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Home My WebLink About10-24-11COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES REV-1162 EX(11-96) DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 015101 FEHL PATRICE K 35 EASTGATE DRIVE CAMP HILL, PA 1701 1 ACN ASSESSMENT AMOUNT CONTROL fold NUMBER ESTATE INFORMATION: SSN: 191-26-8195 FILE NUMBER: 21 1 1 - 1088 DECEDENT NAME: KLEE NATALIE ANN DATE OF PAYMENT: 10/24/201 1 POSTMARK DATE: 10/24/201 1 couNTY: CUMBERLAND DATE OF DEATH: 02/01 /201 1 TOTAL AMOUNT PAID: REMARKS: CHECK# 501 INITIALS: HEA SEAL RECEIVED BY: 59,098.33 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS i J 1505610105 REV-1500 I:x t°2_s1, cFl, '~ PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes OFVYTMfXTOfXEVEMUf County Code Year File Number PO BOX 2806oi INHERITANCE TAX RETURN _- - -- - ------- -- d--- Harrisbu PA i iz8-osoi RESIDENT DECEDENT X11 ~ ; ~ ~ O S ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 191-26-8195 ~ ,' 02/01/2011 j 08/31/1935 --- - _! -- --- ecedent's Last Name -- - -- - --- - - ----------- ---.----- ___ _ Suffix Decedents First Name MI _.__._ _ ---- ___ _.._ _ Klee - --_ _ ____ --_ __-. - I ---- Natalie ! A (If Applicable) Enter Surviving Spouse's Information Below ~ ---' Spouse s Last Name Suffix Spouse's First Name - - ___ - __ _ ____ _ f - -- I Spouse's Social Security Number _ _ - ___ __- - _.___._ _ _J --- --------- --- - _ _ I THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS O 2. Supplemental Return O 3. Remainder Re~rn (Date of Death • i state Prior to 12-13-82) O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) QD 6. Decedent Died Testate O 7. Decedent Maintained a Livin Trust (Attach Copy of Will) 9 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death Between 12-31-91 and 1-1-95 O 11 • Election to Tax under Sec. 9113(A) ) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name ------------- Daytime Telephone Number Patrice Klee Fehl -____-- ___. __i - I (717) 991-2553 FILL INAPPROPRIATE OVALS BELOW m 1. Original Return O 4 Lim~ted E REGISTER OF WILLS USE ONLX . irst Line of Address -- __ - , ~ :.. C7 ...._ ~ O ._ T 35 Eastgate Drive _ - _ -;,~~ c-, 7 ... r;, c~~ , : ~~ ~ n ¢ --- °~ ~ ..s_ ? c~ ~~ Second Line of Address i> r ~ r~ - - ~ ' C/ - _ 7 _ ._- `c7.--? r .. _ _. City or Post Office __ . _ _ --- -- ..i.; -- - - - --- State ZIP Code DATE+~ --- - _ __ _,, -- Camp Hill __ J --t ;, PA ' ~ rTi ____ _ _ __ __ -- 17011 ~- ,.~ ~.~ O __-_ ~~ ~. 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, complete. DeGaretbn of preparer other n 'the personal representative Is based on all Information of which preparer has any knowledge. SIGNA OF P ON SPONSIBLE FOR F IN DAfiE ~~ ~~ ADDRE ~~ SIGNATURE OF PREPARER OTHER THAN RESENTATIVE ~ L DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY L 1505610105 Side 1 1505610105 J J 1505610205 REV-1500 EX (FI) Decedent's Social Security Number oeoede~t's Name: Natalie Ann Klee 191-26-8195 RECAPITULATION 1 . Real Estate (Schedule A) ............ ......................... . ~•~ •••~ 1. 200,000.00. 2 . Stocks and Bonds (Schedule B) .......... - -' ......................... .... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3, 4. Mortgages and Notes Receivable (Schedule D) ... ..................... ... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5, 31,665.00 6. Jointly Owned Property (Schedule F) O Separate Billing Requested 6 7. .... Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ... , __ 18,563.73 O Separate Billing Requested..... ... 7, 8. Total Gross Assets (total Lines 1 through 7) ... ....................... ... 8. 250,228.73 9. Funeral Expenses and Administrative Costs (Schedule H) ..... . ........... .. 9. 8,401.55 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ......... 10 .. .... .. . 39,642.16 11. Total Deductions (total Lines 9 and 10) -`-"~""`' ........... .................... .. 11. 48,043.71, Net Value of Estate (Line 8 minus Line 11) ..... _ 13. . Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been d 12 02,185.02- _. .r . ma e (Schedule J) ...................... ..13. 14. Net Value Subject to Tax (Line 12 minus Line 13) . ~~~ ~ ............ . ........ TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES .. 14. 202,185.02 ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. Amount of Line 14 taxable ~---- 15. at lineal rate X .0,_ 4.50 i 16 17. Amount of Line 14 taxable ' 9,098.33 at sibling rate X .12 ~ ~ - 18. Amount of Line 14 taxable _ 17. at collateral rate X .15 ~ 18. ,___..._______.._._....___._ ______.._._~___~_._r_- 19. TAX DUE ............... ..........................................1s.'- __- 9,098.33 __. _-_ _ -. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O L side 2 1505610205 1505610205 REV-1500 EX (FI) Page 3 Decedent's Complete Address: Flle Number DECEDENTS NAME Natalie Ann Klee STREETADDRESS _ 2110 Page Street clrr Camp Hill STATE PA Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments (1) _ A. Prior Payments B. Discount 3. Interest Total Credits (A + B) (2) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (3) F111 in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) Make check payable to: REGISTER OF WILLS, AGENT ZIP 17011 098.33 9,098.33 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: a. retain the use or income of the ro Yes No P Perty transferred ............................................................................. ^ b. retain the right to designate who shall use the ro """"""' P Perty transferred or its income ........................ ^ c. retain a reversionary interest .............................................. .................... d. receive the promise for life of either payments, benefds or care? ................. ~~~~~~~~~~~~~~~~~~~~~~ 2. If death occurred after Dec. 12, 1982, did decedent transfer ro ~~~~~~~~~~~~~~~~~~ without receiving adequate consideration? ............. P ~~ within one year of death 3. Did decedent own an "in trust for" orpayable-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) (i)]. 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) (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)]. • 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 Hated in (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 at least one parent in common with the decedent, whether by blood or adoption. REV-1737-2 EX + (6-08) (FI) Pennsylvania SCHEp11LE A, PART 1 DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN IN PENNSYLVANIA NONRESIDENT DECEDENT FILE NUMBER Natalie Ann Klee ~~~ Part 1 must include all real property owned by the decedent individually or as a tenant in common with another party(ies), having its situs in Pennsylvania. Property jointly-owned with right of survivorship should be disclosed on Schedule F all ~o~l o~•,.~ ...,..,.. ~_ reported at fair market value. which is ~afho~ ~~ .~,,..._:__ _.._ ._. . - - r-r-• ~• .~~~ aan~C JIL6~ REV-i5o8 EX+ (11-SO) Pennsylvania ~i7 DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDI~LE E CASH, BANK DEPOSITS & MISC. PERSONAL PROPERTY es1ATE OF: Natalie A. Klee FILE NUMBER: Include the proceeds of litigation and the date the proceeds were received by the estate. All arooerty iointly nwna.l ..drti r~~. _s __.__.___ -_ _..---- -• r..r..~ ~~ u~c amne Size. - I i REV-iSo9 EX+ (oi-io) Pennsylvania DEPARTMENT OF REVENUE INHERn'ANCE TAX RETURN RESIDENT DECEDENT CCTw'TC nr. SCI~IEDI~LE F JOINTLY-OWNED PROPERTY Natalie Ann Klee FILE NUMBE ~~~ If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A• Patrice Klee Fehl 35 Eastgate Drive Camp Hill, PA 17011 17011 B. C. JOINTLY OWNED PROPERTY: Lei ieR DATE ITEM FOR JOINT MADE NUMBER TENANT ]OINi DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR % OF DATE OF DEATH I A IDENTIFYING NUMBER. ATTACH DEED FOR IOINTLY HELD REAL ESTATE. _ - DATE OF DEATH VALUE OF ASSET DECEDENT'S VALUE OF , . 12/19/05 .Members 1st 276808 -Savings INTEREST DECEDENT'S INTEREST 4,444.28 50 2,222.14 12/19/05 !Members 1st 276808 -Checking 5,980.53 50 2,990.27 12/19/05 Members 1st 276808 -Savings 4,275.36 50 2,137.68 02/25/08 PSECU 191268195 5,390.61 50 - 2,695.31 02/25/08 PSECU 191268195 17,036.65 50 8,518.33 TOTAL (Also enter on Line 6, Recapitulation) ; ', 18,563.73 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ (10-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF G`~'"'~/ ~~/ ~U~C~ ITEM NUMBER A, FUNERAL EXPENSES: I' Myers Harner Funeral HOme Pealer's Flowers Food Service Cards 800.00 400.00 5~ Accountant Fees: 550.00 6, Tax Retum Preparer Fees: B. ADMINISTRATIVE COSTS; 1• Personal Representative Commissions: Name(s) of Personal Representative(s) ,18meS MCDonnald __.-- Street Address city Hummlestown state PA zIP _ Year(s) Commission Paid: $250 per' hour z• Attorney Fees: 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• 7, !~ TOTAL (Also enter on Line 9, Recapitulation) ; ~ 8,401.55 If more space is needed, use additional sheets of paper of the same size, SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS FILE ueceaent's debts must be reported on Schedule I. DESCRTOTtnN 5,312.00 222.55 975.00 142.00 REV-1512 EX+ (12-08) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS FILE NUMBER Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbu rsed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1• American HomePatient 13.44 Bill Pay 23.70 Brockie Pharmatech 71.15 !.East Pennsboro Ambulance 90.40 West Shore EMS 200.00 Holy Spirit Hospital 70.00 The Homeland Center 3,053.08 The Woods 1,098.79 Pinnacle Health Hospitals 70.00 East Pennsboro Ambulance 85.00 IRS 4,250.00 Janet Miller, Tax Collector 1,088.84 Property Tax 2,658.65 Michael Dickson 400.00 Borough Cam phill Sewer 750.00 PAWC 124.30 Penn Waste 229.25 PP&L 401.27 : Kemper Insurance 439.00 FreeFlow 175.00 GT Watts 52.50 UGI 1,350.05 Verizon 5.74 TOTAL (Also enter on Line 10, Recapitulation) # 16,700.16 , If more space is needed, insert additional sheets of the same size. REV-1512 EX+ (12-08) '~ i~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS w~n~C yr Natalie Ann Klee FILE NUMBER Report debts incurred by the decedent prior to death that remained unpaid at the date of death ITEM i l di ~ ~ NUMBER , nc u ng u nreimbursed medic ex es. DESCRIPTION VALUE AT DATE 1' Carpet Cleaning OF DEATH Repair Window and Screen 163.00 Celing Repair 160.00 .:Flooring Replacement (Basement) 850.00 Toilet Replacement (Basement) i 1,200.00 . Pool Liner ', 1,220.00:. _ Projected Realtor Fees 4,399.00 Misc Repairs and Paint 12,000.00 Settlement Fee 675.00 deed 150.00 Closing Costs 125.00 2,000.00 ' __ TOTAL (Also enter on Line 10, Recapitulation) ; 22 942 00 If more space is needed, insert additional sheets of the same size. , . REV-1513 EX+ (01-10) pennsytvania ~i7 DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT wrnre oF: Natalie Ann Klee SCHEDULE ~ BENEFICIARIES NUMBER NAME AND ADDRESS OF PERSON(S) RECENING PROPERTY I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1~ Patrice Klee Fehl Kateri Martin Pamela Gracey FILE NUMBER: /'D8~ RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE Daughter 1 /3 Daughter 1/3 - Daughter 1/3 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF 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, B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. If more space is needed, use additional sheets of paper of the same size. #