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HomeMy WebLinkAbout07-11-12 (2)e eF~. 1,50561,01,05 PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes oE~.,.„=\-~F~INHERITANCE TAX RETURN County Code Year File Number PO BOX z8o6o1 ~ / ` Harrisburg, PA 1'7128-0601 RESIDENT DECEDENT /~ ~~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 201-16-0217 10/11/2011 08/02/1925 Decedent's Last Name Suffix Decedent's First Name MI Black John L (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 DUPLICATE WITH THE _ REGISTER ®F UVILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (Date of Death O 4. Limited Estate O 4a. Future Interest Compromise (date of Prior to 12-13-82) O 5. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate (Attach Copy of Will) O 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 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 Ronald E. Johnson, Esq (717) 243-0123 r> First Line of Address 78 West Pomfret Street Second Line of Address City or Post Office State ZIP Code Carlisle PA 17013 Correspondent's a-mail address: rejohnson@pa.net REGISTE ~111LLS US~ Y d CD ~ - ~ ~.} . ri i -~_ ~, .,a ~ O ~= : 3 ~ ~ ` DATE FILED 0. C`7 i~ ? ~C7 r`i l:_3 C~~) ~,~ C~7 rn ~i 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, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPON IBLE FOR FILING ET Rl~l_ e I' DATE ADDRESS - c/o 78 West Pomfret Stre isle, PA 17013 i ccl, l~cll IIJIC. r'Ii ~ ~ U ~ .S Side 1 1,5056],1,05 1,5561,01,05 Z ~~ r~tgst usE ORIGINAL FORM ONLY 1,50561,0205 REV-1500 EX (FI) Decedent's Social Security Number Decedent's Name: John Lamont Black 201-16-0217 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. 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. 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 .0 15. 16. Amount of Line 14 taxable at lineal rate X .0 45 41,448.80 16. 17. Amount of Line 14 taxable at sibling rate X .12 17 18. Amount of Line 14 taxable at collateral rate X .15 18 19. TAX DUE ....................................................... ..19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVEP.PAYMENT Side 2 1,50561,0205 1,5~561,02~5 52,000.00 0.00 0.00 0.00 15,693.74 0.00 5,534.29 73,228.03 27, 321.55 4,417.68 31,739.23 41,448.80 0.00 41,44$.80 0.00 1, 865.20 0.00 0.00 1,865.20 O REV-1502 EX+ .;01-10) `. pennsytvania SCHEDULE A DEPARTMENT OF REVENUE [NHERITANCETAXRETURN REAL ESTATE RESIDENT DECEDENT rV ~ni {. vi-. John Lamont Black FILE NUMBER: 21-11-1135 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. NUMBER VALUE AT DATE DESCRIPTION OF DEATH 1' I ALL THAT CERTAIN tract of land with the improvements thereon erected situate in North Middleton Township, Cumberland County, Pennsylvania being improved with a 1 1/2 story frame dwelling house known and numbered as 128 Wynnwood Drive, Carlisle, PA 17013 (See settlement sheet -line 401 attached) 52,000.00 TOTAL (Also enter on Line 1, Recapitulation) $ 52 000.00 If more space is needed, use additional sheets of paper of the same size. ~~.' IlliiiU r` A. Settierrae~tt Statert~te~t (~6lJD-~) OMB Approval No. 2502-0265 -- - •-,-•• ~~ ~~ ...,~~~N~~~o uus corm, unless R displays a currently valid OMB control number. No confidentiality sRassured this dhsclosu e Is mandatory Th shlis desi ned to rovide the arties to a RESPA covered transaction with information Burin the settlement rocess. © 2009-2011 Easy Soft. Previous editions are obsolete. Page 1 of 3 L. Settlement Char es File Number: RE 12-168 Loan Number: 700. Total Real Estate Broker Fees Division of Commission line 700 as follows: Paid From Paid From 701. $ 1, 300.00 to S encer & S encer Borrower's Seller's 702. S1 300.00 to Hooke Hooke & Eckman Funds at Funds at 703. Commission aid at settlement Settlement Settlement 704. 2, 600.0 801. Our on ination char e $ 802. Your credit or char a oints for the s ecific interest rate chosen $ from GFE #1 803. Your ad'usted on ination char es from GFE #2 804. A raisal fee to from GFE A 805. Credit re ort to from GFE #3 806. Tax service to from GFE #3 807. Flood certification from GFE #3 808. from GFE #3 809. 810. 811. 900. Items Re uired B Lender To Be Paid In Advance 901. Dail interest char es from 6/19/2012 to 7/1/2012 @ S /da 902. Mort a e insurance remium for D months to from GFE #10 903. Homeowner's insurance for 0 ears to from GFE #3 904. (fromC;FF~11i ~ uuu. Reserves De osited With Lender 1001. Initial de osit for our escrow account 1002. Homeowner's insurance months @ from GFE #9 1003. Mort a e insurance er mo S months @ 1004. Pro e taxes er mo S months @ 1005. School taxes er mo 5 months @ 10D6 per mo $ . months @ 1007. A re ate Ad~ustment er mo S 1100. Title Char es S0. 00 1101. Title services and lender's title insurance 1102. Settlement or closin fee from GFE #4 1103. Owner's title insurance Old Re ublic Title Co . 1104. Lender's title insurance Old Re ublic Title Co. from GFE #5 570.75 1105. Lender's title olic limit S 1106. Owner's title olic limit $52 000 00 1107. A ent's ortion of the total insurance remium . $985 19 1108. Underwriter's ortion of the total insurance remium . 585 61 1109.Attorne fees to Andrews & Johnson . 1110. _ 225.00 1111. -- --•-•••••~~••••~~~~~~~~ ~iiai csrcecoroer of Deeds 1202. Deed $ 62.00 Mort a e $ from GFE #7 B 6.00 1203. Transfer taxes Release 5 1204. Cit /Count tax/stam s: Deed $ from GFE #8 Mort a e $520 00 520.00 . 1205. State tax/stam s: Deed $520.00 Mort a e S 1206.Sti v Liens to Prothonotar 520 00 1207. $29.00 . 1300. Additional Settlement Char es S 1301. Re uired services that ou can sho for 1302. from GFE #6 1303. 1304. tax claim to Tax Claim Bureau 1305.2012 Countv taxes to Robin Sollenber er 2,291.66 1306. final water sewer to NMTMA 352 79 1307. reimbursement fees to Andrews & Johnson . 405 58 1308. tax certication to Andrews & Johnson . 2,582.75 1400. Total Settlement Char es enter on lines 103 Section J and 502 Section K 5.00 I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, itl~ a true and accurate statement of all re eipts7and d sbursem my account or by~e\n this tr~ sacfion. I further certify that I have received a copy of the HUD-1 Settl ~mw tf St ent smade on B , .r at/finent. ,F([ l f '~ ~ ~ ~~ Hooke & Yenz-per 1?pter rises ` ' ~ / J~~~~ - ap _.._-~' Buyer/Borrower f Estate -of J. LamdDt Black` P= /~ ' f ~il ~ ' r ~ -? ; / Seller Buyer/Borrower This Settlement Statement which I've prepared is a true nd . accurate account of this transaction. I ve caused or will cause the funds to be disbursed in accordance with th ,'( ~' `"'~ ~ r r; fit is statementer . ~ .( Orchard Settlement Services, LLC 6/14/2012 Settlement Agent Date WARNING It is a crime to knowin I make false statements to the United States on this or an other similar form. Penalties u on conviction can include a tine © 20D9-2D11 Easy Soft. Previous editions are obsolete i i or m r son . Page 2 of 3 ment. REV-i5o8 EX+ (ii-io) ~~~~~~,~d.~~~~~~ p g~ gygp p~ p~gEF~+cT p~ p~T DEPARTMENT OF REVENUE ~P9S6 L~ E3!-G i~YB i.~CP®J1.~~ f7i 1.11L~C. 11VHERITANCE TAX RETURN p~~g®€~AL PR~9PEEiT~` RESIDENT DECEDENT EST,4TE ©F: FILE P~lU~IBER; John Lamont Black 21-11-1135 Include the proceeds of litigation and the date the proceeds were received by the estate . III property jointly owned with right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE _ OF DEATH 1. Checking account no: 702447-M&T Bank (see letter attached) 1, 924.68 2 Nationwide Insurance-insurance proceeds for 1997 Chevrolet Blazer damaged prior to decedents death but paid following his death 3,894.50 3. 1973 Pontiac Cataline automobile -proceeds from sale (see line 405 of settlement sheet attached to Schedule A) 3.000.00 4. 1996 Pontiac Firebird automobile -proceeds from sale 4, 000.00 5 Tyco Electronics -pension I Hook & S t 714.27 6 e u er -security deposit refund 635.00 7. Miscellaneous household furniture and personal property 1.000.00 g Nationwide Insurance -auto insurance refund 125.20 g. Hooke & Yentzer Enterprises -reimbursement for real estate taxes paid in advance (see settlement sheet attached to Schedule A) 261.82 10. Miscellaneous deposits -refunds 138.27 TOTl~L (Also enter on Line 5, Recapitulation) $ 15,693.74 If more space is needed, use additional sheets of paper of the same size. Q MBTB~iIk 499 Mitchell Road, Millsboro, DE 19966 Adjustment Services Andrews and Johnson 78 West Pomfret Street Carlisle, PA 17013 Re: Estate of J Lamont Black Social Security: 201-16-0267 Date of Death: October 11 2011 Phone 888-502-4349 F ax (302)934-2955 November 5, 2011 Dear Sir or Madam: Per your inquiry on October 25, 2011, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account Checking Account Account Number 702447 Ownership (Names o, f) J Lamont Black Opening Date 09/01/67 Balance on Date of Death $1, 924.68 Accrued Interest $ .00 Total ---- -- - ---- ----___ $1, 924.68 2. TyAe Of ACCOUnt Account Nuanber Ownership (Names o~ Opening Date Balance on Date of Deat/z Accrued Interest Total hutividual Retirement Account 35004200304571 J Lamont Black Children in Egual Shares 04/18/99 $5,522.22 $ 12.07 $5,534.29 ~~ ~ ~~~~~~~va~i~ L o~NARTME~V~ DF ~EVEN~E INFER-~Ip1'~QS ~RAfVSFEp~Ryy~~~gg°°ppA®®N® INHERITANCE TAX RETURN ~~~~~ ~®N-t'$~®E,I°11 ~ P~iJr ~Pi 1 5 RFSIDEfVT DECED'e NT ESTATE OF FILE NUf~BE~: John Lamont Black 21-11-1135 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. If more space is needed, use additional sheets of paper of the same size. pennsylv~ni~ DEPARTMENT OF REVENUE INHERITANCE TAX R'eTURPI RESIDENT DECEDENT ESTATE OF John Lamont Black ~ L FUNERAL EXPENSES AND ADNfINISTRATIVE COSTS ITEM NUMBER A. 1. Decedent's debts must be reported on Schedule I, _ DESCRIPTION FUNERAL EXPENSES; Hoffman-Roth Funeral Home 2 Hoy's Greenhouse LLC -funeral flowers B, ADMINISTRATIVE COSTS: '. Personal Representative Commissions: Name(s) of Personal Representative(s) Street,4ddress City State Year(s) Commission Paid: 2 3 4. 5, 6. 7. 8. 9. 10. 11. 12. Attorney Fees: ~sCC d ~Ze-i'~ !1'l ~'~ Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address City State Relationship of Claimant to Decedent ZIP Probate Fees: Accountant Fees: Tax Return Preparer Fees: Cumberland Law Journal -advertize estate The Sentinel -advertize estate S.W. Barrett Real Estate & Appraisal Services -real estate appraisal N. Middleton Authority-water/sewer Cumberland County Landfill Cumberland County Landfill TOTAL (Also enter on Line 9, Recapitulation) ~ ~ If more space is needed, use additional sheets of paper of the same size. FILE NUMBER 21-11-1135 ZIP 1NT 10, 354.42 178.08 6, 000.00 254.50 75.00 278.42 350.00 82.30 49.84 75.72 ANDREWS & JOHNSON Attorneys at Law 78 W. Pomfret Street Carlisle, PA 17013-3216 TAYLOR P. ANDREWS RONALD E. JOHNSON Telephone (717) 243-0123 Telefax (717) 243-0061 Schedule H: Attachment B2. Attorney's fees: The attorney's fees in this estate are significantly more than the size of the estate might normally warrant. However, the assets of an estate do not always reflect the amount of time expended to handle an estate. The fee agreed to by the personal representatives was based on an hourly rate of $225 per hour and not on a percentage of the assets. The personal representatives in this estate did not communicate between themselves well and much of the work to be done was left to the attorney. In addition, meetings were often scheduled and frequently one of the personal representatives would cancel at the last minute or simply not show for the scheduled meeting. Finally two civil actions were filed in a Magisterial District Court by Suzanne B. Crull against the Estate of J. Lamont Black. Civil action CV-7-12 was filed seeking a judgment in the amount of $2,789.44 and CV-191-11 was filed seeking a judgment in the amount of $7,000 or a total of $9,789.44. It was necessary to defend both of these actions and the Plaintiff was subsequently awarded a total judgment of $1,153.99 including costs which was $8,635.45 less than she was seeking. The defense of these actions makes up a fair amount of the attorneys fees set forth herein. SC>FIEDULE H -continued Funeral Expenses, Administration Costs and Miscellaneous Expenses ESTATE OF FILL; NUMBER John Lamont Black 21-11-1135 13. Lowes -contractor trash bags $15.88 14. Jack RosenbeiYy $100.00 1 ~. Rex Ciuffo $100.00 16. Spencer Ciuffo $100.00 17. Devin Sheriff $100.00 (each of the above (Items 14-17) where paid to clean out and remove large Items from the house and garage at 128 Wynnwood Drive and haul to landfill) 18. Star Dust Storage -storage unit rental $59.84 19. Star Dust Storage -storage until rental $04.00 20. York Waste Disposal -trash $99.46 21. PP&L -electric $225.07 22. Sheriff of Cumberland County-amount paid upon execution of Judgment obtained by Suzanne B. Crull vs. Estate of John L. Black $1,153.99 23. Spencer & Spencer and Hooke, Hooke & Eckman - Real estate commission $2,600.00 24. Andrews & Johnson, attys $225.00 25. Recorder of Deeds - 1 % transfer tax $520.00 26. Tax Claim Bureau -delinquent real estate taxes $2 241.66 27. Robin Sollenberger, Tax Collector-2012 county real estate taxes $352.79 28. N. Middleton Township-final water/sewer $405.58 29. Andrews &Johnson-reimbursement for tax certification $5.00 30. Register of Wills, filing fee $15.00 31. Reserve for closing and accounting $800.00 TOTAL ca~5o e~~e~o~ i~~e ~, xe~aP~c~ia~~o~~ _ $27,321.55 penns~lvan~a L I DEPARTMENT DE raEVENUE DEBTS ®E DECEDENT, INHERITANCE TAX RETURN ~(~jR-`Gp,GE LIP.SILITIES & LIENS F,ESIDENT DECEDENT ESTATE QF FILE NUMBER John Lamont Black 21-11-1135 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE iJUMBER DESCRIPTION OF DEATH I Verizon Wireless 206.95 2 Three Sprigns Family Practice -medical 59.28 3. Quantum Imaging -medical 44.81 4 Comcast - TV cable 73.82 5 Andrews & Johnson, attys -prior outstanding invoice 480.00 6. Spirit Physicians Services, Inc. -medical 24.93 7. Cumberland Goodwill Fire & Rescue EMS 82.28 8. PP&L -electric 133.55 9. West Shore EMS -Carlisle 136.04 10. Smiths Applicance -repair invoice 37.10 11. PA Retina Specialist, PC -medical 107,95 12. Carlisle Regional Medical Center -medical 364.35 13 Pinacle Health Hospitals -medical 22.06 14. Carlisle Medical Pathology -medical 15.73 15. West Shore EMS -Carlisle 800.00 16. William J. Phelan, MD 25.00 17. Pinacle Health Cardiovascular Inst., Inc. 13.36 18. Mohammad Ismail -medical 139.38 19. Joseph, Mann & Creed -collection agency for Patriot News -newspaper 30.45 20. Kough's Oil Service -fuel oil bill 1,442.79 21 Carlisle HMA Physician Management -medical 126.19 22. Allied Interstate -collection agency for Carlisle Regional Medical Center -medical 51.66 TOTAL (Also enter on Line 10, Recapitulation) $ 4,417.68 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) ~' pennsy(van~a S DEPARTMENT OF REVENUE CMEDIlLE INHERITANCE TAX RETURN RESID BENEFICIARIES ENT DECEDENT ESTATE OF: John Lamont Black NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2),] 1~ Vonnie R. Sheriff, 507 North Walnut Street, Mt. Holly Springs, PA 17065 2 I Vickie Brownawell, 2 Yankee Drive, Mt. Holly Springs, PA 17065 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) -_ daughter daughter ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, IS APPROPRIATE. II 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 FILE NUMBER: 21-11-1135 AMOUNT OR SHARE _ OF ESTATE 50% 50% 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. ~