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Home My WebLink About05-31-11 (3)1505610140 REV-1500 EX ~°'-'°' PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisbur PA 17128-0601 RESIDENT DECEDENT 2 1 1 0 0 9 3 9 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 2 0 4 0 1 7 5 2 0 0 8 3 1 2 0 1 0 0 1 2 3 1 9 2 0 Decedent's Last Name Suffix Decedent's First Name MI S E L L E R S H E L E N E (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 4. Limited Estate ~ 4a. Future Interest Compromise (date of prior to 12-13-82) ~ 5. Federal Estate Tax Return Required D OX 6 d t Di death after 12-12-82) ~ . ece en ed Testate (Attach Copy of Will) ~ 7. Decedent Maintained a Living Trust A 8. Total Number of Safe Deposit Boxes 9 Litigation Proceed R i d ( ttach Copy of Trust) . s ece ve ~ 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 CONFIDE NTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number D A V I D H R A D C L I F F E S Q 7 1 7 2 3 6 9 3.,,,1 8 ;-~--. ~~ -REGISTER ~ S USE O ~~~~ ~# ; ~t ~ ' ~'~ ~ First line of address i ,~ .F:; :~ C7 -+~ ~" R O A D G~ ~c Second line of address ~ ~ -~ ~_t ~ ~ S U I T E 2 0 1 .== ~ ~:w ~ sue=- --~ City or Post Office State ZIP Code ~ D~ FLED ~-- `~~ L E M O Y N E P A 1 7 0 4 3 .~ Correspondent's a-mail address: DHRAD(a~IX.NETCOM.COM ~~~~~~ Nc~iaiues or penury, i Declare tnat 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. eclaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNAT~RE~OF PEN R O ^ E FC~ FILING RETURN ~ - f ADDRESS 110 SHAR N ROAD OF P ENOLA PA 17025 ADDRESS ~' ~"r ~ 1011 MUMMA RD #20 LEMOYNE PA 17~4~ PLEASE USE ORIGINAL FORM ONLY L 1505610140 Side 1 1505610140 J 1505610240 REV-1500 EX Decedent's Social Security Number Decedent's Name: HELEN E• SELLERS 2 0 4 0 1 7 5 2 0 RECAPITULATION 1 . Real Estate (Schedule A) ........................................ ... 1. 1 8 6 9 2 5. 0 0 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. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5. 3 D 4 5 . 5 6 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ..... .. 6. 1 0 0 0 . D 2 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ..... .. 7. 8. Total Gross Assets (total Lines 1 through 7) ......................... .. 8. 1 9 0 9 ? 0 . 5 8 9. Funeral Expenses and Administrative Costs (Schedule H) ................ .. 9. 1 8 2 9 0 . 2 0 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ........... .. 10. 1 3 3 3 . 4 1 11. Total Deductions (total Lines 9 and 10) ............................. .. 11. 1 9 6 2 3 . 6 1 12. Net Value of Estate (Line 8 minus Line 11) .......................... .. 12. 1 7 1 3 4 6 . 9 7 13. Charitable and Governmental Bequests/Sec 9113 Trusts for whi h c an election to tax has not been made (Schedule J) .................... .. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) .................... .. 14. 1 7 1 3 4 6 . 9 7 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 1 7 1 3 4 6 9 7 16. 7 7 1 0. 6 1 17. Amount of Line 14 taxable at sibling rate X .12 0. 0 0 17. 0. 0 0 18. Amount of Line 14 taxable at collateral rate X .15 D O D 1 g. 0. 0 0 19. TAX DUE ..................................................... .19. 7 7 1 0. 6 1 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAY MENT ^ Side 2 1505610240 1505610240 J REV-1500 EX Page 3 Flle Number Decedent's Complete Address: 21 10 0939 DECEDENT'S NAME HELEN E. SELLERS - _ ---- STREETADDRESS _ - -- - -- _ -- -_ 311 GETTYSBURG PIKE -- - CITY - - - - _ ---- - - r---- - -- --- -- --- _---. ZIP STATE MECHANICSBURG ' PA 17055 Tax Payments and Credits: ~ Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments _ 7,200.00 B. Discount 378.94 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. 7,710.61 Total Credits (A + s) (2) 7, 578.94 (3) (4) 0.00 (5) 131.67 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; ............................... ^ Q c, retain a reversionary interest; or ............... . ................................................................................ ^ D 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 "intrust for" orpayable-upon-death bank account or security at his or her death'? ......... ^ Q 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? .................................................................................................. ^ a 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)j. 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)j. • 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)j. • 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, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF: FILE NUMBER: HELEN E. SELLERS 21 10 0939 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property that is jointly-AWnLd With rinh+ of cnniivnr~hi...,,....a -._ ~:__~__ _ ~ _ _ ., . .. _ •• • • •~~ •• ~rw~.. ~~ ~ ioaucu, ~~~ auu,uvnai meets or paper or me same size. REV-1508 EX + (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, a MASC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF HELEN E. SELLERS FILE NUMBER 21 10 0939 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointlyowned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE 1. 1991 CUTLASS OLDS OF DEATH 500.00 2. ~PNC ACCT #51-4019-7899 3. REFUND -BETTER HOMES 4. REFUND - VERIZON 5. (PERSONAL PROPERTY (SEE ATTACHMENT) 1,793.89 3.75 15.92 732.00 TOTAL (Also enter on line 5, Recapitulation) I $ 3,045 56 (If more space is needed, insert additional sheets of the same size) Estate of Helen E. Sellers File No. 21-10-00939 Personal Property Wooden table w/ 4 chairs $ 40.00 Small hutch $ 26.00 Apartment size clothes washer $ 7.00 Apartment size refrigerator $ 7.00 White metal cabinet $ 8.00 3-tier appliance cart $ 5.00 Coffee pot (Mr. Coffee) $ 6.00 2-slice toaster $ 3.00 Electric frying pan $ 12.00 Microwave $ 11.00 Misc table service items $ 10.00 Assorted pots & pans $ 6.00 Electric stand mixer $ 14.00 Assorted serving bowls $ 5.00 1 wooden rocking chair $ 41.00 1 recliner $ 5.00 2 upholstered chairs $ 54.00 Coffee table $ 18.00 Table lamp $ 11.00 End table $ 5.00 Floor light $ 12.00 Footstool $ 2.00 19" portable TV $ 12.00 TV stand $ 5.00 3-tier metal book shelf $ 5.00 6 drawer wooden desk $ 9.00 Sewing machine (cabinet style) $ 9.00 3 drawer sewing chest $ 3.00 2 shelf wooden bookcase $ 8.00 2 wing-back chairs $ 40.00 1 wooden rocking chair $ 25.00 Footstool $ 2.00 4 drawer end table $ 5.00 Table lamp $ 11.00 Floor lamp $ 12.00 Night stand $ 24.00 Double bed w/ box springs & mattress $ 42.00 Dresser w/ mirror $ 36.00 Chest of drawers (4 drawer) $ 25.00 Dressing table w/ mirror $ 30.00 2lamps $ 10.00 Double bed headboard & frame only $ 18.00 6 drawer large chest $ 35.00 Clock radio $ 1.00 Nightstand $ 20.00 Lamp $ 5.00 Metal wardrobe $ 7.00 4 drawer chest $ 20.00 Metal linen closet $ 5.00 Household Items TOTAL $7 32.00 REV-1509 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT r nT.r~ .. SCHEDULE F JOINTLY-OWNED PROPERTY w~n~cvr. -- HELEN E. SELLERS FILE NUMBER: 21 10 0939 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. SIDNEY R SELLERS 110 SHARON ROAD SON ENOLA, PA 17025 B. VICKI L SELLERS 413 ELMSHIRE DRIVE LANCASTER, PA 17603 GRANDDAUGHTER C JOINTLY-OWNED PROPERTY: LETTER DATE DESCR ITEM FOR JOINT MADE IPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR S TH D NUMBER TENANT JOINT IMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE DATE OF DEATH DECEDENT'S VALE OF . VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. B. 3/11/52 MEMBERS FIRST FEDERAL CREDIT UNION ACCT #1704 3,000.00 33.334 1,000.02 TOTAL (Also enter on Line 6, Recapitulation) I $ 1,000 02 If more space Is needed, use addltlonaf 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 ESTATE OF FILE NUMBER HELEN E. SELLERS 21 10 0939 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION A. FUNERAL EXPENSES: AMOUNT 1. COCKLIN FUNERAL HOME 10,255.70 B. 1 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address Cary State ZIP Year(s) Commission Paid: 2. Attorney Fees: RADCLIFF LAW OFFICE, P.C. 7,635.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address Ciry State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 369.50 5 Accountant Fees: 6. Tax Retum Preparer Fees: 7. FILING FEES -INVENTORY AND PA INHERITANCE RETURN 30.00 TOTAL (Also enter on Line 9, Recapitulation) I $ 18,290 20 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 SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER HELEN E. SELLERS 21 10 0939 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 LEFFLER ENERGY (CHECK O/S AT 8/31/10) 250.00 2. VERIZON (CHECK O/S AT 8/31/10) 51.09 3. DISCOVER (CHECK O/S AT 8/31/10) 21.86 4. MOTORISTS INSURANCE GRP 431.50 5. CHESS GARAGE 6. JAMES C LUTZ 7. IPPL 8. ~VERIZON TOTAL (Also enter on Line 10, Recapitulation) I $ If more space is needed, insert additional sheets of the same size. 306.02 159.00 42.28 71.66 1,333.41 REV-1513 EX+ (01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: HELEN E. SELLERS FILE NUMBER: 21 10 0939 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT AMOUNT OR SHARE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Do Not List Trustee(s) OF ESTATE Sec. 9116 (a) (1.2).j 1. SIDNEY R SELLERS Lineal 110 SHARON ROAD 170,846.97 ENOLA, PA 17025 2. VICKI L SELLERS Lineal 413 ELMSHIRE DRIVE 500.00 LANCASTER, PA 17603 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 TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL 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. LAST V`~ILL AND T~+~ST.~~.J~~~IvT OF' hELEN E . SELLERS , I, Helen E. Sellers, of Upper Allen Township, ~umbwrland County, Pe~sylvania, hereby declare this to be my last 6~ilt and. re yoke all ~~~ill s which I have previously made . 1• I direct my Executor to pay the expenses of my funeral and last illness as soon as convenient after my death. 2. All of the rest, residue and remainder of my estate I give, devise and bequeath to my husband, Dwi~~h.t A. Sellers. 3. If my husband, Dwight A. Se11e rs, should. predecease me, or should we both die in a common accident, then I give, devise and bequeath all the rest, residue and remainder of my estate tom s y on Sidney K. Sellers, 4• I appoint my husband, Dwight A. Sellers, Executor of f this Will . Should. he, for any reason, fail to qualify or cease to act as such, I appoint my son, Sidney R. Sellers, Executor of this 'JVill . iN VyITNESS U~HEREOF', I have hereunto set my hand and seal this 23rd. d.ay of October, 19'72. ;, ~. ~. ,_. I ` SIGNED, S:~ALED, PU~3LISHED AND Dr~CLARED by the above named Helen E. Sellers, as and for her last 'J!,ill and 'Testament, in the presence of us, who, at h~B request, in her presence and in the pre Bence of each other have hereunto subscribed. our names a.s ~ritnesses, ~-~, ~, ~, .. ,~ _..--- ~~ ~ ? ~- ' w.~ i PP .--~..._~_ ..................._ .~. ~,e