HomeMy WebLinkAbout09-06-11 (2).~ REV-7rJ~~ Ex`°'-'°' ~ 1505610143
OFFICIAL USE ONLY
PA Department of Revenue pennsytvania County Code Year File Number
Bureau of Individual Taxes DEPARTMENT OF REVENUE
Po Box.2sosol INHERITANCE TAX RETURN 21 11 0 0 8 2 6
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
350 18 7836 12 03 2010 08 17 1924
Decedent's Last Name Suffix Decedent's First Name MI
THOMAS CATHERINE A
i;lf 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 tJVITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
® 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death
prior to 12-13-82)
^ 4. Limited Estate ^ qa. Future Interest Compromise ^ 5. Federal Estate fax Return Required
(date of death after 12-12-82)
Decedent Died Testate ~ Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes
® 8. (Attach Copy of Will) ^ (Attach Copy of Trust)
^ 9. Litigation Proceeds Received ^ ~~ between l2-31-91 andt,di IgeS~f death ^ ~ ~. 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 T0:
Name Daytime Telephone Number
DEBRA K WALLET 717 73'~-~ 1300
First line of address
24 NORTH 32ND STREET
Second line of address
City or Post Office State ZIP Code
CAMP HILL PA 17011
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REGISTER O ]V~k_~ USe.Q;rILY
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Correspondent'se-mail address: walletdeb@ao1.COm
Under penalties of perjury, I declare that 1 have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, co t and Fomplete. claration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATU OF ERSO SP NS LE FO RETURN ~-y „~, ,- GATE ~- .
`/L ~L~ry~ZZ~~ David D. Thomas ;~~'
ADDRESS ~
729 Bosier Avenue, Lemoyne, PA 17043
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
l~yln.s,.'k I„)t„»„~y- Debra K Wallet cS~•b,l-: ~.. Zoll
ADDRESS
24 North 32nd Street, Camp Hill, PA 17011
1505610143
Side 1
1505610143
1505610243
REV-1500 EX
Decedent's Social Security Number
oecedenrsName: THOMAS CATHERINE ANNE 350 18 7836
REC APITULATION
132,000.00
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 & Notes Receivable (Schedule D) ......................................................... . 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ................ 5. 2 , 0 4 7 0 0
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested .............
7.
2 1, 8 4 7 1 1
8. Total Gross Assets (total Lines 1-7) ...................................................................... . 8. 1 5 5, 8 9 4. 1 1
9. Funeral Expenses 8~ Administrative Costs (Schedule H) ........................................ . 9. 1 0, 8 4 7 8 8
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................... . 10. 1 , 7 9 2 0 4
11. Total Deductions (total Lines 9 & 10) ..................................................................... . 11. 1 2 , 6 3 9 . 9 2
12- Net Value of Estate (Line 8 minus Line 11) ........................................................... .. 12. 1 4 3 , 2 5 4.19
13. Charitable and Governmental BequestslSec 9113 Trusts for which
an election to tax has not been made (Schedule J) ................................................ . 13.
14. Net Vafue Subject to Tax (Line 12 minus Line 13) ................................................ . 14. 1 4 3 , 2 5 4.19
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.
16. Amount of Line 14 taxable
at lineal rate x .045 14 3, 2 5 4.19
16.
6, 4 4 6. 4 4
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. 6, 4 4 6. 4 4
20. FILL IN THE OPAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
1505610243 1505610243
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21 - 11 - 00826
Thomas, Catherine Anne
STREET ADDRESS
729 Bosler Avenue
CITY .STATE
L Lemoyne ~ PA
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. CreditslPayments
A. Prior Payments
B. Discount
ZIP
17043
(1) 6,446.44
Total Credits (A + B) ~(2)
3. Interest
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.
Make Check Payable to: REGISTER OF WILLS, AGENT.
(3)
(4)
1;5)
0.00
0.00
6,446.44
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 :.................................................................................. x
b. retain the right to designate who shall use the property transferred or its income :.................................... x
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? ................................................................................................................. .... x
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... x
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 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 Januarryy 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) (u)]. The stafute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of
assets and filing a tax refurn 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)1. A
sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, w ether by blood or adoption.
SCHEDQUTLE A
COMMON WEALTH OF PENNSYLVANIA MEAL ES 1 A~E
INHERITANCE TAX RETURN
RESIDENT DECEDENT '~,
I
FILE NUMBEI3
ESTATE OF Thomas, Catherine Anne 21 - 11 - 00826
All 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 wilting 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.
Attach a copy of the settlement sheet if the property has been sold.
Include a copy of the deed showing decedent's interest if owned as tenant in common.
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 729 Bosler Avenue, Lemoyne, PA 17043 (based on county assessed value x common level 132,000.00
ratio)
TOTAL (Also enter on Line 1, Recapitulation) I 132,000.00
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBEIR
ESTATE OF Thomas, Catherine Anne 21 - 11 - 00826
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.
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 Furniture in house 500.00
2 Wedding ring and band 100.00
3 Cash in possession of Decedent 97.00
4 1995 Buick LeSabre (based on Kelley Blue Book value -see attached -fair condition) 1,350.00
TOTAL (Also enter on Line 5, Recapitulation) 2,047.00
COMMONWEALTH OF PENNSYLVANIA ~i INTER-VIVOSD RANSFERS &
INHERITANCE TAX RETURN
RESIDENT DECEDENT i MISC. NON-PROBATE PROPERTY
--
ESTATE OF Thomas, Catherine Anne FILE NUMBER
21 - 1 '1 - 00826
This schedule must be completed and filed if the answer to any of questions 1 through 4 on pagie 2 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH ~ OF EXCLUSION
NUMBER Include the name of the transferee, their relationship to decedent VALUE OF ASSET DECD'S TAXABLE VALUE
and the date of transfer. Attach a copy of the deed for real estate. '. INTEREST OF APPLICAEILE)
1 Metro Bank checking account #833469299 made joint 5,78893 ' 100% 3,000.00 2,788.93
with Michael Thomas on 09/13/10
2 Metro Bank savings account #7760449481 made joint 19,058.18 100% 19,058.18
with Michael Thomas on 09/13/10
TOTAL (Also enter on line 7, Recapitulation) 21,847.11
SCFEDIAE H
FUNERAL EXPENSES &
COMMONWEALTH OF PENNSYLVANIA ~~~~ ~~
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Thomas, Catherine Anne
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION
NUMBER FUNERAL EXPENSES:
A. 1 Musselman Funeral Home, Inc.
2 Slate Hill Cemetery
B. ADMINISTRATIVE COSTS:
~, Personal Representative's Commissions
Name of Personal Representative(s)
FILE NUMBER
21 - 1 11 - 00826
AMOUNT
5,883.72
845.00
Street Address
City State Zip
Year(s) Commission paid
2. ', Attorney's Fees Debra K. Wallet, Esquire
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
5. Accountant's Fees
6. Tax Return Preparer's Fees
7_ Other Administrative Costs
1 Postage, photocopies, mileage, etc.
2,000.00
355.50
30.00
TOTAL (Also enter on line 9, Recapitulation) 10,847.88
Sd1~e H
Funeral F~er~ses &
COMMONWEALTH OF PENNSYLVANIA ~M
INHERITANCE TAX RETURN A~S~Y~~~d
RESIDENT DECEDENT
__ _...
ESTATE OF Thomas, Catherine Anne
2 UGI
3 PP&L
4 PA American Water
5 Verizon
6 Kreamer Brothers Glass, Inc. (screen repair)
7 Progressive -auto insurance
8 Travelers Indemnity & Affiliates (homeowners' insurance)
FILE NUMBER
21 - 11 - 008:26
658.38
56.35
159.28
197.78
22.37
363.00
276.50
Page 2 of Schedule H
SCHEDULEI
DEBTS OF DECEDENT, MORTGAGE
COMMONWEALTH OF PENNSYLVANIA LIABILITIES & LIENS
INHERITANCE TAX RETURN ~ ~~..
RESIDENT DECEDENT
_ _.
FILE NUMBER
ESTATE OF Thomas, Catherine Anne 21 - 11 - OOEI26
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM DESCRIPTION AMOUNT
NUMBER
1 Faith A. Nicola, Tax Collector (personal taxes) 11.00
2 Faith A. Nicola, Tax Collector {property taxes) 524.39
3 Gates, Halbruner, Hatch & Guise (preparation of power of attorney) 150.00
4 PA Department of Transportation (car registration) 28.00
5 Ambulance Service, Inc. 48.00
6 West Shore EMS 168.55
7 MIB Solutions, Inc. 75.00
8 Comcast 8.67
9 Holy Spirit Hospital 9.33
10 Bank of America (credit card) 769.10
TOTAL (Also enter on Line 10, Recapitulation) I 1,792.04
REV-1513 EX+ (11.08)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA ', BENEFICIARIES
INHERITANCE TAX RETURN ~.
RESIDENT DECEDENT
ESTATE OF Thomas, Catherine Anne
RELATIONSHIP TO
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT
RECEIVING PROPERTY Do Not Liat Trustee(s)
I~ TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116 (a) (1.2))
1 Timothy H. Thomas 'Son
P.O. Box 391 '
Lebanon, PA 17042
2 Bruce M. Thomas 'Son
729 Bosler Avenue
Lemoyne, PA 17043
3 David D. Thomas Son
729 Bosler Avenue
Lemoyne, PA 17043
FILE NUMBER
21 - 1 '1 - 00826
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
113 of residuar~r
Estate
1/3 of residuary
' Estate
1/3 of residuary
Estate
i
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet, as appropriate.
III NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
I
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
LAST WILL AND TEBTAMFNT OF CATHERINE ANNE- THOMAS
I, CATHERINE ANNE THOMAS, a resident of 729 Bosler Avenue,
Lemoyne, Cumberland County, Pennsylvania, being of sound mind, memory
and understanding, do make, publish and declare this as and for My Last
Flill and Testament, hereby revoking and making null and void any and all
[4ills and Testaments, or writings, in the nature thereof by me at any
time heretofore made.
ITEM I - I direct my hereinafter named Executor to pay all my
just debts and expenses as soon as may be conveniently done after my death.
ITEM II - I give, devise and bequeath my entire estate, what-
ever the nature of such property may be, whether real, personal or mixed
and wheresoever situate, unto my husband, BP,UCE H. THOMAS.
ITEM III - In the event my husband, should predecease me, then
and in that event, I give, devise and bequeath my entire estate, whatever
the nature of such property may be, whether real, personal or mixed, and
wheresoever situate unto my three (3) sons, TIMOTHY H. THOMAS, BRUCE M.
THOMAS and DAVID D. THOMAS, share and share alike, or to the survivors
of them.
ITEM 'IV - I nominate, constitute and appoint my husband, BRUCE
H. THOMAS, as Executor of this My Last Mill and Testament. In the event
my husband should prededease me, I then nominate, constitute and appoint
my son, DAVID D. THOMAS, as Executor of this My Last Will and Testament.
IN WITNESS [dHEREOF, I have hereunto set my hand and seal to my
fh
above Will, consisting of this One (1) typewritten page, thisf~ day of
February, A. D. One Thousand Nine Hundred. Seventy-nine (1979).
CATHERINE; NE T OMAS
Signed, sealed., published and declared by the above named Testatrix, as
and for her Last Will and Testament, in our presence, who, in her presence,
at her request, and in the presence of each other, have hereunto set our
hands as attesting witnesses.
:~~'r~ -~%~-r ,G ,' 7t?i~` `/ c ~-:~rC~':~U~;(SEAL)
_ ~~
i ~' '
1995 Buick LeSabre Custom Sedan 4D Trade In Values, Reviews -Kelley Blue Book. Page 1 of 3
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