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Home My WebLink About11-29-111505610143 REV-1500 Ex(°'_'° OFFICIAL USE ONLY PA Department of Revenue Pennsylvania County Code veer File Number Bureau of Individual Taxes 0e'"""°1OF ~ I ~ i ~ ~ ~ to j Po Box.28osot INHERITANCE TAX RETURN 1 D Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 326 10 1434 06 23 2010 09 11 1.913 Decedent's Last Name Suffix Decedent's First Name MI WINTERS JOHN K (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 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 1 Original Return ~ 2 Supplemental Return ~~ 3 Remainder Retum (date of death prior to 12-13-82 4 Limited Estate ~ 4a Future Interest Compromise ~~ 5 Federal Estate Tax Return Required (date of death after 12-12-82 0 8 Decedent Died Testate ~ ~ Qeceder~t Py ints~jN$t a Living True ~_ 8 Total Number of Safe Deposit Boxes (Attach Copy of Will (Attach o of 9 Litigation Proceeds Received ~ 10 ~po~e~PS~"~~ ~j~ ~d't~datsesof death C~ 11 Election to tax under Sec. 9113(A (Attach Sch. 0 CORRF~PONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTWL TAX INFORMATION SHOULD BE DIRECTED TO Name Daytime Telephone Number GARY L JAMES ESQ 717 533 3280 REGISTEI. yr ~~n.w aiv~ ..NLY First line of address ~ ~~_ T_ 13 4 S I PE AVENUE t~ ~ ~ j ~=. r-- Second line of address ~ rr'1 r~.y c;~~c~~l~ ~ ~~~3 DATA _.,. r~ City or Post Office State ZIP Code ;~ ~~ ~"" ~= FiUt~LSTOWN PA 17 03 6 D --~ ~`? i-_._ rn c~~ "~~ , ComespondenYs e-mail address glli~SOC.COm Under penalti of perju I tare that I have ~ in is return, inGuding accompanying schedules and statements, and to the best of my knowledge and belief it is true, and co pl . DeGaratio a other than the personal representative Is based on all information of which preparer has any knowledge SIGNA E O PERSO PONSI FOR FI ETURN DATE John E. Winters ~ ~ ~ ~ ~ 1 132 Hancock Avenue, Vandergrift, PA 15690 _ SIGN RE OF PREPARER OTHER THAN REPRESENTATNE DATE ,~~. /~~ _ _ ~-_ Gary L. James Esq. J/_~ -'~~ !/ 134 1505610143 PA Side 1 1505610143 J .-~~ 1505610243 REV-1500 EX Decedent's Social Security Number oecedenc's Name Winters, John K. 32 6 10 1434 RECAPITULATION 1 Real Estate (Schedule A ...................................................................................... 1 0. 0 0 2 Stocks and Bonds (Schedule B ............................................................................ 2 3 Closely Held Corporation, Partnership orSole-Proprietorship (Schedule C ........ 3 4 Mortgages & Notes Receivable (Schedule D ....................................................... 4 5 Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E .............. 5 1 , 995.90 6 Jointly Owned Property (Schedule F ^ Separate Billing Requested........... 6 7 Inter-Vivos Transfers & Miscellaneous I~nq Probate Property arate Billing Requested Se 7 ........... p (Schedule G u g Total Gross Assets (total Lines 1-7 .................................................................... 8 1 , 995.90 9 Funeral Expenses & Administrative Costs (Schedule H ...................................... 9 12 , 2 5 6 . 0 7 10 Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I ............................. 10 67 , 554 .24 11 Total Deductions (total Lines 9 & 10 .................................................................. 11 7 9 , 810.31 12 Net Value of Estate (Line 8 minus Line 11 ......................................................... 12 -7 7 , 814.41 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 7 , 814.41 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15 Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15 0 . 0 0 (a)(1.2) X .00 16 Amount of Line 14 taxable 0 _ 0 0 16 0 . 0 0 at lineal rate X .045 17 Amount of Line 14 taxable 0 0 0 17 0 . 0 0 . at sibling rate X .12 18 Amount of Line 14 taxable 0 . 0 0 18 0.00 at collateral rate X .15 19 Tax Due ................................................................................................................. 19 0 . 0 0 20 FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^ Side 2 1505610243 1505610243 J REV-1500 EX Page 3 ne..n~nn4~c (_nrnninto Aririrass File Number 21 DECEDENT'S NAME Winters, John K. STREET ADDRESS Chapel Pointe at Carlisle 770 S. Hanover Street CITY Carlisle STATE PA ZIP 17013-4198 Tax Payments and Credits 1 Tax Due (Page 2, Line 19 (1 0.00 2 Credits/Payments A Prior Payments B Discoun 0.00 Total Credits (A + B (2 0.00 3 I nteres (3 4 If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT (4 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 (5 ~,~Q 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 .............................................................................. ^x ^ b retain the right to designate who shall use the property transferred or its income ................................. ^x ^ c retain a reversionary interest; or .............................................................................................................. xx d receive the promise for life of either payments, benefits or care? ........................................................... LJ 2 If death occurred after December 12 1982 did deceden transfer property within one year of death withou ^ ^ receiving adequate consideration? ................................................................................................................... 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 iproperty which ^ ^ contains a beneficiary designation? ................................................................................................................. x 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 percen [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 Oiling 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 1.2) [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)]. A sibling 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-1502 FX+~ (11-08 SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Winters, John K 21 Ail real propsAy owned solely or as a tenant in corrrrrorr must be reported at fair makst valor Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both havingg reasonable knowledge of the relevant fads Real propeAy which is jointly-owned with ripld of survivorship must bs dhKJossd on schedule F Attach a copy of the ssttlansnt sheet N the properly has been sold Include a copy of the deed stawirg dacedsnYs iMar~t if owned as tenant in ccirrrnon ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Real F~tate located at 3710 Walnut Stn:et, Dauphin County, Harrisburg, Pennsylvania - SUSPEND suspend value TOTAL (Also enter on Line 1. Recapitulation) I 0.00 (If more space is needed, additional pages of the same size Copyright (c) 2009 form software only The Lackner Group, Inc Form PA-1500 Schedule A (Rev. 11-08 Rev-1506 F~(+ (6-88 SCHEDULE E CASH, BANK DEPOSITS, ~ MISC PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Winters. John K _21 Include the proceeds of litigation and the date the proceeds were received by the estate All property jolntlyownsd with Ure riyM or wvivorship must bs dlsclossd on schedule F ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Chapel Pointe -balance of in patient accoun 1,915.50 2 Patriot News -refund 80.40 TOTAL (Also enter on line 5, Recapitulation) I 1,995.90 (If more space is needed, additional pages of the same size Copyright (c) 2002 form software only The Lackner Group, Inc Form PA-1500 Schedule E (Rev. 6-98 REY-7751 D(+(10.05 COMMO ~~F,E1~Ntl QF~F~~N~R~ANIA SCHEDULE H FUNERAL EXPENSES ~ ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Winters, John K 21 Debts of decedent must be reported on Schedule I ITEM DESCRIPTION AMOUNT A FUNERAL EXPENSES: See continuation schedule(s) attached B ADMINISTRATIVE COSTS: 1 Personal Representative's Commissions Name of Personal Representatives Street Address City State Zio Year(s) Commission paid 2 Attorney's Fees James, Smith, Dietterick ~ Connelly, LLP 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation Claiman 496.07 7,500.00 Street Address _ City State Zio Relationship of Claimant to Decedent 4 Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7 Other Administrative Costs 4,260.00 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation 12,256.07 Copyright (c) 2009 form software only The Lackner Group, Inc Fonn PA-1500 Schedule H (Rev. 10-06 SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Winters, John K 21 ITEM NUMBER DESCRIPTION AMOUNT Funeral ExRgp$g$ 1 Zimmerman Auer Funeral Home - funera 496.07 H-A 496.07 Other Administrative Costs 2 James Smith Dietterick 8 Connelly LLP -reserve for estate administration closing costs 500.00 3 John Winters -reimbursement for travel expenses to administer estate 3,760.00 H-B7 4,260.00 Copyright (c) 2002 form software only The Lackner Group, Inc Form PA-1500 Schedule H (Rev. 6-98 Rev-1512 EXt (12-08 SCHEDULE 1 DEBTS OF DECEDENT MORTGAGE LIABILITIES, ~ LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Winters. John K 21 Report detke incurred by the decedent prior to death that remained unpaid at the dab of death, indudirq unnimbursed medical expenses ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Departrnent of Public Welfare -medical claim 67,523.12 2 Millennium Pharmacy Systems Mechanicsburg -medical expense 31.12 TOTAL (Also enter on Line 10, Recapitulation I 67,554.24 (If more space is needed, additional pages of the same size Copyright (c) 2009 form software only The Lackner Group, Inc Form PA-1500 Schedule I (Rev. 12-08 SCHEDULE J COMM~QN~ DAE~OF~E$YLVANIA ECE 44~r BENEFICIARIES ESTATE OF FILE NUMBER Winters, John K 21 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(Sl RECEIVING PROPERTY DECEDENT (Words ($$$ I TAXABLE DISTRIBUTIONS [include outright spousa distributions, and transfers under Sec. 9116 a 1.2 Betty Jean Gaisk Daughter 113 of n3sidue 317 Greenawalt Lane Harrisburg, PA 17110 Edward Julian Grandson 112 of 113 of 207 Lynn Road residue Brockton, MA 02302 Tara Julian Granddaughter 112 of 113 of 207 Lynn Road residue Brockton, MA 02302 John E. Winters Son 113 of residue 1329 Hancock Avenue Vandergrift, PA 15690 Tota Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 15 00 cover sheet, as a ro riate NON-TAXABLE DISTRIBUTIONS II A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 Ur Ktv-~ 5uu t;vvtr< snit I I Copyright (c) 2009 form software only The Lackner Group, Inc Form PA-1500 Schedule J (Rev. 11-08 November 28, 2011 Glenda Farner Strausbaugh Register of Wills & Clerk of Orphans' Court 1 Courthouse Square Carlisle, PA 17013 RE: ESTATE OF JOHN K. WINTERS, DECEASED Social Security Number: 326-10-1434 THE ESTATE SECURITY FORI~ZULAr.., Denise M. Long dml@jsdc.com Dear Ms. Strausbaugh: Enclosed are the following documents to be filed in the above-reference;d Estate: 1. An original and two (2) copies of the Pennsylvania Inheritance Tax Return. 2. An original and one (1) copy of the Inventory. 3. A check made payable to the Register of Wills in the amount of $30.00 for the filing fee. Please time-stamp the additional copies of the Return and Inventory and return them to me in the enclosed self-addressed, stamped envelope. If you have any questions, please feel free to give me a call. Sincerely, JAMES, SMITH, DIETTERICK & CONNELLY, LLP ~ `~ Denise M. Long Cc: John E. Winters n ~.~ -,~ ~,= s% :~ -. ,~ -~ j __. D c . -, `n 134 SIPE AVENUE HUMMELSTOWN, PA 17036 MAILING ADDRESS P.O. BOX 650 HERSHEY, PA 17033 TOLL FREE 1.800.942.3660 TEL. 717.533.3280 FAX 717.533.7771 www.jsdc.com OI N (O c0 M r N oN ~ ~fl N r ~o Q N .- - ~ O ~. . O y N ~ G! oo ~ ~ N tC l U~ J ~ ' W _ j 4 ~. _ ~_ - .~~ i C.- -_.l ~. -.' ~ - L _ _.. ~ ( ) L._ L "...~ ~. . i i.1_ t. J M O r Q ^ LL 0 N 7 Q H C L Q _ L ~ V ~ M r N N ~ N ti ~ H~ = ~?~ fl . ao`oa- ~ ~~z ev ~; O '~ ~ rn - d~~~ C7OCVr-V