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Home My WebLink About11-18-10 (2)1505610143 REV-1500 Ex (o,-10, OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code Year File Number Bureau of Individual Taxes DEVARTMENT OF REVENUE PO 80X.280601 INHERITANCE TAX RETURN 21 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 201 18 0974 09 09 2010 10 25 1925 Decedent's Last Name Suffix Decedent's First Name MI PECK SHIRLEY M (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 ^ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) ^ 4. Limited Estate ~ 4a• Future Interest Compromise (date of death after 12-12-82, ~ 5. Federal Estate Tax Return Required ^ 6 Decedent Died Testate (Attach Copy of Will) ^ 7 Decedent Maintained a Living Trust (Attach Copy of Trust, ~ 8. Total Number of Safe Deposit Boxes 9. Litigation Proceeds Received ^ 10• between P2 31 zJ1Candtl(datge5;fdeath ~ 11.Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION ~~HOULD BE DIRECTED TO: Name Daytime Telephone Number JENNIFER B HIPP 717 737 8761 First tine of address 1 WEST MAIN STREET Second line of address City or Post Office SHIREMANSTOWN Correspondent's a-mail address: State ZIP Code PA r.~, REGISTER f~$~dLLS USNLY ~::~. --~ ~ f j t ~ L ~ ~ ~~~ •ha .., k ` ' (, ~' ` ,;, .~ .~.. ~ ~ .. ..w~s ~.--I .,} DAB FILED Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of rriy 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. ADDRESS 1 West in Street, Shiremanstown, PA Side 1 1505610143 1,505610143 ,J ~~ 15241nverness Drive Mechanicsbur PA 17050 SIGNATURE F REPARE~ OTHER THAN REPRESENTATIVE GATE ~., .., Jennifer B. Hlpp I (~ 1 i(„. -r C J 1505610243 REV-1500 EX Decedent's Social Security Number Decedent's Name: pgCk, Shirley M. 201 18 C1974 RECAPITULATION 1. Real Estate (Schedule A) ....................................................................................... 1. 76.00 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. 5,390.00 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5. 6. Jointly Owned Property (Schedule F} ^ Separate Billing Requested............ 6. 82 , 132.14 7. Inter-Vivos Transfers & Miscellaneous NQq Probate Property Re uested arate Billin Se 7 ............ q g p (Schedule G) u . l37 , 598 .14 g_ ......................... Total Gross Assets (total Lines 1-7) ............................................ 8. 858.50 9. Funeral Expenses & Administrative Costs (Schedule H} ....................................... 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule i) .............................. 10. 8 5 8 . 5 0 11. ........... Total Deductions (total Lines 9 & 10} ........................................................ 11. 86,739.64 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............................................... 13. 8 6 , 7 3 9.64 14. ................................... Net Value Subject to Tax (Line 12 minus Line 13)............ 14. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15. 0 . 0 0 (a)(1.2) X .00 16. Amount of Line 14 taxable $ 6 , 7 3 9.64 16. 3 , 9 0 3 .2 8 at lineal rate X .045 17. Amount of Line 14 taxable 0 0 0 17 0. 0 0 . at sibling rate X .12 . 18. Amount of Line 14 taxable 0 0 0 18' 0 • ~ ~ at collateral rate X .15 • 19. Tax Due ..................................................................... ............................... 19. 3 , 903 .28 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ Side 2 ~, 1505610243 1,505610243 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 DECEDENT'S NAME Peck, Shirley M. STREET ADDRESS Chapel Pointe 770 S. Hanover Street CITY STATE ZIF' Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount (1) 3,903.28 195.16 3. Interest 195.16 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box 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. c5) 3,708.12 Make Check Payable to: REGISTER OF WELLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: f d Yes No x :............................................................................... erre a. retain the use or income of the property trans re in the ri ht to desi Hate who shall use the ro ert transferred or its income :.................................. b to g g p p Y ^ ^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 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?....... ^ ^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 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 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 [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)J. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Total Credits (A + B) (2) (3) (4) . Rev-1503 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUME3ER Peck, Shirley M. 21 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 Series EE US Savings Bond -This bond had a face value of 76.00 $50.00. (No copy of the bond was made, nor do we have a record of its serial number.) The bond was redeemed for $75.00 and some cents. However, we are reporting the amount of $76.00 for purposes of this inheritance tax return, given the failure to obtain records of this transaction. TOTAL (Also enter on Line 2, Recapitulation) 76,00 ({f more space is needed, additional pages of the same size) Copyright (c} 2002 form software only The Lackner Group, inc. ~ Form PA-1500 Schedule B (Rev. 6-98) , Rev-1508 EX+ (6-98) t +s I COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Peck, Shirley M. 2~ Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-1509 EX+ (6-98) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMIBER Peck, Shirley M. 21 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 ADDRESS RELATIOINSHIP TO DECEDENT A. Gary W. Peck B. C. 1524 Inverness Drive Son Mechanicsburg, PA 17050-8328 .1~INTLY 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 ASSE % OF= DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1 A Anchor Financial Group -Investment Accoun 163,221.67 50.000% 81,610.84 #082082490 2 A Mid Penn Bank -Date of death balance 1,042.59 50.000% 521.30 $1,042.55; accrued interest $0.04. TOTAL (Also enter on Line 6, Recapitulation) I 82,132.14 (If more space is needed, additional pages of the same size) Copyright (c} 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98) SCHEDULE F JOINTLY-OWNED PROPERTY • Fin~u~ciat Group September 21, 2010 Jennifer Hipp 1 W. Main St Shiresmanstown, PA 17011 RE: Shirley M Peck Dear Attorney Hipp: 415 Fallowfield Rd STE 300 Camp Hiil, PA 17011-4906 1857 William Penn Way sTr ?o~ Lancaster, PA 17601-6741 717-97~-0509 800-377-3Q97 717-975-0587 Fay v~~w~,.anchorfinancialgroup.com anchorG~uanchorfinanciaigroup.com At the request of Gary Peck, I am enclosing a statement that values the account 082082490 as of the date of death for Shirley M. Peck. This account is registered as a joint account with rights of survivorship with Gary M Peck. This account was opened at Anchor in January of 2007. This account was previously held at Citigroup with Smith Barney and was transferred to the above account with the same registration. Please feel free to contact us if you require any additional information. Thank you. Best Regards, Denise K. Wurster Director of Client Relations CC: Gary W. Peck Enc. Solid ~4.dvice from Trusted Advisors S curities and Ad~, :sort' Services offered through Multi-Financial Securities C'or,~oration. Me~,~ber: FII~rRfi*SIf'C Anchor Financial Group is not affiliated t~itl-~ Multi--Financial Securities ~'orp~rati~~r Statement 09/09!2010-09109/2010 Combined Account Portfolio Prepared For Shirley M Peck 1524 Inverness Drive Mechanicsburg, PA 17050 Prepared By DONALD YOST and MICHAEL HOWARD ANCHOR FINANCIAL GROUP 415 Fallowfield Road Suite 300 Camp Hill, PA 17011 Statement Shirley M Peck 1524 Inverness Drive Mechanicsburg, PA 17050 DONALD YOST and MICHAEL HOWARD ANCHOR FINANCIAL GROUP 415 Fallowfield Road Suite 300 Camp Hill, PA 17011 717-975-0509 Table of Contents Holdings by Investor ...................... 1 Portfolio Summary ........................ 2 Disclosure ............................... 3 Combined Account Portfolio Period: 09/09/2010-09/09/2010 Created: 09/20/2010 Incomplete if presented without accompanying disclosure page Statement Shirley M Peck DONALD YOST and MICHAEL HOWARD Combined Account. Portfolio 1524 Inverness Drive ANCHOR FINANCIAL GROUP Period: 09/09/2010-09/09/2010 Mechanicsburg, PA 17050 415 Fallowfield Road Created: 09/20/2010 Suite 300 Camp Hill, PA 17011 717-975-0509 Holdings by Investor Shirley M Peck Acct Name:SHIRLEY M PECK AND GARY W PECK JTWROS 1524 INVERNESS DRIVE MECHANICSBt1RG PA 17050-8328 Acct No:08Z082490 AcctType:Joint AF~GRQWTH FUND OF AMERICA . E3FAFX US STOCKS ~ AMERICAN 935.48 26:59 _24,874.47 'CLASS F FUNDS `~ ' PTIMUM MID CAP FUNQ GHTTX STOCKS RO US 465..08 _ 26.80 12,464,06 _ CLA~S N ., :FUNDS .. . BROKERAGE MONEY MARKET - ..:_: CASH~~ BROKERAGE 2,205.39 'I.00 2,205.39 . MONEY' . '.MARKET DODGE 8~ COX INTERNATIONAL DODFX NON-US .STOCKS DODGE & COX 483.63. 311.78 15,369.62 STOCK FUND FUNDS MANAGERS FREMONT BOND FUND MBDFX "BONDS ' `MANAGERS 3,692.20 11.03 40,724 85 "SURPAS~k ~ ._ ... ' r A MUTUAL FUND PENNSYLVANI PENNX US STOCKS ROYCE FUNDS, 1,301.38 9.58 12,467.20. INVESTMENT CL 'THE..;, . THIRD AVE REAL ESTATE VALUE TAREX ' REAL ESTATE ~ 'THIRD AVENUE ~ ~ "48410 21.38 ,10,350.08 ~, ~ . LL _ } :FUNDS ~ :~ ; TRP EQUITY.INCOME PRFDX US STOCKS T.ROWE PRICE 1,202.01 21.11 25,374`37 VANGUARD.INFLATION ~ : VIPSX BONDS ~ VANGUARD 1,479.15 ~ 13.11 `19,391.62 -PROTECTEDSECURiTIES ~FD #119 . , ~~ ~~ ~ FUNDS . Account Total: $163,221.67 Investor Tota 1: $163,221.67 Incomplete if presented without accompanying disclosure page Page 1 of 3 Statement Shirley M Peck 1524 Inverness Drive Mechanicsburg, PA 17050 DONALD YOST and MICHAEL HOWARD ANCHOR FINANCIAL GROUP 415 Fallowfield Road Suite 300 Camp Hill, PA 17011 717-975-0509 Combined Account Portfolio Period: 09/09/2010-09/09/2010 Created: 09/20/2010 Incomplete if presented without accompanying disclosure page Page 2 of 3 Statement Shirley M Peck DONALD YOST and MICHAEL HOWARD Combined Account Portfolio 1524 Inverness Drive ANCHOR FINANCIAL GROUP Period: 09/09/2010-09109/2010 Mechanicsburg, PA 17050 415 Fallowfiield Road Created: 09/20/2010 Suite 300 Camp Hill, PA 17011 717-975-0509 Disclosure: Securities offered through Multi-Financial Securities Corporation (MFSC), member FINRA/SIPC. Multi-Financial Securities Corporation (MFSC) and ANCHOR FINANCIAL GROUP are affiliated companies. Values are as of 09/09/2010 unless otherwise noted. We believe the sources to be reliable, however, the accuracy and completeness of the information is not guaranteed, as it is a compilation of information from various financial sources (mutual funds, direct participation programs, correspondent brokers, etc.). In the event of any discrepancy, the sponsor's valua~lion shall prevail. Performance data quoted represents past performance and does not guarantee future results. The investment return and principal of an investment will fluctuate so that an investor's shares when redeemed may be worth more or less than the original cost. The values represented in this report may not reflect the true original cost of the client's initial investment. For fee-based accounts only: the figures may or may not reflect the deduction of investment advisory fees. If the investment is being managed through afee-based account or agreement, the returns may be reduced by those applicable advisory fees. Refer to your Advi:;or's Form ADV, Part II. The information contained in these reports is collected from sources believed to be reliable. However, you should always rely on your statements received directly from product sponsors. If you have any questions regarding your report, please call your representative. This report may contain Manually Entered Assets. The accuracy and authenticity of Manually Entered Assets is reliant solely on the provider of the information and not controlled by or attested to as accurate by Multi-Financial Securities Corporation (MFSC), its affiliates or business partners. Any information represented as Manually Entered Assets should be regarded as informational only and not interpreted as official or legal financial positions. Although the securities listed may have been offered through Multi-Financial Securities Corporation (MFSC), member SIPC, the attached report is not aMulti-Financial Securities Corporation (MFSC) report. Investment values listed in this report are as of 09/09/2010, unless otherwise noted. This report has been prepared by Albridge Solutions Inc using sources of information that Albridge believes to be reliable. However, you should always review and rely on statements that you receive from your custodian. The preparation of this report may have required assumptions about the rate of return on investments. The use of the term "ratE: of return" (or similar terms), is not intended to be an expressed or an implied guarantee of actual performance. Securities do not offer a fixed rate of return or risk, so when redeemed or sold, you may receive more or less than you originally invested. Also, past performance data included in thus report does not guarantee future results. The investment return and principal of an investment will fluctuate so that an investor's shares when redeemed may be worth more or less than the original cost. The values represented in this report may not reflect the true original cost of the client's initial investment. Multi-Financial Securities Corporation (MFSC) does not guarantee the accuracy of positions owned or the market value of such positions. In the event of any discrepancy between this report and any statement you receive from a custodian regarding the same investment, •you should rely on the statement from your custodian. If you have any questions regarding a report you receive involving investments in your Multi-Financial Securities Corporation (MFSC) account, please call your representative. Performance calculations are performed using the Modified Dietz Calculation method The Modified Dietz formula is used as an approximation to the true, money-weighted rate-of-return (MWRR) or internal rate of return (IRR). The portfolio or asset is valued at the starting and ending points of the period. Cash flows are included in the calculation based on their timing (i.e., when they occurred during the period). The Modified Dietz will yield a result which approximates the IRR, which is the true, money-weighted rate-of-return. If the cash flows and returns are large, then the ability for the Modified Dietz to approximate the IRR is diminished. Otherwise, the Modified Dietz serves as an acceptable approximation to the IRR. Performance returns for time periods longer than 365 days have been annualized. Page 3 of 3 . I W 1 k • • , • October 19, 2010 James D. Bogar 1 W. Main St. Shiremanstown, PA 17011 Re: Estate of Shirley M. Peck Date of Death: 9/9/2010 SSN: 201-18-0974 Dear Ms. Hipp, In response to your recent letter requesting information on the accounts of Shirley M. Peck, I have accumulated the necessary data below: Account Name: Shirley M. Peck Gary W. Peck Account #: 8004376 -Checking Account Date Opened: 4/1/1997 Balance DOD: $1042.55 Balance Accrued Interest DOD: $.04 Total DOD Balance: $1042.59 Date Joint Ownership Established: 4/1/1997 If you have any questions, please contact me at (717) 896-5381. Sincerely, ~F ~-~_---__. ~~~--- Jes~ca Kerwin Deposit Processing Specialist 349 Union Street, Millersburg, PA 17061 1-866-bHAPPEN • 1-877-9HAPPEN • www.midpe>nnbank.com Member FDIC REV-1151 EX+ (10-06) '~ 3 Sf ' I~ ~ ~h COM IN~ ERITANCE TAX RETURN ANIA RESfDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Peck, Shirley M. 2~ Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A, FUNERAL EXPENSES: B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zia Year(sl Commission raid 2. Attorney's Fees Bogar and Hipp Law Offices 840.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zir, Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 18.50 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 858.50 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUME3ER Peck, Shirley M. 21 ITEM NUMBER DESCRIPTION AMOUNT Other Administrative Costs 1 Mil{enium Pharmacy 18.50 H-B7 18.50 Copyright (c} 2002 form software only The Lackner Group, lnc. Form PA-1500 Schedule H (Rev. 6-98) ' REV-1513 EX+ (11-08) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Peck. Shirley M. ~1 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE P,MOUNT OF ESTATE NUMBER PERSONISI RECEIVING PROPERTY DECEDENT (Words) ($$$) Do No List Trust e s I TAXABLE DISTRIBUTIONS (include outright spousal distributions, and transfers under Sec. 9116 a 1.2 Gary W. Peck Son Rest, residue 1524 Inverness Drive and remainder of Mechanicsburg, PA 17050 Estate Total Enter dollar amounts for distributions shown above on lines 1 5 throu h 18 on Rev 150 0 cover sheet, as a r o ~riate. NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEtV B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08)