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HomeMy WebLinkAbout08-17-11 (2)1505610143 REV-1500 Ex(°'-'°' OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code Year File Number Bureau of Individual Taxes oEFARTMENr of REVENUE PO 80X.280601 INHERITANCE TAX RETURN 21 11 0225 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 198 30 0945 O1 22 2011 Ol 15 1918 Decedent's Last Name Suffix Decedent's First Name MI DOODLING HELEN M (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 O F WILLS FILL IN APPROPRIATE OVALS BELOW a 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death prior to 12-13-82) ^ 4. Limited Estate ^ 4a, Future Interest Compromise (date of death after 12-12-82) ^ 5. Federal Estate Tax Return Required g Decedent Died Testate (Attach Copy of Will) ^ ~ Decedent Maintained a Living Trust (Attach Copy of Trust) ~ -- 8. Total Number of Safe De posit BOxeS ^ 9. Litigation Proceeds Received ^ 1 °, Spousal PovertyY Credit jdate of death between 12-31 ~J1 and 1-1-95) ^ 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 JAMES D HUGHES ESQ 717 249 6333 ., First line of address 354 ALEXANDER SPRING RO Second line of address City or Post Office State ZIP Code CARLISLE pA REGISTER OF~I~S USE Q,M~Y ;_' ~:~ ~ ~ - ~;~ ~ - ,~ .. DATEED `- ;-<-; r~ ' ~-.: >-,, -~ ~( ' s~ j 7 >;, Correspondent's a-mail address: jhughes@salzmannhughes.com Under penalties of perjury, I declare that 1 have examined this return, including accompanying schedules and statements, and to the best of my knowled~~ppe 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 kno~iledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILI TURN DATE _ ~~l/1V'W W ~~t~r-~~~~ _ Dean W. Pannebaker ~-/ti ~ j/ ADDRESS 167 rnest R L disbur PA 17040 SIGN URE OF PRE R OTH R THAN REPRESENTATIVE DATE _ James D. Hughes Esq. (J ~~ /! Alexander Spring Road, Suite 1, Carlisle. PA Side 1 L 1505610143 1505610143 J PA Inheritance Tax F~eturn Signature of Additional Fiduciaries ESTATE OF FILE NUMBER Goodling, Helen M. 21-11-0225 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 complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. _ Signature #2 Name Address1 Address2 City, State, Zip Date Kenneth E. Pannebaker 1886 Douglas Dr. Carlisle, PA 17013 `'~ - ~v Jl J b505610243 REV-1500 EX Decedent's Social Security Number DecedenYsName: Goodling, Helen M. 198 30 0945 RECAPITULATION 1. Real Estate (Schedule A) ....................................................................................... 'I . 2. Stocks and Bonds (Schedule B) ............................................................................. :?. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3. 4. Mortgages & Notes Receivable (Schedule D) ........................................................ 4. 5• Cash, Bank Deposits 8~ Miscellaneous Personal Property (Schedule E) ............... Ei. 2 0 , 2 2 9.18 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ E-. 7. Inter-Vivos Transfers & Miscellaneous I~oq Probate Property (Schedule G) ^ Se t Billi R para e ng equested............ 7• 64,695.64. 8. Total Gross Assets (total Lines 1-7) ...:................................................................. ~~. 84 , 924.82 9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9~. 3 , 730.28 10. Debts of Decedent, Mortgage Liabilities, 8~ Liens (Schedule I) .............................. 10. 3 6 0 . 7 7 11. Total Deductions (total Lines 9 & 10) ................................................................... 11. 4 , 0 91.0 5 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 8 0 , 833.7 7 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. 8 O , 8 3 3. 7 7 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 15. 0 . O O 16. Amount of Line 14 taxable $O 833.77 at lineal rate X .045 r 16. 3 , 637.52 17. Amount of Line 14 taxable at sibling rate X .12 O. O O 17. O. O O 18. Amount of Line 14 taxable at collateral rate X .15 O. O O 18. O. O O 19. Tax Due .................................................................................................................. 19. 3 , 637.52 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMEN1r. ^ Side 2 1505610243 1505610243 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-11-0225 DECEDENT'S NAME Goodling, Helen M. STREET ADDRESS - 1000 West South St. CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest 3,200.00 168.42 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. 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. (1) Total Credits (A + B) (2) (3) (4) (5) 3,637.52 3,368.42 269.10 Make Check Pa able to: REGISTER OF WILLS, 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 :............................................................................... ^ b. retain the right to designate who shall use the property transferred or its inc:ome :.................................. ^ c. retain a reversionary interest; or ............................................................................................................... ^ 0 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 securii:y 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? .................................................................................................................. ~ ^ 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 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 1;? 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) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Goodling, Helen M. 21-11-0225 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. (It more space is needed, additional 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+ (6-981 SCHEDULE G INTER-VIVOS TRANSFERS ~& MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF [~nnrllinn Halan M FILE NUMBER AI I I AAA 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. ITEM NUMBER DESCRIPTION OF PROPERTY THE DATE OF TROANSFER.SATTACN ACOPY OF TIRE DEIED FOOREREAL ESTATE. DATE OF DEA"fH VALUE OF ASSET °~ OF DECD'S INTEREST EXCLUSION (iF APPLICABLE) TAXABLE VALUE 1 Allstate Life Insurance Company -Annuity Contract 64,695.64 100.000% 64,695.64 No. GA0752163; Dean W. Pannebaker, son, and Kenneth E. Pannebaker, son, are the beneficiaries TOTAL (Also enter on Line 7, Recapitulation) I 64,695.64 (If more space is needed, additional 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) COMMNHEgET ~N~E Tic RET~RN ANIA RESIDEN DE EDEN SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Goodling, Helen M. 21-11-0225 ITEM N M R DESCRIPTION AMOUNT A. FUNERAL EXPENSES: See continuation schedule(s) attached 200.00 B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zia Year(sl Commission paid 2. Attorney's Fees Salzmann Hughes, P.C. 2,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach exK>lanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 111.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 100.00 7. Other Administrative Costs 818.78 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 3,730.28 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule R (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Goodling, Helen M. 21-11-0225 ITEM NUMBER DESCRIPTION AMOUNT Funeral Ex enses 1 Messiah Lutheran Church Women -funeral services 125.00 2 Tina Funk -funeral services 75.00 H-A 200.00 Other Administrative Costs 3 Register of Wills -filing fees 30.00 4 Salzmann Hughes, P.C. - reimbusement for payment to Cumberland Law Journal for legal 75.00 advertising 5 Salzmann Hughes, P.C. -reimbursement for three short certificates 12.00 6 Salzmann Hughes, P.C. -reservation held for miscellaneous contingencies closing costs 500.00 held for income tax preparation, postage and miscellaneous contingencies 7 The Sentinel -Legal advertising 201.78 H-B7 818.78 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX+ (12-08) SCHEDULE 1 DE BTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Goodling, Helen M. FILE NUMBER 21-11-0225 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE ©F DEATH 1 Millennium Pharmacy Systems, Inc. -prescription drugs 77.50 2 Robin K. Sollenberger, Tax Collector - 2011 Per Capita Tax 9.80 3 Spring Road Family Practice, Inc. -medical service on 1/7/11 and 1/14/11 balance due, 112.40 applied toward Medicare deductible 4 West Shore EMS-BLS -service on 1/12/2011 not covered by Medicare 161.07 TOTAL (Also enter on Line 10, Recapitulation) I 360.77 (If more space is needed, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08) REV-1513 EX+ (11-OS) p E COM INHRESIDE ~EDECEDENTRN ANIA SCHEDULE J BENEFICIARIES ESTATE OF Goodlina. Helen M_ FILE NUMBER ~fA A A A~fAc NUMBER NAME AND ADDRESS OF PERSON(Sl RECEIVING PROPERTY RELATIONSHIP TO DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE (Words) ($$$) I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 a 1.2 1 Dean W. Pannebaker Son 1/2 Sch. G 40,416.89 167 Ernest Road 1/2 Residue Landisburg, PA 17040 2 Kenneth E. Pannebaker Son 1/2 Sch. G 40,416.88 1886 Douglas Dr. 1/2 Residue Carlisle, PA 17013 Total 80,833.77 Enter dollar amounts for distributions shown above on lines 1 5 throu 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) ~:_. .~~.5~' .~~L .~~.N~7 ~'S7:.~~.~1 ~'. i -r d~~ i ri F~ d .!t t ~L~%~t! \ f.J~ ..., 4t i I, HELEN M. GtiGI~LING, of South Middleton Township, Cumberland County, Pennsylvania, being of sound mind, disposing memory and full legal age, do hereby make, publish and declare this instrument to be my Last ~`~~ill and Testament, l~erebv expressly revoking all Wills and Codicils heretofore made by me. ®NE: I dir vct my Executor or ~ xecutrix, as the case; n~~zv be to pay all c,~ rn~T debts, funeral and administrative expenses as soon as may be donE; conveniently after my decease. Furthernic~e, ~` direct' that all state, inheritance, successi.c~n acid other de~dth faxes imposed or payable by reason o~: nay death and all inti-~M~;st and penalties ti~;~eon with respect to ~~11 property cv~rposing of my gross estate for death tax purposes, whether c}I' not such property passes under this Will, <~l~all he paid by the Ex~acutnr or Executrix of t~Z~y ;state. TWO. My f:xec~~tor or Executrix rr~tcy, at his or her discretion, compromise claims, borrow n: >~lej~, retain property ~~z_,r such length of titrfc, as ,e or she may deem °roper; lease anc sell property for suc11 prices, on such terms, at public or priv ; ,~~y sales, as he or she ~n~,y deem ~.-op.:: ; and ir_vest estate ~ =-operty and ineomE.; without restriction t~:, legal investments unless A otherwise ~~rovided hereunder. Y authorize and emp.°;.~~c~r my Executor or ~;xec~~~tr-Bx to sell any realty and/car personalty owned by me at my death a11d not specif cally devised or hequeathed -~erei~-, at public or plvate :°~~le or sales and to ~ ive good and su'-icie~~i deeds and/or bills of sale therefor, il~ fee simple, as I cc;~~ld do if living. My Executor or Execut; x is authorized and empowered to e~,gage in any business in which I may b e engagedi at my death, for such period of ~i~e <<~er my death as seems expedient to s<.rid f?~~ecutor or Execut~ix. ~, y,, TI-IRIEE: I hereby give, devise and bequeath all of my estate of every nature and wherever situate is nay sons, DEAN W. T~~I`~NEBAKER and I~IJNNETH E. PANI'~I~I3AKER, to be divided equally between them, share and share dike, per stirpes, whic~i provides that the child or children of any deceased child shall take the share their parent would Dave taken if living. F~~IR: No person or persons shall benefit hereunder unless such beneficiary shall survive me by at least thirty (30) days. ~I~; I hereby nominate and appoint my sons, I;~EAN ~~~j. PANNEBAI~ER ., ~1d KENN~:~i~H ~_' . PANNEBAKLR, t~ serve as Co-Exect.ai ors of this my Lest Will and Testament. In the event the ~ either of my s~~;~~, DEAN W. P~z'~;~:t~EBAKER or ILL_1'~I~~TH E. P~~NNEBAKER, f~~ii to qualify or cease to act as Co-Executor for whatever reason, I then appoint Tl~e survivor of them as Executor of this my ~Jast ~~1ill and Testament. SIX: No Ex~.cu~ur or Executrix ~LctiFlg hereunder sha11 Lie required to post bond or enter security ~~ this or any other ju~~isdicti~n. IN WI'I'1VE~S ~-~ ~ HEREOF, I have he eunto set my lla~~d acrd seal this 8th ~f~y of June, 1995. /,~~ _ r"'.~~ (SEAL) ~'~~ 1_ .f ?~ III:LI:N lam. GGGDLIiNG~ z Signed, sealed, published and declared by ~-IELEIV M. GOODLING, the above named Testatrix as and ~~r leer Last Will and Testament, in the presence of us, who, at her request and in her presence and in the presence of each other 1~~ ale subscribed our nr~r~k} ,; as witnesses herein. ~~~ ; f ~~~ , ~ .~ 3 A C`1111®Y~L~D+~1Yl.~NT AND A ~'F.~I)A ~T V6~E, I~ELEN 1V1. G®®-1DLING, CI-BERYL L. CLELANI) and TERESA M. HENRY, the testatrix and witnesses respectively, whose r~,~.mes are signed to the foregoing ins-~rument, being first ~~uly sworn, do heresy declare to tl,~e u~~,1ersigned authority ti2at the testatrix signed and executed the instrument as her Last V6jill and that she had signed willingly, and that she executed it as her free and voluntary act for the pc~rpc;se herein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed tl~e Vr~ill as a witness ~.nd that to the best of their knowledge the testatrix was, at that time, eighteen years of age or older, of sound mind ar d under no constraint :~r undue influence. ~~~ . -~.~ • -- ~! -LEN 1l~Y. GQC~.~~~..G ,~, ~ ~~ ~,~~ { `~'~~; MESA 1VI. HEIR ~~`~' C~'<?~=~1'O~~JNVt~EALTi3 ~~~~E ~ENNS~'LVAN~ F~ SS: CG~JI~ITY G~ CITI~~BERLAND Subscr~ ~ red, s r~~orn to and ackr~o~~~ ~ edged before m~; ley ~ ~ lze, testatrix herein a~ t ~ subscribed and sworn to before me b ~IELEN l~'I. GOGDLII~G, C~~~,~.YL L. CLELAI~T~ and TE ~_5 ~~- Imo. I~[ENRY, t ~~is~~-~ day of June, ~9> . _1,~.~...~.. ~~T~3ta.ryAl~ublic ` ~.wi:'i ~~. ~:trC7{''~.Sl)Il, ~?'::I}~ ~.?t7;H~ "~w (.Gii'filiSS10f1 ~'XCUI-E: i ,.,. ~ j`;~+~ - - _ . - -- - -~. _...-.__..d (J)t~ ~±;_ .;(, ['c;Ylfi:=>~V~2f llc3~~`J':xiC~1(lrJi i :? i~i_~(if.'J Q M&TBank 499 Mitchell Road, Millsboro, DE 19966 Adjustment Services Phone 888-502-4349 F ax (302) 934-2955 March 3, 2011 Salzmann Hughes PC 354 Alexander Spring Road Suite 1 Carlisle, PA 17015 Re: Estate of Helen Goodling Social Security: 198-30-0945 Date of Death: January 22, 2011 Dear Sir or Madam: Per your inquiry on February 24 2011, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. T}pe of Account Accoccnt Number Ownership (Names o~ Opening Date Balance on Date of Death Accrued Interest Total Checking Account 870684 Helen Goodling Kenneth Pannebaker (POA) 08/04/88 $14, 91 S. 74 $ .04 $14, 91 S. 78 For further account information, closures and/or reimbursement of funds please call the High Street Carlisle Office at #717-240.4536. 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, Custodian of Uniform Transfers, Representative Payee, or Trustee under a Written Agreement Sincerely, Tammy Spencer Adjustment Services Allstate Life Insurance Company P.O. Box 94212 Palatine, IL 60094-4212 Telephone: (877) 499-6418 Facsimile: (866) 635-4523 March 15, 2011 Mr. James D. Hughes, Esquire Slazmann Hughes, P.C. Attorney s at Law 354 Alexander Spring Rd. Suite # 1 Carlisle, PA 17015 Via Facsimile #1- 717-249-7334 Re: Helen M. Goodling Contract No: GA0752163 Dear Mr. Hughes: ~~ ~ ~ ~ 'k. You're in good hands. We received a request to complete IRS Form 712 for the above referenced contract. The purpose of Form 712 is to provide an estate or donor with the value of a life insurance contract or its proceeds as of a certain date (usually the owner's date of death or date of transfer of the contract). Because this contract is an annuity, it is not reportable on IRS Forms 712. I can, however, provide the following information for estate purposes: Date of Death: Annuity Value as of Date of Death: Cost Basis: Named Beneficiary: January 22, 2011 $ 64,695.64* $ 64,669.45 Dean W . Pannebaker & Kenneth E. Pannebaker *The actual amount paid may differ due to Market Value Adjustments and/or any applicable Surrender Charges. Please also note that the death claim for the above referenced contract was already processed and the beneficiaries paid If you have any questions, please contact me at 1-877-499-6418 Ext. 24522. Sincerely, Lin Breckler Sr. Claim Examiner