Loading...
HomeMy WebLinkAbout12-29-10-J REV-1500 Ex(01-'°' ;~ 1505610143 PA De artment of Revenue OFFICIAL USE ONLY P pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE Po Box.2soso~ INHERITANCE TAX RETURN 21 0 9 0 9 7 2 Harrisburg, PA 17128-0601 RESIDENT DECEDENT DE EDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 165 44 4319 09 29 2009 06 28 1910 Decedent's Last Name Suffix Decedent's First Name BESSELMAN RUTH (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name 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 12-13-821 ^ 4. Limited Estate ^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax Return Required (date of death after 12-12-82) ® g Decedent Died Testate (Attach Copy of Wilp ^ ~ Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust) -- ---- ^ 9. Litigation Proceeds Received ^ 1 p. 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) MI M MI CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number PATRICIA C ZUCKER ESQ 717 724 9821 First line of address 1035 MUMMA RD STE 101 Second line of address REGISTER OF WILLS USE ON~,,,Y~ C'7 ~:~ ~~ .~ r-. ~r> z m _ ~ r~ f'V < ._ _ ~::~ ~~ ©~ DATE F1L~ City or Post Office State ZIP Code ,. ~> WORMLEYSBURG PA 17043 , Correspondent's a-mail address: pzucker@dzmmglaw.com ~~ c ~~,-:~ t ::::: ~ L...~ yr ~, ~ L"5 Under penalties of perjury, I declare that I have examined this return, inGuding 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. .~. .~~vi~~~ vn~ r C AV~\ KCJr VIYJIGLC r r LIIVl7 KC I U N ~ DATE avid M. Besselman ~Z _ Z8-!~ 790 North Higghland Drive Apartment H,l-larrisburg, PA 17109 ~i4TURE EP1fR'R OTH A REP TATIV DATE /' Patricia C Zucker Esq ~" ~ . ~ . ~(~ s 1035 Mumma Rd., St 10 ormleysburg, PA 17043 Side 1 ~, 1505610143 1505610143 J J 1505610243 REV-1500 EX Decedent's Name: B E S S E L M A N, R U T H M Decedent's Social Security Number 1 6 5 4 4 4 319 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 8~ Notes Receivable (Schedule D) ............................._......................... 4. 5• Cash, Bank De osits & Miscellaneous Personal Pro a p p rty (Schedule E~ .............. 5. 1 0 9 5 8 4 7 ~ 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............. 6. 7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ............. 7. 8. Total Gross Assets (total Lines 1-7) ..............................._............................._..... 8. 1 0, 9 5 8 4 7 9. Funeral Expenses & Administrative Costs (Schedule H) ............................._........ 9. 5 , 3 4 8 4 5 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ............................... 10. 8 , 4 6 5 4 3 11. Total Deductions (total Lines 9 8~ 10~ ............................................................_.... 11. 1 3 , 8 1 3 . 8 8 12. Net Value of Estate (Line 8 minus Line 11) ..............................__........................... 12. ° 2 , 8 5 5 . 4 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. - 2 , 8 5 5.41 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 .00 15. 16. Amount of Line 14 taxable at lineal rate X .045 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 0 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. a Side 2 L 1505610243 1505610243 J REV-1500 EX Page 3 Fiie Number 21 - 09 - 0972 Decedent's Complete Address: Besselman, Ruth M STREET ADDRESS Messiah Village 100 Mt. Allen Drive CITY Mechanicsburg STATE '~i ZIP PA ~ 17055 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A• Prior Payments B. Discount 3. Interest 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 theTAX DUE (3) (4) (5) 0.00 0.00 0.00 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 :...........................................................__................ IL i x~ ~-, ;-__, b. retain the right to designate who shall use the property transferred or its income; .............................. ;~, ~ x L_, ~-, 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? ..............................__............................_............................._...................... ~', ;rX 1 .~ __~ --" 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death.?....... ~_ _ ! ~x l 4. Did decedent own an Individual Retirement Account, annuity, or other non. probate property which L -_, [_ - contains a beneficia desi nation .............. x rY 9 ~ '~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETUR 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 retturn 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 ears 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) (~.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 1.2 percent [72 P.S. §9116 (a) (1.3) . A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by bloo~ or adoption. (1) Total Credits (A + B) (2) i SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT i I I - --- -- ------------ ~ FILE NUMBER ESTATE OF Besselman, Ruth M 21 - 09 - 0972 Include the proceeds of litigation and the date the proceeds were received by the estate411 property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 PNC Bank Checking Account No. 5140232447 3,348.40 Accrued Interest 0.08 2 PNC Bank Savings Account No. 5004938357 6,716.21 Accrued Interest 0.00 3 Refund from Independence Blue Cross 53.78 4 Refund - 2009 Federal Income Tax 360.00 5 Refund - 2008 Federal Income Tax (This amount is anticipated to be received by the estate 480.00 from the IRS as a result of the filing of an amended 2008 tax return.) _ - _ TOTAL (Also enter on Line 5, Recapitulation) 10,958.47 SCHEDULE H COMMONWEALTH OF PENNSYLVANIA ~~ ~ -" INHERITANCE TAX RETURN ~~Q'rp/~"rA/c ~1"~G~ ~ RESIDENT DECEDENT ~~ ~~1IVV ~~ ~~ ~v\\ ~~ ~~ 11II ~V \,-~,/~7 ~ ~7 --- --- ---------- ----------------- jFILE NUMBER ESTATE OF Besselman, Ruth M j 21 - 09 - 0972 Debts of decedent must be reported on Schedule I. ITEM - --- -_- i ___ - -.-- -- ------ NUMBER] AMOUNT FUNERAL EXPENSES: IPTION ------_-- - - -F-- ----___- - -----_---- ----~ A. 1 ;Hoover Funeral Home 2,373.00 B. ~ ADMINISTRATIVE COSTS: 1. ~ Personal Representative's Commissions Name of Personal Representative(s) David M. Besselman - street Address 790 North Highland Drive, Apartment H 2. 3. city Harrisburg state PA zip 17109 Year(s) Commission paid 2010 Attorney's Fees Daley Zucker Meilton Miner & Gingrich, LLC Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant 4. 5. s. ~~ 7. i TOTAL (Also enter on line 9, Recapitulation) 500.00 1,994.45 83.00 i I I 275.00 I' 48.00 5,348.45 Street Address City State Zip Relationship of Claimant to Decedent Probate Fees Register of Wills, Cumberland County Accountant's Fees Tax Return Preparer's Fees Denk Accountants Other Administrative Costs Advertise Estate Notice, The Paxton-Herald C^ ~Sched~~le H COMMONWEALTH OF PENNSYLVANIA ~ ru ~~ INHERITANCE TAX RETURN ~~ ~'~ ~~ RESIDENT DECEDENT FILE NUMBER ESTATE OF Besselman, Ruth M i 21 - 09 - 0972 1 !, Advertise Estate Notice, Cumberland Law Journal '~ 75.00 Page 2 of Schedule H ,. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER ESTATE OF gesselman, Ruth M ; 21 - 09 - 0972 -- ----- _L-- Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM DESCRIPTION AMOUNT NUMBER 1 Messiah Village, final invoice 1,251.28 2 Commonwealth of Pennsylvania, Department of Public Welfare Lien 7,214.15 (Precludes distribution of residue to beneficiaries) TOTAL (Also enter on Line 10, Recapitulation) 8,465.43 REV-1513 EX+ (11-08) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT i, ESTATE OF Besselman, Ruth M ------T-- -_ _- - NUMBER NAME AND ADDRESS OF PERSON(S) __, RECEIVING PROPERTY I~ 1TAXABLE DISTRIBUTIONS[include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 2 ~ David M. Besselman 790 North Highland Drive, Apt. H j Harrisburg, PA 17109 i 3 ~ Mary Lynne Sabo (Deceased) i 4 John Callan 554 Arlington Avenue ~ Milmont Park, PA 19033 '~, RELATIONSHIP TO DECEDENT Do Not List Trustee(s) ~, Son Daughter Grandson FILE NUMBER _ _ 21 - 09 - 0972 SHARE OF ESTATE - TAMOUNT OF ESTATE (Words) ($$$) - ~ ~ - One-half 12.5% Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet, as appropriate. III 'NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN ~~ 'I I it I' B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE~f 0.00 REV-1513 EX+ (8-00) SCHEDULE J I~ COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES continued INHERITANCE TAX RETURN 'I RESIDENT DECEDENT ESTATE OF FILE NUMBER Besselman, Ruth M 21 - 09 - 0972 -- -- -- - -,- -- ~ RELATIONSHIP TO ~-SHARE OF ESTATE NAME AND ADDRESS OF PERSON(S) DECEDENT !AMOUNT OF ESTATE -_ _-- -- ~ Words NUMBER ~ RECEIVING PROPERTY _ _ ~ ( ) ($$$) Do Not List Trustee(s) - - - ' I TAXABLE DISTRIBUTIONS{include outright spousal distributions and transfers ' under Sec. 9116 (a) (1.2)] ' 5 Rick Callan ~ Grandson ~ 12 5% 6 7 ~ 735 Rustling Leaf Court ~ Eldersberg, MD 21784 ~ ' i !, Rob Callan ~ Grandson ~ 12.5% 1016 Springhouse Drive ', Ambler, PA 19002 i I I '' Mary Anne McStravick ~ Granddaughter 12.5% 17 Montclaire Drive '~ Delran, NJ 08075