HomeMy WebLinkAbout03-22-11 (2)' 1505610140
REV-'I 500 EX (01-10)
OFFICIAL USE ONLY _
PA Department of Revenue ---
Bureau of Individual Taxes County Code Year 1=ile Number
Po Box 2$osol INHERITANCE TAX RETURN ~ t~~~ ~ ~~
Harrisburg, PA 17128-0601 RESIDENT' DECEDENT ° ~ ~{ ___ -~~ -~ ~ d~
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
1 8 0 0 1 3 1 0 6 ], 2 2 9 2 0 1 0 1 2 c? 0 1 9 1 7
Decedent's Last Name Suffix Decedent's First Name MI
P R I C E V I O I_ A ~h
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name Nil
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WI1'Fi THE
REGISTER GF WILLS
FILL IN APPROPRIATE OVALS BELOW
1. Original Return ~ 2. Supplemental Return ~` 3. Remainder Return (date of death
prior to 12-13-8?)
4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return RequirE:d
death after 12-12-82)
6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust _ 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
® 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax.~nder Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. q} ,
GC)RRE$PUNUEN 1 - 11115 StG I TUN MUII tSt GUMYLtI tU. HLL 4UKKtJrvlYUCIV~..C Hnu wwr~ur_w ~ NHL IHn IIYfVR1YU111V1Y Jf7VtJLU DC VIRLV 1 CV ~ v.
Name Daytime Telephone Number
R O G E R E] I R W I N 7 ], 7 2 4 `~ 2 3 5 5
REGISTER OF WILL;i U.SE C)NLY
I
First fine of address
;
6 D W E S 'T P O (~ F R E T S T R E E T
1
Second fine of address
City or Post Office State ZIP Code ' DATE FILrD
C A R L ]: S L. E P A 1 7 0 1 =~
Correspondent's a-mail address:
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my k.noavlESdge 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 am~r knowledge.
SI~NI~`11~E~Jr}1QF PERSSON RESPO~I/S;IBLE Fk7ffls ING RETURN 1 {~ATyF ,
'yI~( ~ j ~./ ~' ~ / ir(. ' f~ ~ ''~ ~~/~ ~, ~ C ,/'reef
~~, CCC C. L, .~.~~~
ADDRESS
113 FORGE ROAD ~l BOILING SP~;INGS _PA 17007
SIGNATURE PREPARER OTHER THAN j;tEPRESENTATIVE -~~TI=
~~... L , ~~ . ~ ~ "~ '~L~ z ~,r .,~ .t ~._ t~
ADDRESS
6D WEST POM.~RET STREET __ CARLISLE PA 1,'~GIy3
PLEASE USE ORIGINAL FORM ONLY
Side 1
15D56.],a14D 150561,01,40
;~~
a~
J
1,50561,0240
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: VIOLA M• -PRICE ].~ 8 0 Q 1,~ 3 1, D 6
RECAPITULATION
1. Real Estate (Schedule A) ........ ............................ 1 •
2. Stocks and Bond; (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. ~~ 0 ~~
6. Jointl Owned Pro ert Schedule F
y p y ( ) ^ Separate Billing Requested ....
6. ~ 2 l~ ~ ~~ . 3 ~~
7. Inter-Vivos Transfers & Miscellaneous N n-Probate Property
(Schedule G) ~ Separate Billing Requested ... 7.
8. Total Gross Assets (total Lines 1 through 7) ...................... .. .. 8. Is r? ~ ~ 5 . 3 ~'
9 Funeral Expenses and Administrative Costs (Schedule H) .......... .... 9. 2 .~ `~ .~ . 8 1,
'10. Debts of Decedent Mortgage liabilities, and Liens (Schedule f) .... .... 10. -~ ~{ ~ :~ • 0 0
'I 1 Total Deductions `total Lines 9 and 10) .................... ..... 11. ~ 6 4 4 . 8 1,
12. Net Value of Estate (Line 8 minus Line 11) .................. 12. 8 ~ `j 0 . 5 1,
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. 8 ~r `~ 0 . 5 1,
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Ser, 9116
(a)(1.2) X .0 0 0 0 15.
16. Amount of Line 14 taxable
at lineal rate X .045 8 7 9 0. 5 I, 16.
1 i. Amount of Line 14 taxable
at sibling rate X 12 0 0 0 17.
18. Amount of Line 14 taxable
at collaterah rate :K 15 0 . 0 0 ~ g.
19. TAX DUE .........
...
........................
..
.... . , 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
0 ., 0 D
:1 `~ 5 . 5 7
0. 0 0
0. 0 0
J 9 5. 5 ?
L 15D5610240 150561024
REV-1500 E=X~ Page 3
Oecedent's Complete Address:
t=ile Number
0 0
I DECEDENT'S NAME
~iVIOLA M. PRISE
i STREET ADDRESS
'i 11.3 FORGE ROA[3
CITY
(BOILING SPRINGS
STATE ,ZIP
PA ~ 1 T007
Tax Payments and Credits:
I Tax Due (Page 2, ! ine 19
2 CreditslPayments
A. Prior Payments
~. Discount 13.18
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.
If Line 1 + Line 3 is greater thar Line 2, enter the difference. This is the TAX DUE.
Total Credits (A + B) (2
(3)
(~)
(5)
Make check payable to: REGISTER GF U1IILLS, AGENT
~____~ 395.57
19.78
0.00
___~ 375.79
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; ............................... ^
c. retain a reversionary interest, or ................................................................................................ ^
d. receive the promise for life of either payments, benefits or care? ......................................................
2. If death cocurr~~d after December 12 1982, did decedent transfer property within pane wear ~~~ deat~~~
without receiving adequate consideration? ...................................................................................... ~.
3. Did decedent own an "intrust for" or payable-upon-death bank account or security at his or her death? ........, ^ ^X
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
3 percent [72 P.S. X9116 (a) (1.1 ~~ ~)].
For dates of death on or after Jan, i , 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 clisclosure 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(x)(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, exc;ei~t as noted in
72 P.S. §9116(1.2) [72 P.S. §9116(x)(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(x)(1,3)]. Asibling is defined, undE
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
RFV-15(.19 E.r+ f01-17'
pertnsylvania
DEPARjI,AE~NT OF 1~EVFNUE
INHERIT A.NCE TAX RET'~.1RN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTI~'
ESTATE OF: FILE NUMBER:
VIOLA M. PR{CE 0 0
If an asset was made jointly owned within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT'S) NAME(S) ADDRESS RELA'TIONSHIP'r0 DECEDENT
A. PATRICIA A. GOTTSNALL 113 FORGE ROAD DAUGHTER
BOILING SPRINGS, PA 17007
s
c
JOINTLY-OWNED PROPERTY'
ITEM
NUMBER LETTER
FUR JOINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
IN~LUDE 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
DECEDENT'S
INTEEREST DATE OF DEATH
'JALUE OF
DECEDENT'S INTEREST
1. A. 03/1998 ORRSTOWN BANK 6,741.49 50. 3,370.75
CERTIFICATE OF DEPOSIT #5060060419
~?. A. 05!1999 ORRSTOWN BANK 17,317.40 50. 8,658.70
CERTIFICATE OF DEPOSIT #5060062946
,~. A. 0511999 ORRSTOWN BANK 811.74 50. 405.87
CERTIFICATE OF DEPOSIT #5060062947
I
TOTAL (A{so enter on Line 6, Recapitulation) ~ $
___~ 1 _,435.32
If more space is needed, use additional sheets of paper of the same size.
RF_V-1511 Ex-~ f 1 tJ-09;
' ~ pennsylvania
DEPAR.l CJtENT OF REVENUE
INHERiT?~NCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
VIOLA M. PRICE: 0 0
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. CARLISLE MEMORIAL SERVICE, INC. -INSCRIPTION 185.00
2. BOILING SPRINGS TAVERN -FUNERAL LUNCHEON 411.81
B ADMINISTRAT'VE COSTS:
1. Personal Representative Commissions:
Name{s) of Personal Representative(s)
Street Address
City _ State _ ZIP
Year{:;}Commission Paid:
2 Attorney Fees IRWIN & MCKNIGHT, P.C. 1,200.00
3, Family Exempti~m: (If decedents address is not the same as claimant's, attach explanation.)
Claim~~nt
Street Address
City ~ State _ 7_IP
Relationship of Claimant to Decedent
4. Probate Fees,
5 Accountant Fees
6. Tax Return Prep~jrer Fees: PATRICIA A. ROSENDALE, CPA 350.00
7. REG1STEk OF WILLS -FILING FEE 15.00
TOTAL (Also enter on Line 9, Recapitulation)) 9-__ 2,161. $1
If more space is needed, use additional sheets of paper of the same size. ___._
REV-1 `.i1' EX+ {12-08}
Pennsylvania
DEPARTMENT OF R.EVE=NUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
VIOLA M. PRICE 0 0
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimburse~d medical expenses.
ITEM VALUE AT DATE
NUMBER DESCR{PTION OF DEATH
1. CUMBERLAND GOODWILL FIRE RESCUE EMS -AMBULANCE 1,483.00
TOTAL (Also enter on Line 10, Recapitulation) $
1f more space is needed, insert additional sheets of the same size.
1.483.00
pennsylvania ~ SCHEDULE J
P7EPf~RTMENT OF REVENUE
BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
ylnl A M PRICE n n
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT
Do Not List Trustee(s) _ AMOUNT OR SNARE
OF ESTATE
I TAXABLE DISTR,IBlJTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).)
1. PATRICIA GOTTSHALL Lineal 8,790.51
113 FORGE ROAD REMAINDER
BOILING SPRINGS PA 17007
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 I
THROUG!-I 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:
~i
1. B. CHARITABLE AND ~ OVERNMENTAL DISTRIBUTIONS:
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed, use additional sheets of paper of the same size. .r
r. uu ~ r uu~
~.J.t(1~>~ 1-V W ~1
BANt~
A Tradition of F.xcellc~
Roger B. Irwin, Esq.
Irwin & McKnight PC
60 West Pomfret Street
West Fomfr. et Professional Building
Carlisle, PA 17013
Fax 249-6354
January 13, X111
Re: Estate of Viola M. Price
Social Security Number 180-01-3106
Date of Death December 29, 2010
IT IS .F~.ERE.RBY CERTIFIED THAT THE ABOVE NA~ME.D DECEDENT HAI) ~t'HE
FOLLOWING ACCOUNTS WITH ORRSTOWN BANK:
CERT'1FICATES OF DEPOSIT
Account No. -
Account ape --
Date Opened
Joint Account (name/ date) --
Balance -
Acerued Interest -
5060060419
6-11 Month Growth
3/24/98
Patricia A. Gottshall 3 / 24 / 98
$6,741.49
$.69
Account 1Vo. --
Account 1~rpe --
Da~e Opened --
Date Closed -
Joint Account (name/date) -
Balance at' Redemption --
5060062946
6-11 Month Growth.
5/11/99
9/14/10
Patricia A. Gottshall 5 / 11 / 99
$17,317.40
77 Easy King Street
P.(7. Box 250
Shippensburg, PA 17257
~.888.ORRSTOWN
sary~,i~~,r ia~-ir~i~sslaeeera e+evinn
r, uu~! uu~
Account No. -
Aecount Type
Date Opened -
Datc Closed -
Joint: Account (name/ date) --
Balance a.t Redemption --
56006294?
6-11 Month Growth
5/11/99
9/14/l~
Patricia A. Gott~Shall 5/ 11/99
X811.74
Be t Regards,
~~~
Vicki L. Gullixon
Customer Service Specialist
2.
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~~~ CARLISLE MEMORIAL SERVICE, INC.
41 SOUTH BEDFORD ST
CARLISLE, PA 17013
TRT~ 7!1 T!~'G'
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BILL TO:
ROGER IRWIN, ATTORNEY
60 W. POMFRET ST
CARLISLF_, PA 17013
DATE INVOICE
_2/25!11 31-020 ~
TERMS _ TELEPHONE
NET 15 DAYS 717.243.5480
ITEM DESCRIPTION ~^ AMOUNT
LETTERING FOR VIOLA PRICE. SUPPLY THE YEAR 2011,. 185.00
MONUMENT LOCATED IN MT ZION CEMETERY.
LETTERING WILL BE COMPLETED IN THE
SPRING SEASON
~
185.00
TOTAL BALANCE DUE
THANK YOLJ FOR ALLOWING US TO SERVE YOU.
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Cul~nberfal~~ ~oC~IC~,.,, If Fire Rescue GEMS
Billing CIf1`iC;k~ 10-162698 12/14/2010 $1,392.50
~.Q E;ox 7L%Fa
1Vev~~ ~.u~+berl~~,.,~ ~, ~;-~;~
QUESTIONS AEl;OUI" TNI:hF I3~ L~? Phone: 877-214-6018 Espanol: 866-724-4114 Fax: 717_214-6020 Email: infoC~amFrulaneebillingoffice.com
Date of Sewice: '11'26/:Zt. ~ ::~ )6:36
Patient Name: PRICE::, \~`.)iA M.
F=rom: CLAREIVI'I;:~~IT NSG & REHAB-CLIMB CTY
To: Carlisle R~+~ional Medical Center
Please visit our welbsite to provide insurance or make payment, and
for additional payment options and frequently asked questions:
www,.ambulancebillingoffice.com
.~ .
_. q _... . _ . . _ __ _ _ ..~. _ .- _
* * * Second Re uest * * * bra order to bill ll~edicare, we need the back of this invoice completed & signed and returned to our
office within 10 days. Yor,~ v1i,!1 be responsible for the full balance if you fail to respond. Thank you.
`2 T~ 4 "
.p. B- e o ° o •e a~• ® ° • ~- a 'o ~Inc•e ~ ~,
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11/26/10 ALS Ernergenc4~ transport-Lei A0427 1 1,335.00 1,335.00
11126110 Mileage A0425 5 11.50 57.50 -
Total ~ - ~ 1, 392.50 O.OC~ 0.00
DETACH AND RETURN BOTTOM PORTION WITH YOUR PAYMENT.
~ >n(e,~G`~p>: rSi~~fXl~nt irt`'['1=11Y p~/htCF~G1Cr:' CfeE~t[ C7Ffl of e~ec:TroF~tc. r{cusrr rraR~.urfc~sr~ raya,.,~c,., ~ -
claeck ifi~dactlnn Plea~~ indi=cate your payment choice .below ~; '~ ~_ ~' : ' ~ ~ ~ ~ ~ ~ s
and hlt~ in required information If other at'raligem~nts are Cumberland- Goodwill Fire
necessary, please ail us at 877=214-6018. r~8SCU8 -EMS
10-162698 '~` $ 1,392.50
V~ DISCOVER' - _-..._ __1----- -
•~ '~
Credit Card: D h1ASTERCARD ^ VISA ^ AMERICAN EXPRESS ^ DISCOVER Amount Paid:
Card Number
Please make any corre~aiorns to address below.
Name on Card Expiration
Electronic Check Deduction
P/ease send a voided check OR provide information below: VIOL/~ M. P R I C E
CLAREMONT NSG & REH,~~Ei-C:UMB CTY
__ _____ 1000 CLAREMONT RD
Bank Routing Number Checking Account Number
CARLISLE, PA 17015
Signature
*Returned checks -You will be responsible for all incurred bank fees permissible under state law.