funeral Service Package _ $4150.00 FUNERAL HOME SERVICE CHARGES $4150.00 SELECTED MERCHANDISE: Newport-Stainless Steel Casket, $3560.00 THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED $7710.00 Cash Advances Newspaper Obituary Notice- Sentinel , $120.12 Newspaper Obituary Notice -Patriot News $298.82 Organist, $ l 00.00 Clergy Offering $200.00 Certified Copies of Death Certificates , $24.00 Flowers , $159.00 Hairdresser. _ _ _ _ _ _ _ _ _ _ _ _ _ _ $40.00 TOTAL CASH ADVANCES AND SPECIAL CHARGES . $941.94 Total T otal ost $8651.94 History 05/05/2009 Allianz $-7762.50 05/05/2009 Discount Contract vs PreArrang , $-91.50 TOTAL AMOUNT DUE X797.94 This statement is net and payable in full within 30 days of receipt. Please return this portion with your Remittance $ Amount Enclosed Service ID # 15603-92 Mabel R. Rhoads REV-Z~ll EX+ (1?-08j • ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER MABEL R. RHOADS Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ~~ iiwic aNa~e is neeaea, inseR aaa~tionai sheets of the same size. APR 3 0 2009 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF FINANCIAL OPERATIONS DIVISION OF THIRD PARTY LIABILITY ESTATE RECOVERY PROGRAM PO BOX 8486 HARRISBURG, PA 17105-8486 April 28, 2009 SAIDIS SHUFF FLOWER & LINDSAY JAMES D FLOWER ESQUIRE 26 W HIGH ST CARLISLE PA 17013 Re: MABEL RHOADS CIS #: 420174853 SSN: 175-34-8005 Date of Death: 04/14/2009 Dear Attorney: Please be advised that the Department of Public Welfare maintains a claim in the amount of $191,053.51 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 reimbur;~e 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 $21,645.49, 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 $169,408.02, is to be entered as a priority Class 5.1 claim against the estate. Please acknowledge receipt of this letter and advise whether tYie Commonwealth's claim is admitted and when payment may be expected. If the estate accounting is complete, please provide a copy. If the estates contains real estate, please provide copies of the deed, the latest tax asse~osment, and a current appraisal, if available. Sincerely, Patricia Nace Claims Investigation Agent 717-772-6616 717-772-6553 FAX Enclosure