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HomeMy WebLinkAbout04-11-11r J 1505610140 REV-1500 EX (01-10) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisbur PA 17128-0601 RESIDENT DECEDENT 2 1 0 9 0 7 4 5 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 4 9 0 7 0 1 7 8 0 8 0 1 2 0 0 9 0 5 2 2 1 9 1 9 Decedent's Last Name Suffix Decedent's First Name MI B A R T E L S C A T H E R I N E N (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 ^ 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 DIRECTED TO: Name Daytime Telephone Number M A R C U S A (~ c K N I G H T I I I 7 1 7 2 4 9 2 3 5 3 First line of address 6 0 W E S T Second line of address City or Post Office C A R L I S L E Correspondent's a-mail address: State P A ZIP Code REGISTER .___ ILLS USE ONLY -7.. C ~ _... _-r,- .. "e Y ~.~ ... J C ; --' ~. z~ _I~~ C7 ;. ~- _ _ -- i-n -... ~. .. ,_ ~.~.~ =j ~ .~. ,_ ~~ ~,~ -r; ---i D/~EfiE FILED ~~ '~ 1 7 0 1 3 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 has any knowledge. SIGNATURE OF PERSO ~ E PONSIBL~ E/ ILING RET N DATE r,,. ADDRESS ~ ~ ~ ~~~ PO BOX 27 GRANTHAM SIGNATURE OF PREP (fit THA PRESENTATIVE PA 17027 DATE / ADDRESS '' l,_,.--- ~'"['~ l 60 WEST POMFRET STREET CARLISLE PA ],7013 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 P O M F R E T S T R E E T :1'7 t~ r."„} _, r`t-~ J 1505610240 REV-1500 EX Decedent's Name: CATHERINE M • BARTELS 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, Decedent's Social Security Number 1 4 9 ^ 7 n ~. ~ n 4. Mortgages and Notes Receivable (Schedule D) .... • , ..................... 4. . Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) ....... 5. 6. Jointly Owned Property (Schedule F rate Billing Re 7 I t ~ • . ques ed ....... 6. nter-Vivos Transfers 8 Miscellaneous N p obat (Schedule G) ~ e Property S 4 1 4 6 . 8 9 eparate Billing Requested ....... 7. 1 0 9 6 8 6 2 8. Total Gross Assets (total Lines 1 through 7) ... . , , , , . ............. 8. 1 5 1 1 5. 5 1 9. Funeral Expenses and Administrative Costs (Schedule H) ........... . ...... 9. 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) 8 6 5. 0 0 .... , , , .. . . 10. 11. Total Deductions (total Lines 9 and 10) ..... • ..... ..................... 11. 8 6 5. 0 0 12. Net Value of Estate (Line 8 minus Line 11) ............ 13. Charitable and Governmental Bequests/Sec 9113 Trusts for whi h ~ 12 1 4 2 5 0 . 5 1 c an election to tax has not been made (Schedule J) .. , , , , . . ..............13. 14. Net Value Subject to Tax (Lin 12 • e minus Line 13) ......................14. TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICAB 1 4 2 5 0. 5 1 LE RATES 15. Amount of Line 14 taxable at the spousal tax rate or , transfers under Sec. 9116 (a)(1.2) X .0 16. Amount of Line 14 taxable ~ ~ ~ ~ 15• 0 ~ ~ 0 at lineal rate X .045 1 4 2 5 0. 5 1 1 s. 17. Amount of Line 14 taxable 6 4 1 . 2 7 at sibling rate X .12 0 . 0 0 18. Amount of Line 14 taxable 17. 0 ~ ^ 0 at collateral rate X .15 0 . 0 0 18. 0. 0 0 19. TAX DUE ....... . ..............................................19. 6 4 1. 2 7 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT a Side 2 L 1505610240 1505610240 J _ ~ +~ REV-1507 EX Page :3 File Number Decedent's Complete Address: 21 09 0745 DECEDENT'S NAME CATHERINE M. BARTELS STREET ADDRESS 100 MT. ALLEN DRIVE ciTY MECHANICSBURG STATE Zip PA 17055 Tax Payments and Credits: ~• Tax Due (Page 2, Line 19) 2. Credits/Payments (1) 641.27 A. Prior Payments B. Discount Total Credits (A + B) (2) 3. Interest 0.00 (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT 18.40 . 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) 659.67 Make check payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRI ATE BLOCKS 1. Did decedent make a transfer and: a. retain the use or income of the property transferred : ..................................................................... Yes . ^ No 0 b. retain the right to designate who shall use the property transferred or its income; ............................... ^ c. retain a reversionary interest; or ............... ................................................................................ ^ Q d, receive the promise for life of either payments, benefits or care? ....................................................... ^ a 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ........ ................................... .... ...... .................................. 3. Did decedent own an "in trust for" orpayable-upon-death bank account or security at his or her death? ......... ^ ^ ^ X X^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which .contains a beneficiary designation? ........................................................................................ n rl 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. §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, undE Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1509 EX+ (01-10` Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY CATHERINE M. BARTELS FILE NUMBER: 21 09 0745 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 RELATIONSHIP TO DECEDENT A. ROBERT BARTELS PO BOX 27 SON GRANTHAM, PA 17027 ~3 c JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S DAVAL~E OEFATH NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DE(;EDENT'S INTEREST 1. A. DISCOVER BANK 8,293.77 50. 4,146.89 CERTIFICATE OF DEPOSIT #303-199901-2 TOTAL (Also enter on Line 6, Recapitulation) I $ 4,146 89 If more space is needed, use addi>aonal sheets of paper of the same size. __ REV-1510 EX+ (08-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF -- FILE NUMBER CATHERINE M. BARTELS 21 09 0745 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPUCAeLE) VALUE 1. PROCTER & GAMBLE 10,968.62 100.00 10,968.62 ACCOUNT NUMBER 0000617192 206.760 SHARES X $53.05 PER SHARE _ $10,968.62 TOD ROBERT BARTELS TOTAL (Also enter on Line 7, Recapitulation) $ 10 968.62 If more space is needed, use additional sheets of paper 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 FILE NUMBER CATHERINE M. BARTELS 21 09 0745 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION A• FUNERAL EXPENSES: AMOUNT 1. B• ADMINISTRATIVE COSTS: ~ • Personal Representative Commissions: Names} of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid: 2. Attorney Fees: IRWIN & McKNIGHT, P.C. 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 Fees: S• Accountant Fees: 6• Tax Return Preparer Fees: PATRICIA A. ROSENDALE, CPA 350.00 7• REGISTER OF WILLS -FILING FEE 15.00 TOTAL (Also enter on Line 9, Recapitulation) I $ If more space is needed, use additional sheets of paper of the same size. REV-1513 EX+ (01-10 pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF: CATHERINE M. BARTELS NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [Include outrightspousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. ROBERT BARTELS PO BOX 27 GRANTHAM, PA 17027 FILE NUMBER: 21 09 0745 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Lineal AMOUNT OR SHARE OF ESTATE 14,250.51 REMAINDER ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV 1500 COVER SHEET, AS APPROPRIATE II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS 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 I $ If more space is needed, use additional sheets of paper of the same size. t7 ~.'~~ ~~I ~' N w 0 0 0 0 ~. w III~IIIIIIIII~II"'I'1111111'I~'lll~l~l~l~lllll~ll~I~II~I'I'llllll 31 SBCDRA02 0047357 CATHERINE BARTELS PO BOX 27 GRANTHAM PA 17027-0027 .~ ,~ V CD Account Statement January 1, 2010 to December 31, 2010 DISCOVER Page 1 of 2 Summary Account number 303-199901-2 Issue date .................................................... June 15, 2010 Beginning balance .............................................. $8,405.77 JMaturity date .............................................. June_15, 201-2 Curren~,balance ........................................................... $0.00 r,.: ~- CD Account Term 24 ~months~ Interest rate .............................................. ................................................................ 1.88% . .... Interest payment plan ........................................ Capitalize Annual percentage yield earned 3.42% ............................... Interest paid year to date ..................................... $192.42 Interest accrued but not paid .................................... $0.00 Interest paid during statement period ...........................................:............................................................................. $192.42 Annua! Percentage Yield Earned is based on the following information: Days in Statement Period ........................................... 365 Average daily balance ......................................... $5,197.26 Interest Earned during Statement period 1 /1 /2010-12/31 /2010 ......................................................................... $177.85 Account Activity Jan 1 ENDING BALANCE .......................................................................................................................$ 8,405.77 Jan 15 INTEREST ADDED .........................................................................................................................+ 28.24 Feb 15 INTEREST ADDED .........................................................................................................................+ 28.34 Mar 15 INTEREST ADDED .........................................................................................................................+ 25.68 Apr 15 INTEREST ADDED .........................................................................................................................+ 28.53 May 15 INTEREST ADDED .........................................................................................................................+ 27.69 Jun 15 INTEREST ADDED .........................................................................................................................+ 28.71 Jun 15 RENEWAL-NEXT MATURITY O6/15/12 .....................................................................................+ 0.00 Jun 15 RENEWAL-NEW INTEREST RATE 01.882 ..................................................................................+ 0.00 Jul 15 INTEREST ADDED .........................................................................................................................+ 13.27 Aug 11 EARLY REDEMPTION ................................................................................................................... - 8 586.23 Aug 11 PENALTY ................................................................................... . .................................................. 0.00 ~ ..:,.. n Questions7 Ca111.800-347.7000 ^~, Or write to: Discover Bank, P.O. Box 30416, Salt Lake City, UT 84130 ~( ~ For TDD (Telecommunications Device for the Deaf) assistance only, please call 1-800-347-7454 ( ~"~~ PLEASE DETACH AT DOTTED LINE ABOVE \ Account number 303-199901-2 Please send me the following: CATHERINE BARTELS ^ Discover Money Market Account Information PO BOX 27 GRANTHAM PA 17027-0027 ^ Discover CD Account Information Please mail this form to: Discover Bank P.O. Box 30416 Salt Lake City, UT 84130 ;r ~. ,~ _, N W CO O O O O V W CT1 CATHERINE BARTELS PO BOX 27 GRANTHAM PA 17027-0027 CD Account Statement January 1, 2010 to December 31, 2010 DISC~VEI~ Page 2 of 2 Account Activity (continued) Account number303-199901-2 Dec 31 ENDING BALANCE .......................................................................................................................$ 0:00 Announcements Notice of Change to Discover Bank Deposit Account Agreement We use the daily balance method to calculate the interest on your account. This method applies a daily periodic rate to the principal in the Account each day. Effective 3/1 /11, the following terms apply to Account related telephone communications: You authorize Discover Bank and its.affiliates, agents and independent contractors to: (i) listen to or record telephone calls between you and our representatives without additional notice to you; and (ii) contact you, including by calls and text messages, in order to service or manage your Account, to collect any amounts you may owe or to offer products and services, at any telephone number you provide to us or from which you place a call to us, or any telephone number where we believe we may reach you, including mobile, wireless or similar devices; and via calls or text messages using an automated telephone dialing system and/or prerecorded messages, even if you incur charges for receiving such communications. Questions Call 1-800-347-7000 Or write to: Discover Bank, P.O. Box 30416, Salt Lake City, UT 84130 For TDD (Telecommunications Device for the Deaf) assistance only, please call 1-800-347-7454 PLEASE DETACH AT DOTTED LINE ABOVE ~ ~ ~ ~ ~ ~ ' ~ ~ ' ' ' ' ' ' ' ' ' ' Account number 303-199901-2 Please send me the following: CATHERINE BARTELS PO BOX 27 GRANTHAM PA 17027-0027 ^ Discover Money Market Account Information ^ Discover CD Account Information Please mail this form to: Discover Bank P.O. Box 30416 Salt Lake City, UT 84130 Procter & Gamble Shareholder Services PO Box 5572 Cincinnati, OH 45201-5572 CONFIDENTIAL INFORMATION 0000065928 '**•""•"AUTO*'MIXED AADC 350 CATHERINE BARTELS TOD ROBERT BARTELS SUBJECT TO TOD RULES PO BOX 27 GRANTHAM PA 17027-0027 IMPORTANT TAX RETURN DOCUMENT ~.~ 1099-DIV ENCLOSED WITH THIS STATEMENT -- RETAIN FORM FOR YOUR INCOME TAX RECORDS. -..~.. -~ Account Number Tax Year Endin 0000617192 12/31 /2009 Please retain this statement for your records. * IF YOU ARE SUBJECT TO FOREIGN TAX WITHHOLDING, YOU WILL. RECEIVE A 1042-S FORM IN A SEPARATE MAILING. 2009 YEAR-END STATEMENT The Procter & Gamble Company 2009 YEAR END INFORMATION Questions? 800-742-6253 (US and Canada) or 513-983-3034 • www.pg.com/investors Account~Number Dividend Rate C.ertificated~Shares = ,pirect; Program - - Registration_Shares _ Sha_r_e__s/SIP _.:. _ . 0000617192 0.4400 0 0.000 209.0650 ~r~ll~n Histo From: Janua~ 2009 To: December 31, 2009 Record Date Total Shares 209.0650 12/31/20.08 11 /16/2009 BF R R 0 00 81.73 - 0.00 0 00 _.. 0 00 22 88 ~ 0 00 ` ~: 0 000' ~ ` 0.000 RR 90.41 0:00 25 31 58 85 . 65 1 0 _ ~ 51.: 1.170 R R RR 90:97 91.52 ~ 0:00. 0:00 25 47 25.63 . . 65 50 :: 658 ' ' ~ 2431 1:274 ' .. ~, .. ~..~~~ ,~~. 9 62.417 i .,~ ~. ~. N~, `.- ~. ; ~~ ~ ~.~''~ _ ' ` (~ ~ ` _ . . C `1. .1~.., 1 (' ~ ~ 1. (/' 1 , J? 1 ~. ffi ~:-. .. //~1 ~//J //~C~ / /, l Y/ V • ((v/s•/ U /~j `~ ~~ Summa Of Holdin s as of December 31 2009 Certificated Shares Direct Registration Program Total. Shares Approximate Price' Shares Shares/SIP Per Share $ O 0 0.000 209.065 209.065 61.5800 *See Reverse Side For Activity Type Description. 204.316 209.065 Value ($) $12,874.22 page -- - - - - - - ~~ riistorlcal rrla~~s ' Procter ~ Gamble Company ('t'he) stock -Yahoo! Finance page 1 of 1 Ni, Karen :Sign Out Hel~> Preview Mail wl Taotbar Yahoo! Mail Search I Web Search Dow 0.65% Nasdaq • 0.74% ................. HOME INVESTING NEWS PERSONAL FINANCE MY PORTFOLIOS EXCLUSIVES 1 ~`~ GET QUOTES Finance Sear;J1 ih`ed, Mar 30, 2G' 1, 3:4?pr`t CDT - US Markets close in 12 mins Procter ~ Gamble Co. (PG) At3:32PM EDT: 6~.9'I 1!'0,63 (1.03%) ~»~~ ~T>'T RI~~~~ 3Qtf CA7iH BOFItt$' a on crew IRAs'' t)F'fftt A1N ACC(>UNT ~¢~,` ~1~j~'r~~r a .: cwt~ru uo ; ~ ` Open Ar.COUiiftt i • :Historical Prices Gec Historical Pries for:i GoJ Set Date Range f~ Daily Start Date: Aug „ 1 2009 Eg. Jan 1, 2010 t~ ~ Weekly End Date: ' Aug 1 2009 !;;r Monthly (~ Dividends Only Get Prices Prices First ~ Previous ~ Next ~ Last Date Open High Low Close Volume Adj Close* Jul 31, 2009 56.20 56.75 55.43 55.51 12,663,900 53.05 'Close price adjusted for dividends and splits. First ~ Previous ~ Next ~ Last r`~l Download to Spreadsheet Currency in USD. Copyright ©2011 Yahoo! Inc..All rights reserved. Privacy Policy -About Our Ads -Terms of Service - Copyright/IP Policy -Send Feedback - YahOOI NeWS Network ~~Q ~~~~ ~~~ ~b~~o ~o~ Quotes are real-time fer NASDAQ, NYSE, and Amex.See also delay times for other exchanges. All information provided "as is" forsnforrna;ional purposes only, not intended for trading purposes or advice. Neither Yahoo! nor any of independent providers is liable for any informational errors, incompleteness, or delays, or for any actions taken in reliance on information contained herein. 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