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Home My WebLink About09-19-11EX (01-10) J REV-1500 1505610143 ~} OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code Year File Number Bureau of Individual Taxes UEPFRTMENT OF REVENUE PO 60X.280601 INHERITANCE TAX RETURN 2 1 1 0 12 5 7 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 053 20 2086 12 17 2010 12 19 1925 Decedent's Last Name Suffix Decedent's First Name MI POWELL, DAVID R. (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW ® 1. Original Return ^ 4. Limited Estate ® 8 Decedent Died Testate (Attach Copy of Will) ^ 9. Litigation Proceeds Received Suffix Spouse's First Name THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS ^ 2. Supplemental Return ^ qa Future Interest Compromise (date of death after 12-12-82) ^ ~ Decedent Maintained a Living Trust (Attach Copy of Trust) ^ 10. Spousal Poverty Credit (date of death between ~2-31-91 and 1-t-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. Election to tax under Sec. 9113(A) (Attach Sch. O) MI CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number GEORGE J MORGAN ESQ 717 299 5251 REGISTER OF WILLS USE ONLY First line of address 700 NORTH DUKE STREET -~ Second line of address -=` -` ' - ~ ~ `~ PO BOX 4 6 8 6 ~ ~~'~~ DAB FIL~ -- City or Post Office State ZIP Code - LANCASTER PA 176044686 -,•`,.;~ --_, _. . ;, __; s .. , Correspondent's a-mail address: ~•"- ,--. 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 OF PERSON RESPONSIBLE F R FILING RET TE ~ Raymond Jeffrey Powell ~/AI~J ADDRES 305 North Barbara Street, Mount Joy, PA 17552 SIGNATURE O PREPARER TH R THAN REPRESENTATIVE ATE ^~'~"I~T~ •~~~~" George J Morgan Esq l ~l d/ ~, ADDRESS ~/ V V 700 North Duke Street, Lancaster, PA 176044686 Side 1 1505610143 1505610143 REV-1500 EX oeoeee~YS Name: P O W E L L, DAVID R., Decedent's Social Security Number 053 20 2086 RECAPITULATION 35,000.00 1. Real Estate (Schedule A) ........................................................................................ .. 1. 138.42 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. 35,093.91 5~ Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... . 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............ . 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 9 , 8 3 2 9 1 (Schedule G) ^ Separate Billing Requested ............ . 7. 80,065.24 g. Total Gross Assets (total Lines 1-7) ...................................................................... . 8. 16,982.83 9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... .. 9. 8,186.81 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. .. 10. 25,169.64 11. Total Deductions (total Lines 9 & 10) .................................................................... .. 11. 54,895.60 12 Net Value of Estate (Line 8 minus Line 11) .......................................................... ... 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 5 , 0 0 0 0 0 an election to tax has not been made (Schedule J) ............................................... .. 13. 49,895.60 14. Net Value Subject to Tax (Line 12 minus Line 13) ............................................... .. 14. 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 4 9, 8 9 5. 6 0 16 2, 2 4 5 3 0 at lineal rate X .045 . 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. 2. 2 4 5 3 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 - 10 - 1257 N' Powell, David R., STREET ADDRESS 432 Herman Avenue CITY Lemoyne STATE PA 21P 17043 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments B. Discount (1) 2,245.30 Total Credits IA + B) (2) 0.00 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) 0.00 (4) (5> 2,245.30 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 :.................................................................................. C ~] b. retain the right to designate who shall use the property transferred or its income :.................................... Cj G~' 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?......... ~ ~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. ~. ',s-.' - 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 ears 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) (y.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. 59116 (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, whether by blood or adoption. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE FILE NUMBER ESTATE OF Powell, David R., 21 - 10 - 1257 All real property owned sole)y 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 1 Residence: 432 Herman Avenue, Lemoyne, PA DEATH 35,000.00 TOTAL (Also enter on Line 1, Recapitulation) ~ 35,000.00 SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Powell, David R., FILE NUMBER 21-10-1257 All property jointly-owned with right of survivorship must be disclosed on Schedule F. fEOF .42 TOTAL (Also enter on line 2, Recapitulation) 138.42 SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF Powell, David R., 121 - 10 - 1257 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 VALUE AT DATE OF NUMBER DESCRIPTION DEATH 1 Fulton Bank Savings No. 1125-80698 4,646.20 2 accrued interest 0.49 3 Fulton Bank CD No. 012-0202733 6,030.07 4 accrued interest 0.45 5 PSECU Savings No. S01 14,263.01 6 accrued dividend 2.50 7 PSECU Checking No. S04 8 accrued dividend 9 Household contents 10 1989 Toyota Camry 11 $1,000 money order 12 West Shores Meals On Wheels refund 13 Retirement Check (refund) 14 3643.13 sh Federated Liberty U.S. Govt MM @ 1.00 3,585.41 0.16 825.00 750.00 1.000.00 2.4.00 32.3.49 3,643.13 TOTAL (Also enter on Line 5, Recapitulation) ~ 35,093.91 SCHEDULE G COMMONWEALTH OF PENNSYLVANIA INTER-VIVOS TRANSFERS & INHERITANCE TAX RETURN RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY ESTATE OF Powell, David R., FILE NUMBER 21-10-1257 19 72 TOTAL (Also enter on line 7, Recapitulation) 9,832.91 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. SChEDULE H - FUNEFtAI. EXPENSES & COMMONWEALTH OF PENNSYLVANIA A ~w T INHERITANCE TAX RETURN F1~N~ I rV 1„ 1 ~ ~~ RESIDENT DECEDENT ESTATE OF Powell, David R., Debts of decedent must be reported on Schedule I. ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION FILE NUMBER 21 - 10 - 1257 AMOUNT A. 1 Musselman Funeral Home 2 Lakeview Cemetary ;open/close grave B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Raymond Jeffrey Powell Street Address 305 North Barbara Street 2. 3. City Mount Joy State PA Zip 17552 Year(s) Commission paid 2011 Attorney's Fees Morgan, Hallgren, Crosswell & Kane, P.C. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant 4 5 6 7 1 Street Address I, City State Zip Relationship of Claimant to Decedent Probate Fees Jeffrey Powell; reimbursed probate fee Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs Keystone Oil; heating oil TOTAL (Also enter on line 9, Recapitulation) 1, 555.00 655.00 4,450.00 7,200.00 153.50 542.57 16,982.83 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Schedule H Funeral E~ertlses & Adrrinishative Costs continued FILE NUMBER ESTATE OF Powell, David R., 21-10-1257 2 PAWC ' 20.58 3 Borough of Lemoyne; sewer/trash ~ 167.01 4 ; Keystone Oil; heating oil 774.94 5 Checkbook fee ~ 12.00 6 Erie Insurance; fire insurance premium 302.00 7 PPL 57.00 8 PAWC 58.94 9 Morgan, Hallgren, Crosswell & Kane, P.C.; reimburesed copy of deed 8.50 10 Morgan, Hallgren, Crosswell & Kane, P.C.; reimburesed Cumberland Law Journal; 75.00 estate advertising 11 Morgan, Hallgren, Crosswell & Kane, P.C.; reimburesed The Sentinel; 176.92 estate advertising ', 12 Penn Waste; trash removal ' 45.00 13 Erie Insurance Co.; balance of house insurance ', 57.00 14 Penn Waste; trash removal 45.00 15 Jeffrey Powell; reimbursed for title transfer ', 58.50 16 ~~~ PPL 25.68 17 ' PAWC; water/sewer 59.00 18 ~~ I PPL 28.20 19 PAWC; water/sewer ', 59.81 Page 2 of Schedule H Schedule H ' Funeral E~ei~ses & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT /~~~~ /~~~,,~,~ /~,p ~ ^ lrlA1.7 ~nU~ __ _ FILE NUMBER ESTATE OF Powell, David R., 21 -10-1257 20 Penn Waste; trash removal ' 45.00 21 PPL 19.20 22 I PAWC; water/sewer 59.00 23 PPL ' 13.44 24 PAWC; water/sewer 59.04 25 Morgan, Hallgren, Crosswell & K ane, P.C.; reserve for final costs ', 200.00 Page 3 of Schedule H SCHEDULEI DEBTS OF DECEDENT, MORTGAGE COMMONWEALTH OF PENNSYLVANIA LIABILITIES, & LIENS INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF Powell, David R., 21 - 10 - 1257 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses ITEM NUMBER DESCRIPTION AMOUNT 1 PPL _--- 42.24 2 PAWC 22.03 3 Faith Nicola; 2010 real estate tax (school) 417.07 4 Comcast Cable 162.25 5 Cumberland County Office of Aging 32.24 6 PA Retna Specialists 8.78 7 Internists of Central PA 26.66 8 Pinnacle Health Emergency 47.56 9 Cumberland County Office of Aging 39.76 10 West Shore EMS; paramedic/ambulance 1,103.46 11 Holy Spirit Hospital 56.98 12 Camp Hill Fire Co. 70.78 13 Statewide Tax Recovery; delinquent per capita tax 41.50 14 Manor Care; final bill 6,115.50 TOTAL (Also enter on Line 10, Recapitulation) ~ 8,186.81 REV•1513 EX+(11.08) SCHEDULE) COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Powell, David R., NUMBER I NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I~ ,,TAXABLE DISTRIBUTIONS (include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 Jill Ann Powell 66 Pickford Avenue '~ Buffalo, NY 14223 2 ~ Lisa M. Sundquist 237 Northwood Drive Buffalo, NY 14223 3 Lisa M. Sundquist 237 Northwood Drive Buffalo, NY 14223 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Daughter Stepchild Stepchild Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet, as appropriate. II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1 N/A B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 The Nature Conservancy TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET FILE NUMBER ~ 21 - 10 - 1257 _ SHARE OF ESTATE AMOUNT OF E:~TATE (Words) ($$$) 30,047.02 10.C115.67 9,832.91 5,000.00 5,000.00