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HomeMy WebLinkAbout01-28-11 (2)1505610101 REV-1500 °` ~°'-10' ~' PA Department of Revenue pennsylvarda Bureau of Individual Taxes '~~a"~`~` Po Box 28o6oi INHERITANCE TAX RETURN u~..,~a,,.,. oe ,~,~ss_nrn, RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year Flle Number LI ~ i 16 f j boLl~ ENTER DECEDENT INFORl41AT10N BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY j 560-70-3998 ~ 05/01 /2010 09/27/1914 DecedenYslast Name Suffix Decedents First Name MI Jenkins ~ ~ Adeline LE (If Appiicabte) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's_First Name _ _ ' Mi ~_~_~_._ -----• - i '- -- --- _ _ I _ _ _ _. ~ - -- -- - --- ---- ----------~- Spouse's Soda/ Security Number -- ----- THIS RETURN MUST BE FILED IN DUPLICATE WITH TF~E L- __ ___ REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remainder R ' (date of death O 4. Limited Estate O 4a. Future Interest Compromise (date of death after 12-12-82) dp 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death .between 12-31-91 and 1-1-95) CORRESPONDENT - THIS SECTION MUST 8E COMPLETED. ALL CORRESPONDENCE AND CONFIDEN' use prior to 12-13-8 ) O 5. Federal Estatta Return Required 0 8. Total NumberofSafe Deposit Boxes O 11. Election to tax u der Sec. 9113(A) (Attach Sch. ©) nAL TAX INFORNVITION SHOULD E DIRECTED TO: Daytime Telephone N mbar ~-.. ~ Taylor P. Andrews, Esq -_~ %(717) 243-0123 - ~- __ _ _ _ _ _ _ -_-' -- __ _ REGISTER OF' 3 USE ONLY First Ifne of address I _ _ C ' ~.., =~ ~ j 78 West Pomfret Street O ~ ~ ~ ~- ! , ------ ----------i rn ~ ~ x~ ~- c . > ~: ` Second line of address --- - ~ r" ` ~----- - -- - - ~ ct~ Cp , City or Post Office . - _. _ _ .--- State ZIP Code ' Ca isle ----__._ .__ ._- -- __-- - ___ rI _ .._.__.. _ . i ; ~ ;17013-0000 ~ ~ PA -- , ..~ s i I I c~ Corr~porWsnYs e-mail address:. anarews a.ne>: Under peneetes of perjury, I dsdaro that I have examined this return, induding accompanying schedules and statements, end to the treat Cf y knowledge and belief, K fs Uue, correct and complete. Dedaretbn of preperer other than the pemonal representative is based on all Infom~ation of which ptepei has erry knowledge. SI I~T~1RE ~PER$~N~P IBLE F ~ FILiNG RETURN / /~ A/,/ c/o 78 yanf~f Stmt) C,brlisle, PA 17013 C - - - - v ~,j, ~ .~ AD 8 West Pomfret Street, Carlisle, PA 17013 __ Side 1 1505610101 150561010 __ _ - -r-1-_T_. _. -1 J 1505610105 REV 1500 EX Decederrt's Social Security Number oso.dsnrs Name: Adaline E. Jenkins ! 560-70-3998 1 RECAPRULATION -~ 1. Real Estate (Schedule A) ....................................... ... 1. i 0.00 2. Stocks and Bonds (Schedule B) ....................................... ~ 2. 'i 64,860.62 3. Closely Heki Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... ~ 3. ! I ~ 0.00 _----- .._......------..-- ---...1.._._--- 4. Mort a es and Notes Receivable Schedule D 4. ~, .-.~... 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. , 5,961.12 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. ~ L...-. I 1,659.56 ___.__ 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Properly 1 ' 0 00 (Schedule G) O Separate Billing Requested........ 7. ; , . 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. ! i 72,481.29 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. i I 4,614.25 . 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .............. .______. _._._-~ 10. I 4,389.57 11. Total Deductions (total Lines 9 and 10) ................................. 11. ~ 9,003.82 12. .............................. Net Value of Estate (Line 8 minus Line 11) ~ __- 12. ~, __.T._ _______-_..... i 63,477.47 .r , 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which ._..r ;- ,..._._......__._.,_.~..._...~ .~... 00 ! 0 an eledbn to tax has not been made (Schedule J) ........................ 13. j . 14. Net Value Subject to Tax (line 12 minus Line 13) ........................ i-- 14. - ' 63,477.47 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable. ', at the spousal tax rate, or transfers under Sec. 9116 -_._ __ _ (axt2) x .o ~ 0 00 ~ ; ~ 15.', ; .,._. --- -- 0.00 .__._. _. _....._.____ ~._.~._._..._ 16. Amount of Line 14 taxable ----_ _._ _w...- __... ._. __.~ _ _ at lineal rate X .0 45 47,60810 ~ . 16, 2,142.36 17. _.. - _....-__._._ axable i-_..-....__.._.. _,.___.._ 15 t Amount9 869 37~~ n ix.. , 17 ....~.t . ~,~...m~m.~..~.._. ~_ 1,904.32 2 a X 1 , te . 48. -._____._...---. _._.__.__..._.____....._ _ w___........ _____,____~ Amount of Line 14 taxable r 0 00 ' ~_.__-. ._.__ ____ ! 0'00 . at ootlateral rate X .15 ~ 1 g. ; 19. TAX DUE ......................................................... .19 ..._.._. 4,046.69 __ _ __...------_ ------- --'~ -- 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ', O S(de 2 L 1505610105 1505610185 J REV 1500 EX Page 3 Decedent's Complete Address: Frk Number DE S NAME Adaline E. Jenkins STREETADDRESS 801 N. Hanover St. Carlisle sTnTEPA I' Z1P17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Cred'rtslPayments A. Prior Payments 2,700.00 B. Discount 142.11 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. FIII 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 ~l 4,046.69 O i Total Credits (A+ B) (2) 'I 2,842.11 (3) ! 0.00 -- (4) (5) ~ 1,204.58 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE. FOLLOWING. QUESTIONS BY PLACING AN "X" IN THE APPROPF~IATE BLOCKS 1. Did decedent make a transfer and: Yes ~'~i No 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 : ............................................ [~ Q a retain a reversionary interest; or .......................................................................................................................... d. receive the promise for life of either payments, benefits or care? ...................................................................... ~ 'i X^ 2. If death oocumed after Dec. 12, 1982, did decedent transfer properly within one year of death ~I .................................................................. withqut receiving adequate consideration? ............................................ ~ III .~ 3. Did decedent own an m trust for" orpayable-upon-death bank aa:ount or security at his or her death? .............. 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a benefxtiary designation? .............................................:.......................................................................... ~ I X^ tF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE I~ S PART OF THE RETURN. _ .. _~ a _.. vr. .W. -... .. - ._ .r FL 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 (h 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 this Isurviving 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 requirer0e~rts 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 tlhe 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'.5I percent, except as noted in 72 P.S. §9116(1.2) (12 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(~)(h.3)]. 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. -r. '-T _a SCHEDULE B STOCKS AND BONDS ESTATE OF FILE NUIIVIBER ® ,'T., : = ~~- i ~ Account Statement ~ppenheimerFunds ^...~ The Right Way to Invest `1 Statement Period: Januaryi 0M, 2010 -June 30, 2010 Page 1 of 2 Your Financial Advisor. AV 01 037663 28806E 148 A**5DGT CRAIG A NISSLEY 'lll~~~~ll'I~'I~I'~"III"I'I~III~~"I~~~i~~l~l~llllll'~"I'll'I' INVEST FINANCIALCORPORATI~N ATTN COMMISSIONS DEPT ADALINE E JENKINS 8745 fiENDERSON RD STE 300 I •: 1436 ZIMMERMAN RD TAMPA, FL 33634-1148 CARLISLE PA 17015-9222 Total Account Value Market Value on June 30, 2010 $0.00 ~slt us online at www.oppenhe~imertunds.com ® 24hour automafed servirx: 1-800*CALL-OPP (225-5677) ©ppenheimer Pennsylvania Munieipal Fund Class A Value on .lone 30, 2~ 0 ' Account Number OD740 7400251933 Markef Value ! Share Price $0 , 00 $10 86 Account Reytstrafion ADALINE E JENKINS . fund Symbol OPATX Year-To-Date Summ>~rty Fund Cafegory Municipal Bond Dividends $1, 691.12 Year-to-Date Transaction Detail ', 7raasae~Ton Doflar Stara e+r Endine Data TransacbionDescrtpdon Mrount Price ShareBalance 01/26/10 Dividend Reinvested -1-- $359.31 $10.61 ' 3-3.865 6,813.341 02/18/10 Redemptiai $10,000.00 $10.64 - 9.850 5,873.491 02/23/10 Dividend Reinvested $352:25-- $10:65- 3.075 5,906.566 03/23110. Qivid~d. Reinvested $324:84 ~ $10.72` _..: 0.302 5,936.868 04/27/10 Dividend Reinvested $326.56 $10.86 + 0.070 5,966.936 05/25/10 Dividend Reinvested $326.16 $11.00 9.833 5,996.771 05/28/10 Transferred to Acct. 100740 7400405911 + -5,9 6.771 0.000 Year-to-Date Account Summary Date 01/01/10 i/arket Value Addttlons Withdmrals $71,252.29 + $0,00 -$75,844.55 Changeln V:luelEarnlnps + $4,592.26 NarkstYatuear June3Q, 20te _ $0.00 037663/000OC a SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANIOUS PERSONAL PROPERTY ESTATE OF FILE I ER I ALINE E. JENKINS 21-1'O AI 0477 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 DESCRIPTION VALUE AT DATE NUMBER OF DE,P- Members 1st Accounts: ~~, 1 Regulaz Savings ~~32.20 2 Checking Account ~4 967.54 3 Money Mazket Mgt 468.27 4 Highmazk refund $ ~ 02.00 5 Personal Account at Church of God Home $91.11 i I I 2L1AL (also on une ~, xecapnmaaon~ ~~,Pvi.i~ REGULAR SAVINGS ACCOUNT: Account Number/Suffix 269159-00 Date Account Established 11/24/2006 Principal Balance at Date of Death $332.20 ', Accrued Interest to Date of Death $0.00 Total Principal and Accrued Interest $332.20 Name of Joint Owner None CHECKING ACCOUNT: Account Number/Suffix 269159-11 Date Account Established 11/24/2006 Principal Baiance at Date of Death $4,967.53 Accrued Interest to Date of Death $0.01 Total Principal and Accrued Interest $4,967.54 Name of Joint Owner None MONEY MANAGEMENT ACCOUNT: Account NumberlSuffix 269159-05 Date Account Established 11/24/2006 Principal Balance at Date of Death $468.24 ', Accrued Interest to Date of Death $0.00. Total Principal and Accrued Interest $468.24 Name of Joint Owner None MEMBERS 1/ST~,FEDERAL CREDI~ UNION LeiC~StaBin s '~ 9 9 Lending Insurance Support Specialist May 13, 2010 Estate of: Adeline E. Jenkins Date of Death: May 1, 2010 Social Security Number: 560-70-3998 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 • i v~wwmemberslst.org SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUIVIBER if an asset was made joint within one year of the decedent's death, it must be reported on Schedule G i Surviving JoiJtt Tenant (s): NAME ADDRESS RELATION HIP TO DE EDENT A Charles P: Scott 1436 Zimmerman Rd., Carlisle, PA 17015 Son B Janice M. Bedorz C-13 #221, 20928 N. John Wayne Pkwy, Maracopa, Daugh~teK C Jointly-owned nronertv: I,I,~ ~~ LETTER FOR JOINT TENANT DATE MADE JOadT DHSCRIPTION OF PROPERTY MCLUDENAME OF nISTITUTION AND BANK ACCOUNT NUMBER OR SRdRAR IDENTQ+YING NUMBER ATTACH DEED FOR JOMTLY-HELD REAL ESTATE TOTAL VALUE OF ASSET DECD'S X INT. DOLLAR VALUE OF D HN'IS BJ'rEREST '~, ~ ~~, ~~~I 1 A & B 13-Jun-06 Bank of America $4,978.67 33.33 $1~'I,659.56 acct: **********2083 ~, TU1'AL (also on lino 6, Recapitulation) I ~ 1,660 ~a~~~f~~r~~a ~-~.~ .r~ <~ -.> Bank of America P.O. Box 3609 Los Angeles, CA 90051 June 10, 2010 TAYLOR ANDREWS 78 WEST POMFRET STREET CARLISLE PA 17013 RE: Reference #:L051710000307 Case: Adaline Jenkins Name: Estate of ADALINE JENKINS [Date of Death- 05/01/10] Dear TAYLOR ANDREWS, Below find financial information requested on accounts held in the name of the above-captiloned decedent as of date of death: ccount Number: `""*-"*'`'*""2083 DDA ate of Death Balance: 4978.67 rued Interest: /A tatus: en itle: DALINE E JENKINS Ja ,ICE M BEDNORZ Comments: The date of death balance as of 05/01/2010 is listed above.. The account was opened January 1993 and we maintain seven years records', As of June 2003 the title was Adaline E. Jenkins and Janice M. Bednorz then ', William D. Scott added as a joint-awne~. After,Widliam died June 2006 his name have been removed and from June 13; 20'06~accounttitle is`Adaline E. Jenkins', Janice M. Bednorz and Charles P. Scott joint tenancy. ' If you have any questions, please contact the party listed below. Should you need to forwial'd any additional correspondence to us regarding this matter, please direct it to the address noted) above. When contacting the Bank regarding this request please use the Reference # L051710000307. ' Subpoena Processing/UG1 R 213-240-6636 o~-t~-tans o;-~ooo SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES ESTATE OF FILE NUI~iBER ADALINE E. JENKINS 21-1'0~-0477 Debts of decedent must be reported on Schedule I. I ITEM DESCRIPTION UNT NUMBER A. Funeral Expenses: 1 memorial service -travel expenses $~ 11.80 2 B. Administrative Costs: 1 Personal Representive Commissions Name of Personal Representative(s) Social Security Number of Personal Representative: Street Address: City: State: Zip: Year(s) commissions paid: 2 Attorney fees to Andrews & Johnson $3,00.00 3 Family Exemption Claimant ~' Street: City: State & Zip Relationship of Claimant to Decedent: _ ', 4 Probate Fees to Register of Wills $18.50 5 Accountant Fees to Patricia Rosendale, CPA $ 50.00 6 Tax Return Prepazer's Fees '' 7 Bank chazges X33.95 8 9 10 11 I 12 13 14 15 16 17 ', 18 19 TOTAL (also on Line 9, Recapitulation) $4, 14.25 SCHEDULEI DEBTS OF DECEDENT MORTGAGE LIABILITIES AND LIENS ESTATE OF FILE NUN~BER ADALINE E. JENKINS 21-10 0477 ....... ...~ e,,.,m re , unnv as o e o m unreun acpmtes. SCHEDULE J BENEFICIARIES ESTATE OF F~ ' E NUMBER ADALINE E. JENKINS ' 21-10-0477 ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMO OR SHARE NUMBER Do Not List Trustee(s) ~ O ESTATE I ITAXABIE OGSTRIBUTIONS [mdude atliBht ~pounl diNibutions, and trmsfm udtr Sm. 9I IG(~X1.2)] 1 Chazles P. Scott III; 1436 Zimmerman Rd., Carlisle, PA 17015 Son 25% 2 Janice Bednorz; C-12 #221, 20928 John Wayne Pkwy, Daughter ', 25% Maracopa, AZ 85139 ~~ 3 Joyce Mattos; 37031 West Modragone Lane, Daughter 25% Maracopa, AZ 85138 ', 4 Diana Wise;. 25842 Cherry Hill Dr., Boron, CA 98516 Niece ',12.50% 5 Michele Boren; PO Box 1965, Lucerne Valley, CA 92356 Grand-niece ''..,12.50% II NON TAXABLE DISTRniU110N5: A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE CMrinbb ud Gmwnmmul Bequma: TOTAL CHARITABLE AND GOVERNI~NTAL BEQUESTS (also enter on line 13, Recapitulation) ~ $0 ~~ ~ ~ ~ i"~ LAST WILL AND TESTAMENT ~-+' ~ c~ ~~~~ OF ~ -' ADALINE E. JENI~NNS fU O _ O -,-... -r`t ~C ~'-~- j'-j~i 'T1 ~ ~ f `F r n,_' _~i~. - -~..~ ~ ~--i'It f~ I' I, ADALINE E. JENHINS, of Cazlisle Borough, Cumberland County, Pennsylvania, declare ~i~ to be my last V4'ill ana TCSrtainent and revoke any and ail wills and codicils heretofore made by me. ', ITEM I: ~My personal representative shall pay from the resid~ie; of my estate the c expenses of my last illness, funeral and burial debts duly allowed against my estate, and all death taxes (Pennsylvania inheritance tax and federal estate tax) occasioned by my death ~d incurred with ~-' \ res ect to all roe taxed to m estate re ardless of whether such roe asst p p p rly y g p p rry p by this Will or ~~ passes outside of this Will. ITEM II: I bequeath my personal effects, household goods, anQi other tangible ;~` personal property of like nature (not including cash or securities), together wi I~h any existing insurance thereon, as set forth in 3 separate ~e~orandu:+ which I.hall place withl ir~y ...Will to Cne ~\v persons therein designated. If I shall leave no sepazate memorandum, or with regaFd~ to my personal effects, household goods, and other tangible personal property of like nature (not occluding cash or securities) not referenced by such>memorandum; Ibequeatlz suclrproperty~to mpSon„`CIIARLES P. SCOTT III, or to his wife if he shall not survive me. __.. _. _. __.. _ _.. _. _T ~ -~ ITEM III: I devise and bequeath the residue of my estate, of every nature and wherever situate, as follows: 25% to my son, CHARLES P. SCOTT III, of Monroe Township, Cutr~berland County, Pennsylvania; 25% to my daughter JANICE BEDNORZ, of Apache Junction, Arizonan 25% to my daughter, JOYCE MATTOS, of Maricopa, Arizona; 12.5% to my niece, DIANA WISE, of Boron, California; 12.5% to my grand-niece, MICHELE BOREN, of Lucerne, California; ~.nd ITEM IV: I appoint my Daughter-in-law, GENE L. SCOTT, ~xecutrix of this my Last Will and Testament. Should she fail to qualify or cease to act as Ere~utrix, I appoint CHARLES P. SCOTT III as Executor of my estate. ITEM V: hdiect that my Executrix and her successors shall-n' t be re aired to ~ q give bond for the faithful performance of her duties in this or any other jurisdiction. IN WITNESS WHEREOF, I, ADALINE E. JENI~NS, have hereunto 'Set my hand and seal to this my Last Will and Testament, consisting of three (3) printed pages; eaclp of which bears my signature, this 4th day of January 2007. ~ ' /~'~cr~..c./ ~ C~ ..~~~ (SEAL) . A.DALINE E. JENI~!II~IS, Testatrix. , Signed, sealed, published and declared by the above-named Testatrix, ~'ADALINE E. JENKINS, as and for her Last Will and Testament, in the presence of us, who, at hdr request, in her sight and presence, and in th~ight and presence of each other, have hereunto sub~c$ibed our names as witnesses. ~ i A~ ` ~ '~- r., COMMONWEALTH OF PENNSYLVANIA ) . SS. COUNTY OF CUMBERLAND ) WE, ADALINE E. JENKINS, TAYLOR P. AND~tEWS, and G~ tcs 'p ~o~ ,the Testatrix and witnesses, respectively, whose, dames are signed to the foregoing or attached instrument, being first duly sworn, do hereby declare to ~he undersigned authority that the Testatrix signed and executed the instrument as and for her', Last Will and . Testament and that she signed willingly and that she executed as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witnesses and thatto the best of their laiowledge the Te~tatrix was at the time eighteen (18) or more years of age, of sound mind and under no constraint or'u6ndue influence. ~ay r P. Andrews, Witness , Witness Subscribed, sworn to and aclmowledged before me by ADALINE E. ~ENKINS, the Te trix, and subr~cribed to and sworn or affirmed to be xe me by TAYLOR P. ~REWS and ~~ its 0' SG o"{~ ,witnesses, this ~~h day of January 20!0'x. NOTARIAL SEAL , . ~ ' SHELLY SEXTON, Notar)~ ~uo;:~- ~ (SEAL) Carlisle Boro, CumberlanG ~,C'•ur!~~ Notary Public Pliy Commission Expires Apni 2~, ~'.._ ~_, ~_~_ ~-