HomeMy WebLinkAbout11-21-11__.J 1505610140
REV-1500 ~` `°'-'°'
OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes
INHERITANCE TAX RETURN County Code Year File Number
Po BoX 2aosol 2 1 1 0 0 8 0 1
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYW Date of Birth MMDDYYW
2 0 9 5 0 9 2 4 6 0 6 1 4 2 0 1 0 D 4 2 9 1 9 5 8
Decedent's Last Name Suffix Decedents First Name MI
C H R I S T L I E B J O H N G
(If Applicable) Enter Surviving Spouse's information Below
Spouse's Last Name Suffix Spouse's First Name MI
C H R I S T L I E B P A M E L A
Spouse's Social Security Number
4 6 1 2 3 3 4 7 9 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
® i. Original Retum ^ 2. Supplemental Retum ^ 3. Remainder Retum (date of death
prior to 12-13-82)
^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of ^ 5. Federal Estate Tax Retum Required
death after 12-12-82)
^ 6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
^ 9. Lftigation Prorreeds Received ^ 10. Spousal Poverty Cred'R (date of death ^ 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
H U B E R T X G I L R O Y E S Q 7 1 7 2 4 3 3 3 4 1
First line of address
M A R T S O N L A W O F F I C E S
Second line of address
1 0 E H I G H S T
City or Post Office
C A R L I S L E
State 21P Code
REO
R OF WILL E ONLY
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DATE FI /~
P A 1 7 D 1 3
correspondent's e-maU address: H G I L R O Y a M A R T S O N L"A W• C O M
Under penaltiae of perjury, 1 declare that I have examined this return, including aaompanying schedules and atatementa, and to the beat of my knowledge and belief,
it la true, CArreU and complete. Dedare not preparor other than the personal representative is based on all information of which preparer has any knowledge.
S ~P ~ ~ E F ~ I 'RETURN /ppT~(' l/
THAN REPRESENTATNE
PLEASE USE ORIGINAL FORM ONLY
15D561014D
Side 1
DATE
P
1505610140
1505610240
REV-1500 EX Decedent's Social Security Number
oecedent'sName: JOHN GREGORY CHRISTLIEB 2 0 9 5 0 9 2 4 6
RECAPITULATION
1 Q • Q Q
1. Real Estate (Schedule A) ..................................... .... ..
•
2. Stocks and Bonds (Schedule B) ................................ .... .. 2• 0 • 0 0
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 2 5 1 6 • 0 7
4. Mortgages and Notes Receivable (Schedule D) .................... .... .. 4.
D . 0 0
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E). .... .. 5.
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested . .... .. 6. 0 • 0 0
7. Inter-Vivos Transfers & Miscellaneous N~Probate Property
d
7
0
0
0
.
(Schedule G) Separate Billing Requeste .... .
.. .
8. Total Gross Assets (total Lines 1 through 7) ..................... .... .. 8. 2 5 1 6 • D 7
9, Funeral Expenses and Administrative Costs (Schedule H) ............ .... .. 9. 1 5 8 7 9. 0 9
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ....... .... .. 10. 2 6 8 6 6 5. 2 3
11. Total Deductions (total Lines 9 and 10y ......:....:....: ........ .... .. 11. 2 8 4 5 4 4. 3 2
12. Net Value of Estate (Line 8 minus Line 11) ...................... .... .. 12. 2 8 2 0 2 8. 2 5
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. - 2 8 2 Q 2 8 • 2 5
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X.0 ` 0. 0 Q 15. Q. Q Q
16. Amount of Line 14 taxable
at lineal rate X .045 Q Q O 16. 0• O Q
17. Amount of Line 14 taxable
0
0
Q
17
0
Q
Q
.
at sibling rate X .12 . .
18. Amount of Line 14 taxable
0
0
0
0
Q
Q
.
at collateral rate X .15 1 g, .
19. TAX DUE ......................................................19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
1505610240 1505610240
o. 0 0
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 to oaol
DECEDENTS NAME
JOHN GREGORY CHRISTLIEB
STREET ADDRESS
106 PINE KNOB ROAD
CITY
NEWVILLE STATE
PA ZIP
17241
Tax Payments and Credits:
~. Tax Due {Page 2, Line 19) (1) 0.00
2, Credits/Payments
A. Prior Payments
B. Discount
Total Credits { A + g) (2) 0.00
3. Interest
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. {3)
Fili in oval on Page 2, Llne 20 to request a refund. (4) 0.00
5. If Line 1 + Line 3 is greater than line 2, enter the difference. This is the TAX DUE. (5) 0.00
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 trensferced : ............................................................... ....... ^
b, retain the right to designate who shall use the property transferced or its income : ........................ ....... ^
c. retain a reversionary interest; or ......................................................................................... ....... ^
d. receive the promise for Iffe of either payments, benefits or care? ................................................ ....... ^
2. H death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ................................................................................ ....... ^
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 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)]. 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-1504 EX+ (8-88)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C
CLOSELY•HELD CORPORATION,
PARTNERSHIP OR
SOLE-PROPRIETORSHIP
JOHN G. CHRISTLIEB 21 10 0801
Schedule C-1 or C-2 (including all supporting information) must be attached for each closet'-heM corporationlpartnership irRerest ofthe decedent, other than a
sofa-proprie~rship. See instructions for the supporting information to be submitted for sole-proprietorships.
ITEM
National Property & Casualty Claims Research Service, Inc.
EIN: 25-1441262; assets consisting of:
M&T Bank commercial checking 2689033302 $194.16 (see attached)
Adams County National Bank, business checking 187291 $2,021.91 (see attached)
Miscelleanous office furniture and equipment $300.00 (estimated value)
Final U.S. Income Tax Returns for an S. Corp. were filed in 2008, however, the bank accounts
associated with the business were never closed due to the Decedent's illness
VALUE AT DATE
6.07
TOTAL (Also enter on tine
(If more space is needed, insert addidonaf sltaels of the same size)
REV-1510 EX+ (08-09)
Pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
JOHN G. CHRISTLIEB 21 10 0801
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDEN7AND
THE DATE OF TRANSFER.ATTACHACOPYOFTHEDEEDFORREALESTATE.
DATE OF DEATH
VALUE OF ASSET
96 OF DECD'S
INTEREST
EXCLUSION
vF~wPUOae~I
TAXABLE
VALUE
1. Oppenheimer AB7-2503105 IRA Custodian FBO John Gregory 21,922.00 0.00
Christlieb IRA (Not in pay status) beneficiary John W.
Christlieb, father. (See attached)
2. River Source Funds 020137665582002; beneficiary, 620.85 0.00
Pamela Christlieb, spouse
(See attached)
3. River Source Funds 931075224605004; beneficiary, 77,907.12 0.00
Pamela Christlieb, spouse
(See attached)
TOTAL (Also enter on Line 7, Recapitulation) I S 0.00
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
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
7OHI+1 G. CHRISTLIEB 21 10 0801
Decedent's debts must be roporled on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
8. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
Chy State ZIP
Year(s) Commissbn Paid:
2.
3.
4.
Attorney Fees: MARTSON LAW OFFICES
Famly Exemption: (If decedent's address is not fhe same as daimant's, attach explanatlon.)
Claimant
Street Address
City State _
Relatbnship of Claimant to Decedent
Probate Fees: Ctttnberland County Register of Wills
5. I Acoountanl Fees:
6. ~ Taz Retum Preparer Fees:
ZIP
15,000.00
52.50
7. Filing fee, Inheritance Tax return 15.00
8. EVP stock valuation 1.55
9. Exemplified copies of Letters Testamentary 120.00
10. UPS mailing 16.38
1 ]. The Sentinel, advertising Letters Testamentary 198.16
12. Cumberland Law Journal, advertising Letters Testamentary 75.00
13. Landex, deed copies 0.50
14. Reserved for miscellaneous costs and filing fees 400.00
TOTAL (Also enter on Une 9, Recapitulation) S 15.879.09
If more space is needed, use addlticnal sheets of paper of the same sine.
REV-1512 EX+ (12-08)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
JOHN G. CHRISTLIEB 21 10 0801
Report debts Incurred by the decedent prior to death that remained unpaid at the date of death, Including unrelmbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Capital One Bank 8629; Philips & Cohen collection reference # 17351605 8,709.00
2. Capital One Bank 7739; Estate Information Servies collection reference # 2732453 24,238.69
3. MBcT Bank, Line of credit, 12044435909596001 30,003.39
4. American Express 3002; West Asset Management collection reference # 193491390 15,714.42
5. John W. Christlieb, loans to Decedent 34,000.00
6. American State Bank, Note # 2011011362 000-3 91,515.20
($84,264.91 + $7,250.29 interest)
(See attached)
7. Pamela Christlieb, reimbursement for payments of Decedent's credit card debt paid from life 64,484.53
insurance proceeds, which named her as beneficiary (See list below)
Bank ofAmerica credit card,**** **** **** **** 3439: $4,388.75
Capital One credit card, **** **** **** **** 7389: $16,628.81
Home Depot credit cazd, **** **** **** **** 7220 $1,033.54
Sears CitiBank credit card, **** **** **** **** 1602 $7,576.38
Bank of America credit card, **** **** **** **** 3439 $9,755.88
Chase Bank credit card, **** **** **** **** 8817 $4,943.05
CitiBazilc credit card, **** **** **** **** 8212 $20,158.12
TOTAL (Also enter on Line 10, Recapitulation) I =
If more space is needed, insert additional sheets of the same size.
11~I8c~'Bl~ ~ _.
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BEGIINING 7/1/10, MiT BANK MILL NO LONGER PARTICIPATE IN THE FDIC'S TRANSACTION ACCOUNT GUARANTEE
PROGRAM (TACP). TNUS, AFTER 6/30/10, FUNDS HELD IN NONINTEREST -BEARING TRANSACTION ACCOUNTS AND NOM
ACCOUNTS THAT MERE COVERED UNDER TACP MILL NO LONGER BE GUARANTEED IN FULL UNDER TACP, BUi HILL BE
INSURED UP TO X250,000 UNDER THE fDIC'S GENERAL DEPOSIT INSURANCE RULES. THE FDIC INSURANCE COVERAGE
FEE MILL BE 10.119 PER 11,000 AVERAGE MONTHLY LEDGER BALANCE ON ALL BALANCES. CALL MiT'S COMMERCIAL
SERVICE TEAM AT 1-800-724-2240 FOR MORE INFORMATION.
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NATIONr~t, BANK
acnb.com
acnbbusiness.com
""""•""AUTO"5-DIGIT 17241
46 1.0180 AV 0.460 1 1 46
6~JIh~d~~LId~~6~~Ih~~I1~~11~~~d1~d1~~LL~~~11~~~111
NATIONAL PROPERTY 8 CASUALTY
CLAIMS RESEARCH SERV
51 PARSONAGE ST STE 200
NEWVILLE PA 17241-1313
Statement Date: 06/30/10
Account #: 187291
Page 1
801
INSURANCE FOR YOUR BUSINESS.
Property -Business Auto -Workers Compensation
General Liability -Excess Liability
Look to ndams county National Bank's affiliate,
Russell insurance Group, for all your insurance needs.
Call toll free 1.800.289.4097 for your quote.
BUSINESS CHECKING Account # 187291
Account Summary
Beginning Balance Activity Ending Balance
Previous Statement Balance 05/31/10 54,422.81
+ Deposits and Other Credits .00
-Checks Paid or Other Debits 6 2,400.90-
- Service Charges .00-
+Interest Paid .00
Ending Balance 52,021.91
_ Days in Statement Period 30
Account Detail
Date Activity Description
Checking Statement
Deposits/Credits Checks/Debits Balance
BEGINNING BALANCE 4,422.81
06-O1 CHECK # 4339 54.07 4, 368.74
06-03 CHECK # 4340 987.42 3, 381.32
06-04 CHECK # 4341 874.34 2, 506.98
06-07 CHECK # 4342 317.50 2 189.48
06-29 CHECK#4345 111.32 2,078.16
06-30 CHECK # 4344 56.25 2,021.91
06-30 ENDING BALANCE 2,021.91
Checks Paid --
Check # Date Amount Check # Date Amount
4339 06-O1 54.07 4342' 06-07 317.50
4340 06-03 987.42 4344 06-30 56.25
4341 06-04 874.34 4345 06-29 111.32
Total Number of Checks: 6 Total Amount of Checks: 52,400.90
END OF STATEMENT
P.O. Box 3129, Gettysburg, PA 17325 • Phone 717.334.3161 • Toll Free 1.888.334.ACN6 (2262)
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Estate Valuation
Date of Death: 06/14/2010
Valuation Date: 06/19/2010
Processing Date: 06/22/2011
Shares Security
or Par Description
1) 19900 RITE AID CORP (767759104; RAD)
COM
NYSE
06/14/2010
Total Value:
Total Accrual:
Total: 521,922.00
Estate of: John Gregory Christlieb
Account: 12898.1
Report Type: Date of Death
Number of Securities: 1
File ID: 12848.1.christlieb
Mean and/or Div and Int Security
High/Ask Low/Hid Adjustments Accruals Value
1.16000 1.10000 H/L
1.130000 21,922.00
$21,922.00
50.00
Page 1
This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions,
please contact EVP Systems at (8181 313-6300. (Revision 6.4.1)
Riversourea ufs Insurance Company
December 20, 2010
SCOTT MICHAEL BECHTOLD
STE D
30 E ROSEVILLE RD
LANCASTER, PA 1:7601.-3865
Dear SCOTT MICHAEL BECfITOLD:
RlverSource Funds
Amsriprlsa Grtlflcate t.ompany
Amsriprtss Brokerapa
70100 Amsrlprtse Financial Center
Nannsapo0s, MN 86474
We have received notification. of J d CHRISTLIEB's death. The:deceased's name appears on the following
accounts... At the end of this letter, you will find a list of
beneficiaties shown in our initial review of the accounts
ACCOIIIIt ~IIf017IIat10II
Mutual Funda
AccouutNttmber
02073766958 2002
Anuuittes -Post 1983
Account Number
93107522460 6004
Mutual Funds
Account Number
sha:,e
02013766588 2002
Annuities. -Past 1985
Accouc3t Number
93107522460 6004
CoverdeU ESA. - beneficiary designated
Ownership
IRA -beneficiary designated
Total Value
$620.85
Total Value
577,907.12
# of shares
1.32.661.
Asset Value Per
$ 4.68
The date of death values provided are for estate tax purposes and arenot a value to be paid. Accounts may be
subject to market fluctuation as governed by eachproduct. Please note that the values indicated-for any Life
Insurance products with the insured deceased reflect. the grass death-benefit at date of death and not the cash value.
Values indicated for Life Insurance products with only the ownerdeceased reflect the cash value as of the date of
death. Values forany proprietary mutual funds include aecnred dividends as applicable. Values provided for
brokerage products are manualty calculated, and should be used as estimates only. The prices used to provide
values are estimates obtained from outside sources believed to be reliable. Ameriprise Financial provides these
values as a service to its clients. Actual values used in preparation of tax returns or for planning purposes should be
verified by your legal and accounting advisors.
01-25-2011 Note Inquiry Next Display: 2 50-0705-1
15:19:55 Basic Note Data TREYMAI
Note number: 2011011362 - 000 03
Short name: CHRISTLIEB GREGORY *----------Customer Data---------------*
MEMO ACTIVE GREGORY CHRISTLIEB
_ _ Hata__w~-..-.,---.,..-.. ~..-_s~- -~.-D6-PI~d~-i@i6B---RI3
Note amount: 100,000.00 NEW'V'ILLE PA 17241
Principal bal: 84,264.91
Interest bal: 7,250.29
P/O: 1-25-11 91,515.20
Avail for dish: .00 Contact/Title:
Tax ID: 209-5 0-9246
*----------Iatereat Data-----------* Home phone: 717-776-5411
Int rate: --8.7500 Business phone: 00-000-0000
Daily int factor: 20.481054 Officer: 4911
*-------------Dates----------------* *---------Next Payment Data---------*
Note date: 2-07-06 Next due date: ~,,2-07-11
Last renewed: Next pmt amount: 12,315.99
Maturity dater 2-07-21 Total past due amt: :00
Last active: 2-0'S-10 *-------------Sold Data-------------*
Last paid installment: 2-07-10 Percentage sold: .0000
Interest paid-to date: 2-05-10 Total sold: .00
F3=8xit F7=Priat history F8=Participatioa inquiry F24=More keys