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HomeMy WebLinkAbout06-03-11 (2) 1505610149 J ~'` REV-1500 EX,° '-'°' psnrtsylvania OFFICIAL USE ONLY PA Department of Revenue °`^^^'"10'""""" County Cod• Year File Number Burssu of Individual Taxes INHERITANCE TAX RETURN PO BOX 280807 Harrisburg, PA 17128-08°1 RESIDENT DECEDENT 21 10 116 4 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 195 28 8228 09 12 2010 09 12 2010 Decedent's Last Name Suffix Decedent's Rrst Name MI Ertel Shirley Martha (If Applicable) Enter SuMving Spouse's Infomtation Below Spouse's Last Name Suffix Spouse's Flrst 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 Retum l~ 2. Supplemernal Retum O 3. Remainder Retum (date of death prior to 12-13-82) p 4. Umited Estate O 4a Future Interest Compromise (date of O 5. Federal Estate Tax Retum Required death after 12-12-82) ~ e. Decedent Died Testate ~ 7. Decedern Mairnained a Uving Trust e. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) D 9. Utigation Proceeds Received O 10. Spousal Poverty Credit (date of death p 11. f]ection to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - Thls section must be completed. All Correspondence and Confidential Tax Information Should be Directed fo: Name Daytime Telephone Number Stephanie Kleinfelter 717 901 7786 REGISTEROF WILLS USE ONLY Flrst line of address Saidis Sullivan & Rogers Second line of address 635 N. 12th Street, Suite 400 czty or Post Office Lemoyne N ..~ ~. i cn w State ZIP Code Eo PA 17043 ~ ,;~' r 4 w. Correspondent's a-mall address: skleinfelterCf~ssr-attorneys.com Undarp ties of perjury,ideclare thatl have examined this return, ineludinp accompanying achadules and statements, and to the beat o}my knowledge and belief, it is tr oryset and complete. Oeclaration~f the praparsr other than personal representative is based on all information of which preparer has any knowledge. Hill. PA 17011 PA 17043 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610149 1505610149 J~ ~. M ~ ~~ ~ ~~ ~~ ~ ~~~ ~ ~ ~~ J 1505610249 Rev-1500 EX Decedent's Social Security Number Decedent's Name: Shirley Martha Ertel 19 5 2 8 8 2 2 8 RECAPITULATION 1. Real estate (Schedule A) ......................................... 1. 2. Stocks and Bonds (Schedule B) .................................... 2. 3. Closely Held Corporation, Parcnership or Sole-Proprietorship (Schedule C) . • ... • 3. 4. Morcgages and Notes Receivable (Schedule D) ...... • .. • • .............. 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) ....... 5. 8. Jointly Owned Property (Schedule F) O Separate Billing Requested ...... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) l~ Separate Billing Requested . • .... 7. 8. Total Qross Assets (total Lines 1 through 7) ............................ 8. 236,900.00 262,926.53 o.oo 0.00 381,128.91 0.00 739,779.50 1,620,734.94 9. Funeral Expenses and Administrative Costs (Schedule H) .................. 9. 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............. 10. 11. Totsl Deductlons (total Lines 9 and 10) .............................. 11. 12. Net Valus of Estats (Line 8 minus Line 11) ............................. 12. 13. Charitable and Governmental BequestslSec 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. 33,951.07 22,742.32 56,693.39 1,564,041.55 0.00 1,564,041.55 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 ~ • 0 ~ 15. 1f3. Amount of Une 14 taxable at lineal rate X .045 1, 5 6 4 , 0 41 •5 5 1 s. 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 1 g 19. TAX DUE .................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610249 1505610249 0.00 70,381.87 0.00 0.00 70,381.87 l~ Rev-1500 EX Page 3 Decedent's Complete Address: Fle Number 21 10 1164 Shirle Martha Ertel STREET ADDRESS 200 North 30th Street CITY Cam Hill STATE PA ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A Prior Payments 8. Discourn (1) 70.381.87 60,250.00 3.170.96 Total Credits (A + B) (z) 63,420.96 3. Ineerest 4. If Line 2 is greater than Line 1 + Une 3, enter the difference. This is the OVERPAYMENT. FIII In oval on Papa 2, Uns 20 to roquest a refund. 5. If Une 1 + Une 3 is greater than Line 2, erner the difference. This is tha TAX DUE. (3) 0.00 (4) (s> 6, 960.91 #~~p„ Make Check Payable tto: REGISTERy~OF,}~y~WILL(S, AGENT. !~#~ U .~ ~ ~. ~v a ~"~'iY~balY~ ~ it iq~G(~{ ,s t r~ ~~i ~ ~k~~~,. x! {~ ~:~. :'?~S6iiltll~k{41~~'i~.e''f;? Y ~ i ~.~ ~ +NE~li:~3'9?3~ `~ Ut~'~r;~.l~aEi ~Ct~IEn~w ~i! I~li~1t~ ~` ~' ~..}~.IiiXi~i{~ ~-0i{i^~~....;:T pj. ~h 3i ~~'iYt PLEASE ANSWER THE FOLLOWING GIUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedern 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 tranuferred or Its income : ................ ^ c. retain a reversionary Interest; or ................................................... ^ d. receive the promise for life of either paymerns, benefits or care? ........................... ^ 2. If death occurred after December 12, 1982, did decedern transfer property within one year of death without receiving adequate consideration? ....................................... ^ 3. Did decedent own an "Intrust for" orpayable-upon-death bank accourn or security at his or her death? .. ^ 4. Did decedent own an individual retirement account, annuity, or other non-probate property, which contains a beneficiary designation? ............................................. ® ^ IF T33Hyy E ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUSTT COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. `~~°3s~,Ul',`.,7 ,. { i ; ° ~Mr, )J;?~~i r ~[il , x ~,... ~ln. 43 "?itl.I yl. S , Ni#~ k il liar ~ PSii[[p{~µ{fpp (y F 4' t~71 ,a ~ tt'~ ~ ~'.~ Y tEgg}~ i!~` ~ad~El (~ k z. ~ S'N,* `((~{y(y a 5 ts. ~~. I _ _. •t BPP A~y~,.. KI i 31St ~ iiiii~ r . v <~"a e ,.„~r:x; CdiL.~,.~ 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 peroern [72 P.S. Sect. 9116(ax1.1)(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 peroern [72 P.S. Sect. 9118(a)(1.1 xii)]. The statue does not exempt a transfer to a surviving spouse from tax, and the statutory requiremerns 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: • Tf1a 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 parern, an adoptive parern, or a stepparent of the child Is o percent [72 P.S. Sect. 9116(ax1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedern's lineal beneficiaries is a.s peroern, except as noted in 72 P.S. Sect. 9116(1.2) [72 P.S. Sect. 9118(x)(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. Sect, 9118(x)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedern, whether by blood or adoption. REV-1602 EX+(01-10) Pennsylvania SCHEDULE A OEPARTNENT Or REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENTDECEDENT ESTATE OF: FILE NUMBER: Shirley Martha Ertel 21 10 1164 Ail real property owned aolely or as a tenant in com mon moat be reported at fair market value. Fair market value is d efined as the price at w hic h property would be axehangsd between a willing buyer end a willing seller, neither being eompelisd to buyer sell, both having reasonable knowledge o} the relevant facts. Rssl ro srt that is 'ointl -owned with ri ht of survivors hl must be diacloaed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in Common. VALUE AT DATE 1 Residential Real Property Commonly Known As 200 North 30th Street, 236,900.00 Camp Hill, Cumberland County, Pennsylvania Assessed Value $236,900 X 1 Common Level Ratio = $236,900 TOTAL (Also enter on Line t, Recapitulation.) ~ 236,900.00 If more space is needed, insert additional sheets of the same size. REV-ib03 EX+tB-98 SCHEDULE B COMMONWEALTH OF PENNSVLVANiA STOCKS & BONDS INHERITANCE TAX RETURN RESID ENTDECEDENT ESTATE OF FILE NUMBER Shirley Martha Ertel 21 10 1164 All properly lolntly-owned with rlpht of survlvorhsip must tts disclosed on Schedule F. ITEM vei i ~e er neTc 1 235.7774 Shares Pepsico Inc 15,604.11 Held in Morgan Stanley Smith Barney Account No. 724-1418-12 538 2 334.735 Shares Pfizer Inc. I 5,674.60 Held in Morgan Stanley Smith Barney Account No. 724-1418-12 538 3 528.5167 Shares Reynolds American Inc. 30,130.74 Held in Morgan Stanley Smith Barney Account No. 724-1418-12 538 4 354.7767 Shares Gabelli Utility Trust 2,239.53 Held in Morgan Stanley Smith Bamey Account No. 724-1418-12 538 5 2,595.6953 Shares Alliance Bernstein Income Fund 21,706.50 Held in Morgan Stanley Smith Barney Account No. 724-1418-12 538 6 1,592.225 Shares John Hancock Patriot Premium Dividend Fund II 18,505.64 Held in Morgan Stanley Smith Barney Account No. 724-1418-12 538 7 4,682.8578 Shares Invesco Municipal Fund Inc. I 36,912.63 Held in Morgan Stanley Smith Barney Account No. 724-1418-12 538 8 1,937.2695 Shares Nuveen Premium Income Municipal Fund Inc. I 28,815.43 Held in Morgan Stanley Smith Barney Account No. 724-1418-12 538 9 11,484.2635 Shares Nuveen Municipal Market Opportunity Fund Inc. 22,094.00 Held in Morgan Stanley Smith Barney Account No. 724-1418-12 538 10 7,059.917 Shares Alliance Berstein Global Bond Fund CIA 59,444.50 11 2,246.366 Shares Franklin Income Fund Class A 4,672.44 Held in Morgan Stanley Smith Barney Account No. 724-1418-12 538 12 1,179.565 Shares Lord Abbett Bond-Debenture Fund Class A 8,935.20 Total from continuation Schedule(s) 8,191.21 TOTAL (Also enter on Ilne 2, Recapitulation) 262,926.53 (If rrare space is needed, insert additional sheets of the same size) Page 2 Estate of: Shirley Martha Ertel 21 10 1164 Schedule B -Stocks and Bonds Item Value at Date Number Descriation of Death 12 Held in Morgan Stanley Smith Barney Account No. 724-1418-12 538 13 1.171.847 Shares Prudential Global Total Return Fund Class A 8,191.21 GTRAX TOTAL. (Carry forward to main schedule) ...... 8,191.21 REV -1508 EX+(8-88) COMMONWEALTH OF PENNSYLVANIA INH ERITANCE TA% RETURN RESIDENTDECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Shirley Martha Ertel 21 10 1164 Include the proceeds of litigation and the date the proceeds were received by the estate. All property lolntly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Money Market Fund 358,715.77 Held in Morgan Stanley Smith Barney Account No. 724-1418-12 538 2 Manufacturers & Traders Bank 6,094.97 Checking Account No. 31079075 3 Northwestern Mutual -Access Fund I 4,907.10 Account No. 80200590097437 4 Prudential Mutual Fund Services LLC 2,469.07 - Uncashed Checks 5 ~ 2000 Jeep Grand Cherokee ~ 0.00 6 Household Good and Furnishings 6,000.00 7 U.S. Treasury -Refund of Overpayment of U.S. Individual Income Tax for 2,814.00 Year 2010 8 Commonwealth of Pennsylvania -Refund Of Overpayment of PA Individual I 128.00 Income Tax for Year 2010 TOTAL (Also erner on line s, Recapitulation) I 381,128.91 (If more space is needed, insert additional sheets of the same size) REV-1610 EX+(08-09) ~11115~/~Vdli'Id tlEPo1RTMENT tlF REYEN~E INHERITANCE TAX RETURN RESID ENT D ECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Shirley Martha Ertel 21 10 1164 Thie schedule must 6s completed and filed if the answer to any of qusationa 1 through 4 on page three of the REV-1600 is yss. ITEM NUM DESCRIPTION OF PROPERTY INCLUDE NAME OF TRANSFEREE,RELATIONSNIPTODECEDENTB DATE OF TRANSFER. ATTACH COPYOF DEED FOR REAL ESTATE DATE OFDEATFi VALUE OF ASSET %OFDECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 The Ertel Family Living Trust 569,525.90 Agreement of Trust Dated June 9, 2001 Shirley M. Ertel Grantor and Trustee 51 Acres Commonly Known As 3250 Fishing Creek Valley Road, Middle Paxton Township, Dauphin County, Pennsylvania Tax Parcel No.: 43-037-010 $277,220 Assessed Value X 1.42 Common Level Ratio + $393,652.40 1.29 Acres Real Property Commonly Known As 111 Barbours Cemetery Road, Plunketts Creek Township, Lycoming County, PA 17701 Map No. 48-2530-0136-000 Deed 04342 00254 Assessed Value $68,140.00 X 1.21 Common Level Ratio = $82,449.40 .80 Acres Real Property Commonly Known As 77 Turkey Farm Road, Plunketts Creek Township, Lycoming County, PA 17701 Assessed Value $77,210 X 1.21 Common Level Ratio = $93,424.10 2 Merrill Edge Bank of America Corporation 132,081.85 Individual Retirement Account Account No.: 2AT-34P61 See Attached Asset List Beneficiary: Christel L .Ertel 3 MetLife Insurance Company of Connecticut 38,171.75 Annuity Contract 9059564 Beneficiary: Grace Martha Ertel Stewart, Minor Granddaughter TOTAL (Also enter on Line 7, Recapitulation) ~ 739,779.50 If rtare space is needed, use additional sheets of paper of the same size. REV-1611 Ext(10-09) pennsytvania RIB DEPIIRTMENTOFgEVENUE INHERITANCETAx RETURN RE3IDENTDECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Shirley Martha Ertel 21 10 1164 DacedsnYs debts must be reported on Schedule I. AMOUNT A. FUNERAL IXPENSES: 1 Parthemore Funeral Home -Funeral Service 2 St. John's Lutheran Church -Funeral Service 3 Shultz Memorials B. ADMINISTRATIVE COSTS: 1. Personal Represernative Commissions: Name(s) of Personal Representative(s) Street Address 2. 3. City State Zip Year(s) Commission Paid: Attorney Fees Family F~cemptlon: (If decedent's address is not the same as claimarn's, attach explanation.) gaimarn Street Address 4,219.02 500.00 1,263.00 15, 000.00 atY State Zip Relationship of Claimant to Decedent a. Probate Fees: 610.00 5. Accournarn Fees: 6. Tax Return Preparer Fees: See schedule attached 12,359.05 TOTAL (Also erner on une s, Recapitulation) 33,951.07 If more space is needed, use additional sheets of paper of the same size. Page 2 Estate of: Shirley Martha Ertel 21 10 1164 Schedule H, Part B -Administrative Costs Miscellaneous Expenses Item Number Description Amount 7 The Sentinel -Legal Advertisement 166.30 8 Register of Wills of Cumberland County 74.50 -Miscellaneous Fees JCP Fee $23.50 Automation $5.00 Short Certificates $16.00 PA Inheritance Tax Return $15.00 Inventory $15.00 9 Cumberland Law Journal -Legal Advertisement 75.00 10 Keefer Wood Allen & Rahal, L.P. -Photocopies and Postage 7.26 11 Superior Plus Energy Ser 3,106.69 1 010 7/2 0 1 1 $ 836.70 11 /01 /2010 $ 147.42 02/16/2011 $1,963.65 03/28/2011 $ 158.92 12 Parthemore Funeral Home -Death Certificates 42.00 13 Tuscarora Wayne Insurance Policy Co. 928.00 - Homeowners' Insurance Policy Premium 14 Comcast -Cable Service 759.27 Paid 11/01/2010 $383.00 Paid 02/18/2011 $177.67 Fina105/07/2011 $198.60 15 Harrisburg Storage Company 1,677.50 October, November and December 2010 $457.50 January, February and March 2011 $457.50 April, May, June, July and August 2011 $762.50 16 PPBL -Electric Service 110.00 12/17/2010 $ 30.00 02/18/2011 $ 30.00 03/20/2011 $ 50.00 17 Herr Cable Company 204.00 18 Borough of Camp Hill 300.40 Sewer Service TOTAL. (Carry forward to main schedule) ...... 7,450.92 Page 3 Estate of: Shirley Martha Ertel 21 10 1164 Schedule H, Part B -Administrative Costs Miscellaneous Expenses Item Number Description Amount 19 Verizon -Telephone Service 446.07 09/13/2010 $47.19 10/13/2010 $47.09 11/08!2010 $52.01 11/15/2010 $47.00 12/13/2010 $47.03 01/11/2011 $47.03 02/11/2011 $47.56 02/18/2011 $16.32 03/14/2011 $47.40 04/11/2011 $47.44 20 Shell Oil -Heating Oil 2,184.06 1 2106/2 0 1 1 $ 597.32 12/13/2010 $ 30.21 01/20/2011 $ 398.02 02/07/2011 $ 372.54 03/03/2011 $ 405.36 04/04/2011 $ 380.61 21 White Rudy 8 Company Accountants -Preparation of Individual Income 2,200.00 Tax Returns 22 Pennsylvania American Water 78.00 TOTAL. (Carry forward to main schedule) ...... 4,908.13 REV-1612 EXt (12-OB) Pennsylvania DEP~RINENT OP REYENl1E INH ERITANCE TAX RETURN RESIDENTDECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER Shirley Martha Ertel 21 10 1164 Report debts Incurred by decedent prior to death that romained unpaid at the date of death, Including unreimbursed medical expenssa. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Newport Emergency Physicians 35.78 2 American Home Medical 76.40 3 ~ Coastline Ambulance SE ~ 1,050.00 4 ~ RI Hospital ~ 33.33 5 ~ Montoursville Area School District -Per Capita Tax ~ 9.80 6 ~ Middle Paxton Township Tax Collector ~ 3,765.15 7 Tanya Pomeroy, Tax Collector 2,203.36 8 Senior Homecare By Visiting Angels 628.00 9 PP&L -Electric Service 100.00 10 Commonwealth of Pennsylvania -Estimated Individual Income Tax 36.00 Payment (Third Quarter 2010) 11 Northwest EMS, Inc. -Medical Expense 115.00 12 Hospice of Central Pennsylvania 2,100.00 13 Harrisburg Storage Company 457.50 July, August and September 2010 14 Verizon -Telephone Service 108.00 September 2010 15 Statewide Tax Recovery 72.00 16 I Pennsylvania Department of Revenue - 2008 Individual Income Tax I 1,998.00 17 U.S. Treasury - 2008 Individual Income Tax 9,954.00 TOTAL (Also enter on Une 10, Recapitulation) I 22,742.32 If more space is needed, insert additional sheets of the same size. REV-tb13 EX+101-10) Pennsylvania SCHEDULE J DERIIRINENT Of REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Shirley Martha Ertel 21 10 1164 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBE NAME AND ADDRESS OF PERSONS RECEIVING PROPERTY DO Not Ust Tru a OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions, and transfers under Sec. 9116(a)(1.2).] Christel L. Ertel Daughter 1,525,869.80 2966 Maple Road Camp Hill, PA 17011 Grace Martha Ertel Stewart Granddaughter 38,171.75 2966 Maple Road Camp Hill, PA 17011 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUG H 180E REV-1500 COVER SH EET, AS APPROPRIATE. zt NON-TAXABLE DISTRIBUTIONS: 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. 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