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Home My WebLink About04-20-11--~ REV-'~ 5 Ex (o~-~o) y 1505610143 00 PA Department of Revenue ~ OFFICIAL USE ONLY pennsylvania _ Bureau of Individual Taxes DEPARTMENT OF REVENUE County Code Year File Number PO 60X.280601 INHERITANCE TAX RETURN 2 1 1 1 0 12 3 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 201 18 0881 O1 23 2011 06 23 1925 Decedent's Last Name Suffix Decedent's First Name MATTER MI MARLIN L (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW ® 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (d;ate of death prior to 12-13-82) ^ 4. Limited Estate ^ 4a Future Interest Compromise ^ (date of death after 12-12-82) 5. Federal Estate Tax Return Required ^ g Decedent Died Testate ~ Decedent Maintained a Living Trust 0 (Attach Copy of Will) ^ (Attach Copy of Trust) ___ 8. Total Number of ;iafE'. Deposit Boxes ^ 9. Litigation Proceeds Received ^ 1 p. Spousal PoveRy Credit (date of death between 12-31-91 and 1-1-95) ^ 11. Election to tax uncier Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name JOSEPH D K E R W I N Daytime Telephone Number 717 362 32;15 First line of address 4245 STATE ROUTE 209 Second line of address City or Post Office ELIZABETHVILLE Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS State ZIP Code PA 17023 REGISTER OF VII~~.,S USE ONLY: ~. ~-a t? Tj ~. ' I t 'p F"1 - ~C~;I -._... DATE f~.Ei'f! ~: ; :~~ -, _} ;~.~ ti.:• ~ L , ~,.? Correspondent's a-mail address: j d k@ k e rw i n l a w f i r m. c o m 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 PERSOfY RESPONSIBLE FOR FILING RETUR ~~~~~ ._ a DATE r 7 .~~,~~- Christine Peters -~ i,~. I ADDRESS 5485 Eagl Ridge Lane, Enola, PA 17025 SIGNATURE OF P E AR OTHER THAN REPRFSFNTnrniG ADDRESS 4245 DATE: Joseph D Kerwin ~~r:~f11 ute 209, Elizabethville, PA 17023 I Side 1 1505610143 1505610143 J J 1505610243 REV-1500 EX Decedent's Social Security Number Decedents Name: MATTER , M A R L I N L 2 0 1 1 8 0 8 8 1 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. 4. Mortgages & Notes Receivable (Schedule D) . ......................................................... 4. 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ................ 5. 6 ~ 6 7 8 . 5 2 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............. 6 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property . (Schedule G) ^ Separate Billing Requested ............. 7. 8. Total Gross Assets (total Lines 1-7) ....................................................................... g. 6, 6 7 8 5 2 9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... g. 6 , 7 0 7 5 1 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10. 1 2 6 , 8 $ 1 2 2 11. Total Deductions (total Lines 9& 10) ............................................ 1 3 3 , 5 8 8 7 3 .......................... , 11. 12. Net Value of Estate (Line 8 minus Line 11) ............................................................. - 1 2 6 ,, 9 1 0 2 1 12 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)....... _ .......................................... - 1 2 i5 ,. 9 1 0 2 1 14. 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 .00 15. 16. Amount of Line 14 taxable at lineal rate X .045 16. 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 ..................................................................................................................... 19. 0 0 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505610243 1505610243 J REV-1500 EX Page 3 Decedent's Complete Address: Matter, Marlin L STREET ADDRESS 1700 Market Street cITY Camp Hill Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest STATE ZIP PA (1) Total Credits (A + g) ,,2) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box 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 DUE. Make Check Payable to: REGISTER OF WILLS, AGENT. (4) (5) 17011 0.00 0.00 0.00 0.00 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: a. retain the use or income of the property transferred :........................................................................... Yes No b. retain the right to designate who shall use the property transferred or its income :.................................... c. retain a reversionary interest; or ...................... x . . ........................................................................................... d. receive the promise for life of either payments, benefits or care?...... x ........ 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" or payable 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 ~1 ^ contains a beneficiary designation?............ .......................................................................................................... ^ 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT A,S 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 survivin spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. g For dates of death on or after Januarryy 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 stafute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclo assets and filing a tax reffurn are still applicable even if the surviving spouse is the only beneficiary. sure of 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 u:>e 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 gas 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) . A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, w§ether by bloo~ or adoption. File Number 21 - 11 - 0123 SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Matter, Marlin L FILE NUMBER 21 - 11 - 0123 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the ri ht of survivorship must be disclosed on schedule F. g ITEM __ _ NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Checking Account at Mid Penn Bank No. 610527 - - 6,678.52 TOTAL (Also enter on Line 5, Recapitulation) ~ 6,678.52 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Matter, Marlin L SCHEDULE H FUNERAL DCPENSES & ADIVANISTRATNE COSTS Debts of decedent must be reported on Schedule I. ITEM -- NUMBER FUNERAL EXPENSES: DESCRIPTION A• 1 Hoover Boyer Funeral Home, Inc. 2 Williams Catering 3 Susan Nailor -power point presentation 4 Grace United Methodist Church FILE NUMBER 21-11'-0123 B• ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Christine Peters Marlene Nailor Street Address 5485 Eagles Ridge Lane Ciry Enola State PA Zip 17025 Year(s) Commission paid 2. Attorney's Fees Kerwin & Kerwin 3. Family Exemption: (If 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 Register of Wills 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 AMOUNT 4,129.58 592.43 100.00 200.00 350.00 1,250.00 85.50 TOTAL (Also enter on line 9, Recapitulation) 6,707.51 SCHEDULEI DEBTS OF DECEDENT, MORTGAGE COMMONWEALTH OF PENNSYLVANIA LIABILITIES, & LIENS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Matter, Marlin L FILE NUMBER -- 21-11-0123 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbur~se~ d medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 Commonwealth of Pennsylvania, Department of Public Welfare -- - 126,881.22 TOTAL (Also enter on Line 10, Recapitulation) 126,881.22 REV-1513 EX+ (11_pgl COMMONWEALTH OF PENNSYLVANIA SCHEDULE J INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF Matter, Marlin L NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 Christine Peters 5485 Eagles Ridge Lane Enola, PA 17025 2 Marlene Nailor 1186 Letchworth Road Camp Hill, PA 17011 II. FILE NUMBERR ~ 21-11-0123 RELATIONSHIP TO --------- DECEDENT SHARE OF ESTATE: AMOUNT OF ESTATE Do Not List Trustee(s) (Words) ($$$) Daughter 150% of estate Daughter 150% of estate Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet, as a ro r' NON-TAXABLE DISTRIBUTIONS: NN N late. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 MID PENN BALI( March 15, 2011 Kerwin & Kerwin 4245 Route 209 Elizabethville, PA 17023 Re: Estate of Marlin Matter Date of Death: 1/23/2011 SSN: ~:XX-XX-~J881 Dear Mr. Kerwin: In response to your recent letter requesting information on the accounts of Matter, I have accumulated the necessary data below: Marlin Account Name: Marlin Matter Account #: 610527 -Checking Account Date Opened: 4/1/1983 Balance DOD: $6678.44 Balance Accrued Interest DOD: $.Og Total DOD Balance: $6678.52 Date Joint Ownership Established: N/A If you have any questions, please contact me at (717) 896-5381. Sincerely, ~~ . Jessica Kerwin Deposit Processing Specialist 349 Union Street, Millersburg, PA 17061 1-866-6HAPPEN • 1-877-9HAPPEN • www.midpennbcink.com Member FDIC