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HomeMy WebLinkAbout06-23-11 (2) 1505610140 REV-1500 ~` (°'-'°' PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number Po sox 2ao6D1 INHERITANCE TAX RETURN Hamsburo, PA 17128-0601 RESIDENT DECEDENT 2 1 1 1 0 4 6 8 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth IrMADDYYYY 2 0 0 2 2 5 4 8 1 0 4 0 3 2 0 1 1 0 1 0 3 1 9 2 9 Decedent's Last Name Suffoc Decedent's First Name MI E M L E T B E R N I C E A (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 Retum ~ 2. Supplemental Return ~ 3. Remainder Retum (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Retum 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. 9t 13(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTUIL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number R O G E R B I R W I N 7 1 7 2 4 9 2 3 5 3 REGISTER OF WILLS USE ONLY Q First line of address ~ ~~s 6 0 W E S T P O M F R E T S T R E E T ~ r Second line of address ~ fri W r - r ('~ ~; 7 C~ ~j 'lj [- , ~ ,: City or Post Office State ZIP Code ~ D FILED '• r- T C A R L I S L E P A 1 7 0 1 3 ~~" "~ Correspondent's e-mail address: Under penalties of perjury, 1 declare that I have examined this return, including accompanying schedules and statements, and to the best oT my knowledge and belief, it h hue, correrk and complete. Declaration of preparer other than the personal representative is based on all iMonnation W which preparer has any knowledge. TURE PERSON RE ONSIBLE FOR FILING RETURN 698 BALTIMORE PIKE GARDNERS PA 17324 SIGNATU O PREPARER OTHE AN REPRESENTATIVE AT ~ ' b L3 ~~ ADDR SS 60 WEST MFRET STREET CARLISLE. PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 r Oh2O'C9SOS'[ Oh2O'[9SOS'C Z eP!S 0 6 'S Z 9 2 2 1N3WAtld?l3n0 Ntl d0 ONf!j321 tl ~JNIlS3f1O321321tl ftOA dI ltlAO 3H1 Nl llid 'OZ ............................................. 3f1O X1/1 ~61 61 0 0 ' 0 84 0 0. 0 SL' X a;e~ lee;epo•~;e algexe;glaull;o;unowy 'gl 0 6 ' S Z 9 'C 2 L4 6 h' 2 E 9 0 Q '[ algexe;gl auk;o;ungowy •~4 0 0 ' 0 gl 0 0' 0 algexej y~ aul~;o;unowwy • gL 0 0 ' 0 gL;g ~aeg ~apun s~a;suei; ~o 'a3ei ~3 lesnods ay;;e algexe; qL eull;o;unowy 'SL S31tla 3l8tlOllddtl LIOd SNO11Of1211SN1 33S - NOIl`dlt!OltlO Xtll 6 h ' 2 E 9 0 4 '~ '46 .. .... ................ 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(O alnPa4oS) algenlaoaa sa;oN pue saBs6Noyy "b '£ ' ' ' ' ' (O alnPayoS) d!ysioleladad-slog ~o dlysiauyed 'uoge~odio0 PIaH ~(IasolO '£ • ,Z . .... ................................. (8 alnPa4oS) spuo8'Pue sWooiS 'Z .1 . .... ...................................... (tl alnPa4oS) a;els3 1ea21 ' 1 NOlltllfllldtlO3?J 2 Q h 5 2 2 0 0 2 .L 3 l W 3 ' tl 3 ~ I N 213 8 :eweN sauepe~aa ~agwnN ~unoaS leloog s,;uapaoad X3 OOSI-n3Ll Oh2O'C9SOS'C 1 REV-150o EX Page 3 Decedent's Complete Address: File Number 21 11 0468 DEGEDENTSNAME BERNICE A. EMLET STREET ADDRESS 801 N. HANOVER STREET CITY CARLISLE STATE PA ZIP 17013 Tax Payments and Credits: ~• Tax Due (Page 2, Line 19) (1) 21,675.90 2. CreditslPayments A. Prior Payments B. Discount 1,083.80 Total Credits (A + B) (2) 1, 083.80 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (3) Fill in oval on Page 2, Line 20 to request a refund. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 20, 592.10 Make check payable to: REGISTER OF WILLS, AGENT , iriiwti ~»,~~, ~ ,. :~'I`e. '~,~ i e, ~: ., 66s~i,II~EI ~ ir.. ~° ,:~~"~~~~"o-~i~i^I ~~ .. .ni ~~,F'Tri I~Y~~ i 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 ......................................................................................... ....... ^ 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? .. ....... ^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? ........................................................................................... ....... ® ^ 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 benefiaaries 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)]. 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 + (s.sa) '` SCHEDULE E CDMMONWFJ-LTN OF PENNSYLVANIA CASH, BANK DEPOSITS, ~ MISC. INHERRANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY EHTATE OF FILE NUMBER BERNICE A. EMLET 21 11 048E mdude th p~ ~lidgatlon and the der were received 5Y me eslale. Ay P-oDNb wSh rlpM of s rust ba didoaed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. PNC BANK -CERTIFICATE OF DEPOSIT #31300352569 70,567.76 2. ~ PNC BANK -CHECKING ACCOUNT #5140192043 3. ~ PNC BANK -SAVINGS ACCOUNT #5112936658 6,559.30 27,035.74 TOTAL (Also enter an line 5, Recapitulatbn) I S (It more space is needed, insert edditbnal sheet of the same size) REV-1510 EX+ (08-09) • Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT E8TATE OF SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON•PROBATE PROPERTY NUIriBER BERNICE A. EMLET 21 11 0468 Tn~ achedub moat Is end ~ if the answer m any a queatmns ~ aaDUgn a on page three of f>~ REVaeoo b yea. REM NUMBER DESCRIPTION OF PROPERTY axxuDEn+Ewu~EaFnfiReE,n~eRREUTaNSr~PTOOEC~rANO iFE0AlE0F7RAr~.ATTACNACOPYOFTHEDE~FORREALESTAIE OATEOFDEA7'H VALUE Of ASSET %OFDECD'S INTEREST EXCLUSION Irwq TAXABLE VALUE 1. OHIO NATIONAL FINANCIAL SERVICES 72,982.18 100.00 72,982.18 ANNUITY CONTRACT S1809398 2. PNC INVESTMENT SERVICES 5,052.10 100.00 5,052.10 ALLSTATE ADVANTAGE PLUS ANNUITY CONTRACT #GA0584861 3. PNC INVESTMENT SERVICES 10,123.40 100.00 10,123.40 NEW YORK LIFE INSURANCE ANNUITY CONTRACT #53053672 BENEFICIARY ON ALL ANNUITIES: DORIS M. BREAM TOTAL (Also errter on Line 7, Recapitulation) ~ = 88 157 68 If more space is needed, use additlonal sheets of paper of sre same size. REV-1511 E7(+ (10.09) • Pennsylvania • DEPARTI,ENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECE~Hr SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS EsrwtE vF FILE NUMBER BERNICE A. EMLET 21 11 0468 DecedarYs deble must be repoRed on Schedule L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1, Personal Representative Commissions: Name(s) of Personal Represerdatlve(s) StreetAddress Cdty State ZIP Year(s) Commbebn Paid: y, AtbmeyFees: IRWIN 8~ McKNIGHT, P.C. 3. Family Exemption: (If deoedenCs address b not the same as dalmanYs, etlach explene6on.) Clehient SheetAddreas City State ZIP Relatlonship of Claimant is Decedent 4. ProbateFeea: REGISTER OF WILLS 5. I AocouMardFees: 6. TazReWmPreparerFees: PATRICIAA. ROSENDALE, CPA FIDUCIARY TAX PREPARATION 7. REGISTER OF WILLS -FILING FEE 8. CUMBERLAND LAW JOURNAL -ESTATE NOTICE 9. THE SENTINEL -ESTATE NOTICE 10,750.00 182.50 375.00 30.00 75.00 187.54 TOTAL (Also enter on line 9, Recapitulation) I i , , ~,,,, „. If more space is needed, use additlonal sheets of paper of tl1e same size. REV-1512 EX+ (12-06) Pennsylvania DEPARTMENT OF REVENUE ir~nlERiTANC;E TAx REruRN r~siDENr ix-c~nErrr SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, >I< LIENS BERNICE A. EMLET 21 11 0468 Report debt tncumd by the dsadent prior to death that renuined unpaid at the date of death, irtdudbtg unrebntwreed medical expenstee. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH NUING CARE RX -MEDICAL SPRINGS FAMILY PRACTICE -MEDICAL 25.95 62.00 TOTAL (Also enter on Line 10, ReppitulaGon) I ; H nave space a needed, insert additional sheets of the same s¢e. REV-1513 EX+ (01-10) Pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT RFAAI~('`c a C\AI CT -- - - Z1 11 046$ NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS [Indude outr' ht spousal disMbutions and Vansfers under S 1 i ec. 9 6 (a) (1.2).] 1. DORIS M. BREAM Sibling 180 632.49 698 BALTIMORE PIKE , REMAINDER GARDNERS, PA 17324 KENNETH O. EMLET DIED IN 2007 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 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. 8. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. S n iii~ia apa:e i3 neeueD, use aaamonal sneers or paper or the same size. t ilC ~n~ c~e~t~ttte~ I, BERNICE A. SOWERS, of South Middleton Township, Cumberland County, Pennsylvania, declare this instrument to be my last will and testament, hereby expressly revoking all wills and codicils heretofore made by me. 1. I direct my executrix to pay all of my debts, funeral and administrative expenses as soon as may be done conveniently after my decease. 2. I authorize and empower my executrix to sell any realty owned by me at my death and not specifically devised or bequeathed herein, at either public or private sale, and to give good and sufficient deeds therefor, in fee simple, as I could do if living. 3. I give, devise and bequeath all of my estate of every nature and wherever situate as follows: (a) As long as Kenneth 0. Emlet remains unmarried and living alone and desires to live in my home, and actually does so, he shall have the right to live there and use contents therein. As long as he does live in my home, he shall pay all the expenses incident thereto for upkeep, utilities, insurance and taxes, and (b) All the rest, residue and remainder of my estate, I give to Doris M. Bream, and if she is not living at the time of my death, to her children, share and share alike, the child or children of any deceased child taking the share their parent would have taken if living. 4. I nominate and appoint Doris M. Bream to be the executrix of this my last will and testament; she is to serve as such without bond. Should she die before my death, renounce or refuse to serve for any reason, or die leaving any of my estate unadministered, I nominate and appoint Tammy S. Eads, as substitute executrix, also to serve as such without bond, with the same powers as are given herein to my executrix. 5. I hereby suggest that my personal representative retain the services of Irwin, Irwin & McKnight, as attorneys in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this Ser day of March, 1990. •~~•fSEAL j Signed, sealed, published and declared by Bernice A. Sowers, the testatrix above named, as and for her last will and testament, in the presence of us, who at her request, in her presence and in the presence of each other have subscribed our names as witnesses hereto. ~' ~. ~~.. N ~ ~) ACKNOWLEDGEMENT AND AFF~IDAV~IT ___. WE, BERNICE A. SOWERS, BETZI A. MORRISON 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 that she had signed willingly, and that she executed it as her free and voluntary act for the purpose herein expressed, and that each of the witnesses, in their 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. COMMONWEALTH OF PENNSYLVANIA: ss: COUNTY OF CUMBERLAND . Subscribed, sworn to and acknowledged before me by BERNICE A. SOWERS, the testatrix, and subscribed and sworn to before me by BETZI A. MORRISON and SHARON L. SCHWALM, witnesses, this Son day of March, 1990. ~t__ ~ . . ROGER B. IRWMi, NOTARY PUBLIC SLE BOROUQH, CUA~ERLMIO COUNT MYCOMMISSiON EXPIRES OCT. 3, 1982 Membr.. P&'nev'r,.~? 1:::~<-a-. ~ o'~:a~ares Ir ~. J I/ I I I/ c D~ ~ ~~ LEAbW6THEIMAY May.2, 2011 Irwin & McKnight PC Roger B Irwin Esquire West Pomfret .Professional Bldg 60 West Pomfret Street Carlisle, PA 17013-3222 RE: Bernice A Emlet SSN: 200-2Z-5481 DOD: 04/03n011 Dear Mr. Irwin: In response to your request for Date of Death (DOD) balances for the customer noted above, our records show the following: CertiiScate of Deposit Account # 31300352569 ~ Established: 08/OSn010 BERl`TICE A EMLET DOD balance: $ 70,497.41 + 70.35 accrued interest Interest paid O1ro1n011 tbru oa/oznol l - s21o.60 Checking Aceonnt. .Accouuat # 5140192043 Established: 04/01/1963 BBRIVICE EMLBT DOD balance: $ 6,55928 + 0.02 aecnud interest Interest paid Ol/O1n011 thru 04/03/2x11- $1.19 Savings Acconnt Account # 5112936658 Established: 12/ZIn007 BERIQICE A BMLET DOD balance: $ 27,024.46 + 11.28 accrued interest Interestpaid Ol/O1n011 thru 04/03n011- $34.46 Imestnest Account The decedent maintained Investment Account #30089302. For further lnformatlon, you may call the Brokerage Departnnmt et 1-800-762-6111. Page t of 2 -~~~~~~ sic ~v~ cr-rr nu. 7171 f. ~/c Pleaso note that tbla offtae provides date of deaEh b for deposit accounts (IRAs, CDs, Chocking sad Savinp). VYe do~not proeeaa any 5ttaneial tnwdbm or QtmrWe stntearoob. zey~,t need assistance with arty of those items, please Dell 1-888-PNC-DA,NZC (1-888-762-2265) or stop by Your local PNC Bank bunch office. Sincerely; National Financial Services Canter PNC Back, N.A. Metnber~FblC This message is intended for the use of the indivia'rral or entity to~ which # is addressed and may comain i~ormation thot.rsprivileged, tor~rukndal and exempt from discloeure.unakr gpplicablslaw. 1f t~ reader of thfs msssags is Trot the intend sacipiern or the eutployee or agent responsible for delivering this message to the intended recipient, you are hereby notified drat arty distemination, distribution or copying of this commtnrications !s sb~ictly prohibited If you have receivlad this communication in error, please notffy me immeaKately by reply or by telephone at 8pa762-1773 and immediately destroy this fared doctrmert. Pave 7 of _ _o_ _ • l7iFU~i . t+}gdir~asAF"Yk~. Annuitant: EML,ET, YlRNICE Pixel Annuity Contract Sia09398 Status: /1C"II1/E Atl data Ia as of 04/01/11 or tM date shown. c1.....~... •..a.. e Q~ ~' ^'~r,.~t Foundation Plus Plan Type Non-Qualified Corrbad Issue Date 04/02/2007 Issue Ilge _ _78 . ~ Total Purchase Payment _ _ #62,195.01 .5ppG7 ; - -- - - - - -- -- Surrender Value #69,006.38 (alder, contract charges and taxes not deluded if a li bl Nursing Nome Benefit , pp ca e.) Yes Blllirg does not apply, No Premiums due. Values Values as of 04/04/2011 Genera! Account Accumulated Value Value Allocation Percentage Fixed Account 572,982.18 100.00% Total Value ;73;982;1& TOTAL PREMIUMS PAID ON CONTRACT #62195.01 Transaction pate I Dollar Amount* I Transadh)n Type There are no transadlons for the transaction type and/or dace range selected. * The Dollar Amount does not rafieCt the taxes, charges, and Pees, K any. Please dick 'Show Details' to obtain the Nat Amount. Name Address Tax ID Date of Birth Gender Beneficiary Annuita~rt EMLET,BERNICE 698 BALTIMORE PIKE GARDNERS,PA 17324 -, ._ a*x_**_5481 Dwner EMLET,BERNICE 698 BALTIMORE PIKE GARDNERS, PA 17324 :-- ~. ***_**-5481 01/03/1929 FEMALE DORIS BREAM Agency Name Representative Name Payor EMLET,BERNICE •848 BALTIMORE PIKE GARDNERS, PA 17324 ~, ~~ ~, 3' ~~~~: https://onnet.ohionarional.coal/porlal/site%nnet/template.SOLO/Policy_Search/?javax.porti... 4/4!2011 O rn 0 °m v., v.a O v v .,~, V m O T R M b R ~}, Y m N N '~ o~ ~M z"~°° ~~=°s a E a O F v o ao ~ ~ c ~a ~' ZoQ w v~ ~ WwU Z?~ $UVW ~arn~ N v Y tai 0 U~ ~_ ~` a (~ r C J Z gWo ~~ UQ ~[[- Fi T m N 8 ~n ~~ V~ F - O ~ ~ O a°po r _~ wN =_war -spa =w _Q~¢ wi=-w w =UQZ m O _ ~ W a =m oca7 R a g C O 7 0 J S O s °o °o ~° our °u~ n T w m E a c °"' a c J~ W w ~ t m m U Q 0 F E m U Z a m L C i~ r .~~ _I r as >' 7 O 0 0 ~ ~ 0 10^ (_~/ W 0 N m E 0 m m C m H 0 N m E 0 0 >_ fn U7 U a I-~ .~~' ® C m ~0 L_ W C Y ~ .~ m O .- E ~ m aL.. 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