HomeMy WebLinkAbout04-12-12 1505611185
FI
11
02
REV-1500 EX )
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-
(
OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes
PO BOX 280601 INHERITANCE TAX RETURN
~ I ~ ~ ~~
Harrisburg PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
175-28-7442 0927201], 04221920
Decedent's Last Name Suffix Decedent's First Name M I
WIEBELT DOROTHY D
(If Applicable) Enter Surviving Spouse's Information Below MI
'
Spouse's Last Name s First Name
Suffix Spouse
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)
Decedent Died Testate
^ 6 ^ 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 11 • Election to Tax under Sec. 9113(A)
^ 10. Spousal Poverty Credit (Date of Death
Between 12-31-91 and 1-1-95) (Attach Schedule O)
BE DIRECTED TO:
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL
aAXm
F
D
Telephone Number
E
Name
BRIDGET M• WHITLEY, ESQ• 717-233-1000
First Line of Address
17 SOUTH SECOND STREET
Second Line of Address
6TH FLOOR
City or Post Office State ZIP Code
HARRISBURG PA 17101
REGISTER OF WILLS USE ONLY
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correspondent'se-mail address: BMWaSKARLATOSZONARICH • 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 preparer has any knowledge.
SIGNATURE OF PERSON RE O IBLE FOR FILING RETURN DATE
MARIANN HILLENBRAND y
AD RESS MECHANICSBURG, PA 17050-2247
720 ALBERTA AVE
SIGNF~ URE OF PREPAR R OTHE T~1AN REPRESENTATIVE DATE
BRIDGET M• WHITLEY, ESQ• u/!/ /L
ADD ESS
17 SOUTH SECOND STREET, 6TH FLOOR HARRISBURG, PA 17101
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505611185
OM4647 3.000
1505611185
1505611285
REV-1500 EX (FI)
Decedent's Social Security Number
175-28-7442
Decedents Name WIEBELT DORO THY ~-
RECAPITULATION
1. Real Estate (Schedule A) 1 • ~ • ~ 0
2. Stocks and Bonds (Schedule B) . 2. 0 • 0 0
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) , 3, 0 • 0 0
4. Mortgages and Notes Receivable (Schedule D) 4. 0 • 0 0
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) 5. ~ • ~ ~
6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested 6. 5 8 3 ' 0 0
7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property
Requested
rate Billin
S
7.
4 , 8 7 5 . D 0
g
epa
(Schedule G) ~
8. Total Gross Assets (total Lines 1 through 7) g. 5, 4 58.00
g. Funeral Expenses and Administrative Costs (Schedule H). 9. 2 , 2 9 9 •0 0
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) 10. 3 31 • 0 0
11. Total Deductions (total Lines 9 and 10) , 11. 2 , 6 3 0 •0 0
12. Net Value of Estate (Line 8 minus Line 11) . 12. 2 , 8 2 8 •0 0
Charitable and Governmental Bequests/Sec 9113 Trusts for which
13
.
an election to tax has not been made (Schedule J) , . 13. 0 • 0 0
14. Net Value Subject to Tax (Line 12 minus Line 13) . 14. 2 , 8 2 8 •0 0
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116 Q • 0 0
16. Amount of Line 14 t xable
at lineal rate x .0 4~ 2, 8 2 8 .0 0
1 s.
12 7 .0 0
17. Amount of Line 14 taxable
0
0 0 0 • 0 0
•
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 0 • 0 0
18. 0 • 0 0
127.00
1s.
19. TAX DUE.
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
1505611285 1505611285 J
OM4648 3.000
REV-1500 EX (FI) Page 3
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments ~ '
B. Discount ~ ' ~ ~
File Number
(1) 127.00
Total Credits (A + B) (2) ~ ' ~
3. Interest ~ , ~ 0
(3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. ~ • ~ O
Fill in box on Page 2, Line 20 to request a refund. (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 12 7 • 0 0
Make check payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
Yes No
1. Did decedent make a transfer and: X
a. retain the use or income of the property transferred
b. retain the right to designate who shall use the property transferred or its income ^
c. retain a reversionary interest
d. receive the promise for life of either payments, benefits or care?
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death ^ ^
without receiving adequate consideration? .
? ® O
3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death
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.
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)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(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.
OM4671 2.000
F2EV-1509 EX+ (01-10)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
FILE NUMBER:
Doroth D. Wiebelt
If an asset became jointy owned wkhin one year of the decedent's date of death, it must be reported on Schedule G
SURVNINGJOIMTTENANT(S) NANF.(S)
ADDRESS
RELATIOIJSHIP TO DEC®B~IT
A Hillenbrand, Mariann W 1720 Alberta Ave, Mechanicsburg, P1~
17050 I Daughter
inltir v nwNE~ PROPERTY:
TOTAL (Also enter on Line 6, Recapitulation) S 583
If more space is needed, use additional sheets of paper of the same size.
9W46AE 2.000
REV-1510 EX+(08-09) SCHEDULE G
pennsylvania
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF
NUMBER
Doroth D. Wiebelt
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.
DESCRIPTION OF PROPERTY
ITEM INCLIDETFENAAAEOFTFETRANSFEREE, THEIR REIATIOP15HIP TO DECEDEM Ate
DATE OF DEATH o
/o OF DECD'S EXCLUSION TAXABLE
NUMBE TFEDATEOFTRMISFERATTPGFiACOPVOFTHEDEEDFORREALESTATE. VALUE OF ASSET INTEREST IF APPLICABLE VALUE
~• 1,071.51 Shares
BehringerHarvard
REIT I, INC. Account No: 21983
(1071.510 shares @ $4.55) 4,875 100.0000 0 4,875
Transfered September 27, 2011
to decedent's daughter Mariann
Hillenbrand
TOTAL (Also enter on line 7, Recapitulation) $ I 4 , 875
If more space is needed, use additional sheets of paper of the same size.
9W46AF 2.000
REV-1511 EX+(10.09)
pennsylvania
DEPARTMENTOF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
D r h D. Wi
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER
A. FUNERAL EXPENSES:
~ Harvey's - Repast Lunch
2 TLF Kopriver's Florist
B.
1
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City
Year(s) Commission Paid:
2. Attorney Fees:
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
laimant
4.
5.
6.
7.
9W46AG 2.000
Street Address
City State ZIP
Relationship of Claimant to Decedent
Probate Fees:
Accountant Fees:
Tax Return Preparer Fees:
The above administrative expenses and the debts
listed on Schedule 2 are deductible as the Estate
was insolvent and these items were actually paid by
the co-owner of the bank account shown on Schedule F
and the transfer on death securities shown on
Schedule G. See P.S. Section 9126.
Total from continuation schedules .
DESCRIPTION
AMOUNT
219
89
State ZIP
TOTAL (Also enter on Line 9, Recapit
If more space is needed, use additional sheets of paper of the same size.
1,500
460
31
2,299
Estate of: Dorothy D. Wiebelt
Schedule H Part 7 (Page 2)
Postage
31
Total (Carry forward to main schedule) 31
REV-1512 EX+(12-08) SCHEDULE
Pennsylvania
pEPARTMENTOF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES 8c LIENS
RESI~NTDECEDENT FILE NUMBER
ESTATE OF
Doroth D. Wiebelt
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
VALUE AT DATE
ITEM OF DEATH
NUMBER DESCRIPTION
82
~• Reading Food and Ankle
29
2 Alert Pharmacy
3 IROBC
220
TOTAL (Also enter on Line 10 Recapitulation) ~ $ 331
awasAH z.ooo If more space is needed, insert additional sheets of the same size.
REV-1513 EX+(01-10}
pennsylvania
DEPARTMENiOF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
IMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I TAXABLE DISTRIBUTIONS [InGude outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
1. Mariann W. Hillenbrand
720 Alberta Ave
Mechanicsburg, PA 17050
100$ of Residue: 1,828
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Daughter
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
[I 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
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET.
If more space is needed, use additional sheets of paper of the same size.
FILE NUMCEK:
AMOUNT OR SHARE
OF ESTATE
1,828
0
9 W 46AI 2.000
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
Pennsylvania
HARRISBURG PA 17128-0601 DEPARTMENT OF REVENUE
REV-1543 EX AFP (05-11)
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE FILE No. 21
AND ACN 11173961
TAXPAYER RESPONSE DATE 11-10-2011
EST. OF DOROTHY D WIEBELT
SSN 175-28-7442
DATE OF DEATH 09-27-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
MARIANN W HILLENBRAND REGISTER OF WILLS
720 ALBERTA AVE 1 COURTHOUSE SQUARE
MECHANICSBURG PA 17050-2247 CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
0 RRSTOW N BANK provided the department with the information below, which was used in calculating the inheritance tax due.
Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If yoU are the Spouse of the
deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due. but you must
notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2.
If you believe the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return
it to the above address. Please call 717-787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 147000785 Date 09-07-2010 To ensure proper credit to the account, two
Established copies of this notice must accompany
payment to the Register of Wills. Make check
Account Balance $` 1 , 166.51 payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax $ 583.26 months of the decedent's date of death,
deduct a 5 percent discount on the tax due.-
Tax Rate X • 1 5 Any inheritance tax due will become delinquent
Potential Tax Due $ 87 • 49 nine months after the date of death.
PART TAXPAYER RESPONSE
FAILURE TO RESPONDIiL' R`E~LT Ahl~~ OFFICIAL TAX ~S~SlAENT
A The above information and tax due is correct.
. ~ Remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or return this notice to the Register of Wills and
C H E C K an official assessment will be issued by the PA Department of Revenue.
C ONE
B L 0 C K B. ~
The above asset has been or will be reported and tax Paid with the Pennsylvania inheritance tax return
0 N L Y filed by the estate representative.
C. ~ The above informs ion is incorrect and/or debts and deductions were paid.
Complete PART ~2 and/or PART ~ below.
If indicating a different tax rate, please state OFFICIAL USE ONLY ~ AAF
PART
relationship to decedent: PA DEPARTMENT OF REVENUE
ACCOUNTS PAD
TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST 1
LINE 1. Date Established 1
2. Account Balance 2 $ 2__ ,
3. Percent Taxable 3 X 3
4. Amount Subject t o Tax 4 $ 4
5. Debts and Deduct ions 5 - 5
6. Amount Taxable 6 `~ 6
7. Tax Rate 7 X 7
8. Tax Due 8 $ 8
DEBTS AND DEDUCTIONS CLAIMED
PART
0
PAYEE DESCRIPTION AMOUNT PAID
DATE PAID
TOTAL CEnter on Line 5 of Tax Computation) $
Under penalties of perjury, I declare that the facts I reported above are true, correct and
complete to the best of m knowledge and belief. HOME C ~
WORK ( ~ loZ
r..,~... o crr_uerllR TELEPHONE NUMBER AT
~ PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE FILE N0. 21
BUREAU OF INDIVIDUAL TAXES
PD Box 2eo6o1 Pennsylvania AND ACN 11173961
HARRISBURG PA 17128-0601 DEPARTMENT DP REVENUE TAXPAYER RESPONSE DATE 11-10-2011
REV-1543 EX AFV (OS-13)
TYPE OF ACCOUNT
EST. OF DOROTHY D WIEBELT ^ SAVINGS
SSN 175-28-7442 ® CHECKING
DATE OF DEATH 09-27-2011 ^ TRUST
COUNTY CUMBERLAND ^ CERTIF.
REMIT PAYMENT AND FORMS T0:
MARIANN W HILLENBRAND REGISTER OF WILLS
720 ALBERTA AVE 1 COURTHOUSE SQUARE
MECHANICSBURG PA 17050-2247 CARLISLE PA 17013
0 RRSTO WN BANK provided the department with the information below, which was used in calculating the inheritance tax due.
Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If you are the spouse of the
deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must
notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2.
If you believe the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return
it to the above address. Please call 717-787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REYERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 147000785 Date 09-07-2010 To ensure proper credit to the account, two
Established copies of this notice must accompany
payment to the Register of Wills. Make check
Account Balance $ 1,166.51 payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax ~` 583.26 months of the decedent's date of death.
Tax Rate ~( , lj deduct a 5 percent discount on the tax due.
Any inheritance tax due will become delinquent
Potential Tax Due $ 87.49 nine months after the date of death.
PART TAXPAYER RESPONSE
'I^
FAILURE`~TO~ RESP.U~ID;WILi. ARE',Sl1LI'~~"N'AN~.flFFICIAL_TAX:A5SES5HENT
.;
A. ^ The above information and tax due is correct.
Remit payment to the Register of Wills with two copies of this notice to obtain
C H E C K a discount or avoid interest, or return this notice to the Register of Wills and
an official assessment will be issued by the PA Department of Revenue.
ONE
B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return
0 N L Y filed by the estate representative.
C. ^ The above informs ion is incorrect and/or debts and deductions were paid.
Complete PART 2~ and/or PART 3^ below.
PART If indicating a different tax rate, please state
relationship to decedent:
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TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS f`p
LINE 1. Date Established
2. Account Balance
3. Perc=nt Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
PART
3^
1
2
s X
4 $ ~~
5 .Y
$
6 ;„`i
7 X ~ `:~
8 '~ '»
DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
TOTAL CEnter on Line 5 of Tax Computation) 6
Under penalties of perjury, I declare that the facts I reported above are true, correct and
complete to the best of m knowledge and belief. HOME C ~
WDRK C ) 7 fa
TAXPAY R SIGNATUR TELEPHONE NUMBER AT
BEHRINGERHARVARD
~ ~~
I'I'1111111'1111111"Illl'llllllllllll'llllll'lllllllllllll'll~~l
DOROTHY D WIEBELT
SUBJECT TO DST TOD RULES
2100 BENT CREEK BLVD STE 246
MECHANICSBUR6 PA 17050-1835
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Account Transactions
DISTRIBUTION CHECK
September 1, 211 Page 1 of 2
Accolrn~r Iiv>~ORMA1'lON
,~ Your Financial Advisor
H Account - IN-House Accounts
Uvest Financial Services Inc
2810 Coliseum Centre Dr FL 1
Charlotte, NC 28217-2394
704-348-4304
By Phone
Cal 1866-655-3650
7:OOam to 7:OOpm, Central Time, Mon -Fri
.~d. On the web
www.behringerharvard.com
- --- _.
_--~ Yri Wn~ing
BEHRINGER HARVARD
P.O. Box 219768
Kansas City, MO 64121-9768
Please send all investments and account
changes to the above address.
Please review to verify that all information about you and your investment is correct. If there are any changes, or you have questions
regarding the details of your subscription, please notify your financial advisor or call our Investor Services Department directly at
1 (866) 655-3650.
REIT I, INC
Account Owner Fund Number Account Number
DOROTHY D WIEBELT 3501 21983
SUBJECT TO DST TOD RULES
Transaction Transaction Shares/Units This Total Shares/Units
Date Transaction Description Amount Transaction Owned
Beginning Amount ** $6,115.94 1,344.163
01/12/2011 DISTRIBUTION $11.20 0.000 1,344.163
02/02/2011 DISTRIBUTION $11.20 0.000 1,344.163
01/312011 SHARES REDEEMED DISABILITY $1,240.57 272.653 1,071.510
03/02/2011 DISTRIBUTION $8.93 0.000 1,071.510
04/01/2011 DISTRIBUTION $8.93 0.000 1,071.510
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Skarlatos~.^~ ,visions.
Sound ~'1dv~w. 5martcr ll~
17 South Second Street, 6'h Floor
Harrisburg, PA 17101-2039
717.233.1000 Voice
717.233.6740 Fax
www.skarlatoszonarich.com
April 11, 2012
Register of Wills
1 Courthouse Square
Carlisle, PA 17013
RE: Estate of Dorothy Wiebelt
Dear Sir or Madam:
I am enclosing the following for filing:
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(1) Original and one unt of $127 00 for InherrtancerTaxes owed.eturn.
(2) Check m the amo
(3) Extra copy of the 1St page of Return to be stamped and returned in the self-addressed,
stamped envelope.
If anything further is required, please advise. Thank you.
Sincerely,
~ S. ~~~~~
Heather S. Wildes
Estate Administrator
heather n skarlatoszonarich.com
Enclosures
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