HomeMy WebLinkAbout07-10-121505613143
REV-1500 Ex (01-10> ~ OFFICIAL USE ONLY
PA Department of Revenue pennsylvania County Code Year File Number
Bureau of Individual Taxes DEFnRTMENT OF REVENUE
Po Box.2aosol INHERITANCE TAX RETURN 21 12 0377
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
02 17 2012 06 27 1993
Decedent's Last Name
POLITZER-HARDY
Suffix Decedent's First Name
MICHAEL
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
1. Original Return ~ 2. Supplemental Return
~, 4. Limited Estate C qa. Future Interest Compromise
(date of death after 12-12-82)
6 Decedent Died Testate ~ ~ Atta heCo a~of Trust a Living Trust
~I (Attach Copy of Will) py )
9. Litigation Proceeds Received ~ 10 between i2 3~~J~anditlldatgesof deatn
MI
D
MI
i~ 3_ Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Retum Required
~ 8. Total Number of Safe Deposit Boxes
iu 11. Election to tax under Sec. 9113(A)
(Attach Sch. O}
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
BRADLEY L GRIFFIE 717 243 5551
First line of address
200 NORTH HANOVER STREE
Second line of address
City or Post Office
CARLISLE
State 21P Code
PA 17013
Correspondent's a-mail address: bgriffie@griffielaw.com
REGISTER OF V~Lt~LS USE ON[C17
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Under penalties of perjury, I declare that.l 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 representatwe is based on all informa h preparer has any knowledge.
SIGNATURE OF P SON RESPONSIBLE FOR FILING RETURN DATE
~~~~~~ Geneva Politzer ''• h -1.:,L
42 Kenwood Avenue. Carlisle. PA 17013
SJJ:M7PrDRE REP OTHER THAN REPRESENTATIVE DATE
• Bradley L Griffie ~/ - ~-
R S ,~>°'
rth Hanover Street, Carlisle, PA
Side 1
1505610143 1505610143
1505610243
REV-1500 EX
Decedent's Social Security Number
oecedenesNeme pOlltzer-Hardy, Michael D.
RECAPITULATION
1. Real Estate (Schedule A) ...................................................................................... . 1.
2. Stocks and Bonds (Schedule B) ........................................................................... .. 2. 4 , 980.63
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. 19 , 757.15
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 7 64.8 6
7. Inter-Vivos Transfers & Miscellaneous lynq Probate Property
(Schedule G) ~ J Separate Billing Requested............ 7.
8. Total Gross Assets (total Lines 1-7) .................................................................... . g. 25 , 502.64
9. Funeral Expenses & Administrative Costs (Schedule H) ...................................... . 9. 11 , 0 99.7 6
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................. . 10. 1 , 4 7 0 . 7 5
11. Total Deductions (total Lines 9 & 10) .................................................................. . 11. 12 , 5 7 0.51
12. Net Value of Estate (Line 8 minus Line 11) ......................................................... . 12, 12 , 932.13
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. 12 , 932.13
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate. or
transfers under Sec. 9116
0
00
15
0
00
.
(a)(1.2) x .o0 . .
16. Amount of Line 14 taxable
12
932.13
1s
581
95
,
at lineal rate X .045 . .
17. Amount of Line 14 taxable
at sibling rate X .12 0.00 17. 0.00
18. Amount of Line 14 taxable
at collateral rate X .15 0.00 18. 0.00
19. Tax Due ................................................................................................................. . 19. 581.95
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. a
Side 2
1505610243 1505610243 J
REV-1500 EX Page 3
Der_Pdent's Complete Address:
File Number 21-12-0377
DECEDENT'S NAME
Politzer-Hardy, Michael D.
STREET ADDRESS
42 Kenwood Avenue
CITY ~ STATE ZIP
Carlisle PA 17013
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19) (1)
2. Credits/Payments
A. Prior Payments 1,200.00
B. Discount 60.00
Total Credits (A + B) (2)
3. Interest (3)
4, 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)
Make Check Payable to: REGISTER OF WILLS, AGENT.
581.95
1,260.00
678.05
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 :............................................................................. ~ xx
b. retain the right to designate who shaA use the property transferred or its income :.................................. Lx i
c. retain a reversionary interest; or ............................................................................................................... iJ
d. receive the promise for life of either payments, benefits or care? ............................................................ ~~ lu
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?....... ~ Lx
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................................................................................. -' ' x I
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 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 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)]. A
siblino is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
Rev-1503 EX+16-98}
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Politzer-Hardy, Michael D. 21-12-0377 _
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER CUSIP
NUMBER
DESCRIPTION
UNIT VALUE VALUE AT DATE
OF DEATH
1 Oppenheimer Funds - 4,980.63
Account No. 005005001208394
83.316 shares at $59.78 per share
(See attached statement)
TOTAL (Also enter on Line 2, Recapitulation) 4,980.63
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98)
Rev-1508 EX+ (6-98)
SCHEDULE E
CASH, BANK DEPOSITS, 8t MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Politzer-Hardy, Michael D. 21-12-0377 _
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointlyowned with the right of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 F&M Trust -Account #15712800 19,757.15
(See attached statement)
TOTAL (Also enter on Line 5, Recapitulation) I 19,757.15
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
Rev-1509 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANYA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF ~ILE NUMBER
Politzer-Hardy, Michael D. 21-12-0377 _
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
A. Geneva B. Politzer
B.
C.
ADDRESS
42 Kenwood Avenue
Carlisle, PA 17013
RELATIONSHIP TO DECEDENT
Mother
ICIINTI V f1WNFr1 PR(~PFRTY~
ITEM
NUMBER
LETTER
FOR JOINT
TENANT
DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT
NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR
JOINTLY-HELD REAL ESTATE.
DATE OF DEATH
VALUE OF ASSE °!° OF
DECD'S
INTEREST DATE OF DEATH
DECEDENT'S NTERESI"
1 A F&M Trust -Checking Account No. 3401383 1,529.71 50.000°/a 764.86
(See attached statement)
(Decedent's name was added to this account
of Geneva-Politzer on June 16, 2011)
TOTAL (Also enter on Line 6, Recapitulation) f 764.86
(If more space is needed, additional pages of the same size)
Copyright {c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98)
REV-1151 EX+ (10.06)
COM INHERITAN~E~ ~ R~TURN ANIA
RESIDEN DECED NT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Politzer-Hardy, Michael D. _ 21-12-0377 ___
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
N _
A, FUNERAL EXPENSES:
Hoffman-Roth Funeral Home
2,024.72
B.
1. ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Geneva Politzer
Street Address 42 Kenwood Avenue
city Carlisle state PA zio 17013
Year/sl Commission paid 2012 1,500.00
2. Attorney's Fees Griffie 8~ Associates, P.C. 3,000.00
3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3,500.00
Claimant Geneva Politzer
Street Address 42 Kenwood Avenue
city Carlisle state PA zio 17013
Relationship of Claimant to Decedent Mother
4. Probate Fees 265.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 809.54
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 11,099.76
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Politzer-Hardy, Michael D. 21-12-0377
ITEM
NUMBER DESCRIPTION AMOUNT
Other Administrative Costs
1 Vital Records (additional Death Certificates) 45.00
2 The Sentinel (Estate advertising) 189.54
3 Cumberland Law Journal (Estate Advertising) 75.00
4 Reserves 500.00
H-B7 809.54
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
Rev-1512 EX+ (12-08)
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMON WEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF (FILE NUMBER
Politzer-Hardy, Michael D. f 21-12-0377
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
(If more space is needed, additional pages of the same size)
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08)
REV-1513 EX+ ~ t 1-08}
SCHEDULE J
COM IN~ ERITANCE~ ~ REN UYRN ANIA BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
Politzer-Hard ,Michael D. ~ 21-12-03 77
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
Politzer, Geneva Mother One hundred 12,932.13
42 Kenwood Avenue percent of net
Carlisle, PA 17013 distributable
estate
Total 12,932.13
Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 15 00 cover sheet, as a r o riate.
NON-TAXABLE DISTRIBUTIONS:
II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART ll -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEETI
Copyright (c) 2009 form software only The Lackner Group, {nc. Form PA-1500 Schedule J (Rev. 11-08)
April 18, 2012
I~~~lll~~~lll~~~~~~ll~~ll~i~~l~l
GRIFFIE & ASSOCIATES PC
BRADLEY L GRIFFIE
200 NORTH HANOVER STREET
CARLISLE PA 17013
OppenheimerFunds~
OppenheimerFunds Services
A Division of OppenheimerFunds,Inc.
P.O. Box 5270
Denver, CO 80217-5270
www.oppenheimerfunds.com
Re: 005005001208394 Oppenheimer Discover}~ Fund - Class A Shares
ANN MARIE RIPLEY CUST
FBO MICHAEL D POLITZER-HARDY
UNIT GIFT MIN ACT VT
Dear Mr. Ciriffie:
We recently received your request for information regarding Michael D. Politzer-Hardy's
Uniform Gift to Minors Act account. We were very sorry to hear that he passed away. Please
extend our condolences to his family.
The date-of-death account value was requested in your correspondence. As of February 17,
2012, the total dollar value of account number 005005001208394 was $4,980.53, based on
83.316 shares and a share price of $59.78 per share at Net Asset Value. The above-referenced
account was established on December 28, 1993, and we were not able to locate any other
accounts listed under Michael's Socia] Security Number.
You also mentioned in your correspondence that you would like to know any interest which may
have accrued for his account. Oppenheimer Discovery Fund, Class A shares does not pay
interest. We can also confirm that there were no redemptions from Michael's account in the 12
months prior to his passing. VJe hope you find this information helpful.
If you have any questions or need additional assistance, please email us via the "Contact Us"
section of our website, www.oppenheimerfunds.com, or call us at 1-800-CALL-OPP (225-5677).
We are available Monday through Friday from 8:00 a.m. to 8:00 p.m. Eastern Time. We will be
glad to assist you.
Sincerely,
Emily Ross
OppenheimerFunds, Inc.
The Right GT'ay to Invest
IDOC# 205595018
vuww.f~utrustoufto~.com
April 30, 2012
Bradley L. Griffie, Esquire
200 North Hanover Street
Carlisle, PA 17013
RE: Estate of Michael D. Politzer-Hardy (Deceased)
SSN#: 188-74-0086
Date of Death: February 17th, 2012
Dear Mr. Griffie,
-TRUST
I have enclosed a statement package from July 12, 2005, the day the
account was opened, through date of death, February 17th, 2012. The statement
provides the legal name for the Trust, account number, date of death balance,
any interest accrued over the time the account has been open, and all other
information requested in your letter. There is a final fee that does need taken
from the current market value, that fee totals $878.25. if you need additions
information or have any questions or concerns, please fees free to contact John
McGowan at (717) 441-2097.
Sincerely,
~/~
Brittany Ritchey
Investment & Trust Services
Support Specialist II
Enclosure
717-264-6116 888-264-6116 P.O. Box 6010 Chambersburg, PA 17201-6010
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April 18, 20'12
Grille & Associates
Attorneys and Counselors at Law
200 North Hanover St
Carlisle, PA 17013
RE: Michael D. Politzer-Hardy
To Whom It May Concern:
In reference to the above customer, our records show the enclosed information to be
accurate as of the date of decedents death. If I may be of any further assistance, please
contact me.
Sincerely,
Brenda Hahn
Deposit Operations Clerk
717-261-3668
717-264-6116 :888-264-6116 P.O. Box 6010 Chambersburg, PA 17201-6010
FINA-N.CIAL SO.L,U`710NS... FROM P,,EO~PLE Y.OU KNOW;
June 26, 2012
Griffie & Associates
Attorneys and Counselors at Law
200 North Hanover St
Carlisle, PA 17013
RE: Michael D. Politzer-Hardy
To Bradley L. Griffie:
Per our conversation on June 25, 2012 the information F&M Trust has regarding Michael
Po{itzer-Hardy is as follows: Account 3401383 was opened December 18, 2001 as an
individual account with Geneva B. Politzer as account owner. On June 17, 2011 a
revised signature card was completed adding Michael D. Politzer-Hardy as joint with no
survivorship.
Sincerely,
Brenda Hahn
Deposit Operations Clerk
717-261-3668
. 717-264-6116. X888-264-61:16 P.O. Box 6010 Chambersburg, PA 1720.1-6010