HomeMy WebLinkAbout03-23-121505610143
REV-1500 Ex(°'-'°'
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania County Code Year File Number
Bureau of Individual Taxes oErutrMENT OF REVENUE
PO 60X.280601 INHERITANCE TAX RETURN 21 10 0433
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
200 22 6199 05 13 2009
Decedent's Last Name
RAMP
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name
Spouse's Social Security Number
Date of Birth
02 10 1929
Suffix Decedent's First Name MI
ESTHER L
Suffix Spouse's First Name MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
X^ 1. Original Return ~ 2. Supplemental Return
4. Limited Estate n 4a. Fu~t Qre~r~tere~st Comp?omiso
g Decedent Died Testate ~ ~ Decedent Maintained a Living Trust
(Attach Copy of Will) (Attach Copy of Trust)
9. Litigation Proceeds Received ~ 1 D. Spousal Povert Cresit (date of death
b9lween 12-31 ~J1 and 1-1-95)
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
11. Election to tax under Sec. 9113(A)
(Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
MARK A MATEYA 717 241 6500
First line of address
55 W CHURCH AVENUE
Second line of address
City or Post Office State ZIP Code
CARLISLE pA
Correspondent's a-mail address: mamGmat@yalaW.C01'Y1
REGISTER t(~LS USE;O~ILY
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DA FLED
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Under penalties of perjury, I decla examined this return, including accompanying schedules and statements, and to the best of my knowledge and Gelief,
it is true, rrect d complet ion o reparer other than the personal representative Is based on all information of which preparer has any knowledge.
SIGN U ONSI FOR ING RETURN DATE
Jeff Bouder
Newv
OF PRE~pAR ~R OTHt'1t THAN~i,Pf~ENTATIVE _ DATE
Mark A. Mateya
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ADDRESS ~~
55 W. Church Avenue, Carlisle, PA
Side 1
1505610143 1505610143 J
~~'~
J 1505610243
REV-1500 EX
oe~eae^~'SName: Ramp, Esther L
Decedent's Social Security Number
200 22 6199
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 & Notes Receivable (Schedule D) ...................................................... .. 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............. .. 5. 7 , 424.50
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested........... . 6.
7. Inter-Vivos Transfers 8 Miscellaneous -Probate Property
(Schedule G) ~ Separate Billing Requested........... . y,
8. Total Gross Assets (total Lines 1-7) ................................................................... .. 8. 7 , 424.50
9. Funeral Expenses 8~ Administrative Costs (Schedule H) ..................................... .. 9. 10 , 037.14
10. Debts of Decedent, Mortgage Liabilities, 8~ Liens (Schedule I) ............................. . 10. 22 , 310.47
11. Total Deductions (total Lines 9 & 10) ................................................................. .. 11. 32 , 347.61
12. Net Value of Estate (Line 8 minus Line 11) ......................................................... . 12. -24 , 923.11
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, -24 , 923.11
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 0.00 16.
17. Amount of Line 14 taxable
at sibling rate X .12 0 . 0 0 17.
18. Amount of Line 14 taxable
at collateral rate X .15 0 . 0 0 18.
19. Tax Due ............................................................ ..................................................... . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
1505610243
1505610243
0.00
0.00
0.00
0.00
0.00
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-10-0433
DECEDENT'S NAME
Ramp, Esther L
STREET ADDRESS
1000 Claremont Road
CITY
Carlisle STATE
PA ZIP
17013
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19) (1) 0.00
2. Credits/Payments
A. Prior Payments
B. Discount 0.00
Total Credits (A + B) (2) 0.00
3. Interest (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
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) ~.Op
Make Check Pa able 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 :............................................................................... ^ 0
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? ............................................................ ^ U
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration? .................................................................................................................... ^ 0
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? .................................................................................................................. ^ 0
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 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 blood or adoption.
LAST WILL AND TESTAMENT
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I, ESTHER L. RAMP, of North Middleton Township, Cumberland County,
Pennsylvania, declare this to be my Last Will and Testament, hereby expressly revoking all Wills
and Codicils heretofore made by me.
1. I direct my executors to pay all of my debts, funeral and administrative expenses as
soon as may be done conveniently after my decease.
2. I authorize and empower my executors to sell any realty owned by me at my death and
not specifically devised herein, at either public or private- sale, and to give good and sufficient
deeds therefor, in fee simple, as I could do if living.
3. I give devise and bequeath all of my estate of every nature and wherever situate as
follows:
(a) The sum of $10,000.00 to Brenda Jane Anderson, and
(b) All the rest, residue and remainder to Gail Louise Bouder and James L.
Bouder, share and share alike, or to the survivor.
4. Should the gift in Paragraph 3(b) not take effect, I devise and bequeath all the rest,
residue and remainder to Jeffrey L. Bouder and Ronald L. Bouder, share and share alike.
5. I nominate and appoint Gail Louise Bouder and James L. Bouder to be the executors
of this my Last Will and Testament; they are to serve as such without bond. Should they die
before my death, renounce or refuse to serve for any reason, or die leaving any of my estate
unadministered, Inominate and appoint Jeffrey L. Bouder and Ronald L. Bouder, as substitute
executors, also to serve as such without bond, with the same powers as are given herein to my
li;i lli~ ~~I}; ~i i_i`~n
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executors.
6. I hereby suggest that my personal representatives retain the services of Irwin,
McKnight & Hughes, as attorneys in the settlement of my estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 2ND day of May,
1997.
•,-7
- EAL)
ESTHER L. RAMP
Signed, sealed, published and declared by ESTHER L. RAMP, the testatrix above
named, as and for her Last Will and Testament, in the presence of us, who at her request, in her
presence and in the presence of each other have subscribed our names as witnesses hereto.
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2
ACKNOWLEDGMENT AND AFFIDAVIT
WE, ESTHER L;. RAMP, CHERYL L. CLELAND and MARTHA L. NOEL, the
testatrix and witnesses respectively, whose names are signed to the foregoing instrument, being
first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and
executed the instrument as her Last Will and that she had signed willingly, and that she executed
it as her free and voluntary act for the purpose herein expressed, and that each of the witnesses,
in the presence and hearing of the testatrix, signed the Will as a witness and that to the best of
their knowledge the testatrix was, at that time, eighteen years of age or older, of sound mind and
under no constraint or undue influence.
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ESTHER L. RAMP
Gt'-
C ERYL L. CLELAND
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THA L: NOEL
COMMONWEALTH OF PENNSYLVANIA
. SS:
COUNTY OF CUMBERLAND
Subscribed, sworn to and acknowledged before me by, ESTHER L. RAMP, the testatrix
herein and subscribed and sworn to before me by CHERYL L. CLELAND and MARTHA L.
NOEL, witnesses, this 2NDday of May, 1997.
Not ~ty
Notarial Seal
Roger B. Irwin, Notary Public
Carlisle Boro, Cumberland County
My Commission Expires Oct. 3, 2000
Member, PeArt~yivenia dssaciaiion of Notaries
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF PROGRAM INTEGRITY
DIVISION OF THIRD PARTY LIABILITY
ESTATE RECOVERY PROGRAM
PO BOX 8486
HARRISBURG, PA 17105-8486
July 21, 2010
JEFFREY L BOUDER INSURANCE AGENCY
19 S HIGH ST
NEWVILLE PA 17241
Re: Esther Ramp
CIS #: 120216855
SSN: ###-##-6199
Date of Death: 05/13/2009
Dear Mr. Bouder:
This letter is to advise you that according to the information you
provided to our office regarding the assets of the above-referenced estate,
the Department of Public Welfare will accept the balance of the estate,
approximately $6,000.00 less any administration cost and related expenses,
and a 5% executor commission, as payment of our existing claim.
Per our telephone conversation today, I will await copies of any
receipts for related expenses as well as the copy of the checking statement.
Please have the check made payable to the Department of Public Welfare
and forwarded to my attention at the above address.
Your cooperation in resolving this matter is appreciated.
Sincerely,
Dianna L. Stoneroad
TPL Program Investigator
717-265-7688
717-772-6553 FAX
Rev-1508 EX+IB-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF (FILE NUMBER
Ramn_ Esther L ~~_~nsezz
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointlyowned with the right of survivorship must be disclosed on schedule F.
to more space Is neeaeD, aDDlnonal pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
REV-1151 EX+ (10-06)
COM INHERITANCEDT~ RETURN ANIA
REESSIDENTTTT DE EDENT
SCHEDULE H
FUNERAL EXPENSES ~
ADMINISTRATIVE .COSTS
ESTATE OF FILE NUMBER
Ramp, Esther L 21-10-0433
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
N MBER
q, FUNERAL EXPENSES:
See continuation schedule(s) attached
8,719.10
B.
1. ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Jeff Bouder
Street Address 17 S. High Street
City Newville State PA Zio 17241
Year(s) Commission Daid 2011 375.00
2. Attorney's Fees Mark A. Mateya 475.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State ZiD
Relationship of Claimant to Decedent
4. Probate Fees 109.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 358.54
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 10,037.14
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Ramp, Esther L 21-10-0433
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Ex ep nses
1 Ewing Brothers Funeral Home -Funeral Expense 8,719.10
H-A 8,719.10
Other Administrative Costs
2 Cumberland County Law Journal -Legal Advertisement of Estate 75.00
3 Cumberland County Register of Wills -Fee for Petition for Letters of Administration and 33.00
Renunciation
4 The Sentinel -Legal Advertisement of Estate 250.54
H-B7 358.54
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
Rev-1512 EX+ (12-08)
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, 8~ LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ram , Esther L 21-10-0433
.. .._ ,_ __~__. ____._ ~__.~ a~..-...~~..e,~ .....,~Id ar rt,e dare of death. including unreimbursed medical expenses.
(If more space is needed, additional pages of the same size)
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF PROGRAM INTEGRITY
DIVISION OF THIRD PARTY LIABILITY
~ y.~ (~
ESTATE RECOVERY PROGRAM V v
PO BOX 8486 ~
HARRISBURG, PA 17105-8486 f ,
May 6, 2010 ~n, 1 UnCVI
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JEFFREY L BOUDER INSURANCE AGENCY ~ ~~S
19 S HIGH ST -
~~Yv
NEWVILLE PA 17241 /
COMA
Re: Esther Ramp ~
CIS #: 120216855 R
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SSN: ###-##-6199
Date of Death: 05/13/2009 ~
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Dear Mr. Bouder:
Please be advised that the Department of Public Welfare is attempting to
recover the monetary value of any and all eligible assets in the subject
estate. Although the amount in the estate may be considerably less than that
which is owed to the Department, our claim is against the estate, no one
else. Your responsibilities, as the primary next of
kin/administrator/executor, is to advise the Department of any assets in the
estate and to insure that the remaining money, after all funeral and
administrative costs are deducted, is sent to the Department.
The Department of Public Welfare maintains a claim in the amount of
$22,310.47 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 $22,298.47, 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 $12.00, is to
be entered as a priority Class 5.1 claim against the estate.
Please acknowledge receipt of this letter and advise when payment may be
expected. If the estate accounting ~_s coriplete, ~:? eases provide a copy. If
the estate contains real estate, please provide copies of the deed, the
latest tax assessment and a current appraisal, if available.
Sincerely,
~~
Dianna L. Stoneroad
TPL Program Investigator
717-265-7688
717-772-6553 FAX
Enclosure
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sv~ lar
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
TPL SECTION -CASUALTY UNIT
PO BOX 8486
HARRISBURG PA 17105-8486
May 3, 2010
STATEMENT OF CLAIM SUMMARY
NAME Estate of RAMP, ESTHER
ID 120 216 855
MEDICAL CLASS3 CLASS 5.1 TOTAL
INPATIENT .00 .00 .00
OUTPATIENT .00 .00 .00
LONG TERM CARE 22,169.76 12.00 22,181.76
DRUG 128.71 .00 128.71
REIMBURSEMENT TO DPW 22,298.47 12.00 22,310.47
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
EIN- 23-6003113
REV-1513 EX+ (~~-08)
ER~EE , SCHEDULE J
COMINHRESIDENTEDECED N$.RLNANIA BENEFICIARIES
ESTATE OF FILE NUMBER
Ram , Esther ~ 21-10-04 33
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$)
I TAXABLE DISTRIBUTIONS [include outright spousal
~ distributions, and transfers
under Sec. 9116 a 1.2
Brenda Anderson Niece
21 Mel Ron Court
Carlisle 17015
Gail Louise Bouder Sister
2267 Ritner Highway
Carlisle, PA 17013
Total
Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 15 00 cover sheet as a r o riate.
NON-TAXABLE DISTRIBUTIONS:
II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART it -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08)