HomeMy WebLinkAbout04-05-121505610143
REV-1500 Ex`°'-'°'
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania County Code Year File Number
Bureau of Individual Taxes DEil1RTMENT OF REVENUE
Po Box.2aosol INHERITANCE TAX RETURN 21 11 0825
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
186 10 2900 07 05 2011 09 09 1914
Decedent's Last Name
ROMIG
(If Applicable) Enter Surviving Spouse's Information Below
Suffix Decedent's First Name
CATHERINE
Spouse's Last Name Suffix Spouse's First Name
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
^ 4. Limited Estate ^ qa. Future Interest Compromise
(dale of death after 12-12-82)
o g Decedent Died Testate
(Attach Copy of Will)
^ ~ Decedent Main ned a Living Trust
(Attach Copy o~~rusq
9. Litigation Proceeds Received ^ 1 p, S ousel Povert Credil~date of death
b~lween 12-3t ~Ji and -1-95)
MI
S
MI
^ 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
EDMUND G MYERS (717) 761 4540
First line of address
301 MARKET STREET
Second line of address
PO BOX 109
City or Post Office
LEMOYNE
State ZIP Code
PA 17043
REGISTER O~IJ„~S USE OPiLY
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Correspondent's a-mail address: e9m[~IdSW.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, correct and complete. Declaration of preparer other than the personal representative Is based on all information of which oreoarer has env knowlPriaw
R Rom
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4033 Caissons Court Enola PA 17025
SIGNAT OF PREPARER OTHER THAN REPRESENTATIVE DATE
/~ EDMUND G. MYERS ~/~~fti
ADDRESS
301 MARKET STREET, Lemoyne, PA
Side 1
1505610143 1505613143 J
15D561D243
REV-1500 EX
Decedent's Social Security Number
DecedenPs Name. ROnllg, Catherine S 18 6 10 2 90 0
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. 107 , 097.73
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested........... . 6. 91 , 7 63.55
7. Inter-Vivos Transfers & Miscellaneous f~q Probate Property
(Schedule G) u Separate Billing Requested........... . 7, 9 7 , 2 7 6.13
8. Total Gross Assets (total Lines 1-7) ................................................................... .. g. 2 96 , 137.41
9. Funeral Expenses & Administrative Costs (Schedule H) ...................................... . 9. 11 , 55 8.02
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................. . 10. 1 , 858.65
11. Total Deductions (total Lines 9 & 10) .................................................................. . 11. 13 , 416.67
12. Net Value of Estate (Line 8 minus Line 11) ......................................................... . 12. 2 82 , 720.74
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. 282 , 720.74
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. 0.00
16. Amount of Line 14 taxable 2 8 2 7 2 0. 7 4
at lineal rate X .045 . 16. 12
, 722.43
17. Amount of Line 14 taxable
at sibling rate X .12 0.00 17. 0.00
18. Amount of Line 14 taxable
at collateral rate X .15 0. 0 0 18. 0. 0 0
19. Tax Due ................................................................................................................. . 19. 12 , 722.43
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^
Side 2
~, 15D561D243 15D561D243
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-11-0825
DECEDENT'S NAME
Romig, Catherine S
STREET ADDRESS
Golden Living Nursing Home
46 Ertord Road
CITY STATE ZIP
Camp Hill PA 17011
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
3. Interest
11,000.00
578.95
4, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 2 Line 20 to request a refund
12,722.43
11,578.95
(3)
(4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 1,143.4$
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 :............................................................................... ^ O
b. retain the right to designate who shall use the property transferred or its income :.................................. ^ 0
c. retain a reversionary interest; or ............................................................................................................... ^
d. receive the promise for life of either payments, benefits or care? ............................................. ^
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 "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 RETURN.
_ _ .,.-__ ~ ~.. _ ____.T _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 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)J. 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.
(1)
Total Credits (A + B) (2)
Rav-7508 EX+ (g-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Romi , Catherine S 21-11-0825
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointlyownedwith the right of survivorship must be diaclosedon schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 M&T Bank Power Checking Account 000000072574321 -Item No. 1 on Date of Death 28,532.93
Valuation Letter Attached to this Return
2 M&T Bank Regular Time Deposit Certificate of Deposit Account No. 031003914381072 - 7,003.76
Items No. 5 on Date of Death Valuation Letter Attached to this Return
3 M&T Bank Regular Time Deposit Certificate of Deposit Account No. 031003914471740 -Item 50,002.40
No. 6 on Date of Death Valuation Letter Attached to this Return
4 M&T Bank Regular Time Deposit Certificate of Deposit Account No. 031003914487870 -Item 21,514.04
No. 7 on Date of Death Valuation Letter Attached to this Return
5 Highmark -Refund on prescription drug plan 44.60
TOTAL (Also enter on Line 5, Recapitulation) 107,097.73
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
Rev-1509 EX+ (6.98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF FILE NUMBER
Romig, Catherine S 21-11-0825
If an asset was made Joint within one year of the decedent's date of death, it must be reported on schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Carolyn R ROMIG
B.
C
4033 Caissons Court Daughter
Enola, PA 17025
JOINTLY OWNED PROPERTY:
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT
NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR
JOINTLY-HELD REAL ESTATE.
DATE OF DEATH
VALUE OF ASSE % OF
DECD'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENT'S INTEREST
1 A 08/23!2006 M&T Select 12 Month Certificate of Deposit 100,019.72 50
000% 50
009
86
Account No. 031003913153315 -Item No. 4 . ,
.
on Date of Death Valuation Letter to Attached
to this Return
2 A 08!23!2006 M&T Select 6 Month Certificate of Deposit 83,507.37 50.000% 41,753.69
Account No. 031003913153307 -Item No. 3 on
Date of Death Valuation Letter Attached to
this Return
TOTAL (Also enter on Line 6, Recapitulation) I 91,763.55
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98)
Rev-1510 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
o,........ n..a~__.__ c.
FILE NUMBER
This schedule must be completed and filed ff the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
THE DATE OF R04NSFERSATTACFI A COPY OF THE DEED OR REAL ESTATE. DATE OF DEATH
VALUE OF ASSET % OF DECD'S
INTEREST EXCLUSION
(IF APPLICABLE) TAXABLE
VALUE
1 M8~T Savings Account No. 15004222293249 -Transfer 100,276.13 100.000% 3,000.00 97,276.13
to Carolyn Romig, Daughter
Item No. 2 on Date of Death Valuation Letter Attached
to this Return
TOTAL (Also enter on Line 7, Recapitulation) I 97,276.13
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98)
REV-1151 EX+(10-06)
COMMO~LNT DECEDEN~RN ANIA
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
N M
q, FUNERAL EXPENSES:
ESTATE OF FILE NUMBER
Romig, Catherine S 21-11-0825
See continuation schedule(s) attached ~ 5,679.42
B.
1. ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zio
Year(s) Commission oaid
2. Attorney's Fees JOHNSON DUFFIE 5,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zio
Relationship of Claimant to Decedent
4. Probate Fees 315.50
5. Accountant's Fees
6. Tax Return Preparer's Fees 157.00
7. Other Administrative Costs 406.10
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 11,558.02
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
Romig, Catherine S 21-11-0825
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Ex enses
1 Musselman Funeral Home & Cremation Services, Inc 5.679.42
H-A 5, 679.42
Other Administrative Costs
2 Cumberland County Register of Wills Office -Filing Fees for Inheritance Tax Return and 30.00
Inventory
3 Reserves: Miscellaneous Costs and Expenses 150.00
4 The Cumberland Law Journal -Notice of Estate Administration 75.00
5 The Patriot News -Notice of Estate Administration 151.10
H-B7 406.10
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
Rev1512 EX+112.08)
scHeou~E i
DEBTS OF DECEDENT,
COMMONWEALTH OF PENNSYLVANIA MORTGAGE LIABILITIES, & LIENS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Romi , Catherine S 21-11-0825
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical eYOensea_
tlr more space Is needed, atltlitional pages of the same size)
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I(Rev. 12-08)
REV-1515 EX+ (11-OB)
COM INHERITA~NCEDECEUEN~RLVANIA
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUMBER
r~omi , ~amenne s ~ 21-11-0 825
NUMBER NAME AND ADDRESS OF RELATIONSHIP TO
DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE
PERSON(S) RECEIVING PROPERTY (Words) ($$$)
I_ TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116 a 1.2
Carolyn R Romig Daughter Entire Estate
4033 Caissons Court
Enola, PA 17025
Tota I
Enter dollar amounts for distributions shown above on lines 1 5 throw h 18 on Rev 150 0 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 II -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)
ESTATE OF CATHERINE S. ROMIG
SCHEDULE OF EXHIBITS
EXHIBIT A Last Will and Testament for Catherine S. Romig signed and dated
September 18`h, 1984
EXHIBIT B M&T Bank Account Date of Death Valuation Letter for all
Accounts
489924
__. _ __
~~t~Y ~i11 ~cn~ ~e~Y~crtcQrcY
of
CATHERINE S. ROMIG
I, CATHERINE S. ROMIG, of the Borough of Lemoyne, Cumberland County,
Pennsylvania, make, publish and declare this to be my Last Will and Testament, hereby
revoking and making void any and all former Wills by me at any time heretofore made.
L
I direct the payment of my just debts and funeral expenses as soon after my
decease as convenient to my Executrix hereinafter named.
II.
If I am survived by my daughter, CAROLYN R. ROMIG, I give, devise and
bequeath unto her my household goods and other items of tangible personal property.
III.
All the rest, residue and remainder of my estate, of whatsoever nature and
wheresoever situate, I give, devise and bequeath unto my daughter, CAROLYN R.
ROMIG, if she is living on the thirty-first (31st) day following my death. Should my
daughter, CAROLYN R. ROMIG, not be living on the thirty first (31st) day following
my death, I give, devise and bequeath the residue of my estate unto JAMES R. MILLER
of Warner Robins, Georgia.
IV.
I name, constitute and appoint my daughter, CAROLYN R. ROMIG, to be the
Executrix of this, my Will. Should my daughter, CAROLYN R. ROMIG, fail to survive
me or fail for any reason to complete the administration of my estate, I appoint CCNB
BANK, N. A., to be the Executor in her stead.
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IN WITNESS WHEREOF, I have hereunto set my hand and seal this
of ,.,~ ~2,~j ~_~z ~ _,~--~ , 1984.
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d,ty mot'.
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Catherine S. Romig ~~
Signed, sealed, published and declared by the above-named Testatrix, 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 hereunto subscribed our names as
witnesses.
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ACgNOiVLEDG F
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COM~VIONWEALTH OF PENNSYLVANIA ~`r
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COUNTY OF CUMBERLAND ,
I, CATHERINE S. ROMIG, whose name is signed to the foregoing instrument,
having been duly qualified according to law, do hereby acknowledge that I signed and
executed the instrument as my Last Will and Testament; that I signed it willingly; and
that I signed it as my free and voluntary act for the purposes therein expressed.
< <
Catherine S. Romig t
Sworn or affirmed to and acknowledged before me, by CATHERINE S. ROMIG,
this ! $ ~ day of 1984.
No Pub
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COMMONWEALTH O:F PENNSYLVANIA
ss:
COUNTY OF CUMBERLAND
We, ~ hC~ !~ S / , ~~ %~ ~ and ~ c~~ ~ c~ ~ ~'~ yL° ~_S ,
the witnesses whose names are signed to the foregoing instrument, being duly qualified
according to law, do depose and say that vac were present and saw the Testatrix sign
and execute the foregoing instrument as her Last Will and Testament; that she signed
willingly and that she 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 Z8 or more years of age, of sound mind and under no constraint or undue
influence.
Sworn or affirmed to and subscribed to before me by ~ , ,
and ~,,.~.,,~...~ ,b , y~,~,~o,~,~ witnesses, this / ~ day of - 984.
' Nota ublie
h~%If1ii1 r'::SL.C
;;'~Y Ct~tl'!i'v;!~`v'IUi~ F~4FIi~.ES OTC. 21,,1985
499 Mitchell Road, Millsboro, DE 19966 Adjustment Services
Phone 888-502-4349
F ax (302) 934-2955
August 11, 2011
Law Offices Johnson Duffie
POBox109
Lemoyne, PA 17043-0109
Re: Estate of Catherine S Romi>;
Social Security: 186-10-2900
Date of Death: July 5, 2011
Dear Sir or Madam:
Per your inquiry on August 4, 2011, please be advised that at the time of death, the above-named decedent had
on deposit with this bank the following:
1. Type of Account Checking Account
Account Number 72574321
Ownership (Names o~ Catherine S Romig
Carolyn Romig (POA)
Opening Date 0828/64
Balance on Date of Death $28,530.75
Accrued Interest $ 2.18
Total $28,532.93
2. Type of Account Savings Account
Account Number 15004222293249
Ownership (Names ofl Catherine S Romig
Carolyn Romig
Opening Date 03/18/11
Balance on Date of Death $100,252.36
Accrued Interest $ 23.77
Total ------------------------------------------------------
$100,276.13
3. Type of Account Certificate of Deposit
Account Number 31003913153307
Ownership (Names o, fl Catherine S Romig
Carolyn Romig
Opening Date 0823/06
Balance on Date of Death $83,500.51
Accrued Interest $ 6.86
Total $83,507.37
4. Type of Account Certificate of Deposit
Account Number 3100391315331 S
Ownership (Names o, fl Catherine S Romig
Carolyn Romig
Opening Date 0823/06
Balance on Date of Death $100,000.00
Accrued Interest $ 19.72
Total $100, 019.72
5. Type of Account Certificate of Deposit
Account Number 31003914381072
Ownership (Names o~ Catherine S Romig
Opening Date 11/10/08
Balance on Date of Death $7,000.00
Accrued Interest $ 3.76
Total -----------------------------------------------------------------
$7,003.76
6. Type of Account Certificate of Deposit
Account Number 31003914471740
Ownership (Names of) Catherine S Romig
Opening Date 01/30/95
Balance on Date of Death $50,000.00
Accrued Interest $ 2.40
Total $50,002.40
7. Type of Account Certificate of Deposit
Account Number 31003914487870
Ownership (Names ofl Catherine S Romig
Opening Date 06/09/95
Balance on Date of Death $21,502.55
Accrued Interest $ 11.49
Total $21,514.04
For any additional information on the above accounts, induding ownership and any changes, dosures and/or reimbursement of funds,
please call the highland Park Office at#717-737-3322.
We were unable to locate any safe deposit box for the above-mentioned decedent.
This letter does not indude any accounts in which the decxased may have been listed as Power of Attorney, Custodian of Uniform Transfers,
Representative Payee, or Tmstee under a Written Agreement
Sincerely,
Tammy Spencer
Adjustment Services