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HomeMy WebLinkAbout08-08-12 1505610105 REV-1500 EX (oz-ii) (FI) rli OFFICIAL USE ONLY PA Department of Revenue Pennsylvania Bureau of Individual Taxes ~""~"""` Po Box z8o6oi ~ INHERITANCE TAX RETURN County Code Year a ~ ~ ~ File Number ~ (1 2 ~ ) ` ` Harrisburg, PA 1'7128-0601 R ESIDENT DECEDENT 7 ~V ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 03/27/2012 01 /22/1918 Decedent's Last Name Suffix Decedent's Fir st Name MI Berwager Stuart V (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 FILE D 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) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 4 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 Alex E. Snyder First Line of Address Barley Snyder Second Line of Address 14 Center Square City or Post Office Hanover State ZIP Code PA 17331 REGISTER OF WILLS USE ONLY n °:~ A N ~ :' ~s ~ c i G' Gl? D --t °~) z.~ r=~-t C-; ~; : Q Cif _T f i f }: -~ _ r ,~ -'--r-} -' 7 f` Correspondent's a-mail address: aSnyder@barley.COm W rv C~ O -r~ 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. SIGN U E OF ERSON SPONSI FOR FILING RETURN ATE UI .~- ADD ESS Kathleen A. Berwager, 0 Hum ve., Lemoyne, PA 17043 SIGNATURE OF PRE R E THAN REPRESENTATIVE Q DATE (~ ADDRESS Alex E. Sny er Snyder, 14 Center Square, Hanover, PA 17331 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610105 1505610105 J 1505610205 REV-1500 EX (FI) Decedent's Social Security Number Decedent's Name: RECAPITULATION 1. Real Estate (Schedule A) .......................................... ... 1. 125,251.31 2. Stocks and Bonds (Schedule B) .................................... ... 2. 7,654.63 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. 20,604.11 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. 153,510.05 9. Funeral Expenses and Administrative Costs (Schedule H) ................ ... 9. 13,722.88 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............ ... 10. 52.42 11. Total Deductions (total Lines 9 and 10) .............................. ... 11. 13,775.30 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 139,734.75 13. Charitable and Governmental BequestslSec 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. 139,734.75 --- 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 45 139,734.75 16. 6,288.06 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 1 g. 19. TAX DUE .... 19 6,288.06 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 REV-1500 EX (FI) Page 3 Decedent's Complete Address: File Number DECEDENT'S NAME Stuart V. Berwager STREET ADDRESS 1828 Willow Road CITY Camp Hill STATE PA ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest 5,200.00 260.00 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. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. Total Credits (A + B) (2) (3) (4) (5) 6,288.06 5,460.00 828.06 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. t"LFV 1.5G~' FX+ ~~-08`. Pennsylvania SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Stuart V.Berwager 2012-00434 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-awned 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. VALUE AT DATE NUMBER Of DEATH DESCRIPTION 1' 1828 Willow Road, Camp Hill, Lower Allen Township, PA -settlement date 04/19/2012; per 125,251.31 attached settlement statement TOTAL (Also enter on Line 1, Recapitulation.) $ 125,251.31 If more space is needed, insert additional sheets of the same size. A. Settlement Statement (HUD-1 J OMB Approval No. 2502-0265 1. Q FHA 2. Q RHS 3. Q Conv. Unins. 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number: 4. ~ VA 5. Q Conv. Ins. 12-01-6-22269CAP C. Note: This form is furnished to give you a statement of actual settement costs. Amounts paid to and by the settlement agents are shown Items marked "(p.o.c)" were paid outside the closln9; Ihey are shown here for inf ti l orma ona purposes and are not included in the totals. D. Name & Address of Borrower: E. Name & Address of Seller: F. Name & Address of Lender: Naomi E. Riggs Estate of Stuart V. Berwager 6918 NoAh 30th Street, Arlington, VA 22213 409 Hummel Avenue, Lemoyne, PA 17043 G. Property Location: 1828 Willow Road H. Settlement Agent: I. Settlement Date: 04/19/2012 Camp Hill PA 17011 Banisters Land Abstract Company Disbursement Date: 04!19/2012 , Lower Allen Township 3310 Markel Street, Camp Hill, PA 17011 Telephone: 717-761-6190 Fax: 717-761-0072 Place of Settlement: 3310 Market Street, Camp H81, PA 17011 TitleExpress Printed 04/17/2012 at 4:05 pm by LM r - :. . , . 100. Gross Amount Due from Borrower 400. Gross Amount Due to Seller 101. Contrail sales price 133,000.00 401. Contract sales price 133 000.00 102. Personal roe , 402. Personal ro ert 103. Settlement charges to borrower (line 1400) 2,753.13 403. 104, 404, 105. 405. Ad'ustments for Items aid b seller in advance Ad ustments for items aid b seller in advance 106. CIIyNown taxes to 406. Cityltown lazes to 107. County lazes 0 411 9/2 01 2 to 12131/2012 499.25 407. County taxes 04/19!2012 l01213172012 qgg 28 108. School Taxes 04/19/2012 to 06/30/2012 278.65 408, Scholl Taxes 04H91201210 06130/2012 278 65 109. SewerRrash 0411912012 l0 06/3072012 87.40 409. SewerlTrash 04!1912012 to 06!30!2012 . 87 40 110. 410. . 11 L 41 L i1"c. 412. - - 120• Gross Amount Due from Borrower 131;,618.43 420. Gross Amount Due to Seller 133 865.30 200, Amounts Pald b or In Behalf of Borrower , 500. Reductions In Amount Due fo Seller 2D1, Deposit or earnest money 1,000.00 501. Excess deposll (see insWctions) 202. Principal amount of new loan(s) 502. Set0ement charges to seller (line 1400) 18 213 99 203, ExisBn ba s taken sub' ct l0 , . 503, ExlsBn b s taken su 'ell to ~' 5D4. Pa oil of first mort a loan ~'' 206. 505. Pa off of second morl a e loan 506. 20T 507. 208. ~ 209. 509. Ad ustments for items un aid b seller Ad ustments for items un aid b seller 210. Cityltown taxes l0 570. Cilyltown lazes to 21 t. County taxes to 511. County taxes to 212. Scholl Taxes Ic 512. Scholl Taxes to 213. '513. 214. 514. 215. 515, 216. 51fi. 217. 517. 218. 518. 219. 519 220. Total Paid b for Borrower 1,000.00 . 520, Total Reduction Amount Due Seller (8 213 99 300. Cash at Settlement fromlto Borcower , . 600. Cash at Set0ement toNrom Seller 301. Gross amount due from borrower (line 120) 136,618.43 gp1, Gross amoun! due to seller {line 420) 133 865 30 302. Less amounts paid byHor borrower (line 220) (,000.00 , . 602. Less reductions in amount due se6er (line 520) 303. Cash X~ From ~ 70 Borrower 135,618.43 r 18,213.99 603. Cash XL~ To ~ From Seller 115 6 . .n ,m . on '/MS lam unle-re,pnnrse ru,nly vpe OMB CnnMSn+nbr. No mrt .na,. ,.: d~:....,-.,,.._ _.- •~••wvnnc , 51.31 w a. n m.r m. .~. - _ pMn w PONOn IM pNes N 1 REBP~ mW,M 4mendbn MIA y,lnn„nlb„ EurY,p Ine Previous editions are obsolete Page 1 of 3 HUD-1 inn r_•_i n w, scar w•a•n owner rase y D,J4L.DU Division ofwmmissicn Iine700 asfoUows: Paid From ' Paid From 701. $2,327.50 to ReMaxlstAdvanlage Borrower s Seller's 702. $4,215.00 to HOwARDHANNAREALESTATE 7 Funds at Settlement Funds at Settlement 03. Commission paid at settlement 225.0 0 6,317,50 800. Ifems Pa able In Connection with Loan 801. Our origination charge (Includes Origination Po1n10.000%or $0.00) $ (from GFE #1) 802. Your credit or charge (points) for the specific Interest rate chosen $ (from GFE #2) 803. Your adjusted origination charges (from GFE A) 604. Appraisal fee to (from GFE #3} 805. Credit report tp (from GFE #3) 806. Tax service to from GFE #3 807. Flood certification to from GFE #3 808. to 900. Items Re ulred b Lender to be Paid in Advance 901. Daily interest charges from from 04/19!2012 l0 05/01/2012 @ $0.00/day (from GFE #10) 902. Mortgage Ins. Premium for months to (from GFE #3) 903. komeowners insurance for months to (from GFE #11) 9~• months to from GFE #it 1000. Reserves De osited with Lender 1001. Initial deposit for your escrow aa;ounl (from GFE #9) 1002. Homeowners insurance months $ O.OOlmonlh $ 1003. Mortgage Insurance months $ O.OOlmonih $ 1004. City Property Tax months $ O.OOlmonth $ 1005. County Property Tax months $ 59251month $ 1006. School Taxes months $ 116.42hnonth $ 1007. Aggregate Adjustment $ 1100. Title Cha es 1101. Title services and lender's title insurance from GFE #4 10.00 1102. Setllemenl or Dosing fee to $ 1103. Owners title insurance -Stewart Title Guaranty Company from GFE #5 1104. Lender's title insurance - Stewart Title Guaranty Company $ 1,126.13 1105. Lenders title poUcy limit $0.00 Lender's Policy 1106. Owners title pdicy limit $133,000.00 Owner's Poky 1107. Agent's portion of the local Ulle Insurance premium $857,21 1108. Underwdters portion of the total title insurance premium $168.92 1109. Escrow Fee fo Bardslers Land Abstract Ge 25.00 1200. Government Recordin and Transfer Cha es 1201. Government recordng charges $ (from GFE tf7) 62 00 1202. Deed $62.00 Mort $ Release $ . 1203. Transfer taxes $ (from GFE #8) 1 330.00 1204. City/County taxlstamps Deed $1,330,00 Mori a e $ , 1205. Stale Taxlstamps Deed $1,330.00 Mort a e $ 1206. Deed $ Mort e 8 1,330.00 1207. $ 1300 Additional Settlement Ch . a es 1301. Required services Ihat you can shop for (from GFE #6) 1302. Pest Inspection to Home Ins I , nc $75.00 P.O.C. K' 1303. PesUHome/Radon InspeGions to Ins act a Home $395 00 P O C B' . . . . 1304. SewerlTrash 411 -6/30112 to Lower Alien Tow hi A lh i ns u or 1305. 2D12 Count /Townshi Taxes Y P to Bonnie K Miller T 108.95 . , reasurer t306. Escrow for Inheritance Taxes to Barristers Land Abstract Escrow - Hb 697 54 1307, Reimburse Tax Certification to Bardsters L d Ab t G 9,600.00 an s ract eneral - H 1308. Deed Preparation to Barie Sn der Attome s t L 1000 a aw ~7T7l71wtfa~naaaaaaa~rara. 125.0 • - - - ~ ~ r' ~ - r t 2,753.13 18,213.99 "Paid outside of closing by (B)orrower, (S)eller, (L)ender, (I)nvestor, Bro(K)er. "Credit by lender shown on page 1. "'Credit by s~ler shown on page 1. Previous editions are obsolete Page 2 of 3 HUD-1 REV-~5o3 EX++ (7-») Pennsylvania OE PARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCFIEDULE 6 STOCKS & BONDS ESTATE OF FILE NUMBER Stuart V. Berwager 2012-00434 All property jointly owned with right of survivorship must be disclosed on Schedule F. It more space is needed, insert additional sheets of the same size REV-i5o8 EX+ (u-1o) j pennsylvania DEPARTMEN3 DEPARTMENT OE REVENUE INHERITANCE l'AX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS & MISC. PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Stuart V. Berwager 2012-00434 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F_ -• • ~•~ ~r~~~ ~~ ~~__~ ~, ~~= auwuvnai sneers Dr paper or the same size. Pennsylvania DEPARTMENT"OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 2012-00434 ITEM NUMBER DESCRIPTION AMOUNT A, FUNERAL EXPENSES: 1' Panebaker Funeral Home, Inc. -funeral 9,051.62 SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF Stuart V. Berwager Decedent's debts must be reported on Schedule I. e. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City ____ State ZIP - - Year(s) Commission Paid: Z• Attorney Fees: 3• Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address __ City __ ___ _ ______ Stake ZIP Relationship of Claimant to Decedent 4• Probate Fees: 5• Accountant Fees: 6• Tax Return Preparer Fees: ~• The Sentinel -Legal Notice B. Cumberland Law Journal -Legal Notice s. Total from continuation schedule TOTAL {Also enter on Line 9, Recapitulation) $ If more space is needed, use additional sheets of paper of the same size. 4,000.00 260.00 210.78 75.00 125.48 13,722.88 Continuation of REV-1500 Inheritance Tax Return Resident Decedent STUART V. BERWAGER 2012-00434 Decedent's Name File Number Schedule H -Funeral Expenses & Administrative Costs - B1 Administrative Costs: l Pennsylvania OERAR7MENT OE REVENUE INHERITANCE TqX REi"URN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ~...~ni~. v~ FILE NUMBER Stuart V. Berwager 2012-00434 Report debts incurred by the decedent prior to death that ~Pmal~a~ ~,.,..~;a ~..u...,_._ _~ ..__.._ .. -- - ---...........,~,....,, v. u~c >anic O~GC. kFV-;.57.3 F.X+ (0. LO) Pennsylvania SCHEDULE ] DEPARTMENT OF REVENUE INHERITANCE TAX RE'URN BENEFICIARIES RESIDENT DECEDENT ESTATE OF. FILE NUMBER: Stuart V. Berwager 2012-00434 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Nat List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).j 1• Kathleen A. Berwager Daughter 100% II 1. ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 16 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: 6. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART R -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.