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Home My WebLink About06-19-12 (2)15U5610143 REV-1500 Ex(°'-'°' OFFICIAL USE ONLY PA Department of Revenue Pennsylvania county coda veer File Number Bureau of Individual Taxes M1YrtMOM°Re1°110 PO 60X.280601 INHERITANCE TAX RETURN 2~, 11 1209 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 19 2011 O5 29 1916 Decedent's Last Name Suffer Decedent's First Name: MI CARPENTER HENRY S (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN CIUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Retum ^ 2. Supplemental Return ^ 3. Remainder Return (tlate of death poor to 12-13-82) 4. Limited Estate ^ ^ qa. Future Interest Compromise ^ 5. Federal Estate Taz Retum Requiretl (tlate W tleaM Baer 12-12-92) O g DetedeM Died Testate ^ 7 ~ n r~oPy i~,jrrrea)a Livinq Trust ~ e. Total Number of Safe Dapostt Boxes (Aaach Copy of Wilp ^ 9. Litigation Proceeds Received ^ ertv c 10. pg°~nPt~-31 91 edrt{tle~sa death ^ 11_Election to tax antler Sec 9113(A) (Aaach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED 70: Name Daytime Telephone Number JESSICA L FISHER 717 697 3223 First line of address 555 GETTYSBURG PIKE Second line of adtlress STE C100 City or Post Oifice MECHANICSBU'RG Correspondent's a-mail address: State 21P Code PA 17055 H REiGISTER OF LLS USE Ol~aj' ! ~~(', ry t. 1. 7C - ~C;r_..._ C~Ci' QC DATF,FIC~D -n '~: '~ D _..1 schedules and sUtements, and to the is based on all information or which pr iT~T ~3 G cn-I ~c,: ni~-r _ia t.:': r`~ , : I `n -n rri c~ T 307 Asbury Drive, Mechanfcsburfl. PA 17055 SIGNATURE OF PREPARER'OToHER THAN REPRESENTATIVE DATE Car<~~ a ~~~~, Jessica L Fisher ~/fig I ~~, .__c 555 Gettysburg Pike ,Mechanicsburg, PA 17055 Side 1 L 1505610143 1!i05610143 J J 1505610243 REV-1500 EX Decedent's Social Security Number D~a~,rs r+e~_ Carpenteq Henry S 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 94 , 2 98.91 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers & Miscellaneous h{oq Probate Property (Schedule G) u Separate Billing Requested............ 7, 3. Total Gross Assets (total Lines 1-7) ..................................................................... B. 7 94 , 2 98.91 9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 40 , 952.42 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 783.47 11. Total Deductions (total Lines 9 & 10) ................................................................... 11. 41 , 735.89 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 752 , 563 .02 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been made (Schedule J) ............................................... 13. 14. Net Value Subjeet to Tax (Line 12 minus Line 13) ............................................... 14. 752 , 5 63.02 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 25. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15 0.00 (a)(1.2) X .00 16. Amount of Line l4 taxable 752,563.02 1s. 33,865.34 at lineal rate X .045 17. Amount of Line 14 taxable 0 0 0 17 0.00 . at sibling rate X .12 . 18. Amount of Line 14 taxable 0 00 18 0.00 . at wllateral rate X .15 . 1s. Tax Due .................................................................................................................. 1s. 33,865.34 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 L 1505610243 1505610243 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-11-1209 DECEDENTS NAME Carpenter, Henry S STREET ADDRESS 307 Asbury Drive CITY Mechanicsburg STATE: PA ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 33,865.34 2. Credds/Payments A. Prior Payments 32,118.89 B. Discount 1,890.47 Total Credits (A + g) (2) 33,809.36 3. Interest (3) q. 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) 55.98 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 :............................................................................... x 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? ............................................................ x 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?....... ^ 0 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. 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 dearth 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)j. A sibling is defined under Section 9102, as an individual who has at least one parent in common whh the decedent, whether by blood or adoption. Rav-1606 FJr• (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OFPENNSttVANW INHERITANCE TA%RETURN RESIDENT OELEOENT ESTATE OF FILE NUMBER Carpenter, Henry S 21-11-1209 Inclutle the proceeds W Ilbggetion entl the tlate the proceeds were received M the eatele. All property piMlY4wnad wiM IM fight or survivorsMp must be disclwad on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Americhoice Savings Account 50.43 2 Centric Bank 1625 Market St., Camp Hill, PA 17011- CD- # 3047941 45,087.49 3 Centric Bank 1625 Market St., Camp Hill, PA 17011- CD- # 3047941 accrued interest 31.08 4 Centric Bank 1625 Market Street, Camp Hill, PA 17011- CD- #3034758 81,882.49 5 Centric Bank 1625 Market SUeet, Camp Hill, PA 17011- CD- #3034758 accrued interest 11.03 6 Graystone Bank CD 41,105.67 7 Integrity Bank CD 71,794.32 8 Integrity Bank CD Accrued Interest 39.82 9 Members First Credit Union 5000 Louise Dr., P.O. Box 40, Mechanicsburg, Pa Savings- 10.00 412752-00 10 Members First Credit Union 5000 Louise Dr., P.O. Box 40, Mechanicsburg, PA- CD # 412752 75,552.41 -40 11 Members First Credit Union 5000 Louise Dr., P.O. Box 40, Mechanicsburg, PA CD # 412752 25,000.00 -01 12 Members First Credit Union 5000 Louise Dr., P.O. Box 40, Mechanicsburg, PA- CD # 412752 49.93 -40 accrued interest to date of death 13 Members First Credit Union 5000 Louise Dr., P.O. Box 40, Mechanicsburg, PA PD # 412752 13.59 d1 accrued interest to date of death 14 Members First Credit Union 5000 Louise Drive, P.O. Box 40, Mechanicsburg, PA CD- 412752 65,000.00 42 Total of Continuation Schedules See attached a es TOTAL (Also enter on Line 5, Recapitulation) 794,296.91 (If more space is neetletl, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-7500 Schedule E (Rev. 6-96) Rev-1508 E%~ (B-88) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMON W EPLTH OF PENNSYLVRNIA INHERITNNCE TAX RETURN continued RESIDENT OELEOENT ESTATE OF FILE NUMBER Carpenter, Henry S 21-11-1209 ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 15 Members First Credit Union 5000 Louise Drive, P.O. Box 40, Mechanicsburg, PA CD- 412752 2.21 -42 accrued interest to date of death 16 Mid Penn Bank CD xxxx-003057 51,413.52 17 Mid Penn Bank CD xxxx-003057 accrued interest up to date of death 247.29 18 Mid Penn Bank CD xxxx-03044 45,345.55 19 Mid Penn Bank CD xxxx-03044 Accrued interest up to date of death 265.94 20 Mid Penn Bank CD XXXXX-3066 50.381.84 21 Mid Penn Bank CD XXXXX-3066 accrued interest to date of death 197.69 22 PNC Bank CD XXXXXXX1906 71,513.22 23 PNC Bank CD XXXXXXX7906 accrued interest 33.21 24 PNC Bank XXXXXXX454 55,219.94 25 PNC Bank XXXXXXX454 accrued interest 0.35 26 Sovereign Bank CD 110,000.00 27 Sovereign Bank CD Accrued Interest to date of death 1,247.24 28 2071 PA Personal Income tax return refund 53.00 29 2011 US Personal Income tax return refund 297.00 30 Bethany Village Refund for Room and Board 2,371.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-1508 E%+ (6-98t SCHEDULE E CASH, BANK DEPOSITS, ~ MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INNERITANCE TAX RETURN continued RESIDENT OECEDENi ESTATE OF (FILE NUMBER Carpenter, Henry S 21-11-1209 Copyright (c) 2002 forth software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) REV-1151 Ex+110-08) SCHEDULE H FUNERAL EXPENSES & c~~~~N~"VAR~A ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Carpenter, Henry S 21-11-1209 Debts of decedent must be reported on Schedule 1. ITEM DESCRIPTION AMOUNT NI IMRFR A- FUNERAL EXPENSES: See continuation schedule(s) attached ~ 10,978.00 B. I ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zio Year(sl Commission paid 2. Attomev's Fees Keystone Elder Law P.C. 27,579.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip _ Relationship of Claimant to Decedent 4. Probate Fees 651.50 5. Accountant's Fees 750.00 6. Tax Return Preparers Fees 7. Other Administrative Costs 993.92 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulakion) 40,952.42 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-05) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Carpenter, Henry S 21-11-1209 ITEM NUMBER DESCRIPTION AMOUNT 1 Funeral Expenses KOL-ROCklea Memorials: Monument Inscription 8 Cleaning & Restoration 353.00 2 Lashel's Funeral Home in New York- Funeral service 4,445.00 3 Malpezzi Funeral Home 5,805.00 4 Memorial Service at Bethany Village 75.00 5 Reverend Fred Jackson- Funeral preacher 300.00 H-A 10,978.00 6 Other Administrative Costs Artie's Dinner for Family after Funeral 400.47 7 Cumberland County Register of Wills Filing fees- Inheritance tax, Inventory, Receipts and 45.00 Releases 8 Gas to go home from Funeral in New York 30.00 9 Gas to go to Funeral in New York 20.00 10 Hampton Inn- 2 overnight stays for funeral in Kingston, New York 10/28-10/29 394.02 11 Perkins Restaurant & Bakery: Food for Morning of Funeral 13.00 12 PNC Bank Fee 12.00 13 PNC Bank Fee 12.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Carpenter, Henry S 21-11-1209 ITEM NUMBER DESCRIPTION AMOUNT 14 Post Office 35.20 15 Post Office 0.98 18 Post Office: postage to mail taxes 2.15 17 Post Office: Stamps, Memorial slips 6.10 18 Sovereign Bank Fee 20.00 19 Tolis to Funeral in New York 3.00 H~•87 993.92 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rav-1612 EX+It2L8) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONVYEALTHOF VENNSnVFNIR INHFAITANCE TWI RETURN RESIDENT pECEOENT ESTATE OF FILE NUMBER Carpenter, Henry S 21-11-1209 Report tleb4 ineurtetl by ma decedent prior 1o deem mat romalnetl urpeid et me date o/ death, Ilwlutling unreimburoed medieN expenses. ITEM VALUE AT DATE HUMBER DESCRIPTION OF DEATH 1 Cardiology Practice- Medical Services 9.41 2 Cardiology Practice- Medical Services 19.76 3 Continuing Care Rx-previous balance for Prescription Co-pay 2.28 4 Hampden Physician Associates- Medical Services 92.95 5 Holy Spirit Hospital Medical Services 7.00 6 Holy Spirit Hospital- Medical Services 179.71 7 Meals for family while Henry Carpenter was in hospita110/11/2011-10/18/2011 207.00 8 Mobile X Ray Imaging INC- Medical Bills 25.15 9 Mobile X Ray Imaging INC-Medical Bills 41.28 10 Nephrology Associates of Central PA-Medical Services 58.31 11 Pinnacle Health Cardiovascular Institution- Medical Services 116.47 12 T Mobile Cell Phone bill 24.15 TOTAL (Also enter on Line 10, Recapitulation) I 783.47 (If more space is needeq adtligonal pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Forth PA-1500 Schedule I (Rev. 12-08) RFVd513 FY11N-0Bl SCHEDULE J coM ~4T,~~~rF,(ft(.~y~,ynRV. ~iPYb "~~`(''~~ BENEFICIARIES ESTATE OF FILE NUMBER Car enter, Hen S 21-11-1209 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 1 George H Carpenter Son 250,854.34 307 Asbury Drive Mechanicsburg, PA 17055 2 John F Carpenter Son 250,854.34 1339 State Highway 220 Mc Donough, NY 13801 3 James J Carpenter Son 250,854.34 1136 Ford Road Vestal, NY 13850 Total 752,563.02 Enter dollar amounts for distributions shown above on lines 15 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 TAJC 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. Fonn PA-1500 Schedule J (Rev. 11-08)