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Home My WebLink About09-26-12 (2)J 1505610140 REV-1500 EX (01-10) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes PO BOX 280601 IN HERITANCE TAX RETURN County Code Year File Number Harrisbur , PA 17128-0601 RESIDENT DECEDENT 2 1 1 1 1 0 3 9 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 6 5 3 8 0 8 9 0 0 7 2 2 2 0 1 1 1 2 1 5 1 9 4 5 Decedent's Last Name Suffix Decedent's First Name MI G OF O R T H L O R R A I N E A (If Applicable) Enter Surviving Spouse's Information Belo w Spouse's Last Name Suffix Spouse's First N ame 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 ^ 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 (Attach Copy of Will) ^ death after 12-12-82) 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes ^ 9. Litigation Proceeds Received ^ (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death ^ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO Name : Daytime Telephone Number STEVEN R. S N Y D E R, ESQ 7 1 7 2 1 67 0 ~ ~ ~ REGISTER LLS USELY '" , First line of address ~ _-~: r_ `~ r 1 ~--..'. N ~ "- ~--= ROMI NGE R & A SS OCI RTES c~s~~~ --~, _~ ~ _ Second line of address , ~ ~ ~; - ~ _ ;~~ 1 55 SOUTH HA NOVER STREE T ~~ r ~ ~ ~~ - City or Post Office State ZIP Code I - o DATE FILED ~~`~ CARL I S L E P A 1 7 0 1 3 Correspondent's a-mail address: Sn der rOmingerlaW.COm 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. SI~NATUR ERSO R NS E FO N N ~"'~ D TE ADDRES 73 PINE HILL ROAD ENOLA PA 17025 SIGNA~RE OF PRELiARE6YOTHE~THAN RFPR~cGnireTni~ ADDRESS v I ^ ... 2v~ 155 SOUTH HANOVER STREET CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 ~G J 1505610240 REV-1500 EX Decedent's Social Security Number Decedents Name: LORRAINE A. GOFORTH 1 6 5 3 8 0 8 9 0 RECAPITULATION 1. Real Estate (Schedule A) ................................. 1 2 0 0 0. 0 0 .......... 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. 1 2 4 3 3 4. 3 3 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ...... . 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ...... . 7. 8. Total Gross Assets (total Lines 1 through 7) .......................... . 8. 1 3 6 3 3 4 , 3 3 9. Funeral Expenses and Administrative Costs (Schedule H) ................. . 9. 6 4 8 4 . 5 0 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............ . 10. 3 7 6 4. 5 5 11. Total Deductions (total Lines 9 and 10) .............................. . 11. 1 0 2 4 9 . 0 5 12. Net Value of Estate (Line 8 minus Line 11) ............................ 12. 1 2 6 0 $ 5 . 2 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. 1 2 6 0 8 5 . 2 $ 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.o 0.0 0 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate X .045 0 0 0 16. 0. 0 0 17. Amount of Line 14 taxable at sibling rate x .12 1 2 6 0 8 5. 2 8 17. 1 5 1 3 0. 2 3 18. Amount of Line 14 taxable at collateral rate X .15 0 0 0 18. 0. 0 0 19. TAX DUE ......................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 1 5 1 3 0.2 3 Side 2 1505610240 1505610240 REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 11 1039 DECEDENT'S NAME LORRAINE A. GOFORTH STREETADDRESS 6007 MOCKINGBIRD DRIVE - - CITY STATE ZIP MECHANICSBURG PA 17050 Tax Payments and Credits: ~ ~ Tax Due (Page 2, Line 19) (1) 15,130.2. 2. Credits/Payments - _ A. Prior Payments B. Discount Total Credits (A + B) (2) O.OC 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) 0.00 5, If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE. (5) 15,130.23 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 : ...................................................................... ^ Q b, retain the right to designate who shall use the property transferred or its income; ............................... ^ Q c. retain a reversionary interest; or ................................................................................................ ^ d. receive the promise for life of either payments, benefits or care? ....................................................... ^ Q 2. 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" or payable-upon-death 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? .................................................................................................. ^ X^ 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 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, undo Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX+ (01-10) pennsylvania ~ SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: LORRAINE A. GOFORTH FILE NUMBER: 21 11 1039 __ 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-owned 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. Mobile home located at 6007 Mockingbird Drive, Mechanicsburg, PA 17050 12,000.00 proceeds from sale on August 31, 2012 TOTAL (Also enter on Line 1, Recapitulation.) $ 12,000.00 If more space is needed, use additional sheets of paper of the same size. 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 LORRAINE A. GOFORTH 21 11 1039 __ 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. ITEM _ _ _ --- - -- VALUE AT DATE ( NUMBER DESCRIPTION OF DEATH 1. -___ Pinnacle Health System, pension - --_ 1,925.7E 2/28/2012 2. Addus Healthcare, Inc., refund 132.OC 2/28/2012 3. L.B. Smith, refund 14.15 2/28/2012 4. Social Security checks 6,420.00 2/28/2012 5. U.S. Treasury, tax refund 45.00 2/28/2012 6. Interest deposit 0.01 2/29/2012 7. Interest deposit 0.16 4/1 /2012 8. Interest deposit 0.07 4/30/2012 9. Interest deposit 0.06 5/31 /2012 10. Proceeds from sale of vehicle 23,500.00 6/27/2012 11. Interest deposit 0.58 7/1 /2012 12. Members 1st ECU, account #374557 92,292.58 proceeds from closing account 9/7/2012 13. Interest deposit 3.97 7/31 /2012 TOTAL (Also enter on line 5, Recapitulation) $ 124, 334.33 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (10-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER LORRAINE A. GOFORTH _ ___21_ 11 1039 Decedent's debts must be reported on Schedule I. ITEM NUMBER A. 1. B 2 3 4, 5. 6. 7. 8. 9. 10 11 12 13 14 15 16 17 18 DESCRIPTION FUNERAL EXPENSES: ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Donald R.Liddick Street Address 73 Pine Hill Road City Enola State PA Year(s) Commission Paid: Attorney Fees: Steven R. Snyder, Esquire Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address City State Relationship of Claimant to Decedent Probate Fees: Accountant Fees: Tax Return Preparer Fees: Cumberland Law Journal, advertise Letters Village Associates, mobile home lot rent Michael Langa, T.C., real estate tax Orrstown Bank, chargeback fees Orrstown Bank, excess transaction fees Village Associates, mobile home lot rent Village Associates, water/sewer PPL PPL Village Associates, mobile home lot rent Village Associates, water/sewer PPL 3,000.OC 98.5C 75.OC 363.7._ 34.0 i 28.OC 12.OC 363.7:_ 13.7._ 23.8:_ 25.1 i 363.7:- 14.6: 24.2 r TOTAL (Also enter on Line 9, Recapitulation) I $ 6,484.5C zIP 17025 ZIP AMOUNT If more space is needed, use additional sheets of paper of the same size. Continuation of REV-1500 Inheritance Tax Return Resident Decedent LORRAINE A. GOFORTH Decedent's Name Page 1 Schedule H -Funeral Expenses & Administrative Costs - B7. ITEM NUMBER DESCRIPTION 19. Village Associates, mobile home lot rent, water/sewer 20. Village Associates, mobile home lot rent, water/sewer 21. PPL 22. Michael Langan, T.C., real estate tax 23. Terry Kimball, mobhile home appraisal 24. Village Associates, mobile home lot rent, water/sewer 25. R. C. Leiby, repair water leak at mobile home 26. PPL 27. R.C. Leiby, repairs 28. PPL 29. Donald Liddick, upkeep and maintenance of mobile home 21 11 1039 File Number AMOUNT 322.5C 419.42_ 26.8 77.82 250.00 363.7 113.00 22.33 109.00 39.30 300.00 SUBTOTAL SCHEDULE H-B7 ~ 2,043.99 REV-1512 EX+ (12-08) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF I ORRAINE A GOFORTH FILE NUMBER 21 11 1039 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. Village Associates, mobile home lot rent 2,385.1 E 2. Comcast 105.6E 3. Tax Claim Bureau, real estate tax lien 100.58 4. Verizon 99.95 5. WFCB - Haband 121.1C 6. Premier Eye Care 15.OC 7. Zlotoff, Gilfert & Gold 18.OC 8. Village Associates, mobile home lot rent 767.5C 9. Nephrology Associates 14.8% 10. PPL 136.7 TOTAL (Also enter on Line 10, Recapitulation) I $ 3,764.5'_ If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) pennsylvania ~ SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: LORRAINE A. GOFORTH 21 11 1039 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. Donald R. Liddick Sibling 0.33 73 Pine Hill Road Enola, PA 17025 2. DavidLiddick Sibling 0.33 Susquehanna Avenue, Apt. 204 Enola, PA 17025 3. Wayne Liddick / AP 3139 Sibling 0.33 SCI_ Frackville 1111 Altamont Blvd., Frackville, PA 17931 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: 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 SHEET. $ If more space is needed, use additional sheets of paper of the same size,