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Home My WebLink About12-06-11Ex (01-10) 1505610143 J REV-1500 .~. PA De artment of Revenue ~ OFFICIAL USE ONLY p Pennsylvania County Code veer File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE Po Boxzsoso~ INHERITANCE TAX RETURN 21 11 0 0 9 3 6 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 124 34 1376 07 19 2011 03 09 1944 Decedent's Last Name Suffix Decedent's First Name MI SMITH GLORIA J (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW ® 1. Original Retum ^ 4. Limited Estate ® 8 Decedent Died Testate (Attach Copy of Will) ^ 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS ^ 2. Supplemental Retum ^ 4a. Future Interest Compromise (date of death after 12-12-82) ^ ~ Decedent Maintained a Living Trust (Attach Copy of Trust) ^ 1 ~ Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) ^ 3. Remainder Return (date of death prior to 12-13-82) ^ 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes CORRESPONDENT -THIS SE~"TION MUST BE COMPLETED. ALL Name THOMAS A CAPPER First line of address 2303 MARKET STREET Second line of address City or Post Office CAMP HILL AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Daytime Telephone Number 717 232 8731 r,., State ZIP Code PA 17011 ~~ r*~ 7 r ;; -;-; ;'-r'~ _.~ Correspondent'se-mail address: capper@bmC-law.net Under penalties of pery'ury, I decl$re that I have examined this return, inGuding 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 oreoarer has env knowledge. V RC I VRIV DAT1E n ~ ,,,~ ,t_-~ ~ Dawn Arcati 1a. I ,~~ ~a~"j 154 Martel Circle, Dillsburg, PA 17019 SIGNAT~ OF PREPAR~OT~ THAN REPRESENTATIVE Thomas A Capper ^ 11. Election to tax under Sec. 9113(A) (Attach Sch. O) c~ ,___ _~. REGISTER OF.S USE (Y r? ~ ~ ~ c-~ _' v~ ~"` ,. -' c`> _~ ,:~ ~ ~ t _ _..~ .. L~ ,. DATE FILED DATE 0 ADDRESS 'V V 2303 Market Street, Camp Hill, PA 17011 Side 1 1505610143 1505610143 1505610243 REV-1500 EX Decedent's Name: SMITH , G L O R I A) Decedent's Social Security Number 12 4 3 4 13 7 6 RECAPITULATION 143,000.00 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 & Notes Receivable (Schedule D) ........................................................ .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .............. .. 5. 5 0 0 . 0 0 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ........... .. 6. 6 6 6 . 5 3 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ........... .. 7. g. Total Gross Assets (total Lines 1-7) .................................................................... ... 8. 1 4 4 , 16 6 . 5 3 2 9 , 8 2 6 ' 7 7 9. Funeral Expenses & Administrative Costs (Schedule H) ...................................... ... 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................. ... 10. 4 0 , 5 7 2 . 7 4 11. Total Deductions (total Lines 9 & 10) .................................................................. .... 11. 7 0 , 3 9 9.51 12. Net Value of Estate (Line 8 minus Line 11) ......................................................... .... 12. 7 3 , 7 6 7 . 0 2 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) .............................................. ... 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ............................................. .... 14. 7 3 , 7 6 7 . 0 2 TAX COMPUTATION - SSE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .00 15. 16. Amount of Line 14 taxable 0 2 7 6 7 7 3 16. . , at lineal rate X .045 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. Tax Due ................................................................................................................... .. 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505610243 1505610243 3,319.52 3,319.52 REV-1500 EX Page 3 File Number 21 - 11 - 00936 v`v`v ..............r._-- - ---- --- N A Smith, Gloria J STREET ADDRESS 584 Brighton Place STATE ZIP CITY PA 17055 Mechanicsburg Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest Total Credits (A + B) (1) 3,319.52 (2) 0.00 (3) 0.00 (4) (5) 3,319.52 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box 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. Make Check Payable to: REGISTER OF WILLS, AGENT. «/. h 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 :.................................................................................. ^ ^x b. retain the right to designate who shall use the property transferred or its income :.................................... ^ c. retain a reversionary interest; or .................................................................................................................. x d. receive the promise for life of either payments, benefits or care? .............................................................. ^ ^x 2. If death o6curred after December 12, 1982, did decedent transfer property within one year of death without ^ ^ receiving adequate consideration? ....................................................................................................................... x 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... ^ ^x 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 January 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) n)]. '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 ears 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) p2 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) . A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, wfiether by bloo or adoption. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF Smith, Gloria J FILE NUMBER 21 - 11 - 00936 All real property owned solelyy ort as a tenant in common must be reported at fair market value. Fair market value is aermea as uie N~wC at which property would be exchartged between a willing buyer and a wilting seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on schedule F. Attach a copy of the settlement sheet if the property has been soldl. Include a copy of the deed showing decedent's interest if owned as tenant in common. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 584 Brighton Place, Mechanicsburg, PA 17055 -condominium residence. Value per sale to unrelated third party. (See Attached Settlement Statement -HUD-1) 143, 000.00 TOTAL (Also enter on Line 1, Recapitulation) ~ 143,000.00 SCHEDULE E CASH, BANK DEPOSITS, 8~ MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Smith, Gloria J FILE NUMBER 21 - 11 - 00936 Include the proceeds of litigation end the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 ~ Miscellaneous clothing and personal possessions. 500.00 TOTAL (Also enter on Line 5, Recapitulation) ~ 500.00 SCHEDULE F COMMONWEAL1fH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Smith, Gloria J 21 -11 - 00936 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT($) NAME ADDRESS RELATIONSHIP TO DECEDENT Dawn Arcati 154 Martel Circle Daughter A Dillsburg, PA 17019 OINTLY OWNED PROPERTY" J ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE I JOINT DESCRIPTION OF PROPERTY nclude name of financial institution and bank account number r imilar identifying number. Attach deed for jointly-held real estat DATE C1F DEATH 1/ALUE OF ASSET . I % OF DECD'S NTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST 1 A 11/29/20016 Metro Bank Checking Account 764.33 50% 382.17 Account No. 537571515 2 A 11/29/2006 Metro Bank Savings Account 56$.72 50% 284..36 Account No. 626900724 TOTAL (Also enter on line 6, rtecap~tuiation~ I ooo.~s COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN S(~-EDUI..E H FUNERAL E)~ENSES ~ ESTATE OF Smith, Gloria J FILE NUMBER 21 - 11 - 00936 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION NUMBER FUNERAL EXPENSES: A. 1 Myers-Buhrig Fungal Home and Crematory 37 E. Main St., Melchanicsburg, PA 17055 AMOUNT 8,402.00 B. ADMINISTRATIVE (IOSTS: ~ . Personal Representative's Commissions Name of Personal Representative(s) Dawn Arcati Street Address 154 Martel Circle City Dillsburg State PA Zip 17019 Year(s) Commissidn paid n/a 2. Attorney's Fees '6811, Murren & Connell -Estimated Fees and Costs 3, Family Exemption: (It decedent's address is not the same as claimant's, attach explanation) Claimant Jody Smith street address 3 Walmar Manor City Dillsb~rg State PA Zip 17019 Relationship of Claimant to Decedent SOn 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7, Other Administrative Costs 1 Carpet & Tile Malt, 5103 Carlisle Pike, Mechanicsburg, PA 17050 New carpet & labor costs for listing and sale of real estate 0.00 2, 500.00 3, 500.00 313.50 849.34 TOTAL (Also enter on line 9, Recapitulation) 29,826.77 Schedule H Funeral E~er>ISes & COMMONWEALTH OF PENNSYLVANIA w~.~N ^~ INHERITANCE TAX RETURN !'ILA 1 ~111.7YAYYC VIJO~ RESIDENT DECEDENT ESTATE OF Smith, Gloria J 2 Stanley Steemer, 11960 E. College, Bellefonte, PA 16823 Cleaning of real estate in preparation for listing and sale 3 Closing costs/settlement charges -See Attached Settlement Statement. $23,732 (Line 502) minus Escrow $9,652.50 (Line 1114) _ $14,079.61 FILE NUMBER 21 - 11 - 00936 182.32 14,079.61 Page 2 of Schedule H Schedule H Estate of Smith, Gloria J. File Number 21-11-00936 Family Exemption Continuation Jody Smith, the san of the decedent, resided in the same household as the decedent at the time of decedent's death. Mr. Smith resided in the decedent's household (584 Brighton Place, Mechanicsburg, Pi417055) from June 2009 until August 15, 2011, at which time he vacated the residence so that it could be prepared for sale. Mr. Smith's current address (3 Walmar Manor, Dillsburg, PA 170]9) is listed on Schedule H, 6.3. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF Smith, Gloria J FILE NUMBER 21 - 11 - 00936 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM DESCRIPTION AMOUNT NUMBER 1 Mortgage to Metro Bank on real estate: 40,572.74 584 Brighton Place, Mechanicsburg, PA 17055 (See Attached Settlement Statement -HUD-1, Line 504) 2 TOTAL (Also enter on Line 10, Recapitulation) 40,572.74 REV-1513 EX+ (11-08) SCHEDULE) COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITAIVCE TAX RETURN RESIDENT DECEDENT ESTATE OF Smith, Gloria J NUMBER NAME AND AD RESS OF PERSON(S) RECEI ING PROPERTY I~ TAXABLE DISTRIBUTI~NS[include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 Holly Mahler 10 Colby Road Plattsburg, NY 1202 2 Jody Smith 3 Walmar Manor Dillsburg, PA 17019 3 Dawn Arcati 154 Martel Circle Dillsburg, PA 17019 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Daughter Son Daughter FILE NUMBER 21 -11 - 00936 >HARE OF ESTATE AMOUNT OF ESTATE (Words) ($$$) Gne-half of the residuary estate Gne-half of the residuary estate Enter dollar amounts fort distributions shown above on lines 15 through 18 on Rev 1500 cover sheet, as appropriate. II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBIUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 600.00 TOTAL OF PART II -TENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEETI 0.00 REV-1513 EX+ (9-00) . SCHEDULE) COMMONWEAL1fHOFPENNSYLVANIA BENEFICIARIES continued INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Smith, Gloria J NUMBER NAME RECEIV NG PROPERTY ON(So) I~ TAXABLE DISTRIBUTIONS[di str butions~9and transfers under Sec. 9116 (a) (1.2)] 4 Margaret Solomon' 1022 Level Creek Road Sugar Hill, GA 30518 FILE NUMBER I 21 -11 - 00936 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE DECEDENT (Words) (~) Do Not List Trustee(s) Daughter 0.00 Page 2 of Schedule J