HomeMy WebLinkAbout06-15-121505611188
REV-1500 EX(02-11)(Fq
pennsytvania OFFICIAL USE ONLY
PA Department of Revenue '` `'' ""`"'" County Code Year File Number
Bureau oflndividualTaxes INHERITANCE TAX RETURN
PO BOX 280801
Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 12 0 3 8 3
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYW Date of Birth MMDDYYYY
198 14 3336 03 23 201x, 07 29 1923
Decedent's Last Name Suffix Decedent's Frst Name MI
Lange Catherine G
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's Frst Name MI
Lange Jack E
spouse's social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
159 24 5743 REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (Date of Death
Prior to 12-13-82)
O 4. Limited Estate D 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
0 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death D 11. Election to Tax under Sec. 9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT -This section must be completed. All Correspondence and Confidential Tax Information Should be Directed to:
Name Daytime Telephone Number
John E• Slike, Esquire 717 61 5800 '~"r_
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C "~' -rt ~''"'
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REGIST F„A~3'ILLS USE~AiLY
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Frst Line of Address ~.;..~.' C.ft
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635 North 12th Street, Suite 400 ~~~~
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Second Line of Address T
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City or Post Office State ZIP Code DATE FILED
Lemoyne PA 17043
Correspondent's a-mail address: jSllke@SSr-attOrneyS.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, correctand complete. Declaration of the preparer otherthan personal representative is based on all information of which preparer has any knowledge.
SIGNATUR OF PERSON RESPONSIBLE FOR FILING RETURN DATE
ADDR SS 17 South West venue
Ca p ill, PA 17011
SIGNA R PREPAR~f+~OTHER A REPRESENTATIVE
L'"J R ' DAT
/
~~-t ~~ / L-
ADDRE ~ 35 North 12 h Street, Suite 400
Lemoyne, PA 17043
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505611188
1505611188
1~~
Rev-1500 EX (FI)
1505611288
Decedent's Name: Cathl?rlne G Lange
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 and Notes Receivable (Schedule D) ......................... 4.
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) ....... 5.
6. Jointly Owned Property (Schedule F) O Separate Billing Requested ...... 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested ...... 7.
8. Total Gross Assets (total Lines 1 through 7) ............................ 8.
Decedent's Social Security Number
198 14 3336
0.00
370,167.82
0.00
0.00
56,941.27
0.00
32,853 • 82
459,962.91
9. Funeral Expenses and Administrative Costs (Schedule H) .................. 9.
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............. 10.
11. Total Deductions (total Lines 9 and 10) .............................. 11.
12. Net Value of Estate (Line 8 minus Line 11) ............................. 12.
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.
o•oo
0.00
0.00
459,962.91
0.00
459,962.91
TAX CALCULATION -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 4 5 9, 9 6 2. 91 15.
16. Amount of Line 14 taxable
at lineal rate X .045 0 • ~ ~ 16.
17. Amount of Line 14 taxable
at sibling rate X .12 ~ • ~ 0 17.
18. Amount of Line 14 taxable
0 • 0 0
at collateral rate X .15 18
19. TAX DUE .................................................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
1505611288 1505611288
0.00
0.00
0.00
0.00
0.00
O
Rev-1500 EX (FI) Page 3
Decedent's Complete Address:
File Number
21 12 0383
DECEDENTS NAME
Catherine G. Lange
STREET ADDRESS
17 South West Avenue
CITY
Camp Hill STATE
PA ZI P
17011
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
0.00
(1) 0.00
0.00
Total Credits (A + B) (2) 0.00
3. Interest
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval 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.
0.00
(4)
(5)
0.00
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 .....................................
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 "intrust fog" 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? ............................................. Q(
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. Sect. 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. Sect. 9116(a)(1.1)(ii)]. The statue 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. Sect. 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. Sect. 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. Sect. 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.
(3)
REV-1503 EX+(6-98)
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCETAX RETURN
RESIDENTDECEDENT
ESTATE OF FILE NUMBER
Catherine G. Lange 21 12 0383
All property jointly-owned with right of survivorhsip must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 $28,000 Bank of China New York City, NY dated 5/4/11, maturing 5/4/12 28,008.75
Accrued interest on above asset 148.87
2 $23,000 Ally Bank Midvale Utah dated 11/12/10, maturing 5/11/12 23,007.19
Accrued interest on above asset 62.77
3 $74,000 Bank of India New York, NY dated 3/7/12, maturing 9/5/12 73,953.75
Accrued interest on above asset 9.87
4 $69,000 Bank of India New York, NY dated 9/14/11, maturing 9/12/12 69,021.56
Accrued interest on above asset 181.13
5 Bank of China New York City, NY dated 10/19/11, maturing 10/19/12 60,018.75
Accrued interest on above asset 128.33
6 $73,000 Goldman Sachs Bank USA NY dated 3/07/12, maturing 9/9/13 72,771.88
Accrued interest on above asset 16.22
7 $43,000 Doral Bank Catano P R dated 3/26/12, maturing 9/26/13 42,838.75
TOTAL (Also enter on line 2, Recapitulation) 370,167.82
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX+(11-10)
~~ pennsylvama SCHEDULE E
6f PAR le<,y yr pf RFO r:N~t-
CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENTDECEDENT
ESTATE OF: FILE NUMBER:
Catherine G. Lange 21 12 0383
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
If more space is needed, insert additional sheets of the same size
REV-1510 EX+(08-09)
r~ pennsylvania
uvunwrafv~ n,-atti~rru
INHERITANCETAX RETURN
RESIDENTDECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS AND
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
Catherine G. Lange 21 12 0383
This schedule must be completed and filed if the answer to any of q uestions 1 through 4 on page three of the REV-1500 is yes.
ITEM
NUM DESCRIPTION OF PROPERTY
INCLUDE NAME OF TRANSFEREE, RELATIONSHIP TODECEDENT&
DATE OF TRANSFER. ATTACH COPYOF DEED FOR REAL ESTATE
DATE OF DEATH
VALUE OF ASSET
%OFDECD'S
INTEREST
EXCLUSION
(IFAPPLICABLE)
TAXABLE
VALUE
1 Pacific Life Annuity Contract VA97452850 32,853.82 100 32,853.82
Beneficiary: Decedent's surviving spouse, Jack
E. Lange
Per 5/16/12 letter
TOTAL (Also enter on Line 7, Recapitulation) I 32,853.82
If more space is needed, use additional sheets of paper of the same size.
REV-1513 EX+(01-10)
~~ Pennsylvania SCHEDULE J
I)f NAR7'ar V' ()i' f:k~:4'.Nw~
INHERITANCETAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Catherine G. Lange 21 12 0383
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustees OF ESTATE
z TAXABLE DISTRIBUTIONS [Include outright spousal distributions, and
transfers under Sec. 9116(a)(1.2).)
Jack E. Lange Surviving spouse 459,962.91
17 South West Avenue
Camp Hill, PA 17011
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON L INES 15 TH ROUG H 18 OF R EV-1500 COVE R SH E ET, AS APPROPRIATE.
I>= NON-TAXABLE DISTRIBUTIONS:
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.
If more space is needed, use additional sheets of paper of the same size.
LAST WILL AND TESTAMENT
OF
CATHERINE G. LANCE
I, CATHERINE G. LANCE, of Shiremanstown, Cumberland County. Pennsylvania,
hereb}~ revoke my prior wills and declare this to be my will:
GIFTS
I. Personal and Household Effects: I give all my articles of personal or household use,
including automobiles, Together with all insurance relating thereto, to my husband, JACK E.
LANCE, if he survives me by sixty days. If he does not survive me, then I give all such property
and insurance in accordance with a written list made by me during my lifetime. In the absence of
a list or designation on a list, then I give all such property and insurance thereon to my children as
so survive me, to be divided among them as they may agree or, in the absence of agreement, as
my Executor may think appropriate.
In making the division of my personal property, consideration shall be given to giving
certain items, which are appropriate, to the children of our deceased daughter, Patrice.
My Executor may make whatever a~z•angements my Executor deems appropriate for
storing and delivering articles of personal or household use to the beneficiaries, and may pay the
cost thereof and any related expenses including insurance from niy residuary estate.
II. Residuary Estate: I give the residue of my estate; real and personal:
A. To my husband, JACK E. LANCE, if he survives me;
B. If my husband does not survive me, the residue shall be divided into three equal
shares and;
1
G.~~
(1) one share shall be paid to my son, Paul R. Lange, or if he is deceased, to his
issue per stirpes;
(2) one share shall be paid to my daughter, Rosemary Hill, or if she is deceased, to
her issue per stirpes; and
(3) one share shall be divided among the children of our deceased daughter,
Patrice, or their issue per stirpes.
III. Disclaimer: In addition to any disclaimer rights conferred by law, I authorize my
spouse, within nine months of my death; to disclaim in whole or in part any interest, benefit,
right, privilege or powers granted under my Will or otherwise conferred on my spouse through
joint ownership or designation. The disclaimer shall be in writing executed by the beneficiary or
his or her guardian, committee, executor, administrator or other representative delivered to my
Executor and filed in the court having jurisdiction over my estate or as otherwise provided by
law. Any interest; benefit, right, privilege or power disclaimed under this provision including the
principal supporting any disclaimed income interest shall pass or be distributed as though my
spouse has predeceased me.
IV. Powers of Appointment: No provision of this will shall exercise any power of
appointment 1 may have.
V. Adopted Persons: Persons adopted during minorit}~ shall be considered as
children of their adoptive parents, and they and their descendants shall be considered as
descendants of their adoptive parents.
FIDUCIARIES
VI. Guardian: My daughter; Rosemary Hill, shall be guardian of any shares of my
2 C~
estate which are payable to the children of our daughter Patrice. until they respectively attain the
age. of 21. As guardian, my daughter, in her sole discretion, may pay income as well as principal
to or for the support and education of her children and may pay said sums to their stepfather, Dan
Kyle, or to any person who is caring for our daughter's children without further responsibility. As
each child attains the age of 21, the guardianship shall terminate and that beneficiary's share shall
be distributed to him or her.
VII. E~eeutors: I appoint my husband, JACK E. LAN GE Executor under this Will.
Should he fail to qualify or cease to act as such, then I appoint. my daughter, ROSEMARY HILL,
as Executor in his place. My Executor shall not be required to post bond in this or any
jurisdiction.
VIII. Survivorship: My husband shall be deemed to have survived me if the order of
our deaths is not clear. Any persons other than my husband shall be deemed to have predeceased
me if the order of our deaths is not clear.
IN WITNESS WHEREOF, 1 have hereunto set my hand and seal on this, the -~~
day of , ~~
~~ c, j ~
~Gt~~~~%~-~-r~ i ~.~"'• ~ a~nAp SEAL)
CATHERINE G. LANGE
In our presence the above-named Testatrix signed this and declared it to be her will, and now at
her request, in her p~°esence, and in the presence of each other, we sign as witnesses:
/~%//, ~
l /l ~!i'~ -~ ~
~ Address
i
Address ~~~- 1-1 ~'~~~
3
COMMONWEALTH OF PENNSZ'LVANIA)
COUNTY OF CUMBERLAND)
SS
WE; the undersigned, the Testatrix and the witnesses, respectively, whose names are
signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned
authority that the Testatrix signed and executed the instrument as her Last Will and Testament
and that she signed willingly (or willingly directed another to sign for her), and that she executed
it as her free will and voluntary act for the purposes therein expressed, and that each of the
witnesses, in the presence and hearing of the testatrix signed the will as witnesses and that to the
best of their knowledge the Testatrix was at that time eighteen years of age or older, of sound
mind, and under no constraint or undue influence.
z~'~
Testatrix
U
~" u
V~itness
,~ ~ --
I Witness
~~
Subscribed, sworn to and acla~owledged before me by the Testatrix, and subscribed and sworn to
before me by both witnesses, this ~~~y~{-~ day of ~ , ~~-fl-
~` `~ ° ~ t
otary Public y
cornr~~:~~~~~,v~7r-i o:- P~~~;i~s~~wttivia
NUTAP,IAL S~kL
CYI~ITHIA J. RULE, !~dotar~~ Public
Lemoyne Boro., Cumberland County
My Commission Expires Februar/ 3, 2012
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69000 BAND: I14DIk NEN] YORK Dl Y 16627221:671
Financial Times Interactive Data
DTD: 09/19/2011 !~iat: 69/12/2012 O. SF,
03%' i 2012 I0C .031?5 ? !B
160 .031250 69,021.56
Int: 09/19/2611 tc 03/23/2612 181.13
66006 BA1~iK OF CHIIIz IdEW YORFi GIm`? la (06425H!;F2'j
Financial Times interaCti VE DaLc
DTD: 10/19%2011 Mat: 10!19!'012 C.5%
C iij/2C12 106 .63125 F~,rB
ICO .G3125C 60,618.75
Snt: 10/19/26__ to 63/3;;2012 128.33
X3000 GCLDMAN SACY.S BF OSA D1Y (381<_3F:LK3j
Financial Mimes Interactive Data
DTD: 03!0%!2012 t9aL: 09/05/2013 0.5-0
G3i~3/201~ 99. E8?50 r.!B
99 .687560 ?2,71.68
Int: 03/G~i~GI~ *_c 03 ~~,_'G12 i
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Financial Times Interactive DaLo
TG: 63;''611612 I~;at: C~9;'_6,'_v__ 0.,,~
9~ .n25000 92,838.75
Bond did not begin a_crtinc until 03%2612612
To?a'_ Vague:
Iota_ Accrual:
Total: S3?0,16?.82
169, 62C. 6_
,547.19
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May 16, 2012
MARILYNN R KANENSON
MORGAN STANLEY SMITH BARNEY
WEST SHORE OFFICE CENTER
214 SENATE AVE FL 7
CAMP HILL, PA 17011-2336
Re: Accumulated Cash Value
Contract: VA97452850
Annuitant(s): Catherine G Lange
Owner(s): Catherine G Lange
Dear Ms. Kanenson:
We are writing in response to information requested on the above-referenced contract.
The Accumulated Cash Value as of 3/23/2012 was $32,853.82.
If you have any questions, you may contact an Annuity Information Specialist at (800) 722-2333, Monday
through Friday from 6 a.m. to 5 p.m., Pacific Time. You may also contact your registered representative
with questions. Neither Pacific Life nor its representatives give tax or legal advice.
Sincerely,
C~~~`~
Lorene C Gordon
Vice President, Operations
Retirement Solutions Division
Pacific Life Insurance Company
Retirement Solutions Division
P.O. Box 2378, Omaha, NE 68103-2378 www.PacificLife.com
Securities Distributed by Pacific Select Distributors, Inc., Member, FINRA & SIPC