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Home My WebLink About12-06-10 1505610101 REV-1500 Ex ~°1 .1°' ~ PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes PO BOX 280601 ~EP~a,MEN,,,FaE~E~,~E County Code Year File Number INHERITANCE TAX RETURN Harrisburg, PA 1'7f28-o601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 206-32-2200 11/17/2009 09/17/1942 Decedent's Last Name Suffix Decedent's First Name MI Beamer Ms. Patricia A (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 tN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW Clb 1. Original Return O 2. Supplemental Retum C~ 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust _,_ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 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 SHOVE DIRECTED Name Daytime Telephon ~ber ° -, ~ . Theresa L. Sheaffer Q rt: (717) 432-23 ~ ~ ~ f.. _ _ , REGISTER ._ . ,~ SE Of~1' -~ ('_,- , ., .- _. ~ _, First line of address ~ ~ 24 Pine Street ~ ~ -~ N - ~ ~ ` Second line of address CI"+ ' City or Post Office Dillsburg State ZIP Code PA 17019 DATE FILED Correspondent's a-mail address: Sheaffer5l~VeriZOn.net under aloes of perjury, I eclare at I have examined this return, including accompanying schedules and statements, and to the best °f my knowledge and belief, it is tr orrect and mp la anon of preparer other than the personal representative is based on al( information of which preparer has any knowledge. G P IB E O F LI G RET RN A DRESS ALL 0 ~~ ~ ~ ~ ~~ _.~~al SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DAT AUUKt55 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 1505610101 J REV-1500 EX Decedent's Name: Patricia A. Beafllef Decedent's Social Security Number 206-32-2200 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. Mart a es and Notes Receivable Schedule D 9 9 { ) ....................... .... 4. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)... .... 5. 2,472.71 6. Jointly Owned Property (Schedule F) O Separate Bitting Requested ... .... 6. 0.00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested.... .... 7. 0.00 8. Total Gross Assets (total Lines 1 through 7} ......................... .... 8. 2,472.71 9. Funeral Expenses and Administrative Costs (Schedule H) ................ ... 9. 8,641.$7 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ........... ... 10. 0.00 11. Total Deductions (total Lines 9 and 10) .............................. ... 11. 8,641.87 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. -6,169.16 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ..................... ... 13. 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13) ..................... ... 14. 0.~0 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__ O.OO 15. 16. Amount of Line 14 taxable at lineal rate X .0 _ 0.00 16 17. Amount of Line 14 taxable at sibling rate X .12 0.00 17. 18. Amount of Line 14 taxable at collateral rate X .15 0.00 18 19. TAX DUE ............................................... ........ ..19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610105 1505610105 1505610105 0.00 0.00 0.00 0.00 0.00 C~ J REV-1500 EX Page 3 File Number Decedent's Complete Address: DECEDENTS NAME Patricia A. Beamer STREET ADDRESS C/O Manor Care of Carlisle 940 Walnut Bottom Road CITY STATE ZIP Carlisle PA 17015 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) _ 0.00 2. Credits/Payments 0.00 A. Prior Payments B. Discount 0.00 0.00 Total Credits (A + B) (2) 3. Interest (3) _ 0.00 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) _ 0.00 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 0 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 : .......................................... .. ^ X^ c. retain a reversionary interest; or ........................................................................................................................ .. ^ ^ 0 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? ............................................................................................................ .. ^ ^X 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? ...................................................................................................................... .. ^ 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FI LE 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 p~srcent, 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.?~)]. 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. REV-1508 EX+ (6-98) SCHEDVLE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FIi.E NUMBER Patricia A. Reamer 2009-01108 Indude the proceeds of ktigation and the date the proceeds were received by the estate. Att property jointly-owned with right of survimrship must be disclosed on Schedule F. fir more space is needed, insert additional sheets of the same size) r~` .-t,11 -~` ~ pennsytvania SCHEDULE H DEPAgTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Patricia A. Beamer 2009-01108 Decedent's detrts must tre reported on Schedule I. ITEM NUMBER DESCRIPTION _ AMOUNT A. FUNERAL EXPENSES: I' Funeral director and staff 3,725.00 2. Coffin and vault 2,985.00 3. Cemetary charges and property 1,300.00 4. Certified copies 24.00 5. Death notices/newspapers 457.87 s. Cemetary equipment 150.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid: Z• Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address City State ZIF Relationship of Claimant to Decedent 4• Probate Fees: 5• Accountant Fees: 6. Tax Return Preparer Fees: 7. TOTAL (Also enter on Line 9, Recapitulation) ~ $ 8,641.87 If more space is needed, use additional sheets of paper of the same size. Send inquires to: 5QE10 Louise Drive RO Box 40 Mechanicsburg, PQ 17055 www.members 1 st.org Main Switchboard: {BO0) 283.-2328 EZ Caii: {717) 697-4372 or {800) 283-4372 TDD: (717) 697-5312 or {800) 283-2328 ext. 5312 TeleBranch: (Soo} 237-7288 4139 1 AV 0.335 8277_gi3° IE~~lil~~~lll~~~~~~fll~l~~l~l,~~It~I~I~~I~I~I~~~I~I~I~~I~I~~II PATRICIA A BEAMER CIO THERESA SHEAFFER 24 PINE STREET DILLSBURG PA 17019-9445 Statement of Accounts Oct 25, 2009 thru ~Jov 24, 2009 Account Number : 167261 Balances at a Glan~~e Checking : 2 { 423.01 Savings: 49.70 Certifica#es : 0.00 Loans: 0.00 Money Martiage-~er~t : 0.00 Swipe 5 YTD Reward : 0.00 Page : 1 of 2 Your aggregate balance as of November 1st is $1,878.51. An aggregate balance of $2,500 and having 3 products will place you in the Silver MLR level. Need the perfect gift for someone on your gift fist? Give them a Visa Prepaid Gift Card. For more information visit www.membersl st.orglpromotions.aspx. CHECKING ACCOUNTS 0011 -CHECKING Date Transaction Description Additions Subtractions Balance Oct 25 Ba/once Forward 1,840.84 Joint Owner: CHRYSTAL E RAMSEY Joint Owner: THERESA L SHEAFFER Oct 26 Withdrawal ACH GERBER LIFE INS 4.33- 1,836.51 TYPE : INSURANCE !D : 0000991752 DATA: 800-704-2180 CO: GERBER LIFE INS Oct 27 Check 000900 Tracer 0001332282 15.00- 1, 821.51 Oct 30 Deposit Transfer 10.00 1, 831.51 From RAMSEY ,CHRYSTAL 00001fi0020 Share 11 Nov 02 Check 000902 Tracer 0002202922 11.50- 1,820.01 Nov 03 Deposit Transfer From Share 00 773.00 2,593.01 Nov 06 Deposit Transfer 10.00 2 , 603.01 From RAMSEY,CHRYSTAL XX)CXXXXX)CX Share 0011 Nov ()n Check t"~t'1(1<303 Tracer UOUs1bCi137 ____ ~?0;,.00- 2,4x3.01 Nov 13 Deposi# Transfer 10 - 04 2 , 413.01 From RAMSEY,CHRYSTAL XXXXXX)CXXX Share 0011 Nov 20 Deposit Transfer 10.00 2,423.01 From RAMSEY ,CHRYSTAL X)CXX;~CXX)UCX Share 0011 Nov 24 Endin_q Ba/once 2 , 423.01 CHECK SUMMARY Check # Amount Date Check # Amount Date 000900 15 . ~ Oct 27 000903 200 - 00 Nov 06 000902" 11.50 Nov 02 "Asterisk next to number ind~tes sk$v ,~ number sepuence 3 Checks Cleared for 2215.50 - - - Continued an following page - - - - ~ '' Send inquires to: Main Switchboard: (800) 283-2328 / 5000 Louise Drive EZ Cati: (717} 697-4372 or (800) 283-4372 PO Box 40 Oct 25 , 2009 thrta Nov 24, 2009 iNEMB6RS 1 ~ Mechanicsburg, PA 17055 Tom' 1777} 697-5312 ar (BOCJ 283-2328 ext. 5372 s!%s-=~-y Account Number: 167261 `~~"`°`~"`~"`°~ www.memberslst.org Te1e$ranch: (800) 237-7288 Page : 2 of 2 SAVINGS ACCOUNTS ~~ 0000 -REGULAR SAVINGS Transaction Description Date Aci~itions Subtractions Balance ,+... __ ._.~ Oct 25 Balance Forward 47.00 -- Joint Owner: CHRYSTAL E RAMSEY ~-~ Joint Owner: THERESA L SHEAFFER ~'-"' Nov 03 Deposit ACH 50C SEC 788.00 $35.00 '~'-" iD : 3031036030 CO : SOC SEC ~. Nov 03 Withdrawal Transfer To Share 11 77'3.00- 62.00 Nov 04 Withdrawal ACH 1-800-527-9027 1;2.30- 49.70 TYPE: SBL LIFE 1D: 1030164230 DATA: 07C CO : 1-800-527-9027 Nov 24 Ending Balance 49.70 ~'T~ SU~~1t#A~~~S TOTAL DIVIDENDS PAID 000 REGULAR SAVINGS 0.00 0011 CHECKING 0-00 Total Year To Date Dividends Paid 0.00 NOTE : Tata! includes closed shares Don't forget about our new Member Loyalty Rewards Program. The more products you have with us, the more benefits you'll receive. Ask an associate for details or visi# our avebsi#e at www.memberslst.org for details. W (~p ` O ) ~ ~ C a ~„ ~ ~ o ~ t~0~• Z Od~C)M~ ~~ s~~~o a~ ~-ate " ~}o ~a ~ Wd ~ ~ ~ ~ ~ ~ M r. _ ~~ 1' r .~. ~~ w v_ ~ r A ~ N O O r` Q J ~ N ~ C / ~ Ii ,~ x . °;~<. ~;~URT Q~~N; , . Cl~~~"~~y ~ ~ C~., F . `6 ~~