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HomeMy WebLinkAbout07-18-11 1505610105 REV- ~ 5 00 EX (o2-S i) (FI) j 1 W PA Department of Revenue OFFICIAL USE ONLY Pennsylvania - Bureau of Individual Taxes oEP.aTME"T OFaE~E"°` County Code Year 1=ile Number INHERITANCE TAX RETURN PO Box z8o6oi ~ ~ ,.., ~ ~ Harrisburg, PA 1128-0601 RESIDENT DECEDENT ~' ' ~ ,~~ ENTER DECEDENT INFORMATION BELOW - Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 088-18-0434 '. 02/28/2011 10/05/1924 Decedent's Last Name Suffix Decedent's First Name MI Tristan MD Theodore A (I# Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Tristan Faith B Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 074-18-0449 REGISTER OF WILLS FILL tN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Com romise date of P ( O 5. Federal Estate Tax Re' urn Required death after 12-12-82) ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under ;>ec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number William E. Miller, Jr. (7171 737-9581 First Line of Address 1962 Chestnut Street Second Line of Address City or Post Office State ZIP Code Camp Hill PA 17011 Correspondent's a-mail address: REGISTER OF WII LS USE ONLY '`: v---~ - ~~ ~~ ~:.. "77~ ..,C c:~ :,~7' ~; rte-- r", ~~ C~~ --,~ - - ,~ ~ __ DATE fILE~ ~~,_3 D .... ~,;" 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, i'. is true, correct and complete. Declaration of preparer other than the personal representative is based on a~! information of which preparer hay. any knowledge. SIGNATURE OF PERSON RESPO SIBLE FOR FILING RETUR DATE .y _ ,~. ADS G~ L Z .11...._ ~~~ ~ : ~r 2%~-.2. ~ Lu ~ L -~'SC__ -'. • 1 ,c ! _ . -'~.__. / "" ~ ~' "" RESS - SIGNATUR 1:E ..-~-~ _- -~ - e. _ -~_-- DATE: ADDRESS ~~ --~ ~~ !~ PLEASE USE ORIGINAL FORM ONLY Side 1 150561,01,05 1,50567,O1,Q5 ".~"7 ~:! ,;~"i r-~_ ~ : ~~ '~, ~ ~., f.. ~? 1 ,.,.~ ..~ ~ ~. 4.~ ' ~..~ J 1505610205 REV-1500 EX (FI) Decedent's Social Security Number Decedents Name: Theodore A. Tristan, M. D. 088-18=0434 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. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 21,686.93 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 459,971.26 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. 481,658.19 9. Funeral Expenses and Administrative Costs (Schedule H) ............. ...... 9. 8,603.30 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ......... ...... 10. 2,880.00 11. Total Deductions (total Lines 9 and 10) ........................... ...... 11. 11,483.30 12. Net Value of Estate (Line 8 minus Line 11) ........................ ...... 12. 467,674.89 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. 470,174.89 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 .......... . 16. Amount of Line 14 taxable __ at lineal rate X .0 _ 16. 17. Amount of Line 14 taxable _ - at sibling rate X .12 17 18. Amount of Line 14 taxable at collateral rate X .15 1 g 19. TAX DUE ................................................. 19 ... ..... . ~.~~ 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p Side 2 1505610205 1505610205 REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME - Theodore A. Tristan, M.D. - --- ---- - ---- - -- -------- -------- - -- ----------------- ----- STREETADDRESS 353 North 28th Street CITY ---------_ ---- - - -- ------- -- - - - -- Camp Hill II sTATE PA ' ziP 17011 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments _--__ _ B. Discount 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. (1) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRI~-TE BLOCKS 1. Did decedent make a transfer and: Yes Nn 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 .............................................................................................................................. ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. If death occurred after Dec. i2, 1982, aid 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? .............. ^ 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 FART 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 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(x)(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 no~:ed in [72 P.S. §9116(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. §9116(x)(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. Total Credits (A + B) (2) (3) (4) (5) REV-15og EX+ (oi-io) --~ ' pennsyLvania SCHEDULE F DEPARTMENT OF REVENUE INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY RESIDENT DECEDENT ESTATE OF: Theodore A. Tristan, M.D. FILE NUMBER: 21-11-0351 If an asset became jointly owned within one year of the decedents date of death- it mi~ct ha rannrhsarl ~., c,-hed..~n r ~u1n I LY UWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY I INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % Of DECEDENT'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1' A' 07/24/01 PNC Bank CD-See attached statement 5,417.03 50`% 2,708.52 2. A. 07/10/92 PNC Bsnk-Checking Acct-See Attached 17,577.15 50`% 8,778.58 3. A. 07i0ii92 PivC Bank-Savings Acct-See Attached 12,319.94 50`% 6,159.97 4. A. 05/28/03 M&T Bank-Checking Acct-See Attached 8,078.71 50~/, 4,039.86 I TOTAL (Also enter on Line 6, Recapitulation) $ 21,686.93 If more space is needed, use additional sheets of paper of the same size. Apr. 18. 2011 10.59AM PNC BANK 412-705-2747 No, 4074 P, ' '2 r~~uc Ll~iG TNT iAFAY lipril I8, 2011 Wil~a~ E MilXez Jr., Esq. Miller & Associates P.C. 1822 ~ Market St Camp Hill, PA 17011 :~.E: Theodore A Tristan SSN: 088-18-0434 DOD:.02-28-2011 Dcar Mr. Miller: Irz response to your request f or Date off" Death (DUD) balances for the customer noted above, our records show the following: ~Gertitf cafe of Deposit Account # 11020002708 Estabiished: 07-24-20( ~ I'HE+DD(~12E A TIiISTAI~111~ID ~~i'lf'1L-li R 'T'r? YCT A i~T I~OD balance: $ 5,416.23 + 0.80 accrued interest Interest paid 01-01-2011 thru 02-28-2011 $ 12.32 STD ~heckiug Account 1~.ccount # 5112008018 Establisled_ Q ~~-10-19~~ '. TH~O]~ORE A TRISTAN MD FAITS ~ T~ISTAN DOD balance: $ 17,576.91 + 0.24 accxu.ed interest Interest paid 01-0 l -2011 thru 02-28-2011 $ 1.74 XTD Sa~z~ags ,Accouant Account # 5.112055607 Established; 0701-19~~ ! TI~EODOPE A TRISTAN NiD FAITH S TRISTAN DOD balance: $12,318.02 + 1.92 accrued interest interest paid O 1-01-2011 thru 02-28-2011 $ 4.61 YTD -~ Page 1 of 2 __ Apr. 18. 2011 10:59AM PNC BANK 412-705-2747 Nc. 4()74 P. ~ '2 Safe Deposit Boa The decedent maintained safe deposit bax # 01074 T~:QDnRE A TR.f 5'i'AN 1ViD DAVID S T,RISTAN FAITI~I B TI~STAN Located at: Camp Hill Branch 2148 Market St Camp I-ii11, PA 17011 C7 ~ f~ X30- ~ ago Please note that this office provides date of death balances for deposit accaunss {IRAs, CDs, C]~ecking a~ad savings), Fde do oat process any financial tr~nsactians or provide statemen#s. I,f you need assistance ~ zth aray of tl}ese items, please tail 1-$88-PNC-BANK (1-$88-?62~22~5) or stop by your local PNC`. Sank brand t oilice. Sincerely, National Financial Services Centex PNC dank, N.A. Member FDIC 'his rrtessage is' intended. for the use of the individual or entity to which rt is addressed and may contain infvrmcztian that is privileged, confidential and exempt from disclosure under applicable I. w. If the reader o, f this message rs rrot the intended recipient or the employee or agent resp~onsihle fot~ delivering this message to the intended r~ecrprerit, yogi are hereby notified that arty dissemination, dlStribution Or Copying Of thlS COm1n7~t121GlItiGn.S ZS strictly prohibited If you have received this oofrrtrlunication in error, please note me immediately by reply ar vy telephone at 800-,76Z-1775 a rd imrrrediately destroy this faxed document. Page 2 of 2 Phone 888-502-4349 F ax (302) 934-295 Apri121, 201 I Miller and Associates PC 1822 Market Street Camp Hill, PA 17011 Re: Estate of :Theodore A Tristan MD Social Security: 074-18-0449 Date of Death: February 28, 2011 Dear Sir or Madam: Per your inquiry on March 30, 2011, please be advised that at the time of death, the above-namec[ decedent had on deposit with this bank the following: 1. Type of Account Account Number C}u~yierchin (IJrrmvc nfl Opening Date Balance on. Date of Death Accrued. Interest 1 otal Checking Account 951214872 Faith R Trigtan Theodore Tristan Katharine E Tristan (POA) 0528/03 $8, 079.70 $ .01 $8,078.71 ---------- ------------__ For any addifional information on the above accounts, including ownership and any changes, closures and/or reimbursement of funds, please call the West Shore Plaza Office at #717-731-1730. We were unable to locate any safe deposit box for the above-mentioned decedent. This letter does not include any accounts in which the deceased may have been listed as Power of Attorney, Chstodian of Uniform Transfers, Representative Payee, or Trezstee under a Written Agreement Sincerely, Tarlrny Spencer AdJustmen~ Services REV-I51{~ EX+ ;G8.Of1) ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBEF~ Theodore A. Tristan, M.D. 21-1 'I-0351 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 EXCLU~~ION (IF APPLICABLE) TAXABLE I VALUE 1. Merrill Lynch Wealth Management IRA Acct 872-75427 rima b n fi i , , p ry e e c ary surviving spouse, Faith B. Tristan, date of death value, see attached state. 459,971.26 100 459,971.2E i I TOTAL (Also enter on Line 7, Recapitulation) $ ~ 459,971.26 If more space is needed, use additional sheets of paper of the same size. _ ._ Merril[ Lynch 1Neattl~ t1+[arcagement Bank of America Corporation Robert F. Brenner, C:FP Vice President Wealth Managernent Advisor 214 Senate Avenue 5`h Floor Post Office Box 081() Camp Hill PA 1700:L-0810 William E. Miller, Jr. Miller & Associates, PC 1822 Market Street Camp Hill PA 17011 RE: Theodore A. Tristan, deceased Date of Death: 02/28/2011 Merrill Lynch Account #872-75427 Dear Mr. Miller: With reference to your letter dated May 12, 2011, we are providing the following requested information: At the time of Dr. Tristan's death we had only one account in his ilai-i~e whicri was titled as fOllOws: Account #872-75427 MLPF&S Cust FPO Theodore A. Tristan FBO Theodore A. Tristan The primary beneficiary of this account was his wife, Faith B. Tristan. The date of death value for this IRA Account was $459,971.26 Should you require any additional information, please feel free to give us a call. Sincer y, (~obert F. Brenner, CFP Vice President Wealth Management Advisor RFB:emm Meml] Lynch Wealth Management makes available products and services offered by Merrill Lynch, Pierce, Fenner & Smith Incorporated and other subsidiaries of Bank of America Corporation.. Ranking products are provided b~~ Bank of America, N.A and a~liared banks. Members FDIC and wholly owned subsidiaries of Bank of America Corporation. Investment products offered through Merrill Lvnch; Pierce, Fenner & Smith Incorporated and insurance and annuity products offered through Merril] Lynch Life Agency Inc.: Are Not FDIC Ensured Are Not Bank Guaranteed May Lose Vafue Are Not Deposits Are Not Insured by Any Federal Government A enc 4 Y Are Nat a Condition to Any t3ankSng Service or Activity Merrill Lvnch; Pierce, Fenner K Smith Incorporated is z registered broker-dealer, member Securities Investor Protection Corporation (SIPCj; and a wholiv nvrned SllD$)olar.' o: B2n~.: of .4rnericz REV-I.51.1.EX+ ;10-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER; Theodore A. Tristan, M. D. 21-11-0351 Decedent's debts must be reported on Schedule I, ITEM NUMBER DESCRIPTION ~ _ AMOUNT A. FUNERAL EXPENSES: i 1' Auer Cremation Services of Pennsylvania, Inc. ~ 1,728.00 West Shore Country Club, Camp Hill, PA Celebration of Life Services, refreshments ~ 4,511.10 B. ADMINISTRATIVE COSTS; 1, Personal Representative Commissions: Name(s) or` Personai Representative(s) _ ______ Street Address City ___- _ -- __-- State Year(s) Commission Paid: Z• Attorney Fees: 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address City ----- - ------- State Relationship of Claimant to Decedent 4, Probate Fees: 5~ Accountant Fees: 6, Tax Return Preparer Fees: ~~ Cumberland Law Journal, estate notice 8. The Sentinel, estate notice 9. Harrisburg Patriot News, newspapre obituary ZIP ZIP TOTAL (Also enter on Line 9, Recapitulation] i $ If more space is needed, use additional sheets of paper of the same size. 0.00 1,000.00 167.50 75.00 168.30 953.40 8,603.30 REV-I.51.?. EXµ ;.i2-OS) ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER Theodore A. Tristan, M.D. 21-11-0351 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed rried'ical expenses Ir more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN SCHEDULE ] BENEFICIARIES Theodore A. Tristan, M.D. NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1~ Faith B. Tristan, 353 North 28th Street, Camp Hill, PA 17011 FILE NUMBER: c:1-11-0351 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE Surviving Spouse ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS AFPR,OPRIATE. 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: 1. Entire TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I $ If more space is needed, use additional sheets of paper of the same size.