HomeMy WebLinkAbout08-01-11 (2)1505610140
REV-1500 ~` `°'-'°'
PA Departrnent Of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes ^County Code Year File Number
Po Box z6D6D1 INHERITANCE TAX RETURN C.~I ~ I (J~ 2 ~1
Hanisburg, PA 17128-0601 RESIDENT DECEDENT ` ~C~~ /
ENTER DECEDENT INFORMATION BELOW
Socal Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
1 8 0 2 6 5 1 5 4 0 1 1 0 2 0 1 1 0 5 1 3 1 9 3 2
Decedent's Last Name Suffix Decedent's First Name MI
ALL E N RUSSELL H
(H Applicable) Eller Survlving 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 INAPPROPRIATE OVALS BELOW
® 1.Original Retum ^ 2. Supplemental Ratum ^ 3. Remainder Retum (date of death
poor to 12-13-82)
^ 4. Limited Estate ^ 4a. Futuro Interest Compromise (date of ^ 5. Federal Estate Tax Retum Requlrod
death after 12-12-82)
^ 6. Detxident 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 CredR (date of death ^ 11. Election to tax under Sec. 9113(A)
between 12-31-91 end 1-1-95) (Attach Sch. 0)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Tebphone Number
J O E L R. Z U L L I N G E R 7 1 7 2 6 4 6 0 2 9
First line of address
14 NORTH MAI
Second line of address
S U I T E 2 0 0
City or Post Office
C H A M B E R S B U R G
N S T R E E T
State ZIP Code I
PA 1 7 2 0 1
REGI8TER OF YYILL8 USE ONLY
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Comsspondent's e-mail address:
Under penaPoea of perjury, I dedare that I have examined this return, induding acxompanying schedules and statements, and to the beat of my knowledge and belie},
h la true, correct and complete. Dedaretlon of preperer other than the personal representatlve is based on all Intormaflon of whbh preparer hae arty knowledge.
OF
14iNORTH MAI
1505610140
CE 200 CHAMBERSBURG PA 17201
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610140 J
~~
O
~~
REV-1500 EX Pape 3
Decedent's Complete Address:
Flla Number
0 0
DECEDENTS NAME
RUSSELL H. ALLEN
STREET ADDRESS
111 S. Queen Street
CITE
Shi nsbur STATE
PA ZIP
17257
Tax Payments and Credits:
t• 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.
FIII In oval on Page 2, Line 20 to request a refund.
5. If Line 1 + Line 3 is greater than lane 2, enter the difference. This is the TAX DUE.
(1) 1,220.93
Total Credits (A + B) (2) 0.00
(3)
(4) 0.00
(5) 1,220.93
Make check payable to: REGISTER OF WILLS, AGENT
"'~"ril'C , ~_4 enpa~Ai n!€^ 'il"^ ^ r ~ , ~ ~'~~'i~~ ~ ~ Pi ` "~^ fi=R x $ @ a', ~ "',',k r '! ,.,,,., k FWp..;~;,aa{p p i r " n i'"N;"'P ~i i C `~}~',~€Js ^ x• ^..~ s.*~,,,y S"~ R.q,, i .¢. e.. s. a .. ".i i ~ vi,: iL i ~€i atps~ ~ k2L a i :,,
," ~4".: kE x4^ili~i~~~4i r kk I~AI~I ~,"~ api~yl iM~~9ii{~~I~IFI~IF~PBC€;:CI~GC~ENil6.i&"[~I'1~1~~kPI ~~i[ii~''~,"N6iih~i~.pq^&~p.{~''€!{ti~t~~'N4!I~IIF~~'r ~VCte~°o~,E~..~~:9a~'~~-?~~M~3r~9;ti°.9&e i~"~~°e"~'°~~k.~ ,'Iii ~8 r ,~•.:'-a~{~~t,~4""~4 ~~tR.ai. ~ 1. "re!
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 properly 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 Iffe of either payments, benefits or care? ....................................................... ^
2. H death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate corlsiderafian? ....................................................................................... ^
3. Did decedent own an "in trust for" or payable-upon~eath 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 QUESTION813 YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
{"'oLSne i"~e,~~3~'o IIg! @3t :".@e Wi{ t~.;:ai °)p a s,' 3 s9lv;ag es Y!ltt4&-, ':@ ag~i "igC€iia ec the .. ~:, .s av~'€-ppp ( res, , . ,v svgv g$eqgp :s ..
iii r. ~A I,tl{~i91d9,ii€e€ €a8jk ?il ,i tr 5i :r ] f r k x as IliilillC ii"irw I{I# {'iu~r~ {p r, I e"E€. € e, E-111 6 d iq 5,r li eid9,lrgiggl9. 6 ggggglggqq ppgge is p8 R .F ~'~ " z` ii, !{hr{~ii~, i': iii i ~ i f a
n uy "" .. ,9 . i . 4 7 .. , a _........: ~ .._. v2a. P A_..e.c et _. ''~(~9Rk,l..., ., a P,W,~9~W ~8989€9V~1,...1 ,„.r.. ^;^, 9 9 3d9r3R~89iS$d16NRRntl,Si~i n n ..... n ... .$@:n .a ,t I a a€ i Yal6 ~iq +I i 6~4
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
p2 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 disdosure of assets and
filing a tax return are still applicable even ff 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 p2 P.S. §9116(a)(1.2)].
• The tax rate imposed on the net value of transfers to or for the use of the decedents 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 decedents 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.
1505610240
REV-1500 EX Decedent's Social Security Number
Oscsdent'sName: RUSSELL H. ALLEN 1 8 0 2 6 5 1 5 4
RECAPITULATION
1.
.....................................
Real Estate (Schedub A)
....
..
1 • •
2. Stocks and Bonds (Schedule B) ................................ .... .. 2.
3. Closely Held Corporation, Partnership or Sob-Proprietorship (Schedub C) ... .. 3.
4. Mortgages and Notes Receivable (Schedule D) .................... .... .. 4.
4 3 5 7 ' 1 4
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E). .... .. 5.
B. Jointly Owned Property (Schedule F) ^ Separate Billing Requested . .... .. 6. 2 6 3 1 2 8
7. Inter-Vhros Transfers & Miscellaneous N -Probate Property
ested
t
Billi
Re
~ S
S
G
7
3
8
7
2
0
5
7
.
epara
e
ng
qu
(
chedub
) .... ..
. .
8. Total Gross Assets (total Lines 1 through 7) ..................... .... .. 8. 4 5 7 0 8 • 9 9
9.
............
Funeral Expenses and Administrative Costs (Schedule H)
.... 9.
.. 1 0 4 0 1 5 0
10. Debts of Decedent, Mort a e Liabilities, and Liens Schedule I
9 9 ( ) .......
.... 10.
.. 8 1 7 5. 7 1
11. Total Deductions (total Lines 9 and 10) ......................... .... .. 11. 1 8 5 7 7 • 2 1
12. Net Value of Estate (line 8 minus Line 11) ...................... .... .. 12. 2 7 1 3 1 7 8
13. Charitabb and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedub J) ................ .... .. 13.
14. Net Value 8ubJect to Tax (Line 12 minus Line 13) ...................... 14. 2 7 1 3 1 7 8
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 Llne 14 taxable
2 7 1 3 1 7
8
1
2
2
0
9
3
at lineal rate X .045 1s. .
17. Amount of Line 14 taxable
0
0
0
17
0
0
0
.
at sibling rate X .12 . .
18. Amount of Line 14 taxable
0 0
0
0
0
0
at collateral rate X .15 18. .
19. TAX DUE ......................................................19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
1 2 2 0.9 3
Side 2
L 1505610240 1505610240 J
REV-1508 EX + (8-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, 8r MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
~GC,nG\IT f1LPGAG\IT
FILE NUMBER
RUSSELL H. ALLEN 0 0
Include the proceeds of IHigatlon and the date the pror~eds were received by the estate.
All oroDSrhr JoiMlYOwnsd rdtlr right of survhronhip must be dlscbsed on ScheduN F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
~. Patriot Federal Credit Union Prime Share Account 98.14
2.
U.S. Treasury, income tax refund 2010
4,259.00
TOTAL (Also enter on line 5, Recapitulation) ~ S
(If more space is needed, insert additlonal sheets of the same size)
REV-1509 EX+ (01-10)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULEF
JOINTLY-OWNED PROPERTY
ESTATE OF: FILE NUMBER:
RUSSELL H. ALLEN 0 0
k an asset was made jolMly owned wkhln one year of the decedents date of death, k must be reported on Schedule G.
10 Walnut Dale Road
hioaensburq, PA 17257
TO DECEDENT
ADDRESS
SURVNING JOINT TENANT(S) NAME(S)
A. Stanley R. Allen
B.
c.
JOINTLYAWNED PROPERTY:
son
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCW.INSTffUTIONAND BANKACCOUNTNUMBER ORSIMILAR
IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY•HELD REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET %OF
DECEDENTS
INTEREST DATE OF DEATH
VALUE OF
DECEDENTS INTEREST
1. A. 10/05 Checking Account #300187, Orrstown Bank, including 5,262.55 50. 2,631.28
interest accrued to date of death
TOTAL (Also enter on Line 6, Recapitulation) I S 2,831.28
If more space Is needed, use additional sheets of paper of the same size.
REV-1510 EX+ (0a-09)
Pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
re of
RUSSELL H. ALLEN 0 0
This schedule must be completed and tiled 'd the answer to any of questlons 1 through 4 on page three of the REV-1500 is yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
INCLUOETHENMAEOFTHETRANSFEREE,THEIRRELATIONSHIPTODECEDENrAND
THE DATE OF TRANSFER. ATTACHACOPY OF THE DEED FOR REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET
%OFOECD'S
INTEREST
EXCLUSION
OF~i~EI
TAXABLE
VALUE
1. IRA Certificate of Deposit Patriot Federal Credit Union, 38,720.57 100.00 38,720.57
named beneficiary Stanley R. Allen, son of decedent
TOTAL (Also enter on Line 7, Recapitulation) I S 38,720.57
If more space is needed, use additional sheet 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
RUSSELL H. ALLEN 0 0
Dscsderh's de6te must be reported on &heduN I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Fogelsanger-Bricker Funeral Home, funeral expenses 9,136.50
B.
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
StreetAddreas
City
Year(s) Commission Peid:
2. Attorney Fees: Joel R. Zullinger
3, Famiy Exemptbn: (If decedenrs address is not the same ~ daimanrs, attach explanation.)
Clainwnl
4.
Street Address
Cky State _
Relatlonvhip of CleimaM to Decedent
pF~: filing return
5 Awountant Fees:
6. Tax Return Preparer Fees:
7.
State ZIP
ZIP
1,250.00
15.00
TOTAL (Also enter on Line 9, Recapitulation) I S
If more space b needed, use additional sheets of paper of the same size.
REV-1512 Ex+ (12-08)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF rrr.e nuara~R
RUSSELL H. ALLEN 0 0
Report debb incurred by the decedent prior to death that remained unpaid at the date of death, Including unroimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Ultra Sound Svcs., Inc., medical services 19.20
2. Kinetic Imaging, medical services
3. ~ Millennium Pharmacy, prescriptions
4. Green Ridge Village, balance due for nursing home care
5.Robert T. Henry Pharmacy, balance due on account
TOTAL (Also enter on Line 10, Recapitulation) I S
If more space is needed, insert additional sheets of the same size.
142.80
69.67
7,802.04
142.00
REV-1513 EXr (Ot-10)
ESTATE OF:
pennsylvania ~ SCHEDULE J
DEPARTMENT OF REVENUE I BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE
RUSSEL L H. ALLEN U U
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Llst Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS pndt~e p~IpM I distdbudone and transfeB under
Sec. 91 i6 (a (1.2).]
1. Stanley R. Allen, 210 Walnut Dale Road, Shippensburg, PA Lineal
residue
Residue
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 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.
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.
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VRAL RECORDS
CERTIFICATE OF DEATH
fSee InstrueHons and examples on rownN1 E..,t ~,
1.Nrr a fderdetl IFiel mldre, beL ra•1 2 fir 3. sail Seoay Nrra e. Dw d OeeR IWna, ew, Nrl
5154 January 10, 2011
26
Male 180
.
.
Russell H. Allen
6. eq (W! ei.ldry) UNr f UMM 1 8. Ore a Bri T. ' rr tlaea w. Pbr a BeM ar
ebru BeN Fbr ii,e„ Hrppr: Dmr:
5-13-32 Shippeneburg, PA ~j
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Cumberland S.Middleton Twp. Carlisle Regional Medical Center I Via.) It~+rl1 White
H. Derdre'a UrW anal Osr nee d W.4irrre 12 Wr Deoebr esx b tle 13. IMfdrfe Eduutlon (6pedy aw leiler Baee ampwee) 1e. s Mrr0. 16. 9avniq fiyaw lM Mb, piw nrdr romel
Sbtlawai rJrd BUemer/meury U.6. Mnee Fars? eI~ISemldery (Pi2l Ddbg•11Ja5.1
widowed
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Howard Allen Mary Naugle
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Stanley R. Allen 210 Walnut Dale Road, Shippensburg, PA 17257
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elsanger-Bricker Funeral Home Inc., Shippensburg, PA 17257
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atriot
FEDERAL CREDIT UNION
Catch the Sptrlt ojFinancia! Freedom
Law Offices of Zullinger-Davis
Joel R. Zullinger
14 North Main Street, Suite 200
Chambersburg, PA 17201
RE: Estate of Russell H. Allen
Account # ending in 4916
July 6, 2011
I am writing in response to your request for date of death values on the above referenced member.
These accounts are individually owned by Russell Allen.
Account Date of Death Accrued Interest to Interest Maturity Date
XXXXXX4916 Princi al DOD Rate
Prime Share (00) $98.14 $0.00 0.15%
O ened 01/06/95
5 Year IRA CD (40) $38,691.80 $28.77 3.016% 04/16/2015
O ened 04/21/95
If you have any questions with regard to the above balances, or need additional information, please
feel free to contact me at 263-4444, extension 4203.
Sincerely,
~,~ 9
Tracy L. Burk
Support Analyst II
A Tradition of Excellence
July 21, 2011
Joel R. Zullinger
Law Of&ces of Zullinger-Davis
14 North Main Street, Suite 200
Chambersburg, PA 17201
Fax: 264-1884
Re: Estate of Russell H. Allen
Social Security Number 180-26-5154
Date of Death 1110/11
IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD THE
FOLLOWING ACCOUNT WITH ORRSTOWN BANK:
CHECKINGACCOUNT
Account No: 300187
Account Type- 50+ Interest Checking
Data Opened- 6/1/73
Joint Account (name/date)- 'Stanley R. Allen, 10/5/OS
Balance- 55,262.54
Accrued Interest- $0.01
Best RegardsJ, , I ~,
l~ ~l~t~ ~
Jill R. Worthington
Deposit Processing Clerk
2695 Philadelphia Avenue
Chambersburg, PA 17201
1.t388.ORR5TOWN
Received Time Ju1.21. 11:11AM
wwvararrstown.com