HomeMy WebLinkAbout02-03-12 1505610105
REV-1500 IX (oi-ii) (Fl)
OFFiCW. USE ONLY
PA Department of Revenue perstaylvania
Bureau of Individual Taxes ""'"`"'"""~`""`
PO BOx z80601 INHERITANCE TAX RETURN Coudy Code Year
~ ~ ~ r File Number
~ / ~/ /]
.
Harrtstwrq, PA 17128-0601 R ESIDENT DECEDENT / / /
ENTER DECEDENT INFORMATNNI BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
571-541180 02/06/2011 09/02N921
Decedent's Last Name Suffix Decedent's First Name MI
OWENS CHARLES C
(ff APPI~M) Enter Surviving Spousss Inlbormation Bebw
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 Compromise (date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
(~ 8. Decedent Died Testate O 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of VJIII) (Attach Copy o9 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 SE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DNtECTED T0:
Name Daytime Telephone Number
Paul D. Daggs, Esquire (717) 884-4963
First Line of Address
130 W. Church Street
Second Line of Address
Suite 100
City or Post Office
Dillsburg
CortsspondenPs a-rnall address: Up8 I
State ZIP Code
PA 17019
REGISTER OF YVILLS USE ONIN
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Under penalties d perjury, I declare that I have examined this return, Including accompanying schedules aM statarnents, and to the best d my knowledge and belief,
it is true, caned erxi wmplele. Declaration of preparer other than the persorrel represeraatlve is based on alt inforrrration d which prepwer has any kmwledge.
SIGNATtR21F~pF PERSONONSIBLE FOR F~MG RETURN __~. DATE l s
64 31st Street, NW, Barberton, OH 44203
SIGNATURE OF P~IE~ORER OTHER TWj(-1 REPRESENTATIVE DATE 1
_.
ADDRESS
130 W. Church Street, Suite 1 , Dillaburg, PA 17019
FORM
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L 1505610105
1505610105
J ~~(
J 1505610205
REV-1500 EX (FI)
Decedent's Social Security Number
oecedenrs New: Charles C. Owens 571-541180
RECAPITULATION
1. Real Estate (Schedule A) ........................................... .. 1. 0.00
2. Stocks and Bonds (Schedule B) ..................................... .. 2.
3. Cktsely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .... . 3.
4. Mortgages and Notes Receivable (Schedu~ D) .......................... . 4.
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)...... . 5. 7,626.11
8. 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 Gress Assets (total Linos 1 through 7) ............................ . 8. 7,626.11
9. Funeral Expenses and Administrative Costs (Schedule H) .............. ..... 9. 4,025.77
10. Debts of Decedent, Mortgage Liabilities and Liens (Sdredule I) .......... ..... 10. 28,802.06
11. Total Deductions (total Lines 9 and 10) ............................ ..... 11. 32,627.83
12. Net Vatua of Estate (Line 8 minus Line 11) ......................... ..... 12 -25,001.72
13. Charitable and Governmental BequestslSec 9113 Trusts for which
an election to tax has not been made (Schedule J) ................... ..... 13.
14. Nat Value Subject to Tax (Line 12 minus Line 13) ................... ..... 14. -25,001.72
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_ 15.
16. Amount of Line 14 taxable
at lineal rate X .0 _ 1 g,
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at ooNateral rate X .15 1 g,
19. TAX DUE .................................................... ..... 19. 0.00
20. FlLL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
L 1505610205 1505610205
REV-1500 EX (FI) Page 3
Decedent's Complete Address:
File Number
DECEDENTS NAME
Charles C. Owens
STREET ADDRESS -
604 State Street
CITY STATE ZIP
Lemoyne PA 17043
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
3. Interest
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
F7N in oval on Page 2, Lire 20 to request a refund.
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE
(1)
0.00
Total Credits (A + B) (2)
(3)
(4)
(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 inoome of the property transferred ........................................
b. retain the right to designate who shall use the property trensferred or its income ..................................... ....... ^
c. retain a reversionary interest ....................................................................................................................... ....... ^
d. receive the promise for life of either payments, benefits or care? ............................................................... ....... ^
2. If death orx:urred after Dec. 12, 1982, did decedent transfer property within one year of death
without receiving adequate constderatbn? ....................................................................................................... ....... ^
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 tleneficiary 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 a 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)].
Fa 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
(/2 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 r>aed 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.
flEV-1508 EX+ (11-10)
~`"~ ~~ ~~'~~ Pennsylvania
DEPARTMENT OF REVENUE
INHERRANCE TAX RETURN
RESIDENT DECEDENT
scN~ou~~ E
CASH, BANK DEPOSITS 8e MISC.
PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
CHARLES C. OWENS 2011-00177
Indude the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right aF suMvorehip must be disclosed on Sdrodule F.
u more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+ (10-D9)
':~ ~~ ` Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
CHARLES C. OVt1ENS 2011-00177
Decedent's debts must be reported oa Sdredule I.
ITEM
NUMBER DESCRIPTION AMrn wr
A. I FUNERAL EXPENSES:
1' Parttremore Funeral Horne
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City State ZIP
Year(s) Commission Paid:
Z• Attorney Fees:
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
Claimant
Street Address _ _
City _ State Z1P
Relationship of Claimant to Decedent
4• Probate Fees:
5. Accountant Fees:
6. Tax Return Preparer Fees:
~• Preparer fees for 2010 Tax Return
8. Fees for Estate putllications
TOTAL (Also enter on Line 9 Recapitulation) I;
If more space is needed, use additional sheets of paper of the same size.
2,675.27
1,000.00
100.50
75.00
175.00
4,025.77
REV-1512 EX+ (12-08)
`~ ~ ~ pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES 8t LIENS
ESTATE OF FILE NUMBER
CHARLES C. OWENS 2011-00177
Report debts Inwrtcd bT the decedent prior to death that remained unpaid at the date of death, inducting unrcimbursed medipl expenses.
.~~~o ~ ______~__. VALUE AT DATE
1• IRS - 2010 Indiv. Tax Payment
2. IRS -Final Lump_sum Payment for 2004 Tax Liability
3. Borough of Lemoyne - Sewer/Trash
4. Discover Finanaal Services (Credit Card # xxxxxx3470)
5. Members First Fed. Credit Union (Personal Service Loan #0000006501-0026)
6. Members First Fed. Credit Union (Credit Card #4672090000114082)
7. CitibanklSears (Credit Card #5049948029757871)
8. CfibanklCitl Card (Credit Card #5424180536223479)
9. Chase Bank (Credit Card #4262770102391359)
10. GE Money Bank (Credit Card #6019180032041523)
11. Capital One (Credit Card #5291151916058975)
934.00
574.31
606.34
3,517.17
106.41
2,374.20
1,862.47
2,191.38
14,171.59
337.01
1,927.18
TOTAL (Also enter on Line S0, Recapitulation) I; 28,602.06
If more space is needed, insert additional sheets of the same size.
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CHARLES C . OWENS ~°' ~:~~ ~.~o
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I, CHARLES C. OWENS, of the Borough of Lemoyne, Cumberland
County, Pennsylvania, being of sound and disposing mind, memory and
understanding, do hereby make, publish and declare this my Last Will and
Testament, hereby revoking and making void any and all prior Wills by me at any
time heretofore made.
1.
I direct the payment of all my just debts and funeral expenses as soon after
my decease as the same can conveniently be done. I direct that I be cremated and
interred at Indiantown Gap National Cemetery.
2.
I direct that there shall be paid out of my residuary estate all estate,
inheritance and like taxes together with any interest or penalty thereon imposed by
the Government of the United States, or any state or territory thereof, or by any
foreign government or political subdivision thereof, in respect to all property
required to be included in my gross estate for estate, inheritance or like tax purposes
by any of such governments, whether the property passes under this will or
otherwise.
3.
All the rest residue and remainder of my estate real, personal and mixed, of
whatsoever nature and wheresoever the same may be situate, I give and bequeath in equal
-1-
shares to my two children, LARRY C. OWENS and LISA K. BORTNER, absolutely
and in fee simple.
Lastly, I nominate, constitute and appoint my son, LARRY C. OWENS to
be Executor of this my Last Will and Testament. I further direct that no bond or
other security be required of my personal representatives to guarantee faithful
performance of his duties.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this /~'~i~
day of January, 2008.
~"' .> '
~Fiar es .Owens
-2-
COMMONWEALTH OF PENNSYLVANIA )
• SS
COUNTY OF CUMBERLAND )
I, CHARLES C. OWENS, the testator, whose name is signed to the
attached or foregoing instrument, having been duly qualified according to law, do
hereby acknowledge that I signed and executed the same instrument as my Last
Will and Testament; that I signed it willingly, and that I signed it as my free and
voluntary act and deed, for the purposes therein-e~c ressed. .,
..-~' -
r ; f - f SEAL)
ar es . y wens
Sworn and subscribed to before
me t/his j ~;~h day~of January, 2008.
otary Public
COMMONWEALTH OF PENNSYLVANIA )
COUNTY OF CUMBERLAND) S
We, the undersigned, J. Robert Stauffer and John M. Eakin, the witnesses
whose names are signed to the attached or foregoing instrument, being duly
qualified according to law, depose and say that we were present and saw the
testator, CHARLES C. OWENS, sign and execute the instrument as his Last Will
and Testament; that the said testator executed it as his free and voluntary act for the
purposes therein expressed; that each of us, in the hearing and sight of the testator,
signed the Will as witnesses; and that, to the best of our knowledge, the testator
was, at the time, eighteen (18) or more years of age, of sound mind, and under no
constraint, duress or undue influence.
Sworn and subscribed to before
me this / ~ h, day of January, 2008.
`~~~L.LL( `-/~. `7~..~ ~~ ~
otary u is
Nownat ~t
N~1 M NEI.~ON - 3 -
M!c]YliC~p~pK~
MW Co~n~ laple~s .lun 21, ZOl 1
NOTi1R1A~ +EAt
Mr comrnpq,,, ,x,nx~nn°" Zr
EB'rATE OF CHARLES C. oWENB FILE xo. 2011-o01TT
Explanation of Insolvent Estate
The deceased's son (and Executor) opened an estate out of a moral
obligation to fmalize the deceased's affairs. Attempts to deal with creditors
directly were unsuccessful. In fact, creditors filed formal claims against the
estate. Therefore, the Executor retained counsel.
Counsel Fees
In order to minimize expenses to the estate (and possibly the Personal
Representative), it is counsel's practice to charge a flat fee of $1,000 for
insolvent estates. Charging an hourly rate for this estate would have depleted
all available funds given the number of creditors and the fact that a Formal
Accounting will need to be filed together with a Petition for Distribution
including pro-rated calculations.
®~~~
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604 STATE ST
LBMOYNB PA 17D43-1533
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01-24-11 G7~ RHF CHSCKPAYMT 000000000001871 100.00 -5,053.81
_ 01-31-11 DEYOBIT 72.91 :5;125.72
02-01-11 II8 TRSABDRY 312 CIVIL 88RV 1,899.17 ~7,~024.89
' ~02-03-11 II8TR8A8URY 312 80C 88C 621.00
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"' ACCOUNT N0. ACCO[MiT TYPE STATEMENT. PERIOD PAGE
65586816 CLASSIC CHECKING FEB.08-MAR.07,2011 1 OF 1
00 0 06123M NM 017
14129
CHARLES C OWENS
604 STATE ST
LEMOYNE PA 17043-1533
INTEREST EARNED FOR STATEMENT PERIOD 0.00 HEST SHORE PLAZA
ACCCIIINT Sl1MMnRV
.,,
R ADD ;:
'CNBd[S"RkID ;:
31J9T ;
':I[ffi~ eS7`:
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N0. AMOUNT N0. AMOUNT NO. AMOUNT
7,246.22 0 0.0 0 0.00 ,246.22 0.00 0.00
ACCOUNT ACTIVITY
NARM UP KITH SPECIAL SAVINGS THIS SPRING AT POPULAR RETAILERS NHEN YOU USE YOUR
MiT CHECK CARD OR MiT VISA CREDIT CARD IN STORES, ON THE NEB AND OVER THE PHONE.
PICK UP A COUPON BOOK AT YOUR LOCAL MiT BRANCH, OR VISIT MTB.COM/SHOPPING FOR
GREAT DEALS ON SPRING SAVINGS. IF YOU PAY NITH YOUR NiT CHECK CARD, BE SURE TO
SELECT [OR ASK TO USE YOUR CARD ASl ^CREDIT".
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ACCOUNT NO. ACCOUNT TYRE
15004216635001 RELATIONSHIP SAVINGS
STATEMENT PERIOD PAGE
JAN.08-APR.08,2011 1 OF 1
00 0 06123M NM 017
CHARLES C OWENS
604 STATE ST
LEMOYNE PA 17043-1533
INTEREST EARNED FOR STATEMENT PERIOD 0.00
INTEREST PAID YEAR TO DATE 0.01
45510
ACCOUNT SUMMARY
NEST SHORE PLAZA
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DT R .,.. ;; <.:x. ; .
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BALANCE
N0. AMOUNT N0. AMOUNT
190.24 0.00 0.01 0.00
ACCOUNT ACTIVITY
PDST=IIC's:, '; : DEPOSi'f$1;3l1i!E~T:::MfDRA1tA1:&: R 01i11ER. £'IlAILY i" <':
'<DATE TR1~ifG'T~1l1 OEgtRIP'TION i OYME1f Amlii~IONS S1RAtTIONS >s. s£B~kLANCE .:,
01-OB-11 BEGINNING BALANCE 0190.24
02-00-11 INTEREST PAYMENT 0.01 190.25
02-10-11 CLOSEOUT 190.25 0.00
ENDING BALANCE 00.00
ANNUAL PERCENTAGE YIELD EARNED = 0.00
EFFECTIVE JUNE 22, 2011, THE FEE FOR EACH NITHDRANAL FROM YOUR SAVINGS OR MONEY MARKET ACCOUNT IN
EXCESS OF 4 PER MOIfTNLY SERVICE CHARGE CYCLE HILL BE Ob. THIS FEE MILL BE CHARGED REGARDLESS OF THE
BALANCE IN YOUR ACCOINIT, AND IS IN ADDITION TO ANY FEE fOR ANY ELECTRONIC fIRO TRANSFER SERVICE NE MAKE
AVAILABLE. A NITlDRANAL INCLUDES, AMONG OTHER THINGS, A NITHDRANAL MADE BY A CHECK, AT A TELLER, BY
USING AN ELECTRONIC BANKING CARD TO TRANSFER FUNDS TO ANOTHER DEPOSIT ACCOUNT MITN US, OBTAIN CASH OR
PAY THE PURCHASE PRICE OF GOODS OR SERVICES, OR BY TRANSFER MADE BY TELEPHONE TO ANOTHER DEPOSIT
ACCOUNT KITH US.
~ooea (aon
`~~ (~~!
~~~/ A Family Tradition Of Caring
... ~ !-
PARTHEMORE Funeral Home & Cremation Services, .Inc.
Mrs. Lisa K McDonald 2/8/2011
151 Evergreen Circle
Dillsbwg, PA 17019
1303 Bridge Street
P.O. Box 431
New Cumberland, PA 17070
(717)774-7721
(Fax)774-5546
www.parthemore.com
Gilbert W. Parthemore,
Founder
Gilbert J. Parthemore,
Supervisor
Stephen K. Parthemore,
CFSP
Bruce R. Parthemore,
Pre-Need Coordinator, CPC
Professional Memberships:
NFDA•PFDA
DCFDA•CCFDA
ro~d~.
C
The Rvle You Know
The People You 7Must
f
For the Service of Charles C. Owens
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way
we can. Flease 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 that ycu selected
when making the funeral arrangements.
Terms Due Date Account #
Net 30 3/10/2011 2011011.12
Description Amount
SERVICES & MERCHANDISE
Direct Cremation 2,250:00
Total Services and Merchandise 2,250.00
CASH ADVANCE ITEMS
Death Notice, Harrisbwg Patriot 385.27
10 Certified Copies of Death Certificate 60.00
Cumberland County Coroner Fee, Cremation Authorization 25.00
Total Cash Advances 470.27
Immediate Pay. Discount -Thank you! -45.00
V'
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Total az,675.z7
Payments/Credits $o.oo
Balance Due $2,675.27
Shawna M. Simpson
426 S 3rd St Ste 104
Lemoyne, PA 17043-2000
(717)761-2311
sdsimps4@yahoo.com
March 1, 2011 \\
Charles Owens \~
604 State St ~ p
Lemoyne, PA 17043-1533 ~ •~
Statement of Charges for Services Rendered:
Final Taz Preparation Fees:
Tax Preparation $ 75.00
Total fee $ 75.00