HomeMy WebLinkAbout03-09-12- ~ 1505610140
REV-1500 EX ~°'-'°'
OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
Po Box 2aosol INHERITANCE TAX RETURN ++ _ __
Harrisburg, PA 17128-0601 RESIDENT DECEDENT ~ I ~} l ' ~ 1 I
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
2 0 7 2 2 2 2 0 2 1 2 1 8 2 0 1 1 0 7 2 4 1 9 3 1
Decedent's Last Name Suffix Decedent's First Name MI
A L S P A U G H P A U L I N E W
(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
0 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 ~ 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephor~lumber -- ...
4,
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M A T T H E W A M c K N I G H T 7 1 7 2~=
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REGISTER ~ SE O LY -
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First line of address ~~' <--%'`~
I R W I N & M c K N I G H T P C z' {~ "'
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Second line of address , ,r;~ - ~ '1
6 0 W E S T P O M F R E T S T R E E T
City or Post Office State ZIP Code DATE FILED '~
C A R L I S L E P A 1 7 0 1 3
Correspondent's a-mail address:
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, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
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~~
ADDRESS
186 VIRGINIA AVENUE CARLISLE PA 17013
SIGNATU~~ OF P~R OTHER THAN REPRESENTATIVE
ADDRESS ' ~ ~D~1 E fj~
60 WEST POMFRET STREET CARLISLE PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610140 1505610140 J
rUK FILING Kt I UKN
}
J 1505610240
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: PAULINE W• ALSPAUGH 2 0 7 2 2 2 2 0 2
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. 5 5 4 3 6 . 1 3
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested . .... .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested . .... .. 7.
8. Total Gross Assets (total Lines 1 through 7) ..................... .... .. 8. 5 5 4 3 6 , 1 3
9. Funeral Expenses and Administrative Costs (Schedule H) ............ .... .. 9. 3 6 3 5. 0 0
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ....... .... .. 10. 1 8 3 8 9 5. 5 4
11. Total Deductions (total Lines 9 and 10) ......................... .... .. 11. 1 8 7 5 3 0. 5 4
12. Net Value of Estate (Line 8 minus Line 11) ...................... .... .. 12. - 1 3 2 0 9 4 . 4 1
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. - 1 3 2 0 9 4 . 4 1
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.o _ 0 0 0 15. 0. 0 0
16. Amount of Line 14 taxable
at lineal rate X .045 0 0 0 16. 0. 0 0
17. Amount of Line 14 taxable
at sibling rate X .12 0 0 0 17. 0• Q Q
18. Amount of Line 14 taxable
at collateral rate X .15 0 0 0 1 g. Q~ 0 0
19. TAX DUE ........................................ .... ..19. 0 . 0 0
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^
Side 2
1505610240 1505610240 J
REV-1500 EX Pgge 3 File Number
Decedent's Complete Address: 0 0
DECEDENT'S NAME
PAULINE W. ALSPAUGH
- --
STREETADDRESS - _
1000 WEST SOUTH STREET
CITY _ _- _ _ -- -
CARLISLE ~ srATE ~ zIP
PA ' 17013
Tax Payments and Credits:
~ ~ Tax Due (Page 2, Line 19)
2. CreditslPayments
A. Prior Payments
B. Discount 0.00
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 2, enter the difference. This is the TAX DUE.
0.00
Total Credits (A + B) (2) 0.00
(3)
(4) 0.00
(5) 0.00
Make check payable to: REGISTER OF WILLS, AGENT
b-. .. - :'•-t: 4,~'.. ~ ~a~. 7~.~'~icn;, .., `~fj4!f~r'~;.a4 G,. ~ ~,~[ ,f,~~,V9E 'TS°~fu~}IC;'."~''r ~,-F~:,~.~'! X,~~
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 : ................................................................ ^
.... X^
b. retain the right to designate who shall use the property transferred or its income; ......................... ..
...... ^ X^
c. retain a reversionary interest; or .......................................................................................... .
^ 0
d. receive the promise for life of either payments, benefits or care? ................................................. .....
...... ^ ^X
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .................................................................................. ..... ^
3. Did decedent own an "intrust for" or payable-upon-death bank account or security at his or her death? .... ..... ^ X^
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.
~~--~;t:
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(1.2) [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-1508 EX+ (~ 1.10)
pennsylvania
SCHEDULE E
DEPARTMENT OF REVENUE
CASH, BANK DEPOSITS, 8~ MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
PAULINE W. ALSPAUGH 0 0
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.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. PROCEEDS FROM SALE OF REAL ESTATE 55,436.13
TOTAL (Also enter on Line 5, Recapitulation) I $ 55 436 13
If more space is needed, insert additional sheets of paper of the same size
REV-1511 EX+ (10-09)
pennsylvania
' DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
PAULINE W. ALSPAUGH 0 0 `
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B.
1
City State ZIP
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
Year(s) Commission Paid:
2. AttomeyFees: IRWIN & McKNIGHT, P.C.
3. Family Exemption: (If decedent's address is not the same as claimants, attach explanation.)
Claimant
4.
5.
6.
7.
Street Address
City State ZIP
Relationship of Claimant to Decedent
Probate Fees:
Accountant Fees:
Tax Retum Preparer Fees:
REGISTER OF WILLS
3,500.00
135.00
TOTAL (Also enter on Line 9 Recapitulation) I $
If more space is needed, use additional sheets of paper of the same size.
00
REV-1512 EX+ (12-08)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, 8~ LIENS
caiHic yr
FILE NUMBER
PAULINE W. ALSPAUGH 0 0
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION VAOF DEATHTE
1. DPW CLAIM
183, 895.54
TOTAL (Also enter on Line 10, Recapitulation) I $
1
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+ !p ~ _^ ~~
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
PAULINE W. ALSPAUGH
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
1. DEBRA K. WHARAM
186 VIRGINIA AVENUE
CARLISLE, PA 17013
AMOUNT OR SHARE
OF ESTATE
REMAINDER
I 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:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
FILE NUMBER:
0 0
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Lineal
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $
If more space Is needed, use addltlonal sheets of paper of the same size.
LAST WILL AND TESTAMENT
I, PAULINE W. ALSPAUGH, of the Borough of Carlisle, Cumberland County,
Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare
this to be my Last Will and Testament, hereby revoking any and all former Wills or Codicils by me
made.
1.
I direct that all my legally enforceable debts, funeral expenses, testamentary expenses and all
inheritance taxes (whether such taxes may be payable by my estate or by any recipient of any
property) shall be paid from my residuary estate as soon as practicable after my decease and as part
of the administration of my estate. My personal representative shall have no duty or obligation to
obtain reimbursement for any such tax so paid, even though on proceeds of insurance or other
property not passing under this Will.
2.
If my spouse shall survive me by thirty (30) days, then I give, devise and bequeath all of my
estate, whether real, personal or mixed property, whether tangible or intangible, and wherever
situated, unto my spouse, RICHARD O. ALSPAUGH, absolutely.
3.
In the event my said spouse shall predecease or fail to survive me by more than thirty (30)
days, then I give, devise and bequeath all of my estate, whether real, personal or mixed property,
whether tangible or intangible, and wherever situated, unto my daughter, DEBRA K. WHARAM,
absolutely, with substitution of issue per stirpes.
Page 1 of 4 Pages ~~
~--r~'9 ,
P.W.A.
4.
I nominate, constitute and appoint my daughter, DEBRA K. WHARAM, as Executrix of my
estate.
5.
I direct that my personal representative shall not be required to file a bond to secure the
faithful performance of her duties in any jurisdiction.
6.
I authorize and empower my personal representative, in her sole and absolute discretion, to
purchase or otherwise acquire and retain any investments or any property of any nature which I own
at my death; to sell, lease, pledge, mortgage, transfer, exchange, dispose of or grant options in regard
to any or all property of any kind forming a part of my estate for such terms and such prices as she
may deem advisable; to borrow money for any purposes connected with the protection and
preservation of my estate; to mortgage or pledge any real or personal property forming a part of my
estate or to join in or secure the partition of same; to compromise any claims or demands of my
estate against others or of others against my estate; to make distribution in kind and to cause any
share to be composed of cash, property or undivided fractional shares in property different in kind
from any other share; to employ agents, attorneys and proxies and to delegate to them such power as
my personal representative considers desirable and to pay reasonable compensation for such services
as may be rendered by such agents, attorneys and proxies; and to execute and deliver such
instruments as may be necessary to carry out any of these powers. In addition, I direct that my
personal representative shall have the power to conduct an inventory of any safe deposit box
necessary to the administration of my estate.
Page 2 of 4 Pages
~. f'.~
P.W.A.
IN WITNESS WHEREOF I have hereunto set my hand and seal this 15th day of March, 2006.
Pauline W. Alspaugh
SIGNED, SEALED, PUBLISHED AND DECLARED bythe above-named Testatrix, as and
for her Last Will and Testament, in the presence of us, who at her request, have hereunto subscribed
our names as witnesses thereto, in the presence of the said Testatrix and of each other.
Page 3 of 4 Pages
COMMONWEALTH OF PENNSYLVANIA )
COUNTY OF CUMBERLAND ~ SS.
I, PAULINE W. ALSPAUGH, Testatrix, 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 instrument as my Last Will; that I signed it willingly; and that I signed it as my free and
voluntary act for the purposes therein expressed.
Paul><ne W. Alspaugh
Sworn or affirmed to and acknowledged before me by PAULINE W. ALSPAUGH, the
Testatrix, this 15`" day of March, 2006.
Notary Public
Notarlal seal
COMMONWEALTH OF PENNSYLVANIA st,at~t, E. Bloom, Notary Public
NorCt Il~ddleton Twp., Cumberland Courriy
S S . ~ ~ ~~ August 5, 2006
COUNTY OF CUMBERLAND ~ Member. Pennsylvania Association orNoharles
We, VUC~ I- ~ 0(~YY~ and ~G ~ V ~
the witnesses whos names are signed to the attached or fore of lS ~
g ng mstrument, be ng qualified
according to law, do depose and say that we were present and saw PAULINE W. ALSPAUGH, the
Testatrix, sign and execute the instrument as her Last Will; that the Testatrix signed willingly and
that the Testatrix executed it as her free and voluntary act for the purposes therein expressed; that
each of us, in the hearing and sight of the Testatrix, signed the Will as witnesses; and that to the best
of our knowledge the Testatrix was at that time 18 or more years of age, of sound mind and under no
constraint or undue influence.
Address ~.~~~ ~ „~,~5 ~ G ~ ~oG ~
Address ~~ ~~ -
Sworn or affirmed to and subscribed before m his 15`h day of March, 2006.
Notary ublic "
Notarlel seal
C:\SLB\Estate Planning\3602.1w-wi11.2doc stlaron E. BIOOm, Notary Public
Nortl1 MidtNe~n Twp., Cumberland County
My Catttmission E~ires August 5, 2006
Page 4 of 4 Pages Member, Pennsylvania Assodauon Of Notaries
-~ ;eroeJ rel Handbook 4305.2
A Setflement Statement ~~,mr,~~
a negligence penal)
SUBSTITUTE FORMOr0other sanction wll be mposr:dhon your Tanis ilemt slrrequi erd t lbenrepOrledland the RS determines I1h21 Irhas not 6elen reported TTe Contract Sales Pdce tlescri0etl on
line 607 above conslifules the Gross Proceeds of Ihls Iransaclion. you are requiretl to file a return,
SELLER INSTRUCTIONS: II Ihis real estate was your principal residence, rile Form 2119, Sale or Exchange of Principal Residence, for an
complete the applicable parrs of Form 4797, Foml 8252 andPor Schedule D (Form 7040J.
y gain, with your Income laz return, for other Iransacliens.
n'ou are required by law to provide the settlement agent (Fetl. Tax ID No:
umber, you may be subje<I to civil or criminal penalties imposed by law. nder penal) e5 o perjuryh lycerlify that the numeber shoLwn ton Ihis slDatemlentui5 mn cmrecltlaz a
Y p yer Idenli(caPon numbeficalien
TIN: ~
-- SELLER(S) SIGNATURE(S):
SELLER(S) NEW MAILING ADDRESS:
w~. ~:~trAK l Iwtly I ur ht ll IsIMr: n nln I loo n r.i r,~„~, ,....._.._
au in spa -+--~-, t
WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE The HUD-1 Sellle Stale enl which 1 have prepared is a True and accurate account of this lransattion.
UNITED STATES ON THIS OR ANV SIMILAR FORM. PENALTIES UPON CONVICTION
CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18. I have causetlp will cause a funtls to be disbursed in accordance wish Ibis statement
U.S. CODE SECTION 1001 ANO SECTION 1010.
6y_ ~ ~~
ris tr ian. I lu hi ha haver a co of yy
re ully review he 1 5 menl 1 e em antl to dr est al m knowletlge and belie(, it is a Inie and accurate aalemenl of all receipts and disbursements made an my account or b
PY D-1 Settlement slalemenl. yme
~ n 5
y .,.._.. _ -, _.. -.
pennsylvana ~4~~~;~a ~ ,
DEPARTMENT OF PU$iIC WELFARE ;{INji~j~ ~~~-~'j,~i(;;r
ji'~ll Lii ~. ; ..
March 1, 2012
IRWIN &MCKNIGHT LAW OFFICES
MATTHEW A MCKNIGHT
WEST POMFRET PROFESSIONAL BUILDING
60 WEST POMFRET STREET
CARLISLE PA 17013-3222
Re: Pauline Alspaugh
CIS #: 540211225
SSN: ###-##-2202
Date of Death: 12/18/2011
Dear Mr Mc Knight:
Please be advised that the Department of Public Welfare maintains a claim in the
amount of $183.895.54 against the above-mentioned estate. This claim is for restitution
of medical assistance granted on behalf of the decedent for which the Probate Estate is now
responsible to reimburse the Department according to Act 49, 62 P.S. 1412, effective
August 15, 1994, as amended by Act 20-95, effective June 30, 1995. Enclosed is the
Department's itemized statement of claim.
A portion of this medical expense, namely $24.001.35, was incurred during the last
six months of the decedent's life; therefore, it is a Class 3 claim pursuant to Section 3392 of
the Decedents, Estates, and Fiduciaries Code, 20 Pa. C.S.A. 3392(3). The balance of the
claim, namely $159.894.19, is to be entered as a priority Class 5.1 claim against the
estate.
Please acknowledge receipt of this letter and advise whether the Commonwealth's
claim is admitted and when payment may be expected. If the estate accounting is
complete, please provide a copy. If the estate contains real estate, please provide
copies of the deed, the latest tax assessment, and a current appraisal, if available.
Sincerely,
Marianne Meckley
TPL Program Investigator
717-772-6246
717-772-6553 FAX
Enclosure
Bureau of Program Integrity ~ Division of Third Party Liability ~ Recovery Section
PO Box 8486 i Harrisburg, Pennsylvania 17105-8486