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Home My WebLink About01-25-1115D5610143 REV-1500 Ex (o,-,o) OFFICIAL USE ONLY PA Department of Revenue Pennsylvania County Code Year File Number Bureau of Individual Taxes DEFARTMENTOFREVENUE Po Box.2soso~ INHERITANCE TAX RETURN 21 10 0750 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 04 25 2010 Decedent's Last Name 5IEMON (If Applicabie) Enter Surviving Spouse's Information Below Spouse's Last Name Spouse's Social Security Number FILL {N APPROPRIATE OVALS BELOW Date of Birth 08 22 1921 Suffix Decedent's First Name MI MARCELLA P Suffix Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS a 1. Original Return ^ 2. Supplemental Return ^ 4. Limited Estate 4a. Future Interest Compromise (date of death after 12-12-82) ^ 8 Decedent Died Testate (Attach Copy of Will) ~ 7• AnacdheCopy Hof Trust)a Living Trust ^ 9. Litigation Proceeds Received ^ C 10. b~tweenl2 31 X31 ant (datge5~f death ^ 3. Remainder Return (date of death prior to 12-13-82) ^ 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes ^ 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ROBERT P GRUBB 717 697 3223 First line of address 555 GETTYSBURG PIKE Second line of address SUITE C100 City or Post Office State ZIP Code MECHANICSBURG PA 17055 REGISTER OF WILLS USE Q,N,~Y ~_- = ; - .- E-1 __ ._-_- - ...__ __ << (,,.~ 4 ___, DATE-~F.1 ~- D _-~ -.. i -~~ _~ -,-:~ '~ _ti .~" ;`E°I Correspondent's a-mail address: Bob c~keystoneelderlaw.com Under penalties of perju declar t I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and co pl . De ara 'on of preparer other than the personal representative Is based on all information of which preparer has any knowledge. SIG 0 ESP N IB F R FILING RETURN DAT X ~ _ Edward A. Siemon III ~ ~ 2 ~~ 1 ADDRESS 540 Bre Roa m Hill PA 17011 SIGNATURE PR ER THAN REPRESENTATIVE DATE Robert P. Grubb /-Z, j -ZO/~ 555 L Suite C-100 ,Mechanicsburg, PA 17055 Side 1 15D5610143 1505610143 J c~4 J REV-1500 EX Decedent's Name: Slemon, Marcella P. RECAPITULATION 541,350.00 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. 19,968.27 5. Cash, Bank Deposits 8~ Miscellaneous Personal Property (Schedule E) ............... 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers & Miscellaneous tin-Probate Property (Schedule G) U Separate Billing Requested............ 7. 2 6 5 , 4 4 5. 8 7 8. ........................................ Total Gross Assets (total Lines 1-7) ............................. g 82 6 , 7 64.14 48 901.83 9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 440,041.30 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 4 8 8 , 9 4 3.13 11 Total Deductions total Lines 9 8~ 10 11 337,821.01 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. 337,821.01 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 (a)(1.2) X .00 . 16. Amount of Line 14 taxable 337 , 821 . O1 16. at lineal rate X .045 17. Amount of Line 14 taxable 0 . 0 0 17. at sibling rate X .12 18. Amount of Line 14 taxable 0 . 0 0 18 at collateral rate X .15 . 19. Tax Due ................................................................................................................ .. 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 15D561D243 0.00 15,201.95 0.00 0.00 15,201.95 Side 2 L 1505610243 1505610243 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-10-0750 DECEDENT'S NAME Siemon, Marcella P. STREET ADDRESS 859 Hilltop Road CITY Lemoyne STATE PA ZIP 17043 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 15,201.95 2. CreditslPayments A. Prior Payments 8,000.00 B. Discount 421.05 Total Credits (A + B) (2) 8,421.05 3. Interest (3) 4, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) 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. (5) 6,7$Q.9Q Make Check Pa able 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 :............................................................................... ^x ^ b. retain the right to designate who shall use the property transferred or its income :.................................. ^x ^ c. retain a reversionary interest; or ............ ................................................................................................. ^ 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? .................................................................................................................... ^ 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)]. A sibling is defined under Section 9102, as an individual who has at feast one parent in common with the decedent, whether by blood or adoption. Rev-1502 EX+ (11-08j SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF I FILE NUMBER Siemon, Marcella P. 21-10-0750 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on schedule F. Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 11-08) (If more space is needed, additional pages of the same size) Rev-1508 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Slemon, Marcella P. 21-10-0750 Include the proceeds of litigation and the date the proceeds were received by the estate. Alt property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Citizens Bank Account # 620016-809-5 DOD Value 490.55 2 Citizens Bank Account # 621546-913-4 3131/10 3,698.72 3 1991 Lincoln Mark 7: 44,000 Miles- Poor Condition 0.00 4 2004 Jaguar X-Type Sedan - V!N# SAJEA51CX4WD57900 11,165.00 19, 337 miles as of 1/17/2011 5 Miscellaneous Personal Property Itemized and Appraised by Roy Gottshall, Auctioneer 4,614.00 TOTAL (Also enter on Line 5, Recapitulation) f 19,968.27 (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-1510 EX+ (6-98) SCHEDULE G INTER-VIVOS TRANSFERS 8~ MISC. NON-PROBAT PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Siemon, Marcella P. 21-10-0750 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY THE ATE OF TROANSFERSATTACIiTA COPY OF TIHE DEIED OR REAL ESTATE. DATE OF DEATH VALUE OF ASSET °r6 OF DECD'S INTEREST EXCLUSION CIF APPLICABLE) TAXABLE VALUE 1 Integrity Bank #0201040668 105,315.51 105,315.51 2 U BS IRA #VP11763 20,183.79 20,183.79 3 UBS RMA #VP11739 139,946.57 139,946.57 TOTAL (Also enter on Line 7, Recapitulation) I 265,445.87 (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 G (Rev. 6-98) REV-1151 EX+ (10-06) COM IN RES~DENT D CED~N~RN ANIA SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Siemon, Marcella P. 21-10-0750 ~Yw.w Y• MY YY VY..r ...MVO YV ^ V'/V^ AVM V.. VV..VYM~ii ~• ITEM DESCRIPTION AMOUNT N A, FUNERAL EXPENSES: See continuation schedule(s) attached B. 1 2 3 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Edward Siemon Ill Street Address 540 Brentwater Road City Camp Hill State PA Zia 17011 Year(sl Commission oaid Attorney's Fees Keystone Elder Law P.C. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Edward Siemon III Street Address 859 Hilltop Road city Lemoyne state PA zip 17043 Relationship of Claimant to Decedent SOn 4,441.82 14,276.00 14,276.00 3,500.00 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 12,408.01 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 48,901.83 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 NUMBER Siemon, Marcella P. 21-10-0750 ITEM NUMBER DESCRIPTION AMOUNT Funeral Ex e~nses 1 Neill Funeral Home 3401 Market Street, Camp Hill, PA 17011 4,441.82 H-A 4,441.82 2 Qther Administrative Costs 2010 Cumberland County and Borough of Lemoyne Real Estate Tax -For 859 Hilltop Road 3,397.98 property -School Tax 3 East Pennsboro Township County Tax for Brentwater property 858.34 4 East Pennsboro Township School Tax for Brentwater property 2,670.48 5 Expense to Maintain Brentwater Property -Sears Rug Cleaning Check 143.10 6 Expense to Maintain Brentwater Property -Carpet House fixed carpet and linoleum 595.00 7 Expense to Maintain Brentwater Property -Stanley Steamer 874.50 8 Expense to Maintain Hilltop property - Schultr Landscaping 215.00 9 Expenses for Brentwater property -Diane Burgraff: for paying handyman to keep cats out of 100.00 the walls. 10 Expenses to Maintain Brentwater Property -Brad Gable Landscaping/maintenance 159.00 11 Expenses to Maintain Hilltop property and prepare for Sale -PPL Electric utility bill 338.00 12 Expenses to Maintain Hilltop property and prepare for Sale -Dirty Dog Junk Remover 450.00 13 Expenses to Maintain Hilltop property and prepare for Sale -PPL Electric utility bill 337.98 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Siemon, Marcella P. 21-10-0750 ITEM NUMBER DESCRIPTION AMOUNT 14 Expenses to Maintain Hilltop property and prepare for Sale -ADT Security Service 42.57 15 Expenses to Maintain Hilltop property and prepare for Sale - PA American Water 96.61 16 Expenses to Maintain Hilltop property and prepare for Sale -PPL Electric utility bill 337.95 17 Expenses to Maintain Hilltop property and prepare for Sale -Dirty Dog Junk Remover 625.00 18 Expenses to Maintain Hilltop property and prepare for Sale - PA American Water 48.29 19 Expenses to Maintain Hilltop property and prepare for Sale -Lemoyne Borough utility bill 120.50 20 Expenses to Maintain Hilltop property and prepare for Sale -Roy Gottshall Auctioneer For 100.00 personal property 21 Expenses to Maintain Hilltop property and prepare for Sale -PPL Electric utility bill 182.16 22 Expenses to Maintain Hilltop property and prepare for Sale -ADT Security Service 42.57 23 Expenses to Maintain Hilltop property and prepare for Safe - PA American Water 46.93 24 State Farm Insurance 626.05 H-B7 12,408.01 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX+ (12-08) scHEOU~E i DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Siemon, Marcella P. 21-10-0750 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 2010 Cumberland County and Borough of Lemoyne Real Estate Tax -For 859 Hilltop Road 1,664.05 property -County/Library/Borough Tax 2 Bank of America First Mortgage for Hilltop property Account # 870802666 200,000.00 3 Chase Visa #4417-7286-9461-8941 - As of 4/20/2010 5,664.77 4 Citi Mortgage 1st mortgage on Brentwater property 55,073.71 5 Citibank Platinum Credit Card # 5410658426674279 68.70 6 Citizens Bank Line of Credit (Loan) 2nd mortgage on Brentwater property Account # 6007 122,171.28 -515048 7 Citizens Bank Line of Credit (Loan) 2nd Mortgage on Hilltop property 43,001.56 8 Debt to Maintain Hilltop property and prepare for Sale -Schultr Landscaping Debt for 86.00 Lawncare from April 9 Debt to Maintain Hilltop property and prepare for Sale -Schultr Landscaping Debt for snow 91.16 removal before 4/14-4/21 10 Delta American Express # xxxx-xxxxx6-23003 - As of 4/20/2010 419.64 I Total of Continuation Schedules See attached pages TOTAL (Also enter on Line 10, Recapitulation) 440,041.30 (If more space is needed, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08) Rev-1512 EX+ (6-98) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN continued RESIDENT DECEDENT ESTATE OF FILE NUMBER Siemon, Marcella P. 21-10-0750 ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 11 Diane Burgraff- Reimbursement expenses as itemized for April 2010 - 4/21 Dr. Brent- 403.94 eyeglasses deposit $100 4/07 American Home Medical Toilet Bucket $9.95 4/28 Boscov's- underwear for Marcella P. Siemon for funeral $13.28 4/17 CVS-Tylenol caplets for Marcella P. Siemon 4/29 Dollar Tree- cups/plates for food for after funeral $9.54 4/09 Boscov's clothing for Marcella P. Siemon $73.91 4/14 Rite Aid- Depends Underwear $14.99 4/02 Rite Aid- Depends under wear paid in cash $14.99 4/28 Marcella P. Siemon's drycleaning from Quality Cleaners $87.25 4/21 Rite Aid- 4 cans of dog food $5.90 4121 CVS- pick up of prescription for Mom and ear drops $12.99 4/22 Paid Bob (the handyman) in cash to move the mattress $25.00 4119 Karns- bought coffee and ginger ale for Marcella P. Siemon $6.74 4/13 Karns- scrubber for Barb to clean the kitchen $2.72 4/24 Karns- soda for Marcella P. Siemon $2.39 4/16 Farmers Market- Uncle George's-fish and chips for Edward and Marcella Siemon $12.00 4/17 Farmers Market- small meat loaf and stuffier potato $7.50 12 Edward Siemon III Check # 2178 Dated 12/25/2009 issued by decedent prior to death for 2,000.00 Christmas present 13 Edward SiemonReimbursement Expenses as Itemized for 2010 -Home instead- 3/11-4/22 2,531.32 _ $544.65 American Express pmt 4102 = $30.00 Krame Glass 4/02 = $119.76 Central State (Garage Door) 4/01 = $135.00 Citi Mortgage pmt 4/07 = $692.03 PA American Water 4/07 = $12.01 Susquehanna Medicine Co-pay 4/11 = $10.00 Life Line Systems 4/19 = $141.26 Callen Kinback Jaguar Maintenance 4/25 =$291.43 Callen Kinback Jaguar Maintlinspection 5/12 =$123.71 Callen Kinback Jaguar Brake Repair 6/10 = 431.47 14 Expense to Maintain Hilltop property - Schultr Landscaping 182.32 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) Rev-1512 EX+ (6-98) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN continued RESIDENT DECEDENT ESTATE OF FILE NUMBER Siemon, Marcella P. 21-10-0750 ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 15 Expense to Maintain Hilltop property - Schultr Landscaping -paying old invoice #6321 269.82 16 Home Instead 365.10 17 Jaguar Credit # 40327528 As of 3/02/2010 4,903.97 18 Lemoyne Borough -Utility Debt 120.50 19 Moffitt Heart and Vascular -Medical Debt 10.00 20 PA American Water -Utility Debt 77.60 21 Penn American Water -Utility Debt 134.50 22 PPL Electric -Utility Debt 169.58 23 Premier Eye Care Group -Medical Debt 106.00 24 Retail Services Check Payment -Retail Debt 114.64 25 Schultr Landscaping -Debt 391.14 26 Susquehanna Internal Medicine Medical Debt 20.00 TOTAL (Also enter on Line 10, Recapitulation) I 440,041.30 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV-1513 EX+ (11-08) COM INH~ITA~IT~ TP~C R~T~RNVANIA R ID N DE ED N SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER aiemon, marceiia r. ~ 21-10-0 750 NUMBER NAME AND ADDRESS OF RELATIONSHIP TO DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE PERSON(S) RECEIVING PROPERTY (Words) ($$$) I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 a 1.2 1 Diane Burgraff Daughter All Jewelry, 168,910.51 PA Kitchen and bedroom television_s_, any 2 Edward A. Siemon III Son Father's 168,910.51 540 Brentwater Road Diamond ring Camp Hill, PA 17011 Total 337,821.02 Enter dollar amounts for distributions shown above on lines 1 5 throw h 18 on Rev 150 0 cover sheet as a r o riate. II NON-TAXABLE DISTRIBUTIONS: . A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 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) MARCELLA P. SIEMON LIVING TRUST 27-6622306 Tax Allocation PRE RESIDUE Spouse/Parent of Minor 4.5% 12% 15% Exempt Total Sch A - E ~- ~ ~---- _ ~- _ ~ _ ~"_ Sch F Sch G 265 445.87 ®„~ 265 445.87 Tota l 265 445.87 265 445.87 8 GROSS ASSETS........... 826,764.14 9 Funeral /Administrative 48,901.83 10 Debts /Mortgages........ 440,041.30 11 TOTAL DEDUCTIONS... 488,943.13 12 Net Val ("Clear Value"). 337,821.01 13 Charit /Govt / 9113....... 0.00 14 Subject to Tax ............... 337,821.01 15 Sps/Parent of Minor...... ~ 16 Amount at 4.5%............ _ 337,821.01 17 Amount at 12% .............. ~ 0.00 18 Amount at 15% .............. ~- 0.00 19 Principal Tax ................. 'Q~` ~`/y~g Schedule A - E: Total Available ................... 72,375.14 Schedule A - E: Pre-Residue Used .............. Schedule A - E: Residue Available ..............2,375:14 CALCULATION OF PRINCIPAL TAX Tax at 0% (Spouse/Parent of Minor Child)... 0.00 Tax at 4.5% .................................................... 15,201.95 Tax at 12% ....................................................... 0.00 Tax at 15% ....................................................... + 0.00 Total Principal Tax ~ ~ ~ 1'~;~'Q~1~;~9`5 RESIDUE % G ross Residue R ECAPITULATION Residue to 0% Spouse 0.0000% 0.00 a Total Gross............ 826,764.14 Residue to 4.5% Beny 100.0000% 72,375.14 b less Deductions.... 488,943.13 Residue to 12% Beny ~~ 0.00 c less Pre-Residue... 265,445.87 Residue to _ 15% Ben y ~ 0.00 d Gross Residue....... 72, 375.14 Residue to Exem t Ben p y ~ 0.00 a p less Princi al Tax.. ~ X1°5 0'x:95 ~, Total % Residue ~ 0.0000% 72,375,14 f Net Residue........... 57,173.19 VIEW #1 PRE-RESIDUARY BEQUESTS RESIDUARY BEQUESTS ~- B C D E F=D+E Share Tax Share of - - Gross Residue Tax/Residue on Pre-Residue Total Tax Spouse 0.00 0.00 0.00 0.00 0.00 4.5% 265.445.87 11,945.06 72,375.14 3,256.88 11,945.06 15,201.94 12% 0.00 0.00 0.00 0.00 15% 0.00 0.00 0.00 0.00 Exempt 0.00 0.00 0 00 Total 265 445.87 11,945.06 72,375.14 ' 3,256.88 . 11 945.06 . `-'; ~ ~ ',.. } ~ r~4 , r PRE-RESIDUE RESIDUE TOTAL A C F G=C-F H=A+G Pre-Residue Gross Residue Share of Total Tax Net to Residuary Beneficiari _s Net to ALL Spouse 0.00 0.00 0.00 0.00 4.5% 265.445.87 72,375.14 15,201.94 57,173.20 322,619.07 12% 0.00 0.00 0.00 0.00 15% 0.00 0.00 0.00 0.00 Exempt ~ 0 00 Total 265,445.87 72,375.14 ~`i ~, ~ ,.; , _ . ,~ 57,173.20 322,619.07 wpyngni ~ y°c - Ruud i ne ~acKner group, Inc. All rights reserved. MARGELLA P SIEMQN LIVING TRUST 27-6622306 Tax Allocation PRE RESIDUE Spouse/Parent of Minor 4.5% 12% 15% Exempt Total Sch A - E ~- ~~ ~~ ~ ~~ Sch F Sch G ~ ~_~ ~ ~~ - - -~-- 265 445.87 Total 265..445.87 2 445.87 8 GROSS ASSETS........... 826,764.14 CALCULATION OF AVAI ABLE RESIDUE 9 Funeral /Administrative . 48,901.83 10 Debts /Mortgages........ 440,041.30 Schedule A - E: Total Available ................... 72,375.14 11 TOTAL DEDUCTIONS... 488,943.13 Schedule A - E: Pre-Residue Used .............. - 12 Net Val ("Clear Value"). 337,821.01 Schedule A - E: Residue Available .............. ~ 72,375.14 13 Charit /Govt / 9113 0 00 ....... . 14 Subject to Tax ............... 337,821.01 ~~ CALCULATION OF PRINCIPAL T X 15 Sps/Parent of Minor...... ~ Tax at 0% (Spouse/Parent of Minor Child)... 0.00 16 Amount at 4.5%............ ~ 337 821.01 Tax at 4.5% .................................................... 15,201.95 17 Amount at 12% .............. 0.00 Tax at 12%....................................................... 0.00 18 Amount at 15% .............. ~ 0.00 Tax at 15%....................................................... + 0.00 19 Princi al Tax ................. P %--~-.r-~-- ' 15,~0~~9~ Total Principal Tax ~~ st ~ ' . ~ _,15,20, ;.95° RESIDUE % G ross Residue R ECAPITULATION Residue to 0% Spouse 0.0000% 0.00 a Total Gross............ 826,764.14 Residue to 4.5% Beny 00.0000% 72,375.14 b less Deductions.... 488,943.13 Residue to 12% Beny ~- 0.00 c less Pre-Residue... 265,445.87 Residue to _ 15% Beny ~ 0.00 d Gross Residue....... 72,375.14 Residue to Exem t Ben P Y I- 0.00 a less Princi al Tax P ~ ' ~~~` ~5~. Total % Residue ~ 0.0000%~ 72,375.14 f Net Residue........... 57,173.19 VIEW #2 Spouse/Parent of Minor 4.5% 12% 15% Exempt Total PreResid G ross Res otalGross C 0.00 337,821.01 0.00 0.00 ~ 0.00 337,821.01 Pre-Resid axPreRes ~_ 0.00 272.375.84 ~~~ 265 X5.74 0.00 0.00 0.00 72. 0.00 265 945.06 ~~ 0.00 215 945.06 GrossRes B 0.00 ~ 72,375.14 ~- 0.00 0.00 ~ 0.00 72 375.14 TaxRes 0.00 ~-3.256.88 0.00 0.00 0.00 3 256.88 Share of T 0.00 11 945.06 0.00 0.00 0.00 11 945.06 Total Tax 0.00 15,201.94 0.00 0.00 0.00 15_,201.94 Net Res 0.00 ~ 57,173.20 0.00 0.00 0.00 ~ 57,173.20 TotalGross C 0.00 337 821.01 0.00 0.00 0.00 337,,821.01 Total Tax 0.00 15,201.94 0.00 0.00 0.00 15.201.94 ~.upynynt ~~°° - ~uuv ~ ne ~acKner group, inc. Ail rights reserved. Marcella P. Sielman Date of Death Sun, A r 25, 2010 3 Months After DOD ...Mon, Jul 26, 2010 PA Estate Tax Optimal Discount Payme 0.00 Click here if Paid at Discount Date Paid ~ 14,441.85 ~ Total Paid at Not Paid at Tax Paid Discount Discount ® Fri, Jul 23, 2010 8,000.00 8,000.00 Tax Discount A. Tax Paid at Discount (per above) ~ 8,000.00 x 5 / 95 = 421.05 B. ^ Tax Due if Entire Balance paid on/before Mon, Jul 26, 2010 x 5 / 95 = C. Total NET Tax Paid/To be Paid at Discount 8,040.00 x 5 / 95 = r 421.05 D. Discount C. ~ 8,000.00 x 5 / 95 = 421.05 (1) F. 15,201.95: x 5% = 760.10 (2) Lesser of (1) or (2) above 421.05 E. Tax Credit (C + D) 8 421.05 F. GROSS Tax Due (Page 1, Line 19) 15,201.95 G. Balance of Tax Due ~ 6,780,90 * The calculations in (1) and (2) are intentionally different. Item (1) computes the amount of discount based upon an assumed NET payment. Item (2) computes the maximum potential discount based upon an actual GROSS principal tax due. Thus, a discount always equals the NET payment x 5 / 95, or the GROSS tax x 5%. ~ Marcella P. Siemon . . Decedent Date of Death 9 Months After DOD Final Payment Date Suggested Interest Daily Year Rate # Days Sun, A r 25, 2010 Tue, Jan 25, 2011 0.0 Interest Amount for Year 1990 .000301 1991 .000301 1992 .000247 1993 .000192 1994 .000192 1995 .000247 1996 .000247 1997 .000247 1998 .000247 1999 .000192 2000 .000219 2001 .000247 2002 .000164 2003 .000137 2004 .000110 2005 .000137 2006 .000192 2007 .000219 2008 .000192 2009 .000137 2010 .000110 # Days to Add for Holiday Filing Deadline Tue, Jan 25, 2011 PrincipalTaxDue 15,201.95 Credits 8,421.05 Interest TaxDue 6,780.90.. Suggested Interest 0.000000'