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HomeMy WebLinkAbout09-28-11 (2) 1505610105 REV-1500 Ex(°~- "'t~" PA Department of Revenue OFFICIAL USE ONLY pennsytvania - Bureau of Individual Taxes PO BOX z8o6o1 "`~~'"~" ""'"°' County Code Year Fie Number INHERITANCE TAX RETURN Harrisburg, PA 1'7128-o6ot RESIDENT DECEDENT 2 1 1 1 I~ 5 2 9 ENTER DECEDENT INFORMATION BELOW - Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 135-24-7840 04/19/2011 02!03/1930 Decedent's Lasf Name Suffix Decedent's First Name MI Purcell Barbara A (If Applicable) Enter Surviving Spouse's Infor mation Below Spouse's Lasl 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 IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return !Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust U 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLE TED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Richard L. Placey, Esq. (717) 236-9577 First Line of Address Placey & Wright Second Line of Address 3621 North Front Stre City or Post Office State ZIP Code Harrisburg PA 17110 Correspondent's a-mail address: pWlaW@eplX.net ~z-a i. ~i :~ ~) ~~ ~~c~ Nc~ iamea u. Neilury, i oeciare tnat 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. SIGNrjy~E'bF F~RSON RESPO IBLE FO ING RETURN ,,._~ ~~ Ja yar, Executrix, c/o Place right, 3621 N. Front Street Harrisburg PA 17110-1533 ~ fr~y~/~;~. z SIGNATURE OF PREPAR OTHER THAN R SF~JTATIVE DATE ADDRESS J - Richard L. Placey qui PI ~gh~t; 36 N. Front Street, Harrisburg, PA 171 10-1533 PLEASE USE ORIGINAL FORM ONLY 1505610105 Side 1 1505610105 ~J" J 150561025 REV-1500 EX (FI) Decedent's Social Security Number Decedents Narne: Bal-barn A. PUrCell 135-24-7840 RECAPITULATION 1 . Real Estate (Schedule A) ........... ........... .............. 1. 225,000.00 2 Stocks and Bonds (Schedule B) ........................ ......... . ... 2. 54,529.25 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. .. 3. 0,00 4. Mortgages and Notes Receivable (Schedule D) ................. .... . ... 4. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5. 35,674.31 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. 653.72 7 Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule Gl O Separate Billing Requested..... ... 7. 9$6,311.73 8. Total Gross Assets (total Lines 1 through 7) .......................... ... 8. 1,302,169.01 9. Funeral Expenses and Administrative Costs (Schedule H) ................ ... 9. 102,997.58 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............ ... 10. ~'~,915.71 11. Total Deductions (total Lines 9 and 10) .............................. ... 11. 106,913.29 12. Net Value of Estate (Line 8 minus Line 11) ................. ......... ... 12. 1 ,195,255.72 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which ari election to tax has not been made (Schedule J) ..................... ... 13. 16,000.00 14. Net Value Subject to Tax (Line 12 minus Line 13) ..................... ... 14. 1,179,255.72 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(t2) x .o ~ 0.00 15. 0.00 16. Amount of Line 14 taxable at lineal rate X .0 45 0.00 16. 0.00 17. Amount of Line 14 taxable at sibling rate x .12 1,081,317.21 17 129.758.07 18. Amount of Line 14 taxable at collateral rate X .15 97,938.51 18, 14,690.78 19. tax DuE 19. 144,448.85 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 J REV-1500 EX (FI) Page 3 File Number 21 -1 1 - 0 5 2 9 Decedent's Complete Address: DECEDENT'S NAME -- Barbara Anne Purcell, a/k/a Barbara A. Purcell STREET ADDRESS 527 Country Club Road CITY STATE ZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19j 2 Credits/Payments A. Prior Payments 130,000.00 B. Discount 6,842.10 3. Interest 4 If Line 2 is greater than Llne 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval 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. 136,842.10 (3> 0.00 (4) 0.00 (5) 7,606.75 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIi4TE 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 income ..................................... ....... ^ c. retain a reversionary interest .........................................._.........................................................._........... ...... ^ d. receive the promise for life of either payments, benefits or care? ................................................................ ...... ^ 2. If death occurred after Dec. 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 al 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 QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS FART 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 dales 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 [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)J. The tax race imposed on the nel value of transfers to or for the use of the decedenfs lineal beneficiaries is 4.5 percent, except as nosed in [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers io or for the use of the decedent's siblings is 12 percent [72 P.S. §91161a)i".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, (1) 144,448.85 Total Credits (A + B) (2) Pennsylvania SCHEDULE A DEPAPTMEM OF ftEV ENUE ,NHERiTn,vcr rr~y REniRN REAL ESTATE RESIDENT DECEDENT ESTATE OF FILE NUMBER BARBARA ANNE PURCELL, a/k/a Barbara A. Purcell 21-11-0529 HII real property ownea 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 that 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. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION I Real estate situate in the Borough of Camp Hill, Cumberland County, Pennsylvania, more particularly described in Cumberland County Recorder of Deeds Office to Instrument Number 200734872, known and numbered as 527 Country Club Road, Camp Hill, PA 225,000.00 (Valued at price for which sold. Copy of settlement sheet attached.) TOTAL (Also enter on Line I, Recapitulation,) I ~ 225,000.00 IF more space is needed, insert additional sheets of the same size. REV-1503 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER BARBARA ANNE PURCELL, a/k/a/ Barbara A. Purcell 21-11-0529 All property jointly-owned with right of survivorship must be disclosed on Schedn~a F ~~~ mule space is neeoea, insert aooiuonal sheets of the same size) REV-iso8 EX+ (ii-io it Pennsylvania !. DEPARTMENT OP REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS & MISC. PERSONAL PROPERTY ESTATE OF: FILE PJUMBER: BARBARA ANNE PURCELL, a/k/a Barbara A. Purcell 21-11-0529 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 DESCRIPTION VALUE AT DATE OF DEATH PNC Bank Savings Account 5112904023 (Principal-$30,904.13; Interest-$5.29) 30,909.42 Erie Insurance -refund unused premium personal catastrophe policy 42.00 Erie Insurance -refund unused premium automobile insurance 608.00 2003 Saturn Station Wagon 3,320.00 Erie Insurance -refund unused premium homeowner's policy 45.00 Unum Life Insurance Company -refund unused premium long-term care policy 86.16 Holy Spirit Hospital -refund 28 73 Household Goods: Dining Room Set 50.00 Desk 25.00 Sofa 35.00 Coffee Table and Two End Tables 35.00 Red Wing Chair 40.00 Bookcase and Small Wooden Plant Stand 10.00 Television 50.00 Wicker Furniture (sofa, chair, end table) 35.00 Twin Bed 15.00 Queen Bed 25.00 Oval Floor Mirror 5.00 2 Large Area Rugs and 2 Small Area Rugs 80.00 Marble-Top Small Chest 45.00 Washer and Dryer 100.00 Knick Knacks, Dishes, Utensils, Towels and other Miscellaneous Household Items 75.00 Costume Jewelry 10.00 Miscellaneous Personal Effects TOTAL (Also enter on Line 5, Recapitulation) $ 35,674.31 1. 2. 3. 4. 5. 6. 7. 8. If more space is needed, use additional sheets of paper of the same size. REV-Iso9 EX+ (oI->o) pennsytvania DEPA RTf9 ENT OF FEV ENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF: FILE NUMBER: BARBARA ANNE PURCELL, a/k!a Barbara A. Purcell 22-11-0529 If an asset became jointly owned within one year of the decedent's date of death, it must be reported on >chedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A• Mary F. Dyar 2260 Riverside Drive, Apt. 407 Sister Cincinnati, OH 45202 B Jane C. Dyar 3667 Kendall Avenue Cincinnati, OH 45208 Niece C JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FlNANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FORIOINTLY HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % of DECEDENT'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. t0 10 Diocese of Harrisbur Savin s Account 01-37400 g g 113.37 1 /2 56.69 2 AB 09123!09 PNC Bank Checking Account 5000868734 1 791 09 1 /3 59 I , . 7.03 TOTAL (Also enter on Line 6, Recapitulation) I $ 653.72 If more space is needed, use additional sheets of paper of the same size. Pennsylvania DEPARTMENT OF HEV EIVUF INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER BARBARA ANNE PURCELL, a/k/a Barbara A. Purcell 21-11-0529 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT ANG THE DaTE of rRANSFER. anaa a coPr of THE DEED EoR REAE ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION IIF v~RUCaeEEI TAXABLE VALUE 1 PNC Investments IRA 68408571. Beneficiary Estate of Barbara A. Purcell. Transferred April 19, 2011. 13,945.25 100 13,945.2! 2 New York Life Insurance Annuity Policy 52157435. Beneficiary Estate of Barbara A. Purcell. Transferred April 19, 2011. 518,325.12 100 518,325.1< 3 Midland National Life Insurance Annuity Policy 16s0304560. Beneficiary Estate of Barbara A. Purcell. Transferred April 19, 2011. 11,534.14 100 11,534.12 4 Jackson National Life Insurance Company Annuity Policy 1004243621. Beneficiary niece, Jane Dyar. Transferred April 19, 2011. 86,438.51 100 86,438.51 5 Jackson National Life Insurance Company Annuity Policy 1004243710. Beneficiary sister, Mary Dyar. Transferred April 19, 2011. 145,066.46 100 145,066.46 6 North American Company Annuity Contract 8000124004. Beneficiary sister, Mary Dyar. Transferred April 19, 2011. 147,298.56 100 147,298.56 7 Bankers Life and Casualty Company Annuity Contract 7931205. Beneficiary sister, Mary Dyar. Transferred April 19, 2011. 63,703.69 100 63,703.69 _ TOTAL (Also enter on Line 7 Recapitulation) $ 986,311.73 If more space is needed, use additional sheets of paper of the same size. ~i`1 Pennsylvania SCHEDULE H ~ DERARTME"' °` RE~ENDE FUNERAL EXPENSES AND wFIER,T"NCE TAx: RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER BARBARA ANNE PURCELL, a/k/a Barbara A. Purcell 21-11-0529 Decedent's debts must be reported on Schedule I. ITEM -- NUMBER DESCRIPT]ON AMOUNT A. FUNERAL EXPENSES: --- 1 Neill Funeral Home 3,340.00 2 Gate of Heaven Cemetery 745.00 3. Flowers and Picture Frames for Funeral Service 120.06 a. Appalachian Brewery -funeral luncheon 145.08 B. ADMINISTRATIVE COSTS: i. Personal Representative Commissions: 33,000.00 Name(s) of Personal Representative(s) Jane Dyar street Address 3667 Kendall Avenue city Cincinnati state OH zIP 45208 Years; Commission Paid: 2011/2012 ~~ Attorney Fees 28,000.00 3~ Family Exemption: ([f 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: 373.50 5 Accountant Fees: 3,495.00 6. Tax Return Preparer Fees: ~ Estate Advertising (Cumberland Law Journal-$75.00; Patriot-News-$116 45) , 191.45 a. Woof Appraisal Group -real estate appraisal 350.00 s. Mary Dyar -reimbursement death certificate of Jane Purcell 27.00 ~o. Net settlement expenses re sale of 527 Country Club Road Camp Hill PA , , 19,130.49 i ~ US Departrment of Treasury - 2010 1040 9,080.00 ~Z Reserve for future costs, taxes and expenses 5,000.00 TOTAL (Also enter on Line 9 Recapitulation) I $ 102.997.58 ]f more space is neeaed, use additional sheets of paper of the same size. ji`l Pennsylvania SCHEDULE I ~ DEFARTME"~ °F REVENUE DEBTS OF DECEDENT, mr+ER~TnNCE TFx RETURN RESIDENT DECEDENT MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBEF! BARBARA ANNE PURCELL, a/k/a Barbara A. Purcell 21-11-0529 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed rnedical expenses. ITEM NUMBER DESCRIPTION /AIUE AT DATE OF DEATH __ 1 Borough of Camp Hill -sewer 150.00 2. C. Brian Peffer, DPM -medical debt of decedent 8 12 3. Discover Card -debt of decedent 13.90 4. PA State Employes' Retirement System -refund over prorated amount of April benefits 191.05 5. Verizon -debt of decedent 7 68 6. PPL Electric Utilities -debts of decedent 320.22 7. Penn Waste, Inc. -debt of decedent 45.75 8. Pennsylvania American Water -debts of decedent 170.86 9. Camp Hill Emergency Physicians -debt of decedent 28.73 10. Appleby Systems, Inc. - debt of decedent 1,519.00 11. Joshua McClellan - mowings at 527 Country Club Road Camp Hill , 525.00 12. Linda Lou's Cleaning Service, LLC 63.60 13. Torrey Steigleman -household painting 425.00 14. PNC Bank Checking Account 5000868734 -checks cleared after date of death 446.80 TOTAL (Also enter on Line 10 Recapitulation) I $ 3,915.71 If more space is needed, insert additional sheets of the same size. REV-1S 3 EX+ (O1 10; Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE BENEFICIARIES t~lAlt OR F]:LE NUMBER: BARBARA ANNE PURCELL, a/k/a Barbara A. Purcell 21-11-0529 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS I I d -- - [ nc u e outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1 • Maureen Neville, 2001 Ackerly Road, Montoursville, PA 17754 No Relation 2. Betty Howe, 2911 Chestnut Street, Camp Hill, PA 17011 No Relation 3. Kaela E. Wuesthoff, 3667 Kendall Avenue, Cincinnati, OH 45208 Great-Niece 4. Ben Singh Dhiman, 10413 Londonridge Court, Cincinnati, OH 45242 Great-Nephew 5. Samuel Singh Dhiman, 10413 Londonridge Court, Cincinnati, OH 45242 Great-Nephew 6. Max A. Wuesthoff, 3667 Kendall Avenue, Cincinnati, OH 45208 Great-Nephew 7. Barbara Kegelmeyer, 5924 Naughten Ridge Court, Columbus, OH 43213 No Relation 8. Mildred Bramer, 12695 Cameron Road, Kendrick, ID 83537 No Relation 9. Mrs. James E. Johansen, 108 Beverly Road, Camp Hill, PA 17011 No Relation (See Continuation Schedule attached) ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIB UTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. Human Life International, 4 Family Life Lane, Front Royal, VA 22630 2. Morning Star Pregnancy Services, 3837 Walnut Street, Harrisburg, PA 17109 3. Red Cloud Indian School, 100 Mission Drive, Pine Ridge, SD 57770 4. Catholic Relief Services, 228 W. Lexington Street, Baltimore, MD 21201 Total from Continuation Schedule Attached TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ If more space is needed, use additional sheets of paper of the same size. 250.00 250.00 250.00 250.00 250.00 250.00 500.00 500.00 500.00 5,000.00 1, 000.00 1,000.00 2, 000.00 7, 000.00 16,000.00 ATTACHMENT TO SCHEDULE J BENEFICIARIES ESTATE OF BARBARA ANNE PURCELL a/k/a Barbara A. Purcell 22-11-0529 I. Taxable Distributions: 10. Robert J. McCurdy and Jean McCurdy 11 Dulles Drive West Camp Hill, PA 17011 No Relation $1,000.00 1 1. Rose Marie Allison 2070 Enheld Street Camp Hill, PA 17011 No Relation $ 500.00 12. Suzanne Dhiman 10413 Londonridge Court Cincinnati, OH 45242 Niece $ 500.0() 13. Jane Dyar 3667 Kendall Avenue $ 500 Cincinnati, OH 45208 Niece .0() and Schedule G, Item 4 14. Thomas Dyar 10117 Mill Road Cincinnati, OH 45231 Nephew $ 500.00 15. James Dyar 868 Liverpool Place Westerville, OH 43081 Nephew $ 500.00 16. Lucille Schmieder 4005 South Atlantic Avenue Wilbur-by-the-Sea, FL 32127 No Relation $5,000.00 17. Mary Dyar 2260 Riverside Drive, Apt. 407 Residue of Estate and Cincinnati, OH 45202 Sister Schedule G, Items 5, 6, 7 II.B. Charitable Distributions: 5. Catholic Church Extension Society 150 South Wacker Drive, 20t" Floor Chicago, IL 60606 $2,000.00 6. Diocese of Harrisburg 4800 Union Deposit Road Harrisburg, PA 17105 $5,000.00