HomeMy WebLinkAbout08-08-1115056051058
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 11 0273
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
__
209-12-9670 02/09/2011 07/29/1926
Decedent's Last Name Suffix Decedent's First Name MI
Eppley Doris J
_ _
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
_ _. _ .
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
;~ 1. Original Return
_;;: 4. Limited Estate
°~': 6. Decedent Died Testate
(Attach Copy of Will)
;~_. 9. Litigation Proceeds Received
_ _ .
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
~:'~_ 2. Supplemental Return
~;:,... 4a. Future Interest Compromise (date of
death after 12-12-82)
;~_M 7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
_~~ 10. Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95)
__.. 3. Remainder Return (date of death
prior to 12-13-82)
_;°-. 5. Federal Estate Tax Return Required
_ 0 _ 8. Total Number of Safe Deposit Boxes
..-. 11. El~action 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
__ _ _
David A. Baric, Esquire (717) 249-68~~ ---
Firm Name (If Applicable) ~. ~
i_______ __ _.--- ~~~~ _ _.-_- - .-._ -- ~
REGISTER ' ~S~USE 0491! , -~
~~
..
Baric Scherer
~;* :~ ~ C~
~
- s
~'
;n~
First line of address «'• ,`~-~ ~, ~ ,~'
19 West South Street
~ ,~~ ~ ~ -~^w
~°-~; ~~
_ --
~~ ~ ~ . _
Second line of address ~ ~ ti.t~
C:` ,
DATE FILED
City or Post Office State ZIP Code ~----------- -_..___ _._____ __.._ ._. _..__.__._.
Carlisle PA 17013
Correspondent's a-mail address: dbarlC@t)arICSCherer.COt71
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, anti to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
TUR F PER ON ESPONSIBLE FO ~ ILING~ URN ~ D~~ /I
• [~J /J t
D S5
09 York Road, Carlisle, Pennsylvania 015
SIGNATURE O R RER~OTHE N~PRES TIVE DA /~
ADDRESS ''~ /~ • • • ~~ ~/` !' V (~/~~ ~ ~
19 West outh Street, Carlisle, Pennsylva la 7013
PLEASE USE ORIGINAL FORM ONLY
Side 1
15056051058
15056051058
J
_-GV,u~
J 15056052059
REV-1500 EX
Decedent's Social Security Number
___ Decedent's Name: DOris J Eppley
______..._._..._._.___._v_.____ 209-12-9670
RE .__._~_..._.~..~_..~...___.._.._.._~,_._.____..___._..__.___._.~._.___._
CAPITULATION ...____ _...-----.-___ .....~_~..~..__~..~_______ ___._.__ .--.-..___~.._.____..
1. Real estate (Schedule A) . ....................................... ..... 1. 179,000.00
2. Stocks and Bonds (Schedule B) .................................. ..... 2. 149,092.50
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3.
4. Mortgages & Notes Receivable (Schedule D) ........................ ..... 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ... ..... 5. 320,834.40
6. Jointly Owned Property (Schedule F) _:f Separate Billing Requested .. ..... 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) `:~;:'~ Separate Billing Requested... ..... 7.
8. Total Gross Assets (total Lines 1-7) ............................... ..... 8. 648,926.90
9. Funeral Expenses & Administrative Costs (Schedule H) ................ ..... 9. 27,553.50
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ........... ..... 10.
11. Total Deductions (total Lines 9 & 10) .. . ........................... ..... 11. 27,553.50
12. Net Value of Estate (Line 8 minus Line 11) ......................... ..... 12. 621,373.40
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. 621,373.40
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 .0_ 15.
16. Amount of Line 14 taxable
at -ineal rate x .0 45 621,373.40 16. 27,961.80
17. Amount of Line 14 taxable
at sibling rate X .12 17,
18. Amount of Line 14 taxable
at collateral rate X .15 18.
19. TAX DUE ..................................................... .... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
15056052059 Side 2
]15056052059
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 11 0273
DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER
Doris J Eppley 209-12-9670
STREET ADDRESS
610 Somerset Drive
CITY
Mechanicsburg STATE
PA ZIP
17055
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19) (1) 27,961.80
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments 25,920.00
C. Discount 1,296.00
Total Credits (A + B + C) (2) 27,216.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E) (3) 0.00
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. (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 745.80
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 745.80
Make Check Payable fo: REGISTER OF W/LLS, AGENT
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 :.......................................................................................... ^ 0
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 "in trust for" or payable upon death bank account or security at his or her death? .............. ^ 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ ^ ^x
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G A.ND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is three (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 zero (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 twenty-one 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 zero (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 four and one-half (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 twelve (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.
REV-1502 EX+ (6-98)
SCHEDULE A
COMMONWEALTH OF PENNSYLVANIA REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Doris J. Eppley 2'1-11-0273
Afl real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F.
(If more space is needed, insert additional sheets of the same size)
Prev;ous editions are obsolete
A Settlement Statement
R TVr1P of I nan
form HUD-1 (31861 ref Hantlbook 4305.2
U.S. Department of Housing and Urban Development
none n...........i ~~.. ~cm n~ec
1 FHA 2 ~FmHA 3 ~Conv. Unins.
4. VVA 5. pConv.lns. 6. File Number
20111EPPLEY 7. Loan Number 8. Ivlorigage Insurance Case Number
~ ~s orm is umis e o give you a s a emen o ac ua se amen cos s. moun s pai o an y e se emen agen are s own.
i C Note: Items marked "(p.o.c.)" were paid outside the closing; they are shown here for information purposes and are not inclutletl in the totals TItIeEXpreSS Settlement System i
WARNING: It is a came to knowingly make false statements to the United Slates on this or any other similar form. Penalties upon ~
conviction can include a fine and im risonment. For details see: Title 1 i3 U. S. Cotle Section 1001 and Section 1010.
D NAME OF BORROWER: John A. Eppley and Debra A. Eppley
ADDRESS:
_
E NAME OF SELLER: Estate of Doris J. Eppley
ADDRESS:
F. NAME OF LENDER:
ADDRESS:
G PROPERTY ADDRESS: 610 Somserset Drive, Mechanicsburg, PA 17055
Mechanicsbur Borou h
H SETTLEMENT AGENT: Baric Scherer, Telephone: 717-249-6873 Fax: 717-249-5755
PLACE OF SETTLEMENT: 19 West South Street Carlisle PA 17013
I. SETTLEMENT DATE: 0612912011
J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION:
100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER
101. Contract sales rice 179 000.00 401. Contract sales rice 179 00
102. Personal Pro ert 402. Personal Pro ert
103. Settlement char es to borrower line 1400 1 211.38 403.
104. 404.
105. 405.
Ad~ustments for items aid b seller in advance Ad'ustments for items aid b seller in advance
106. Cit (town taxes 406. Cit /town taxes
107. Count taxes 06129111 to 12!31111 470.19 407. Count taxes 06129111 to 12131111 470.19
108. School Tax 06!29111 to 06130111 11.11 408. School Tax 06129111 to 06130111 11.11
109. 409
11~ 0 .
410. ,
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 180 692.68 420. GROSS AMOUNT DUE TO SELLER 179 481.30
200. AMOUNTS PAID BY OR ON BEHALF OF BOR ROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER
201. De osit or earnest mone 501. Excess De osit see instructions
202. Princi al amount of new loans 502. Settlement char es to seller line 1400
203. Existin loans taken sub ect to 503. Existin loan s taken sub'ect to
204. 504. Pa off of First Mort a e Loan
205. 505.
206. 506.
207. Credit a ainst Est. interest 179 000.00 507. Credit a ainst Est. interest 179 000.00
208. 508.
209. 509.
Ad'ustments for items un aid b seller Ad'ustments for items un aid b seller
~ 210. Cit (town taxes 510. Cit (town taxes
211. Count taxes 511. Count taxes
' 212
School Tax 512. School Tax
~
211 3. 513.
~ 214. 514.
215. 515.
~ 216. 516.
217. 517.
~ 218. 518.
219. 519.
220. TOTAL PAID BYIFOR BORROWER 179 000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 179 000.00
300. CASH AT SETTLEMENT FROM OR TO BORR OWER 600. CASH AT SETTLEMENT TO OR FROM SELLE R
301. Gross amount due from borrower line 120 180 692.68 601. Gross amount due to seller line 420 179 481.30
302. Less amounts aid b !for borrower line 220 179 000.00 602. Less reduction amount due seller line ;i20 179 000.00
303. CASH FROM BORROWER 1 692.68 603. CASH TO SELLER ' 481.30
previous earcions are oosoiete
form HI;U-t (3/86; ref Handbook 4305.2
U.S.~EPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number: 20111EPPLEY PAGE 2
SETTLEMENT STATEMENT __ rnPFYr,I-p~~ .co,,,oman, ~„for.,
L. 5t I I LtMENT GIIARGES PAID FROM PAID FROM
700. TOTAL SALESlBROKER'S COMMISSION based on rice $179 000.00 = BORROWER'S SELLER'S
Division of commission line 700 as follows: FUNDS AT FUNDS AT
701. $ to SETTLEMENT SETTLEMENT
702. $ to I
703. Commission aid at Settlement
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
I 801. Loan Ori ination Fee
802. Loan Discount
803 A raisal Fee
804. Credit Re ort
805. Lender's Ins ection Fee
806. Mort a e A lication Fee
I 807. Assum lion Fee
808.
809.
810.
811,
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From to $ /da
902. Mort a e Insurance Premium for to
903. Hazard Insurance Premium for to
904.
905.
1000. RESERVES DEPOSITED WITH LENDER FOR
1001. Hazard Insurance mo. $ !mo
1002. Mort a e Insurance mo. $ Imo
1003. Cit Pro ert Tax mo. $ /mo
1004. Count Pro ert Tax mo. $ Imo
1005. School Tax mo. $ !mo
1009. A re ate Anal sis Ad ustment 0.00 0.00
1100. TITLE CHARGES
1101. Settlement or closin fee
~ 1102. Abstract or title search
1103. Title examination
' 1104. Title insurance binder
1105. Document Pre aration
i 1106. Nola Fees to Cash 10.00
1107, Attorne 's fees to Baric Scherer 1 128.38
includes above items No Attorne Certification
I 1108. Title Insurance
includes above items No.
1109. Lender's Covera e $
1110. Owner's Covera e $ 179 000.00
1111.
' 1112.
i 1113.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recordin Fees Deed $ 63.00 Mort a e $ Release $ 63.00
I 1202. Cit !Count tax/slams Deed $ ~ Mort a e $
~ 1203. State Tax/stam s Deed $ Mort a e $
1204.
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301, Tax Certification to Bar L. Heckard Tax Collector 10.00
1302. Pest Ins ection
1400. TOTAL SETTLEMENT CHARGES enter on lines 103 Section J and 502 Section K 1 211.38
IyUU GER7IFIGATION OF BUYER AND SELLER
i have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowletlge and belief, it is a true antl accurate statement of al! receipts and disbursements made on my account
or by me ~n t tra/nsw~action. I further certify that I have received a copy of the HUD-1 Settlement Statement.
v"
o pp ey
e ra ~. pp ey
-~fE taw
s e ons ppey
WARNING IT IS A CRIME TC KNOWINGLY MAKE FALSE STATEMENTS TO THE The HUD-1 Settlement St a which i Aa prepay tl is ue nd ccurate account of this
UNITED STATES ON THIS OR ANY SIMILAR FORM PENALTIES UPON CONVICTION transaction. I have taus w ause Ih funds to e - r• d i cortlance with this statement.
CAN iNCL'UDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18:
U S CODE SECTION 1001 ANO SECTION 1010. r /1~
SETTLEMENT AGE DATE /
REV-1503 EX+ (6-98)
1
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF FILE NUMBER
Doris J. Eppley 21-11-0273
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION VALUE AT DATE
OF DEATH
~ ~ 768 shares; Verizon @ $36.68
28,170.24
2. 184 shares; Fontier Comm. @ $9.42 1,733.28
3. 1,978 shares; AT & T @ $27.97 55,324.66
4. 21 shares; LSI Corp. @ $6.44
135.24
5. 792 shares; PNC Bank @$64.21
50,854.32
6. 37 shares; NCR @ $18.89
698.93
7. 75 shares; Alcatal-Lucent @ $3.56 267.00
8. 200 shares; PPL @ $25.01 5,002.00
9. 217 shares; Comcast @ $23.53
5,106.01
10. 38 shares; MetLife @ $47.39 1,800.82
TOTAL (Also enter on line 2, Recapitulation) $ 149,092.50
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX+ (6-98~
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Doris J. Eppley 21-11-0273
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. checking account, Sovereign Bank 3,994.00
2. money market savings, Sovereign Bank 17,347.00
3. CD # 1685551358; Sovereign Bank 37,276.00
4. CD # 1685552539, Sovereign Bank 10,018.00
5. regular savings, Members First Federal Credit Union 4,618.00
6. life savings, Members First Federal Credit Union 4,000.00
7. CD # 7223-40, Members First Federal Credit Union 5,677.00
8. CD # 7223-42, Members First Federal Credit Union 46,559.00
9. CD # 7223-49, Members First Federal Credit Union 9,920.00
10. CD # 7223-50, Members First Federal Credit Union 4,047.00
11. CD # 7223-51, Members First Federal Credit Union 45,305.00
12. CD # 7223-56, Members First Federal Credit Union 15,337.00
13. CD # 7223-57, Members First Federal Credit Union 5,511.00
14. CD # 7223-58, Members First Federal Credit Union 1,696.00
15. CD # 7223-59, Members First Federal Credit Union 12,655.00
16. CD # 7223-60, Members First Federal Credit Union 30,685.00
17. personalty 3,694.00
18. Chevy Cavalier 4,100.00
19. refund Verizon 209.00
20. refund Patriot News 288.00
21. federal income tax refund 1,102.00
22. Forest Park refund 5,160.00
23. Granulawn refund 273.00
24. CD # 334312-42, Members First Federal Credit Union 51,363.40
TOTAL (Also enter on line 5, Recapitulation) $ 320,834.40
(If more space is needed, insert additional sheets of the same size}
REV-1511 EX+ (12-99)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUME3ER
Doris J. Eppley 21-11-0273
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
~ Musselman Funeral Home 1,882.00
g. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s) None
Social Security Number(s)IEIN Number of Personal Representative(s)
Street Address
City .State
Year(s) Commission Paid:
2. Attorney Fees
3 Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant None
Street Address
City State
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
z. West Shore EMS
s. Guardian LT Care
9. appraisal fee
~ o. United Water
~ ~ . Comcast
*`***************SEE ATTACHED SHEET***********************
Zip
21,440.00
Zip
573.50
250.00
240.00
268.00
350.00
53.00
251.00
TOTAL (Also enter on line 9, Recapitulation) I $ 2 ~ ~ 5 5 3 . 5 0
(If more space is needed, insert additional sheets of the same size)
Estate of Doris J. Eppley
No. 21-11-0273
Schedule H Continued:
12. PP L $457.00
13. lawn care $280.00
14. Verizon $ 26.00
15. Mechanicsburg Borough $118.00
16. Nationwide Insurance $501.00
17. Patriot News (advertising) $ 60.00
18. Cumberland Law Journal (legal adv ertising) $ 75.00
19. Sentinel (legal advertising) $15 5.00
20. auction expenses $112.00
21. personal tax $ 10.00
22. county real estate taxes $452.00
REV-1513 EX+ (g-00)
".~.
SCHEDULE J
COMMONWEALTH OF PENNSYL`JANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Doris J. Eppley 21-11-0273
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
~ TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1 • John Eppley son 1 / 2
2• Donna Barneycastle daughter 1/2
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MAC1E
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $' 0.00
(If more space is needed, insert additional sheets of the same size)