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Home My WebLink About02-22-12 (2) 1505611185 FI ) REV-1500 EX (02-11) ( OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN ~ ~- ~ ~, '7 PO BOX 280601 ~ ~ ~ ~ ~) ~ ~ J Harrisburg PA 17128-0601 o RESIDENT DECEDENT l ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 183-07-8398 11282011 04041917 Decedent's Last Name Suffix Decedent's First Name M I HEELER JANET M (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M I Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW ® 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (Date of Death 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) ^ 6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust - 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) ^ ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (Date of Death Between 12-31-91 and 1-1-95) 11 • EAtt tch S hedule Oer Sec. 9113(A) ( ) CORRESPONDENT - THIS SECTION MUS T BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Daytime Telephone Number Name R. THOMAS MURPHY 717-762-1032 First Line of Address 14 N. MAIN STREET Second Line of Address SUITE 306 City or Post Office CHAMBERSBURG State ZIP Code PA 17201 G ---7 ; ~~ _~ i -:' ;- ~( _' f'-'r ~. ~ C.i --c-~ Correspondent'se-mail address: TOMM@RTHOMASMURPHY.COM 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, coq~ct and complete. Decjlaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. 290 STROHM ROAD SHIPPENSBURG, PA 17257 SIGNATUR OF P~EPARER OTHER THAN REPRESENTATIVE ,~ I -- AD f~ESS 14 N. MAIN STREET, SUITE 306 CHAMBERSBURG, PA 17201 PLEASE USE ORIGINAL FORM ONLY Side 1 1505611185 1505611185 ~ ~;. OM4647 3.000 REGISTER OF,1llIILLS USE ON ~'~C, ~_ 0 :,~ w-,z ; ~ F "- 1 ~~~ N N _= ` :!~ ~ '~.~ 1 l1 ~~ 1 ~ \\ -J~`TR y «> j ~ 3~/ ---~t~ DA ILED 1505611285 REV-1500 EX (FI) Decedent's Social Security Number 183-07-8398 Decedent'sName• HEELER JANET M RECAPITULATION 1. Real Estate (Schedule A) O.OO 2. Stocks and Bonds (Schedule B) O.OO 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) O.OO 4. Mortgages and Notes Receivable (Schedule D) O,OO 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) ~ 1 ,284.00 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ~ 1,158.00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property Requested arate Billin ~ Se l G 21$ 799 00 g p (Schedu e ) , . 8. Total Gross Assets (total Lines 1 through 7) 221,241.00 9. Funeral Expenses and Administrative Costs (Schedule H) 1,684.00 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) 168.00 11. Total Deductions (total Lines 9 and 10) 1 $52,00 12. Net Value of Estate (Line 8 minus Line 11) 219,389.00 13. Charitable and Governmental BequestslSec 9113 an election to tax has not been made (Schedule J) 0,00 14. Net Value Subject to Tax (Line 12 minus Line 13) 219, 389.00 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers u~f{er Sec. 9116 (a)(1.z) x .0~! O.OO 15. O.OO 16. Amount of Line 14 ~xable X 0 li l t 00 219 389 873 00 9 . - nea ra e at , . 1 s. , . 17. Amount of Line 14 taxable at sibling rate X .12 O.OO 17. O.OO 18. Amount of Line 14 taxable at collateral rate X .15 O,OO 1 g. O.OO 873.00 9 19 . TAX DUE , 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^ Side 2 1505611285 1505611285 OM4648 3.000 REV-1500 EX (FI) Page 3 rlnnn'lent'c (`mm~intn AAr~~ncc• File Number DECEDENTS NAME HEELER JANET M STREET ADDRESS 29 TR HM R AD CUMBERLAND CITY SHIPPENSBURG STATE PA ZIP 17257- Tax Payments .and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 9.380.00 B. Discount 493.00 (1) 9,873.00 Total Credits (A + B) (2) 3. Interest 9,873.00 (3) 0.00 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 TWE FALLOWING QUESTIONS BY PLACING AN "X" IN TWE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: No a. retain the use or income of the property transferred b. retain the right to designate w c. retain a reversionary interest. ' 1 v1 ? d. receive the promise for fife of either payments, benefits or care 2. If death occurred after Dee. 12, 1982, did without receiving adequate c~sideration? 3. Did decedent awn an "in trust far" ar payable-upon-death bank account or security at his or her death? 4. D'+d decedent awn an individual retire contains a beneficiary designation? tF THE ANSNIER TO ANY OF TWE ABCIVE QUESTIONS IS YES, YOU MUST COMPLETE SCWEDULiy G .AND FILE IT AS PART OF TWE 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. Fates of death on or after July 1, 2000: e 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)]. e 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)]. e 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. OM4671 2.000 REV-1508 EX+ (t1-10) pennsylvania SCHEDULE E DEPARTMEM OF REVENUE CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIOEIVr oECEOErrr ESTATE OF: FILE NUMBER: Janet M. Heller Include the proceeds of litigation and the date the proceeds were received by the estate. All ro ert -ointl owned with ri ht of survivorshi must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. M&T Bank Checking Account #950963812 1,123 2 Providence Place, refund , 161 TOTAL (Also enter on line 5, Recapitulation) $ ~ 1, 284 ow46AD 2.000 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 SCHEDULE F JOINTLY OWNED PROPERTY ESTATE OF: FILE NUMBER: Janet M. Heller If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVNINGJOIPfrTENANI-(S)NANE(S) I ADDRESS ~RE.ATIONSHIPTODECEDENT A Cook, Susan H JOINTLY-0WNED PROPERTY: 290 Strohm Road, Shippensburg, PAI 17257 Daughter ITEM NUfvHER ~rrER FOR JgNT TENANT ~~ MADE JQIM DESCRIPf10N OF PROP9ZTY INCLUDE NAhE OF FINANCIAL INSTITUTION AND BANKACCOUNT NUNEER OR SIMLAR IDENTIFYINGNUNBER.ATTACHDEEDFCFIJgNTLVHELDREALESTATE. DATE OF DEATH VALUE OF ASSET % OF DECEDENPS INTEREST DATE OF DEATH VALUE OF DEC®B`!l'SINTEREST 1 A 9/20/2004 Orrstown Bank Checking Account #103005084 2,317 50.0000 1,158 TOTAL (Also enter on Line 6, Recapitulation) E 1 ,158 swasAE 2.00o 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 ca i HI t yr FILE NUMBER Janet M. Heller 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 NUMBS DESCRIPTION OF PROPERTY ~Nq-U7ET}ENMdEOFT}fliYNlSFEREE,TFEIRRELATIOMSHPTODECEDEMAPD 7FEDATEOFIR.MSF9ZgTiAdiACOPYOFTFEDEEDFORRFJLLESTATE DATE OF DEATH VALUE OF ASSET %OFDECD'S INTEREST EXCLUSION IFAPPLICABLE TAXABLE VALUE ~• Janet M. Heller Irrevocable i Trust dated May 14, 2004; M&T Bank Certificate of Deposit #31003916126319 - $65,000.00; Orrstown Bank Money Market Account #103800167 - $153,798.92; Beneficiary - Susan H. Cook, daughter 218,799 100.0000 0 218,799 TOTAL (Also enter on line 7, Recapitulation) $ If more space is needed, use additional sheets of paper of the same size. 18,79 9W46AF 2.000 REV-1511 EX+(10-0g) SCHEDULE H pennsylvania DEPARTAAEhfrOF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Janet M. Heller Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 Kathi's Deli 104 B. 1 2. 3. 4. 5. 6. 7. 1 9W46AG 2.000 Total from continuation schedules ~ 65 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City Year(s) Commission Paid: State _ 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 Fees: Tax Return Preparer Fees: Cumberland County Register of Wills TOTAL (Also enter on Line 9, Recapitulation) ~ $ If more space is needed, use additional sheets of paper of the same size. 1,500 15 1,684 Estate of: Janet M. Heller Schedule H Part 1 (Page 2) Item No. Description 2 Crider Meats funeral luncheon Amount 65 Total (Carry forward to main schedule) 65 REV-1512 EX+ (12-08) pennsylvania DEPARTMENiOF REVENUE INHERITANCE TAX RETURN RESIOENroECEOENr ESTATE OF Janet M. Heller SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES ~ LIENS FILE NUMBER Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 • WSEMS ambulance service 2 Alert Pharmacy prescriptions 3 IShippen Cleaners drycleaning 65 81 22 TOTAL Also enter on Line 10, Reca itulation $ 168 awasAH 2.00o If more space is needed, insert additional sheets of the same size. REV-1513 EX+(01-10) pennsylvania DEPARTMENrOF REVENUE INHERffANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES IMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1, Susan H. Cook 290 Strohm Road Shippensburg, PA 17257 1 1 FILE NUMBER: RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE Daughter ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE, NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX iS NOT TAKEN: i B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. swasAi z.ooo If more space is needed, use additional sheets of paper of the same size. R. Thomas Murphy c~ Associates, P. C. Attorneys at Law Mail correspondence to: 2005 East Main Street 14 North Main Street, Suite 306 Waynesboro, PA 17268 Chambersburg, PA 17201 Phone: 717-762-1032 www.rthomasmurphy.com Phone: 717-261-0117 Fax: 717-762-1832 Writer's E Mail: tomnr(a~rthomasmarrnhy com R. Thomas Murphy, CELA Jared S. Childers February 20, 2012 Register of Wills o =-=~ Cumberland County Courthouse '~ -~ --~ -~ 1 Courthouse Square _:~ ,~ ; _ ~ ;~:% ~-~ Carlisle PA 17013 .~ n, ;- ~ - , ,_~~ _, ; Re: Estate of Janet M. Heller ~, ~ -, -~~ File No. ~ ,~, `~~ Date of Death: 11/28/2011 `-~ ~ ~ SS#: 183-007-8398 Dear Register: Please find enclosed two (2) signed originals of the PA REV-1500, a check payable to you in the amount of $9,380.00 representing payment of Pennsylvania Inheritance Tax, and a check payable to you in the amount of $15.00 for payment of filing fees in the Estate of Janet M. Heller. I would appreciate it if you would provide me with a receipt for my file. Sincerely, R. THOMAS MURPHY & ASSOCIATES, P.C. R. Thomas Murphy RTM/ksb Enclosures cc: Susan Cook 5:\Estate RTM\Heller, Janet M-RTM-ksb\Ltr to Ciunberland Co ROW.docx anur ceuer c.aw rounaanon, as authorised by the Pennsylvania Supreme Court y /'°Z, ems'` ~<.w d Bp6 sMHP "4333111 '. ~~ '~~3,ilM3~~ ;~`,~~.. 1~_ ~ c- ~,_ ~JG N ~~ ~ ~ pC F• ^~ N N U ~r ^ ~~ ~I U vOi ~ ~ 0 v~ ~ a~ ~ ~ ~ ~U ~ ~ O N N ~3~~ U N ~M 1~ ~ ~ o 023 `~ `~ ~ ~ ~ ~ ~ 0 ~ 3 O ~ , U 0 a C fs. ~, i -fl ~ u i ~, p W ~ O b ~ ~ ~ ~ ~ ~ O Sa td A N ~ ~ ~ ~ ~ ~ N c~S to O ~ •1-i •~A O~ ~ ~ ~ U ~ ~ ~ U ~ U H