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Home My WebLink About05-10-111505610143 REV-1500 Ex(a,_,o, PA De artment of Revenue OFFICIAL USE ONLY p Pennsylvania County Code Vear File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE Po Box.2sosol INHERITANCE TAX RETURN 21 I ( l~~ n~ Harrisburg, PA 17128-0601 RESIDENT DECEDENT ~ l~' ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 163 24 9375 02 15 2011 06 07 1929 Decedent's Last Name Suffix Decedent's First Name MI CLAUSER IRMA I (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 Retum ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise ~ 5. Federal Estate Tax Return Required (date of death after 12-12-82) a g Decedent Died Testate ~ ~ Decedent Maintained a Living Trust ~ 8. Total Number of Safe De (Attach Copy of Will) (Attach Copy of Trust) pOSlt BOXES 9. Litigation Proceeds Received ~ 1p, spousal Poverty Creditt(date of death ~ 11,Election to tax under Sec. 9113 A between 12-3, 91 and -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 GARY L JAMES ESQ 717 533 3280 First line of address 134 SIPE AVENUE Second line of address City or Post Office HUNIl~~LSTOWN State ZIP Code PA 17036 REGISTER ~ MILLS USE-ONLY ~. - ~ __ _: i..rl _ -~ ~_, ~~ ~.,~ _~ - .- EFILED `. C_ Correspondent's a-mail address: gljt~,jsdC.COm X1-1 --r-~ O --r1 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 anv knowledge. SIGN E OF PREPARER THAN REPRESENTATIVE ~ LIATF ~..: "..- ,l.> Gary L. James Esq. ~ --- .~~ - Z-~s(/ 134 Sipe Aave¢ue, Htryinmelstown, PA =--~---~ Side 1 1505610143 1505610143 17 W. Main Street, Shiremanstown. PA 17011-3371 PA Inheritance Tax Return Signature of Additional Fiduciaries ESTATE OF FILE NUMBER Clauser, Irma I. 21 Under penatties 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 #2 Name Address1 Address2 City, State, Zip Date ~~~ ~ ~ T~ Steven D. Clauser 4 Way Side Court Dillsburg, PA 17019 Signature #3 (~~.,~j't/(Je.~' -- `,`~ Name Address1 Address2 City, State, Zip Date Constance M. Merkel 138 Saw Mill Road Elizabethtown, PA 17022 1505610243 REV-1500 EX Decedent's Name: CIaUSer, Irma I. Decedent's Social Security Number 163 24 9375 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. 3 , 0 0 0 . 0 0 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5. 6 ,163.75 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers & Miscellaneous -Probate Property ~ Separate Billing Requested l G ............ (Schedu e ) 7. 1 , 2 7 6 ,165.. 11 8. Total Gross Assets (total Lines 1-7) ..................................................................... 8. 1 , 2 $ 5 , 32 8 . 8 6 9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 2 6 , 507.21 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 1, 98 9.32 11. Total Deductions (total Lines 9 & 10) ................................................................... 11. 2 8 , 4 9 6. 5 3 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 1 , 25 6 , 832.33 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. 1 , 25 6 , 832.33 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 1 256 832.33 16 at lineal rate X .045 , , . 17. Amount of Line 14 taxable at sibling rate X .12 0 . 0 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 0 . 0 0 18. 19. Tax Due .............................................. ................................................................... . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 0.00 56,557.45 0.00 0.00 56,557.45 Side 2 1505610243 1505610243 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 DECEDENT'S NAME Clauser, Irma 1. STREET ADDRESS 17 West Main Street CITY Shiremanstown STATE PA ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 2,827.87 56,557.45 2,827.87 3. Interest 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. (5) 53,729.58 Make Check Payable to: REGISTER OF WILLS, AGENT. 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 :............................................................................... ~ ^ b. retain the right to designate who shall use the property transferred or its income :.................................. ~ ^ ry x ^ c. retain a reversions 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 consideration? .................................................................................................................... ^ 3. Did decedent own an "in trust 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? .................................................................................................................. ^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 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 January 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)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. (1) Total Credits (A + B) (2) (3) (4) Rev-1507 EX+ (6-98) SCHEDULE D MORTGAGES & NOTES RECEIVABLE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Clauser, Irma I. 21 All property jointlyownedwith right of survivorship must bedisclosed on Schedule F. (Ir more space Is needed, acltlitional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule D (Rev. 6-98) Rev-1508 EX+(6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Clauser, Irma I. 21 Include the proceeds of litigation and the date the proceeds were received by the estate. Ail property jointly-owned with the right of survivorship must be disclosed on schedule F. (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-1510 EX+ (6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Clauser, Irma I. 21 This schedule must be completed and filed if the answer to any of questions t through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY THE DATE OF TROANSFER.SATTACNTAOOPY OF TIHE DEIED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 ING Annuity Contact # 1025694-OW -valued per letter 815,611.70 815,611.70 dated March 31, 2011; Beneficiary is the Jack R. Clauser (deceased March 12, 2004) and Irma I. Clauser Living Trust dated August 22, 1994 2 Presidential Life Insurance Company Non-Qualified 93,747.11 93,747.11 Annuity # 455869 -valued per letter dated March 10, 2011; beneficiaries are Cynthia R. Clauser, Kathleen A. Brown, Steven D. Clauser, Jack Clauser II, and Jeannie Strausbaugh 3 Vanguard Roth IRA Account # 25666506 -valued per 54,277.89 54,277.89 letter dated April 11, 2011; Beneficiaries are the natural born children of Irma Clauser 4 Vanguard Roth IRA Account # 88033885353 -valued 18,761.79 18,761.79 per letter dated April 11, 2011; Beneficiaries are the natural born children of Irma Clauser 5 Integrity Bank Checking Account# 201042115 -titled 11,780.31 11,780.31 in the Jack R. Clauser (deceased March 12, 2004) and Irma I. Clauser Living Trust dated August 22, 1994; valued per letter dated April 13, 2011 Accrued interest on Item 5 through date of death 7.77 7,77 6 Integrity Bank Checking Account #201000327 -titled 26,237.09 26,237.09 in the Jack R. Clauser (deceased March 12, 2004) and Irma I. Clauser Living Trust dated August 22, 1994; valued per letter dated April 13, 2011 Accrued interest on Item 6 through date of death 8.02 g,02 Total of Continuation Schedules See attached a es TOTAL (Also enter on Line 7, Recapitulation) (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. 1,276,165.11 Form PA-1500 Schedule G (Rev. 6-98) Rev-1510 EX+ (5-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN continued RESIDENT DECEDENT ESTATE OF (FILE NUMBER Clauser, Irma I. 21 ITEM NUMBER DESCRIPTION OF PROPERTY THE DATE OF RANSFERSATTACNTA COPY OF T~E DEED ~OREREAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 7 Integrity Bank Savings Account # 401000841 -titled in 34,362.04 34,362.04 the Jack R. Clauser (deceased March 12, 2004) and Irma I. Clauser Living Trust dated August 22, 1994; valued per letter dated April 13, 2011 8 Integrity Bank Savings Account # 401003793 -titled in 29,632.23 29,632.23 the Jack R. Clauser (deceased March 12, 2004) and Irma I. Clauser Living Trust dated August 22, 1994; valued per letter dated April 13, 2011 9 240.194 units of Munder Funds Inc Growth 6,446.81 6,446.81 Opportunities CL C -held in the Vanguard brokerage account # 80097217; titled in the Jack R. Clauser (deceased March 12, 2004) and Irma 1. Clauser Living Trust dated August 22, 1994; valued per public listing 10 347.666 units of Munder Funds Inc Growth 10,252.67 10,252.67 Opportunities Class A -held in the Vanguard brokerage account # 80097217; titled in the Jack R. Clauser (deceased March 12, 2004) and Irma I. Clauser Living Trust dated August 22, 1994; valued per public listing 11 463.2275 shares of Principal Financial Group Inc - 14,915.93 14,915.93 held in the Vanguard brokerage account # 80097217; titled in the Jack R. Clauser (deceased March 12, 2004) and Irma I. Clauser Living Trust dated August 22, 1994; valued per public listing 12 719.011 units of Saratoga Advtg Tr Technology & 11,331.61 11,331.61 Comm Part CL I -held in the Vanguard brokerage account # 80097217; titled in the Jack R. Clauser (deceased March 12, 2004) and Irma I. Clauser Living Trust dated August 22, 1994; valued per public listing Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) Rev-1510 EX+ (6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN continued RESIDENT DECEDENT ESTATE OF (FILE NUMBER Clauser, Irma I. 21 ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE NAME OF TRANSFEREE THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET °~ OF DECD'S INTEREST EXCLUSION (IF APPLICABLE ) TAXABLE VALUE 13 4,105.622 units of Vanguard Capital Value Fund -held 48,692.68 48,692.68 in the Vanguard account # 09950365663; titled in the Jack R. Clauser (deceased March 12, 2004) and Irma I. Clauser Living Trust dated August 22, 1994; valued per public listing 14 34,274.65 units of Vanguard Prime Money Market 34,274.65 34,274.65 Fund -held in the Vanguard account # 09950365663; titled in the Jack R. Clauser (deceased March 12, 2004) and Irma I. Clauser Living Trust dated August 22, 1994; valued per public listing Accrued income on Item 14 through date of death 0.99 0.99 15 917.661 units of Vanguard Primecap Admiral Fund - 65,823.82 65,823.82 held in the Vanguard account # 09950365663; titled in the Jack R. Clauser (deceased March 12, 2004) and Irma I. Clauser Living Trust dated August 22, 1994; valued per public listing TOTAL (Also enter on Line 7, Recapitulation) 1,276,165.11 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) REV-1151 EX+(10-06) COMMONWEALT OF PENNSYLVANIA INHERITAN E TAX RETURN RESIDEN DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF I FILE NUMBER Clauser, Irma 1. 21 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER q, FUNERAL EXPENSES: See continuation schedule(s) attached B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(sl Commission paid 2. Attorney's Fees James, Smith, Dietterick & Connelly, LLP 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant 2,931.71 15,000.00 Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 15.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 550.00 7. Other Administrative Costs 8,010.50 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 26,507.21 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF (FILE NUMBER Clauser, Irma I. 21 ITEM NUMBER DESCRIPTION AMOUNT Funeral Ex eg nses 1 Cocklin Funeral Home -funeral 2 Lower Bermudian Lutheran Church -contribution -funeral 3 St. Paul's Church -urn spot and engraving 4 Steve Clauser -reimbursement for meal after funeral H-A Other Administrative Costs 5 Cumberland Law Journal -trust estate advertisement 6 James Smith Dietterick 8~ Connelly -reserve for trust estate administration closing costs 7 John R. Zimmerman -messenger fee to Cumberland County ROW office 8 Masonic Village Elizabethtown -check written prior to and cashed after date of death 9 The Sentinel -trust advertisement H-B7 705.64 500.00 1,240.00 486.07 2,931.71 75.00 500.00 50.00 7,113.00 272.50 8,010.50 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX+112-08) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Clauser, Irma I. 21 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursedmedical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Lancaster General Health -medical expense January 12, 2011 64.16 2 Lancaster General Health -medical expense February 2, 2011 64.16 3 I Transamerica Life Insurance Company -reimbursement for benefit overpayment to Masonic I 1,400.00 Homes 4 ~ U.S. Treasury - 2010 personal income tax liability 461.00 TOTAL (Also enter on Line 10, Recapitulation) I 1,989.32 (If more space is needed, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08) SCHEDULE J BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Irma I. Clauser 02/15/2011 163-24-9375 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) 1 Kathleen A. Brown Daughter 19% of residue of trust; 243,774.72 1845 Stone Mill Drive 4/17th share of the Elizabethtown, PA 17022 Presidential Life Insurance Company Non-Qualified Annuity #455869 2 Cynthia M. Clauser Daughter 19% of residue of trust; 243,774.72 4470 Vegas Valley Drive 4/17th share of the Space # 79 Presidential Life Las Vegas, NV 89121 Insurance Company Non-Qualified Annuity #455869 3 Jack R. Clauser II Son 19% of residue of trust; 243,774.72 17 West Main Street 4/17th share of the Shiremanstown, PA 17011 Presidential Life Insurance Company Non-Qualified Annuity #455869 4 Steven D. Clauser Son 19% of residue of trust; 243,774.72 4 Wayside Court 4/17th share of the Dillsburg, PA 17019 Presidential Life Insurance Company Non-Qualified Annuity #455869 5 Constance M. Merkel Daughter 19% of residue of trust 221,716.57 138 Saw Mill Road Elizabethtown, PA 17022 1 F~~~ :_L~Iil ~l ~J BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Irma I. Clauser 02/15/2011 163-24-9375 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) Jeanette R. Strausbaugh Stepchild 5% of residue of trust; 60,016.87 2401 Philadelphia Avenue 1/17th share of the Unit # 123 Presidential Life Ocean City, MD 21842 Insurance Company Non-Qualified Annuity #455869 Total 1.256.832.32 2 VIA HAND DELIVERY May 10, 2011 Glenda Farner Strausbaugh Register of Wills & Clerk of Orphans' Court 1 Courthouse Square Carlisle, PA 17013 RE: ESTATE OF IRMA I. CLAUSER, DECEASED Date of Death: February 15, 2011 SS# 163-24-9375 Dear Ms. Strausbaugh: Enclosed are the following documents to be filed in the above-referenced Estate: T . ~. ESTATE SECURITY Denise M. Long dml@jsdc.com 1. An original and two (2) copies of the Pennsylvania Inheritance Tax Return. 2. A check made payable to the "Register of Wills, Agent" in the amount of Fifty Three Thousand Seven Hundred Twenty Nine Dollars and Fifty Eight Cents ($53,729.58) representing the tax due paid within the 90 day discount period. 3. A check made payable to the "Cumberland County Register of Wills" in the amount of Fifteen Dollars ($15.00) representing the filing fee. 4. Estate information sheet. The will was not probated as all the assets at time of death were titled in the name of a n living trust. ~ ~7 ---- ;=` Please time-stamp the additional copy of the tax return and return to me in the encla~e~ ~` `' stamped self-addressed envelope. ~ ~' ~- __ . , -~ - ~_ ,-- ,_ , ,, If you have any questions, please feel free to give me a call. - _~ L .: ~__ Sincerely, ~-_ ~' .TAMES, SMITH, DIETTERICK & CONNELLY, LLP c~ Denise M. Long // 134 StPE AVENUE HUMMELSTOWN, PA 17036 Enclosures MAILING ADDRESS P.O BOX 650 HERSHEY, PA 17033 Cc: Jack R. Clauser, II TOLL FREE 1.800.942.3660 TEL. 717.533.3280 FAX 717.533.7771 www.jsdc.com