HomeMy WebLinkAbout01-10-11J 1505610101
REV-1500 I:xt°1.1°~ ~-
PA Department of Revenue
Bureau of Individual Taxes
PO BOX z8o6oi
OFFICIAL USE ONLY
CountyyCode Year File Number
10 0430
pennsytvaMa
OEE~ETMExT OF EEYFxVE
INHERITANCE TAX RETURN
RESIDENT DECPnFr-tr
Date of Birth MMDDYYYY
__.
10/17/1930
- --- i
Decedent's First Name ~~ MI
Gladys ~ ~~~
.__ ~ , ,
[ ~
se's First Name ~~ ~ ~ MI
- • ~ -~
' ~ !
THIS RETURN MUST BE FILED IN DUPLICATE WITH TH
~______._~ ~__________ __ E
_~ REGISTER OF WILLS
FILL INAPPROPRIATE OVALS BELOW
~ 1. Original Return O 2. Supplemental Return
O 3. Remainder Return (date of death
O 4. Limited Estate prior to 12-13-82)
O 4a. Future Interest Compromise (date of
O 5. Federal Estate Tax Return Required
death after 12-12-82)
dD 6. Decedent Died Testate
(Attach Copy of Will) O 7. Decedent Maintained a Livin Trust
(Attach Copy of Trust) g 8. Total Number of Safe Deposit Boxes
O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death
O 1
1. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95)
(Attach Sch. O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED
A
Name .
LL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
DOUg18S C. YOhe _ _ _ _ _ Daytime Telephone Number _
_
4..___________~_._.~______._...________. __ (717) 620-2424
~ ~
Latsha Davis Yohe & McKenna, p.C, ~~~~~~~~~~~~
~~- ~~~----------------------_--..
REGISTER OF WILLS USE ONLY
First line of address c'~'
__ ~ , -~
-.__
( _ c ~ }
1700 Bent Creek Blvd ~ --
~.~~ ~~.
~~_~_____._.._ -~l ~ ~~ ~ ~ -,
t i 1-~ C--j :.~: r
Second line of address `~~" ~-----~----~-- ~ w
_. ~~ ~: ,
_. _
~ .~ fTl -'
Suite 140 _~_ ~l? c~ r,
City or Post Office ~`~~~- - , , j .1
_ State ZIP Code FI ED -~e - _r ?
Mechanicsburg ~ ~,~ ~-~ ~:
_._.__ _. __._ _ ~. __ _ _.__._~..._ PA ~ ~ 1705~~ 0 -o ,
! `~ cn a
~_-= ~
__ ~.,:
Correspondent's a-mail address: dy0he Idy18W.COm
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 tx3lief,
it is true, correct and complete. Declare ' n of preparer other than the personal representative is based on all information of which preparer has any knowledge.
;SI ATUf2E~t~ERSOt~SP~g E FOR Fj~,ING RETURN
ADDRESS ` l ~d ~~~
1700 Bent Creek Blvd, Suite 140, Mechanicsburg, PA 17050
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610101
1505610101
J
J
1505610105
REV-1500 EX
Decedent's Social Security Number
decedent's Name: Gladys J. Fields _
'; 172-24-7953
RECAPITULATION i
1. Real Estate (Schedule A) ......................................... .... L '
2. Stocks and Bonds (Schedule B) ......... '
.......
................... .... 2. ~ 267,134.50
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C ..
3. ~~
4. Mortgages and Notes Receivable (Schedule D)
....................... ~
.... 4.{
~
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)... .... 5.
364,745.90 j
6. Jointly Owned Property (Schedule F) O Separate Billing Requested ...
7
I .... 6. ~
i
.
nter-Vivos Transfers & Miscellaneous Non-Probate Property _~
(Schedule G) O Separate Billing Requested.... .... 7.'
I
8. Total Gross Assets (total Lines 1 through 7) ........................ 1
8 '
.....
, 631,880.40
9. Funeral Expenses and Administrative Costs (Schedule H) ......
......... I
.... 9., I
7,096.46 I
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .. 10
E
i
........ ....
.
,____ _ 25.,355.46 j
11. Total Deductions (total Lines 9 and 10) ...... ~~•
....................... .... 11. 32,451.92
12. Net Value of Estate (Line 8 minus Line 11) ..........
.............
12
;
....
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which ...
. 599,428.48 f
an election to tax has not been made (Schedule J)
..................... ~
...13.i !
~
14. Net Value Subject to Tax (Line 12 minus line 13) ......... , .
• • - •
14
~
......
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES ...
. 599,428.48
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 couateral rate X .15 599 428.48
_. ;
18 _
89,914.27
19. TAX DUE ....................................................... ..19.1 89,914.27!
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Q~
I_._ Side 2
1505610105 1505610105
REV-1500 EX Page 3
Decedent's Complete Address: File Number
DECEDENT'S NAME
Gladys J. Fields
STREET ADDRESS
100 Mount Allen Drive
clTV --
Mechanicsburg sTATE zlP
PA 17050
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments (1) 89 214 27
A. Prior Payments 85,500.00
B. Discount 4,460 71
3. Interest Total Credits (A+ B) (2) 89,960.71
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (3)
Fill in oval on Page 2, Line 20 to request a refund.
(4) 746.44
5. If Line 1 + Line 3 is greater than. Line 2, enter the difference. This is the TAX DUE.
(5)
Make check payable to: REGISTER OF WILLS, AGENT.
- _~...~..~ ~ F,r ~ r_... c. Y4Mr r .. ,.. .,.. t, fiy_~~. ..,~.v.~i ~Y~_fi,U~, ~+r .,~ 1.2t _-~ [,.
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 shalt use the property transferred or its income :............................................ ^ a
c. retain a reversionary interest; or .......................................................................................................................... ^ o
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 ^ X
without receiving adequate consideration? .............................................................................................................. ^ a
3. Did decedent own an "in trust 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 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 ,~
3 percent [72 P.S. §9116 (a) (1.1) (i)j. surviving spouse is
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)j.
• 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. 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-1503 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDVLE B
STOCKS & BONDS
ESTATE OF
Gladys J. Fields FILE NUMBER
21-10-0430
ITEM All property jointlyowned with right of survivorship must be disclosed on Schedule F.
NUMBER DESCRIPTION VALUE AT DATE
~'
~.....~..__ _,.~.~_~.. ~_. ,.~._ _ ..uw~_ .n,~
986.680 Shares / Mone M ~~
y ar et Mutual Funds OF DEATH
_ _..
..n~,__~ _m~.wa.
~w~~_.~ ~_._.~ . ~,_ ._
Value per share =1.00 ~~ `~~`~ ~°° ~ ~~~ 986.68
2. 2,500 shares of Corporate Property Associates
.Value per share =11.80 29,500.00
3. :500 shares of CNL Lifestyle Properties
'M'
Value per share =10.00 S, 000.00
4. 3,936.51 shares of COL Strategic Income
Value per share = 5.94 23,382.88
5• ,~s
.5,991.30 shares of Eaton Low Duration
,.. _
.Value per share = 9.15 __ 54, 820.26
-
6. 2,449.57 shares of Eaton Nat'I Mun, Inc.
.;
Value per share = 9.63 23,589.34..
7•
- 753.71 shares of Fid Adv New Insights
_ ....
Value
per share =18.23 , .
13, 740.06
8• 795.91 shares of Opp Small & M/Cap Val
,>
Value per share = 29.18 23,224.57
_~.~>k~ .
continued on attachment /total fro
~ m attachment) _ ~.~.~ .
_ _ 92,890.71
TOTAL (Also enter on line 2, Recapitulation) $; 267,134.50
(If more space is needed, insert additional sheets of the same chPi
Attachment to
SCHEDULE B
Stocks & Bonds
ESTATE OF
Glad s J. Fields FILE NUMBER:
ITEM 21-10-0430
NUMBER VALUE AT DATE
DESCRIPTION OF DEATH
9. 9,882.35 shares of CVS Diversified Bond
48,225.86
Value per share = 4.88
10. 4,210.53 shares of RVS Dividend Opp
30,652.63
Value per share = 7.28
11. 6.88 shares of Thread Global Equity
14,012.22
Value per share = 6.88
TOTAL THIS PAGE
92,890.71
REV-i5o8 EX+ (u-io)
_ r Pennsylvania SCI~IEDIJLE E
DEPARTMENT Of REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
w~r-~cvr:
Gladys J. Fields FILE NUMBER:
21-10-0430
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.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
1. Account No. 930070445422004 -
166,192.34
_.. .
Account Type: Annuities
Ameriprise Brokerage
-:.<
70100 Ameriprise Financial Center
era.,..., .~
Minneapolis, MN 55474
~. ~_
.~ _ ..
,..._.;.
2, ccount No. 514-0275791
~, 128,566.32
...,.
Account Type: Certificate of De osit `
P
,.
=,~ -~
Fulton Bank, N.A. `_
One Penn Square _ , .. - _ _
..,~...
~,.: _
Lancaster, PA 17602
If more space is needed, use additional sheets of paper of the same size.
Attachment to
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Glad s J. Fields FILE NUMBER:
ITEM 21-10-0430
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
5. Cash Balance
66,642.68
Account No. 000167416395021
Ameriprise Brokerage
70100 Ameriprise Financial Center
Minneapolis, MN 55474
6. ~ Cash Balance
1,342.62
Account No. 000167429679021
Ameriprise Brokerage
70100 Ameriprise Financial Center
Minneapolis, MN 55474
TOTAL THIS PAGE
67,985.30 ~
REV-1511 EX+ (10-09)
~ Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
ee•r~r~ w RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
Gladys J. Fieids
ITEM
VUMBE
A•
1.
FILE NUMBER
21-10-0430
Decedent's debts must be reported on Schedule I.
FUNERAL EXPENSES: AMOUNT
Ayer Cremation Services (programs, cremation, death certificates)
647.23
_ _
2• Memorial Service
_. _ . 292.96
~. __.
_.. . _.
_.
B• ADMINISTRATIVE COSTS: ~ -..--
1• Personal Representative Commissions:
Name(s) of Personal Representative(s) Beverly J. Krick
Street Address 40 Bridle Court
City Etters state PA
ZIP 17319
Year(s) Commission Paid:
z• Attorney Fees: Latsha Davis Yohe & McKenna, p,C, 5,000.00-
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: Initial filing and short certificates, advertising 477.50
5, Accountant Fees:
6• Tax Retum Preparer Fees:
_..
_.__
_. _.._ _
7.
Mileage ~.. .. ._._ _. _
253.00
$• Lunch meeting with financial advisor
_., 15.85
-. ~ . _..
9. Phone card
- _ 39.99
~ o. Postage
_ 13.37
~ t Timeshare payments
__
_ ::- _ 334.04
12• Electricity for Florida real estate
_ ,.
_ _ 22.52
,.:._,
TOTAL (Also enter on Line 9, Recapitulation) $ 7,096.46
IF more space is needed, use additional sheets of paper of the same size,
. REV-1512 EX+ (12-08)
~ Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
FILE NUMBER
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreilnbu~ed medical expenses.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
~_`~ ~~ OF DEATH
Alert Pharmacy
_._ _ 21.00
2. :Care Giving
100.00
3. 'Capital Area Health
_ 100.96
4. Nursing Home
11, 733.50
5. :Federal Income Tax
13, 000.00
6. State Income Tax
400.00
TOTAL (Also enter on Line 10, Recapitulation) $ 25,355.46
If more space is needed, insert additional sheets of the same ci~a
REV-1513 EX+ (O1-10)
~``~~ Pennsylvania SCHEDULE ~
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF:
FILE NUMBER:
Gladys J. Fields 21-10-0430
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RE o NotSList Trustee(s)NT AMOOF ESTATE ARE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).)
1. Beverly J. Krick _ _. Niece 100%'
40 Bridle Court
Etters, PA 17319
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, 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. S
If more space Is needed, use additional sheets of paper of the same size,
LAST WILL AND TEST.AI'VIENT
OF
(~
GLADYS J. FIELDS
I, GLADYS J. FIELDS, being domiciled in the State of Florida and being of
sound and disposing mind and memory and not acting under any duress, menace, fraud
or undue influence in any manner from any person, do make, publish and declare this to
be my Last Will and Testament hereby revoking all wills and codicils heretofore made
by me.
ITEM I
I direct that all my legal debts, including funeral expenses and expenses of last
illness, if any, be paid as soon as practical after my death.
ITEM II
I make no provision in this will for my stepdaughter, BARBARA I. FIELDS
VENT'ROIVE.
ITEM III
I direct that my bodily remains be cremated, and that the cremains be delivered
to my Personal Representative.
ITEM N
I give, devise and bequeath all the rest and residue of my property, both real,
personal and mixed, of whatsoever kind and wheresoever situate to my niece,
BEVERLY J. KRICK or if she predeceases me, to her husband, L. ARVIN KRICK or
if he predeceases me, then to my stepdaughter, ELIZABETH L. FIELDS.
ITEM V
I hereby name, nominate and appoint my niece, BEVERLY J. KRICK, Personal
Representative of this my Estate, to act without bond; and my said Personal
Representative shall have all the powers to sell, transfer, lease or mortgage any of the
property of my estate in her absolute discretion as she deems necessary or advisable to
the proper or convenient administration of my estate.
-~"~`°',~ ~Cy~ ~~~~ (SEAL)
GLADYS . F DS ~ ~ .~
ll_~.
In the event said Personal Representative shall predecease me or for any reason
be unable or unwilling to serve, I hereby name, nominate and appoint my niece's
husband, L. ARVIN KRICK, as Alternate Personal Representative of my Estate, under
the same conditions and with the same powers, rights, and privileges as set out above.
In the event said Alternate Personal Representative shall predecease me or for
any reason be unable or unwilling to serve, I hereby name, nominate and appoint my
stepdaughter, ELIZABETH L. FIELDS, as Second Altennate Personal Representative
of my Estate, under the same conditions and with the same powers, rights, and
privileges as set out above.
IN WITNESS WHEREOF, I have hereunto set my hand and seal at
,/ ~
/~ ~ ~~~ ,Florida, this ~ day of //,~O j/t' /n ~~ ~ , 2007.
-'~.~~ ~ • b//~~~'~ (SEAL)
GLADYS .FIE S
The foregoing instrument consisting of three pages, including the following
page, was on this ~ ~ day of %t'~~ c,~ c' ~^ S '' '' , 2007, subscribed on each page
and at the end thereof by the above-named Testatrix, and by her signed, sealed,
published and declared to be her Last Will and Testament, in the presence of us and
each of us, who thereupon, at her request, in her presence, and in the presence of each
other, have hereunto subscribed our names as attesting witnesses thereto.
l~-l~Cl~1~~ Illf ~L(! of ~~ • ~~O.k'~ (~''C_
STATE OF FLORIDA
COUNTY OF OSCEOLA
I, GLADYS J. FIELDS declare to the officer taking my acknowledgment
of this instrument, and to the subscribing witnesses, that I signed this instrument as my
will.
~,~ ~ ~~~
Testatrix
2
We, C. D. LEWIS, JR. and MELINDA L. HOLSMAN have been
sworn by the officer signing below, and declare to that officer on our oaths that the
Testatrix declazed the instrument to be the Testatrix's will and signed it in our presence
and that we each signed the instrument as a witness in the presence of the Testatrix and
of each other.
~o ~-,
Witn
r
Witness
Acknowledged and subscribed before me by the Testatrix, GLADYS J.
FIELDS, who i personally known tom r who has produced
as identification, and sworn to and subscribed before me by the witnesses,
C. D. LEWIS, JR who is personally lmown to me and MELINDA L. HOLSMAN
who is personally known to me, and subscribed by me in the presence of the Testatrix
and the subscribing witnesses, all on l~u°~ °'~'~"i*~ '- `'
2007.
.~~7~'^L
Notary Public, State of Florida
``\\~~~~~ee ~H u~~,,~~ My Commission Expires: 5'~ _ j a /2 ~ ;
`,,, ~, .............as ~-,,
'~~,p~~~3p~?O~o~~`
9~::QOffgO~p r.