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Home My WebLink About09-29-11J 1505610148 REV-1500 Ex t°'-'°' PA Department of Revenue OFfIC1AL USE ONLY County Code Year File Number Bureau of Individual Tams Po sox zs°sot INHERITANCE TAX RETURN 2 0 11 CI O D 41 Harrisburg, PA 17128-0801 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMOOYYYY 144-80-3144 12292010 09171983 Decedent's Last Name Suffix Decedents First Name M I GERMAN NICOLE F (If Applicable) Enter Surviving Spouse's IMormation Below Spouse's Last Name Suffix Spouse's First Name M I Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE'. - - REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW ® 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death ^ 4 Limited Estate ^ 4 F t I ^ prior to 12-13-82) . a. u ure nterest Compromise (date of 5. Federal Estate Tax Return Required ^ 6 Decedent Di d T t t ^ death after 12-12-82) 7 D d . e es a e . ece ent Maintained a Living Trust _ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (date of death ^ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name D aytime Telephone Numtx:r ELIZABETH P. MULLAUGH 717-237-5243 First line of address 1D0 PINE STREET Second line of address PO BOX 1166 City or Post Office State ZIP Code HARRISBURG PA 171081166 correspondents e{ttail address: E M U L L A U G H o~ M W N. C O M REGISTER OF WILL:i USE ONLY ~_ r-~ c~ :7 ~rri - +~ `'~ ' -',~ - :-''C - DATE FI~ .. t t Under penalties of perjury, I declare that I have examinod 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 ort all information of which preperer has rmy knowledge. SIGNf~dRE OF PERSON RESPONSIBLE FnR FILING RETURN / -DATE 1.-~_ ?1 1 j~/ ~ t._. ADDRESS 330 ENTREKIN ROAD __ PURVIS, MS 39475 SIGNATURE F REPARER OTHER THAN REPRESENry;~TNE ,HATE PO ~B-9-X~ 1166 ~ HARRISBURG, PA 1710-1166 PLEASE USE ORIGINAL FORM ONLY _ .7 , _ ,_.~' .. ~ :~ C=~ .~, Side 1 1505610148 9M46474.000 1505610148 ,~,, J REV-1500 FCC 15D5610248 Decedent's Social Security Number 144-80-3144 Decedent's Name: B E R M A N N I C O F F RECAPITULATION 1. Real Estate (Schedule A) . . . . . . . . . . 1 0 • 0 0 2. Stocks and Bonds (Schedule B) . .. . . . . . . . . . . .. 2 0 • 00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) , 3 0 • 0 0 4. Mortgages and Notes Receivable (Schedule D) 4 0 • 0 0 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) 5 51 , 2 7 2 • 8 8 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested g 0 • 00 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested . . . . 7. 0 , 0 0 8. Total Gross Assets (total Lines 1 through 7) . . 6 5 ], , 2 7 2.8 8 9. Funeral Expenses and Administrative Costs (Schedule H), .. g ], 5 , ~ 7 2 • 7 9 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) 10 1 , 17 2 • 9 2 11. Total Deductbna (total Lines 9 and 10) , 11 ], 6 , 2 4 5.71 12. Net Value of Estate (Line 8 minus Line 11) 12 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which . . 35 , 027 • 17 an election to tax has not been made (Schedule J) , 13 . 0 • 0 0 14. Net Value Subject to Tax (Line 12 minus Line 13) , 14. 3 5 , 0 27 • 17 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 .o - 0.0 0 15. 0.0 0 16. Amount of Line 14 xable ~ at linealrateX.Q 4 17. 35,027.17 Amount of Line 14 taxable 1s. 1,576.22 at sibling rate X .12 0.0 0 17. 0 , 0 0 1 B. Amount of Line 14 taxable at collateral rate X .15 0. 0 0 18 0. 0 0 1s. TAx DuE ................................... 1s. :1, 576.22 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610248 1505610248 J 9M4848 4.000 REV-1500 EX Page 3 DeCBdenYS Cmm~Wfa Arfrlrocc• Flte Number ~n , , +..u uuu~y DECEDENTS NAME F STREET ADDRESS CfTY STATE illP M A 17055- Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) _ 1,576.22 2. Credits/Payments A. Prior Payments 0 . ~ ~ e. Discount ^ , 0 0 Taal credne c a + s) (2) 0.0 0 3. Interest (3) _ 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (4) _ 0 • ~ ~ 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) _ 1 , 57 6 , 2 2 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCICS 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; or . . .. . .. . . . . .. . . . .. . . . . . . . . . . ^ d. receive the promise for life of either payments, benefits or care?. ^ 2. If death occurred after Dec. 12, 1982, did decedent transfer property wRhin one year of death without receiving adequate consideration? . 3 Did d d " " ^ . ece ent own an in trust for or payable-upon-death bank account or security at 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 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) (f)]. For dates 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) (i)). 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 beneficary. 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)]. Asibling is defined, under Section 9102, as an individual who has al least one parent in common with the decedent, whether by blood or adoption. 9M4671 2.000 REV-1508 EX w (&98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, 8c MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF FILE NUMBER Nicole F. Berman 20 it 0004:1_ Include the proceeds Of Iftigation and the date the proceeds were received by the estate. All property Jointly-owned whh the right of survlvorshlp must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER r~ero~annwi 01= DEATH 1 Wachovis Bank Savings Account No. 7919 See attached bank letter; Amount reported is closing balance on January 13, 2011 2 Personal Property Proceeds 3 MidPenn Legal Services - Paycheck 4 UNUM Checking Account No. 611529906 Proceeds deposited to estate account 5 US Treasury - Refund re 2010 individual income tax return 19.12 2,390.00 1,094.83 46,197.93 1,571.00 TOTAL (Also enter on line 5 Recapitulation) $ ~ 51 , 272.8 @ 3wa8AD i.ooo (It more space is needed, Insert additional sheets oftha same size) REV-1511 EX~ (10-09) Pennsylvania SCHEDULE H OEPARTAENrOF REVENUE FUNERAL EXPENSES AND N1-EPoTANCE7AXRETURN ADMINISTRATIVE COSTS RES~oENroECEOENr ESTATE OF FILE NUMBER Nicole F. Berman 20 11 00041 Decedent's debts must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNER14L EXPENSES: -- ~. J.L. Apter Memorial Chapels, Inc. Funeral Expense 9,649.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid: 2. Attorney Fees: McNees Wallace & Nurick LLC (estimated) 4 , 500.00 3. Family Exemption: (If decedent's address is not the same as Gaimant's, attach explanation.) Claimant Street Address C~~' State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 193.50 5. Accountant Fees: B. Tax Return Preparer Fees: 7. 1 Central Penn Business Journal Legal Advertising 140.00 2 Cumberland Law Journal Legal Advertising 75.00 Total from continuation schedules 515.29 swaenc aooo TOTAL (Also enter on Line 9 Recapil If more space is needed, use additional sheets of paper of the same size. 072.7 Estate of: Nicole F. Berman 20 li 00041 Schedule H Part 7 (Page 2) 3 Gunn Mowery Administrator Bond Premium; Bond required by Cumberland County Register of Wills 368.00 4 Cumberland County Register of Wills Filing Fees re PA Inheritance Tax Return and Inventory 30.00 5 McNees Wallace 6 Nurick LLC Costs Advanced as follows: Duplicating $6.20 Toll Calls .O1 Postage 11.08 17 29 6 McNees Wallace & Nurick LLC Reserve re closing costs re postage, duplicating, etc. 100.00 Total (Carry forward to main schedule) 515.29 REV-1512 EX • (12-06) Pennsylvania SCHEDULE I CEPAFt1MFxroF REVENUE DEBTS OF DECEDENT, INFiEPoTANCE Tnx RETURN MORTGAGE LIABILITIES 8 LIENS RES~ENroECEOENr ESTATE OF FILE NUMBER Nicole F. Berman 20 11 00041 _ Report debts incurred by the decedent prior to death that remained unpaid at the date of death. Including unreimbursed mndlcal nYnoneoe - - • --• •~ • - --~ ~ ~ ~ ~ ~.., c apace ~s neeaea, msen aaomonal sh@@ts of th@ Same Sit@. REV-1513 EX+ (01-10) Pennsylvania OEPARTMENTOF REVENUE INHERRANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES w ~nio vr: FILE NUMBER: Nicole F. Berman 2011 OOC141 RELATIONSHIP TO DECEDENT Ati10UNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) QF ESTATE TAXABLE DISTRIBUTIONS Ilnclude outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. Mitchell E. Berman 330 Entrekin Road Purvis, MS 39475 All of Residue: 35,027.17 Father 35,027.17 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 151HROUGH 18 OF REV•1500 COVER SHEET AS APPROPRIAI"E. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CFWRITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBU710NS ON LINE 13 OF REV 1500 COVER SHEET I S 0.00 9W46AI 2.000 If more space Is needed, use addlhonal sheets of paper of the same size. - Jan. 13. 2011 12:33PM COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLANp No. 5536 P. 1/1 SHORT CERTIFICATE I, G~ENDA EARNER STRASBAUGH _ ,register for the Probate of W,il.is and Granting Letters of Adrrri,nistratzon in and for CUMBERLAND Ct~u,n ty, do hereby certify that on the 13th day of January, Two Thousand and. EI even, Letters of Al7MlNISTRATION in common foam were ,granted by the Reg.i s te,r of said County, on the estate of NICOLEFBERMAN Late of SILVER SPRING TOWi"VSH/P raNSr. M,ddlc test/ in sa.zd couxzty, deceased, to MITCHELL BERMAN Iprsr, Middk, lastl and that same has riot ,since been revoked. IN TESTINfONY WHEREOF, I have hezeunto set my hand and aff,zxed the seal of sa,zd offz ce a t CARLISLE, PENNSYLVANIA, this I3 th day of January Two Thousand and Eleven. File No. PA Fzle No. Date of Death S.S. # 20 r ~ - 0004 ~ 'mil N R J /~A ~ u 71/1',.x/2010 144-80-,3144 v NOT VALID Wz2'HOUT ORIGINAL SIGNATURE AND IMPRESSED ,SEAL Reference II), 3277287 ~~ Wachovia Bank Balance Confirmation Services P O Box 40028 Roanoke, VA 24022 February 6, 2011 MCNEES WALLACE & NURICK LLC SUBJECT: Verification / Confirmation of Acoalult and Balance Information provided for: Customer; 1vICULE F HERMAN (SSN# I~-XX-3144) Date of Death; December 29, 2010 Deposit Account Information Account Account Date of Death Average Balance Date Maturity Interest Accrued YTD Date Type Number Ba]ance Opened Date Rate Interest IrAerest Paid Closed CHECHING ~~1541 ($164.33) 8/14/2006 $0.00 $0.00 LEGAL TITLE: NICOLE F HERMAN GARY ALAN CARTWRIGHT SAVIIVGS X7191 $15.08 6/14/2008 $0.02 $0.81 1/13x2011 IEGAL TTI'LE: NICOLE F HERMAN CLASING BALANCE: $19.12 Page 1 of 2 Lam.~~C * Date of death balance does not include accrued interest Referenoc II) 3277287 + if date of death oa~urs m a weekend or a holiday, date of death balance does not include any transactions that were made during that time period 3 s~ Jennifer Straub Servicenter Associate Phone: (540)563-7323 ]s~Ja By acceptarg this information, the recipient thereof represenh and warrants to Wells Fargo Bank, N.A ("Wells Fargo', that the recipient is authorized by the customer to receive lawfully this inforrnatim. The rerapiant agrees that it will not disclose this information to arty third party, unless compelled b do so by legal process, and that it will lawfullyuse-this information The recipient acknowledges that Wells Fargo does not represent and warrant that the information is complete and accurate. The recipient fur9rar admowladges that the informatim may not disclose the entire re]ationship between customer and Welk Fago. The information is subject to change without entice to the recipient The recipient agrees to indemnify, defend, and hold Wells Fargo harmless from and:prinst any claim resulting fran the disclosure and use of the information by the rec.-ipient or from the breach by the recipient of a~ agreement, representation, oc warranty contained herein Wachavia Bank and Wachovia Bank of Delaware are divisions of Wells Fargo Bank, N.A Page 2 of 2