HomeMy WebLinkAbout11-29-11, r
REV-1500 Ex (oz-u)(FI)
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania
Bureau of Individual Taxes ~""~~~`~ ~ County Code Year File Number
PO BOX z8D6oi ~ INHERITANCE TAJC RETURN ~ 1 (} G~ ~~
Harrisburg PA >_~i28-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
517-52-1105 11 /14/2010 06/03/1946
1505610105
Decedent's Last Name
Engberg
(If Applicable) Enter Surviving Spouse's Information Below
Suffix Decedent's First Name
Larry
MI
A
Spouse's Last Name Suffix Spouse's First Name MI
Engberg Diane E
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
198-44-8968 REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
QD 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)
O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust ~ 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 COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
Taylor P Andrews, Esq (717) 243-0123
First Line of Address
78 W Pomfret St
Second Line of Address
City or Post Office
Carlisle
State ZIP Code
PA 17013
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REGISTER OF ,~~M~ USE ONLY
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DATE FILED { •, ~
Correspondent's a-mail address: tpandreWS a~pa.net _
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.
SIGN OF P- ERSON REpPON LE FOR LING RETURN /' ~A~ ' / /
ADDRESS ° ~
4129 EnolaRoad.,,Pl~wville,~ 17241
~ -~ ~-
St, Carlisle, PA 17013
1505610105
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610105
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1505610205
REV-1500 EX (FI)
Decedent's Social Security Number
decedent's Name: Larry A Engberg 517-52-1105
RECAPITULATION
1. Real Estate (Schedule A) ........................................... .. 1. 134,300.00
2. Stocks and Bonds (Schedule B) 2. 0.00
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 0.00
4.
9 ( ) .........................
Mort ages and Notes Receivable Schedule D 4.
.. 0.00
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. 0.00
6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. 0.00
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
016
38
136
(Schedule G) O Separate Billing Requested...... .. 7. ,
.
8.
9 ) ...........................
Total Gross Assets (total Lines 1 throw h 7 8.
.. 270,316.38
9. Funeral Expenses and Administrative Costs (Schedule H) ................. .. 9. 11,081.65
10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............. .. 10. 6,662.88
11. Total Deductions (total Lines 9 and 10) ............................... .. 11. 17,744.53
12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 252,571.85
13. Charitable and Governmental BequestslSec 9113 Trusts for which
00
0
an election to tax has not been made (Schedule J) ...................... .. 13. .
14.
1 ( ) ......................
Net Value Sub'ect to Tax Line 12 minus Line 13 14.
.. 252,571.85
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116 194,294.12
(a)(1.2) X .0 0
15.
0.00
16. Amount of Line 14 taxable
at lineal rate X .0 45 58,277.74
16.
2,622.50
17. Amount of Line 14 taxable
00
0
.
at sibling rate X .12 17.
18. Amount of Line 14 taxable 0
00
.
at collateral rate X .15 18•
19. TAX DUE .........................................................19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
1505610205
Side 2
1505610205
2,622.50
O
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REV-1500 EX (FI) Page 3
rlpr_arl~an+'c CemDlete Address:
File Number
DECEDENTS NAME
Larry A Engberg
STREET ADDRESS
4129 Enola Road
CITY
Newville STATE
PA ZIP
17241
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. CreditslPayments
A. Prior Payments
B. Discount
3. Interest
0.00
0.00
4. If Line 2 is greater than Line 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.
Total Credits (A + B) (2)
(3)
(4)
(5)
2,622.50
0.00
2,622.50
Make check payable to: REGISTER OF WILLS, AGENT.
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 .................................................................................... ...... ^
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 "intrust 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) (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)J. 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 noted in [72 P.S. §9116(a)(1)J.
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.
SCHEDULE A
REAL ESTATE
ESTATE OF
FILE NUMBER
Larry A. Engberg 21-11-0481
All real estate owned solely or as a tenant in common should be reported at fair mazket value with is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to sell, both having rea:>onable knowledge of the relevant facts.
Property jointly-owned with Right of Survivorship must be disclosed on Schedule F.
ITEM DESCRIPTION VALUE AT DATE
NUMBER OF DEATH
1 Land and house at 4129 Enola Road, Upper Frankford Township, Cumberland County $134,300.00
parcel: 43-11-3069-007
Deed attached
common level ration for Cumberland County = 1.00
Property was destroyed by a fire on 12/25/2010 with no insurance
Total (also enter on Line 1, Recap) $134,300.00
THIS DEID
t~WDE Tf3E ~ < " ` " ~`="'~ t~ day of ~ (r ~ ~ in the year of
our Lord one thousand nine hundred ninety-ode (1991)
BETWEEN 'LARRY A. ENGBERG and DONNA J. ME.ASE, his wife, N
hereinafter Grantor(s) ~
AND LARRY A. ENGBERG,
hereinafter Grantee(s) ~
C!7
N
WITNESSETH, that the Grantor(s), for and in consideration of the sum of One
and 00/100 Dollars, ($1.00) lawful money of the United States of America, unto
LARRY A. ENGBERG and DONNA J. MEASE well and truly paid by the Grantee(s), at
and before the sealing and delivery of these presents, the receipt whereof is
hereby acknowledged, the Grantor(s) have remised, released and quit-claimed,
and by these presents do remise, release and forever, ouit-claim unto the said
Grantee(s), his heirs, assigns and successors
ALL that certain tract of land situate in the Village of Bloserville, Upper
Frankford Township, County of Cumberland and State of Pennsylvania, bounded
and described as follows:
BEGINNING at a point in the middle of the public road leading from Bloserville
to Roxbury, which point is also a corner of land now or formerly of Raymond
Fry; thence Southwardly along lands of said Fry, a distance of 21.2 feet to a
point; thence still along lands of said Fry, South 85 degrees East, 147.8 feet
to a point in the center of an alley; thence along the center of said alley,
South OS degrees West, a distance of 161.2 feet to a point in line of lard of
said Raymond Fry; thence along land of said Raymond Fry, North 85 degrees
west, 196.5 feet to a point in line of land of the Evangelical United Brethren
Church; thence along land of the said Ewangel.ical United Brethren Church,
North OS degrees East 74.5 feet to a point; thence still along property of
said Church, North 19 1/2 degrees West, 74.6 feet to a point in the center of
the aforesaid public road; thence in a Northeastwardly direction along the
center of said public road, a distance of 78 feet to a point, the place of
BEGItA1ING.
BEING improved with a frame dwelling house, barn, garage, shop building and
other improvements.
BEING the same premises which Michael L. Stum and Sue E. Stum, his wife, by
deed dated October 11, 1988 and recorded in Cumberland Count Deed Book "P",
Vol. 33, Page 710, granted and conveyed to Larry A. Engberg and Donna J.
Mease, Grantors herein.
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BOOK 3S PAGE 803
a
THIS is a tax exempt transfer of property from Husband and Wife to Husband
pursuant to the Settlement Agreement.
TOGETf~ft with all and singular, the tenements, hereditaments and appurtences
to the same belonging, or in anywise appertaining, and the reversion and
reversions, reminder and reminders, rents, issues and profits thereof; and
also, all the estate, right, title, interest, property claim and demand
whatsoever, both in law and equity, of the said parties of the first part, of,
in to br out of the said premises, and every part and parcel thereof.
~ HAVE AND 'IU HOLD the said premises, with all and singular the appurtences,
unto the said Grantee(s), his heirs and assigns, to and for the only proper
use and behoof of the said Grantee(s), his heirs, assigns and successors
forever.
IN WITNESS WHEREOF, the sa=d Grantor(s) has/have hereunto set their hands and
seals the day and year first above written.
SIGNID, SEALED AND DELIVEREp IN
THE PRESENCE OF:
-- t~z~:3'~ " `'~~- (seal )
___-__ ~ LARRY A!ENGgERG
-(seal)
DON*IA J. E
STATE OF PENNSYLVANLA
COUNTY OF CUMBERLAND ~ SS.
On this, the ~tc+f` day of -~ , 1991, before
me, the undersigned officer, personally appeared LARRY A. ENGBERG knovm to me
(or satisfactorily proven) to be the person whose name subscribed to the
within instrument, and acknowledged that he executed same for the purposes.; ~~;°~_,~
therein contained.
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In witness hereof, I here -set ~`'~t••
-my-hand\ official se~1:=''}~~~;)., -
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Y ~r i r .,1 A i l
~_ NoWnxl Seel
Steven J.Fishm~.r.,NotaryPublK ~~ "'
Grlisle Boro, CumberWnd ;aunty ~~'
My Comm~~ron E.yros Juty 20,1391
Member, PennsyMana ,tisocia4cn of Nalaries-.
oooK ~ 35 rncE 804
SCHEDULE G
TRANSFERS
ESTATE OF
Larry A. Engberg
FILE NUMBER
21-11-0481
This schedule to be completed and filed if the answer of the question on the revl:rse of the cover is yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
MCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT
AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. TOTAL VALUE
OF ASSET DECD.%
II1T EXCLUSION
(if applicable) TAXABLE
VALUE
1 TIAA 1H6038R7 Diane Engber $132,435.08 100.0% 0.0% $]32,435.08
Dickinson College Defined Wife
Contribution Retirement Plan
2 TIAA A5967359; CREF: P5967356 Diane Engber $3,547.69 100.0% 0.0% $3,547.69
Dickinson College Defined Wife
Contribution Retirement Plan
3 CREF P5967356 Diane Engber $33.61 100.0% 0.0% $33.61
Dickinson College Tax Deferred
Annuity Plan
TOTAL (also on line 7, Recapitulation) $136,016.38
TIAA
CREF
FINANCIAL SERVICES
November 15, 2011
PST6790?680
liulll~i~li~lili~iilnillililil
Estate of
Larry A. Engberg
C/O Diane E. Engberg
4126 Enola Road
Newville PA 17241
Re: Valuation of Annuity Contract(s)/Certificate(s) at Decedent's Date of Death
Dear Diane E. Engberg,
You have requested the value of the amluity contract(s)/certificate(s), held by TIAA-CREF, on the date of
death of Larry A Engberg. This statement has been prepared for you based on the following information:
Name of Decedent: Larry A Engberg
Decedent's Date of Birth: 06/03/1946
Decedent's Date of Death: 11/14/2010
VALUE OF ANNUITY CONTRACT(S)/CERTIFICA'TE(S) AT
DECEDENT'S DATE OF DEATH
Contract/Certificate Date of Death
Number Value of the
ContracbCertificate
IH6038R7 $132,435.08
A5967359 $3,547.69
P5967356 $33.61
Total Date of Death $136,016.38
Value
Investment in $0.00
Contract Total Value
TIAA-CREF Individual & Institutional Services, LLC Member FINRA, SIPC. BENEBLTND - VD
Headquarters: 730 Third Avenue, New York 10017-3206 Tel: 212-490-9000
SCHEDULE H
FUNERAL EXPENSES, ADMINISTRATIVE
COSTS AND MISCELLANEOUS EXPENSES
ESTATE OF FILE NUMBER
Larry A Engberg 21-11-0481
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. Funeral Expenses:
1 Ewing Brothers $4,056.49
2
g, Administrative Costs:
1 Personal Representive Commissions
Name of Personal Representative(s)
Social Security Number of Personal Representative:
Street Address:
City: State: Zip:
Year(s) commissions paid:
2 Attorney fees to Andrews & Johnson $3,000.00
3 Family Exemption $3,500.00
Claimant Diane Engberg
Street: 4129 Enola Road
City: Newville State & Zip PA 17241
Relationship of Claimant to Decedent: Wife
4 Probate Fees to Register of Wills $250.00
5 Accountant Fees
6 Tax Return Preparer's Fees
7 Advertising of Letters $275.16
8
9
10
11
12
13
14
15
16
17
18
19
TOTAL (also online 9, Recapitulation) $11,081.65
SCHEDULE I
DEBTS OF DECEDENT
MORTGAGE LIABIL(T[ES AND LIENS
ESTATE OF FILE NUMBER
L A. En ber 21-11-0481
Report de is incurred by the ecedent pnor to death which remained unpaid as of a date of death, including unreimbursed medical expenses.
ITEM DESCRIPTION VALUE AT DATE
_ ._ ._ _rr„ OF DEATH
Carlisle Propane $59.34
Adams Electric $319.54
Dr. Philip Carey $20.00
Trash bill $76.08
G.S. Harris -taxes $87.60
Kough's Oil $500.00
Doubleday Book Club $181.09
Mystery Guild Book Club $154.48
.Real Estate Taxes $5,264.75
TOTAL (also on line 10, Recapitulation) $6,662.88
SCHEDULE)
BENEFICIARIES
FILE NUMBER
ESTATE OF
21-11-0481
L A. En ber
ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR SHARE
NUMBER Do Not List Trustre(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, end vansfers under Sec. 9116(x)(1.2)]
1/2 of Probate Estate
1 Diane Engberg, 4129 Enola Rd., Newville, PA ] 7241 Wife
114 of Probate Estate
2 Eric Enberg, 4139 Brenmar Lane, Durham, NC 27713 Son
i /4 of Probate Estate
3 Andrew Engberg, 3952 Walnut St., Harrisburg, PA 17109 Son
II NON-TAXABLE DISTRIBU rwns:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
Charitable and Governmental Bequests:
$0
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (also enter on line 13, Recapitulation)