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Home My WebLink About03-23-12Ex (01-10) -~ REV-1500 1505610143 Ls: OFFICIAL USE ONLY PA Department of Revenue Pennsylvania Bureau of Individual Taxes ocr~avimrur or aweNw County Cc,de Year File Number PO 80X.280601 INHERITANCE TAX RETURN 2 1 1 1 0 0 0 6 6 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 202 20 2775 12 19 2010 O1 25 1918 Decedent's Last Name Suffix Decedent's First Name MI DAWGERT NELLIE (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 ® 1 Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death prior to 12-13-82) ^ 4. Limited Estate ^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax Return Required (date of death after 12-1?_-82) ® g Decedent Gied Testate ^ ~ Decedent Maintained a Living Trust 8. Total Number of Safe De OSit BOxeS (Attach Copy of Will) (Attach Copy of Trust) P ^ 9. Litigation Proceeds Received ^ 1p, Spousal Poverty Credit (date of death 11.Election to tax under Sec. 9113(A) between i2-31-91 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 Telephone Number JILL M SPOTT ESQUIRE 570 587 2600 First line of address 108 NORTH ABINGTON ROAD Second line of address City or Post Office State ZIP Code CLARKS SUMMIT PA 18411 Correspondent's a-mail address: REGISTER Of7WILLS USE ^- -_ '~t OC7 ~~ ~ !, -_rf~~ W -~ ~ C1 C ~ -Z7 t -`i 'L J -'r1 DRTE.~LED r,~ ~-_ .-.., -.a 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 or preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG URE PERSON RFSPONSIBLfX Oft FILING RLTURN ATF /~`/~\JI~- F. Dennis Dawgert ADDRESS 1006 Woodland Way, Clarks Summit, PA 18411 SIG TURF OF PR[PARER O rl-IFi rHAN REPRESENTATIVE i)A?'f= 0~ ~_'~. Jill M Spott Esquire ~~'I~ 0 108 North Abington Road, Clarks Summit, PA 1841'1 SiJ:1e 1 1505610143 1505610143 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 - 11 - 00066 DE EDENT'S NAME Dawgert, Nellie STREET ADDRESS 911 Acri Road CITY STATE ZIP Mechanicsburg PA 17050 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 3,340.05 2. Credits/Payments A Prior Payments B. Discount Total Credits (A + g) (2) 0.00 3. Interest (3> 0.00 4 If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (q) Check box 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. (5) 3, 340.05 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 :................................................................................. x b. retain the right to designate who shall use the property transferred or its income :................................. x c. retain a reversionary interest; or ......................................................................._......................_............. x 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?..........__ ................... _...__ ......................._.............. ., x ................... 3. Did decedent own an "in trust 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? .................... _....__. _ ._.... ..x ................................................................... IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETUR ___ __ _ _ ___ __ ___ _. 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) li)]. For dates of death on or after January 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) . A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by bloo~ or adoption 1505610243 REV-1500 EX oe~~de~r5 Name D A W G E R T, N E L L I E ~ RE CAPITULATION 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 & Notes Receivable (Schedule D)........_._...._... _. _ ._...._.._ .... 4. 5 Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........... ..... 5. 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 1-7).._.........._....... _ .._ .. _ .............._....... ..._.. g, 9. Funeral Expenses & Administrative Costs (Schedule H)....__.... .__ ........... ..... 9. 10. Debts of Decedent.. Mortgage Liabilities, & Liens (Schedule I) ........................... ..... 10. 11 Total Deductions (total Lines 9 & 10) .............................................................. .......11 12 Net Value of Estate (Line 8 minus Line 11) ........................... . _..12 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. TAX COMPUTATION -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 00 15. 16. Amount of Line 14 taxable at lineal rate X .045 7 4, 2 2 3. 4 3 16. 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. 20 FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Decedent's Social Security Number 202 20 2775 20,006.33 83,665.76 0.00 103,672.09 28,147.09 1,301.57 29,448.66 74,223.43 74,223.43 3,340.05 3,340.05 Side 2 1505610243 1505610243 J COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RET'UfiN RESIDENT DECEDENT ESTATE OF Dawgert, Nellie All property jointly-owned with right of survivorship must be disclosed on Schedule F. FILE NUMBER 21 - 11 - 00066 ITEM DESCRIPTION UNIT VALUE VALUE AT DATE OF NUMBER DEATH 1 Merck Stock -taxes taken out prior to distribution -Amount prior to taxes 0.00 0.00 taken out $38,206.08 (comprised of 1056 units at $36.18 each), total distribution was $27,353.00 to estate 2 MetLife Stock (no taxes taken out prior to distribution) 32.248 5,191.93 3 Bonds for granddaughter Stephanie Franchak, deceased -POD to Nellie 14,814.40 Dawget) SCHEDULE B STOCKS & BONDS TOTAL (Also enter on line 2, Recapitulation) 20,006.33 SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF Dawgert, Nellie 21 - 11 - 00066 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER 1 Merck Dividend 2 Balance in M&T Bank Account 3 Bank Account Interest 4 The Investment Center DESCRIPTION VALUE AT DATE OF DEATH 401.28 32,764.08 10.79 50,489.61 TOTAL (Also enter on Line 5, Recapitulation) I 83,665.76 COMMONWEALTH OF PENNSVI.VANIA INHERITANCE TAX RETURN RESIDENT UECEDENI ESTATE OF Dawgert, Nellie SCHEDULE H FUNERAL EXPENSES & ADMINISTRATNE COSTS FILE NUMBER 21 - 11 - 00066 Debts of decedent must be reported on Schedule I. ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT A• 1 Gilbert Dailey Funeral Home 9,000.72 2 Sophia's on Market 1,696.11 3 All Saints Cemetary 1,250.00 4 Ann Marie Franchak -reimburse for (OIP - $505.80, Fed Ex - $159.65, Sophia's on 944.66 Market - $189.21. Priest - $90.00) 5 B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) F. Dennis Dawgert ,000.00 Street Address 1006 Woodland Way city Clarks Summit state PA zip 18411 Year(s) Commission paid 2012 2. Attorney's Fees Shells Law Associates, P.C. 9 771 29 3. 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 4. Probate Fees Cumberland County Register of Wllls 173.50 Cumberland Law Journal 75.00 The Patriot News 231.86 5 Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 Copying and Postage 3.95 TOTAL (Also enter on line 9, Recapitulation) 28,147.09 SCHEDULEI y ~ ' DEBTS OF DECEDENT, MORTGAGE COMMONWEALTH OF PENNSYLVANIA LIABILITIES, & LIENS INHERITANCE TAX RETUf2N RESIDENT DECEDENT ESTATE OF FILE NUMBER Dawgert, Nellie 21 - 11 - 00066 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 Golden Living Centers 266.00 2 State Employees Retirement System 287 07 3 Spirit Physician Hospital 66.50 4 F. Dennis Dawgert -reimbursement for tax payment for 2010 on The Investment Center, Inc. 682.00 Account TOTAL (Also enter on Line 10, Recapitulation) I 1,301.57 REV-1513 EX+ (11-08) SCHEDULE) COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Dawgert, Nellie RELATIONSHIP TO NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT RECEIVING PROPERTY Do Not List Trustcols) I, TAXABLE DISTRIBUTIONS[include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 F. Dennis Dawgert Son 1006 Woodland Way Clarks Summit, PA 18411 2 Ann Marie Franchak Daughter 911 Acri Road Mechanicsburg, PA 17050 3 FILE NUMBER 21 - 11 - 00066 SHARE OF ESTATE AMOUNT OF ESTATE (Words) ($$$) Enter dollar amounts for distributions shown above on lines 15 through 18 on 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 O.OO REGISTER OF WILLS OF COMMONWEALTH OF PENNSYLVANIA } SS COUNTY OF Cumberland } F. Dennis Dawgert INVENTORY CUMBERLAND COUNTY, PENNSYLVANIA File Number 21 - 11 - 00066 rersonal Kepresentative(s) of the Estate of Dawgert, Nellie deceased, depose(s) and say(s) that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I verify that the statements made in this Inven- tory are true and correct. I understand that false state-} ments herein are made subject to the penalties of ~ F. Dennis Dawgert 18 Pa.C.S § 4904 relating to unsworn falsification to authorities. Attorney -- (Name) JIII M Spott Esquire (Supreme Court I.D. No.) 88640 (Firm) Sheils Law Associates, P.C. 108 North Abington Road (Address) Clarks Summit, PA 18411 (Telephone) 5701587-2600 nATE Of D[.ArFI I_11S1 Rr:SIDENCE 911 ACrI Road DECEDENT'S SOC SEC. NO 12/19!2010 Mechanicsburg, PA 17050 202-20-2775 FIGURES MUST BE TOTALED Personal Property Merck Stock -taxes taken out prior to distribution -Amount prior to taxes taken 0.00 out $38,206.08 (comprised of 1056 units at $36.18 each), total distribution was $27,353.00 to estate MetLife Stock (no taxes taken out prior to distribution) 5,191.93 Bonds for granddaughter Stephanie Franchak, deceased -POD to Nellie 14,814.40 Dawget) Merck Dividend 401.28 Balance in M8~T Bank Account 32,764.08 (Attach additional sheets if necessary) Total Personal Property and Real Estate $225,753.49 INVENTORY (continued) REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA COMMONWEALTH OF PENNSYLVANIA } SS COUNTY OF Cumberland } File Number 21 - 11 - 00066 DATE OF DEATH LAST RESIDENCE 911 ACri Road DECEDENT'S SOC. SEC. N0. 12/19/2010 Mechanicsburg. PA 17050 202-20-2775 t3ank Account Interest The Investment Center Allstate Life Insurance Company -Annuity 10.79 50,489.61 122.081.40 Total Personal Property 225,753.49 2 A % 2!-i j/ ' ~ T$ !- an n.~~~y uou>wy J 33 '7{i' _ l ~: ~. a.~~o, ~. ~.~,,,~, M ~- ~, ~~ .n ,~;, ~~ +~ ` ~~ ;. x i ', °. -. J ~ •--~ A..~~ vi ~ ~ O Q' U bA ~ Q Q .. ,~ O ~ ~z~ °° ^~ ~ U Q .a rn ~ ~ M r~ ~ ~ O C~ r.,~ ~ ~~ ~ = o C s ~ e~ ice. •' ~ L (~ ~~ ~ O .a: ec ~ ~ U ~ .., v C ~ ~ ~ ~ ~ D U