HomeMy WebLinkAbout06-29-121505610105
REV-1500 E` t°~13't~' ~
PA Department of Revenge Pe~Yt~a OFFICIAL USE ONLY
~~ ~ ~~ County Code Year File Ntmleer
Bureau of Individual Taxes
PCi BOx z806oi INHERITANCE TAX RETURN -~ ` ~
Harrisburg, PA i~i28-0601 RESIDENT DECEDENT "` 1 I ~~~` ~ -~'-~ ~
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
11/08/2011 02/16/1922
Decedent's Last Namme Suffix Decedent's First Name MI
Kane Esther A
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix 5pouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
Rj 1. Original Retum O 2. Supplemental Retum O 3. Remainder Retum (Date of Death
Prior to 12-13-82)
O 4. Limited Estirte O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Retum 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.)
O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Se:c. 9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFlDENTiAL TAX INFORMATI01~1 SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
Elden H Swartz Jr (717) 766-1077
REGISTER OF WILLS USE ONLY~,x
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First Line of Address °~a -~_, ~-
CA
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1415 Concord Road !
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Second Line of Address ~ -- ~ f\)
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City or Post Office
State ZIP Code _
_
DATE
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Mechanicsburg PA 17050 ~ -
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Correspondent's e-mail address: SwartzmbQVefizon.net
Under penalties of perjury, I n3 that I have examined this return, rrx~uding accanpenyurg schedules and statements, and to the best of my knowlaclge and belief,
it is true, correct and complete. aratbn of preparer other than the personal representative is based on all lnfomration of which preparer has any knowledge.
SIGNA P NSIB FI G RETURN DATE
~~ ~ '~ ~ ' ~ - 06/26!2012
AODRESS
1415 Concord Road Mechani burg, PA 17050
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
L, 1505610105
Side 1
1505610105 J
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J 1505610205
REV-1500 EX {F1)
Decedent's Social Securih~ Number
Decedents Name: Esther A Lane
RECAPITULATION
1. Real Estate (Schedule A) ...................................... . . . .... 1. 0.00
2. Stocks and E3onds(Schedule B) ................................... .... 2. 0.00
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . .... 3. 0.00
4. Mortgages and Notes Receivable (Schedule D) ....................... .... 4. 0.00
5. Cash, Bank 'Deposits and Miscellaneous Per~nal Property (Schedule E)... .... 5. 16,512.99
6. Jointly Owned Property (Schedule 1=) O Separate Billing Requested ... .... 6. 0.00
7. Inter-Vivos Transfers 8 Misoellaneous Non-Pn~bate Property
(Schedule G) O Separate Billing Requested.... .... 7. 0.00
8. Total Gross Assets (total Lines 1 through 7) ......................... .... 8. '16,512.99
9. Funeral Expf;nses and Administrative Costs (Schedule H) ............... .... 9. 898.56
10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ........... .... 10. 14,456.50
11. Total Deductions (total Lines 9 arxi 10) ............................. .... 11. '15,355.06
12. Net Value of Estate (Line 8 minus Line 11) .......................... .... 12. 1,157.93
13. Charitable and Govemmerrtal Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) .................... .... 13. 0.00
14. Net Value SubJect to Tax {Line 12 minus Line 13) .................... .... 14. 1,157.93
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES _ -
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(ax1.2) X .0__ 15.
16. Amount of Line 14 taxable
at lineal rate X .0-_ 16
17. Amount of Line 14 taxable
at sibling rate X .12 17
18. Amount of Line 14 taxable
at collateral rate X .15 1,157.93 18. 173.69
19. TAX DUE ...................................................... ... 19. 173.69
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
1505610205 1505610205 J
REV-1500 EX (FI) Page 3
Decedent's Complete Address:
Esther A Kane
3TREETADDRESS
1415 Concord Road
CITY
Mechanicsburg
Tax Payments and Credits:
i. Tax Due (Page 2, Line 19)
2. CreditslPayments
A. Prior Payments ____ 0.00
B. Discount _ 0.00
3. Interest
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This i5 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.
Flle Number
---
--- ---- -
-- -- i STATE ,ZIP
PA 17050
(1) 173.69
Total Credits (A + B) (2) 0.00
(3) 0.00
(4} 0.00
(5) 173.69
Make check payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSVNEER THE FOlLOWiNG QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a Vansfer and: Yes
^ No
a. retain the use or income of the property transferred ..........................................................................................
it
i ^
ncome ............................................
s
b. retain the right to designate wha shall use the property transferred or
c. retain a reversionary interest .............................................................................................................................. ^
^ ~
d. receive the promise for life of either payments, benefits or care? ......................................................................
ff death occurred after Dec. 12,1982, did decedent transfer property within one year of death
2
.
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 property, which
contains a beneficiary designation? ........................................................................................................................ ^
IF THE ANSVIfER TO ANY OF THE A80VE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE R 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 deaftl ce 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 evenrf the surviving spouse is the onty 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 decedents lineal benefidaries is 4.5 percent, except as noted in (r2 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. §9i16(a)(1.3)]. Asibling is defined,
under Section 9102, as an individual who has at least one parent in cr»rtmon with the decedent, whether by blood or adoption.
REV-i5o8 EX+ (ii-io)
Pennsylvania SCEIE1~t~LE E
DEPARTMENT OF REVENUE CASH BANK DEPOSITS & MISC.
INMERTTANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Esther Q Kane
Include the proceeds of litigation and the date the proceeds were received by the estate.
All properly jointly owned with right of survivorship must be disdosed on Schedule F.
~~ ~ ~ ~~~ C ,pal:c 1, neeoeD, use aaamona~ sneets of paper of the same size.
REV-1511 E-::+ ('<'J-i~9;
~-i~ Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Esther A Kane
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER
A. FUNERAL E};PENSES:
1.
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissim~s:
Name(s) of Personal Representative(s) ,__~_.~
Street Address `___ _~ f__~-~-~-------
City _ ------------ -..__ State _^_. ZIP
Year(s) Commission Paid: , ____ _________-_____ _ _.____
2. Attorney Fees:
3. family Exemption: {If decedent's address is not the same as claimant's, attach explanation.)
Clairant
Street Address __
City ------- -------- _. State ---
Relationship of Claimant to Decedent
4. Probate Fees:
5. Accountant Fees:
6. Tax Return Preparer Fees:
~• Estate Notice -Cumberland County Law Journal
- Carlisle Seminal
Funeral Luncheon
Inheritance Tax Return Filing Fee
ZIP
TOTAL (Also enter on Line 9, Recapitulation) ~ ~
If more space is needed, use additional sheets of paper of the same size.
z95.oo
119.50
75.00
147.06
247.00
15.00
898.56
REV-l;i? EX~ (1~-081
Pennsylvania SCHEDULE I
DEPARTMENT OAF REVENUE DEBTS OF ~ECE~ENT~
INHERITANCE Ti1% RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Esther A Kane
Report debts incurrrd by the decedent prior to death that remained unpaid at the date of death, including unreimbursed media! expenses.
,~ nwic space u neeaea, mserl aaomonai sheets of the same size.
REV-1513 EX+ (O1-10)
pennsylvania SCHEDULE ]
DEPARTMENT OF REVENUE '
iNHfRITANCE TAx RETLRN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Esther A Kane
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Indude outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
1 • Elden H Swartz Jr ~ Mary E Swartz Nephew-in-law 8 Niece 1157.93
1415 Concord Road, Mechanicsburg, PA 17050
ENTER DOLLAR AMOUNT5 FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
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. I #
If more space is needed, use additional sheets of paper of the same size.
LAST WILL AND TESTAMENT
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ESTHER A
KANE
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I, ESTHER A. KANE, of Mechanicsburg, Cumberland, Pennsylvania, d.o make,
publish and declare this to be my Last Will and Testament, hereby revoking all Wills and
Codicils by me at any time made.
ITEM I: I direct that all inheritance and estate taxes becoming due by reason of
my death, whether such taxes may be payable by my estate or by any recipient of any
properly, shall be paid by the Executor out of the property passing under ITEM I'V of this
Will, as an e~;pense and cost of administration of my estate. The Executor shall have no duty
or obligation to obtain reimbursement for any such tax so paid, even though on praceeds of
insurance or other property not passing under this Will.
ITEM II: I direct the Executor to pay my just debts and the expenses of my last
illness and funeral expenses from the property passing under this Will as an expense and cost
of administration of my estate.
,~~~- ~
1~_
1
ITEM III: I make the following specific bequests:
(1) To my niece, Mary E. Swartz and mynephew-in-law, Elden H. Swartz, Jr.,
the sum of Ten Thousand Dollars ($10,000.00) in consideration for their acting
as Executors of my Estate. In the event they choose not to act as Executors or
choose to take a fee percentage of the Estate in lieu of the specified sum, this
special bequest shall lapse. I do direct that all actual out of pocket expenses
incurred by my niece, Mary E. Swartz and my nephew-in-law, Elden H.
Swartz, Jr., acting as Executors of my Estate shall additionally be reimbursed
to them at the time of Administration of my Estate;
(2) My brother, Vernon Frazer and his wife, Jean, the sum of Twenty Thousand
Dollars ($20,000.00);
(3) The sum of One Thousand Dollars ($1,000.00) to Miriam Frazer;
(4) The sum of One Thousand Dollars ($1,000.00) to my friend, Regina Pinko of
Oberlin, Pennsylvania; and
(5) The sum of Five Hundred Dollars ($500.00) to Charlotte Knisely.
ITEM IV: I devise and bequeath all the rest, residue and remainder of my estate
of whatsoever nature and wherever situate, together with any insurance policies thereon, to
be distributed as follow:
(1 } Ten percent (10%) to my nephew, John Lobb;
(2) Ten percent (10%) to my niece, Mary E. Swartz,
~~
2
r e
(3) Ten percent (10%) to my niece, Beverly Sutherland;
(4) Ten percent (10%) to my nephew, Robert Fissel;
(5) Ten percent (10%) to my niece, Barbara Jean Mirachi;
(6) Ten percent (10%) to my nephew, Gary Frazer;
(7) Ten percent (10%) to my niece, Sharon Saytor;
(8) Ten percent (10%) to my niece, Debra Landis;
(9) Ten percent (10%) to my nephew, David Frazer; and
(10) Ten percent (10%) to my niece, Teresa DeShong.
If any of the foregoing beneficiaries do not survive me, his or her share shall lapse and
be distributed in equal shares to the remaining beneficiaries set forth in Item IV hereof.
ITEM V: In the settlement of my estate, my Executor shall possess, among others,
the following powers:
(a) To retain any investments I may have at my death, as long as the
Executor many deem it advisable to my estate to do so;
(b) To sell either at private or public sale and upon such terms and
conditions as the Executor may deem advantageous to the estate, any or all real or personal
property or interest therein owned by the estate;
(c) To pay all costs, taxes, expenses and charges in connection Frith the
administration of my estate; -~r~~~
3
(d) To compromise controversies; and
(e) To do all other acts in the Executor's judgment deemed necessary or
desirable for the proper and advantageous management, investment and distribution of the
estate.
ITEM VI: Any person who shall have died at the same time as I shall have, or in a
common disaster with me, or under circumstance that the order of deaths cannot be
established by proof, or within thirty (30) days of my death, shall be deemed to have
predeceased me.
ITEM VII: I hereby nominate, constitute and appoint ELDEN H. SWARTZ, JR.,
and MARY E. SWARTZ, to be the Co-Executors of my Estate. In the event one can not act
or refuses to act, I nominate the other as alternate Executor. In the event neither can act or
refuses to act as Executors for any reason, I nominate, constitute and appoint my niece
BARBARA JEAN MIRACHI, as alternate Executrix. Any Executor(rix) is specifically
relieved from the duty or obligation of filing any bond or other security.
~t1
4
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last
Will and Testament, consisting of this and the preceding four (4) pages, at the end of each
page of which. I have also set my initials for greater security and better identification this 27~'
day of September, 2007.
ESTHER A. KANE
We, th.e undersigned, hereby certify that the foregoing Will was signed, sealed,
published and declared by the above-named Testatrix as and for her Last Will and Testament,
in the presence of each othex, have hereunto set our hands and seals the day and year first
above written., and we certify that at the time of the execution thereof, the said Testatrix was
of sound mina and memory.
~~~~~-~~~ ~1c.~~
Amanda L. Sc-uders
Laura J. ghes
Residing at: 129 Herman Avenue
Lemoyne, PA 17043
Residing at: 123 Seventh Street
New Cumberland, PA 1707'0
S
(SEAL)
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS.
I, ESTHER A. KANE, Testatrix, whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, do hereby acknowledge that I
signed and executed the instrument as my Last Will and Testament; that I signed it willingly,
and that I signed it as my free and voluntary act for the purposes therein expressed.
Sworn to and ub 'bed
before rre t th ay
of Septe_ ` , 2
NOTARY PUBLIC
My Commission Expires:
(SEAL)
~.~%~'-1~- /~L ~ ~~a~~ (SEAL)
ESTHER A. KANE
NOTARIAL SEAL
BARBARA SUMPLE-SULLIVAN
Notary Public
NEWCUMBERLAND BOROUGH
CUMBERLAND COUNTY
My Commission Expires Nov 15, 2007
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF CUMBERLAND
We, Amanda L. Souders, and Laura J. Hughes, the 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 Testatrix, ESTHER A. KANE, sign and
execute the instrument as her Last Will and Testament; that Testatrix signed willir-gly and
she executed said Will 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 ou.r knowledge the Testatrix was at that time eighteen (18) or more years of age,
of sound mind and under no constraint or undue influence.
~~~~ ~ ~~
Amanda L. Souders
Sworn to
before m,
of S.e~en
bscribed
7`~ v1
NOTARY PUBLIC
My Commission Expires:
(SEAL)
~ ;,
Laura J. Hu s
NOTNOT-~e
BARBARA SUMPLE-SULLI4'AA(
Notary Public
NEWCUMBERLAND BOROUGH
CUMBERLAND COUNTY
EWy Commission Expires Nov T 5, 2007
.~.5.,~. r~. ~'
ACCOUNT NO. ACCOUNT TYPE
50095358'RELATIONSHIP CHECKING KITH INTEREST
00 0 06123M NM I17
13632
ES'THER A KANE
14:15 CONCORD RD
MECHANICSBURG PA 17050
INTEREST EARNED FOR STATEMENT PERIOD 0.12
INTEREST PAID YEAR TO DATE 0.80
Af`~`f111A1T CIIMMADV
STATEMENT PERIOD PAGE
OCT.20-NOV.18,2011 1 OF 2
NEST SHORE PLAZA
BEGINNING
BALANCE
DEPOSITS &
OTHER ADDITIONS - - - -
CHECKS PAID
OTHER
SUBTRACTIONS
CURRENT
INTEREST PD
ENDING
BALANCE
N0. AMOUNT NO. AMOUNT H0. AMOUNT
14,792.71 3 3,221.70 1 1,354.84 1 146.71 0.13 16,512.99
Af`f`f111AIT Af TTVTTV
POSTING
DATE
TRANSACTION DESCRIPTION DEPOSITS,INTEREST
8 OTHER ADDITIONS CHECKS & OTHER
SUBTRACTIONS DAILY
BALANCE
10-20-11 BEGINNING BALANCE 514,792.71
10-31-11 CHECK NUMBER 4486 1,354.84 13,437.87
11-01-11 US TREASURY 312 XXCIV SERV 1,518.00
11-01-11 US TREASURY 312 XXCIV SERV 1,318.00
11-01-11 CAPITALBLUECROSS INS. PREM 146.71 16,127.16
11-03-11 US TREASURY 303 XXSOC SEC 385.70 16,512.86
11-18-11 INTEREST PAYMENT 0.13 16,512.99
ENDING BALANCE 516,512.99
CHECKS PAID SUMMARY
4486 10-31-11 1,354.84
ANNUAL PERCENTAGE YIELD EARNED = 0.00
IT•S THE SEASON TO GIVE. AND KITH M8T, IT•S THE SEASON 70 SAVE, TOO.
ENJOY HOLIDAY DISCOUNTS AT MAJOR RETAILERS NHEN YOU USE YOUR M&T CHECK CARD OR
M&T CREDIT CARD IN STORES, ON THE MEB AND OVER THE PHONE. FOR FULL DETAILS AND
TO START SAVING, PICK UP A COUPON BOOK AT YOUR LOCAL M8T BANK BRANCH, OR VISIT
MTB.COM/SHOPPING.
FOR CUSTOMER SERVICE QUESTIONS, PLEASE CALL 1-800-724-2440.
Camp Hifl
17p0 \Earket Sn-ee*.
Camp Hill, P~1 1?(il 1
?17-?37-?189 Fas
January 2~1, 2012
To: Estate of Esther Kane
From: Manor Care Health Services
ManorC;are'°
Health Services
We are pleased to have been Esther's provider of choice. However there still remains an
outstanding balance on Esther's account of $1,127.08.
Please remit the above balance today or call the business office to discuss plans for
payment.
If you have an anticipated time period for the estate to settle, please call and notify the
business office.
Should you have any questions, please do not hesitate to call.
Sincerely,
Steven Vignati
Business Office Manager
pennsylvarria
DEPARTMENT 9F PUBLIC WELFARE
June 15, 2,012,
ELDEN H SWARTZ JR
1415 CONCORD RD
MECHANIC:SBURG PA 17050-1955
Re: Esther Kane
CIS #: 410508327
SSN: ###-##-4876
Date of Death: 11/08/2011
Dear Mr. Svvartz:
This is to acknowledge receipt of payment in the amount of $13,324.42 regarding
the above-referenced estate. The Estate Recovery Program's claim is satisfied.
Your cooperation in resolving this matter is appreciated.
Sincerely,
Elizabeth M. Wilson
TPL Program Investigator
717-214-1868
717-772-6553 FAX
Bureau of Program Integrity ~ Division of Third Party Liability ~ Recovery Section