HomeMy WebLinkAbout12-30-101505610140
-' REV-1500 ~` ~°'-'°'
OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes
INHERITANCE TAX RETURN County Code Year File Number
Po Box 2sosol 2 1 1 0 0 2 3 2
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
1 7 5 1 4 7 1 7 9 0 2 2 1 2 0 1 0 1 1 3 0 1 9 2 0
Decedent's Last Name Suffix Decedent's First Name MI
McLaughl i n Grov er H
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Mc L a u g h l i n Do r o t b y F
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 ~ 5. Federal Estate Tax Return Required
death after 12-12-82)
0
Q 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
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
Scot t W. Mor ri son, Esq 717 582 2300
~~..~
REGISTER OI USE 01 ~
~~ Q
t"t°i~ f"r1
First line of address ~ w r- ['3 ~ ~~
6 Wes t Mai n S t r e e t ~;~ ° -~- ~,
Second line of address ~ ~'~ a., ~;
P O. Box 2 32 ~--+ Ev ~~~
City or Post Office State ZIP Code BATE FILED q ~
"a
New B I o o mf i e l d PA 1 7 0 6 8
Correspondent's a-mail address:
Under penalties of perjury, I declare that I have examined this return, indudi 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 pe I representati is sed on all information of which preparer has any knowledge.
SIG T RE F PERSAAI RE O, SI LE FOR FILING RETURN ~ DATE
ADDR S
3 Co D Mechanicsbur ~ 124 Pointe Ride York PA
SIGNATURE RE R HAN REPRESEN E , Z ~q
L ~ ~~
ADDR
6 W s ain Street New Bloomfield PA 17068
PLEASE USE ORIGINAL FORM ONLY
1505610140
Side 1
1505610140
J
1505610240
REV-1500 EX Decedent's Social Security Number
Decedenrs Name• Grover H. McLaughlin 1 7 5 1 4 7 1 7 9
RECAPITULATION
1. Real Estate (Schedule A) ........................................... 1 • •
Z. 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. •
2 7 4 8 8 6 • 9 5
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5.
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6.
7. Inter-Vivos Transfers 8 Miscellaneous NQn-Probate Property
d
R
t
te Billi
7
•
.......
e
ng
eques
(Schedule G) (~ Separa .
9 5
2 7 4 8 8 6
8. Total Gross Assets (total Lines 1 through 7) ........................... 8. .
9 1 1 6 9 6. 2 4
9. ............
Funeral Expenses and Administrative Costs (Schedule H) .... .
..
7 2 9 2 ' 2 8
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ....... .... .. 10.
11. Total Deductions (total Lines 9 and 10) ......................... .... .. 11. 1 8 9 8 8 • 5 2
12. Net Value of Estate (Line 8 minus Line 11) ...................... .... .. 12• 2 5 5 8 9 8. 4 3
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. 2 5 5 8 9 8. 4 3
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
Q
0
Q
15
0.
0
Q
.
(a)(1.2} X .0 .
16. Amount of Line 14 taxable
4
2 5 5 8 9 8
3
16 1 1 5 1 5. 4 3
.
at lineal rate x .045 .
17. Amount of Line 14 taxable Q Q Q 17 Q • Q Q
at sibling rate X .12 .
18. Amount of Line 14 taxable
~ Q
Q
18 Q • Q Q
at collateral rate X .15 .
19. TAX DUE ............................................... .... ...19. 1 1 5 1 5. 4 3
20. FILL IN THE OVAL iF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Q
Side 2
1505610240 1505610240 J
J
REV-1500 EX Page 3
Decedent's Complete Address:
Flle Number
21 10 0232
DECEDENT'S NAME
Grover H. McLau hlin
STREET ADDRESS
2100 Bent Creek Boulevard
CITY
Mechanicsbur STATE
PA ZIP
17050
Tax Payments and Credits:
7 • Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments 12,000.00
B. Discount 575.77
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) 11,515.43
Total Credits (A + B) (2) 12, 575.77
(3)
(5)
(4) 1, 060.34
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 : ............................................................... ....... ^
^
0
b. retain the right to designate who shall use the property transferred or its income; ....................... ........
^ X
c. retain a reversionary interest; or ........................................................................................ ........
^ X
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? ............................................................................... ........ ^ 0
3. Did decedent own an "intrust for" orpayable-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? .......................................................................................... ........ ^ 0
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 i.
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-1508 ~X + (6-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Grover H McLaughlin 21 10 0232
Include the proceeds of litigation and the date the pnxeeds were n3ceived by the estate.
All property jointly-0wned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER ~ DESCRIPTION OF DEATH
1. PNC Bank checking account #5006443876 12,718.54
2. PNC Bank savings account #5005191021 148,531.39
3. RBC Wealth Management -see attached letter 101,722.37
4. Sale of Ford Focus 10,000.00
5. Genworth -Long term care refund - 197.26
6. Income tax refund 1,480.00
7. Allstate Insurance refund 13.60
8. Comcast/Allstate refunds 223.79
TOTAL (Also enter on line 5, Recapitulation) ~ S 274,886.95
(If more space is needed, insert additional sheets of the same size)
REV-1511 ~X+ (10-09)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Grover H McLaughlin 21 10 0232
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Myers-Harner Funeral Home -funeral 7,396.00
B.
2.
3.
4.
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City
Year(s) Commission Paid:
Attorney Fees:
State ZIP
Family Exemption: (If decedents address is not the same as claimants, attach explanation.) 3, 500.00
Claimant Dorothy F. McLaughlin
Street Address 2100 Bent Creek Boulevard
~;ty Mechanicsburg State PA zIP 17050
Relationship of Claimant to Decedent wife
Probate Fees: Glenda F. Strasbaugh, Register of Wills 431.50
5 Accountant Fees:
6. Tax Return Preparer Fees:
7.
8
Cumberland Law Journal -estate advertising 75.00
The Sentinel -estate advertising 293.74
TOTAL (Also enter on Line 9, Recapitulation) I ~ 11,696.24
If more space is needed, use additional sheets of paper of the same size.
REV-1512 EX+ (12-08)
pennsytvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF .FILE NUMBER
Grover H. McLau hlin 21 10 0232
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Rosa Lucidon -nursing care 180.00
2. ~ Prsim -hospital care
3. ~ ROBC Limited -Bridges final bill
TOTAL (Also enter on Line 14, Recapitulation) I $
If more space is needed, insert additional sheets of the same size.
155.00
6,957.28
REV-1513 EX+ (01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF:
FILE NUMBER:
Grover H. McLau hlin ~~ ~u UL3L
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not list Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outtsn'ght spousal distributions and transfers under
Sec. 91't6 (a) (1.2).]
1. Melissa McLaughlin, n/b/m, Melissa Humer Lineal
3 Connie Drive one-half
Mechanicsburg, PA 17050
2. Dennis A. McLaughlin Lineal
124 Pointe Ridge Drive one-half
York, PA 17402
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER S HEET, 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, a
If more space is needed, use additional sheets of paper of the same size.
LAST WILL AND TESTAMENT
OF
GROVER H. McLAUGHLIN
I, GROVER H. McLAUGHLIN, of Camp Hill, Cumberland County,
Pennsylvania, being of sound mind, memory and understanding, do
hereby make, publish and declare this to be my Last Will and
Testatnent, revoking hereby all wills and codicils at any time
heretofore by me made .
~--~ r~~
`rt~~
-~~}
y~ : :. -.
`
.~~ ~
I direct that all of my just debts, together with thie~~~~ '~'" ~ " ~'
expenses of my funeral and the cost of a gravemarker, be ~3'did as CT ~~~~
soon as practicable after my death.
II.
I give, devise and bequeath all the rest, residue and
remainder of my estate, both real and personal, of whatever kind
and wheresoever situate, of which I shall die possessed or of
which I shall be entitled to dispose at the time of my death, to
my beloved wife DOROTHY F. McLAUGHLIN.
PAGE ONE OF THREE PAGES
~ ~.
~. /''u~, ~,Cd
GROVER H. McLAUGHLI
III.
In the event my wife DOROTHY F. McLAUGHLIN shall predecease
me, dies simultaneously with me or dies within thirty (30) days
after my death, my aforesaid devise and bequest to her shall
lapse and, in t~iat event, I give, devise and bequeath all the
rest, residue and remainder of my estate to my beloved son
DENNIS A. McLAUGHLiN and my beloved daughter MELISSA A. HUMER,
per stirpes.
IV.
I hereby nominate, constitute and appoint my wife DOROTHY
F. McLAUGHLIN as Executrix of this my Last Will and Testament.
In the event she shall for any reason fail to qualify, or having.
qualified shall cease to act as Executrix hereof, then I
nominate, constitute and appoint my son DENNIS A. McLAUGHLIN and
daughter-in-law MELISSA McLAUGHLIN as Alternate Co-Executors of
this my Last Will and Testament in her place and stead. In the
event one of them predeceases me though I nominate, constitute
and appoint the survivor as my Alternate Executor or Executrix,
as the case may be.
v.
I direct that all taxes that may be assessed in consequence
of my death, of whatever nature and by whatever jurisdiction
imposed, shall be paid from my residuary estate as a part of the
expense of the administration thereof, without apportionment.
. ~~ _ ) ~.
GROVER H. McLAUGHLI
PAGE TWO OF THREE PAGES
VI.
I direct that no person serving as Executrix or Executor of
this Will be required to enter security in any jurisdiction in
which they might act.
1
IN WITNESS WHEREOF, I have this ,~ t'~~~ day of ~~~~''~'" ~"~
2006 hereunto set my hand and seal.
Signed, sealed, published and declared by the above-named
Testator, DROVER H. McLAUGHLIN, as and for his Last Will and
Testament in the presence of us, who, at his request, in his
K
presence and in the presence of each other, all being present at
the same time, have subscribed our names as witnesses.
WITNESS:
1
~ -~~ ~~~
U
;;.
of
DROVER H. McLA GHL~
PAGE THREE OF THREE PAGES
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF DAUPHIN
We, DROVER H. McLAUGHLl"N,
SS
Herschel Lock
Thomas P. Lyon the Testator and the Witnesses
and
respectively, whose names are signed to the attached or
foregoing instrument, being first duly sworn, do hereby declare
to the undersigned authority, that the Testator signed and
executed t?~.e instrument as his Last Will and that r~° read signed
willingly, and treat he executed it as his free and voluntary act
for the purposes therein expressed, and that each of the
witnesses, in the presence and hearing of the Testator signed
-~
the Will as witnesses and that to the best of their knowledge
the Testator was at the time Eighteen (18) years old or older,
of sound mind and under no constraint or undue influence.
DROVER H. McLAUGHLIN
.^ ~ /
~ ~, ~/
.~ .
WITNESS ~;
e
.~:
Subscribed, sworn. to and
acknowledged before me~by
DROVER H. McLAUGHLIN, the
Testator, and subscribed
and sworn before me by
Herschel Lock
WITIv'~SS
and Thomas P. Lyon
witnessed t is 3 ,.~ day of ,
~~~~~ 2006.
Notary Public
e~ ,
~r
QFNC
~~~
April 5, ~~ I 0
Sccxtt ~ Mar~so~n Es~qu~xe .
+~eatict Scluete
F4 Box 232
Nevi Blooxuf eld, PA 1708
RE: Cnover H I4~cL~ugt
ESN: 175-14-7I79
pQD-: 0~l2I1 ~tI10
Dear Mr. Ivioaison:
In response tt} your reg~st fir DeEe oaf Dealt D~ bala~tces t~ ct~am~c ~t'e~ eve, our
retards show fallowing:
~b Account
Account # 504f~443876- ~s#abls~he~d: 101082409
~RC~~R H NICLAUCIHI.Il'~
DOD b~aace: ~ 12,71$.SA~ + O.a4 nan interes# g
Acca~ # 514Q5 Established: 491(11!1962
"` CRO~ER I~ 1VICI~UG1iI~I~1'
R~T~" F CLAUGHLIN
~30D ba~nce: ~ ?,.35'1.79 + 0..16 sc+~n~ed intere~
~ d Q1101~241Q - 02/21~Q10 -~ $4.43
Swings Accenn#
Accc~uot # 3(x05191 x21 Estab~lisbed: Q6~;?l2~?
~RDV~ 1-I M~LAUQrHI.IN
~~ Nance: $ 148,456.58 + ?4.$1 act intst
Interest paid t11/f1112010 -- Q~1/Z@1Q - $88.Q5
Page t of 2
RBC Wealth Managernent°
Renaissance Place
635 North 12th St, 2nd FL
Lemoyne, PA 17043
Phone: 717-724-4200
Toll Free: 800-480-7497
Fax: 717-724-4239
ESTATE OF GROVER H. MCLAUGHLIN
DATE OF DEATH: 2/21/2010
S/S #175-14-7179
Quantity Description Symbol Unit Cost Total Cost
9,227.872 Eaton Vance Income Fund ECIBX $5.54 $51,122.41
50,599.96 Prime Money Market TPMXX $1.00 $50,599.96
This material is based on data obtained from sources we consider to be reliable; however, it is not
guaranteed to accuracy and does not purport to be complete. The illustration represents a hypothetical
situation and is for informational use only.
R B CNealth Management, a division of RBC Capital Markets Corporation, Member NYSE/FINRA/SIPC
COMMONWEALTH OF PENNSYLVAN{A
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF PROGRAM INTEGRITY
DIVISION OF THIRD PARTY LIABILITY
ESTATE RECOVERY PROGRAM
PO BOX 8486
HARRISBURG, PA 17105-8486
April. 6, 2010
SCOTT W MORRISON ESQUIRE
P 0 BOX 232
6 W MAIN ST
NEW BLOOMFIELD PA 17068
Re: Grover Mclaughlin
SSN: ###-##-7179
Dear Attorney Morrison:
Pursuant to your letter dated March 11, 2010, the Department of Public
Welfare (DPW), Estate Recovery Program, has reviewed the information you
provided regarding the above-referenced individual.
It has been determined that this individual did not receive any type of
assistance during the questioned period.
Therefore, according to the information you provided, the Department's
Estate Recovery Program will not seek any recovery from this estate. If your
client applied for Medical Assistance and had an application and/or hearing
pending at the time of death, please advise us and provide any additional
information that may affect a recovery by our Department.
If you have any questions, please feel free to contact me.
Sincerely,
rr'~~
~~ {~ ~d
Vince A. Porter
Recovery Section Manager
(717)772-6604