HomeMy WebLinkAbout01-12-12 (3)1505610140
REV-~ 500 EX `°'_'°'
OFFICIAL USE ONLY
PA Departure t of Revenue County Code Year File Number
Bureau of Indiiridual Taxes INHERITANCE TAX RETURN
PO BOX 2806101 2 1 1 1 1 2 5 3
Harrisbur P 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMA ION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
1 6 6 1 4 1 9'3 4 1 0 1 8 2 0 1 1 1 1 1 0 1 9 1 7
Suffix Decedent's First Name MI
Decedent's Last Name
M U L L E N K E D W A R D
(If Applicable) Enter Surviving Spouse's Information Below MI
Spouse's Last Name Suffix Spouse's First Name
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALIS BELOW
l Return
t
l
^
3. Remainder Return (date of death
X 1. Original Return
^ ^ a
emen
2. Supp prior to 12-13-82)
^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of ^ 5. Federal Estate Tax Return Required
death after 12-12-82)
0
it B
® 6. Decedent Died Testahe ^ 7. Decedent Maintained a Living Trust oxes
8. Total Number of Safe Depos
(Attach Copy of Will)',
^ 9. Litigation Proceeds F~eceived
^ (Attach Copy of Trust)
10. Spousal Poverty Credit (date of death
^
haOunder Sec. 9113(A)
11 •
h S
between 12-31-91 and 1-1-95) c
Attac
( )
CORRESPONDENT - THIS SE TION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Daytime Telephone Number
Name
W I L L I A M R S W I N E H A R T E S Q 5 7 0 2 8 6 7 7 7 7
__ ------
REGISTER @F~tMLLS USE OILY
`Z~
• ,.~
(-~
-,-~
j
`
~
First line of address r.~ = ~ ~ -
2 4 0- 2 4 6 '' M A R K E T S T R E E T n~~ r::r _-
__ ,
Second line of address • ! -~ }
.. ~ :. ~:
,
F
•
City or Post Office State ZIP Code LED
.~ ~^}
D~E
------- - - _ ' --- -'~
S U N B U R Y P A 1 7 8 0 1
Correspondent's a-mail adg Jress:
knowledge and belief.
t of m
b
th
d
Under penalties of perjury, I decla
it is true, correct and complete. y
es
e
to
that I have examined this return, including accompanying schedules and statements, an
aration of preparer other than the personal representative is based on all information of'which preparer has any knowledge.
SIGNATGIBE OF pE ~ON ESP
/t Y-~•"/ NSIBLE FOR FILING RETURN DATE
/ -1 ~ - / Z
ADDRESS
3807 OXBOW DRI
E CAMP HILL PA 17011
SIGN TORE F PREPARE
t~- E A IVE / A` ~ ,Z
ADORESS
240-246 MARKET~
STREET SUNBURY PA 1?801
PLEASE USE ORIGINAL FORM ONLY
Side 1
150560140 1505610140 J
1505610240
REV-1500 EX ' Decedent's Social Security Number
decedent's Name: K• E D W A R D M U L L E N 1 6 6 1 4 1 9 3 4
RECAPITULATION
1. Real Estate (Schedule Pl) ......................................... .. 1
2. Stocks and Bonds (Schedule B) .................................... .. 2•
3. Closely Held Corporatio~t, Partnership or Sole-Proprietorship (Schedule C) ... .. 3.
4. Mortgages and Notes Receivable (Schedule D) ........................ .. 4.
5. Cash, Bank Deposits an d Miscellaneous Personal Property (Schedule E)..... .. 5. 8 8 1 9 . 1 4
6. Jointly Owned Property Schedule F) ^ Separate Billing Requested ....
~ ... 6. 3 7 7 7 . 4 6
7. Inter-Vivos Transfers 8 illiscellaneous N-Probate Property
~ 1 6 6 1 5 6 5 9
(Schedule G) Separate Billing Requested .... ... 7. .
8. Total Gross Assets (to~al Lines 1 through 7) ........................ ... 8. 1 7 8 7 5 3 . 1 9
9. Funeral Expenses and /administrative Costs (Schedule H) ............... ... 9• 1 3 8 7 7 . 7 4
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .......... ... 10. 5 2 1 7 . 9 1
11. Total Deductions (totaM Lines 9 and 10) ............................ ... 11. 1 9 0 9 5. 6 5
12. Net Value of Estate (Li ne 8 minus Line 11) ......................... ... 12• 1 5 9 6 5 7 . 5 4
13. Charitable and Govern~ ental Bequests/Sec 9113 Trusts for which
0
0
0
an election to tax has n t been made (Schedule J) ................... ... 13. .
14. Net Value Subject to ax (Line 12 minus Line 13) ................... ... 14. 1 5 9 6 5 7 . 5 4
TAX CALCULATION -SEE NSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxa le
at the spousal tax rate, r
transfers under Sec. 91 16
(a)(1.2)x.o _ 0. 0 0 15. 0. 0 0
16. Amount of Line 14 taxa~le
at lineal rate x .045 1 5 9 6 5 7. 5 4 1 s, 7 1 8 4. 5 9
17. Amount of Line 14 taxa~le
at sibling rate X .12 0 0 0 17. 0. 0 0
18. Amount of Line 14 taxa~le
at collateral rate X .15 0 0 0 18. 0• 0 ~
19. TAX DUE ................................................... ...19. 7 1 8 4• 5 9
20. FILL IN THE OVAL IF `rOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^
Side 2
L 150561040 1505610240
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 11 1253
DECEDENTS NAME
K. EDWARD MULLEN
STREET ADDRESS
3807 OXBOW DRIVE
CITY
CAMP HILL STATE
PA ZIP
17011
Tax Payments and Credits:
~ • Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount 359.23
3. Interest
4. If Line 2 is greater than Line 1 + Line 3 enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2~ Line 20 to request a refund.
5. If Line 1 + Line 3 is greater than Line 2j enter the difference. This is the TAX DUE.
(1) 7,184.59
Total Credits (A + B) (2)
(3)
359.23
(a) 0.00
(5) 6,825.36
Make check payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER TF~E FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make ~ transfer and: Yes No
a. retain the use or i ficome of the property transferred : ...................................................................... ^
9
c. retain ahreverstion~esignate who shall use the property transferred or its income; ............................... ^ Q
~ry interest; or ................................................................................................ ^
d. receive the promi a for life of either payments, benefits or care? ....................................................... ^ Q
2. If death occurred aft~r December 12, 1982, did decedent transfer property within one year of death
3. Did duecedent sown a~'quate consideration? ....................................................................................... ^ ^X
"in trust for" orpayable-upon-death bank account or security at his or her death? ......... ^ Q
4. Did decedent own anindividual retirement account, annuity or other non-probate property, which
contains a beneficiary designation? .................................................................................................. 0 ^
IF THE ANSWER TO ANY OF THE A~OVE 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 ar after Jan.1,1
[72 P.S. §9116 (a) (1.1) (ii)]. The statu~
filing a tax return are still applicable ev
For dates of death on or after July 1, 2
• The tax rate imposed on the net val
adoptive parent or a stepparent of ti
• The tax rate imposed on the net val
72 P.S. §9116(1.2) [72 P.S. §9116(
• The tax rate imposed on the net val
Section 9102, as an individual who
15, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
if the surviving spouse is the only beneficiary.
of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an
child is 0 percent [72 P.S. §9116(a)(1.2)].
of transfers to or for the use of the decedent's lineal beneficiaries is 4..5 percent, except as noted in
1)].
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
at least one parent in common with the decedent, whether by blood or adoption.
REV-1500 Discount, Interest and Penalty Worksheet
Discount Calculation
Total Amount Paid within three calendar months of the decedent's date of death: 7,184.59
Discount: 359.2,
Interest Table
Year Days
this ti elinquent
a period Balance Due
this year Interest
this period
Before 1981
1982
1983
1984
1985
1986
1987
1988 throu h 1991
1992
1993 throu h 1994
1995 throw h 1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
TOTALS
Penalty Calculation
If the decedent's date of death w~s on or before March 31, 1993, insert the applicable amount:
Total Balance Due on January 17J 1996:
Penalty: I,
REV-1508 EX + (6-98)
SCHEDULE E
NKD
EPO
SITS,
&
M~SC.
COMMONWEALTH OF PENNSYLVANIA CASH, BA
~+
p
~
p
T~
IN RES DENTEDE EDENTRN PERSONAL PROPER 1 1
ESTATE OF FILE NUMBER
K. EDWARD MULLEN 21 11 1253
Include the proceeds of litgation and the date the proceeds were received by the estate.
', All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION VALUE AT DATE
OF DEATH
~, rocee s o sa o m><sce aneous persona property guns g
2. County Meadovl,~s West Shore -refund 1,885.22
3. TDS -refund 17.40
4. Long term care benefit for September, 2011 2,700.00
5. Long term care benefit for October, 2011 1,620.00
6. Stone Valley Insurance -refund of insurance premium 5.60
7. Donegal Insurar}ce -refund of insurance premium 178.00
8. PPL, -refund 15.24
9. Pinnacel Health'- refund / co-pay 20.00
10. Holy Spirit Hosj~ital -refund / co-pay 20.00
11. Cash in possessipn of decedent 447.00
TOTAL (Also enter on line 5, Recapitulation) I $ 8 819 14
(If more space is needed, insert additional sheets of the same size) ~
- I
REV-1509 EX+ (01-10)
pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE
JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF. FILE NUMBER:
K. EDWARD MULLEN 21 11 1253
If an asset was mape jointly owned within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAM~(S) ADDRESS RELATIONSHIP TO DECEDENT
a. ennet u en x ow rive on
Camp Hill, PA 17011-1448
B.
c.
JOINTLY•OWNED PROPERTY:
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT
INCLUDE N
IDE DESCRIPTION OF PROPERTY
ME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR
TIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET % OF
DECEDENTS
INTEREST DATE OF DEATH
VALUE OF
DECEDENT'S INTEREST
~. A. 3/23/10 Checki~hg account number 5701-56794 @ FNB, 7,554.91 50. 3
777
46
Bank,NLA
~,
'~~ ,
.
TOTAL (Also enter on Line 6, Recapitulation) S 3,777 46
If more space is needed, use additional sheets of paper of the same size.
REV-1510 EX+ (08-09)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS AND
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
K. EDWARD MULLEN 21 11 1253
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 DESC IPTION OF PROPERTY
NUMBER INCLUDE THE NAME OF THE TR
THE DATE OF TRANSFER. SFEREE, THEIR RELATIONSHIP TO DECEDENT AND
TTACH ACOPY OF THE DEED FOR REAL ESTATE DATE OF DEATH
VALUE OF ASSET "/o OF DECD'S
INT
R EXCLUSION TAXABLE
. E
EST (IF APPLICABLE) VALUE
~, ro erage account nu er ran view ~ _97
Asset Management re istered jointly with his son, ~
Kenneth H. Mullen an opened on December 7, 2010
2. Annuity contract num er 5118988 @ Woodmen of 21,069.59 100.00 21
069.59
the World. The deced~nt named his son, Kenneth H. ,
Mullen as beneficiary ',
3. Individual Retirement Account number 1000230967 5,725.03 100.00 5
725.03
@ Jackson National. The decedent named his son ,
,
Kenneth H. Mullen as beneficiary
TOTAL (Also enter on Line 7 Recapitulation) ~ S 166,156 59
If more space is needed, use additional sheets of paper of the same size.
- I
REV-1511 EX+ (10-09)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF I FILE NUMBER
K. EDWARD MULLEN ' 21 11 1253
Decedent's debts must be reported on Schedule 1.
~ I
ITEM
NUMBER ! DESCRIPTION AMOUNT
A. FUNERAL EXPENSE
~, Stephen J. Rot ermel Funeral Home -funeral services 10,170.00
2. Funeral Luncheon 203.00
3. Judy White - mlusic /gratuity 50.00
4. Sausser Memorials -tombstone ingraving 120.00
B. ADMINISTRATIVE CASTS:
1. Personal Representative Commissions:
Name(s) of Pliersonal Representative(s)
Street Addre$s
City State ZIP
Year(s) Commission Paid:
2, Attorney Fees: W1f~St, Muolo, Noon & Swinehart
3. Fatuity Exemption: (If decedents address is not the same as claimant's, attach explanation.)
Claimant i
Street Addre$s
City State ZIP
Relationship bf Claimant to Decedent
4. Probate Fees: Curr~berland County Register of Wills
5 ~ Accountant Fees
6. I Tax Return Preparer Fees
~. C'umberland I~aw Journal -legal advertising
8 Fatriot News + legal advertising
9 Reserve for additional administrative expenses and filing fees
10. Cumberland ounty Register of Wills -inheritance tax return & inventory
filing
2,500.00
92.50
75.00
13 7.24
500.00
30.00
TOTAL (Also enter on Line 9, Recapitulation) 13 13,877.74
If more space is needed, use additional sheets of paper of the same size.
REV-1512 EX+ (12-OS)
Pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERIraNCETAXRETURN MORTGAGE LIABILITIES, & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
K. EDWARD MULLEN 21 11 1253
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
~, CitiMaster Card',- outstanding balance due on account 185.00
2. Continuing Cary RX -pharmaceutical supplies 197.29
3. PPL -electric serrvices 15.24
4. TDS -telephone', services 20.38
5. County Meadow's West Shore -October invoice 4,800.00
', TOTAL (Also enter on Line 1 q, Recapitulation) 13 5,217 91
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+ (01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
K. EDWARD MULLEN ', 21 1 > > 2.5~
NUMBER
NAME AND ADDR SS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT
Do Not List Trustee(s) AMOUNT OR SHARE
OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outs' ht spousal distributions and transfers under
Sec. 91 f6 (a) (1.2).]
1. K. Edward Mullen Lineal
3807 Oxbow Drive'' Schedule F & G
Camp Hill, PA 170 ~ 1 & residue of estate
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTI NS:
A. SPOUSAL DISTRIBUTIO SUNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1. None
0.00
B. CHARITABLE AND GOVE~tNMENTAL DISTRIBUTIONS:
1. None
i
0.00
--
TOTAL OF PART II - ENT~R TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET, S O 00
If more space is needed, use additional sheets of paper of the same size.
__ r
..
.~ v
~ lM~ w i..aonNt
BE IT REMEMBERED, that I, K. EDWARD MULLEN of the Township of Upper Mahanoy,
County of Northumberland (land Commonwealth of Pennsylvania, do make, publish and declare this as
and for my Last Will and Testament, hereby revoking and making null and void any and all Wills and
Testaments or Writings in the nature thereof by me at any time heretofore made.
FIRST. I ord$r and direct that all my just debts, being those to which I have no legal
defense, and funeral expe~ses be paid as soon as may be convenient after my decease by my
hereinafter named Executor.'
SECOND. I he>feby expressly authorize, empower and direct my hereinafter named
Executor for the payment c}f debts or for any purpose of administration or distribution, to sell any
property, reel or personal, publicly or privately, for cash or on time, without an Order of Court, upon
such terms and conditions a$ to [him or her] shall seem best, and to execute deeds for the conveyance
of real estate, without liabil~ty on the part of the purchaser to see to the application of the purchase
money.
THIRD. I give, devise and bequeath all of my estate, whatsoever the same may be and
wheresoever the same may bje situate at the time of my decease, real, personal and mixed, or to which I
may be entitled at the time'' of my decease, unto my son, KENNETH H. MULLEN, his heirs and
assigns forever.
FOURTH. In the ievent that my son, KENNETH H. MULLEN, fails to survive me or in the
event we both meet a simultaneous death or die under such circumstances as to render it impossible to
determine which predeceased the other, then I give, devise and bequeath all of my estate, real, personal
and mixed, whatsoever the same may be and wheresoever the same may be situate at the time of my
decease ,unto my granddaughter, CHRISTINE E. MULLEN, her heirs and assigns forever.
FIFTH. I nomijnate, constitute and appoint my son, KENNETH H. MULLEN, to be the
Executor of this, my Last Wi~l and Testament. Should my son, KENNETH H. MULLEN, predecease
me or should we suffer a simultaneous death or die under such circumstances as to render it impossible
to determine which predeceased the other, or should he fail or cease to qualify to so serve, then I
~+!` ~ (SEAL)
K. EDWARD MULLEN
__ T
hereby nominate, constitute and appoint my granddaughter, CHRISTINE E. MULLEN, to be the
Alternate Executrix of this, my Last Will and Testament.
SIXTH. No f~duciary acting hereunder shall be required to post bond or furnish sureties
in this or any other jurisdiction.
LASTLY. Untilli actual distribution to him or her, no interest of any beneficiary hereunder
shall be subject to anticipati nor to voluntary or involuntary alienation.
IN WITNESS WH REOF, I, the Testator, have hereunto subscribed my name and affixed my
seal to this, my Last Will an~ Testament, written on these 3 sheets of paper this 7~' day of May, 2010.
l • .X.~./ (SEAL)
K. EDWARD MULLEN
Signed, sealed, publ~shed and declared by the above named Testator as and for his Last Will
and Testament in our presence, who, in his presence, at his request, and in the presence of each other,
have hereunto subscribed out names as attesting witnesses.
C/~
COMMONWEALTH OF P
COUNTY OF
YLVANIA
. SS..
I, K. EDWARD M LLEN, the Testator whose name is signed to the attached or foregoing
instrument, having been dul qualified according to law, do hereby acknowledge that I signed and
executed the instrument as y Last Will; that I signed it willingly; and that I signed it as my free and
voluntary act for the purpose therein expressed.
,~ie1~
K"~ AW RD MULL - 0 r2 (SEAL)
Sworn to and subscribed
before me this 7`h
day of May, 2010.
. COMMONWEALTH OF PENNSYLVANIA
Notary ublic Noarial seal
Carolyn J. MtGlinn, Notary Public
Point Tvp., NoMumbMand County
My Commission Expfros Nov. 23, 2012
Member, Pennsylvania Association ~r Notaries
COMMONWEALTH OF
COUNTY OF NOR'
We, ~.1~iaen ~
witnesses whose names azt
according to law, do depos
instrument as his Last Will;
act for the purposes therein
the Wil] as witnesses; and th
or more years of age, of sow
Sworn to and subscribed
before me this 7`b
day of May, 2010.
N
,VANIA
SS.:
n
~~ i n9~art 4t1 d J ~ 1 l [Yl . 4ru ,the
signed to the attached or foregoing instrument, being duly qualified
and say that we were present and saw Testator sign and execute the
hat he signed willingly and that he executed it as his free and voluntary
Kpressed; that each of us in the hearing and sight of the Testator signed
to the best of our knowledge, the Testator was at that time eighteen (18)
l mind and under no constraint or undue influence.
Notarial Seal '~
Carolyn J. McGhnn, Notary Publi
Point 7wp ,Northumberland Coun
My Commission Expires Nov 23, 2 12
Member Penncvlvania Asseniatinn n1 u lance