HomeMy WebLinkAbout09-18-12J 1505610140
REV-1500 ~` (°'-'°'
OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
Po Box zfio6D1 INHERITANCE TAX RETURN rl
~ I ~ I O (~
Hartisburg, PA 1 N28-0601 RESIDENT DECEDENT ~- .
ENTER DECEDENT INFORMATION BELOW
Social Securely Number Date of Death MMDDYYYY Dete Of Birth MMDDYYYV
2 1 0 2 4 6 5 8 4 0 6 2 6 2 0 1 2 0 6 0 7 1 '9 1 6
Decedent's Last Name Suffur Decedenfa First Narne MI
B E A M J O S E P H I N E L
(N Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffd Spouse's First Nemr: MI
Spouse's Sodal Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
^X 1. Original Retum ^ 2. Supplemental Retum ^ 3. Remainder Return (date of death
poor to 12-13-82)
^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of ^ 5. Federel Estate Tax Retum Required
death after 12-12-82)
^ 6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust 8. Total Number of Sefe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
^ 9. LRigation Proceeds Received ^ 10. Spousal Poverty CredH (date d death ^ 11. Eledion to tax under Sec. 9113(A)
belvreen 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT -THIS SECTH)N MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TA7(INFORIMTpN SHOULD BE DIRECTED T0:
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 4 5 3
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REGIS
F~IaILLS US
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First line of address
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I R W I N & M c K N I G H T P C U' n~
Second line of address x .~
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6 0 W E S T P O M F R E T S T R E E T -.;
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City or Post Office
D
FILED
State ZIP Code
C A R L I S L E P A 1 7 0 1 3
Correspondent's e-mail address:
Under penalties d perjury, I dedare that l have examined this return, induding accomperrying schedube aM statements, and tome heat d my knowledge and belief
h is true, coned and compote. Dedaretlon of preperer omer man me personal repraeemative la based on all inronnatbn d which preparer has erry knowledge.
ADDRESS ~
415 GREENBRI .ROAD ELLIOTSBURG PA 1724
SIONATIJRE OF PR A THER THAN REPRESENTATNE ~'E/ / ~ /~
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610140
150561014
J ~,
D
1505610240
REV-1500 EX
DecedenPS Social Security Number
oecedenrsName: d0$EPHINE L- BEAM 2 1 0 2 4 6 5 8 4
RECAPITULATION
1. Real Estate (Schedule A) ........................................... 1.
2. Stocks and Bonds (Schedule B) ...................................... 2.
3. Closely Held Corporation, Partnership orSole-Proprietorship (Schedule C) ..... 3.
4. Mortgages and Notes Receivable (Schedule D) .......................... 4.
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5.
B. Jointly Owned Property (Schedub F) ^ Separate Billing Requested ....... 6.
7. Inter-V'rvos Transfers & Miscellaneous -Probate Property
(Schedule G) ~ Separate Billing Requested ....... 7.
8. Total Gross Assets (total Lines 1 through 7) ........................... 8.
9. Funeral Expenses and AdminisUadve Costs (SGustlule N) .................. 9.
10. Debts of Decedent, Mortgage Uabilifies, and liens (Schedule I) ............. 10.
11. Total Deductions (total Lines 9 and 10) ............................... 1 t.
12. Nat Value d Estate (Litre 8 minus Line 1 t) ............................ 12.
13. Charitable and Govammental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ...................... 13.
14. Nat Value SubJect~o Tax (Line 12 minus Line 13) ...................... 14.
3 3 0 5, 3 9
2 0 2 5, 0 1
5 3 3 0. 4 0
1 9 6 3. 2 1
2 6 5 1 7 0. 1 6
2 6 7 1 3 3. 3 7
- 2 6 1 8 0 2. 9 7
- 2 6 1 8 0 2. 9 7
TAX CAGCULATION? Ii~E INSTRUCTIONS FOR APPLICABLE RATES
15. Antiodnt of Line~4taxable
at t119 spousaLtax~r$te, or
transfers underSeot 9116
16. Amount of Line 14~taxable
0 D
0
a)lipealrate X .045 ts.
17. Ajriount of Line 14 taxable
'
'
D
D
D 17
s~bling rate X
.12
at • .
18. Amount of Line 14 taxable
D D
0
at collateral rate X .15 18.
19. TAX DUE ...................................................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OYERPAYMENT
Side 2
150561O24D 1505610240
D. D D
0. 0 D
0. D D
D. a D
D. D D
REV-1500 EX Page 3
rfnrPdent's Complete Address:
File Number
0 0
DECEDENT'S NAME
JOSEPHINE L. BEAM _.
STREET ADDRESS
213 E. MAIN STREET _
CITY
NEW BLOOMFIELD STATE
PA ZIP
17068
Tax Payments and Credits:
Tax Due (Page 2, Line 19)
Credits/Payments
A. Pdor Payments
8. Discount
0.00
3. Interest
4. If Line 2 is greater than Une 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.
(1) o.oo
Total Credits (A + B) (2) 0.00
(3)
(4) 0.00
(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 properly transfened : ................................................................. ..... ^
b. retain the right to designate who shall use the property transferred or its income; ^ ^
c. retain a reversionary interest; or .......................................................................................... ...... ^ ^X
d. receive the promise for life of either payments, benefits or care? ................................................. ...... ^ ^X
2. It death occuned 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-upontieath 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? ............................................................................................ ...... ^ ^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, 8 MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
FILE NUMBER:
JOSEPHINE L. BEAM 0 0
Include the proceeds of litigation and tits date the proceeds were received by the estate.
en nn.nnM inl.rw numnA whh right of aurvNorshio must t>e disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
t. MANOR AT PERRY VILLAGE -BALANCE ON ACCOUNT 3,305.39
TOTAL (Also enter on Line 5,
If more space is needed, insert additional sheeLS of paper of the same size
REV-1509 EX• (0'I-10)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF:
NUMBER:
JOSEPHINE L. BEAM 0 0
Nan asset was made joiMty owned within one year of the decedent's date of death, N must be reported an Schedule G.
SURVIVING JOINT TENANT(S) NAME(S)
A. JULIE R. EDGIN
s.
c.
JOINTLY-OWNED PROPERTY:
TO DECEDENT
ITEM
NUMBER LETTER
FORJOINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANKACCOUN?NUMBER OR SIMILAR
IDENTIFYINGNUMBER. ATTACH DEEDFORJOINTLY-HELD REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET %OF
DECEDENT'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENT'S INTEREST
t. A. 1985 SUSQUEHANNA BANCSHARES, INC. 4,050.01 50. 2,025.01
CHECKING ACCOUNT #1110887809
TOTAL (Also enter on Line 6, Recapitulation)
ADDRESS
CARLISLE, PA 17013
If more space is needed, use additional sheets of paper 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
JOSEPHINE L. BEAM 0 0
Daeedenfs debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. ROBERT D. HEATH FUNERAL HOME, INC. 1,103.21
2. FUNERAL LUNCHEON 345.00
B.
2.
3.
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representatlve(s)
Street Address
City
Year(s) Commission Paid:
Attorney Fees: IRWIN & McKNIGHT, P.C.
Family Exemption: (If decedenCs address is not the same as daimanYs, attach explanation.)
Claimant
Street Address
City State
Relationship of Claimant to Decedent
4. Probate Fees:
5. Accountant Fees:
6. Tax Return Preparer Fees:
7. I REGISTER OF WILLS
State ZIP
ZIP
500.00
15.00
TOTAL (Also enter on Line 9, Recapitulation) S
If more space is needed, use additional sheets of paper of the same size.
REV-1512 EXt (12-08)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDEM
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
JOSEPHINE L. BEAM 0 0
Report debts Incurred try the decedent prior to death that remained unpaid atthe date of death, Including unrelmburaed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION Of DEATH
DPW CLAIM
2. IMANOR AT PERRY VILLAGE -NURSING
264, 951.24
218.92
TOTAL (Also enter on Line'10, Recapitulation) I S
If more space b needed, insert additional sheets of the same size.
REV-1513 ~Xt (Ot-10)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE iAX RETURN
RESIDENT DECEDENT
SCHEDULE)
BENEFICIARIES
ESTATE OF: FILE NUMBER:
JOSEPHINE L. BEAM 0 0
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Tnistee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outr~'ght spousal disMbutions and transfers under
Sec. 9116 (a) (1.2).]
1. JULIA EDGIN Lineal
123 ORIOLE DRIVE 1l2 REMAINDER
CARLISLE, PA 17013
2. DOROTHY J. TRAVIT~ Lineal
77 EVERGREEN DRIVE 1/2 REMAINDER
PITTSBORO, NC 27312
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-15
NON-TAXABLE DISTRIBUTI NS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
APPROPRIATE.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-15(x1 COVER SHEET. E
If more space is needed, use additional sheets of paper of the same size.
P
LAST WILL AND TESTAMENT Y
OF
JOSEPHINE R. BEAM
I, JOSEPHINE R. BEAM, currently of Washington Township, County of Dauphin
and Commonwealth of Pennsylvania, being of sound mind, memory and understanding, do
make and publish this, my Last Will and Testament, hereby revoking and malting void all
former 'Vi~ills by me at any time heretofore made.
I direct my hereinafter named Executrix to pay all my legally
enforceat}le debts, funeral expenses, administration expenses, and inheritance, estate,
succession or excise taxes, which I owe or may become due on account of my death, as soon
as may bts convenient after my decease.
~Q(yp: I give, devise and bequeath all of my property, be it real, persomal and
mixed, wb'atsoever or wheresoever the same maybe situate at the: time of my death as follows:
A. i4lf/ty percent (50%) of my estate shall pass to my daughter JULIA R. EDGIN,
if she survives me. In the event my daughter, JULIA R. EDGIN, predeceases
me or fails to survive me, I direct that her share of my estate shall pass to her
children, DIANE L. MII.LER and CURTIS A. EDGIN, in equal shares.
B. Fifty percent (50%) of my estate shall pass to my daughter, DOROTHX J.
'~"~, if she survives me. In the evem my daughter, DOROTHY J.
to survive me, H direct that her share of my
and
,~
I
~]Z; I nominate, constitute and appoim my daughter, J[JL1fA R. EDGIN, as
Executrix of this, my Last Will and Testament, authorizing and empowering her to sell and
convey any and all real estate which I own at the t~ of my death. ht the event my daughter,
JULIA R. EDGIN, predeceases me or fails to survive me or is unable or unwilling to serve
as Executrix, then I rnominate, constitute and appoint my granddaughter, DIANE L. MII.LER
as Executrix of this, my Last Will and Testament.
I further direct that my Executrix or personal representative shall not be required to
posy bond to act in said capacity.
IN WITNESS WHEREOF, I, JOSEPHBVE R. BEAM, have hereunto set my band and
seal, to this, my Last Will and Testament, this 7~day of October, 2004.
SIG}IVED, SEALED, PUBLISHED
and' DECLARED by the above-
narrred Testatrix, JOSEPHINE R.
BEAM, as and for her
Lask Will and Testament, in
the presence of us, who at
her request and in the
presence of each other, have
hereunto set our rtames as
i~ (,~~., (SEAL)
OS HINE R. BEAM
GIIEEORY M K[RWIN
TERRQIGE J. KEPWIN
JOEFPK D. KERWIN
KULLY MGGIAIRL KERWM
witnesses:
September 12, 2012
ROGER B IRW[N
IRWIN & MCIt~IIGHT PC
WEST POMFRIGT PROFESSIONAL BLllG
60 WEST POM~'RET STREBT
CARLISLE PA 17013-3222
RF.: .Tnsephipe R (I.ongecrc) Bcam Estate
DOD: 06!26/2012
SS#: 7IXX-X~-6564
Tracking # 26920
Ta Whom It Mary Concern:
Susquehanna
Susquahanm Banuhares, Inc.
26 North Ce4ar Stre•t
P.O. Box 1000
Li01z, PA 17543.7000
Te11.800.311.3192
Fes 717.625.447a
(Revised)
In response to ybur letter of September 6, 2012, here is the above customer account infomtation
as of 7nne 26, 2412.
Account#1
Account #2 Account #3
• Account Title: Josephine R Beam
Julia R Edgin
• Account Type/# Ckg111108878U9
• Date Opened'/Maturity 8/05/1985
• Interest Raze: .OS%
• AccountBalAnce*: 4,050.01
• Aocrued Interest: .14
• YTD ]nteresC: .85
*Account balance does not include accrued interest.
® There is qo safe deposit box iu the name of the decedent.
^ There is a safe deposit box M 0 in the name of the decedent located at the branch name.
Josephine appointed Diane L Miller as POA 212712008; documents received 4/06,/2011.
Z/Z BLbb-SZ9-LlL~luegeuueyanbsnS WdIZ£t~bZIOZ/A/daS
If I can be of farther assistance, please fuel free to call.
Sincerely,
~4Lcc~~ . ~[2u.~
Dawn M BerrieY
Deposit Research -Reporting Department Lead
1-717-625-6546
DMR/jlg
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Pennsylvania
DEPARTMENT OF PUBLIC WF-LFAR:E
August 7, 2012
IRWIN & MCKNIGHT'tAW OFFICES
ROGER BIRWIN ESQUIRE
WEST POMFRET PROFESSIONAL BUILDING
60 WEST POMFRET 5TREET
CARLISLE PA 170133222
Re: Josephine Beam
CIS #: 470187267
SSN: ###-##-6584
Date of Death: 06/26/2012
Dear Mr. Irwin;
RECEI
AUG 1 1 20121
IRWIN & McKINCi6P
LAW OFFICES
Please be adWised that the Department of Public Welfare maintains a claim in the
amount of 5264,95,124 against the above-mentioned estate. This claim is for restitution
of medical assistancc,e~e granted on behalf of the decedent for which the Probate Estate is now
responsible to reimLiurse the Department according to Act 49, 62 P.S. 1412, effective
August 15, 1994, a& amended by Act 20-95, effective June 30, 1995. Einclosed is the
Department's itemised statement of claim.
A portion of 1 his medical expense, namely 414,463.55, was incurred during the last
six months of the drpcedent's life; therefore, it is a Class 3 claim pursuant to Section 3392 of
the Decedents, Est tes, and Fiduciaries Code, 20 Pa. C.S.A. 3392(3). The balance of the
claim, namely , is to be entered as a priority Class 5.1 claim against the
estate.
Please ackngwledge receipt of this letter and advise whether the Commonwealth's
claim is admitted amd when payment may be expected. If the estate accounting is
complete, please prrovide 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,
Tina M. Wise
TPL Program Investigator
717-214-1204
717-772-6553 FAX
Enclosure
Bureau of Program In[egrtty I Dfvfsfon of Third Party Liability I Recovery SeRlon
PO Box 8486 I Harrtsburg, Pennsylvania 17105-6486
.The Mnr at Perry Vlg
213 East Main Street
New Bloomfield PA 170689657
(717)582-4346
OF
RESIDENT NAME $ ID:
JOSEPHINE RBEAM - BEAM038533
ROOMIBED 1406-A
PAYER: RResident Liability-Standard
SERVICE DATE
FROM: 7/1/2012 TO: 7131/2012
BILL TO:
Diane Miller PLEASE PAY THIS AMOUNT
415 Greenbrier Road
Elliottaburg, PA 17024 $218.92
Pleew roam as patian d ilik e'tiiiemant atiiiJe iiia'line'wu'n"yurp'a'ymera
FROM THROUGH DESCRIPTION QUANTITY TRANSACTION
A O NT RUNNING
BA NC
7/1/2012 7/31/2012 RL $0.8115-The Mnr at Perry Vlg
1/1/2012 1/31/2012 Resi~dentLiability 31 Days $866.79 $1,877.89
1/1/2012 1/31/2012 ResldentLiability"REV• 31 Days ($866.79) $1,011.10
2/1/2012 2/29/2012 Resident Liability'REV' 29 Days ($866.79) $144.31
2/112012 I 2/29/2012 I Resident Liability + 29 Days $866.79 $1,011.10
3/1/2012 I 3/31/2012 I Resident Liabilty 1 31 Days $901.64 $1,912.74
3/1/2012 + 3/31/2012 I Res dent Liability "REV` 1 31 Days ($901.64) $1,011.10
5/31/2012 ~ 5!31/2012 I Res6deni Liability 1 Day $54.73 $1,065.83
6/1/2012 I
6/23/2012 6/1/2012 I
6/25/2012 ReyidentLiabiiity 1
Resident Liability 1 Day
3 Days I ~-$5q,73 I
$164.19 I $1,120.561
. $1,284.75 1
6/23/2012 8/25/2012 Resident Liabilky'REV` 3 Days J ($164.19) I $1,120.56
7/1/2012 7/31/2012 Rey Liability Advance Bill •REV• 31 Days ($901.64) $218.92
7/23/2012 7/23/2012 Pallment Transaction - $54.73 $273.65
7/23/2012 I 7/23/2012 I PaNment Transaction I I ($54.73) I $218.92
JOSEPHINE RBEAM -
1
PLEASE PAY THIS AMOUNT >»>» $218.92
BEGINNING BALANCE; $1,011.10
PAYMENTS OR CREDITS: ($3,701.05)
DUE:
$0.00