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HomeMy WebLinkAbout95-027121-g5 - 0271 N105.igq•v. 21p7 nor w vuwaa xwcx ^ This is to certify that the certificate hereunto attached is a true and accurate copy of the original death record on file with the Division of Vital Records, and that Frank Yeropoli, whose name is subscribed thereto, was at the time of subscribing the same and now is Director, Division of Vital Records of the Department of Health, for the Commonwealth of Pennsylvania, duly appointed and commissioned as directed by Act 66 of the General Assembly, approved 29 June 1953, P.L. 304. AUG 16 2ppl' Date ? • Fran eropoli, ' ect Division of Vital Records P.O. Box 1528 New Castle, PA 16103 coMMONwEALTFI of PENNSYLIMINIA • DEPAfiTMENT OF NEALTN • 4rcAL RECORDS u 3 6 8 7 6 ' CERTIFICATE OF DEATH bU1~~~~i-~~~ ~- REV-1500 EX± (7.94) • ~t t` ~ _ "'~ ~~ INHERITANCE TAX RETURN n RESIDENT DECEDENT COMMONWEALTH OF PENNSYLVANIA l.~ (TO BE FIL~rD IN DUPLICATE DEPARTMENT OF REVENUE DEPT. 280601 WITH REGISTER OF WILLS) HARRISBURG, PA 17128-0601 z W O W W O W Y 4 h :C W D_ V =oo V ~ m a ,~ H 2 W u,t C p Q = O :tea L~1, MATT •~~~•.,•wn~~. i~umocrt (DATE OF 518-38-4418 /24/9 APPLICABLE( SURVIVING SPOUSE'S NAME (LAST, f1R57 AND MIDDLE INITIAL( Return jJ 4. Limited Estate ~`b. Decedent Died Testate (Attach copy of Will} AND Ealamd G- Myers. F.,sq• FOR DATES OF DEATH AFTER 12/31191 CHECK HERE IF A SPOUSAL POVERTY CREDIT IS CLAIMED ^ FILE NUMBER 21 95 0271 COUNTY CODE YEAR NUMBER Messiah Ville BIRTH l0U Mt. Al lr~n j~1Vg 7/05 icsbur~PA 17055 COUnt ^ 2. Supplemental Return ^ 4a. Future Interest Compromise (for dates of death aher 12.12-82) ^ 7. Decedent Maintained a Living Trust (Attach copy of Trust) ~TIAL-TAX INFORMATION SNOUlD-B 717 1 761-4540 ^ 3. Remainder Return (for dates of death prior to 12-13-82) ^ 5. Federal Estate Tax Return Required _ 8. Total Number of Safe Deposit Boxes AILING AD R S~5 n, Du~t~ie, STewatt & Weir3ne_r rket St., P. O. Box 109 ~, PA 17043-0109 z 0 ~- a a W o: z 0 f- o. 0 x 1. Real Estate (Schedule A) (1 ) 2. Stocks and Bonds (Schedule B) (2) 142,401.04 ~ 3. Closely Held Stock/Partnership Interest (Schedule C) (3 ) 4: Mortgages and Notes Receivable (Schedule D) (4 ) 5. Cash, Bank Deposits 8 Miscellaneous Personal Property S h (5) 11, 773.OU ( c edule E) 6. Jointly Owned Property (Schedule F) (6 ) 7. Transfers (Schedule G) (Schedule L) (7) 60 951.77 8. Total Gross Assets (total Lines 1-7) i3~Q~ ~ Q 9. funeral Expenses, Administrative Costs, Miscellaneous Expenses (Schedule H) (9) __ ~`6';'e9}':~'~ 10. Debts, Mortgage liabilities, Liens (Schedule I) (10} 3,358.64 ~~ 1 1. Total Deductions (total Lines 9 8 10) 12. Net Value of Estate (Line 8 minus Line 1 1) ~ C% ~ 'J(o ~ a y 13. Charitable and Governmental Bequests (Schedule J) / 14. Net Value Subject to Tax (line 12 minus Line 13) ` C~'7 -7G ~ ©g 7 15. Spousal Transfers (for dates of death offer 6-30-94) >~ ~ ~; " '` g:` ~ i, ,\ (B)_ 2]5,125.81 -~+.~~zca v . ~oi'~ (11) (12) 185,675 77 (13) -0- (14) 185 , 675.77 ee Instrudlons for Applicable Percentage on Reverse (15) x, __ _0_ Side. (Include values from Schedule K or Schedule M.) ~ 7(p ~ a ~~/ g~ `. ~ S 16. Amount of Line 14 taxable at 6% rate (16) x .06 = (Include values from Schedule K or Schedule M.) 17. Amount of Line 14 taxable at 15% rate (17) x .15 = -0- (Include values from Schedule K or Schedule M.) ~ ~ ;_ ~ / ~, 18. Principal tax due (Add tax from Lines 15, 16 and 17.) (lg) 1-1,140.55 19. Credits Spousal Poverty Credit Prior Payments Discount Interest + 9.500_00 + 500_00 20. If Line 19 is greater than Line 18, enter the difference on Line 20. This is the OVERPAYMENT. ~^ 21. IF Line 18 is greater than Line 19, enter the difference on Lina 21. This is the TAX DUE. A. Enter the interest on the balance due on Line 21A. - 12/24/95-6/19/96 B. Enter the total of Line 21 and 21A on line 218. This is the BALANCE DUE. _ Make Cheek Payable to: Register of Wills, Agent ,: I-~„BESURET~ Under penalties of perjury, I declare that 1 have it is true, correct and complete. I declare that all based on all information of which preparer has Ii rr TURE OF SPQ~IB R FILING RETURN 51(`,N~R RE A N A E~mun~""'~ yers, sq. .sul Market St. P, O. Box 109 Lemoyne, PA 17643-0109 (t 9) 10.000 00 (20) (2 ~) 1,140.55 (2 t A) _ 50 L (2 t B) 1.190 70 tined this return, includin accompan ing schedules and statemPn g y ts, and to the best of my knowledge and belief, estate has been reported at true market value. Declaration of reparer other than the personal r res alive is nowledge. ~° yul Silver Lake Road ~~r Lewisberry, PA 17339 Lai ~Ci~7~ DATE ~- ~" Act #48 of 1994 provides for the reduction of the tax rates imposed on the net value of transfers to or for the use of the spouse. The rates as prescribed by the statute will be: • 3% (.03) will be applicable for estates of decedents dying on or after 7/1/94 and before 1/1/96 • 2% (.02) will be applicable for estates of decedents dying on or after 1/1/96 and before 1/1/97 • 1 °k (.O1) will be applicable for estates of decedents dying on or after 1 /1 /97 and before 1 /1 /98 • Spousal transfers occurring on or after 1/1/98 will be exempt from inheritance tax. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK (-~j IN THE APPROPRIATE BLOCKS. YES NO 1. Did decedent make a transfer and: 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, ............... X c. retain a reversionary interest; or ................................................................................... X d. receive the promise for life of either payments, benefits or care? ....................................... 2. If death occurred on or before December 12, 1982, did decedent within two years preceding death transfer property without receiving adequate consideration? If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................................................................................... X 3. Did decedent own an 'in trust for' bank account at his or her death? X IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOGI MUST~COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Cu3 t/) ~ ~~ L~., Q ,.? N ~+ ~. ~ __ 7 C `. ,- aT.t ~~ ~ ~ ~ vv REV-1503 EX+ (4-fib) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE B STOCKS AND BONDS LEVI, MATT (All property iointly-owned with Right of Survivorship must be disclosed on Schedule F.) ITEM NUMBER DESCRIPTION 1. 2,249 Shares - American High Incase Trust Fund @ 13.430 per share 2. 5,304 shares - VAn Eck Global Balanced Fund @ 9.220 per share 3. 5,645.521 Shares - IDS Federal Incase Fund Account No. 0012 4386 3592 7 002 @ 4.875 per share Accrued Dividend 4. 7,395.083 .shares - IDS Bond Fund Account No. 0011 2386 3592 1 002 @ 4.790 per share Accrued .Dividend FILE NUMBER 21-95-0271 VALUE AT DATE OF DEATH 30,204.07 48,902.88 27,521.91 151.55 35,422.45 198.18 TOTAL (Also enter on line 2 Recapitulation) I $ 142 ~~01 04 REKISOB Ex+12.871 SCHEDULE E ~` CASH, BANK DEPOSITS AND COMMONWEALTH OF PENNSYLVANIA MISCELLANEOUS INHERITANCE TAX RETURN PERSONAL PROPERTY Please Prin+ or Type RESIDENT DECEDENT ESTATE OF FILE NUMBER LEVI, MATT 21-95-0271 (All property jointly-owned witb the Riyht of Survivorship must be diselesed on Schedule F) ITEM DESCRIPTION VAWE AT NUMBER DATE OF DEATH 1. Cash in decedent's possession 193.00 2. PNC Bank, N.A. - Checking Account No. 5140225124 - Date of death balance, plus accrued interest 3. Harris Savings Bank - Money Market Account No. 10-05-002356 i Date of death balance, .plus accrued interest. 4. Capital Blue Cross/PA Blue Shield - premium refund 5. Midwest Hearing Industries, Inc. - Hearing Aid insurance refund 6. Brotherhood Mutual -homeowner's insurance refund - Florida property 4,852,43 6,270.27 342.30 -27.00 88.00 TOTAL (Also enter on line 5, Recapitulation) i $ 11,73 00 _ 1 (Attach additional 8'h" x N" sheers ii more space is needed.) ~ REV-1510 EX + 12-851 ' SCHEDULE G COMMONWEALTH OF PENNSYLVANIA TRANS'FERS' INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF LEVI, MATT PLEASE PRINT OR TYPE NUMBER 21-95-0271 IIS SCHEDULE MUST BE COMPLETED AND FILED 1F THE ANSWER TO ANY OF THE QUESTIONS ON THE REVERSE clnc no ruc rnveo ~.,«~ ~~ .,.. ITEM NUMBER DESCRIPTION OF PROPERTY Include name of the transferee, their relationship to decedent, date of fransfer. EXCLUSION TOTAL VALUE OF ASSET DEAD. ° INT. DOLLAR VALUE OF DECEDENT'S INTEREST 1. Life of Virginia - Single Premiu __ Deferred Annuity. Policy Number: 002503725 Owner: Matt Levi Beneficiaries: Mary Lou Raffensperger, Daughter Floyd Milton Levi, Son Date of Death value - 60,951.77 __ r TOTAL (Also enter on line 7, Recapitulation) $ 6~~ 51.77 (If more space is needed, insert additional sheets of same size.) •E`~1311 (I~ pAq 1 ~. _, SCHEDULE H ~" ~` ;;;; FUNERAL EXPENSES, COMMONWEALTH Of fENNSYlVAN1A ADMINISTRATIVE COSTS AND INHERtUNCE UX RETURN MISCELLANEOUS EXPENSES RESIaENT OEGEDENT Please Print or Type ESTATE OF FILE NUMBER LEVI, IKATT 21-95-0271 ITEM NUMBER DESCRIPTION AMOUNT A. Funeral Expenses: ~• Beaver-Urich Funeral Home, Lewisberry, PA 6,327.00 2. Gingrich Memorials -Marker Lettering 60.00 3. Amy Raffensperger, Granddaughter -Air Fare - 3/25/95 N th t Ai li - "~ or wes r nes from Indiana to Harrisburg and return. 528.00 4. Floyd M. Levi, son -air fare - 3/25/95 ~,~ from Oregon to Harrisburg, PA and return - 700:00 1 B. Administrative Costs: 1. Personal Representative Commissions Social Security Number of Personal Representative: Year Commissions paid 2. Attorney Fees -Johnson, Duffie, Stewart & Weidner 7, 000.00 3. Family Exemption Claimant Relationship Address of Gairrmant at decedent's death Street Address C'h' State Zip Code 4. Probate Fees -Register of Wills -Cumberland County 264.00 C. Miscellaneous Expenses: ~, Cumberland Law Journal -advertise letters 40.00. 2. The Patriot-News (Metro-West) advertise letters 59.08 3. Register of Wills -Short Certificates -Estate investments 12.00 4, PNC Bank -Estate check printing fee 13.00 5, Register of Wills -file inventory & Inheritance Tax Return 25.00 6. Register of Wills -Exemplified copies of Estate documents for Ancillary administration in Florida 36.50s ~' Register of Wills -Exemplified copies of Estate documents / a for Ancillary administration in South Dakota. 50 ~, 36 • Reserve for close-out costs . 125.OO~f SUB-'~D-~AI' FRCM ADDITIp~L g~T 10,865.32 TOTAL Also enter on line 9, Recapitulation) $ .-''" 1 t ~`: ~Er more space is needed, insert additional sheets of some size.) r ESTATE OF: LEVI, 1~TT 21-95-0271 C. Miscellaneous Expenses, Continued: 9. Florida Real Estate No. 6507 13th St. Brandenton, Manatee County, Florida: Ancillary Administration Expenses and expenses relating to sale of real estate: O'Conner & Associates - appraisal of Florida Property 250.00 ~J H. Greg Lee, Esquire, 2014 Fourth St., Sarasota, Florida - filing charges for filing required documents for ancillary administration & sale of real estate 430.90 H. Greg Lee, Esquire - attorney fee for ancillary administration and real 0/ estate sale. 1,185.0 Brotherhood Mutual - fire insurance coverage Florida property. 164.00 Sale expenses: C di f l i r re t to Buyer or c os ng costs per agreement 1,940.OO J. Kevin Drake, P.A. - attorney's title Ins. Fund 120.67`` ~ J. Kevin Drake, P.A. - Title insurance 403.93" Florida Form 9 40.40' ALTA Endorsement 25.00`' Documentary Stamps - Deed 461.30`` Recording 2 Powers of Attorney & 2 Death Certificates (Matt & Clara Levi, Deceased) 51.00 Overnight Mail Charges to J. Kevin Drake, P.A. 35.00`` Recording Court Order Approving Sale 6.00-"s 1995 Real Estate Taxes to Manatee County 920.45: ~:~ ` Septic & Plumbing Repairs prior to settlement 415.13 ° 10. Agricultural Land - South Dakota: Ancillary Administration Expenses and expenses relating to sale of real Estate: Appraisal Services - appraisal of South Dakota property 603.96/ County, Township & School real estate taxes - Edmunds ~,.~` County, South Dakota property. 1,447.08 Title Insurance - sale of South Dakota property 487.50 Transfer Fee - South Dakota property 128.00,x`" William K. Sauck, Jr., Esquire, Aberdeen, South Dakota attorney's fee, plus costs - ancillary administration, ~.~' Edmunds County, South Dakota. 1,750.00/' SUB-SAL , REy~1Sli fY• X1.931 ~ 1~~ COwwONwE~tTN Of -ENNS~1v~Nu 1NMERITAN(:E iAR RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS LEVI, MATT ITEM NUMBER 1. 2. 3. 4. 5. PleasR~ Print or T LE NUMBER 21-95-0271 DESCRIPTION I AMOUNT Messiah Village - Roan & Board charges for March (month of death) 2,755.69 Messiah Village Pharmacy charges - 250.81 Gateway Healthcare Corp. -decedent's account balance ( 39.13 Ripley Doom & Ca~rrpany -preparation of decedent's 1994 Federal & State incane tax returns 190.00 K.C. Life -decedent's account -pension payment received 123.01 after death. TOTAL (Also enter on line 10, Rscapitulofion) $ 3,3 .64 (If mono spore u needed, insert odditionol sMeis of some size.) REV.1517 E7l,~ (2.87) ~ a COMMONWEAITN OP PENNSYLVANIA INNERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF LEVI, MATT ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY A. Taxable Bequests: ~• Floyd M. Levi 2358 S. E. Kyle Road Prineville, Oregon 97754-9419 2. Mary Lou Raffensperger 981 Silver Lake Road Lewisberry, PA 17339 ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY B. Charitable and Governmental Bequests: 1. FILE NUMBER 21-95-0271 RELATIONSHIP AMOUNT OR SHARE OF ESTATE Son ~j,a One-half tangibles; ~`(~ One-half residue. Daughter One-half tangibles; One-half residue. AMOUNT OR SHARE OF ESTATE TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13 Recapitulations $ (If more apace is needed, insert additioeol sheets of same size) SCHEDULE J BENEFICIARIES r REV-1547 EX AFP (12-95) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX ACN 101 BUREAU OF INDIVIDUAL TAXES APPRAISEMENT, ALLOWANCE OR DISALLOWANCE DEPT. 280601 OF DEDUCTIONS AND ASSESSMENT OF TAX DATE 09-23-96 HARRISBURG, PA 17128-0601 ESTATE OF L V M FILE N0. 2 9 -02 DATE ^!~ ~Ei~TH 03`24-95 COUNTY CUMBERLAND NOTE: i'O INSURE PROPER,CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS FORM WITH YOUR TAX PAYMENT TO THE REGIST[R OF WILLS. MAKE CHECK PAYABLE TO "REGISTER OF WILLS, AGENT" REMIT PAYMENT T0: EDMUND G MYERS ESQ REGISTER OF WILLS JOHNSON ETAL CUMBERLAND CO COURT HOUSE PO BOX 109 CARLISLE, PA 17013 LEMOYNE PA 17043 Amount Remitted CUT•ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS 1 REV-1547 EX AFP (12-951 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF LEVI MATT FILE N0. 21 :95-0271 ACN 101 DATE 09-t3-96 TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN . 1. Real Estate (Schedule A) (1) .00 2. Stocks and Bonds (Schedule B) (2)_ 142,401.04 3. Closely Hsld Stock/Partnership Interest (Schedule C) (3)_ .00 4. Mortgages/Notes Recsivabl• (Schedule D) (4)~ .00 5. Lash/Bank Deposits/Misc. Personal Property (Schedule E) (5) __ 11 , 773.00 6. Jointly Owned Property (Sehadul• F) (6) .00 7. Transfers (Schedule Gl (7)_ 60.951 .77 8. Total Assets ~ (s1 215,125.81 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (g) 1 3,998.08 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 3.358.6, 11. Total Deductions (11) ~ 17.356.7 12. -Net Value of Tax Return (121 197,769.09 13. Charitable/Governmental Bequests (Sehedul• J) (131 .00 14. Net Value of Estat• Sub3eet to Tax (141 197,769.09 NOTE: If an assessment was issued previously, lines 14, 15 andior 16, 17 and 18 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: ' 15 . Amount of L ins 14 at Spousal rate (15 ) . 0 0 X . 0 0_ . 0 0 16. Amount of Lins 14 taxable at Lineal/Class A rate (16) 197,769.09 X .06. 11,866.15 17. Amount of Line 14 taxable at Collateral/Class 8 rate (171 .00 X .15. .00 18. Principal Tax Due ( lg 1 11 , 866.15 TAX CREDITS: PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST (-) AMOUNT PAID 06-2'2-95 AA047914 500.00 9 500 00 06-19-96 AA112958 82.05- , . 1,190.70 INTEREST IS CHARGED FROM 06-20-96 TO 10-01-96 TOTAL TAX CREDIT 11,108.65 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 757.50 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 19.46 TOTAL DUE 776.96 * IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN 51, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAV BE DUE RPV-1470 E% 16-881 I _ - •` INHERITANCE TAX COMMONWEAI.TN Of PENNSYLVANIA EXPLANATION BUREAU OF INDIOVIDUAL TAXES OF CHANGES DEPT. 280601 HARRISBUF'G, PA 1 7 1 2 8-060 1 DECEDENT'S NAME FILE NUMBER ~. tt T evi 41 cj 5-C` 71 ACN SCHEDULE STEM l;iZ NO. EXPLANATION OF CHANGES .. ~ ;. E--', I`~ she aze~iu,_tians claimed far ~ -~ E. x, en„e., related r.o x; r.a~~erty aut:~ir?e ~'eu3}s~~ivar3ia have i;eeo disallavied. . ~i?bt.: ~E'_C:3rL-'d Icy ,1JT'E ri~T situ'? ''utsl.;e ai "e37nsylvania are nat allacaa'ule far. ~-en:3s~~lv~~ ija =, ~ teal ,._rllc=s , the _ _ _ ; ~~rnose& a .~ecure:~ debt eacee~s the value of tt1e: ,>ro~erCT, _' ',.3,4 "t:e ~+ea'r:r_tlar; far trawl erl3enses '.~~s er.? ;-!iS<`ti , 1 C "C'~tOr i" :,t~tLe IS the U!11~ ycr80ri t'_J1t1tlEVC? 'tU Cl.;ll_": 1:1.E::~L,t ~;2~PU~a -` ~. }~ r iO;i c<.~~e- i l COn"iUnC- ,t'It~i ti; c? 3r'r'li~lStr~("]..Or3 Of' t,'f:k.. E.,~t,'itt?. TAX EXAMINER: ~~?~e;rl.es :,'ri2~(?t PAGE ~ ~ - 9S- ;,? 7/ ~.------ REV-1547 EX AFP t12-951 COI~IONNEALTH OF PEINISYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAxES NOTICE OF INHERITANCE TAX ACN 101 DEPT. zsoeol APPRAISEMENT, ALLOMANCE OR DISALLOWANCE HARRISBURG, PA 171z8-o6o1 OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE of DATE 09-23-96 DATE OF DEATH 03-24-95 ~~~~ FILE N0. - NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF CTHIS T ORM WITH YOUR RAX ND PAYMENT TO THE REGISTER OF WILLS. MAKE CHECK PAYABLE TO "REGISTER OF WILLS, AGENT" . REMIT PAYMENT TO: EDMUND G MYERS ESQ JOHNSON ETAL PO BOX 109 ' LEMOYNE PA 17043 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 • Awount R~wittod DCT•4,TM L_~wep pQRTr.r~~+ Fdo YOUR RFCORDF .~ ---- --•- S?131~~3• ~ ~2 Tie~7iTi1TnT~-:rmrn~r,.~..,..,......_.. v