HomeMy WebLinkAbout11-30-11 (2)~ ~
1505610105
REV-1500 ~ (oz-u) (FI)
IAL USE ONLY
FFI
PA Department of Revenue O
C
Pennsylvania
„FP W, a~~t~~t County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO BOX z8o6oi
Harrisburg, PA 1~iz8-o6oi
RESIDENT DECEDENT ~ ~ ~~ ~b
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
180-01-9759 "! 07/18/2011 09/25/1916
Decedent=~ Last Name Suffix Decedent's First Name MI
BLACK SARA E
_
__ _
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last 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. Oiriginal 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)
CiD 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes
(P,ttach 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 Daytirne Telephone Number
H Anthony Adams (71 i') 532-3270
First Line of Address
49 West Orange Street
Second Line of Address
Suite 3
City or Post Office State ZIP Code
Shippen~sburg PA 17257
Correspondent's a-mail address: htadamslaw@embargmail.com
REGISTERSTER S USE ONLY
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DATE FILED - ~
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Under penaB;ies of perjury, I tare that I hav mined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true correct and co .Dec do of reparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNA RE:p PE S SI L FOR FILING RETURN DATE
< as ~i
ADDRESS ~\ n • r n ~ _ •~-.
DATE
US-E~1 INAL FORM O LY
Side 1
15D5610105 1505610105
~~~~
1505610205
REV-1500 EX (FI) Decedent's Social Security Number
180-01-9759
Deczdent's Name:
RECAPflTULATION
50,000.00
1. Real Estate (Schedule A) ............................................. 1.
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. ! 8,467.74
6. Joimtly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested...... .. 7.
8.
( 9 ) ...........................
Total Gross Assets total Lines 1 throu h 7 8. •
.. 58,467.74
9. Funeral Expenses and Administrative Costs (Schedule H) ................. .. 9. 1,106.50
_.
10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............. .. 10. 30,045.64 '
11. Total Deductions (total Lines 9 and 10) ............................... .. 11. ' 31,152.14
12. Nclt Value of Estate (Line 8 minus Line 11) ............................ .. 12. 27,315.60
13. Charitable and Governmental BequestslSec 9113 Trusts for which
any election to tax has not been made (Schedule J) ...................... .. 13.
14. NE!t Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. ' 27,315.60
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Arnount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
-
16. Arnount of Line l4 taxable
at lineal rate X .0 45 27,315.60 16. 1,229.20 ;
17. Amount of Line 14 taxable ,
at sibling rate X .12
_ 17.
__ __
18. Amount of Line 14 taxable
at collateral rate X .15 18.
19. U1X DUE ...................................................... ... 19.
20. FALL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
O
Side 2
L 1505610205 ],505610205
REV-1500 EX (FI) Page 3 File Number
rlocorlan4'c ~mm~lptp Address:
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Paymeints
A. Prior Payments _ _____ _....____....
B. Discount
(1)
Total Credits (A + B) (2)
1,229.20
3. Interest
(3)
4. If Line 2 is gn;ater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4)
5. If Line 1 + Linel 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 1,229.30
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 "in trust for" or payable-upon~eath 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 noted 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-3508 EX+ (11-10)
'A~~i -`~' Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS & MISC.
PERSONAL PROPERTY
ESTA FILE NUMBER:
SARA E BLACK
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property iointly owned with right of survivorship must be disclosed on Schedule F.
If more space is needed, use additional sheets of paper of the same size.
REV-1512 EX+ (12-08)
~ Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
ESTAT FILE NUMBER
SARA E BLAICK
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
If more space is needed, insert additional sheets of the same size.
REV-1511 EX+ (10-09)
~ plennsylvania
m DEPARTMENT OF REVENUE
INtIERITANCE TAX RETURN
RE',iIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTAT~ FILE NUMBER
SARA E BLACK
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. Fl1NERAL EXPENSES:
1.
B.
1
i.
3.
4.
5.
6.
7.
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s) _._._-_...-_____..____
Street Address
City State _ _ ZIP
Year(s) Commission Paid: __ _
Attorney Fees:
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
Probate Fees:
Accountant Fees:
Tax Return Preparer Fees:
900.00
206.50
TOTAL (Also enter on Line 9, Recapitulation) I $ 1,106.50
If more space is needed, use additional sheets of paper of the same size.
LAST WILL AND TESTAMENT
I, Sarah E. Black, of Southampton Township, Cumberland County,
Pennsylvania, declare this to be my Last Will and Testament and revoke any
will or codicil previously made by me.
ITEM I: I direct that all my just debts and funeral expenses, including
my gravemarker and all expenses of my last illness, shall be paid from my
residuary estate as soon as practicable after my decrease as a part of the
administration of my estate.
ITEM II: I give, devise and bequeath all of my estate of every nature and
wheresoever situate to Isaac W. Black, providing he shall survive me
by thirty days.
ITEM III: Should my spouse, Isaac W. B"lack, predecease me or die on or
before the thirtieth day following my death, I give, devise and bequeath
all of my estate of every nature and wheresoever sii:uate to Isaac W. Black,
Jr. and Walter D. Coffey, their heirs and assigned :share and share alike.
ITEM IV: I direct that all taxes that may be assessed in consequence of
my death, of whatever nature and by whatever jurisdiction imposed, shall be
paid from my residuary estate as part of the expenses of the administration of
my estate.
ITEM V: I appoint Isaac W. Black executor of this my Last Will and
Testament. Should he fail to qualify or cease to a~~t as executor,
I appoint Isaac W. Black, Jr. and Walter D. Coffey, Co-executors of
this my Last Will and Testament.
ITEM VI: I direct that my executor or his successors shall not be
required to give bond for the faithful performance of their duties in any
jurisdiction.
IN WITNESS WHEREOF, I hereunto set my hand and seal to this my Last Will
and Testament, written on a~ sheets of paper, dated this 19th day of
November, 1991.
(SEAL)
Sarah E. Black
The preceding instrument, consisting of this and one other typewritten
page, each identified by the signature of the testatrix Sarah E. Black,
was on the day and date thereof signed, published and declared by Sarah E.
Black, the testatrix herein named, as and for her Last Will, in the presence
of us, who, at her request,. in her presence, and in the presence of each
other, have subscribed our names as witnesses hereto.
residing at /~~,,,cTV'Z.~C/(.~ p~
residing at ~,
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
SS
We , Sarah E . Black , ~~ n ~ ~.C~J~ ____ _ and ~6~~ ,
the testatrix and the witnesses, respectively, whose names are igned to the
attached or foregoing instrument, being first duly sworn, do hereby
declare to the undersigned authority that the testatrix signed and executed
the instrument as her Last Will and Testament and that she signed willingly
(or willingly directed another person to sign for her), and that she executed
it as her free and voluntary act for the purposes therein expressed, and
that each of the witnesses, in the presence and hearing of the testatrix,
signed the will as witnesses and that to the best of our knowledge, the
testatrix was at that time eighteen years or older, of sound mind and under
no constraint or undue influence.
G?/1~
Sarah E. 1 .
~ ~~_~~~~
Subscribed, sworn to and acknowledged,
by Sarah E. Black, the test trix _
and sworn to bef ore me by .~,~Q61, ttl~
and witnesses, this
19th day November, 1991.
ota Public
1V04~ria! ~~t i
~~Wira-c r '4-~~'1r ~',,;~
/ lira C,a-r ra ,•,~ , ;~-.
Thomas S. Mitros
Tom@Mitros.com
www.Shippensburg.com
12, 2011
her Walter Coffey. Originally we put a
~wered it t:o $55,000.00 but no offers
tance. My commission is 6%.
~~~ Homefinders
115 E. Nang Street
Shippensburg, Pennsylvania 17257-1360
Phone: (717) 532-6131, Fax: 532-4380
Each Office Independently Owned and Operated
~~~~ Thomas S. Mitros
4~v ' Tom(c~LMitros.com
www.Shippensburg.com
December 4, 2~ 10
Elizabeth Blac
604 Walnut Bo om Road
Shippensburg, a 17257
RE: Appraisal ~or: Elizabeth Black
604 Walnut bottom Road
Shippensburg, Pa 17257
Dear Mrs. Blac~C
In response to your request, I have inspected the subject property for the purpose of
estimating its Market Value.
Market Value ay be defined as the highest price, estimated in terms of money, which a
property will br~i'ng if exposed in the open market by a willing seller, allowing a
reasonable time' to find a purchaser who will willingly buy, both having knowledge of all
the uses to whi~h it may be adapted and for which it is capable of being used.
After consideri g relevant factors pertaining to the property, it is my opinion that its
Market Value a~ of December 4, 2010 to be SIXTY FIVE THOUSAND DOLLARS
($65,000).
Kindly accept ray sincere thanks for the privilege of serving you in this matter
Sincerely,
S.
RE/MAX
TSM/tb
~~~ Homefinders
115 E. King Street
Shippensburg, Pennsylvania 17257-1380
Phone: (717) 532-6131, Fax: 532-4380
Each Office Independently Owned and Operated
Identification of Subject Property
The subject property is located on .97 acres in Cumberland County at 604 Walnut
Bottom Road, Shippensburg, Pennsylvania. The subject property is a two story house
with attached rental unit. Parcel Id # 39-33-1883-049, Deed Book/Page 0013H/00419
Neighborhood
The subject property is in a rural residential neighborhood.
Building Description
The subject property is a two story brick farm house with an attached rental unit. The
house includes 3 bed rooms, one full bath. The main level consists oi' a living room,
kitchen, dining room and laundry. It has been maintained in fair condition.
Market Appraach
In analyzing the Market Approach, sales of comparable properties wc;re obtained from
current court house records and the subject property was compared to each of the sales.
Properties with this particular zoning are most similar; however, physical condition,
location, size and particular usage are too diverse to draw exact comparisons.
Comparable Sales:
Address Date Sold Sales Price Duplex
220 E King Street Oct 2010 $47,500 over/under
109 W Orange Street May 2010 $65,000 sideby/side
206 Roxbury Road June 2010 $75,000 side by/side
CE;rtification
I hereby certify that the subject property has been inspected and the pertinent and factual
data carefully analyzed.
Further, that I have no interest in the subject, financially or otherwise;, and that no fee for
services was contingent upon my findings. If you have any questions, please feel free to
call me. Thank you.
Sincerely, ~~__
Thomas S. Mitt~os,
Broker/Owner
C67~61'0945` .. ~ '~ Page 1 of 1
ReSldentla) SynOpSIS -Agent Ile~,II f °~°<llt' ire (~~alTil 05-Jul-2011
604 WALNUT BOTTOM RD SHIPPENSBURG . PA 17257-9648 4:03 pm
Status: ACTIVE
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List Price: E55,000 . ~a
- ~ ~;~ ; ~, ~ ' ~~'~
Ownership: Fee Simple -Sale '
BR/F6/HB: 3/1/0 ^~,.
Lot AC/SF: 0.97 / 42,253.00
Lvls/Fpls: 3 / 0
Tot Fin SF: 0 ,~u ~ ~"°'`
Tax Living Area: 3,112 ~
Year Built: 1900
Total Tax: $1,652
Tax Yr: 2010
Ground Rent:
Style: Farm House ®~+° ~~~
~~
o
Type: Detached ,+M;z,~4„
~~
Foreclosure: No Auction: No Potential Short Sale: No
Legal Sub: HOA Fee: / Tax Map: 39331883049
Adv. Sub: Lees Cross Roads C/C Fee: / Liber:
Model: Other Fee: / Folio:
C/C Proj Name: Parcel:
TotallMain Upr1 Upr2 Lwr7 Lwr2 Schools: BloCk/Square:
BR: 3 0 3 0 0 0 ES: Lot:
FB: 1 1 0 0 0 0 MS: ADC Map: 0013H-004 Area:
HB: 0 0 0 0 0 0 HS:
Exterior: Exposure:
Exterior Const: Astlestos, Brick Front Roofing:
Other Structures:
Lot Desc:
Basement: Yes, Cellar, Sump Pump
Parking: Dirt Driveway Gar/CrptlAssgd Spaces: //
Heating System: Hot Water Heating Fuel: Oil
Water: Public Hot Water: Electric
Cooling System: None Cooling Fuel: None
Sewer/Septic: Septic Soil Type:
Appliances:
Amenities:
HOA/C/C Amenitiesl:
List Date: 25-May-2011 Update Date: 05-Jul-2011 DOM-MLS: 41 DOM-Prop: 41
Remarks: House being sold in "as is" condition. Extensive termite damage, and leaking roof observed bey l isting agent. Electrical
service is fuse type .and needs upgrade.
Directions: NORTH ON WALNUT BOTTOM ROAD TO INTERSECTION OF KLINE ROAD AND WALNUT BOTTOM
Show Instructions: 24 Hour Notice, Appt Only-Lister, , -
Listing Co: RE/MAX Homefinders, RMAX95 Phone: (717) 532-6131 Fax: (717) 532-4380
Listing Agent: TONI MITROS Home: (717) 261-6129 Fax: (717) 532-4380
Office: (717) 532-61131 Pager: Cell: (717) 261-6129
Owners: BLACK Home:
Show Contacts: TOM MITROS Home:
Sub Comp: 0 Buy Comp: 2% Add'I: Dual: 1( DesR: N VarC: N
Copyright (c) 2011 Metropolitan Regional Information Systems, Inc.
Information is believed to be accurate, but should not be relied upon without verification. ~
Accuracy of square footage, lot size and other information is not guaranteed.
..~
penn~y~vania
DEPARTMENT OF PUBLIC WELFARE
July 27, 2011
H ANTHONY ADAMS
49 W ORANGE ST
SHIPP'ENSBURG PA
ESQUIRE
17257
Re: Sara Black
CIS #: 061716330
SSN: ###-##-9759
Date of Death: 07/18/2011
Dear P~Ir. Adams:
Please be advised that the Department of Public Welfare maintains a claim in the
amount of $28.155.27 against the above-mentioned estate. This claim is for restitution of
medic~afassistance granted on behalf of the decedent for which the Probate Estate is now
responsible to reimburse the Department according to Act 49, 62 P.S. 1412, effective
~- August 15-=I994,~ as amended by Act 20-95, effective June 30, 1995. Enclosed is the
Department's itemized statement of claim.
A portion of this medical expense, namely X19.835.74, was incurred during the last
six months of the decedent's life; therefore, it is a Class 3 claim pursuant to Section 3392 of
the Decedents, Estates, and Fiduciaries Code, 20 Pa. C.S.A. 3392(3). The balance of the
claim, namely $8,$19.53, is to be entered as a priority Class 5.1 claim against the estate.
Please acknowledge receipt of this letter and advise whether the Commonwealth's
claim is admitted and when payment may be expected. If the estate accounting is
complete, please provide a copy. If the estate contains real estate, please provide
copieaa of the deed, the latest tax assessment, and a current appraisal, if available.
Sincerely,
~ y' `~ ~.:..:~ ~
i
Jessica L. Strawbridge
TPL Program Investigator
717-772-6238
717-772-6553 FAX
Enclosure
Bureau of Program Integrity ~ Division of Third Party Liability ~ Recovery Section
PO Box 8486 ~ Harrisburg, Pennsylvania 17105-8486