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HomeMy WebLinkAbout08-09-1115D561D143 REV-1500 Ex(°'-'°' OFFICIAL USE ONLY PA Department of Revenue Pennsylvania county code Year File Number Bureau of Individual Taxes DEFRRTMENT OF REVEMIE Po Box.2aosol INHERITANCE TAX RETURN 21 11 00733 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 207 28 7985 03 23 2011 04 11 1936 Decedent's Last Name ENGLE Suffix Decedent's First Name MAE (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix ENGLE Spouse's Social Security Number Spouse's First Name WILLIAM THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW t. Original Return ~ 2, Supplemental Return 4. Limited Estate ~ qa Future Interest Compromise (date of death after 12-12-82) I~ 6 Decedent Died Testate (Attach Copy of Will) ~ ~ Decedent Maintained a Living Trust (Attach Copy of Trust) g, Litigation Proceeds Received ^ 10. behveen P2 31 ~3Cand~tl(datgespf death MI M MI ~~ 3. Remainder Return (date of death ` prior to 12-13-82) ~~ ~ 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes ~. ~ 11 Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number MARIELLE F HAZEN ESQ 717 540 4332 First line of address 2000 LINGLESTOWN ROAD Second Tine of address SUITE 202 City or Post Office State ZIP Code HARRISBURG PA 17110 REGISTER ~,W~LLS USE6NLY-;~ ~.~ , C7 i. - - : r- -rrt , ry, D FILED • . `' " Correspondent's a-mail address: mhazen@hazenelderlaw.com _z_ T'"c C 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, it is true, correct and Jcpmplete. Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge ai~rvH i urct ur r~ON RESPONSIBLE FOR FILING RETUFjN DATE ,~ -1 ~ --~ William En le 440 Valley Rd. Etters PA 1731 ~IGfJgrrl/~tE OF Pfj,Ep R OTHER T PRESE TIVE Marielle F Hazen, Esq. DATE C/ _ 2000 Linglestown Road, Harrisburg, PA Side 1 15D561D143 15D561D143 J 'c~ REV-1500 EX Decedent's Name: Engie, Mae M Decedent's Social Security Number 207 28 7985 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. 5. 6. 7. 8. Mortgages & Notes Receivable (Schedule D) ...................................................... Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............. Jointly Owned Property (Schedule F) ^ Separate Billing Requested........... Inter-Vivos Transfers & Miscellaneous coq Probate Property (Schedule G) LJ Separate Billing Requested........... Total Gross Assets (total Lines 1-7) ................................................................... .. 4. .. 5. . 6. . 7. .. g. 21 , 845.80 $ $ ~ $ 91.32 110 , 737.12 9. Funeral Expenses & Administrative Costs (Schedule H) ...................................... . 9. 12 , 547 .20 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................. . 10. 11. Total Deductions (total Lines 9 & 10) ................................................................. .. 11. 12 , 5 4 7 . 2 0 12• Net Value of Estate (Line 8 minus Line 11) ......................................................... . 12. 98 , 18 9.92 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. 98 , 18 9.92 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 98, 189.92 15. 0.00 16. Amount of Line 14 taxable at lineal rate X .045 0. 0 0 16. 0. 0 0 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 0 • 00 18. 0.00 19. Tax Due .................................... ............................................................................. 19. . 0 . 0 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ 1505610243 Side 2 L 1505610243 1505610243 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-11-00733 DECEDENT'S NAME Engle, Mae M ---- -- -- -- ----- - STREET ADDRESS - Messiah Village 100 Mt. Allen Dr. CITY STATE 'ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19} (1) 2. CreditslPayments A. Prior Payments B. Discount 0.00 Total Credits (A + B) (2) 3. Interest (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (q) Check box 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. (5) 0.00 0.00 ~.0~ Make Check Payable t©: REGISTER OF WILLS, AGENT. r3 ~.~; ~' 4,. 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 :.................................. ,i -_; c. retain a reversionary interest; or ............................................................................................................ .. ' -] x 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? ...................................... r _. 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? .................................................................................................................. x ~ L J IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. -- -~- - __ __ _ .__ -_ ~ T _T_, 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 January 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)]. A sibling 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-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Engle, Mae M 21-11-00733 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. to more space Is neetletl, atltlrtional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-1510 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER _ Engle, Mae M 21 11 00733 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. i~~ ~~~~~~ aHacn ~s neeaeD, aaamonal pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) REV-1151 EX+(10-06) COM INHERITANCE RETURN ANIA RESIDENTT DE EDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Engle, Mae M 21-11-00733 Debts of decedent must be reported on Schedule I. ITEM N BE DESCRIPTION AMOUNT A. FUNERAL EXPENSES: See continuation schedule(s) attached B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) 11,356.62 Street Address City State Zip Year(sl Commission Daid 2. Attorney's Fees Hazen Elder Law 1,000.00 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 105.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 85.08 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 12,547.20 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER En le, Mae M 21-11-00733 ITEM NUMBER DESCRIPTION AMOUNT 1 Funeral Ex enses Food Vault, Etc. - -funeral meals 377 77 2 Monument marker 2,125.00 3 Rothermel Funeral Home - -burial lot 7,340.00 4 Rothermel Funeral Home - -funeral preparation 1,013.85 5 Rothermel Funeral Home - -transportation out of county to church and cemetary 500.00 H-A O 11, 356.62 6 ther Administrative Gost Cumberland Law Journal -estate notice 75 00 7 Hazen Elder Law -disbursements 10.08 8 Sentinel -estate notice H-B7 85.08 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) REV-1513 EX+ (~ 7-0S) SCHEDULE J COMMOHERITANCE TAX RETURN ANIA B E N E F I C IARI E S N RESIDENT DECEDENT ESTATE OF En le, Mae M FILE NUMBER 21-11-00733 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$) I~ TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 a 1.2 1 William Engle Spouse 100% beneficiary 440 Valley Rd. Etters, PA 17319 Total Enter dollar amounts for distributions shown above on lines 1 5 throw h 18 on Rev 150 0 cover sheet, as a r o riate. II 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 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08) REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA No . 20 1 1- 00733 Estate Of : MAE M ENGLE CERTIFICATE OF GRANT OF LETTERS ADMINISTRATION PA No. 21- 11- 0733 (First, Midd/e, Lasrl WHEREAS, MAE M ENGLE Late Of : MECHANICSBURG BOROUGH CUMBERLAND COUNTY Deceased Social Security No: 207-28-7985 (First, Middle, Lastl _ late of MECHANICSBURG BOROUGH CUMBERLAND COUNTY died on the 23rd day of March 2011 and, WHEREAS, the grant of Letters of Administration is required for the administration of the estate. THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wi 11 s in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, have this day granted Letters of Administration to: WILLIAM ENGLE who has duly qualified as ADMINISTRATOR(RIX) of the estate of the above named decedent and has agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARL/SLE, PENNSYL VANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 5th day of,July 2011. * *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) ,,dv Integrity Life Insurance Company A member of Western & Southern Financial Group July 19, 2011 HAZEN ELDER LAW ATTN CORINNE EGGERS WOODHOUSE 2000 LINGLESTOWN RD STE 202 HARRISBURG PA 17110 SUBJECT: Contract # 2100162547 -Mae Engle Dear Ms. Woodhouse, JUL 2 5 21711 This letter is in response to a request for information regarding the above referenced contract. Please keep this as confirmation that our records indicate the following: • Contract was owned by Mae Engle. Annuitant was Mae Engle and Contingent Annuitant was William Engle. • Contract Value as of 03/23/2011 - $21,845.80. • Current Interest Rate - 4.15%. Interest earned since inception is $1, 845.80. • No changes to policy until Mae's death and we changed to William on 7/17/2011. Value as of 7/17/11 - $22,131.63. If you have any questions or need additional assistance, please contact Client Services at 1-800-325-8583. We can be reached Monday through Friday between 9 a.m. - 5 p.m. EST. Si erely, obin ox Senior Case Consultant Integrity Life Insurance ING July 20, 2011 HAZEN ELDER LAW 2000 LINGLESTOWN 202 HARRISBURG PA 17110 ING USA Annuity and Life Insurance Company Contract Owner: MAE M. ENGLE Contract Number: 90277428 Claim Code: 03010 Dear Representative ~ ~~ UL 2 5 2011 Thank you for your recent inquiry regarding the annuity contract listed above. Please find the contract information below. Date of Death 03/23/2011 Death Benefit Value - $88,991.32 Cost Basis $43,000.00 Client holds no other contracts with ING If you have any questions please call the Customer Contact Center toll free at 1-800-369-5303, Monday through Thursday 8:30 a.m. to 6:30 p.m., and Friday, 8:30 a.m. to 5:30 p.m. Eastern Time, enter option 2 followed by the claim code in place of your social security number. Sincerely, Claims Services sm Please advise information prior to the date of death is not available for release 909 Locust Street Des Moines IA 50309-2899