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HomeMy WebLinkAbout02-24-11 (3) 15056051058 REV-1500 EX (06-05) PA Department of Revenue OFFICIAL USE ONLY Bureau oflndNidualTaxes County Code Year File Number INHERITANCE TAX RETURN PO BOX 280801 Hardsburg, PA 17128-0801 21 10 0423 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number _,_ _ Date of Death Date of Birth __ _ 209-20-4167 ' 07/29/2009 06/07/1927 Decedent's Last Name _ _ _. _ Suffix Decedent's First Name MI .... _ Keller Dorothy M (If Applicable) Enter Surviving Spouse's Information Below Spouse's Lasl 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 t1Nr,9 1. Original Return :~"°: 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) r -; 4. Limited Estate ;v'~t 4a. Future Interest Compromise (date of ;`~', 5. Federal Estate Tax Return Required death after 12-12-82) z 6. Decedent Died Testate C°;~ 7. Decedent Malnlained a Living Trust 0 _ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) r„.~:~ 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death C' 11. Election to tax under Sec. 9113(A) Delween 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST 8E COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name _ Daytime Telephone Number _. _ _ _ Dennis E. Boyle, Esq. (717) 737-2430 _ _ Firm Name (If Applicable) _ * , _ f"~ . = 7p .... REGISTER ~ BLS USE O~Y iTl Murphy B A ~ e ; ~ - _ ~ rt 1 _ rst F na of addres Z 4660 Tnndle Road ~ ~cn~ '~ --' .._ o ~ ~ ;~ Second line of address }O i ~ - -i-~ ~ _~'C ~ 'Suite 200 ~ ~ -~ .. .- i Sr City or Post Office State ZIP Code DAB FILED ~ ' i 'i`i Camp Hill PA 17011 Correspondent's a-mail address: OeDOyleLtlennlSboylelBW.COm Under penalties o1 perjury, I declare that I have examined this Tatum, including accompanying schedules and statements, and to the best of my knowledge and belief it is We, correct and complete. Dedaretlon of preparer other Than the personal representative is based on all information of which preparer has any knowledge. SIG ATURE OF PER N ES NSIBLE FOR FILING RETURN DATE ADDRESS 186 Latimore Road, ardners, PA 17324 4508 Fritchey St., Harrisburg, PA 17109 SIGNATU FIRER OT~ THAN REPRESENTATIVE DATE _ ADDRESS 4660 Trindle d, Suite 200, Camp Hill, PA 17011 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051058 15056051058 ~~ J 15056052059 REV-1500 EX Decedent's Social Security Number _. _ ___ Decedents Name: Dorothy M Keller ' 209-20-4167 '~.. RECAPITULATION ~"' "-'-----°---' 1. Real estate (Schedule A) ........................................... .. 1. _.__ _ 0.00 2. Stocks and Bonds (Schedule B) ..................................... .. 2. 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 0.00 4. Mortgages 8 Notes Receivable (Schedule D) ........................... .. 4. 0.00 5. Cash, Bank Deposits $ Miscellaneous Personal Properly (Schedule E) ...... .. 5. ; 28,433.55 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ..... .. 6. " 0.00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Properly "`""' '°"'__°` °"°'' _---_- -- - -' (Schedule G) C~ Separate Billing Requested.. , . , . .. 7. B. Total Gross Assets (total Lines 1-7) ..........:....................... .w__ _._ .,,.... .. 8. ` .w ......... .. ..__.,._. .., 28,433.55 9. Funeral Expenses 8 Administrative Costs (Schedule H) ........ .......... .. 9. 8,981.20 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .. 10. 17,755.63 11. Total Deductions (total Lines 9 & 10) .................................. . 11. 26,736.83 12. Net Value of Estate (Line 8 minus Line 11) ............................. . 12. 1,696.72 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which `" """ ""'" """"` °' ' ` ° •° - -' an election to tax has not been made (Schedule J) ....................... . 13. ', 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13) ....................... . 14. i 1,696.72 TAX COMPUTATION -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. 18. Amount of Line l4 taxable at lineal rate X .0 45 1,696.72 16. 76.35 17. Amount of Line 14 taxable at sibling rate X .12 17. _ .. 18. Amount of Line 14 taxable - at collateral rate X .15 _ _. 18 _,. 19. TAX DUE ....................................................... 76.35'.. ..19.1 _ _ 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT C~:': L_ 15056052059 Side2 15056052059 ._J REV-1500 EX Page 3 Decedent's Complete Address: F~1,4.Nxm.... M..,...w... 21~ ~ 10 (60423 DECEDENT'S NAME DECEDENTS SOCIAL SECURITY NUMBER Dorothy M Keller 209-20-4167 STREET ADDRESS 186 Latimore Road CITY Gardners STATE ZIP PA 17324 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 76 35 2. CreditslPayments . A. Spousal Poverty Credit B. Prbr Payments C. Discount ~- Total Credits (A+ g + C) 3. InteresUPenalty 'd applicable (2) 0.00 D. Interest E. Penalty Total InteresUPenaity (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (3) 0.00 Fill in oval on Page 2, Line 20 to request a refund. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 76.35 A. Enter the interest on the tax due. (5A) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 76.35 Make Check Payabl e to: REGISTER OF WILLS, AGENT yt ~+~µ y f y ~~I~~P~ rvL^`~ ~~~'`T"T`uf:~ i Lry ~x~ ~ l..'.#~ 'i, ~ L~~"P k~w.,.° {{p~~'C, :. yy ... k ~.Fy{~, « F,. t K... ...d. .. i$r'~. $~. ~~{ `~' T ~ '. ~.'~. r'~ s" e.^J A {. .::. ;a ~ , .. ,. o. i + d $Re , + .. .~:k~ . PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIAT E 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? .................................................. ........ ^ ............ 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate considera6on? .................................................................................................. ............ ^ 3. Did decedent own an "in trust for' or payable upon death bank account or securRy at his or her death? .. ............ ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ...............................................................................: ............................. ........... ^ x: ^ 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 January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (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 Uansfers to or for the use of the surviving spouse is zero (0) percent (72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from lax, and the statutory requirements for discbsure of assets and filing a tax return are still applicable evend the surviving spouse is the only beneficiary. For dates of death on or after JUIy 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one 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 zero (O) percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or far the use of the decedent's lineal beneficiaries is four and one-half (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 twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling isdefined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adop0on. REV-1508 EX+(6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, 8~ MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Dorothy M. Keller 21-10-0423 Indude the proceeds o(Ikigation and the data the proceeds were receNed hY the estate. All property JolMlyowned wMh right of survfvonhlp must be discMsed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. Pre-Paid funeral policy 7,688.00 2. Checking account with M/4~T Bank, Acct. #9845291476 4,513.66 3. Checking account with M&T Bank, Acct. #50697781 10,149.66 4. Checking account with M&T Bank, Acct. #9843927618 4,251.70 5. Miscellaneous personal property 25.00 6. Money Market account with Nationwide Bank, Acxt. #100001294143 1,641.75 7. IRA account with M&T Bank, Acct. #35004201773535 163.78 TOTAL (Also enter on line 5, Recapitulation) ; 28,433.55 (If more space is needed, Insert additional sheets of the same s¢e) ESTATE OF FILE NUMBER Dorothy M. Keller 21-10-0423 Debts of decedsM must be reported on Schedub L SCHEDULE N FUNERAL EXPENSES & ADMINISTRATIVE COSTS ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Neill Funeral Home 7,951.74 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)IEIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. AHomey Fees 3. Family Exemptlon: (Ii decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees ~. Terry Lerew -Reimbursement of expenses a. Boyle, Autry & Murphy -Costs expended during administration TOTAL (Also enter on line 9, Recapitulation) I S (If more space is needed, insert additional sheets of the same size) REV-1511 EX+(12.99) COMMONWEALTH OF PENNSYWANIA INHERITANCE TAX RETURN RESIDENT DECEDENT 902.00 74.50 49.00 3.96 8,981.20 REV•1512 EX+ (12-OB) pennsylvania SCHEDULE I ~ DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Dorothy M. Keller 21-10-0423 Report debts incurred by the decedent prior to death that romained unpaid at the date of death, including unreimburoed medical expenses. u more space Is neeoeD, insert atltlltional sheetr of the same size. REV•1513 EX+ (11-OB) ~i ' pennsylvania DEPARTMENT OF REVENUE INHERITANCE TA% RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Dorothy M. Keller c ~-IV-VYGJ NUMBER NAME AND ADDRESS OF PERSON(S) RECENING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS [Indude outright spousal distributions and transfers under Sec. 2116 (a) (1.2).] 1. Terry Lerew -186 Latimore Road, Gardners, PA 17324 Daughter 848.36 2. James Keller - 4508 Fritchey Street, Harrisburg, PA 17109 Son 848.36 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, A S APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ . •~ nrv,c aya~.c n ncwCll, INSCfC d001CIDDdI sneers Or CDe Sanle SIZe. © M~TF~ank 499 Mitchell Road, Millsboro, DE 19966 Adjustment Services Phone 888-502.4349 F ax (302) 934-2955 January 5, 2011 Dennis E Boyle Esquire 4660 Trindle Road Suite 200 Camp Hill, PA 17011 Re: Estate of Dorothy M Keller Social Security: 209-20-4167 Date of Death: July 09.2009 .;AN l 0 20 Dear Sir or Madam: Per your inquiry on December 27, 2010, 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 2. Type of Account Account Number Ownership (Names o~ Opening Date Balance on Date of Death Accrued Interest Total Checking Account 50697781 Mervin E Keller Dorothy Keller 0828/64 $10,149.59 $ .07 ..$10,149.66 ................. Checking Account 9843927618 Dorothy Keller (Principal) Terry A Lerew (Rep Payee) 09R?4iD7 $4,251.70 $ .IS $4,251.70 3. Type ofAccount Account Number Ownership (Names o, fl Opening Date Balance on Date of Death Accrued Interest Total 4. Type of Account Account Number Ownership (Names o, fl Opening Date Balance on Date of Death Accrued Interest Total Checking Account 9845291476 Dorothy M Keller (Principal) Terry A Lerew (Guardian) II~i79A77 $4,513.54 $ .12 $4.513.66 __.._........._......_..__..__ ...................... Individual Retirement Account 35004201773535 Dorothy M Keller 1124/82 $163.28 $ .50 $163.78 For farther account intormatloa, closures and/or reimbursement o[ funds please call the Paxton Street f)tflce at 1{717.255-2240. We were unable to locate any sate deposit box for the above-mentioned decedenk 71is letter does not hxiude say amounts is vvhi~ the deceased may have been Itsfed eg Power of Attorney, (}adodiaa o[ Uniform 1Yaasfers, Itepreseatatlve Payee, or TnuRee under a Written Amt Sincerely, , . ~~ ,.~~,~ ~J Tammy Spencer Adjustment Services Nationwide Bank On Your Side' January 6, 2011 Boyle, Neblett & Wenger Attorneys at Law 4660 Trindle Road, Suite 200 Camp Hill, PA. 17011 Re: Estate of Dorothy M Keller Dear Mr. Boyle, This letter is in regards to information on Dorothy's account. We respectfully submit the following. ACCOUNT DATE OWNERSHIP BALANCE Money Market IRA 7/29/2009 Single; beneficiary $1,641.75 # 100001294143 Mervin Keller ( DOD balance includes accrued interest) If you have any questions, please contact me at 614-435-6788. Sincerely Tara Leonard Nationwide Bank ~Pw i 0 u 1894 MERICAN MEMORIAL Life Insurance Company® P.O. Box 2730 • Rapid City, SD 57709-2730 December 29,2008 DOROTHY M KELLER TERRY A LEREW 186 LATIMORE RD GARDNERS PA 17324 Contract Number: 6-863844 Insured: DOROTHY M KELLER Dear Customer: Each year thousands of individuals are realizing the importance of prearranging their funeral and final expenses. NEILL FUNERAL HOME and their affiliates are leading providers of prearranged funeral services and have many years of experience assisting families during difficult times in their lives. As you know, your prearranged funeral is funded with an insurance policy issued by AMERICAN MEMORIAL LIFE INSURANCE CO. In keeping with our commitment to provide you with the best possible customer service, this notice is to report your current death benefit and cash value as noted below. Please note that this notice will be provided to you each year on your contract's anniversary simply for your records and does not require you to respond in any way. You have made a wise and caring decision to prearrange your funeral and final expenses and we appreciate you choosing us as your funding vehicle. We know you understand the benefits of your prearrangement. There may be other families you know that do not have the protection you have so wisely provided yourself. We would be privileged to contact anyone for whom you would like to receive more information or have them visft www.dignitymemorial.com. If you know of someone you feel could benefit from information on prearrangement or if you have any questions regarding this coverage, please feel free to contact our Customer Service Department at 1-800-533-2220. We will be happy to be of service. Customer Service Death Benefit: $7,688.00 Cash Value: $6,086.12