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HomeMy WebLinkAbout02-07-12J 1505610105 REV-1500 ex to2_~~, tF,, l OFFICIAL USE ONLY vania PA Department of Revenue Pennsy Bureau of Individual Taxes ~~~~~~~ ,« r INHERITANCE TAX RETURN County Code Year File Number PO BOX 280601 r ' ~ ~ ~ ~ r ~ ~ ~ Harrisburg, PA iyi28-D6oi R ESIDENT DECEDENT ~,~ ( ' j ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 186-34-4951 ' ' 08/28/2007 07/25/1943 Decedent's Last Name Suffix Decedent's First Name MI Shenk ' Myrel R (If Applicable) Enter Surviving Spouse's Information Below Spouse's last Name Suffix Spouse's First Name MI 'Shenk I ' 'Melissa J Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW (~ 1. Original Return O 2. Supplemental Return O 4. Limited Estate O 4a. Future Interest Compromise (date of death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust (Attach Copy of Will) (Attach Copy of Trust.) m 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death Between 12-31-91 and 1-1-95) O 3. Remainder Return (Date of Death Prior to 12-13-82) O 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes O 11. Election to Tax under Sec. 9113(A) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Suzanne S. Friday (717) 236-3010 First Line of Address 200 N. 3rd St. 18th flr Second Line of Address City or Post Office State ZIP Code Harrisburg ' PA ' 17101 C_7 ' ._ REGISTER OF? S USE ONLY} ~) ~ ~..~ _ _~m I - -ri ~? -a _ _. -.-7 -~ c. - ~3;` ~ ~ ~ I y DATE FILED ' ``' Correspondent's a-mail address: SSfriday@nSSh.COm ~_ ~ -'T]l f +-i `'i -.~. ~"'> t.~'J -~7 Under penalties of perjury, I declare that 1 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. SI T OF PE N ESPONSIBLE F F G RET. RN DATE ~' ADDRE S ll/L~b -~- P S~ -tti~t Ol A- j ~ ~-4 Z - 3 ' ~ o~ SIGNATURE FPREPARER OTHER HA REPRESENTATIVE DATE v PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 ,; .~ ( ~ ~.~'\, 1505610205 REV-1500 EX (FI) Decedent's Social Security Number decedent's Name: Myrel R. Shenk 186-34-4951 RECAPITULATION 1. Real Estate (Schedule A} ........................................... .. 1. 0.00 2. Stocks and Bonds (Schedule B) ..................................... .. 2. 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 0.00 4. Mortgages and Notes Receivable (Schedule D) ......................... .. 4. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. 255,626.00 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. 0.00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested...... .. 7. ' 0.00 8. Total Gross Assets (total Lines 1 through 7} ........................... .. 8. 255,626.00 9. Funeral Expenses and Administrative Costs (Schedule H) ................. .. 9. 33,126.00 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I)... ,......... .. 10. 58,785.00 11. Total Deductions (total Lines 9 and 10) ............................... .. 11. 91,911.00 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 163,715.00 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. 163,715.00 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 81 857.50 , (a)(1.2) X .0 15. 16. Amount of Line 14 taxable at lineal rate X .0 45 81,857.50 16, 3,683.59 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE ....................................................... .. 19. 3,683.59 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT (~ Side 2 L 1505610205 1505610205 REV-'500 EX (FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Myrel R. Shenk STREET ADDRESS 226 Reno Avenue CITY i STATE ZIP New Cumberland PA 17101 Tax Payments and Credits: 1. Tax Due (Page 2, line 19) 2. Cred~tslPayments A. Prior Payments B. Discount 3. Interest Total Credits (A + B) (2) (3) 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. (4) (t) 3,683.59 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 3,683.59 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->5o8 EX+ (iI-io) iii Pennsylvania SCFIEDULE E fi DEP"RT"'E"T of RE~E"uE CASH BANK DEPOSITS & MISC. INHERITANCE rnx RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Myrel R. Shenk 21-08-1108 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. REt~ "1L ['> 0_flaj ail Pennsylvania ~' DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Myrel R. Shenk 21-08-1108 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: I' Stone & Murray Funeral Home 1,500.00 B. 1, ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) LE street Address 2333 Noble Street city West Lawn Year(s) Commission Paid: 10,000.00 2. 3. Attorney Fees: Family Exemption: (If decedent's address is not the same as claimant's, attach explanation,) claimant Melissa J. Shenk 17,500.00 3,500.00 Street Address 226 Reno Avenue city New Cumberland _ state PA ZIp 17010 Relationship of Claimant to Decedent Wife 4. Probate Fees: 364.00 5. Accountant Fees: 6, Tax Return Preparer Fees: ~~ Recorder of Deeds -Copy of L. Shenk's Deed obtained for proof of PA address 4.00 Register of Wills -filing fee for Petition for Removal of Administrator 15.00 Cumberland Legal Journal -Estate Notice 75.00 Central Penn Business Journal -Estate Notice 150.00 Death Certificates 18.00 TOTAL (Also enter on Line 9, Recapitulation) $ 33,126.00 Ann Shenk State PA ZIp 19609 If more space is needed, use additional sheets of paper of the same size Re'v`- I ~ ~ "_. ~ 2 -081 i~ Pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Myrel R. Shenk 21-08-1108 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 1~ ACS Recovery as subrogation agent for Health American & Health Insurance 31,996.00 EIS Recovery as agent for E-Cast Settlement claim 3,001.00 Capital One Bank Claim 1,429.00 Pathology Asso. of Central PA -unpaid medical bills 48.00 Urology of Central PA 1,172.00 Pinnacle Health Hospital - ~ 16,895.00 Mid Penn Radiation Oncology ~ 3,401.00 Quantum Imaging ~ 657.00 Pinnacle Health Emergency ~ 186.00 TOTAL (Also enter on Line 10, Recapitulation) I $ 58,785.00 If more space is needed, insert additional sheets of the same size. ~r v ~~ ~~ pennsylvan~a SCHEDULE J P.RTP?LN 'ir qPY ~1Gc BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Myrel R. Shenk 21-08-1108 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).] Melissa Jane Shenk, 226 Reno Ave., New Cumberland, PA 17010 Spouse 50"~; Leigh Ann Shenk, 2333 Noble Street, West Lawn, PA 19609 Daughter ; 6.66 Christine Shenk, 253 Snooks Hill Road, Lewistown, PA 17044 Daughter ' 6.07 Stephanie Shenk-Little, 9464 Carlisle Road, Dillsburg, PA 17019 Daughter 16.67 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS 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 OF REV-1500 COVER SHEET. $ If more space is needed, use additional sheets of paper of the same size. ,.a O O ~ ~ o ~ ~ _ m O ti O r O ~_ • • W r W O ru u~ O O .~ W .a w i ~``~+NZ`" >ooa~ 'y z~~ ~ ~ '~ ° C/1 ~ W w '~ ~ . ~ ~ ' ' ~ ~ ~. m v, ,ry Z ' N ~ ` 2 OC- ~UC/1 Z ncy~~ ~ y, ~ _~Q ~ ADD ~, ~ m~~yv ~o _ yyz ~y/v J' ~ ~x~ D~pDN .- ~ ~ y V y , o ~' D f7 Z ~ ~"~ O Y ~~ o ~ °cZ ~y A -~ ~ r` ~ ~. ~ ~ Q ~ ~ ~. k . .. Q ' ~ - . ' rr ~ p ~ y b ~' ~ ~ .O.m ~ ~ ~~ N~~i~ :~ ,.,, ~ >O ~ G Cle ;~~ i ~ ~ , ~~ o~ © . ~ a o ~ ~a m ~, o ° ~ 0 m ~ K ~, b a ,; ~ ! ~ ~ ~- o ~ W ~ z ~ D ~„ Qo II I ' °z N Q ~E _ ~ _ Z ~ < ~ m N O ~ D p i v ~ D ~ O N C `~ ~ ~ ~ ~ I W N ,v N ~I ~ ~' N ~y `~ 9 -a ~a A~ o 1r ~~ ~: ~ °p ~~' ~~~~_____ Sxunty Faatut es mciueea. ~ Qe~ ails~n tack J ~-~ ()~ _ • ~~ ~ . Attorneys At yaw Please reply to: P. O. Box 840 Sherry A. May, Paralegal Harrisburg, PA 17108-0840 Sama-----ti'~nssh tom T: (717) 236-3010 ext. 25 February 6, 2012 Cumberland County Register of Wills Cumberland County Courthouse 1 Courthouse Square, Room 102 Carlisle, PA 17013 RE: Estate of M. Robert Shenk No.: 2008-01108 Our File No.: 15375 Dear Sir or Madam: Enclosed please find an original and two copies of the Pennsylvania Inheritance Tax Return and Inventory for the Estate of M, Robert Shenk. Enclosed is Estate check # 123 made payable to Register of Wills, Agent, in the amount of $3,683.59 for payment of the inheritance tax due. Also enclosed is our firm's check in the amount of $30.00 for payment of the required filing fee for each document. Please return the time-stamped extra copy of each document to me in the envelope enclosed for your convenience. Should you have any questions, please do not hesitate to contact me. Thank you. Sincerely, ~G Sherry A. May, Paralegal to Suzanne S. Friday, Esquire /sm Enclosures cc: Leigh Ann Shenk, Administrator D.B.N. ~J ~O ~~ v-~ ~- {-~ ~.,~ -,~~-r, .,i_ v "l3 ~ -1 ~:% ~, hJ --,~, Tt cr, _,.,, ~. 1'v~ Ql ~~~ F,,< < --, ~-, _ ~~ ?'7 L.~ Superior a n a l y s i s . F P f e e t i v e s o l u t i o n s . Since 1 8 7 1. Nauman Smith Shissler & Hall, LLP • Z00 North 3rd Street, 98th Floor • Harrisburg, PA 9710] . 717.236.3010 . Fax: 717.234.1925 . www.nssh.com R c ~~ ~ ~ , ,.; ~ ~ a ~. .,s~~~`' k ~. , w a *, 'a ~~ u:' -. i.i_ ~• } wcY t`~- r c±~ ~I ^~ ~', N N V ~ ~ ~r` ~ _ a r J ~ . ^ ~ ~ ~ `~ ' ~ -` a ~ o o ao y O ~i ~ ~ N ~ (n > N O ~ ~ LL X ~ O } tx U .. a0 ~ O w ~ ~ ~ ,-+ o F Z a d U U~ ~ N ~ 'C3 '~ `~ Q m cad c~C O Q+ ~ %, s., -~ ~ ~ ~ ~ ~ ~ O ~ _ ~ iz ~U--U