HomeMy WebLinkAbout05-24-1215D561D143
EX (01-10) ~
REV-1500 OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania County Code Year File Number
Bureau of Individual Taxes DEPARTMENT OF REVENUE
Po Box.2sosoi INHERITANCE TAX RETURN 21 12 0098
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
164 30 3122 12 18 2011 08 29 1938
Decedent's Last Name Suffix Decedent's First Name MI
ORNER ELAINE M
(If Applicable) Enter Surviving Spouse's Information Below
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
X 1. Original Retum i~,~ 2. Supplemental Retum
~,~ q, Limited Estate I~~~, 4a. Future Interest Compromise
~-- (date of death after 12-12-82)
(r j 6 Decedent p ed Test) to ~ 7. (AttacdheCopy lof Trust)a Living Trust
~ n (Attach Co of Will
g Remainder Return (date of death
~~ prior to 12-13-82)
5. Federal Estate Tax Retum Required
g. Total Number of Safe Deposit Boxes
MI
g. Litigation Proceeds Received ~ 10. between P2 3rt~Jt a tlltTdatSes~f death ~ 11 Election to tax under Sec. 9113(A)
(Attach Sch. O)
CORRESPONDENT - THtS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
MICHAEL L BANGS 717 730 7310
First line of address
429 SOUTH 18TH STREET
Second line of address
City or Post Office State ZIP Code
CAMP HILL PA 17011
Correspondent's a-mail address: mikebangs@verizon.net
REGISTER OF~111fILLS USE O~NIY
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DATtE.y FILED
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Under penalties of perjury, I deGare 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. DeGaration of preparer other than the personal representative Is based on alt information of which preparer has any knowledge.
awrvr~l vKL~) Vr• rCKJVN KC/JYVNJItlLJt YSJK hILINIi Kt I UKN f DATE
~J%frl/~~ Y~~~~ / ~il~- F-~.~ ,~ Kristin M. Rogers ~,~y~d ~~ .
ADDRESS
615 Third Street New Cumberland PA 17070
SIG MATURE OF PREPARER OTH THAN REPRESENTATNE DATE
t'/'~ ~_.?,~~-' ! ~, ~ _.~,,- ~% Michael L. Bangs ,, ,f;;
J `~. ~ n ~ t. L'
ADDRESS J/
429 South 18th Street, Camp Hill, PA
Side 1
15D561D143 15D561D143
~Y
J 15D561D243
REV-1500 EX
Decedent's Name: ~rner, Elaine M. Decedent's Social Security Number
- -_
RECAPITULATION 164 30 3122
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
.......... .....
,
27,938.70
6. Jointly Owned Property (Schedule F) lI Separate Billing Requested
........
(Schedtule G ransters & Miscellaneous No4
Probate Property .... 6.
Separate Billing Requested......... ...
7.
8. Total Gross Assets (total Lines 1-7)
.................................................................
- .... g
27,938.70
9. Funeral Expenses & Administrative Costs (Schedule H) .
................................... ... g.
13,219.58
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
........................... ... 10.
36, 626.43
11. Total Deductions (total Lines 9 & 10) .............................
.................................... ..
11.
49, 846. O1
12. Net Value of Estate (Line 8 minus Line 11) ..................
.............. .
.......................
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
.. 12.
-21, 907.31
an election to tax has not been made (Schedule J) ....
......................................... .. 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) ............
................................. ..
1a.
-21, 907.31
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 . 0.00
at lineal rate X .045 0. 0 0
17. Amount of Line 14 taxable 16. 0. 0 0
at sibling rate X .12 0.00
18. Amount of Line 14 taxable 17.
~ ' ~ ~
at collateral rate X .15 ~ . ~ Q 18.
0.00
19. Tax Due ...............
................................................................................................... 19.
0.00
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
15D561D243
15D561D243 J
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
__ Orner, Elaine M.
STREET ADDRESS
615 Third Street
CITY
New Cumberland
File Number 21-12-0098
STATE ZIP
PA I 17070
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
(1)
2. Credits/Payments
0.00
A. Prior Payments
B. Discount 0.00
Total Credits (A + g) (2) 0.00
3. Interest
(3)
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 (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(5) 0.~0
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:
a. retain the use or income of the property transferred :.................................................................
b
ret
i
th Yes No
....... .
.
a
n
e right to designate who shall use the property transferred or its income :........................
c
retain a ^ n
..........
.
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 on
e year of death without
receiving adequate consideration?............
..................................................................
^
....
....
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 Retireme
t A
^ ^
^
n
ccount, 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 P ART O F 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.
Rev-1508 FJ(+ (6-98)
COMMONWEALTH Of PENNSYLVANIA
INHERRANCE TAX RETURN
RESIDEM DECEDENT
ESTATE OF
Orner, Elaine M.
FILE NUMBER
21-12_nn9ft
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.
ITEM
NUMBER DESCRIPTION
1 PNC Bank, N.A.
2 Refund from Capital Blue Cross
3 Refund from GGNSC Administrative Services -Golden Living Center
4 Refund from Golden Living Center -Credit balance on account
VALUE AT DATE
OF DEATH
22,832.59
119.70
3,144.20
1,842.21
TOTAL (Also enter on Line 5, Recapitulation) I 27,938.70
(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)
SCHEDULE E
CASH, BANK DEPOSITS, ~ MISC.
PERSONAL PROPERTY
REV•1151 EX+(10-06)
SCHEDULE H
COMINRESIDENTDEOEON~N$_RLVANIA FUNERAL EXPENSES &
V~ N ADMINISTRATIVE COSTS
ESTATE OF
Orner, Elaine M.
Debts of decedent must be reported on Schedule 1.
ITEM
DESCRIPTION
A. FUNERAL EXPENSES:
FILE NUMBER
21-12-0098
AMOUNT
See continuation schedule(s) attached I
2,890.02
B• ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Kristin M. Ro ers
Street Address 615 Third Street
city New Cumberland state PA zip 17070
Year(s) Commission paid
5,000.00
2. Attorney's Fees Michael L. Bangs
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
107.50
5• Accountant's Fees
6. Tax Return Preparer's Fees
~• Other Administrative Costs
See continuation schedule(s) attached 222.06
TOTAL (Also enter on line 9, Recanitulat~on)
Copyright (c) 2009 form software only The Lackner Group, Inc.
13, 219.58
Form PA-1500 Schedule H (Rev. 10-06)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF
Orner, Elaine M.
FILE NUMBER
21-12-0098
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Ex n c
Parthemore Funeral Home & Cremation Services, Inc.
2,890.02
H-A 2,890.02
Other Adminictrativ rostc
2 Cumberland Law Journal -estate advertising
75.00
3 The Sentinel -estate advertising
147.06
H-B7 222.06
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
Rev-1512 EXF (12-08)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE i
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
tJ1Alt OF
Orner, Elaine M.
FILE NUMBER
21-12-0098
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
1 Golden Living Center -Return of duplicate credit on account
550.00
2 IRS -Installment Agreement for 2006 income taxes due (balance due as of 1/16/12) 2,963.00
3 PA Department of Public Welfare -Claim for restitution of medical assistance
30,824.41
4 Richard Magill, M.D.
315.00
5 Social Security Administration -refund of January 2012 payment
1,909.00
6 Statewide Tax Recovery, Inc. - 2011 per capita taxes
36.00
7 Verizon
29.02
TOTAL (Also enter on Line 10, Recapitulation) I 36 626 43
(If more space Is needed, addltlonal pages of the same size) '
Copyright (c) 2009 form software only The Lackner Group, Inc.
Form PA-1500 Schedule I (Rev. 12-OS)
REV-1513 EX+ (11-08)
COMMN,~NT ~ECEDENTR~VANIA
SCHEDULE J
BENEFICIARIES
ESTATE OF
Orner, Elaine M.
NUMBER NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
I~ TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116(al(1.211
Marc H. Omer
326 6th Street, Apt. B
New Cumberland, PA 17070
William Sean Orner
781 Ivanhoe Lane, Apt. 4
Hershey, PA 17033
Kristin Rogers
615 Third Street
New Cumberland, PA 17070
FILE NUMBER
21-12-0098
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
DECEDENT
(1Nords) ($$$)
Son
Grandson
Daughter
I ~ Total I
Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 1500 cover sheet as a ro
II• NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
• - •`-- --~ ~ •+~~ ~ ~~ - ~~~ i crc I v I HL NUN- TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1
Copyright (c) 2009 form software only The Lackner Group, Inc.
Form PA-1500 Schedule J (Rev. 11-08)
~~
~~~~~
March 6, 2012
Micl~l L Bangs
Attorney at Law
429 S 18`~ St
Camp Hill, PA 17011
RE; Elaine M 4rner
SSN; 1b4-30-3122
DOD: 12-18-2011
Dear Mr. fangs:
Iu response to your request for Date of Death (DOD) balances for the customer noted above, our
records show the following:
Checking Acepant
Account ~ X004490273 Established: 11-04-2005
ELAINE M o~1v.F~tt
DoD ba~~e; $ 2a,s3~.s9 nay interest'bearing
Please note that this office provides date of death balances for depvsi~t accounts (.IRAs, CDs, Checking and
Saviztgs}. We do not process any financial tr$aagdions or provide statemeflia, If you need assistance with
any of these items; please call 1-888-PNC-SANK (1-888-762-2265) or stop by your local pNC Barak branch
office.
Sincerely,
National Financial Services Ceirter
PNC Bank, N.A.
Member FDIC
This message is intended for the use of the individual or entity to which it is addressed and may
contain information that is privileger.~ confidential and exempt from disclosure under applicable law.
If the reader of this message is not the intended recipient or the employee ar agent responsible for
delivering this message to the intended recipiett, yvu are hereby notified that arty dissemination,
distribution or copying of this communications is strictly prohibited If you have received this
communication in error, please note me immediately by reply or by telephone at 800-762-1775 and
immediately destroy this faxed document.
Page 1 of 1
I, ELAINE M. ORNER, of Wormleysburg, Cumberland County, Pennsylvania, declare
`g this to be my last will and revoke any will previously made by me.
ITEM I. I direct that all my just debts and funeral expenses, including my gravemarker
~-- and all expenses of my last illness, and any and all taxes and assessments imposed by any
governmental body as a result of my death, whether on property passing under this will or
otherwise, shall be paid from my residuary estate as soon as practicable after my decease as a
part of the expense of the administration of my estate.
ITEM II. I give and bequeath all of my household goods, automobiles, jewelry, and all
other articles of household and personal use, equipment and ornament, together with all
insurance thereon and relating thereto, in equal shares, to my issue, per stirpes, as survive my
death by thirty (30) days.
ITEM III. I give, devise, and bequeath all the rest, residue, and remainder of my
possessions and estate of every nature and wherever situate, in equal shares, to those of my issue,
per stirpes, as survive my death by thirty (30) days.
ITEM IV. All of the interests of the beneficiaries hereunder shall not be subject to
anticipation or to voluntary or involuntary alienation nor shall they be subject to any execution or
attachment.
ITEM V. I appoint my daughter' KRISTIN ROGERS executrix of this my last will.
Should my daughter predecease me or otherwise fail to qualify or cease to serve as executrix of
this my last will, I appoint my son-in-law BRIAN S. ROGERS executor of this my last will.
ITEM VI. In addition to the other powers and authorities granted to my personal
~ representatives by Pennsylvania law and by the other terms and provisions of this will, I hereby
~~
Q give to my personal representatives the following powers and authorities effective without court
~ approval and until actual distribution of all property: to compromise any claim or controversy;
,~ to make distribution in cash or in kind, or partly in cash and partly in kind, and in such manner as
my personal representatives may determine and at valuations finally to be fixed by them; to
invest in all forms of property, including any stock or other securities in any corporate fiduciary
or its successor without restriction to investments authorized for Pennsylvania fiduciaries, as my
personal representatives deem proper, without regard to any principle of risk or diversification;
to retain any or all assets of my estate, real or personal, without regard to any principle of risk or
diversification; to sell at public or private sale, to exchange, or to lease for any period of time,
any real or personal property and to give options for sales, exchanges, or leases, for such prices
and upon such terms or conditions as my personal representatives deem proper; and to allocate
receipts and expenses to principal or income or partly to each as my personal representatives
deem proper in their sole discretion.
ITEM VII. I direct that my personal representatives and fiduciaries shall not be required
to give bond for the faithful performance of their duties in any jurisdiction.
IN VYT~ WHEREOF, I gave hereunto sa my hand this 3 ~ day of
2006.
ELAINE M. ORNER
The preceding instrument. GOB of this and THREE other t!~~ p each
identified by the signature of the testatrix was on the date thereof signed, published, and declared
by ELAINE M. ORNER, the testatrix therein named, as and for her last will, 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.
~~ .~j
4
("OMI-~O~WC~,7A OF P'El+~~~li~tl }
COUNTY Of CUMBlE7iIAND
The undersignevL being tfie testatrix wbo~e name is signed ~ ttile ateacJ~ed ar
instrument, having been duty qualified according to law, does y a~v~ge tfiat f and
executed the foregoing instrument as my last will, that t signed it willingly; and that [signed it as my free
and voluntary act for the purposes therein expressed.
rn
ELAINE M. ORNER
. - S:~irL or affirmed to and acknowledged
-_ _ -}ie~ore the by the to tatrix named above
\ th't~ ~J _ day of: ~ , 2006.
~, ~~ ~ ~ ,,
- Alatary Pabli
l~t,,'1'~~i.~.l.:'~ ~,1.
Wri~~Y ~. ~~cS~ti~O ~~~~~ R.r~c
COMMON C~nr'~r;~~ `'`' `±~ l~sy 10, 2~
COUNTY OF CUMBERLAND (SS:
WE, >~ •c-l~-.~ 1 ~ /J~(i n, c S and 'G tom/ S~/ ~J c~ e! j
witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according
to law, do depose and say that we were present and saw the testatrix sign and execute the instrument as
her last will; that she signed it 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 18 or more years of age, of
sound mind, and under no constraint or undue in ence.
_ (/.
_ - `sivotri~r affirmed to nd acknow]edged
b~£~e ~ this~~~ day of
- --`~ , 2006.
Notary Public
~~
VY€i+I~Y ~. C'~c;?~<~ ~ ice` PutiiC
..~-
E_rv,~A"~t Tom., ~";.~n?~~r=r
Ayy rJRf~?~~:~ ~:Ye.~ ~~ ~fl
/` ~tti ~G ~~n~ ~
5