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HomeMy WebLinkAbout05-16-111505610140 '~ REV-1500 ~` ~°'-'°' OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 1 0 0 1 7 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYW Date of Birth MMDDYYW 1 8 9 0 9 4 8 3 3 1 2 2 4 2 0 1 0 0 3 0 7 1 9 1 4 Decedent's Last Name Suffix Decedent's First Name MI T H O M P S O N B E R T H A B (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 ^X 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) VVI~f~G~7f VI\VGI• ~ - ~ ~~W a7L.V ~ IVn n1VV ~ vL. vvnu ~..a.~ a-v. ~~~ vv....w. v..vr..vr. r~..r vv..~ ... r... vim.. ., v. .... .~.........~.. ~..~~..~ ~~ .....~~. __ _. Name Daytime Telephone Number M A R C U S A M 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 ~ 1 7 0 1 3 i : ~ WILLS U~E'ONLY ~~-~ ~ ..._..... _..' I ~_..... 1.., ,. _. i .___ ~_-~ .~~, ~ ., ~... - r.._ - ~ C.-; ,, _~, :-_ ~ - ;1 ~ - . 1 '~~ DATE FILED-- ~` -,, Under penalties of perjury, I declare that I have it is true, correct and complete. Declaration of F S RE OF PERSON RESPONSIBLE FC ADDRESS 19 DEW R Y E SIGNAT F OTI~N~fiFy4jV mined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, arer other than the personal representative is based on all information of which preparer has any knowledge. LING RETU N ,, DATE LEVITTOWN PA 19055 EPRESENTATIVE DATE ~i7///1.... ~ ~ ~!/ 60 WEST PO/~1FR~T STREET 1505610140 P O M F R E T S T R E E T CARLISLE PLEASE USE ORIGINAL FORM ONLY Side 1 A 17013 1505610140 J 150561D240 REV-1500 EX Decedent's Social Security Number Decedent's Name: BERTHA B• THOMPSON 1 8 9 0 9 4 8 3 3 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 and Notes Receivable (Schedule D) .......................... 4. • 1 9 2 3 6 4 . 1 1 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. • 7. Inter-Vivos Transfers 8 Miscellaneous N -Probate Property Re uested arate Billin ~ S l S h d G 7 6 2 0 3 7 . 3 0 ....... g q ep ( e u e ) c . 8. Total Gross Assets (total Lines 1 through 7) ........................... 8. 2 5 4 4 0 1 . 4 1 9. Funeral Expenses and Administrative Costs (Schedule H) .................. 9• 1 3 6 ? 2 . 6 4 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule 1) ......... .... 10. 2 6 3 7 . 9 4 11. Total Deductions (total Lines 9 and 10) ........................... .... 11. 1 6 3 1 0 . 5 8 12. Net Value of Estate (Line 8 minus Line 11) ..................... ... .... 12• 2 3 8 0 9 0 . 8 3 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. 2 3 8 0 9 0 . 8 3 TAX CALCULATION -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 0. 0 0 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate x .045 2 3 8 0 9 0. 8 3 1 s. 1 0 7 1 4. 0 9 17. Amount of Line 14 taxable 0 0 0 17 0 0 0 . at sibling rate X .12 . . 18. Amount of Line 14 taxable at collateral rate X .15 0. 0 0 1 g. 0. D O 19. TAX DUE ............................................... ... ....19. 1 0 7 1 4. 0 9 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^ Side 2 1505610240 1505610240 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 11 0017 DECEDENT'S NAME BERTHA B. THOMPSON STREET ADDRESS 770 S. HANOVER STREET CITY CARLISLE STATE PA Z1P 17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 10,178.39 B. Discount 535.70 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. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. Total Credits (A + B) (2) 10, 714.09 (1) 10,714.09 (3) (5) (4) 0.00 0.00 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; .......................... ..... ^ c. retain a reversionary interest; or ........................................................................................... ..... ^ 0 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 "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? ............................................................................................. ..... 0 ^ 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)J. 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-1508 EX + (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. ~N RES DENT DECEDENTRN PERSONAL PROPERTY ESTATE OF FILE NUMBER BERTHA B. THOMPSON 21 11 0017 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointty-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. M&T BANK -CHECKING ACCOUNT #2675050906 54,212.12 2. ~M&T BANK -CERTIFICATE OF DEPOSIT #31003913027099 ~ ~ 138,151.99 TOTAL (Also enter on line 5, Recapitulation) I $ 192, 364.11 (If more space is needed, insert additional sheets 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 BERTHA B. THOMPSON 21 11 0017 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 NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE 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 pF APaucnaLE- TAXABLE VALUE 1. WESTERN & SOUTHERN FINANCIAL GROUP 62,037.30 100.00 62,037.30 ANNUITY TOTAL (Also enter on Line'7, Recapitulation)I ~ 62,037.30 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ (10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER BERTHA B. THOMPSON 21 11 0017 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. HOFFMAN-ROTH FUNERAL HOME 1,334.60 2. FIRST UNITED METHODIST CHURCH -MINISTER 400.00 3. FUNERAL LUNCHEON 300.00 4. ORGANIST 150.00 5. CUSTODIAN 40.00 6. GEORGE'S FLOWERS 310.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid: 2, Attorney Fees: IRWIN & McKNIGHT, P.C. 10,000.00 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 307.50 5 Accountant Fees: 6. Tax Retum Preparer Fees: PATRICIA A. ROSENDALE, CPA 515.00 INCOME TAX RETURN & FIDUCIARY TAX RETURN 7. REGISTER OF WILLS -FILING FEE 30.00 8. CUMBERLAND LAW JOURNAL -ESTATE NOTICE 75.00 9. THE SENTINEL -ESTATE NOTICE 187.54 10. NOTARY FEES 15.00 11. REGISTER OF WILLS -SHORT CERTIFICATE 8.00 TOTAL (Also enter on Line 9, Recapitulation) I $ 13.672.64 If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-08) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER BERTHA B. THOMPSON 21 11 0017 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. ALERT PHARMACY -MEDICAL 54.20 2. MILLENNIUM PHARMACY -MEDICAL 16.40 3. CUMBERLAND-GOODWILL-AMBULANCE 85.25 4. M&T BANK -REIMBURSEMENT OF ANNUITY 2,482.09 TOTAL (Also enter on Line 10, Recapitulation) S 2 637.94 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: BERTHA B. THOMPSON ~~ „ nn~~ .... , . RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. DONNA B. JENKINSON Lineal 238,090.83 19 DEWBERRY LANE REMAINDER LEVITTOWN, PA 19055 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ It more space is needed, use additional sheets of paper of the same size. L LAST WILL AND TESTAMENT I, BERTHA B. TgIOIVIPSON, of °the Borough of Carlisle, iunlberland County, Pennsylvania, declare this instrument to be my Last Wi11 and Testament, hereby expressly revoking all Wills and Codicils heretofore made by me. ONE: I direct my Executrix to pay all of my debts, funeral and administrative expenses as soon as maybe done conveniently after my decease. TWO: I specifically give, devise, and bequeath all of my estate of every nature and wherever situation to DONNA B. JENKINSON. THREE: If DONNA B. JENKINSON has predeceased me then I specifically give, devise and bequeath all of my property of every nature and wherever situate in equal shares per stirpes to the following: a. To JAMES ROBERT JENKINSON......... 50% b. To JULIE ANN GRAViJER ............... 50% If any of the above beneficiaries should predecease me, then their share shall be distributed to their issue who survive me. If any of the above beneficiaries predecease me without leaving living issue, then their share shall be divided equally by those beneficiaries named above who survive me. F_: I appoint DONNA B. JENI~TSON to serve as Executrix of this my Last Will. If she predeceases me, fails to qualify or ceases to serve as Executrix, I appoint MARCUS A. McIOVIGHT, III, as substitute Executor of my Last Will. F=: My Executrix may, at her discretion, compromise claims, borrow money, retain property for such length of time as she may deem proper; lease and sell properly for such prices, on such terms, at public or private sales, as she may deem proper; and invest estate property and income without restriction to legal investments. SS X: No Executrix or Executor acting hereunder shall be required to post bond or enter security in this or any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 1st day of July, 2003. BERTHA B. THOM ON 2 Signed, sealed, published and declared by BERTHA B. THOMPSON, the above named Testatrix, as and for her Last Will and Testament, in the presence of us, who, at her request and in her presence and in the presence of each other have subscribed our names as witnesses hereto. .Q~_~n nn~e~^ 1~aio~ ~lk~s~ 3 ACKNOWLEDGMENT AND AFFIDAVIT WE, BERTHA B. THOMPSON, KAMELA S. CORNMAN and SHARON L. SCHWALM, the Testatrix and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and 'Testament, that she had signed willingly, that she executed it as her free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as a witness and that to the best of their knowledge the Testatrix was, at that time, eighteen years of age or older, of sound mind and under no constraint or~ undue influence. S. CORNMAN SHARON L. SCHWALM COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND Subscribed, sworn to and acknowledged before me by BERTHA B. THOMPSON, the Testatrix herein, and subscribed and sworn to before me by KAMELA S. CORNMAN and SHARON L. SCHWALM, witnesses,. this 2nd day of July, 2003. ~, IVotazial Seal "------~---.,_._. Jacqueline L. Drawbau 4 C•:•,; I`s':' boro, CumNand tC~.. Public 1Y~y _;;,,SSio ~• P:~:~ "8iiIlSJil14`1~1!clAgg ...-_ Q M~TSank 499 Mitchell Road, Millsboro, DE 19966 Adjustment Services Irwin and McKnight PC 60 West Pomfret Street Carlisle, PA 17013-3222 Re: Estate of Bertha Thompson Social Security: 189-09-4833 Date of Death: December 24, 2010 Phone 888-502-4349 F ax (302) 934-2955 January 24, 2011 ~~~ ~- i ~~A~ ~: ~~ ~~~~` x..~1r~i O'~F~C~e: Dear Sir or Madam: Per your inquiry on January 11, 2011, 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 oj~ Opening Date Balance on Date of Death Accrued Interest Total 2. Type of Account Account Number Ownership (Names o, fl Opening Date Balance on Date of Death Accrued Interest Total Checking Account 2675050906 Bertha B Thompson 05/01/78 $54,211.76 $ .36 $54,212.12 Certificate of Deposit 31003913027099 Bertha B Thompson 08/03/06 $137,705.52 $ 446.47 $138,151.99 _ _ _. _. t 'or Financial Professional Use Only - Accessful.com Account Profile -Fixed Aruniity Page 1 of ] What's New home > client accounts > account profile Rep Name: KIMBERLY ~ HEAVNER Account Search Bank Name: M 8c T SECURITIES Credited Rate Account values are shown as of 1/3/2011 Beneficiary Required Minimum Distribution Contract Number Product Contract Status W0020879596 MultiRate Active Owner Date of Birth Account Type Contract Extension THOMPSON BERTHA B 3/7/1914 NonQualified N/A 770 S HANOVER ST CARLISLE, PA SSN or TIN Contract Value Contract Date 17013-4105 ***-**-4833 $62,037.30 3/4/2004 Available Free Surrender Value $6,203.73 $60,362.29 joint Owner Minimum Rate Income Date N/A 2.00% 3/4/2014 Annuitant Systematic W/D RMD Option THOMPSON BERTHA B No N/A Received Credited Rate Premium 3/4/2004 2.90% $55,000.00 Systematic Withdrawal Book of Business Statements/Confirms Transaction History home ~ privacy statement ~ business continuityplan ~ sitemao ~ cs,ntact us ~ feedback ~ site hela t~1 2011 W&S Financial Graup Distributors, Inc. All rights reserved. FOR FINANCIAL PROFESSIONAL USE QNL`( FI-31-017-0807 >e ~ ~~,~~ ~~ ,~~ P~~x~~ Last Updated: 10/13/09 ttps://www.accessful.com/clientaccounts/ca020203.asp 1 /4/2011 DER A~CCbUN'1~ 'lf`#~41MSilofil~ ~~ ~ ~~i##~Iglldrl~ illlC ~ ~~t1!',a~E'~ 1~~if5 ~r ~11F1~ '' ,~ ,~/ ~ ~t11~~RAL I-~OM~ c~ CREMA~"C-RY, INC. 219 North Hanover Street Carlisle, Pennsylvania 17013 717.243.4511 toll free 1.866.451.4511 fax 717.243.3723 www.hoffmanroth.com info®haffmanroth.com January 11, 2011 Donna Boyd Jenkinson 19 Dewberry Lane Levittown, PA 19055 Statement of Funeral Expenses for: Bertha Boyd Thompson Date of Death: December 24, 2010 Account Id: 1 61 1 2-287 PACKAGE: Traditional Funeral Service TRADITIONAL FUNERAL SERVICE PACKAGE $ 4;,550.00 Sub Total: $ 4,550.00 MERCHANDISE: Casket: Hyacinth $ 2, 975.00 . Sub Total: $ 2,975.00 TOTAL FUNERAL HOME CHARGES: $ 7,525.00 CASH ADVANCES: Westminster Cemetery $ 1,595.00 10 Certified Death Certificates at $ 6.00 each $ 60.00 Newspaper Notice -Sentinel ~ $ 211.58 Newspaper Notice -Patriot $ 408.02 Sub Total• _ $ 2,274.60 Total Funeral Expense: $ 9,799.60 Total Payments Made: $ 8,485.00 Paymients Made: Allianz Check 513516 Jan 11, 2011 8,139.16 PreNeed Disc Discount Jan 11, 2011 325.84 Balance: ~ 1.334.60 Please return this portion with your Remittance. $ Amount Enclosed Bertha Boyd Thompson Service ID#: 16112-287 SERVING OUR COMMUNITY SINCE 1 907 * * * This is an Advice P.O. Box 4650 ACH/EDI Services Buffalo, NY 14240-9975 (800) 724-2240 Date: Monday, January 03, 2011 BERTHA B THOMPSON DONNA JENKINSON 19 DEWBERRY LN LEVITTOWN PA 19055 Subject: Notification of Death /Reclamation Case Number: 31780 Funds Deposited to Account: * * * * * * 0906 Funds Deducted from Account(s): * * * * * *0906 $2,482.09 This is to advise you that on 1/3/2011 we deducted from the account(s) shown above the amount of $2482.09, for the PA Treasury Annuity of 12/30/2010. Due to the fact that BERTHA B THOMPSON has passed away prior to the issuance of the credit, the Treasury of the United States is requesting reimbursement. In accordance with Federal Regulations, direct deposits may not be retained by the beneficiary unless the beneficiary lived through the entire month prior to the date of issuance. If the number of the 'account deducted from' is different from the account into which the funds were originally deposited, the deduction is authorized under the bank's rules for right of offset because one or more of the owners on both accounts are the same. Should you have any further questions about this charge, please call and refer to~ the case number above. This advice is provided to facilitate the reconcilement of your monthly account .statement. Respectfully, ACH/EDI Services M&T