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Home My WebLink About02-10-11150561D101 '~' REV-1500 Ex ~°1.1°' ' OFFICIAL USE ONLY PA Department of Revenue Pennsylvania Bureau of Individual Taxes UEYANiMEN10FNEVENVE County Code Year .File Number INHERITANCE TAX RETURN PO BOX 28o6oi '-l `~ ~ Harrisburg, PA i~128-0601 RESIDENT DECEDENT ~` 1 ~ ~ ~' 't ~ _ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 173-38-6418 f 04/18!2010 08/02/1953 _. Decedent's Last Name Suffix Decedent's First Name MI Lewis ;Sherry ~ A (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Mf Lewis Forrest ~, R Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 585-62-8001 REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 4'j 1. Original Return O 2. Supplemental Return O 3. Remainder Retun~ (date of death (~ 4. Limited Estate O 6. Decedent Died Testate (Attach Copy of Will) O 9. Litigation Proceeds Received O 4a. Future Interest Compromise (date of death after 12-12-82) O 7. Decedent Maintained a Living Trust (Attach Copy of Trust) O 10. Spousal Poverty Credit {date of death between 12-31-91 and 1-1-95) prior to 12-13-82) O 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes O 11. Election to tax urnder Sec. 9113(A) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Nurnber Mindy S. Goodman, Esq. (717) 540-8742 .- .~ First line of address 2215 Forest Hills Drive _.. .. ,. Second line of address Suite 35 City or Post Office State ZIP Code Harrisburg PA 17112 _ c~ _ _. REGISTER d(ll!1 .LS USE QNhY 4 . :"1~7 _ t (;, f ~;' - ~~ . _I r^~. ,...~ .J ~ti... ~ '1 .. L ~ t ...J _.t....f - = ~ y ~.,._.. ~~~~ DATE FILED Correspondent's a-mail address: goodmanlaw@verizon.net 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 true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer h;as any knowledge. SI F P ON RE IBL ETUI~A1- DATE 0~(~/11 301 S. Stoner Avenue, Shiremanstown, PA 17011 _ _ _ _ _ __ NATUf?~E OF PRE~E~HER THAN REPRESENTATIVE DAl"E .-.~~ _ ~,'L~~_-~+ 01 / 14111 ADDRESS 2215 Forest Hills Drive -Suite 35, Harrisburg, PA 17112 PLEASE USE ORfGINAL FORM ONLY' Side 1 1505610101 1,505610101 :~ °'T"t r_. 5~- ~.~ _, . ~ _.~ .~ ~ ..-~ f~:~ i-~ "'t1 J 15056101,D5 REV-1500 EX Decedent's Social ;>ecurity Number Decedent's Name: Sherry A. Lewis 173-38-6418 RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. 173,000.00 2. ....................................... Stocks and Bonds (Schedule B) 2. ' _. 0.00 _ e __ ~.__ ._ A 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. , 0.00 4. 9 9 ( ) ........................... Mort a es and Notes Receivable Schedule D 4. ' 0.00 f 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. ; 3,000.00 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 29,614.50 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property .~ K _.. ~, _~_ ~~_ ,. ._._,..,d. _..M.~_~ (Schedule G} O Separate Billing Requested........ 7. 0.00 8. Total Gross Assets (tots{ Lines 1 through 7) ............................. 8. 205,614.50 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. 12,627.50 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .............. 10. 186,388.95 11. Total Deductions (total Lines 9 and 10) ................................. 11. ' 199,016.45 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. ' 6,598.05 13. Charitable and Governmental BequestslSec 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. 6,598.05 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 _ .i (a}(1.2) x .o_ 3,299.03 15. ~ 16. ... _. __ ~ __.. _. Amount of Line 14 t xable ,. _. _ ~. ., ..... ~~ r . at lineal rate X .o ~ 3,299.03 ' 16, 148 46 17. Mv_ .,. ~ . ~ .... ~~~ w ~ .. _ Amount of Line 14 taxable ~ _ ... ~ ...y_ ___ .. _ .. _.. at sibling rate X .12 17. 18. ~_ e _ ~__.,.. _ . _ . _ .., _ _._ .. Amount of Line 14 taxable ~... _ ~ .~ - - _ . „N __ ~.. at collateral rate X .15 18. 19. TAX DUE ......................................................... 19. 148.46 `. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~ Side 2 1505610105 1505610105 REV-1500 EX Page 3 File Number Decedent's Complete Address: Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments 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. 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 DIfE. Total Credits (A + B) (2) (3) (4) (5) 148.46 148.46 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" 1N THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes 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 : ............................................ ^ c. retain a reversionary interest; or .......................................................................................................................... ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 0 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? X 3. Did decedent own an "in trust for" orpayable-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 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 transfiers 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 sti11 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. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER Lewis, Sherry A 21 - 10 - 00487 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 wilting seller, neither being compeNed 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. {TEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 301 S. Stoner Avenue, Shiremanstown, PA -- recent countywide assessment valued property at $17'3,()00 173,000.00 TOTAL (Also enter on Line 1, Recapitulation) ~ 173,000.00 SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Lewis, Sherry A 21 - 10 - 0048? Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 2005 Nissan Maxima -very poor condition 3,000.00 TOTAL (Also enter on Line 5, Recapitulation) ~ 3,000.00 i SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Lewis, Sherry A 21 - 10 - C10487 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G„ SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A Forrest R. Lewis 301 S. Stoner Avenue Husband Shiremanstown, PA 17011 B C JOINTLY OWNED PROPERTY: ITEM NUMBER i LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PR PER Include name of financial institution and bank account number or similar identifying number. Attach deed for jointly-held real estate. DATE OF DEATH VALUE OF ASSET °!~ OF DECD'S INTEREST ' DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1 A 'i PNC Checking Account ~ 42,202.73 '~0% 21,101.37 2 A PNC Money Market 1,076.25 50% 538.13 3 A i l 2007 Nissan Murano 15,950.00 50% 7,975.00 ---- ~- TOTAL (Also enter on I~ne 6, ttecapitu~ationJ Ly,614.5U SCHEDULE G ' I~+NTER-VIVOS TRANSFERS & COMMONWEALTH OF PENNSYLVANIA MISC. NON-PROBATE PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT - ESTATE OF Lewis, Sherry A FILE NUMBER 21 - 10 - 00487 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY Include the name of the transferee, their relationship to decedent and the date of transfer. Attach a copy of the deed for real estate. DATE OF DEATH VALUE OF ASSET % OF DECD'$ INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 Retirement with SERS -beneficiary is Husband and not subject to tax. 1 I i TOTAL (Also enter on line 7, Recapitulation SCHEDUIF H FUNERAL DCPENSES & COMMONWEALTH OF PENNSYLVANIA ' ^` ^~,~~ INHERITANCE TAX RETURN ~ry RESIDENT DECEDENT ESTATE OF FILE NUMBER Lewis, Sherry A 21 - 1() - 00487 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER _ A, FUNERAL EXPENSES: 1 Myers-Hamer Funeral Home, Inc. 5,681.00 2 Flowers 250.00 3 Luncheon ~ 250.00 B. I ADMINISTRATIVE COSTS: 1. ~ Personal Representative's Commissions ~ Forrest R. Lewis Social Security Number(s) J EIN Number of Personal Representative(s): Street Address 301 S. Stoner Avenue C;ty Shiremanstown State PA Zip 17011 Year(s) Commission paid 2. Attorney's Fees Mindy S. Goodman 2,500.00 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3,500.00 Claimant Forrest R. Lewis Street Address 301 S. Stoner Avenue City Shiremanstown State PA Zip 17011 Relationship of Claimant to Decedent Spouse 4. Probate Fees Register of Wills 323.50 Advertising Fees 123.00 5. Accountant's Fees 6. ~ Tax Return Preparer's Fees I ~I 7. Other Administrative Costs j 1 TOTAL (Also enter on line 9, Recapitulation) ~ 12,627.50 SCHEDULE I DEBTS OF DECEDENT, MORTGAGE COMMONWEALTH OF PENNSYLVANIA LIABILITIES, & LIENS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Lewis, Sherry A 21 - 10 - 00487 Include unreimbursed medical expenses. ITEM DESCRIPTION AMOUNT NUMBER 1 Nissan Maxima 2,456.00 2 Nissan Murano -total debt $18,080 -jointly owned vehicle 9,040.00 3 Chase INK Credit Card 1,145.90 4 Chase Disney 2,613.40 5 Capitol One 3,673.64 6 CitiBank 8,917.15 7 Discover 3,417.29 8 Mortgage 142,000.00 9 General Finance Installment Loan 6,690.00 l0 General Finance Installment Loan 1,495.00 11 School Property Taxes 2,500.00 12 HSBC Bank 1,633.57 13 2008 Federal Income Tax 807.00 TOTAL (Also enter on Line 10, Recapitulation) ~ 186,388.95 Performance Select Account Statement PNC Bank For the period 04/09/2010 to 05/07/2010 c SHERRY ANN LEWIS H FORREST R LEWIS ~ 301 S STONER AVE SHIREMANSTOWN PA 17011-6760 Primary account number: 50-0100-1649 Page 1 of 3 Number of enclosures: 0 ~ For 24-hour banking, .and transaction or interest rate information, :sign on to PNC Bank Online Banking at pnc.com. 'a For customer service call 1-888-PNC-BANK Monday -Friday: 7 AIVI - 10 PM ET Saturday & Sunday: 8 AM - 5 PM ET Para servicio en espano'T, 1-866-HOLA-PNC Moving? Please contact us at 1-888-PNC-BANK ® Write to: Customer Service PO Box 609 Pittsb~!rgh PA 15230-9738 Visit us at pnc.com TDD terminal: 1-800-531-1648 For hearing impaired clients only Important Account Information About the Payment of Overdrafts on Your Account Effective August 15, 2010 A new rule will affect standard overdraft practices and the way we pay overdrafts on ATM and everyday debit card transactions. Included in this statement is an Overdraft Notification document that explains our standard overdraft practices, our Overdraft Protection and other information that you need to know about this upcoming change. Enclosed, the "Overdraft Rules are Changing, Know the Facts" insert explains our Overdraft Solutions that can help you manage your money and avoid overdraft fees. Please read this important information and retain it with your records. You can also visit pnc.cotn/overdraftsolutions for more information. Performance Select Sherry Ann Lewis Forrest R Lewis Interest Checking Account Summary Account number: 50-0100-1649 Overdraft Protection Provided By: Contact PNC to establish Overdraft Protection Balance Summary Beginning Deposits and Checks and other balance other additions deductions 34,034.59 33,889.26 16,904.38 Average monthly balance 47,025.26 Ending balance 51,019.47 Charges and fees 35.00 - Transaction Summary Checks paid! withdrawals 11 Total ATM transactions 12 Check Card POS signed transactions 2 PNC Bank ATM transactions 0 Check Card/Bankcard POS PIN transactions 1 Other Bank ATM transactions 12 40.:121 -points balance as of May 6, 2010 For CheckCard xxx;K x~;xx xxxx 7497 Performance Select Account Statement For 24-hour information, sign on to PNC Bank Online Banking on pnc.com. Account number: 50-0100-1649 -continued Interest Summary Annual Percentage Yield Eamed (APYE) 0.18% Number of days Average collected in interest period balance for APYE 29 46,756.50 For the period 04/09/2010 to 05/07/2010 SHERRY ANN LEWIS Primary account number: 50-0100-1649 Page 2 of 3 As of 05/07, a total of $28.39 in interest was Interest Paid paid this year. this period 6.74 Activity Detail Deposits and Other Additions Date Amount Description 04/09 3.00 Non-PNC ATM Surcharge Reimbursement 04/12 3.00 Non-PNC ATM Surcharge Reimbursement 04/13 3.00 Non-PNC ATM Surcharge Reimbursement 04/14 7,894.37 Deposit Reference No 521124750 04/16 1,518.73 Direct Deposit -Payroll PA Treasury Dept XXXXXXXXXXX1289 04/19 3.00 Non-PNC ATM Surcharge Reimbursement 04/19 3.00 Non-PNC ATM Surcharge Reimbursement 04/19 3.00 Non-PNC ATM Surcharge Reimbursement 04/19 3.00 Non-PNC ATM Surcharge Reimbursement 04/19 2.00 Non-PNC ATM Surcharge Reimbursement 04/19 12,619.68 Direct Deposit -Annuitant PA Treasury Dept XXXXXXXXXXX7287 04/20 3.00 Non-PNC ATM Surcharge Reimbursement 04/20 3.00 Non-PNC ATM Surcharge Reimbursement 04/22 6,000.00 Branch Deposit Tel 0400011511 0087 04/23 4,296.00 Direct Deposit -Tax Refund US Treasury 220 XXXXX8001 04/26 3.00 Non-PNC ATM Surcharge Reimbursement 04/29 3.00 Non-PNC ATM Surcharge Reimbursement 04/30 1,518.74 Direct Deposit -Payroll PA Treasury Dept XXXXXXXXXXX1292 05/07 6.74 Interest Payment There were 19 Deposits and Other Additions totaling $33,889.26 Checks and Substitute Checks Check Date Reference Check Date Reference number Amount paid number number Amount paid number 3180 158.15 04/26 086554087 4047 252.00 05/04 oss332717 3287 * 6,609.08 04/20 084579168 4048 240.00 05/07' ()83837741 4043 '' 300.00 05104 521161210 4049 253.00 05/05 o8sso2306 4044 170.OG 05104 5211ii1209 9997' 53.00 4^%21 0°5150856 4045 812.71 05/05 oas7anss 9999 ' 100.00 04/09 084137716 4046 222.62 05/03 520335045 Gap in check sequence Banking/Check Card Withdrawals and Purchases Date Amount Description 04/09 103.00 ATM Withdrawal M&T Harrisburg Hos Harrisburg PA 04/12 403.00 ATM Withdrawal 720 Bow Creek Road Grantville PA 04/13 103.00 ATM Withdrawal M&T Harrisburg Hos Harrisburg PA 04/19 503.00 ATM Withdrawal 720 Bow Creek Road Grantville PA 04/19 403.00 ATM Withdrawal 720 Bow Creek Road Grantville PA 04/19 303.00 ATM Withdrawal 720 Bow Creek Road Grantville PA 04/19 203.00 ATM Withdrawal 720 Bow Creek Road Grantville PA 04/19 135.24 7543 Check Card Purchase Dtv*Directy Service There were 11 checks listed totaling $9,170.56 _ There were 12 Banking Machine withdrawals totaling $3,635.00 There was 1 Check Card/E3ank card PIN POS purchase totaling $36.00 There were 2 other Banking Machine/Check Card deductions totaling $309.41 Banking/Check Card Withdrawals and Purchases continued on next page Performance Select Account Statement For 24-hour information, sign on to PNC Bank Online Banking on pnc.com. Account number: 50-0100-1649 -continued For the period 04/09/2010 to 05/07/2010 SHERRY ANN LEWIS Primary account number: 50-0100-1649 Page 3 of 3 Banking/Check Card Withdrawals and Purchases -continued Date Amount Description 04/19 102.00 ATM Withdrawal 5140 Simpson Ferry Mechanicsbur PA 04/20 403.00 ATM Withdrawal 720 Bow Creek Road Grantville PA 04/20 303.00 ATM Withdrawal 720 Bow Creek Road Grantville PA 04/26 503.00 ATM Withdrawal 720 Bow Creek Road Grantville PA 04/29 303.00 ATM Withdrawal 720 Bow Creek Road Grantville PA 05/03 174.17 7497 Check Card Purchase Attm"464009601384Phi 05/06 38.00 POS Purchase Toms Milroy Milroy PA Online and Electronic Banking Deductions Date Amount Description 04/12 354.96 Web Pmt Recur- Directpay Capital Grie Auio 00004136987 i 001 04112 190.00 Direct Payment -Loan Paymt Am Genl Finance XXXXXXXX5159 04/20 150.42 Direct Payment -Payment Encompass Ins XXXXXXXXXXX6464 04/21 32.01 Direct Payment - Paymentrec Verizon XXXXXXXXX5317 04/21 3.00 Direct Payment - Paindivltx Personalincome XXXXX8001 04/22 200.00 Web Pmt Single - E-Payment Discover 6181 04/22 200.00 Web Pmt Single -Online Pmt Capital One 011139910281445 04/22 1,145.90 Phone Order Pmt- Epay Chase 907429172 04/22 200.00 Direct Payment -Phone Pymt Citicards Pymt 3090 04/22 200.00 Direct Payment - Elec Remit American Express XXXXXXXXXXX0488 05/04 101.00 Web Pmt Single - Inst Xfer Paypal 4Hk2248Ectxwe 05!07 59.50 Direct Payment -Central PA Comcast Central 22514102 There were 12 Online or Electronic Banking Deductions totaling $2,836.79 Other DedUCtIOnS There was 1 Other Deduction totaling Date Amount Description $914.62 04/29 914.62 Loan Payment 00000 4003048112730992 Daily Balance Detaii Date Balance Date Balance Date Balance Date Balance 04/09 33,834.59 04/19 53,187.17 04/26 53,331.61 05/05 51,350.23 04/12 32,889.63 04/20 45,727.67 04/29 52,116.99 05/06 51,312.23 04/13 32,789.63 04/21 45,639.66 04/30 53,635.73 05/07 51,019.47 40,684.00 ~ 04/22 49,693.76 05/03 53,238.94 04/16 ~,~~ 04/23 53,989.76 05/04 52,415.94 Achieve your homeownership goals with PNC Mortgage. Whether you are purchasing your first home, moving up to ;sornething larger or refinancing, we have the borrowing options to make your dreams a reality. PNC Mortgage is a division of PNC Bank, National Association, a subsidiary of PNC, All loans are provided by PNC Bank, National Association and are subject to credit approval and property appraisal. Equal Housing Lender.