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Home My WebLink About11-30-111505611180 REV-1500 ~ I°2-„> 1i=1> Pennsylvania OFFICIAL USE ONLY PA Department of Revenue DEPMTAENTOFP~EVENUE County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 ` f k Harrisburg, PA 17128-0601 RESIDENT DECEDENT l ` 1 ~ U~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 174-05-2522 07102011 12031912 Decedent's Last Name Suffix Decedent's First Name MI MCKILLIP WILLIAM A (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 REGISTE R OF WILLS FILL IN APPROPRIATE BOXES BELOW Q 1. Original Retum Q 2. Supplemental Retum Q 3. Remainder Return (Date of Death Prior to 12-13-82) Q 4. Limited Estate Q 4a. Future Interest Compromise (date of 0 5. Federal Estate Tax Retum Required death after 12-12-82) Q 6. Decedent Died Testate 0 7. Decedent Maintained a Living Trust 0 8. Total Number of :iafe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) Q 9. Litigation Proceeds Received 0 10. Spousal Poverty Credit (Date of Death Q 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 T0: Name Daytime Telephone Number ROBERT G. FREY 717243583$. _. __.. REGISTER LS USE ONtY . "C3 =r) : +'v : ~~ 7 ` First Line of Address . r r.' ~ . t 1 CJ 5 SOUTH HANOVER ST --., --~- > . :. -~ Second Line of Address _ _. ,-,- ~ ~ . ~ _ ,_.) ' City or Post Office State ZIP Code DATE FILED ~ T 1 CARLISLE PA 17013 Correspondent's a-mail address: R F R E Y a~ F R E Y T I L E Y. C O M 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. SIGNATUC~RSON RE~NSIBLE FOR FILI G RETURN ~ / DAT~ ! / .,,.,~.- i f ;~o SIGNAT~ O EPA ER A REPRE'S TATIVE DATE l _~o [ ADDRESS 5 SOUTH HANOVER STREET_ C L SLE_ PA 17013 Side 1 L 1505611180 1505611180 J J 1505611280 REV-1500 EX (FI) Decedent's Social Security Number oecedenYsName: WILLIAM A MCKILLIP 174-05-2522 RECAPITULATION 1. Real Estate (Schedule A) ........................................ . 1. N 0 N E 2. Stocks and Bonds (Schedule B) ................................... . 2. N 0 N E 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. . 3. NON E 4. Mortgages and Notes Receivable (Schedule D) ....................... . 4. N 0 N E 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) ... . 5. 10 4 9 3 . 0 0 6. Jointly Owned Property (Schedule F) OSeparate Billing Requested ..... .. 6. 1419 . O O 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) OSeparate Billing Requested ..... .. 7. N 0 N E 8. Total Gross Assets (total Lines 1 through 7) ........................ .. 8. 11912.0 0 9. Funeral Expenses and Administrative Costs (Schedule H) ............... . 9. 2 6 3 5 . 0 0 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ........... . 10. 7 9 2 O 9 . O O 11. Total Deductions (total Lines 9 and 10) ............................ . 11. 818 4 4 . 0 0 12. Net Value of Estate (Line 8 minus Line 11) .......................... . 12. - 6 9 9 3 2.O 0 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) .................... .. 13. O . 0 0 14. Net Value Subject to Tax (Line 12 minus Line 13) .................... .. 14. - 6 9 9 3 2.0 0 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 O 15. O .O O 16. Amount of Line 14 taxable at lineal rate x .0 4 5 16. O.O O 17. Amount of Line 14 taxable at sibling rate X . 12 17. 0 . 0 0 18. Amount of Line 14 taxable at collateral rate x .15 18. 0 . 0 0 19. TAX DUE ...................................................... . 19. O . O 0 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0 Side 2 L 1505611280 1505611280 J REV-1500 EX (FI) Page 3 File Number 174-05-2522 Decedent's Complete Address: 21-11-880 DECEDENT'S NAME WILLIAM A MCKILLIP STREET ADDRESS CITY STATE ZIP Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 0.00 2. Credits/Payments A. Prior Payments B. Discount 3. Interest Total Credits (A + B) (2) 0.00 (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 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 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-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(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-1508 EX+(11-10) SCHEDULE E Pennsylvania CASH, BANK DEPOSITS, 8~ MISC. DEPARTMENT OF REVENUE PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: William A McKillip 21-11-880 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly 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-1509 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: William A McKillip 21-11-880 If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER: SURVIVING JOINT TENANT(S) NAME(S) I ADDRESS I RELATIONSHIP TO DECEDENT A. Joan E. Kamowski Longs Gap Road sle, PA 17013 Daughter C. JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECEDENT INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST M&T savings account 15004201378509 ~. A. 2,838.00 50.()0% 1,419.00 TOTAL (Also enter on Line 6, Recapitulation) I $ 1,419.00 If more space is needed, use additional sheets of paper of the same size. REV-1511 Ex+(10-09) SCHEDULE H Pennsylvania DEPARTMENT OF REVENUE FUNERAL EXPENSES AND RESIDENT DECEDENTTURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER William A McKillip 21-11-880 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. ST MATTHEW UNITED CHURCH OF CHRIST 500 2. CEMETERY PLACQUE 467 3. FAMILY RECEPTION 500 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 500 Name(s) of Personal Representative(s) Joan E. Kamowski _ Street Address Longs Gap Road city Carlisle State PA zIP 17013 _ Year(s) Commission Paid: 2011 _ 2. Attorney Fees: 500 3. 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 4. Probate Fees: 93 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. Advertising in Cumberland Law Journal and the Sentinel 75 TOTAL (Also enter on Line 9, Recapitulation) ~ $ 2,635 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 SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES ~ LIENS ESTATE OF FILE NUMBER William A McKillip 21-11-880 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. Pennsylvania DEPARTMENT OF PUBLIC WELFARE October 7, 2011 FREY & TILEY ROBERT G FREY ESQUIRE 5 S HANOVER ST CARLISLE PA 17013 Re: William Mckillip CIS # : 510194174 SSN: ###-##-2522 Date of Death: 07/10/2011 Dear Robert G. Frey, Esquire: Please be advised that the Department of Public Welfare is attempting to recover the monetary value of any and all eligible assets in the subject estate. Although the amount in the estate may be considerably less than that which is owed to the Department, our claim is against the estate, no one else. Your responsibilities, as the primary next of kin/administrator/executor, is to advise the Department of any assets in the estate and to insure that the remaining money, after all funeral and administrative costs are deducted, is sent to the Department. The Department of Public Welfare maintains a claim in the amount of $79,209.06 against the above-mentioned estate. This claim is for restitution of medical assistance, 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, 1994, 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 $16,203.64, was incurred during the last six months of the decedent's life; therefore, it is a Class 3 claim pursuant to Sectian 3392 of the Decedents, Estates, and Fiduciaries Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $63,005.42, is to be entered as a priority Class 5.1 claim against the estate. Please acknowledge receipt of this letter and advise when payment may be expected. If the estate accounting is complete, please provide a copy. If the estate contains real estate, please provide copies of the deed, the latest tax assessment and a current appraisal, if available.. Please complete the enclosed Decedent's Assets Itemization Form and return to the Department. Please include proof of funeral bill, proof of burial account, proof of personal care account, copies of original life insurance policy forms naming beneficiaries, proof of any and all stocks and bonds, date of death bank statements and copies of original signature cards or proof from banking institution showing ownership of any and all bank accounts. Please forward these documents to the address above no later than October 31 2011. Sincerely, ~~ ~ Karin L. Tyler Claims Investigation Agent 717-772-6614 Bureau of Program Integrity ~ Division of Third Party Liability ~ Recovery Section PO Box 8486 ~ Harrisburg, Pennsylvania 17105-8486 p ~~ 499 Mitchell Road, Millsboro, DE 19966 Adjustment Services Phone 888-502-4349 F ax (302) 934-2955 August 31, 2011 Frey and Tiley 5 South Hanover Street Carlisle, PA 17013 Re: Estate of William A McKillip Social Security: 174-OS-2522 Date of Death: July 10, 2011 Dear Sir or Madam: Per your inquiry on August 2~, 2011, please be advised that at the time of death, the above-named. decedent had on deposit with this bank the following: 1. Type of Account Checking Account Account Number 463078 Ownership (Names o~ William A McKillip Joan E Kamowski (POA) Opening Date 08/01/68 Balance on Date of Death $5,176.70 Accrued Interest $ .03 Total _.. _ __ __ $5,176.73 2. Type of Account Saving Account Account Number 15004201378509 Ownership (Names o, fl William A McKillip Joan E Kamowski Opening Date 03/12/99 Balance on Date of Death $2,837.49 Accrued Interest $ .07 Total __ _ _ . $2, 837.56 3. Type of Account Account Number Ownership (Names o~ Opening Date Balance on Date of Death Accrued Interest Total Saving Account 15004206016120 William A McKillip Joan E Kamowski (POA) 0128/83 $874.51 $ .00 ------------------------------- --- $874.51 - For any additional information on the above accounts, induding ownership and any changes, dosures and/or reimbursement of funds, please call the Stonehedge Office at#717-1A0-4524. We were unable to locate any safe deposit box for the above-mentioned decedent. This letter does not indude any accounts in which the deceased may have been listed as Power of Attorney, Custodian of Uniform Transfers, Representative Payee, or Trustee under a Written Agreement Sincerely, Tammy Spencer Adjustment Services \C~ ~ 3~ ~~ `~,~G ~~ 1~