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Home My WebLink About11-22-11 ' , J 1585610105 REV-1500 ex (nz-„) (FI> OFFICIAL USE ONLY PA Department of Revenue pennsylvarria Bureau of Individual Taxes `~""~"`" °`°`" County Code Year File Number PO e0X z8o6ot INHERITANCE TAX RETURN ~' // ~ ~n~ Harrisburg, PA 1128-0601 RESIDENT DECEDENT ,` ENTER DECEDENT INFORMATION BELOW ~- Social Security Number Date of Death MMDOYYYY Date of Birth MMDDYYYY 171-20-4845 07/01/2011 12/11/1927 Decedent's Last Name Suffix Decedent's First Name MI LANDIS HOWARD L (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. Original 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 Com romise date of P ( O 5. Federal Estate Tax Return Required death after 12-12-82) ~] 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 0 g, Total Number of Safe Deposit Boxes (Attach 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 T0: Name Daytime Telephone Number VERNON M. MARTIN, JR (717) 766-8156 First Line of Address 12 SUMMIT DR. Second Line of Address City or Post Office DILLSBURG State ZIP Code PA 17019 REGISTER OF ~ LS USE ONL` -U . Yie- 'rT_C7 c 'rn ~-' na ~~~- N C7 `j J C ~ "r~ ~" U DA FIL~D ~ ~' 3 rn ~~ ' t7 _ ,, Y") -f t ~ ~ Y' . T n i:/~ Q "r'1 Correspondents a-mail address: Vern@ymartlrlCpa.COm Under penalties of perjury, I declare that I have exa ~ d t is return, including accompanying schedules and statements, and to the best of my knowledge antl bekef d is true, correct and complete. Declaration of pre rer o er than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FO FILI RETURN DATE ADDRESS ~_ /~ z s~v"~,~ 2 ~It_~,.sawn rr Pa c~~ ~ 4 SIGNATURE OF PREPARER OTHER THA EPRESENTATIVE DATE nUURCJJ PLEASE USE ORIGINAL FORM ONLY Side 1 1585618185 1585618185 J ~~ ~ ~~' ~ ~`~~~~j ~~`~ 11\ ,~ ~~~,~ J 1505b10205 REV-1500 EX (FI) Decedents Name: HOWARD L. LANDIS Decedent's Social Security Number 171-20-4845 RECAPITULATION 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. 51,367.52 6. Jointly 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. Total Gross Assets (total Lines 1 through 7) ......... .... ............ .. 8. 51,367.52 9. Funeral Expenses and Administrative Costs (Schedule H) ................. .. 9. 3,251.71 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I)........ _ . .. 1U. 64,108.11 11. Total Deductions (total Lines 9 and 10) ............................... .. 11. 67,359.82 12. Net Value of Estate (Line B minus Line 11) ............................ .. 12. 0.00 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. 0.00 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amoun[ of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 15. 16. Amount of Line 14 taxable at lineal rate X .0 _ 16. 17. Amount of Line 14 taxable at sibling rate X .12 t7 18. Amount of Line 14 taxable at collateral rate X .15 16 19. TAX DUE ......... .... .................................... ....19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 150561D205 15D5610205 0.00 O REV-1500 EX (FI) Page 3 Decedent's Complete Address: File Number DECEDENT'S NAME HOWARD L. LANDIS STREET ADDRESS 770 S. HANOVER ST. CITY STATE ZIP CARLISLE PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments B. Discount 3. Interest (1) 0.00 Total Credits (A + B) (2) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (3) Fill in oval on Page 2, Line 20 to request a refund. (q) 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? .................................. Did decedent own an "In trust for" or payable-upon-death bank account or security at his or her death? ........ ...... I~ 4. Did decedent own an individual retirement account, annuity or other non-probate property, whictl 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)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)]. 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-1508 EX • ~t-97) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, ~ MSC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Include the proceeds of litigation and 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~ . SCa.~~~ ~..~ ~-; ~ N ~ ?~ VAS .~ ~Ey ~'~~ l~ ,~ ~ 5~' (~ ~ ~=~ (' "7 ~.. to `{~~/ I t•t GS ~ ~G ~ ~ ~o ~. ~ ~~ V~~E.~ C. C- ~~~~~ '..i,.4-=v/L l'l".rJt6~. o~-'a N Y'+ 3, L-~ 17.3 ~ 1 / " ~ ~r TOTAL (Also enter on line 5, Recapitulation) I $ 5~~, 3 ~- ~. ~ °~'-' (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCI~IEDt~LE N FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t. ~ II `` C:. f~ )'" _ ~.r~~ '~,,~. ~~ ~ ~. (~ ;'~,+..o ~;~ ~''~ i - '~'L o W E (~ S I f Y~ i ~ r s ~ Eti" ~` (=. p, i,._ =~ ~ ''o `3 ..> a ~ ~ ~ - B. 1 2 3 4. 5. 6. ~. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address _ City Year(s) Commission Paid: e Zip - 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's Fees Tax Return Preparer's Fees ~~~~ t/ E2 ~`c e S - ss F Stat /`-t~~~O OUP. ~ o ~, ~ , lc ~- ~15. ~~ TOTAL (Also enter on line 9, Recapitulation) I $ 3 2 SI ,7X (If more space is needed, insert additional sheets of the same size) REV-.1512 EX+ (12-03j COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT sc~~ouLE ~ DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITENt VALUE AT DATE NUMBER DESCRIPTION ~O/F DEATH~-) ~~~,~•,,,,.o~wL~s~'CH~ fir- ,~',~~ ~ J ~f''-~ ~ \' ~U.~~C,~c. ~~CLr- ~'+i~.~ (~,`'t" I~ X, I( __ __ TOTAL Also enter on line 10, Recapitulation) $ ~ {~~ ~ ~~ ---LLL=- jif more space is needed, insert additional sheets of the wine size) REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. N~ ~ N , ~~ r ~ e c ~ ~~ Ga ~-c n ~- ~,~.f ~C~E~~t=~~~,~/~I~S ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 TH ROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) SUSQUEHANNA ALLEY F E D E R A L C R E D I T U N I O N 3850 HARTZDALE DRIVE CAMP HILL, PA 17011-7809 (717)-737-4152 ~iu~~~u~~~~ur,n~~~~~~n~~~n~~~~r,~u~~~~~un~~~u~i~~u~r;) ;~•r•• 00000408 1 AT 0.365 ~~ HOWARD L LANDIS C/O VERNON MARTIN 12 SUMMIT DR DILLSBURG, PA 17019-9589 0000408 D00408 1-000108 Member#: 5869 Statement Date: 07/31/2011 Page#; 1 Mail Code: Tran Eff Transaction Date Date Description Tran Fee Finance Loan ----- ___ _____ _____ Amount Amount Charge; Principal ---`----- _____ Balance Type: 00 - REGULAR SHARES - 00 --- --------- 07/15 07/15 Share Withdrawal PREVIOUS BALANCE 468 14 ~ 07/31 9463.14- ~ 0 07/01 Type: 40 - SHARE DRAFT - 40 NEW BALANCE 5.00 07/01 07/01 ACH Credit PREVIOUS BALANCE 36812.35 US TREASURY 303 - 3031036030 PPD XXSOCISEC 38605.45 07/01 07/01 ACH Credit TIAA-CREF DISTR. - 1131624203 PPp.. ANNUOTY 39504.4~7`~(i 07/13 07/13 Share W/D (Tellers Check Out (GUI)) 20AO.OOr ® 37504.47 07/15 07/15 Share Withdrawal 07/31 32504.47-~, 5000.00 Member Year-to-.Date Totals NEW BALANCE 5000.00 YTD Taxable Div.deeds:- 8.76 YTD Interest; 0.00 Visit SVFCU the week of August 22. forYourCDollar ~`Da s-, of 0.00 cash and prizes! And bring the kids on y Summer event where you can with the Star, at Saver's Welcome Party 1, Saturday,, August. 27 to meet our new mascot, Saver _ ~. t ~.- ~.. ~ ~ ~` ~ `~~ ETC- ~~ ~E ~~_~~ .~ c~t ~~~~~~~. ~~ ~ ~3 ~ ~ Cocklin Funeral Home, Inc. 30 N. Chestnut. St. Dillsburg, PA 1']019 (717)432-5312 July 18, 2011 Mr. Vernon M. Martin Jr. 12 Summit Drive Dillsburg, PA 17019 The Funeral Service for Howard L. Landis We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING iS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT, AND MERCHANDISE TI-IAT YOU SELECTED WHEN MAKING TIIE FtrNERAL ARRANGEMENTS. Professional Services Cremation Option #15 1 985.00 Printed Material 185.00 -----------------~;1'1i1i:130 --- ota Professional Services Merchandise Matthews Capri Frost Companion Urn - 245.00 Total Merchandise Selected ------'----'-"""-'" AT THE TTME FUNERAL ARRANGEMENTS WERE MADE, WE ADVANCED CERTAIN PAYMENTS TO OTHERS AS AN ACCOMMODATION. THE FOLLOWING iS AN AC COUNTING FOR THOSE CHARGES. Cash Advances Grave Opening and Closing 300.00 Newspaper Notice-Harrisburg 183.72 Newspaper Notice-Souderton 241.10 Certified Copies 30.00 Total Cash Advances --''""------"""----- 75"4.83'--- SALES TAX 0.00 SUTi-TOTAL 3,169.82 INITIAL PAY MENT i DISCOUNT /CREDITS 2,6.4.79 TO'T'AL AMOUNT DUE 555.03 The unpaid balance over 1 days is subjected to a 0.5 % service charge per month - 6 % per annum. Page 1\ ~~,\ ~1 -~ :,~~:~:. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF FINANCIAL OPERATIONS TPL SECTION -CASUALTY UNIT PO BOX 8486 HARRISBURG PA 17105-8486 October 7, 2011 STATEMENT OF CLAIM SUMMARY NAME Estate of LANDIS, HOWARD ID 960 217 997 MEDICAL CLASS 3 CLASS 5:1 TOTAL INPATIENT .00 .00 00 OUTPATIENT .00 .00 .00 LONG TERM CARE 9,686.13 54,132.14 63,818.27 DRUG 78.84 211.00 289.84 REIMBURSEMENT TO DPW 9,764.97 54,343.14 64,108.11 \ COMMONWEALTH OF PENNSYLVANIA :DEPARTMENT OE PUBLIC WELFARE ElN - 23-6003113 ~ / ~ ~ ~ e. a ~ t. ~ r: to ~, _~ N ; ~ {~; _; i c~4 -y .t ~ E I k_ ~ C _~. ~ ~y 4 n: ~. k #1i ;1 ~? !~ f } ,} } ;i t 1f '' §~ ti C { `i ~ ,'ri ~i of qi .; ~c 't 7l ~ ~f A ~~Si ,t ` ~ ~ {, 4 ' `f p a (~. ;~ lia.~i ^; ~x G' Cl)1,, , j ~~ ~ M M ~ -~ 3 5 ~~ + M ~ U 0 ~ ~ .v ~ ~ ~.. Q- ~j yy 1~ ~ ~ ~ J ~_ Ul ~ ~ ~. ~ l~ V