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HomeMy WebLinkAbout09-06-12 J 1505610140 REV-1500 EX ~°'-'°~ PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number Po Box 2sosol INHERITANCE TAX RETURN Harrisbur , PA 17128-0601 RESIDENT DECEDENT 2 1 1 2 0 8 1 5 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 0 6 0 5 2 0 1 2 0 7 2 5 1 9 3 0 Decedent's Last Name Suffix Decedent's First Name OVER MI B E R N I C E G (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 a 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death 4. Limited Estate ~ 4a. Future Interest Compromise (date of prior to 12-13-82) ~ 5. Federal Estate Tax Return Required ^ 6. Decedent Died Testate ~ death after 12-12-82) 7. Decedent Maintained a Living Trust ~ 8 (Attach Copy of Will) (Attach Copy of Trust) . Total Number of Safe Deposit Boxes 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death b ~ 11. Election to tax under Sec 9113(A) etween 12-31-91 and 1-1-95) . (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMA Name TION SHOULD BE DIRECTED TO : Daytime Telephone Number KURT A BLAK E E S Q U I R E 7 1 7 8 4 8 3 0 7 8 REGISTER OF WILLS USE ONLY First line of address r.. c~ BLAKE & GROS S LL C rv m© m- Second line of address , ._. , 2 9 EAST PHI L ADEL P HI A ST I 1:~ or+ ~~ ~. ~~ ?~= City or Post Office . . ~ ~ State ZIP Code DATE ~ -- `n YORK P A 1 7 4 0 1 - n ~=- ~ ~ . c.s Correspondent's a-mail address: KBLAKE4 C1 COMCAST net 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 kn wledg . 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(Q alnPa4oS) algenlaoa~ sa;oN pue sa6e6~oW '4 4 £ ~ ~ (~ alnpayoS) dlysao;audad-agog ~o dlys~au~ed 'uol;e~od~o0 PIaH blasol~ •E ' ................................... (g alnPa4oS) spuog pue s~loo3S 'Z Z .. ......................................... (y alnpayoS)a;e;s3 lead ~L N0111/lnlldy0321 21~/~O ~J 3'JIN2~38 aweNs,;uapaoaa gwnN ~(;unoag le!oog s,;uapaoa0 X3 005 L-A321 ObZOT9SOSI REV-1500 EX 1505610240 Decedent's Social Security Number UecedenrsName: BERNICE G. OVER 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. 4 9 9 1 8 9 . 9 7 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 4 2 2 3 0 . 1 5 7. Inter-Vivos Transfers 8 Miscellaneous N -Probate Property (Schedule G) ~ Separate Billing Requested ....... 7. 8. Total Gross Assets (total Lines 1 through 7) ........................... 8. 5 4 1 4 2 0 • 1 2 9. Funeral Expenses and Administrative Costs (Schedule H) ............ ...... 9. 2 3 7 5 . 5 0 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ....... ...... 10. 6 8 1 8 . 5 8 11. Total Deductions (total Lines 9 and 10) ......................... ...... 11. 9 1 9 4. 0 8 12. Net Value of Estate (Line 8 minus Line 11) ...................... ...... 12. 5 3 2 2 2 6 . 0 4 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. 5 3 2 2 2 6 . 0 4 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 _ 0 0 0 15. 16. Amount of Line 14 taxable at lineal rate X .045 5 3 3 2 2 6. 0 4 1 s. 17. Amount of Line 14 taxable at sibling rate X .12 0 0 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 0. 0 0 1 g_ 19. TAX DUE .................. ............................. ..... .. 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 1505610240 Side 2 0. 0 0 2 3 9 9 5. 1 7 0. 0 0 0. 0 0 2 3 9 9 5. 1 7 1505610240 • •~ - ~ wv ~n rage J Decedent's Complete Address: BERNICE G. OVER STREET ADDRESS 325 Wesley Drive apt. 218 CITY Upper Allen Twp Tax Payments and Credits: ~ • Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments B. Discount 1 199.76 3. Interest File Number 21 12 0815 STATE PA Total Credits (A + B ) ZIP 17055 (1) 23 995.17 (2) 1 199.76 4. If Line 2 is greater than line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (3) Fill in oval on Page 2, Line 20 to request a refund. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 22 795.41 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; ....................... . .............................................. o° a b. retain the right to designate who shall use the property transferred or its income; ............................... c. retain a reversionary interest; or ................................................................................................ ^ 0 d. receive the promise for life of either payments, benefits or care? ................................ 2. If death occurred after December 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~Jeath bank account or security at his or her death? ......... ^ Q 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? .................................................................................................. ^ 0 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(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)]. 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 + (g_gg~ SCHED~ILE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER BERNICE G, OVER 21 12 0815 Indude the proceeds of litgation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Bethany Village Refund 797.50 2. IAmeriprise Achiever Circle Portfolio I 472,075.41 3. I Western National I 26,317.06 TOTAL (Also enter on line 5, Recapitulation) 13 499 189 97 (If mare space rs needed, insert addltronal sheets of the same size) fccv iwa tA+ (Vl-7 U) , pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY t51 A I t UF: RERNICE G. OVER FILE NUMBER: 21 12 0815 flan asset was made jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVNING JOINT TENANT(S) NAME(S) ADDRESS RELATIC A. David Farley 95 Steffie Drive Mt. Wotf, PA 17347 Son e. C. TO DECEDENT JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S D VALUE o 4TH NUMBER TENANT JOINT IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A: 4/2010 BB&T Checking Account 84,460.30 50. 42,230.15 TOTAL (Also enter on Line 6, Recapitulation) S If more space Is needed, use add~6onal sheets of paper of the same size. 5 rccv 10T1 t1C+tiD-DS) .pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT CCTATC nr SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ERi'~IiCC G. Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION A• FUNERAL EXPENSES: 1. B. 1 2. 3. 4. 5. 6. 7. ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address Cdy State ZIP Year(s) Commission Paid: Attorney Fees: Blake & Gross, LLC Family Exemption: (If decedenCs address is not the same as daimanCs, attach explanation.) Claimant Street Address Cdy State ZIP Relationship of Claimant to Decedent Probate Fees; Cumberland County Accountant Fees: Tax Return Preparer Fees: Legal advertising AMOUNT 1, 500.00 525.50 350.00 TOTAL (Also enter on Line 9 Recapitulation) 13 If more space ~s needed, use addrtwnal sheets of paper of the same size. FILE NUMBER 21 12 0815 2,375.50 REV-1512 EX+ (12-08) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF _ FILE NUMBER BERNICE G. OVER 21 12.0815 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 NUMBER DESCRIPTION OF DEATH 1. Albright Pharmacy Serices 3,206.40 2. Continuing Care 152.63 3. Alphia Diagnostics 140.00 4. Hospital 5. UHC Medicate RX 6. Home Instead 7. Estimated 2012 federal, state and local income tax obligations TOTAL (Also enter on Line 10, Recapitulation) I S If more space is needed, insert additional sheets of the same size. 1,100.00 36.60 682.95 1, 500.00 RCY 1c17.7 tJC+(01-10) _ - - - - - _ _ _ _ • Pennsylvania SCHEDULE J DEPART MENT OF REVENUE - INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: BERNICE G. OVER FILE NUMBER: 21 12 0815 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT AMOUNT OR SHARE j TAXABLE DISTRIBUTIONS [Indude outright spousal distributions and transfers under Do Not List Trustee(s) OF ESTATE Sec. 9116 (a) (1.2).j 1. David A. Farley Lineal 95 Steffie Drive 165,742.01 Mt. Wolf, PA 17347 2. Douglas E. Farley Lineal 1115 Manor Way 165,742.01 Kennesaw, GA 30144 3. Steven R. Farley Lineal 810 Fishing Creek Road 165,742.02 Harrisburg, PA 17112 4. Chad A. Noll Lineal 280 Abbey Drive 5,000.00 Mt. Wolf, PA 17347 5. Brian F. Noll Lineal 122 Calvary Church Road 5,000.00 Wrightsville, PA 17368 6. Alex L. Farley Lineal 1319 Girard Avenue 5,000.00 Wyomissing, PA 19610 7. Erin Farley (Oleski) Lineal 12101 North Dale Mabry, #312 5,000.00 Tampa, FI 33618 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET AS AP II. NON-TAXABLE DISTRIBUTIONS: , PROPRIATE. 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHFFr Ir more space is needed, use additional sheets of paper of the same size. t RE\/-1500 Discount, Interest and Penalty Worksheet Discount Calculation Total Amount Paid within three calendar months of the decedent's date of death: 24 017.67 Discount: 1 199.76 Interest Table Penalty: Penalty Calculation If the decedent's date of death was on or before March 31, 1993, insert the applicable amount: Total Balance Due on January 17, 1996: Continuation of REV-1500 Inheritance Tax Return Resident Decedent BERNICE G. OVER Decedent's Name 21 12 0815 Page 1 File Number Schedule J -Beneficiaries -1 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT AMOUNT OR SHARE I TAXABLE DISTRIBUTIONS pndude outr' ht spousal distributions and transfers under Sec. 91 i6 (a) (1.2).] Do Not List Trustee(s) OF ESTATE 8. Katherine J. Farley Lineal 1319 Girard Avenue 5,000.00 Wyomissing, PA 19610 ' 9. Ian R. Farley Lineal 142 Red Oak Court 5,000.00 Honeybrook, Pa 19344 10. Kiersten Faye Noll Lineal 1850 Ivy Pump Lane 1,000.00 York, PA 17408 11. Jessica Taylor Noll Lineal 1850 Ivy Pump Lane 1,000.00 York, PA 17408 12. Alyssa Morgan Noll Lineal 122 Calvary Church Road 1,000.00 Wrightsville, PA 17368 13. Leah Grace Noll Lineal 122 Calvary Church Road 1,000.00 Wrightsville, PA 17368 14. Maddison Mae Marie Farley Lineal 142 Red Oak Court 1,000.00 Honeybrook, PA 19344 15. Connor Oleski Lineal 12101 North Dale Mabry, #312 1,000.00 Tampa, FI 33618 ~ gi GROSS, L ~,~ „~~~ 'c G~.~rl . KURT A. BLAKE, ESQUIRE RONALD J. GROSS, ESQUIRE* SEAMUS D. DUBBS, ESQUIRE *AD,~rirreo rev PA d MD ATTORNEYS AND COUNSELLORS AT LAW August 30`h, 2012 Cumberland County Register of Wills 1 Courthouse Square Carlisle, PA 17013 RE: Bernice G. Over 2012-00815 To whom it may concern: OF COUNSEL: ANGELA N. DOBRINOFF-BLAKE, ESQUIRE Enclosed please find an original and two copies of the Inheritance Tax Return for the above referenced Decedent. Please time stamp one copy and return in the self addressed stamped envelope at your earliest convenience. Thank you in advance for your attention to this matter. y have any further questions or if this is not acceptable, please do not hesitate to contact me V~v T'rltly Y A. Blake, Esquire KAB/lmw cc: file Client 29 EAST PHILADELPHIA STREET YORK PENNSYLVANIA 17401 717.848.3078 FAx 717.848.2777 W W W. BLAKEANDGROSS. COM