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HomeMy WebLinkAbout08-02-12~~~- 1505610105 REV-1500 EX (oz-ii) (FI) PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes °E""'"`"`°`"`~`"°` County Code Year File Number INHERITANCE TAX RETURN PO BOX 280601 Harrisburg, PA i~i28-0601 RESIDENT DECEDENT 2 ~ ~ L C ~' / `~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY __ ' 05/08/2012 01/15/1920 __ Decedent's Last Name Suffix Decedent's First Name MI :Holland Edna M (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 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 O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) OD 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 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 Lisa Marie Coyne, Esq. (717) 737-046 ,.,,, <. REGISTER ~ LS USE t '_r,7 ,~ t~ -~ i^-- rrt . , _ ., r x I C :+ ;; 7 G ~ First Line of Address ~,~ ~'~ I _ ~, ' - J > Coyne & Coyne, P.C. __ _. ~c > ,-. fu f T . +, `"~ ~,` .; `,,, - ~l . ;7 Second Line of Address tu~ _E:' .._. 'r'7 _.. '- 3901 Market Street ~ `~ -= - ~ .c- DATE FILED ~ j '~ City or Post Office State ZIP Code __ Camp Hill PA ' 17011 Correspondent's a-mail address: 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. `IGNATURE F PERSON RESPON E FOR FILING R N D TE JC $ .~ ADDRESS Mary O'Donn II 3E Round Ridge Road, Mechanicsburg, PA 17055 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 J 1505610205 REV-1500 EX (FI) Decedent's Social Security Number Decedent's Name: Edna M. Holland RECAPITULATION 1. Real Estate (Schedule A) ........................................... .. L 0.00 2. Stocks and Bonds (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 Personal Property (Schedule E)..... .. 5. ' 21,468.69 ! 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. 0.00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested...... .. 7. 0.00 8. Total Gross Assets (total Lines 1 through 7) ........................... .. 8. ' 21,468.69 9. Funeral Expenses and Administrative Costs (Schedule H) ................. .. 9. 18,420.84 '', 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............. .. 10. ' 134.00 11. Total Deductions (total Lines 9 and 10) ............................... .. 11. 18,554.84 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. __ _ 2,913.85 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ...................... .. 13. I 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. 2,913.85 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 __ 16. Amount of Line 14 taxable _ at lineal rate x .0 45 2,913.85: is. 131.12 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. 131.12 : 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: File Number ? ~ 12 " ~1 ~' ~ ~{ DECEDENT'S NAME Edna M. Holland STREET ADDRESS 3E Round Ridge Road clTV - Mechanicsburg - -------- STATE ZIP PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 131.12 2. CreditslPayments A. Prior Payments __.. _.. _ _____._._ B. Discount 6.56 Total Credits (A+ g) (2) 6.56 3. Interest (3) 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. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 124.56 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 "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 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 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 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(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)]. Asibling 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-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Edna M. Holland 21-12-0614 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointlyowned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) r,~ ~~ ~~. ~ ~iti~erts dank t ti" ::; ~~ ~~~ ~~, ~~~~ ~ F ~' `~,~ :. Account Number 6100245403 Account Title Edna Mae Holland Date ened 2/1/1975 Account T e Principal Balance as of DOD Checking $4,527.50 Interest from Last Posting to DOD $ .00 Account Balance as of DOD $4,527.50 YTD Interest to DOD $ .00 ,~ ~, 1~~.~_ ~: _ _. 7~fr'~~~!'r~^*_wt~wad~e~~u~r~arw w~ww~aro,;„,a,~, , , „~r~m ~ ,..; ., p,mm~,. r.,tiN;.~.~, .,-.~:.,a.. _...,~ y~~ Account Number Account Title 6140012031 Date ened Edna. Mae Holland Account T e 8/31/2000 Princi al' Balance as of DOD Savin s Interest from Last Posting to DOD $6,223.92 Account Balance as of DOD $ .06 YTD Interest to DOD $6,223.98 $1.03 ~~ ~, :. ~ ._ _ .. .w ~,LL., t i ~~ + .~ G~~ °. f ~~ ~ Account Number 6243906669 Account Title Edna Mae Holland Date ened 5/17/2004 Account T e Time De osits Principal Balance as of DOD $10,208.57 Interest from Last Postin to DOD $8.64 Account Balance as of DOD $10,217.21 1'TD Interest to DOD $42.11 ~, REV-1511 EX+ (12-99) SCHEDULE M COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Edna M. Holland 21-12-0614 Debts of decedent must be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~' Berkebile Funeral Home, Bedford, PA 9,042.34 2. Reception 500.00 s. Honorarium 200.00 4. Flowers 175.00 5. Bedford County Memorial Park 1,100.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Sheet Address City .State Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Mary O'Donnell street Address 3E Round Ridge Road, Unit E. Zip 2,500.00 3,500.00 city Mechanicsburg State PA .Zip 17055 Relationship of Claimant to Decedent Daughter 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Cumberland Law Journal -legal advertisement s. Patriot News -legal advertisement s. Postage 10. Reserves 11. Filing Fee for Inheritance Tax Return 75.50 500.00 75.00 150.00 88.00 500.00 15.00 TOTAL (Also enter on line 9, Recapitulation) $ 18,420.84 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-08) x ~~~ ` Pennsylvania SCHEDULE I OEPARTM ENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT --- ESTATE OF FIDE NUMBER EDNA M. HOLLAND 21-12-0614 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, insert additional sheets of the same size. REV-1513 EX+ (11-08) ' ~~ ~h~`=' Pennsylvania SCHEDULE ~ DEPARTMENT Of REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Edna M. Holland 21-1?-OFi14 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).) 1. Mary O'Donnell daughter 1/8 of residual 2. Ronald Holland son 1/8 of residual 3. Damian Albano grandson 1 /8 of residual 4. Christopher Albano grandson 1/8 of residual 5. Rhonda Holland granddaughter 1/8 of residual 6. Sheila Fink granddaughter 1/8 of residual 7. Michael Douglass grandson 1/8 of residual 8. Diane Person .granddaughter 1/8 of residual ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, A S 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. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 1r more space is needed, insert additional sheets of the same size. LAST WILL AND TE:STAIKENT Off' ED'NA M. HOLLAND a I, EDNA M. HOLLAND of 1010 12th Street, Apt. 618, Altoona, Pennsylvania 16601, being of s.oun.d and disposing mind; memory and under- r standing, do hereby make,. publish and declare this to be my Last Will and Testament, hereby revoking and making void all former Wills, Testaments and C~dicils~by me at any time heretofore made and as to such estate as shall have at the time of my death, whether it be real, .personal and/or . mixed, of whatsoever nature and ch.aractez and wheresoever situate including that over which may have the power of disposition, I direct that the same shall be disposed of as follows: ,' FLR.ST. I declare that I am the widow of EDWARD H. HOLLAND and that I have tw© children, to wit: MARY L. O`DONNELL and RONALD M. HOLLAND. I have one child who predeceased me, to wit:. NANCY DOUGLAS. SECOND. All federal, state and other death taxes (in.cluding-any interest and penalties th.ereo.n} payable:on the"property forming my gross estate for those purposes which may be payable by reason of my death with = ~ respect to property passing under this will, shall be paid out of the principal of m~ probate estate ju-st as if they were my debts , anal none of those taxes shall be•charg.ed• against any beneficiary. This provision shall not apply.,to any property over which have 'a general power of appointment fox federal estate tax purposes nor shall it apply to any generation skipping taxes. ~, ~'. Vii. %~/. l THIRD . ~~ 7 I direct that all my just debts,-funeral eXpenses and expenses ". _i~ cannection with the administration of m~ estate be paid ,as so~in as pr:act-cable after m~ death.~~ ~k F~UR~~3. ~ All the rest, .rte.~.idue, --and remainder of m~ estate afores.a.id., I d~ hereby give, devise :.and, :.be-qu.e~ath unto MARS' L. 0' DpNNELL., RbNALZ3 Ni. HO~LAi~D, DANiI~T?l .AI.~.H~Ia7,0,~- ,CH~t3,STOPHFR ,AI,BANO, RH.ONDA HOLLAND, SHEILA FIL7I~, M~ZO~Zr- DOII`GLAS and DANE- ~H~S~ON~, im ~e.qual shares, share and share alike. FIFTH. In the event that..a;n~ .of the aforesaid MARY. L. D'DONN~ZL,,. BDNALD M. HOLLAND, DAMII~N ALBANO, CHRISTOPHER ALB~ANO, .RHDNDA fi,O~L~ND, SHEILA FIN.F~, MIC.~iAEL DOUGLAS and/or DIANE ~ERSD~7 .shou.ld pr.edece;ase .mom,, _ then are<d in such event , the-. share which he or she would have., tak:;en here under s~.a11. pass.. unto. his or ,her issue: per stirpes _; ... ~ ... S.T~TH-. In .the event that.RHONDA HOLLAND should predecease me without issue, then an,d in such event, the share xahich she. would .have taken ~i.ere- under ,shall pass unto SHEILA. FINK. SEVEN'T'H. In the event. that SHEILA FINK should predecease me without issue, then.anc~ in such event, the share which she would have taken here- unde shall pass unto RHDNDA HOLLAND. EIGHTH. In -the event . that. DAMiAN ALBANO should preriec2as~e me without issue, then and in such event, the share which he would have taken here- under shall pass unto CHRISTOPHER ALBANO. NINTH. In the event that CHRIS TOPHEI~ ALBANO should predecease me without issue,'then and in such event, the share which he would have i taken hereunder shall pass unto DAMIAN ALBANO. !~ ., ~- J ~ - `` TENT~i . Imo: he-event tha~~ ~I3~~AE~` D'OUGL =~ ~-- ~ -- usho~i~d r.. re-de~~a.s~ .. - .. ~~-~ :~z <.,i~ , . F me ~ without a- z's~~e th~~ and in such e"v~en-t ;" "t'~Yie ' s~a~~ w~i~ch. - ~e -wri'~ld __have- taken ~i~ere:~: under ~ sha'1:-1 pads unto DI~'~E PERSD'i~. , -; -, ~- . ~L'EV~~T~; In the .event` t~h.at DIANE PERSflN shflul~3 pred~~ce-ase ~t~ 'vaithout ssi~~, then anc3 • in~ such event., the shay-e which she would have .taken h .. under shall ere` pass -unto MICHAEL D,OU~L~S. TWELFTH. I r]o hereby name, constitute and a.; ~oint PP MAB~' L. O'DONNELL as Executrix of this my Last 'Will ar~d Testament . . In the event tha"t NI~RY L. O'DONNEI,I, should fail to qualify cease to act or predecease me, then an in such event ~ `~ I do :.hereby name, constitute and a~pc~~it ,OEg~LDIIrT~ NI:~C~ as Executrix o.f this my Last Will and Testament. I direct tha - t r~o fiduciary acting hereunder be required to enter bond or any other security i.n any jurisdiction.. IN WITNE.S~ WFiERE.O, I, EDNA M. HOLL~iND, Testatrix, have hereunto initialed th.e first two pages of this Will and t© the last a hereunto set m~ hand and seal this ~ p ~e T have ~~ i day of .,~ ~ d 20D1, ~ SE.AL ) Testatrix r 4 .. J ~ ~ ~ ,~ .. .. ,, -, ,. N.. - .. .... .... i - 1. :..... - .. .>~.... .. .. -. .. ~'- . v. - ..... .. - ., ~ -- _ . r ~ pubii`s~hecl and dec.3.ared as and for the. - Last Wi1.. tad ~':esta.~npen;t- ~b~ EDNA H. tH.OLL~I~ID, Testatrix 3-ie~ein named,F aaha signez3 'th.e swine in cur presence and we , at her request .and , in her presence and in the presence of each other, have signed the same as subscribin a . . g nd attesting wtrae~;~es . . - .~~. - 7~Di i~~o. Seconc] St . , Joni-a'ta ~it~oona P;~ 16~Oi . 7D1 No.:.Seocnd St.; Juniata, ~1t w. $., e S i~601 °i '. . R:.t t V ~4 ;.c' ~ - ., -, I, E~I>iA H. H:OLL~ND, Testatrix, whose. name is signed t.o the . att~c_~.ed or foregoing instrument, having been duly qualified accnrdirig to r iaw, do hereby ack.nowl~edge that I sign:ec3 and executed the instrument as a~ my Last Will; that I signed it willi.n 1 g y; and that I signed it as my free ~`I and voluntary act for the .purposes therein expressed. S-worn. or affirmed to, and acknowledged before me, by EDNA H_ HOLI.,~N,D, Testatrix, this ~~}~ dad of ~ ~" ~y/ ~ r 2001. _ ~ ~ ~,, sue' r----_._ . Testat i.x ~. ~ ~ -s I t ~~;_ ~-r ~~ ~:. i - ~ ~ z ~- , ., .. _ .. •~b ~ ~ ~..;~ •- ,t's''j~A; ~ ~5'~.S~i~ ~4Yd~..~# :. ~~ - ~L ~1r~.-~ w •,~~,rq~y4 - ~ x , - .... .... _ ~ _ - ~ - _ .._ ,_ < ~-s~ _ ,. We, ADEN E. GTBB~.I~TE~' and DCJ~:~1LD T. GTBBONEY, the wittles~ez whose names are sign~.d to the attached or foregoing.i.nstrument, bein. du1_• qualified. acc,o~ding to law, do depose and say that we were present and the testatrix si-. n sac g c~nc1 execv~te tie instrument as her Last Will; that shy signed willingly and that she e ~ecuted it as her free .and vol untary act for the purposes therein expressed; that each of us in the hearin an' sight of the testatrix signed the Wi11 as witnesses; anal that to t.he~bes~ of our knowled e ~ # g the testatrix was at that time .eighteen or more years of age, °f sound mind a.nr3 under n~ cpnstrant or undue influence. Sworn,an:d affirmed to and subscribed to before me by ~LLBN B. GIBBC~N~y anzl DONALD T. - GIBBONEY, witnesses, this ~_ ~ul~! - d.ay of 2401. . ~~ Witness • ' ~ t Witness- fVtELfl}C ~ ~cGA'[~'tiA~11, Not~r Public ~ ~4f~oona Burr LDbun~r f ~~~ Cc~mmissi~n ~_ac~ives Jan: ~, 2{?03 ~~ ~ac~