HomeMy WebLinkAbout09-24-121505610140
REV-1500 ~` ~°'-'°'
PA Department Of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO Box 280601 INHERITANCE TAX RETURN 2 1 1 2 0 7 4 8
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
0 7 0 1 2 0 1 2 0 2 0 2 1 9 2 0
Decedent's Last Name Suffix Decedent's First Name MI
A U G H E N B A U GH V I O L A
(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
Q 1. Original Retum ~ 2. Supplemental Return ~ 3. Remainder Retum (date of death
prior to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required
death after 12-12-82)
QX 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
9. Litigation Proceeds Received ~ 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 CONFIDENTWL TAX INFORMATION SHOULD BE DMECTED TO:
Name Daytime Telephone Number
R O G E R B I R W I N E S Q U I R E 7 1 7 2 4 9 2 3 5 3
First line of address
I R W I N &
Second line of address
6 0 W E S T
City or Post Office
C A R L I S L E
M c K N I G H T P- C-
P O M F R E T
REGISTER OF WILLS USE ONJ.,Yy
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S T R E E T
State ZIP Code
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P A 1 7 D 1 3
Correspondent's e-mail address:
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Under penalties of pery'ury, I dedare that I have examined this return, induding accompanying sdiedules and statements, and to the best of my knowledge and belief,
it is true, corced and complete. Dedaretion of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNA~RSON EL~LE FOR FILING RETURN ~ 9
ADDRESS
1778 SUMMERFIELD DRIVE MECHANICSBURG PA917055
SIGNATURE~THERJHAN RF,P,t2ESENTATNE 9/ 2-~~'-
60 WEST PQ'MF/RET STREET
1505610140
PLEASE USE ORIGINAL FORM ONLY
Side 1
13
15D5610140 J
15D5610240
REV-1500 EX
Decedent's Social Security Number
DecedenrsName: VIOLA AUGHENBAUGH
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 De osits and Miscellaneous Personal Pro e
P p rty (Schedule E).
....
.. 5. 8 0 6 2. 1 8
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested . .... .. 6.
7. Inter-Vivos Transfers & Miscellaneous N -Probate Property
(Schedule G) ~ Separate Billing Requested . .... .. 7.
8. Total Gross Assets (total Lines 1 through 7) ..................... .... .. 8. 8 0 6 2. 1 8
9. Funeral Expenses and Administrative Costs (Schedule H) ............ .... .. 9• 2 1 0 3 • 5 1
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ....... .... .. 10. 1 2 7 4 6 5. 5 9
11. Total Deductions (total Lines 9 and 10) ......................... .... .. 11. 1 2 9 5 6 9. 1 0
12. Net Value of Estate (Line 8 minus Line 11) ...................... .... .. 12. - 1 2 1 5 0 6. 9 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 1 5 0 6. 9 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. D 0
17. Amount of Line 14 taxable
at sibling rate X .12 D 0 D 17. 0. D O
18. Amount of Line 14 taxable
at collateral rate X .15 D 0 D 18. 0. 0 0
19. TAX DUE ................................................ .... ..19. 0 • D 0
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^
Side 2
15D5610240 1505610240
REV-1500~EX Page 3
Decedent's Complete Address:
File Number
21 12 0748
DECEDENTS NAME
VIOLA AUGHENBAUGH
STREET ADDRESS
1000 CLAREMONT ROAD
CITY
CARLISLE STATE
PA ZIP
17013
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. CreditslPayments
A. Prior Payments
B. Discount 0.00
3. Interest
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.
Total Credits (A + B) (2)
(4)
(1) 0.00
(3)
0.00
0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00
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 ................................................................................................ ^ ^X
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? ....................................................................................... ^ 0
3. Did decedent own an 'intrust for" or payable-upon~eath bank account or security at his or her death? ......... ^ X^
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 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+ (11-10)
Pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE
CASH, BANK DEPOSITS, ~ MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
VIOLA AUGHENBAUGH 21 12 0748
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship moat be discbsed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. CITIZENS BANK -CHECKING ACCOUNT #6100729753 4,970.67
2. CLAREMONT NURSING AND REHABILITATION CENTER 3,091.51
PERSONAL ACCOUNT
TOTAL (Also enter on Line 5, Recapitulation) I ; _ 8,062.18
If more space is needed, insert additional sheets of paper of the same s¢e
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
VIOLA AUGHENBAUGH 21 12 0748
Decedern's dells must be nported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. EWING BROTHERS FUNERAL HOME 177.47
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)ofPersonalRepresentative(s) CORRIN L. AUGHENBAUGH
Street Address 1778 SUMMERFIELD DRIVE
City MECHANICSBURG State PA ZIP 17055
Year(s) Commission Paid:
2. AttomeyFees: IRWIN & MCKNIGHT, P.C.
3. Family Exemption: (If decedents address is not the same as daimants, attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4• Probate Fees: REGISTER OF WILLS
5 Accountant Fees:
6. Tax Retum PreparerFees: PATRICIA A. ROSENDALE, CPA
7. REGISTER OF WILLS -FILING FEE
8. CUMBERLAND LAW JOURNAL -ESTATE NOTICE
9. THE SENTINEL -ESTATE NOTICE
425.00
750.00
81.50
375.00
30.00
75.00
189.54
TOTAL (Also enter on Line 9, Recapitulation) I S 2,103.51
If more space is needed, use additional sheets of paper of the same size.
REV-1512 EX+ (12-08)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, 8~ LIENS
ESTATE OF
FILE NUMBER
VIOLA AUGHENBAUGH 21 12 0748
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
DPW CLAIM -CIS #: 300275531
127,465.59
TOTAL (Also enter on Line 10, Recapitulation) I S 127
If more space ~ 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:
VIOLA AU GHENBAUGH 21 12 0748
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 [Indude outrtr'g ht spousal distributions and transfers under
Sec. 91'f6 (a) (1.2).)
1. CORRIN L. AUGHENBAUGH Lineal
1778 SUMMERFIELD DRIVE 1/2 REMAINDER
MECHANICSBURG, PA 17055
2. J. ROGER AUGHENBAUGH Lineal
1002 PFOUTZ VALLEY ROAD 1/2 REMAINDER
MILLERSTOWN PA 17062
3. JAMES R. AUGHENBAUGH -DECEASED Lineal
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. S
If more space is needed, use additional sheets of paper of the same size.
LAST WILL AND TESTAMENT
I, VIOLA AUGHENBAUGH, of the Borough of Cazlisle, County of Cumberland,
Commonwealth of Pennsylvania, being of sound and disposing mind, memory and
understanding, do make, publish and declare this as and for my Last Will and Testament,
hereby revoking and making void all former wills and codicils by me at anytime
heretofore made.
FIRST. I order and direct that all my just debts and funeral expenses be paid by
my personal representative or representatives, hereinafter named, as soon as conveniently
may be done after my decease. I further authorize my personal representative to expend
funds from my Estate in such amounts as my personal representative shall consider
appropriate, for the disposition and memorial of my remains.
SECOND. All the rest, residue and remainder of my Estate, real, personal and
mixed, whatsoever and wheresoever situate, I give, devise and bequeath unto my
children, CORRIN L. AUGHENBAUGH, JAMES R. AUGHENBAUGH and J. ROGER
UGH, in equal shares. If any of them should fail to survive me, I give,
devise and bequeath the said residue of my Estate unto such of my issue who shall
survive me, in equal shares, by representation and not per capita.
'I'kiIRD. For the purposes of this my Last Will and Testament, a person shall not
be deemed to have survived me unless he or she shall have survived me by more than
wnnvE F. sxnnE ninety (90) days.
Attorney at Law
53 West Pomfret Street
Carlisle, Pemsylvania
17013
w
Sworn to or affirmed and subscribed to before me by T+,Tayne F _ ha ~ p
and Karen F . Byers, witnesses, this 27th ~y pf February
1998. '
~e,~ce ~~
~..~.- ~~
Notary Publi
Notarai~e~l
Connie J. Tritt, Notary'P~plic
Carlisle, Cumiie~lan. C~utity . .
iwy Commission Expirps.0~: 5,~2t300
WAYNl3 F. SHADE
Attorney at Law
53 West Pomfret street
Carlisle, Pemisylvania
17013
-S-
~-
July 26, 2012
LAW OFFICES IRWIN & MCI~NIGHT PC
WEST POMFRET PROFESSIONAL BLDG
60 WEST POMFRET STREET
CARLISLE PA 17013-3222
Estate of VIOLA AUGHENBAUGH
Date of Death: Ju101, 2012
SSN: 174-20-2670
Dear Sir/Madam:
One Citizens Drive
ROP112
Riverside, RI 02915
RE
JUL 3 0 2012
IRVVrINN & McKNiGHT
LAW OfFlCES
In accordance with your request, the attached information sheet has been provided in the above decedent's
name as of his/her date of death.
Per your request there was no change of ownership within one year prior to date of death.
For Installment Loans or Line of Credit accounts, contact our Loan Department at 1-800-708-6680. For
all other inquiries, please call 877-579-2667 option 2.
Sincer ,
~c~
Lisa Drainville
Decedent Account Processing
REF#: 554493
~~ Citizens Bank
Account Number 6100729753
Account Title VIOLA AUGHENBAUGH
Date ed 6/6/1966
Account T e Checkin
Princi al Balance as of DOD $4970.67
Interest from Last Postin to DOD $ .00
Account Balance as of DOD $4970.67
YTD Interest to DOD $ .00
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RECEIPT_FOR_PAYMENT
GLENDA FARNER STRASBAUGH Receipt Date: 7/09/2012
Cumberland County - Register Of Wills Receipt Time: 14:08:39
One Courthouse Sqquuare Receipt No.: 1070550
Carlisle, PA 17Q13
AUGHENBAUGH VIOLA B
Estate File No.: 2012-00748
Paid By Remarks: IRWIN & MCKNIGHT PC
HMW
------------------------ Receipt Distrib ution ----- -------- -------- ---
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS TEST 30.00 CUMBERLAND COUNTY GENERAL FUN
WILL 15.00 CUMBERLAND COUNTY GENERAL FUN
SHORT CERTIFICATE 8.00 CUMBERLAND COUNTY GENERAL FUN
JCS FEE 23.50 BUREAU OF RECEIPTS & CNTR M.D
AUTOMATION FEE 5.00 CUMBERLAND COUNTY GENERAL FUN
Check# 31993 $81.50
Total Received......... $81.50
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July 9, 201
Cowin L. Aughenbaugh
1778 Summerfield Drive
Mechanicsburg, PA 17055
L..ll.~ ~~-uiuer~ r uneral Home, inc.
630 South Hanover Street
Carlisle, PA 17013-
(717)243-2421
The Funeral Service for Viola B. Aughenbaugh
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please
feel free to contact us if you have any questions in regard to this statement.
THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT,
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
1. PROFESSIONAL SERVICES
Basic Services of Funeral Director/Staff , $1200.00
Bathing & Embalming $895.00
Dressing, Casketing, Cosmotology etc. $295.00
2. FACILITIES/SERVICES/STAFF/EQUIPMENT
Basic Use of Facility , $200.00
Document Prep/Permanent Recording, $325.00
Staff Usage for Funeral/Memorial , $375.00
Staff for Graveside/Interment $125.00
Equipment/Extra Staff& Time Off Premise Event $375.00
3. AUTOMOTIVE EQUIPMENT
Vehicle to transfer remains to Funeral Home, $295.00
Hearse (Casket Coach) $295.00
Safety Lead/Clergy Car $135.00
Utility Car , $135.00
FUNERAL HOME SERVICE CHARGES $4650.00
SELECTED MERCHANDISE:
645 Spartan Silver 20G Gasketed Cas , $1350.00
#12 Guardian in Silver with Setup , $1395.00
Acknowledgement cards, $10.00
Register Book(s) $40.00
Memorial folders , $85.00
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE
THAT YOU HAVE SELECTED $7530.00
Cash Advances
Opening Grave, _ $550.00
Sentinel Obituary , $22.61
Patriot Obituary w/Photo, $385.27
Certified Copies of Death Certificate $30.00
Clergy Honorarium $100.00
Organist Honorarium, $75.00
Flowers. $159.00
Stone Cutting , $170.00
TOTAL CASH ADVANCES AND SPECIAL CHARGES . $1491.88
Total
Total Cost , $9021.88
SUB-TOTAL $9021.88 //~~ ~.-
• INITIAL PAYMENT /DISCOUNT /CREDITS 8120.00 = ~~Ze~'/~pe~p~.~Q~
TOTAL AMOUNT DUE ~°i'°° ~~'"
The unpaid balance over 30 days is subjected to a 1.50 % service charge per month - 18.0000 % per annum.
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DEPANTMEN7 OFSPU6LIC WELFAH'E
July 23, 2012
IRWIN & MCKNIGHT LAW OFFICES
ROGER B IRWIN ESQUIRE
WEST POMFRET PROFESSIONAL BUILDING
60 WEST POMFRET STREET
CARLISLE PA 17013-3222
Re: Viola Aughenbaugh
CIS #: 300275531
SSN: ###-##-2670
Date of Death: 07/01/2012
Dear Attorney Irwin:
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IJUL 2 6 2012
iRYVIN & McKNtGHT
LAW OFFICES
Please be advised that the Department of Public Welfare maintains a claim in the
amount of 5127.465.59 against the above-mentioned estate. This claim is for restitution
of medical assistance granted on behalf of the decedent for which the Probate Estate is now
responsible to reimburse the Department according to Act 49, 62 P.S. 1412, effective
August 15, 1994, as amended by Act 20-95, effective June 30, 1995. Enclosed is the
Department's itemized statement of claim.
A portion of this medical expense, namely 531.858.48. was incurred during the last
six months of the decedent's life; therefore, it is a Class 3 claim pursuant to Section 3392 of
the Decedents, Estates, and Fiduciaries Code, 20 Pa. C.S.A. 3392(3). The balance of the
claim, namely 595.607.11, is to be entered as a priority Class 5.1 claim against the estate.
Please acknowledge receipt of this letter and advise whether the Commonwealth's
claim is admitted and when payment may be expected. If the estate accounting is
complete, please provide a copy. If the estate contains real estate, please provide
copies of the deed, the latest tax assessment, and a. current appraisal, if available.
Sincerely,
~` ~~~
Karen H. Peterson
Claims Investigation Agent
717-772-6615
717-772-6553 FAX
Enclosure
Bureau of Program Integrity ~ Division of Third Party Liability i Recovery Secdon
PO Box 8486 (Harrisburg, Pennsylvania 17105-8486
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