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HomeMy WebLinkAbout06-14-12' REV-1500 EX (o2-11)(FI) OFFICIAL USE ONLY PA Depenment of Revenue County l;oda Yaer File Number Bureau of lntlividual Terns Po eox 2soaot INHERITANCE TAX RETURN 21 11 1010 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Dale of Death MMDDVWV Date of Birth MMDOYVVV Decedent's Last Name 09142011 02141930 Suffix Decedent's First Name OrBRIEN MARY ANN (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 APPROPRU\TE BOXES BELOW ® 1. Original Return ^ 4. Limitetl Estate ® 6. Decedent Died Testate (Attach Copy of Will) ^ 9. Litigation Proceeds Receivetl ^ 2. Supplemental Return ^ 4a. Future Interest Compromise (date of death after 12-12-ffi) ^ 7. Decedent Maintained a Living Trust (Attach Copy of Trust.) ^ 10. Spousal Poverty Credit (Date of Death Between 12-31-91 and 1-1-95) MI MI ^ 3. Remainder Return (Date of Death Prior to 12-13-82) ^ 5. Fetleral Estate Tax Return Required _ 8. Total Number of Safe Deposit Boxes ^ 11. Election to Tax under Sec. 9113(A) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD eE DIRECTED TO: Name Daytime Telephone Number PETER J• RESSLER, ESQUIRE First Line of Adtlress 3401 NORTH FRONT STREET Second Line of Address PO BOX 5950 City or Post Office State ZIP Code HARRISBURG PA 17110 717-232-5000 REGISTER OF WILLS USE ONL~ c~ ~ ~~ rv L ~~`' z ~cii='i nLl'~~ ?7 neTC ~bn .~- Grt L;i~ C~ - r_„i r n -~ CJ /--r~l r; -Y'e a~j _ r-n ~~ correspondenrsa-malladdrese: PJRE$SLERaMETTE•COM Untlar penalties of perjury, I declare that I have examined this velum, inGuding accompanying schedules end atatementa, and to the beat d my knaMedge antl belief, it is true, correct and complete. Declaration of preperer other then Ne personal representaliva is based on all infannatiori of which preparer has any knowledge. -/L SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE PLEASE USE ORIGINAL FORM ONLY 1505611185 Side 7 OM4947 3.000 lsase111a5 J REV-1500 EX (FI) 1505611285 Decedents Neme O r B R 2 E N MARY A N N RECAPITULATION 1. Real Estate (Schedule A) ............................ 1 Side 2 2. Stocks and Bonds (Schedule B) ......................... 2. 114 , 8 2 7.81 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) , 3. D • D D 4. Mortgages and Notes Receivable (Schedule D) 4. D , D D 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) 5, 4 7 , 0 4 5.15 8. Jointly Owned Property (Schedule F) ~ Separate Billing Requested g. D • D D 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested .... 7. 4 4 , D 9 2 • 2 3 8. Total Gross Asset (total Lines 1 through 7) 8 34 6 , 865.19 9. Funeral Expenses antl Administrative Costs (Schedule H) ............. 9. 81, 293.62 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) , 10. 2 , 552.35 11. Total Deductions (total Lines 9 and 10), 11. $ 3 , 8 4 5.97 12. Net Value of Estate (Line 8 minus Line 11) 12. 263, 019.22 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to taz has not been made (Schedule J) , , , , , , , , , , , , , , , , 13, 2 6 2 , D 19 • 2 2 14. Net value Subject to Tax (Line 12 minus Line 13) , 14. 1 , D D D • D D TAX CALCULATION - $EE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers un er Sec. 9118 2 x o~ (a)(1. > . 0 • DO 15. 0.00 16. Amount of Line 14 xable li l x o4s nea rate . at 0.OD 18. 0.00 17. Amount of Line 14 taxable at sibling rateX.12 D•DD 17. D•DD 18. Amount of Line 14 taxable at collateral rate x .15 1, 0 0 0• D O 18. 15 0• D O 19. TAX DUE ................ 19. 20. FILL IN THE BDX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 1505611285 151]5611285 Decedent's Social Security Number 191-24-7275 140,900.00 150•D0 OM<6<9 3.000 REV-1500 EX (FI) Page 3 File Number Decedent's Com late Address: 21 11 1010 DECEDENTS NAME r STREET ADDRESS CITY STATE ZIP Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest (7) _ 150.00 Total Credits (A + B) (2) _ I) • ~ ~ (3) _ ~.~~ 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. FIII in box on Page 2, Line 2g to request a refuntl. (4) _ 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) _ 1$ 0 • O O 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 Vansferretl ........................ ^ 0 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? ............................ . ^ 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 properly, which contains a beneficiary designetion9 ................................ ® ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Far dates of death on or after July 1, 1994, and before Jan. 1, 7995, 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. §911 S (a) (1.7) (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)]. 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. Far dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a tleceased child 21 years of age or younger at tleath to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9718(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decetlent's lineal beneficiaries is 4.5 percent, except as noted in p2 P.S. §9116(a)(7)]. • 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. ouasn zooo REV-1502 EX+(m-10) Pennsylvania OEPARIaIENr OF REVENUE INHERRANCE TA%RETURN ESTATE OF: SCHE©ULE A REAL ESTATE FILE NUMBER: Marv Ann O'Srien :.1111010 All real property owned solely or u a tenant In common must bs reported at fair market value. Fair market value Ia deAned u the pdce al which property would be exchanged between a willing buyer end a willing seller, neither being comPalled to buy or ull, both hevng roeaonable knowledge of the rolevant lads. Real property that Ia jolndyowna0 wIN right of survlvorehip must ba disclosed on Schedule F. Attach a copy of the aeribmant sheet H the preperty has been eokl. ITEM Include a copy o1 the deed showing decedent's interest gowned ae tenant in common. VALUE AT DATE NUMBER DESCRIPTION OF DEATH 15 Circle Drive, Camp Hill PA Tax Parcel #09-20-1850-240 County, Valuation is determined by using the tax assessed value of $140,900 multiplied by the applicable Common Level Ratio factor of 1.0 $140,900 x 1.0 $140,900 140,900.00 TOTAL (Also enter on Line 1, Recapitulation.) 5 140, 900.00 9W4895 2.000 If more space is needed, use additional sheets of paper of the same size. REVn503 EX i (B'BB) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS 8r BONDS Marv Ann O'Brien 21 it 1010 All property Jointly-owned with right of survivorship must be disclosed on Schetlule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. MBRRILL LYNCH $872-55229 870 Shares 8lackrock Divers OMB STRAYS CIISIP: 09255W102 8,363.75 2 238.275 Shares 8lackrock Multi St Nun Ser TR CIISIP: 09253A680 2,621.03 3 59.885 Shares Gambier Opportunity Fund Advisors Inner Circle Fund CIISIP: 00758M261 998.28 4 25.272 Shares Dreyfus Appreciation Fund Inc. CIISIP: 261970107 970.16 5 237.724 Shares D9P3 Tax Free Tr CIISIP: 23337X509 2,776.62 6 292.748 Shares Baton Vance Investment Tr 2,962.61 7 259.213 Shares Federated Strategic Bquity Funds CIISIP: 314172560 1,169.05 8 37.241 Shares Ivy Funds Inc. 887.45 9 73.101 3haree Legg Mason Ptrns Income Tr CIISIP: 52469F556 995.64 10 1,510.423 3haree Loomis Sayler Funds II CIISIP: 543487268 22,339.16 Total from continuation schedules 70,744.06 3W~898 1.000 (If more space s neetletl, insert atltliUOna sheets of the same size) 8etate of: Nary Ann O'Brien Schedule B (Page 2) Item No. Description 11 258.961 Shares Lord Abbott Nunicipal Income Tr 12 143.778 Shares Nalnatay Funds CIISIP: 56062X641 13 2,717.167 3haree Oppenheimer Nulti 9t Nunicipal CIISIP: 683940886 14 933.61 Shares Sunamerica Focused ser Inc. CIISIP: 867048798 15 6,310.722 Shares SunAmerica Strategic Income Funds CIISIP: 866918642 16 205.558 Shares T. Rowe Price Intermediate Nunicipal Fundd CIISIP: 77957N209 17 1,382.529 Shares Transamerica Funds al 11 logo Value at Date of Death 2,724.27 1,029.45 18,666.94 10,260.37 21,456.45 2,380.36 14,226.22 Total (Carry forward to main schedule) 70,744.06 REV-1508 EX. (11-10) pennsylvania SCHEDULE E DEPARiMENTOF REVENUE 8 MISC. CASH BANK DEPOSITS IT~C~E p TNRN , , PERSONAL PROPERTY E REa DEN ESTATE OF: FILE NUMBER: 7.f..-., a.... n~nri m.. ~7 77 707(1 ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. 2006 Toyota Avalon - sales price 18,000.00 2 AAA Refund 59.75 3 Caeh 53.55 4 Health Insurance Refund 353.91 5 Household items and personal furnishings 4,467.00 6 Junkets with Judy Refund 105.00 7 Merrill Lynch Account #872-11634 193.80 8 Miscellaneous costume jewlery 1,000.00 9 Patriot Newe Refund 86.00 10 PNC Hank Checking Account #5140047436 See attached statement 5,506.71 11 PNC Haak 3avinga Account #5130094263 See attached statement 16,604.67 12 PNC Safe Deposit Hox Refund 52.50 13 Susquehanna Valley Federal Credit IInion Christmas Club Account #1839 See attached correspondence 0.03 14 Susquehanna Valley Federal Credit Vnion Savings Account #1839 See attached correspondence 80.90 MBRRILL LYNCH #872-55229 15 Merrill Lynch Money Market Account #872-55229 CIISIP= 126991918 481.33 47,045.15 OwaeAD 2.000 If more apace is needed, use etldeionel sheets of papa o(the same a¢e. REV-1510 EX+(08-09) pennsylvania DEPARTMEM OF REVENUE INHERITANCE TAX RETURN RESIDEM DECEDEM SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY Marv Ann O'Brien 2:L 11 1010 This schedule must be completed and filed it the answer to any of questions i through 4 on page 01ree of the REV-1500 is yes. ITEM NUMBE DESCRIPTION OF PROPERTY RLLIDE IIE NV.IE OF TE iRAH6FEREE, TIEIR R9IATIONSHP TO DELEOEM hVD TEMlECf 1RM9FFA ATiMA1ACOPY OF THE EEO FOR flEY ESTATE. DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST EXCLUSION IF A~Ft1CABLEI TAXABLE VALUE 1~ Merrill Lynch IRA Account #872 -86016 Beneficiary: Department of Gynecology/Oncology at the Hospital of the Aniveraity of Pennsylvania 44,092.23 100.0000 0.00 44,092.23 TOTAL (Also enter on line 7, Recapitulation) 5 I 44, 092 .23 If more space is neetletl, use atltlitiarel sheets of paper of the same 91ze. 9 W 48AF 2.000 REN~1511 EX~ (10.09) Pennsylvania pEPgRiMENrOF REVENUE SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS -___ ESTATE OF FILET NUMBER N~a 'Y Ann O'Hrien 21111010 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~ Naill Funeral Home Funeral Sxpenaee B. 1 Total from continuation schedules . ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address CiN State ZIP Year(s) Commission Paitl: 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant 4. 5. 6. 7. 1 2 ewesAC z.aoo Street Address City State ZIP Relationship of Claimant to Decedent Probate Fees: Accountant Fees: Tax Return Preparer Fees: Debbie Lupold, Tax Collector 2012 County and Local taxes Alfred Ieopi Lawn care Total from continuation schedules TOTAL (Also enter on Line 9, Recapit If more space is needed, use additional sheets of paper of the same size. 8,727.55 1,308.00 25,000.00 464.50 422.98 733.00 44,637.59 8state of: Nary Ann O'Brien Schedule H Part 1 (Page 2) 21 11 1010 Item No. Description Amount 2 4Peet Shore Country Club Funeral Luncheon 1,178.00 3 Hayhurst Nemoriala Inscription on gravestone 130.00 Total (Carry forward to main schedule) 1,308.00 8etate of: Mary Ann O'Srien 21 11 1010 Schedule H Part 7 (Page 2) 3 Bobby Rahal - vehicle repaira 333.90 4 Rowa's Auction Commission for sale of personal items and household furnishings 1,260.70 5 Commonwealth of PA--Replacement of vehicle title 22.50 6 East Pennaboro Township Sewer 276.00 7 PA American Water 92.88 8 PPL Electric 194.14 9 Harland Clarke - Check Order 104.71 10 Merrill Lynch - Administrative Fees 42.86 it Peter J. Ressler Reimbursement for gaa in automobile 48.45 12 Peter J. Ressler Reimbursement for IIPS to S. Senta 199.65 13 Carl Wagner Reimbursement for repaira to vehicle 139.00 14 Bouder Trash & Hauling Trash removal at residence 1,100.00 15 Travelers Insurance Automobile iaeurance 431.00 16 Zimmexa:an's Automotive Vehicle Inspection 97.91 17 Dellinger'e Auto Body Vehicle Repairs 455.07 18 Superior Plua Energy Heating oil 1,369.53 Total (Carry forward tq main schedule) 6,168.30 i 8state ofs Mary Ann O'Brien 21 11 1010 Schedule H Part 7 (Page 3) HOIIS$ RBNOVATION3, RBPLACEMSNT3 AND RBPAIR3 TO NARB HOII3B NARRSTASL$, AS LISTHD BLOW: 19 Scroggin Contractors - paint interior, clear basement of mold, sand floors for animal feces, replace bottom cabinets and hardware because of pet damage 32,233.50 20 Kathryn Widmer - Renovation Coordinator 2,500.00 21 Rreamer Brothers Repair broken glass windows and doors 253.44 22 sears Replace damaged appliances 3,432.35 Total (Carry forward to main schedule) 38,469.29 REV-154E%+11Y~09) SCHEDULE pennsylvania CEPARTMENTOF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS FILE NUMBER Mary Ann O'Brien 21 11 1010 Report tlabts Incurred by the decedent prior to tleath that remained unpaid at the date of death, including unrelmbureed medical expenses. ewasAH z.ooo If more space is needetl, insert additional sheets of the same size. REV-1513 EX+(01-10) SCHEDULE J Pennsylvania DFPPRIAIENTOF REVENUE BENEFICIARIES INFERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER: Ma Ann O'Brien 21 11 1010 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS Ilnolutle outnghl aDOUSeI distributions and trensfare antler Sec. 9116 (a) (1.2).] i. Stephanie L. Bentz Miscellaneous costume jewlery Inventory Value: 500.00 None 500.00 2 Jackie Lumley Miscellaneous costume jewlery Inveatory Values 500.00 Noae 500.00 ENIER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1 8 OF REV-1500 COVER SHEET, AS APP ROPRIATE. II NON-TAXABLE DISTRIBUTIONS A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTON TO TAX IS NOT TAKEN: 1. e. CHARfiABLE AND GOVERNMENTAL DISTRIBUTIONS: 1~ 3ee Attached 1 TOTAL OF PART II - ENl'~R TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVEF; SHEET. S 262 ~ 019.22 9wasAl s.ooo If more space Is needed, use additional sheets of paper of the same size. estate of: Nary Ann O'Brien Schedule J Part 2B (Page 1) Item No. Description 1 The Hospital of the IIniversity of Pennsylvania, Department of Gynecology/Oncology Philadelphia, PA Nerrill Lynch IRA Account X872-86016 Beneficiary: Department of Gynecology/Oncology at the Hospital of the IIniversity of Pennsylvania Inventory Valuee 44,092.23 21 it 1010 Amount 100+k of Reaidueto The Hospital of the IIniversity of Pennsylvania, Department of Gynecology/Oncology Philadelphia, PA: 217,926.99 262,019.22