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Home My WebLink About02-10-110 J 1505610101 REV-1500 tsx(nt-r°' ~ OFFICIAL USE ONLY PA Department of Revenue Pennsylvania Coun Code Year File Number Bureau of Individual Taxes ~ `~ ~~ ~~~~~~ INHERITANCE TAX RETURN ~" ~ i Oq ______. .....--.- PO BOX z8o6ot I ~ ~ ~ ,y / \ Harrisburg, PA 17t28-0601 RESIDENT DECEDENT ' j '( (J ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 10/30/2009 ' 01/05/1941 Decedent's Last Name Suffix Decedent's First Name MI ,,, .-... Wilson ' Homer D' (If Applicable) Enter Surviving Spouse's information Below Spouse s Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW OIb 1. Original Return O 2. Supplemental Retum O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 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 DIRECTED T0: Name Daytime Telephone ber r..i R. Scott Cramer `~' (717) 834-5700~~0 -""' ~ "* ' tom. -"F ~~, i,~ REGISTER OF(7M0 ONICb Cra ~7 ~'vi~ O r?~ '~'i Firsl line of address r~-~C7 S` i~ P.O. Box 159 G~ ..~ - -' =`', Second line of address °° - ~ ~ _-° -- i= ti (..~ i7 City Of P05t Office State ZIP Code DATE FILED Duncannon PA ii 17020 Correspondent's a-mail address: Under penalties of perjury, I declare that I have examined this return, Including accompanying schedules and statements, and to thebest 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 has any knowledge. SIG RSON.RESPONSIBLE FOR FILING RETURN DATE Side 1 1505610101 1505610101 ADDRESS J 1505610105 REV-1500 EX Decedent's Social Security Number Decedent's Name: ~ RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. 2. Stocks and Bonds (Schedule B) ....................................... 2. ~, ~......_...__ ,_.__.,...,. __._.._.-_._.....,.,_.--___w..._._,_.._... 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. j 4. 5. 6. 7. 8. Mortgages and Notes Receivable (Schedule D) ........................ Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... Jointly Owned Property (Schedule F) O Separate Billing Requested .... Infer-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested..... Total Gross Assets (total Lines 1 through 7) .......................... ... 4. ... 5. ! ... 6. ; ... 7. '! i_ ..,_, _...._.__, ... B. , 4,848.61 i ; _ __.,.__ _.._.. __ 4,848.61 ', 9. Funeral Expenses and Administrative Costs (Schedule H) ....:........... ... 9. ' 10,587.45 i 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ........... ... 10. 11. Total Deductions (total lines 9 and 10) .............................. ... 11. : 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12.: 0.00 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which d_°°-- -- - __ . _,.._. _. _,.~_.,w._. . ,.,._; an election to tax has not been made (Schedule J) ..................... ... 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ..................... ... 14. 0.00 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 .. .. ..m.-... .n......._ __.._._me._ i .......... . .........n,.., . ..m.... m __..,._... .. at lineal rate X .0 _ ' 1g, 17. _..,. _....m.m.. ,_.._....._.,. __. Amount of Line 14 taxable _. _. ~~.,,_.,.. .. ._,.._.._,__... _,_.._. at sibling rate X .12 17, 18. Amount of Line 14 taxable at wllateral rate X .15 ' 18. 19. TAX DUE ...................................................... ... 19. 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610105 1505610105 J REV-1500 EX Page 3 Decedent's Complete Address: File Numbsr DECEDENT'S NAME Homer David Wilson STREET ADDRESS 90 Salem Church Road CITY Mechanicsburg STATE PA ZIP 17050 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 0.00 2. CreditslPayments A. Prior Payments B. Discount Total Credits (A + B) (2) 3, Interest (3) 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. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 Make check payable to: REGISTER OF WILLS, AGENT. ` ;~;hi ii,`„!:S~ti~ {A!~„~y'i4' ""'if+s -~•wazcawmmL •-.a~aw 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 :...................................... ...... ^ Q c. retain a reversionary interest; or .................................................................................................................... ...... ^ 0 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 without receiving adequate consideration? ........................................................................................................ ...... ^ ^fc 3. Did decedent own an "intrust for" or payable-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? .................................................................................................................. ...... ^ 0 IF TyyHE ANSWE~Rg~TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. r #§Sf~k 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)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)]. 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. SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY Estate of Homer David Wilson No. - 2009-01070 (All orocerty jointly-owned with Rieht of Survivorship must be disclosed on Schedule F ) ITEM NUMBER DESCRIPTION 1. Bank Accounts M&T Bank 499 Mitchell Road Millsboro, DE 19966 Checking - # 950584820 DOD accrued interest TOTAL VALUE AT DATE OF DEATH $ 4,848.45 .16 $ 4,848.61 $ 4,848.61 SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Estate of Homer David Wilson No. - 2009-01070 Debts of decedent must be reported on Schedule I ITEM NUMBER DE RIPTIQN AMOUNT A. FUNERAL EXPENSES: Auer Cremation Services $ 1,495.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commission - Name of Personal Representative (s) - Social Security Number(s) iEIN Number of Personal Representative(s) Address: 2. ATTORNEY FEES - 3. FAMILY EXEMPTION: (If decedent's address is not the same as claimant's, attach explanation) Claimant - Street Address - City - State Zip - 4. PPL $ 92.55 5. PA Department of Public Welfare $ 8,999.90 $ 10,587.45 499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12 Phone (888)502-4349 Fax (302)934-2955 December 16, 2009 R Scott Cramer 5 S Market St PO Box 159 Dttncannon, PA 17020 Re: Estate of: Homer David Wilson Social Security: Date of Death: October 30.2009 Dear Sir or Madam: Per your inquiry, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account Account Number . Ownership (Names o, fl Opening Date Balance on Date of Death Accrued Interest Total Checking Account 950584820 HDutvd Wilson 03/16/01 closed 1?J16/D9 $ 4848.45 $ 0.16 -- $ 4848.61 ----------------- Please be advised, there was no safe deposit boz found for. the above decedent. • If upon reviewing the ioformstion above, you be4eve there are additional accotmts not referenced, please provide us with an account number and/or name of any poss,'bk joint atxount holden For any additional lmformation on the above atxounts, mcinding ownership and any changes, dosures and/or reimbursement of ifunds, etc., please contact our llau~den brandy 5528 Carlisle Pie, Mechanicsburg, PA 17050. Ol'lfoe # 717-255-2293. Sitxxrely, __'„~ ) o/riss~a Sears Adjustment Services OH g • ~P `'~~ AVER CREMATION SERVICES OF PENNSYLVANIA, INC. gv ~~+' 4100 Jonestown Road • Harrisburg, PA 17109. 1-800-720-8221 • Fax 717-541-9943 • Shawn E. Carper, Supervisor Oct 30, 2009 ,. , , Mra. Donna J. Sipe 90 Salem Church Road, #506 Mechanicsburg, PA 17050 Homer David Wilson - Deceased ,ri n: ~, , ,•: ,.. SPECIAL CHARGES ~ ~ : .. ... .. _ , X Direct Cremation $1,495.00 Nationwide Guarantee Program Worldwide Travel Protection TOTAL SPECIAL CHARGES ..,~. $1,495.00 PROFESSIONAL SERVICES X Services of Funeral Director & Staff Included Other Preparation of~~ahe` Body , Faci 1 idea & Staff 1~olr, Memorial Service ;. . . Staff & Equipment for Memorial Service _,• Witnessing the Cremstion ;,; s . Private Family Viewing/Witnessing Cremation Packaging And Forwarding Cremated Remains . Personal Dellvery,af Cremated Remains Scattering of Cremated Remains ,._, . Medical Documents/Courier Fee ._ ,~: ~,. TOTAL PROFESSIONAL SERVICES .. ., ••-$0.00 AUTOMOTIVE EQUIPMENT X Removal Vehicle: ::• ~ ~ ~ Included Lead Car/Clergy Car Family Car Service Vehicle TOTAL AUTOMOTIVE EQUIPMENT $0.00 r COMMONWEALTH OF PENNSYLVANW DEPARTMENT OF PUBLIC WELFARE BUREAU OF PROGRAM INTEGRYTY DNISION OF THIRD PARTY LIABILIT' ESTATE RECOVERY PROGRAM PO BOX 8486 ~ HARRISBURG, PA 17105488 February 12, 2010 R SCOTT CRAMER ESQUIRE P 0 BOX 159 5 S MARKET ST DUNCANNON PA 17020 Re: Homer Wilson CIS #: 410461370 SSN: ###-##- Date of Death: 10/30/2009 Dear Attorney Cramer: Please be advised that the Department of Public Welfare maintains a claim in the amount of $8,999.90 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. 1912, effective August 15, 1999, 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 $4,300.59, 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; hamely $4,699.31, 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 cogies of the deed, the latest tax assessment, and a current appraisal, if available. Sincerely, Elizabeth M. Wilson TPL Program Investigator 717-214-1868 717-772-6553 FAX Enclosure cc: Donna J Sipe 90 Salem Church Rd _,. 506 Mechanicsburg PA 17050 ~~~I - __ '~ _, r aen3aoe - -- ~ i ~ \ ~ v ~7v '~'~. a3naao~ ~~'~~ ~-,~ ,- 'T'~~ a ~_ `.; ~ ,`, j~ \/~~I ~~ o N I ~ N U b .- tA J, b+ ~ '-I ~ •'1 ~ N 3 O m orox°i a +~ N ro N v m~ a ~ +~ N O v1 wN U•~ •~ A ~ to 6 v N ~~ ~ ro a~ou u R. SCOTT CRAMER ATTORNEY AT LAW 3 f. MARKET fT., 1!O. f07( 168 DUNCANNON, PENNSYLVANIA 17020 17171 f6I•f700 FIV[ Ho. (717) f9hf012 February 9, 2011 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, Pennsylvania 17013 ~ c~~ ~~ -n 'T ~ C.~;7 ~~~ lr +J CT1~n i f W ,- c„'i iJ l:` r _. D --i ~ Cn Re: Estate of Homer David Wilson D.O.D. 10/30/09 SS# Dear Sir/Madam: Please find enclosed herewith an original and one (1) copy of the Pennsylvania Inheritance Tax Return as regards the above-referenced estate. You will note the estate is insolvent and, as such, no inheritance tax is owed. Also enclosed is a check in the amount of $15.00 for filing fee of same. Thank you for your kind attention. Very truly yours, R. Scott Cramer RSC/jmh Enclosures cc: Donna J. Sipe