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Home My WebLink About07-11-12J REV-1500 Ex(0/-70' 1505610143 PA Department of Revenue Pennsylvania Bureau of Individual Taxes ue.asmEnror ~vsxue Po Box.26osot INHERITANCE TA Harrisburg, PA 17128-0601 RESIDENT DE( ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 345 10 3170 09 26 2011 Decedents Last Name Suffix DICK (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW OFFICIAL USE ONLY County Catle Vear Flle Number (21 11 01048 Date of Birth 07 02 1915 Decedent's First Name MI MARY S Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS ® 1. Original Retum ^ 2. Supplemental Retum ^ 4. Limited Estate ^ qa. Future Imerest Canpromise (date of tleath aver 12-12-a2) ^ 6 Decedent Dietl Testate (Attacn copy a wllp ^ 7. Decetlent Maims ~t)a Win9 Trust ( cosy ^ 9. Dtigation Proceeds Received ^ 10. spousal PoveM Crean (tlate w deatn between 1231.91 and f-t-95) ^ 3. Remainder Retum (date of death prior to l2-13-82) ^ 5. Federal Estate Tex Retum Required 8. Total Numtxir of Safe Deposit Boxes ^ t f, Election to tex untler Sec. 9113(A) (Attach Sch. O)~ r j CORRESPONDENT-THIS SECTION MUST BE COMPLETED. ALL Name SAMUEL L ANDES First line of address 525 NORTH 12TH STREET Seeond line of address Chy or Post Office LEMOYNE correapondenra e-mau address: I aw a n d ea ~ a o l. c o m 'ONDENCE AND CONFIDENTIAL TAX INFORMATI ULD BE DIfiECTED~ Daytime Telepho r ~ r'~ ~% ?7 717 761 r ~-_? -r '~' r-n r'n REGISTER OFLWJ _(l.~E OlWY - =r= ~ 7 S ~ j _ _I _... T~lTC~ ~ O ~ Js tV ~ `i`I DATE flLED State ZIP Code PA 17043 ~,luding accompanying schedules end statemems, entl ro the trsonal representative is based on all InfonnaUon of vfiich pr Donald R. Howe ADDRESS [ 2425 Rolling Hills Drive, Mechanicsburg, PA 17055 Samuel L Andes 525 North 12th Street, Lemoyne, PA 17043 Side 1 1505610143 1505610143 REV-1500 EX oeeeeern~suame: DICK, MARY SUE Decedents Social Security Number 345 10 3170 RECAPITULATION 1. Real Estate (Schedule A) ........................................................................................ .. 1. 1, 8 3 4, 6 2 0. 7 7 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. 4 6. 3 51.2 6 5. Cash, Bank Deposits R Miscellaneous Personal Property (Schedule E) .............. .. 5. 6. Jointly Owned Property (Schedule ~ ^ Separate Billing Requested ........... .. 6. 1 5 , 5 6 4.14 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property Separate Billing Requested ........... .. 7 1 4 31 7 0 8 . 9 9 ~ ~ (Schedule G) ^ . 8. Total Gross Asseta (total Lines 1-7) ..................................................................... .. 8. 3 , 3 2 8 , 2 4 5.16 14 8 , 1 8 6 . 7 4 9. Funeral Expenses & Administrative Costs (Schedule H) ................................ ......... g. 2 , 0 12.2 3 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ....................... ......... 10. 11. Total Deduetiona (total Lines 9& 10) ............................................................ .......... 11. 1 5 0, 1 9 8. 9 7 12. Net Value of Estate (Line 6 minus Line 11) ................................................... .......... 12. 3 , 17 8 , 0 4 6 . 1 9 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................................ ......... 13. 14. Net Value Sub)ect to Tax (Line 12 minus Line 13) ....................................... .......... 14. 3 , 17 8 , 0 4 6 . 1 9 TAX COMPUTATION -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 0 . 0 0 15. 16. Amount of Line 14 taxable 0 0 0 16. at lineal rate X .045 . 17. Amount of Line 14 taxable at sibling rate X .12 0 . 0 0 t7~ 18. Amount of Line 14 taxable at collateral rate X .15 3 , 17 8 , 0 4 6.19 18. 19. Tax Due ............................................. ...................................................................... .. 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 1505610243 476,706.93 476,706.93 Side 2 L 1505610243 1505610243 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 - 11 - 01048 Dick, Mary Sue STREET ADDRESS 4837 E. Trindle Road CITY Mechanicsburg STATE PA ZIP 17050 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credit.4Payments A. Prior Payments 350,000.00 e. Discount 18,421.05 3. Interest q, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Cheek box on Page 2 Line 20 to request a refund 5. If Llne 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. Total Credits (A + B) (1) 476,706.93 (z) 368,421.05 (3) 0.00 (q) (5) 108,285.88 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 Vansfer and: Yea 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; or .................................................................................................................. d. receive the promise for I'rfe of either payments, benef'as or care? .............................................................. 2. If death occurred after December 72, 1982, did decedent Vansfer 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 property which containsabeneficiary designation? ...................................................................................................................... ^ ~~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE n AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before Jan. 1, 1995, the tax refs imposed on the net value of transfers to or for the use of the surviving spouse is 3 peroent [72 P.S. §9116 (a) (1.1) (i)]. For dates~of death on or after January 1, 1995, the tax refs imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9118 (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 'rf 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 Vansfers from a deceased child 21 years of aga or younger at death to or for the use of a natural parent, an adopOve parent, or a stepparent of the child is 0 peroent [72 P.S. §9118 (a) (1.2)j. • The tax rate Imposed on the net value of transfers to or for the use of the decedents lineal beneficiaries is 4.5 percent, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9118 (a) (1)]. • The tax refs Imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. 69116 (a) (1.311. 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. COMAONWEPLTN Or RENNSnvu~u NHEARANCE TA%REiURN RESIDENTDECEDENT SCHEDULE B STOCKS & BONDS FILE NUMBER ESTATE OF Dick, Mary Sue 21 - 11 - 01048 All property Jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM DESCRIPTION UNIT VALUE VALUE AT DATE OF NUMBER DEATH Smith Barney investment account No. 724-12641-13-139 1,746,273.52 2 ~ 76 shares of MetLife, Inc. at $33.37/share 3 ~ Annuity account with Aviva Life & Annuity Co. 2,536.11 85,811.14 TOTAL (Also enter on Ilne 2, Recapitulation) 1,834,820.77 SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMDNWEOLTN OrrwNSVVVnru PERSONAL PROPERTY PMERRMlCE TAC RENRN pEEDENi DECEDENT FILE NUMBER ESTATE OF Dick, Mary Sue 21 - 11 - oioas Include the proceeds of litigation and the date the proceeds were received by the estate. All property Jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 Rental refund from Country Meadows Home 2,817.30 2 Metro Bank -payment of interest from savings account 2.58 3 Erie Insurance -renters policy premium refund 57.00 4 Items of jewelry (see schedule attached) 13,463.00 5 Metro Bank account No. 536116882 30,011.38 TOTAL (Also enter on Line 5, Recapitulation) ~ 46,351.26 Estate of Mary Sue Dick File No. 21-11-01048 Attachment to Schedule E -list of jewelry 18 carat gold ring with diamond $990.00 14 carat white gold cultured pearl ring $270.00 Ladies' platinum ring with diamond $7 346.00 14 carat yellow and white gold ring $119.00 14 carat white gold wedding band $15.00 Sterling silver necklace $38.00 14 carat yellow gold tie clasp $298.00 14 carat gold cufflinks $394.00 14 carat gold chain $674.00 14 carat yellow gold pin with pearl and amethyst $153.00 5 assorted gold pins $276.00 3 white gold "bendix" tie tacks $214.00 14 carat rose gold art deco ring $406.00 3 strand cultured pearl necklace $310.00 14 carat gold amethyst and diamond ring $167.00 Ladies' platinum "eternity" ring $964.00 Ladies' 14 carat gold ring with imitation stone $59.00 Ladies' 14 carat white gold ring with diamond $155.00 Assorted items of costume jewelry $113.00 TOTAL $13,463.00 SCHEDULE F co^+Nw"wEwTM°RRENNSVLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Dick, Mary Sue 21 - 11 - 01048 If an asset was made Joint within one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT Donald R. Howe 2425 Rolling Hills Drive Nephew A Mechanicsburg, PA 17055 JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE I MADE o JOINT e nclude name of Tina vial IfIO$1I[U Ion a^o bank account numbe r similar Identifying number. Attach deed for Jointly-held real state. DATE OF DEATH VALUE OF ASSET I DECD'S NTEREST DA A~ oFTM DECEDENTS INTEREST 1 A 08/2002 Metro Bank account No. 536116619 at,t2e.z~ 50% 15,564.14 TOTAL (Also enter on Ilne 6, Recapitulation) I 15,564.74 COMMONWEALTH OF PENNSYLVANIA SCHEDULE G INHERITANCE TAX RETURN INTER-VIVOS TRANSFERS & RESIDEFR DECEDEM MISC. NON-PROBATE PROPERTY ESTATE OF Dick, Mary Sue FILE NUMBER 21 - 11 - 01048 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY Ir¢lune ttie Hama dthe treneleree. their reletlduMpt°tleceEent ark the Hate a transfer. Anach a copy of the °ea° for reel estate. GATE OF DEATH VALUE OF ASSET xOF ItRER~E3T ExcwsloN (IF APPLICABLE) TAXABLE VALUE 1 Date of death value of decedent's interest in Q-TIP 7e2,tts.2t 100% 782,116.21 Marital Deduction Trust of Mary Sue Dick and Morris Dick, net of expenses paid for final adjudication and disribution of the trust. See First and Final Account of Donald R. Howe, co-trustee, and Penny Archer, co-trustee. 2 Date of death value of decedent's interest in Credit sas,ssz.~e 100% 649,592.78 Shelter Trust of Mary Sue Dick and Morris Dick, net of expenses paid for final adjudication and disribution of the trust. See First and Final Account of Donald R. Howe, co-trustee, and Penny Archer, co-trustee. TOTAL (Also enter on line 7, Recapitulation) 1,431,708.99 MILE H RA~EFiAl.p~pJSES& cowaoNwRxrN Or re+NSn.va+u .~E`.~ MIHERRANCETPX RETURN RERIDENTDECEDENT FILE NUMBER ESTATE OF Dick, Mary Sue 21 - 11 - 01048 Debts of decedent must be reported on Schedule I. - NUMBER DESCRIPTION AMOUNT FUNERAL EXPENSES: a 1 Musselman's Funeral Home 2,240.00 2 Chesterfield Inn (funeral lunch) 39.25 3 Pealer's Flowers 366.60 4 Comfort Inn (room for memorial service) 724.19 5 Pastor Martin Romainc (fee for memorial service) 200:00 B. ADMINISTRATIVE COSTS: ~. Personal Representative's Commissions Name of Personal Representative(s) Donald R. Howe Penny Archer 71,000.00 Street Address 2425 Rolling Hills Drive Ciry Mechanicsburg state PA Zip 17055 Year(s) Commission paid 2012 z. Attorneys Fees Samuel L. Andes 35,500.00 3. Family Exemption: (If decedenYS address is not the same as claimants, attach explanation) Claimant Streei Address Ciry State Zip Relationship of Claimant to Decedent a. Probate Fees Register of Wills 1,818.50 s. Accountants Fees Michael Cox, CPA (to review Accounts) 1,000.00 6. Tax Return Preparers Fees Michael CoX, CPA 4,600.00 7. Other Administrative Costs 1 Mumma Jewelry (appraisal) 1~•~ TOTAL (Also enter on Ilne 9, Recapltulatlon) 148,186.74 Sdie~kie H Rneral Ei & COMMONWEALTH OF PENNSYLVANIA ~^~~~yy ~r INHERITANCE TAX RETURN y\A1.1 V1J11161W1A RESIDEM DECEDEM FILE NUMBER ESTATE OF Dick, Mary Sue 21 - 11 _01048 2 US Postal Service (mailing of annuity claim form) 7.12 3 U.S. Treasury (2011 Fiduciary income tax) 264.00 4 Pa. Department of Revenue (2011 personal income tax) 264.00 5 Pa. Department of Revenue (2011 personal income tax on Credit Shelter Trust 338.00 6 Pa. Department of Revenue (2011 fiduciary tax return) 310.00 7 Commissions and liquidation costs of trust assets paid to Morgan Stanley Smith 14,988.93 Barney 8 Commissions and liquidation costs of estate assets paid to Morgan Stanley Smith 14,126.15 Barney Page 2 of Schedule H Schedule H, Part Bi, Personal Representative Commissions Dick, Mary Sue SS# 345-10-3170 9/26/2011 '~ Name Donald R. Howe sac seas 181-32-7460 Address 2425 Rolling Hills Drive Year Pam 2012 city, state, zIp Mechanicsburg PA 17055 Amt Pald 38,000.00 2 Name Penny Archer sac sec a address: 403 Maplewood Drive Year Pald 2012 city, state, zlp Franklin TN 37064 Amt Pald 33,000.00 3 Name Soc Sec S Address Year Pald City, State, Zip Amt Pald 4 Name Soe Sec # Address: Year Pald City, State, Zip Amt Pald 5 Name Soc Sec # Address: Year Peld Clty, State, Zlp Amt Paid 6 Name Soc See li Address: Year Pald City, State, Zip Amt Pald 7 Name Soe Sac ~ Address: Year Paid City, State, Zip Amt Pald SCHEDULEI DEBTS OF DECEDENT, MORTGAGE cw.xaNxexiH OR REHHSrtvnr~u LIABILITIES & LIENS ~ N HEiiRPNCE iNtflETURN flESOBR O~EDENT FILE NUMBER ESTATE OF Dick, Mary Sue 21 - 11 - 01048 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 Samuel L. Andes (professional services related to power of attorney) 250.00 2 Pinnacle Health (emergency room fee) 28.73 3 Donald R. Howe (payment for power of attorney services) 200.00 4 Capital Self-Storage 69.96 5 Azizkhan Internal Medicine 17.90 6 Mobile X-Ray Imaging 41.94 7 Social Security Administration (recovery of overpayment) 1,397.00 8 Continuing Care Pharmacy (medicine) 6.70 TOTAL (Also enter on Llne 10, Recapltulatlon) ~ 2,012.23 REV-1513 FXa (11-09) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDEM DECEDEM SCHEDULE) BENEFICIARIES ESTATE OF FILE NUMBER Dick, Mary Sue 21 - 11 - 01048 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) RECEIVING PROPERTY oo Na un Trustee(s) I, TAXABLE DISTRIBUTIONS[include ouVight spousal distribubons and transfers under Sac. X116 (a) (1.2)] 1 Linda Griesemer P.O. Box 202 Allendale, IL 62410 2 Brenda Weiler RR #2, Box 32 Lawrenceville, IL 62439 3 Marie Smith RR 1, Box 338 Bridgeport, IL 62417 Niece Niece Niece 9% 9% 4% Enter dollar amounts for distributions shown above on lines 75 through 18 on Rev 1500 cover sheet, as appropriate. II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR W HICH AN ELECTION TO TAXIS NOT TAKEN CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 73 OF REV-1500 COVER SHEETI 0.00 REV-1513 E%~ (800) SCHEDULE) COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES continued INHERITANCE TA% RETURN RESIDEM DECEDEM ESTATE OF FILE NUMBER Dick, Mary Sue 21-11-01048 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) (w>w>$) RECEIVING PROPERTY oo Na ust Tr°etee(e) I~ TAXABLE DISTRIBUTIONS[include outright spousal distributions, and ransfers under Sec. 9116 (a) (1.2)] 4 Penny Archer Niece 14% 403 Maplewood Drive Franklin, TN 37064 5 Elizabeth Archer-Myers Niece 2% 6 Soden Court Yardville, NJ 08620 6 Jeffrey Archer Nephew 2% 1639 Belvedere Blvd. Silver Spring, MD 20902 7 Mildred Howard Sister-in-Law 10% 185 Pinehave Shore Rd Apt 209 Shelburn, VT 05482 8 LawrenceHoward Nephew 4% 2453 S. Brownell Williston, VT 05495 9 Willa Kravitz Niece 4% 666 W. Germantown Pike Plymouth Meeting, PA 19462 10 Dana Freeman Niece 1% 166 Sutton Farm Road Williston, VT 05495 11 Venessa Howard Violette Niece 1 107 Gold Book Circle Stowe, VT 05672 12 Lois Rich Niece 4% 3 Riverview Terrace Irvington, NY 10533 13 Barbara Egerman Niece 4% 52 Round Lake Road Richfield, CT 06877 Page 2 of Schedule J REV-1513 E%t (400) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES continued INHERITANCE TAX RETURN RESIDENT DECEOEM ESTATE OF Dick Mary Sue FILE NUMBER , 21 - 11 - 01048 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) RECEIVING PROPERTY Do N°I Uat Truslee(a) I~ TAXABLE DISTRIBUTIONS[include ouhight spousal i i d tr f ers ons, an ans distr but under Sec. 9118 (a) (1.2)] 14 Madeleine Nicklin Niece 2% 501 Rio Grande Ave C-3 Santa Fe, NM 987501 15 Jane Piepes Niece 2% 227 Pebble Beach Drive Goleta, CA 93117 16 David Kravitz Nephew 1 895 Dogwood Drive Delray Beach, FL 33483 17 Heather Doyle Niece 1% 3509 Aristedes Drive Modesto, CA 95355 18 Michael Howe Nephew 2% 2256 Ritner Highway Shippensburg, PA 17257 19 Laurie Howe Thompson Niece 2% 5502 S. Hyde Park Blvd. Unit 3 Chicago, IL 60637 20 Donald R. Howe Nephew 14% 2425 Rolling Hills Drive Mechanicsburg, PA 17055 21 Anita J. Winkles (child of decedent's 1% P.O. Box 80 niece, Marilyn Kocher, St. Francisville, IL 62460 deceased) 22 Michele Siverly (child of decedent's 1 6 Valley View Road niece, Marilyn Kocher, Corydon, IN 47112 deceased) 23 Ivan Kocher (child of decedent's 1 P.O. Box 39 niece, Marilyn Kocher, St. Francisville, IL 62460 deceased) Page 3 of Schedule J REV-isa Ex+tsm) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TA%RETLRN RESIDEN/ DECEDEPR SCHEDULE) BENEFICIARIES continued ESTATE OF Dick, Mary Sue FILE NUMBER 21 - 11 - 01048 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT D° Not Llst Trusme(s) SHARE OF ESTATE (Words) AMOUNT OF ESTATE ($$$) I~ TAXABLE DISTRIBUTIONS[include outright spousal d t f disVibuhons, an rans ers under Sec. 9116 (a) (1.2)] 24 James Kocher (child of decedent's 1% P.O. Box 753 niece, Marilyn Kocher, Mt. Carmel, IL 62863 deceased) 25 Gizella Dick Niece 4% 183 Rainbow Drive, Box 8388 Livingston, TX 77399 Page 4 of Schedule J