The URL can be used to link to this page

Home My WebLink About01-27-11' 1505610140 REV-1500 EX (01-10) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 2 1 1 0 1 0 5 4 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 2 0 1 1 8 8 5 3 5 0 8 0 2 2 0 1 0 0 3 0 2 1 9 2 5 Decedent's Last Name Suffix Decedent's First Name MI S h u ma n G I e n n A (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI N A Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW D 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) ~ 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 oIRECTEO rv: Name Daytime Telephone Number Scot t W. Mor r i son, Esq 717 582 2300 First line of address 6 West Mai n St reet Second line of address P O Box 2 3 2 City or Post Office State New B I o o mf i e l d PA Correspondent's a-mail address: ZIP Code ~ 1 7 0 6 8 REGISTER OF ~YV~.LS USE ONLY' C'r~ ;~7 --~- 1 ~ _. f _ ~~~ °'1 _ -~ -_ ~ ~? - _.;F -`.~ ..`w~ ..~" DATf:~ILE~ Y -T-1 Y- ~~1 t-'! , 5 __ , ,I ., _: __ ..{, ~ ."~ ~' i 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 belief, it is correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG RE.OF Pr~30N SPONSIBLE FOR FILING RETURN ~O ~) j~ DAjE _ ~ _ Coysvill~, PA 17047 -,-- -- SIGNATIJREA89R~P71~6~R OTHER 6 V'V~es~t'Main Street 1505610140 REPRESENTA' Shermans Dale New Bloomfield PLEASE USE ORIGINAL FORM ONLY Side 1 PA 17090 D E P 170 8 1505610140 1505610240 REV-1500 EX Decedent's Social Security Number Decedents Name: Glenn A. Shuman 2 0 1 1 8 8 5 3 5 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 and Notes Receivable (Schedule D) .......................... 4. • 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 4 ~ 1 4 • 8 8 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. • 7. Inter-Vivos Transfers 8~ Miscellaneous N n-Probate Property (Schedule G) ~ S Bill eparate ing Requested ....... 7. 8. Total Gross Assets (total Lines 1 through 7) ........................... 8. 4 ~ 1 4 . 8 8 9. Funeral Expenses and Administrative Costs (Schedule H) ................. . 9. 3 4 4 9 . 2 4 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............. 10. 1 1 5 3 4 1 6 9 11. Total Deductions (total Lines 9 and 10) ............................... 11. 1 1 8 7 9. 9 3 12. Net Value of Estate (Line 8 minus Line 11) ............................ 12. - 1 1 4 7 7 6 . ~ 5 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. - 1 1 4 7 7 6 . ~ 5 TAX CALCULATION -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 .0 ~ ~ ~ 15. ~. 16. Amount of Line 14 taxable at lineal rate X .0 ~ 0 ~ 16. ~• ~ ~ 17. Amount of Line 14 taxable at sibling rate X .12 ~. ~ 0 17. ~. ~ ~ 18. Amount of Line 14 taxable at collateral rate X .15 ~ ~ ~ 18, 0. 19. TAX DUE ............................................... ....... 19. ~ . ~ ~ 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^ Side 2 1505610240 1505610240 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 10 1054 DECEDENT'S NAME Glenn A. Shuman STREET ADDRESS 940 Walnut Bottom Road CITY Carlisle STATE PA ZIP 17013 Tax Payments and Credits: ~ • Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount Total Credits (A + B) (2) 0.00 0.00 0.00 0.00 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. (3) (4) (5) 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 : ...................................................................... ^ Q b. retain the right to designate who shall use the property transferred or its income; ............................... ^ Q c. retain a reversionary interest; or ................................................................................................ ^ X^ d. receive the promise for life of either payments, benefits or care? ....................................................... ^ Q 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ^ Q 3. Did decedent own an "intrust for" orpayable-upon-death bank account or security at his or her death? ......... ^ Q 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 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 EX + (8-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Glenn A. Shuman 21 10 1054 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. The Bank of Landisburg Irrevocable Burial Fund PS Account #68515049 201.15 2. The Bank of Landisburg DDA#2638711 ~ 3,813.73 TOTAL (Also enter on line 5, Recapitulation) I $ 4 014. (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (10-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Glenn A. Shuman 21 10 1054 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) G_a_ry A. Shuman 750.00 Street Address 3451 Fort Robinson Road City Loysville State PA zIP 17047 Year(s) Commission Paid: 2. Attomeyi=ees: Scott W. Morrison, Esquire 1,500.00 3. Family Exemption: (If decedent's address is not the same as claimants, attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4• Probate l=ees: Glenda Farner Strasbaugh 80.50 5 Accountant Fees: 6. Tax Retum Preparer Fees: 7. The Sentinel -estate advertising 293.74 8. Cumberland Law Journal -estate advertising 75.00 TOTAL (Also enter on Line 9, Recapitulation) ~ 3 449.24 If more space is needed, use additional sheets of paper of the same size. Continuation of REV-1500 Inheritance Tax Return Resident Decedent Glenn A. Shuman Decedent's Name Page 1 21 10 1054 File Number Schedule H -Funeral Expenses & Administrative Costs - 61 ITEM NUMBER DESCRIPTION AMOUNT B. ADMINISTRATIVE COSTS: Personal Representative Commissions: 2• Name(s) of Personal Representative(s) Patty J. Rowe 750.00 Street Address 250 Reibers Church Road city Shermans Dale State PA zIP 17090 Year(s) Commission Paid: SUBTOTAL SCHEDULE H-B1 ~ 750.00 REV-1512 EX+ (12-08) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Glenn A. Shuman 21 10 1054 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. Highmark Blue Shield -account 537.30 2. MCHS Carlisle -account 168.41 3. Department of Public Welfare -claim 114,635.98 TOTAL (Also enter on Line 10, Recapitulation) I $ 115, 341.69 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) pennsylvania ~ SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Glenn A. Shuman 21 10 1054 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 outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. Debra E. Weller Lineal 342 Bridgeport Road one-seventh Landisburg, PA 17040 2. Sharon L. Bender Lineal 25 Kennedy Valley Road one-seventh Landisburg, PA 17040 3. Gary A. Shuman Lineal 3451 Fort Robinson Road one-seventh Loysville, PA 17047 4. Peg L. O'Hara Lineal 304 E. Main Street one-seventh Landisburg, PA 17040. 5. Glenna Shuman Lineal 34 Landis Lanes one-seventh Millerstown, PA 17062 6. Linda Shuman Lineal 34 Landis Lanes one-seventh Millerstown PA 17062 7. Patty J. Rowe Lineal 250 Reibers Church Road one-seventh Shermans Dale, PA 17090 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE ANb GOVERNMENTAL DISTRIBUTIONS: TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. ~ Ir more space is needed, use additional sheets of paper of the same size. The (~3~R~of Landisbue~ ESTABLISHED 1903 P.O. BOX 179 • LANDISBURG, PA 17040 Bank records indicate the following account balances on August 2, 2010 for: Glenn A. Shuman 250 Reibers Church Road Shermans Dale, PA 17090 Acct Sole Jt. Acct. Opened Ownership With 8/26/2009 Yes irrevocable burial fund 6/5/1998 Yes SS# 201-18-8535 Account Type Balance Interest Accrued Number Bearing Interest 68515049 PS $200.94 Yes $0.21 2638711 DDA $3,813.73 No $0.00 Respectfully, ~_ Community Office anager ~~~ LANDISBURG - 717-789-3213 BLAIN - 536-3118 SHERMANS DALE - 582-8511 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF PROGRAM INTEGRITY DIVISION OF THIRD PARTY LIABILITY ESTATE RECOVERY PROGRAM PO BOX 8486 HARRISBURG, PA 17105-8486 November 5, 2010 LAW OFFICES OF SCOTT W. MORRISON CENTER SQUARE P.O. BOX 232 NEW BLOOMFIELD PA 17068 Re: Glenn Shuman CIS #: 410383605 SSN: ###-##-8535 Date of Death: 08/02/2010 Dear Scott W. Morrison: Please be advised that the Department of Public Welfare maintains a claim in the amount of $114,635.98 against the above-mentioned estate. This claim is for restitution of medical assistance granted on behalf of the decedent for which the Probate Estate is now responsible to reimburse the Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's itemized statement of claim. A portion of this medical expense, namely $26,638.18, was incurred during the last six months of the decedent's life; therefore, it is a Class 3 claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $87,997.80, is to be entered as a priority Class 5.1 claim against the estate. Please acknowledge receipt of this letter and advise whether the Commonwealth's claim is admitted and when payment may be expected. If the estate accounting is complete, please provide a copy. If the estate contains real estate, please provide copies of the deed, the latest tax assessment, and a current appraisal, if available. Sincerely, t~~ ~ Karin L. Tyler Claims Investigation Agent 717-772-6614 717-772-6553 FAX Enclosure aanaao~ s~,v, > ~ ;r~~ i ~r,i h k r !' a` ~, u - ~ ,; ', p k ~: r}. k :, .i k i ~~ i k, :r r ..~, l1_. ~^ ~.... ~m ~ .~ '_ ~ ~~ ~ r- ~~,~ F ~ ~... }~^ r. :~. ~...v,. 4__t.._ .. .. ... rte: `~~idi ~,~z~~~;,~~~, ~~ I I y ~. ~~'•~; U '; ~.~. I '~ tt~ I ~~ ,i W v] O h 1 ;; {`~ O U W ~ V1 ~ C+'1 zao~® ~HC!]~~ O 3 w v--~ w cn ~ O~~- ~ ~ W a w F-+ -? ~ E-~ x cn W ~ ~ H ~ HO~-1 C7Uf~ W e U A; ~ U