HomeMy WebLinkAbout10-14-11REV-~ 500 1505611180
D((02.11)(Fl)
PA D of Revanw rtsy~va~~ OFFICIAL UdE ONLY
Bureau of Mdlvldu°I Taxes Count' Cade Year
~ seat ~~ INHERITANCE TAX RETURN ~1 I ~' N~°`
ENTER DECEDENT (NFORMA17TIpN LOW RESIDENT DECEDENT GC 1 ~ ~ C~ I J Gj
Sodal selx,rrty Number Date of Death MMDDYYYY 1
072-14-0825 Date ofBtrth MMDDYYYY
Decadence Last Name 01212 011 010 319 2 2
Sufic Decedent's Flrst Name
O'CONNOR MI
(M Applicable} Enter 8urvlving Spouse's fnfonnsBon Below EDWARD L
Spouse's Last Name
SufrGc Spouse's Flrst Name
MI
Spouse's Soda) sea,tfty Number
THIS RETURN MUST BE FILED IN DUPLIC
FILL IN ApPROpRtA~ BOXES BELOW ATE WITH THE
REGISTER OF WILLS
® '' °~' Retxn p t s~parernen,,, Retum
4• L~Ited Estate
0 3• RernaNMp Re4rn (Oslo of Deatlr
Prtor 1012-13-x2)
4a' ~° 1rEUeat COrnprorNse (dale
f
® 8• Dacedsrd Died Testsle
~ o
death after 12-12-a2) ~ s' ~°~ Estate Tax Return Required
~
(AGaeh Copy of YYIN)
(~ 9. lJNgalton Proceeds Recei
d ' { ~°a ~ a Llvlrg Trust 1 9. Tot°I Wurober of Safe OePONt ttoxes
~
ve Q 10. Spousal Poverty Credit {Oats p f p~~ Q 11. Ekctlon to Tax under Sec, 9113(A)
Behvaen 121-91 and 1-1~)
COflIIEtPONOENT-TINS tiECil0I1 MUBT 8E COMPLETED. ALL
Name CORRE6pONpENCE AND {AWeh SeheduN O)
IilAl TAl(WFOpMAiWN NII01lLD B
E O~CTEO Ttk
Robert G. Frey Daytlme Telephone Number
7172435838
First Line of Address
,-;
~' `~ ----- -„
, .. ,
'~
5 South Hanover Stree ? ,-~
-={-~-~
Second Line oiAddress __ ~
- _.
,_-
clty or Post OEioe -L - - -
Carlisle State ZIP Code ,•; ,_..,
=-~
PA 17013
CO-~Pondents e-mail addroas: RFRE Y aF R E Y T I L E Y. C O M
under penaldee al psrjrpy.l dedars that t tnve exam
N b
d trred ~ ~r~
sN+
d
d
an
e
r
ea and
. oedaattan of other emn lha 0
~ I+ based on aN
SK3NATLNtE OF P RES It3L R F statemems, and b the frost of my Iarowhdye and baief,
Irdprnegan of vNtlch
I ~
ADDRESS ~ / ~ OATE~~ ~ ~~~
SIGNATURE p ! ~..ti„i,,,~ ~-Z.~.-'~ .L,'l' j ~ ~
~
ENTATIVE ~
ADLNiE55
5 South Hanover Street lisle PA 17D13
PLEASE U3E ORIGINAL FARM ONLY
15056
L Slde 1
11180
1505611180
J
REV-151m EX (Ft)
- a.
9. Funeral Expenses and Administ-athro
Costs (Schedule H) ....... .
10. Debts o/ Decade ........ 9.
~ MortBape Liabilities and Liens (Schedule I) .......... .
t 1. Total Deductions 10.
(total Lines 9 and 10) ....... .
..................... 11.
12. Net Value of Estate (Lme 8 minus Line 11) . , , , , , , ,
13. Charitable and Governrrienfal B u ................... 12.
an ekidton to tax has not been maw S~ 9113 Trusts for wt~lch
(Schedule J) ........ .
~. ..----- .............13.
__ ~.....~ ~~~ws tale 13 .... .
AX CALCULATION .SEE INSTRUC'ryONS FOR APPLICABLE RATES .......14
15• Amount of Line 14 taxable at
the spousal tax rate, or
transfers under Sea 911 B
16. (Amount of Line 1D4 taxable
et lineal rate X .0 4 5 15.
1 ~, amount of Una 14 13 7 7 8 92.6 6 18.
taxable at sibltrlg rate X .12
18. amount of Una 14 taxable 17.
at ooNateral rate x .15
19. TAX DUE ................... 18.
........................ ........... 1a.
20• FILL IN THE BOX !F YOU ARE RECUESTING A REFUND OF AN OVERPAYMENT
°°`°d°"r'na~ ED~IaRD L 0'
RECAPITt1WT10N
DecedenPs Social Secwily Numb
D72-14-na~r
1 • Real Estate (Schedule A) ........... .
2• Stocks and B ............................. 1• NONE
onds(Schadule B)..........
.......................... 2. N 0 N E
3. Closely Held Corponitlon, Partnership or Sofe-P
roprletorahip (Schedule C) ... 3. NON E
4• MoRpages and Notes Receivable
(Schedule D)........
5. Cash. Bank . ............... 4. N 0 N E
~Posils and Miscellaneous Pe
rsonel Property (Schedule E) .... 5,
8• Jofndy Owned Property, (Schedule F) OSaparate Bill
'. (nSchadV We G ransfers b MisceNaneous Non-Probate Prop guested ....... 6.
) Separate Bill Requested ....... 7.
! T.._. .
1505611280
217909.00
6729.66
116as1D.DD
148.6
5947.00
9309.00
15256.00
2377892.66
O. DD
637789a _ r_~
0.00
62005.17
0.00
0.00
62005.17
L
150561128D
Side 2
1505611280 J
Rtv-tsoo ac f~,y P,~ s
Decedent's Complete Address: Fits Numbrtr
DECEDENTS NAME 21-11-0119 072-14-082g
Tax Pa PA
yrments and Credits; 172x1
1. Tax Oue (Page 2, Une 19)
2. Credrys/payments
(1)
A. Prior Payments
62006.17
t3. Discount 00.00
2975,00
3. interest Total Credits (A + e) (2j
4. Ii Une 2 is
greater than Une 1 +Une 3, ~~ Use dif(erer~, This is the OVERP
FHI In box on Page 2
(3)
Un
2 62475.00
,
s
AYMENT.
0 to r'equeet a ns/und.
5. I1 Une 1 + Ura 3 is greater than Une 2, enter the diN (4)
erenca. This Is the TAX DUE 469.133
(5) 0.00
Make check payable to: REGIST
ER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWIN
G QUESTIONS BY PLACING AN "X" I
1
N THE AP
. DId decedent make a transfer and: PRO
a
PRIATE BLOCKS
• the use or income of th
e PropeRy transferred ....................
................
b. retain the right Oo designate who shall use ........................
.
.......
Yes
No
................... D
P-oPerty transferred
c. rotaln a reversionary interest
Incarre
.............
......................,...................
d. receive ...........................
................
........
the Worries for life of ...
eNrer payments, benefits or rro ...................
ro7 .....................
2. It death occurred after Dec
12 ^ ^
^
. ^
.
.
. 1982,
without receiving a axle did decedent transfer ..........................
~a om>aw ProP~ within ..................
erotion9
one Year of d ^
^
............
eath
3. Ord
Wst for' ...............
....................
decedent own an "in .................
....
or PeYebb-uAon-death bank account or security at his or her death? .........
4. Did
lndlvid
~ent
en
+
~
a
^
a
..
bf
ne
ry
Aci
aocorxrt, annuity or other ran-probate property
ation7
~ ~+9 ...........
which ^
,
...............................................
...................
. ...........
IF THE ANSWER TO ANY OF THE ........................... ^
ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE Q AND FILE R AS PART OF THE RETURN.
For dales of death on or aAaer Jay 1. 1994. and before Jan. 1. 1995. the ~x rate imposed on the net value of transfers to or
spouse is 3 percarrt [~ P.S. §9118 (a) (1.1) {i)j.
For dates of death on or after Jan. 1, 1995, the tax rate !m ~ the use of the survivlrg
Posed on the net value of transfers to or for the use of the au
(M P.S. §9116 (a) (1.1) (p)j. The statute does rat exempt a transfer to s aurWvi s ~9 spouse is 0 pendent
assets and Aling a tax rearm are still aPakable even if the sruvi ~ ~~ from Mx• and the eta
For dates of death on or after J 1, ~ spouse is the only beneRciary. tutory reQuiroments for dlsclosuro of
ulY 2000:
• The tax rate imposed on the net value of
~PAve Front or a stepparent of the cM~~ frorrr a deceased Child 21 Years of age or
• The tax rate f ~~ (M P.S. §9116(ax1.2)]. Yoru~ger at deelh ~ pr ~ Use use of a natural parent, sn
rnpossd on the net value ~ trana~ to ar for the use ar the
• The tax rata Imposed on the net value of transfers to or for the use of tl~ ~ s is 4.5 per~oent, except ag ~ ~ ~ P.S. 11 a 1 .
dsAned, under Section 9102, as an indivldusl who has at least one ~ ~ x )I
Paront in canrmon w~ pre deceder~it,~w ~~ • ~118(a)(1.3)j. A sibl(ng Is
by Wood or adoption,
REV-1508 EX+ (17-10)
Pennsylvania
~~ENroa nEV
~»
~~
ESTATE
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
- •.~we use prong of Iltlgetlon and x,e .~s~e w._ ~~__-
NUMBER:
REV•~so4 Ex• ro,.,ot
pennsylvania
OEPARTUIErtrOF REVErIUE
INHERITANCE TAX RETURN
` RESIDENT DECEOEHT
SCHEDULE F
JOINTLY-OWNED PROPERTY
It an asset t~scaeN jmntty wlthln one
SURVIVING JOINT TENANT(S) NAME(S)
A. Carol A. Nelson
B. Joanne Gingrich
C.
~"•^ ~ ~r vwnED PROPERTY:
of the degdent~s date of death, It must t» 21-11-0119
reported on f3ehedule ti.
ADDRESS RELATIONSFIiP TO DECEDENT
Avondale Drive
Bvrtown, PA 18940 ~ugMer
0 East Linden Drive
arlisle, PA 17015
~~ ~~ ~~
riE>w Foa ~oINT t~ ItA ~ OF OESCRIpT~ OF PROPERTY
"~"~ rENANr .tarn ~ aND Bloat ACCOUNT NUMBER oR stuuAR are w= DEATH % oa oAre a: OEATN
IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VAWa OF VALUE OF
1 • A• 12/17107 aChovig Money Market Acct. 643p "~ ~' +rs INTEREST
20,191
TOTAL (Also enter on Line 6, Recapitulation)
if mon space is needed Use addHfona! sheets of s
PaP~ of the same size.
33.3396 I 8,729.66
REN-1510 FJf• (0®-0g~
ITEM
1.
2.
a
b
c
d
9
h
1
1
k
1
m
n
P
4
r
u
3.
4.
pennsytvania
~ARTYENT OF REVENUE
RITE TA1(RsruaN
SCHEDULE G
INTER-V1VOS TRANSFERS ~
MISC. NON-PROBATE PROPERTY
Tfea acFleduk moat bs ~ and flied 0>f+e aravvar m 21-11-0119
DESCRfPTION OF PROPERTY ~ of ~ ~+Oh 4 on p~ tl>rss of m° REV-~~ ~ ~•
wculo¢ n~ wvraoF n~
1-EU~a or ne~ea*. ~ ~naw,r ro oecme/r,wo
COFlr CI lka Daap Fp11161~ ESTAiL
RA, Vanguard Wellington Fund, 4959.138 shares
`:dward L. O'Connor Living Trust:
/anguard Dividend Growth Funds, 919.215 shares
'NC, 39 shares, X61.135 ave prbe
%onagra, CAG, 200 shares, 23.44 ave. price
;axon Mobil, XOM, 200 shares, 78.58 ave price
leneral Electric, GE, 800 shares, 19.81 ave price
ubrizol, LZ, 200 shares, 103.88 ave price
ledco Heal Solution, MHS, 200 shares, 84.395 ave. price
Derck, MRK, 400 shares, 34,05 ave. pAce
finer, PFE, Z00 shares, 18.275 ave. price
~yal Dutch Shell, RDSA, t00 shares, 88,80 ave price
'M International, RPM. 200 shares. 22.48 ave. price
ithem Co, S0, 500 shares, 38.385 ave price
aril Lynch Money Market Account
~ County Ohio Hospital 8d, 5,000 units, induding accruals
Turnpike Bond, 35,OOp units, including accruals
iladelphia Hospital Authority Bd, induding accruals
A, 1,248 shares, 155.87 ave. price
f+rles Schwab money market account
erican Express certificate of deposit
covet Bank NA certificate of deposit
Bank of Richmond certificate of deposit
chovia certificate of deposit IRA
b Federal certificate of deposit IRA
DATE OF OEATfi X OF DECD'S EXCLUSION TAXABLE
/ALE F A ~t? I T s.uw,c,~,q
273,329 100.0096 VAL
273,329
13,478 100.0096
2.384 100.00% 13,478
4.888 100.009E 2'~
15.718 100.009E 4'~
11,788 100,Opo~ 15,718
20,778 100.0096 11'766
12,879 100.0096 20,778
13,820 100.0096 12,879
3,855 100.00% 13'820
8,880 100.0096 3.655
4.492 100.009E 8,880
19,183 100.009E 4,492
14,324 100.0096 19,183
4.372 100.009E 14,324
33,065 100.009E 4.372
32,989 100.009E ~'~
194,526 100.00% 32,989
31,893 100.0096 194,526
95,594 100.0096 31,693
98,488 100.0096 95'594
95,010 100.0096 ~'~
157,517 100.009E 95,010
10,108 100.00% 157,517
10,108
If more space is needed, use additional sheets of rail of the ~~
P Pe same size.
t=EV•15t 1 EX + (tq•Og)
Pennsylvania SCHEDULE H
°~"a*~*~~ut:
FUNERAL EXPENSES AND
aa~ER1TANCE TAX RETURN
RE$1D~ °~D~ ADMINISTRATII/EcOSTS
°_3TATE OF
:dward L O'Connor FILE NUMBER
1-11
~sasdeM'a debts must be roported o
S 119
n
chedule 1.
ITEM
NUMBER
A FUNERAL EXPENSES: DESCRIPTION
AMOUNT
1 • HoRrman Roth Funeral Home
2. CarNste Sentinel Obituary 2.230
3. Chagrin Falls Obituary 145
4. Sheffield Monument -headstone 165
5. Chagrin FaNs Cemetery 140
Memorial cards and postage 275
89
B• AOMlNISTRATIVE COSTS:
1.
~~:
Name(s) ar Persona{ Reprey«sl
Street Address
~Y
Stets ~p
YeaKs) Commissbn Paid:
2• Attorney Foss:
3.
FamOy ExampNOn: (M dacedenCs address f3 not It1a saflu as ciatrnanCs, attach expteti~ 1,000
Gatmant
SbestAddresa
CiN
Sfate ~p
RNalbroNp of ClNmant to aeceeent
4• Probate Fees:
s. A~ountaM ~: 937
6• Tax Return Preparer Fses: 241
7. Post Offtce box
8. Bank fee 49
9. Expenses of cleaning retirement cottage to be sold ~
641
TOTAL Also enter on Line 9, Re
If more Specs (s needed, use additional sheets of
Paper of the same slze.
r~w~s~z oc.I~z-0al
Pennsylvania SCHEDULE I
DEPA4iTM[NT OF R
INHERITANCE TAX RETURN DEBTS OF DECEDENT,
RESENT DECEpENT MORTGAGE LIABILITIES & LIENS
ESTATE et:
rd O'Connor FILE NUMBER
~tbrt ttabfs Mwlllred by tla daadept pbr to daalh that nmafnad unpaid at the daa of dntll, 21-11-0119
rTEM unnlmburab ma~eal expeneaa.
NUAABER
DESCRIPTION VALUE AT DATE
1' of DEATH
Federal income tax obligation at time of death
Final Medical ~~~~
Expenses:
2- Carlisle Regional Medical Center
3• Cumberland Good WNI Fire 8 Rescue EMS 14
4• Health Network Labs 121
5. Mlllenlum Pharmacy 9
6• NewviUe Community Ambulance 22
7• Pion-Spirivie Handhaler ~
8• West Shore EMS ~
9• West Shore Ambulance 25
1,085
TOTAL (Also enter on Une 10 RecapilWadon) I : 9
Insert addluonar stroets of Ifss same s~ ,309
REV•1513 EX• (01-10)
pennsyivania
DEPARTIAEI~ OF NEVENUE
~WIERIfANt3i TAX Rt1URN
AE910ElIT OECEOtM
ESTATE OF:
SCHEDULE J
BENEFICIARIES
FILE NUMBER:
NUMBER -
NAAAE AID ~~ ~ pER30k(S) RECEIVING, PROPERTY
I TAXABLE asTRIBUrIONS (Inaude
t~ousel dlatributlone and trarWeq under
Saa 9118 (a) (1.2~)
1 Carol A. Nelson
6 Avondale Drive, Newtown, PA 18940
2 Joanne L. Gingrich
10 East Linden Drive, Carlisle, PA 17015
RElAA0I1:~ TO DECEOEM
Do Not Lbt Tn+stee(e)
AMOUNT OR SHARE
OF ESTATE
1/2 of Remainder
1/Z of Remainder
ENTER DOLLAR AMOUNTS FOR OISTRIBUTIONS SHOwN ABOVE ON LINES 13 TH I
II ~-T ~ ROUGFI 18 OF REV-1600 COVER SHEET. AS APPROPRIATE.
A. SPO<~AL D~~ ~~ SECTION 9113 FOR YVHICN AN ELECTION TO TAX LS NOT TAKEN:
1.
8. CHARITABLE AND c3ovERNMENTAL dsTRI9unONS:
TOTAL OF PART 0 -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET. s
H n+Oro >kiwos b needed. use additlonal al+sels o(peper ar tlw same size.
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Wells Fargo Advisors, LLC
NC1164
401 3oulh Tryon 3trsM
CharbtEs, IVC 2828ti
WACHOVIA
February 26, 2011
Estate Of Edward L. O'Cowor
Attn: Frey & Tiley
5 South Hanover Street
Carlisle, PA 17013
Dear Frey & Ti1ey:
IItE: Edward L. O'Connor
Thank you for contacting Wells Fargo Advisors regarding the account(s) of Edward L. O'Connor.
Attached is the information regarding the date of death valuation requested.
If you need any further assistance, please contact an Estate Processing Specialist at 866-786-4890,
weekdays 8 a.m. to 6 p.m., ET.
Sincerely,
,,~srdii~,rd .~,«
Patrick Lane
Managing Director
Wells Fargo Advisors, LLC
Member NYSE and SIPC. - - - -~ -'-~
Waebovia Bank is a diviaiaa of Wella Fargo Baalc, NA
~•••~ I nor ~ ueFortt Of Or Goaraatesd BY~
A 8aak or Aoy Back ABBbua
a revered >uolcer-valet acd a separate. aonbulc atRiiata of Wells Far~a.
BKDOA.N 9Z6M1010 EOOieCti
Fax Server 2/15/2011 11:26:17 AM PAGE
WACHO~YIA
Wa~ovia Bang
BaLaoe Cat>flrtnetioo Services
P O Banc 40028
Roanoloe. VA 24022
Febneary 15, 2011
FRSY ~ TILEY
ATTN: kOBERT G FilEY
••
1/002
Fax Server
Rdaaooe m: 3'tts94:
SUBIECl': VtxiScation / CataBnmtltipn of Aooount aced Balance la>nnmation psovidod Por.
Cbrtomer: EDWARD L OCONNOR (55Nf~ JQGiC-71QIG88Z~
DaUe of Dnth: Jao~ary 21, 2011
Wi
.~ Ai Date of Delb Awys Baleme DaL tdaturiq~ totaeet Asaued YTD »~
Halmoe ~ Dale Rate Ide~ed Idenet Paid Claeed
csmPtcA~ aF ~ooooootx~sas 590,64I.T6 3n~rmoe
~~ s6a.so x1w.93 1/Z6/mll
lE0AL7TIZ8: SDWARDLOOONNOtt
~~~ X7DDOaOD0C4720 S46,ZS~.44 9/1OR007
t0.0I ti11 1/t7B011
l~0AL177Z8; BDWARDLOOONNOIt
JQAAINB LCIRV(3RIC~I - POA
CAita[-A Nffi.80N- PDA
~~~ ~ X7DDDDi10IX6430 sto,l9o.se IZ/17~2007
~~ 5736 1/~6/=Oll
~A1.1Tii8:1~fIARD L OOONNOIt
CARt7i.A NEI~i
AANNEL~RICH
iilA XlDODDOODD0~14~ SIS?.517.11! 4/lOClQOS
5416.89 50.00
IEl3Ai,'1T1'1$: EDgVARDL000NNOlt
FaBearlaiatyCyaiao Pam A~ at111(i66)7a6.4i90.
Other Aot:annt Ll6nlmation
.n,~ N ~ Dete ad'Bdaoee p~ ~e DOlleded
D~
DPI Cloead
liA1+8 DI~OBrI' 7000iDa0DOI0379 9/10/J007
8OX
LRCIALTITI~: EDiRIARD La00NNOA
IIDANNBLdII~it}RiCH- AOA
CARiOL A t+f~.SOld • POA
LOCA'I70N:
604 B IIICiH STRFEf
CARI1tiL$ PA 17013
71749-fIR2
Papa 1 d 2
Estate Valuation
Edxard L. O'Con:or
Date o! Dsath: 61/21/2011 Estate ol:~Ed++ard L. O'COnnoz
Valuation Date: 61/21/2011
Proeessing Date: 02/26/2011 Accamt: 257400081145148
Report ?yp.: Date of Death
Htnobsr o! Sacuxitiea: 1
EYle ID: 257400081145148
Shares Security Mean and/or Div and Int Security
or Par Description Nigh/Ask Lox/Bid Adjustments Accruals Valne
21 157517,08 IRA CD 2574000811451/8 60 months (CASH) 157,517.08
Total Valne:
Total Accrual: 5157,517.08
Total: 5157,517.08 50.00
?itled:
?dxard L. O'Connor
210 8iq Spring Rd.
Newville, PA 17241
Accouat was opened on 04/10/2008.
Portfolio Endnotea
Page 1
?his zeport xas produced with 8stateVal, a proQuct of Sstate Valuatiarts i Pricing Systems, Inc. If you have questions,
please contact EVP systems at (818} 313-6300 or axw.evpsya.aom. (Revision 7.1.1)