HomeMy WebLinkAbout10-04-121505610140
REV-1500 °` ~'~'°'
PA Dspartrnerd of Revenue ~~ ullE ~'Y
etneau of tndlvklual Taxes INHERITANCE TAX RETURN COUry Cods Yam ~ Ntunber
Po sax 2eoeol 2 1 1 1 0 8 0 2
Hartlebur~. PA 17128-0801 RESIDENT DECEDENT
ENTER L'ECEDBIT MFOftMATN]N BELOW
Social Security Number Oalr of Death IirdDDYYYY t3aM of Birtlt MAADDYYYY
0 7 1 2 2 D 1 1 0 7 0 2 1 9 2 2
Deoederr's Uat Name gu}Ibc Dsoedsrrt's Fleet Name ~
S i m o n s Rut h H
(If AppNGIbN) Enbr 8urvlvirq 8poues's IMonnatlon Bslovr
Spouss'a L.aet Name SuQbr Spouse's First Harris MI
Spouse's SociN Security Number
THI8 RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL INAPPROPRIATE OVALS BELOW
® 1.OrgMral Redim ^ 2. Suppiernerdal Rslum ^ 3. Remainder Raihrm (dais of death
P~ 1012-13.82)
^ 4. LlmiEed Estale ^ 4a. Future Inlersst Compromise (dale Of ^ 5. Federal Ettale Tax Retum Required
death albr 12-12-82)
® 8. Daoeder-t Died TesMle ^ 7.Oscedsrtt llAahttained a tivirg Trust ~ 8. Total Number of Ss6s Dspoeft Bmaee
Attach COPY ~ W~ (A1~ Copy of That)
^ 9. Lkigation Proceeds RsoeNed ^ 10. Spousal Poverty Crsdk (dale of death ^ 11. Elecxion t0 tax under Sac. 9113(/
belweart 123181 and 1-1-A5) (Attach Sch. O)
CORRESPONt>ENT - TINS sECT10N WaT BE fA~LETt~. ALL AND OOIIFDEMiIU. TAX lNt~ORM11TtON SI1011L.0 f3E OrtECTED T0:
~^ ~ Daydms Teiepltorte Number
M e l a n i e W a l z S car i n g i 7 1 7 6 5 7 ? 7 7 0
Ffrst Nrte 0f address
S c a r i n g i $ S c a r i n g i
SeoOnd line of sddrem
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Csy or Pest OttlOe
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756 Mornin star Ave Harrisbur PA 17112
of PntaA~le Attvte
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20DD in lastown Rd, Ste 106 Harrisbur PA 17110
PLEASfE UsE ORIGINAL FORM ONLY
Side 1
L 1505610140 1505610140 J
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1505610240
REV-1500 EX
Decedent's Social Security Number
Ruth H. Simons
Decedent's Name:
RECAPITULATION
1. Real Estate (Schedule A) ........................................... 1. •
2. Stocks and Bonds (Schedule B) ...................................... 2. 2 0 0 • 0 0
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 7 6 3 3 4 . $ 5
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested .... ... 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested .... ... 7. 3 4 7 0 0 0 0 0
8. Total Gross Assets (total Lines 1 through 7) .................... .... ... 8. 8 2 3 5 3 4 , 8 5
9. Funeral Expenses and Administrative Costs (Schedule H) ........... .... ... 9. 4 4 1 4 1 0 1
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ...... ..... .. 10.
11. Total Deductions (total Lines 9 and 10) ......................... .... .. 11. 4 4 1 4 1 0 1
12. Net Value of Estate (Line 8 minus Line 11) ...................... .... .. 12. 7 7 9 3 9 3. 8 4
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ............. .... .. 13. 4 0 2 6 7 . 5 7
14. Net Value Subject to Tax (Line 12 minus Line 13) ............... .... .. 14. 7 3 9 1 2 6. 2 7
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 15. 0. 0 0
16. Amount of Line 14 taxable
at lineal rate X .045 6 7 0 2 9 5. 7 9 16. 3 0 1 6 3. 3 1
17. Amount of Line 14 taxable
at sibling rate X .12 0 0 0 17. 0• 0 0
18. Amount of Line 14 taxable
at collateral rate x .15 6 8 8 3 0. 4
8
18.
1
0
3
2
4.
5
7
19. TAX DUE ............................................. .... ..19. 4 0 4 8 7. 8 8
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVE RPAYMENT
Side 2
1505610240 1505610240 J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 11 0802
DECEDENT'S NAME
Ruth H. Simons
STREET ADDRESS
100 Media Road
CITY STATE ZIP
Carlisle PA 17013
Tax Payments and Credits:
1 ~ Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments - 44,000.00
B. Discount 2,024.39
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.
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(1) 40,487.88
Total Credits (A + B) (2) 46, 024.39
(3)
(4) 5,536.51
(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; .......................... ......
..... ^ X^
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-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? ............................................................................................. ..... ^ 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
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, undE
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1503 EX + (6-98)
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ruth H. Simons 21 11 0802
All property jointlyowned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 1000 units of Boston Capital Tax Credit Fund 2LPS14 50.00
($0.05/unit)
2. 500 units of Boston Capital Tax Credit Fund 4LPS23 50.00
($0.10/unit)
3. 500 units of Boston Capital Tax Credit Fund 4LPS29 100.00
($0.20/unit)
TOTAL (Also enter on line 2, Recapitulation) I $ 200 00
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX+ (11-10)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, S MISC.
PERSONAL PROPERTY
t5 i A t t ~r: FILE NUMBER:
Ruth H. Simons 21 11 0802
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned wkh right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
1. M&T Bank Checking Account No. 9845712091
2. Personal Property located at Decedent's residence (appraised value)
(Including $119.00 of coins)
3. Dickinson College Trust Deposits
7/19/2011 and 10/13/2011
4. U. S. Treasury -IRS Tax Refund
5. Social Security Income Direct Deposit
8/3/2011
6. Edward Jones Account No. 896-12881-1-8: Money Market Funds
7. Cash in wallet
8. Unclaimed Property -State of Florida, Dept of Financial Services
9. United Healthcare refund due to automatic payment withdrawn from checking acct.
10. Lehigh University Gift Annuity check for July 2011
11. PA Dept of Revenue tax refund - 5/18/2012
12. Bankers Life/Casualty Co Refund
13. Edward Jones Account no: 896-12881-1-8
Mutual Funds and Miscellaneous Securities
TOTAL (Also enter on Line 5, Recapitulation) ~ $
If more space is needed, insert additional sheets of paper of the same size
VALUE AT DATE
OF DEATH
6, 531.25
3,617.00
94.76
225.00
911.00
39,041.00
85.00
2,378.73
32.40
85.56
288.00
52.76
422, 992.39
476, 334.
REV-1510 EX+ (08-09)
pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON•PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ruth H. Simons 21 11 0802
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM DESCRIPTION OF PROPERTY
NUMBER INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND
THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH
VALUE OF ASSET % OF DECD'S
INTEREST EXCLUSION
IiF aPaucaeLel TAXABLE
VALUE
1. Shaubut C. Walz III, son. Gift was made on 8/24/2010` 100,000.00 100.00 3,000.00 97
000.00
Value on date of gift is provided in the next column ,
2 Barbara J Baer, daughter. Gift was made on 8/24/2010'' 100,000.00 100.00 3,000.00 97
000.00
Value on date of gift is provided in the next column ,
3 Betsy L. Thompson, daughter. Gift was made on 8/24/2010' 100,000.00 100.00 3,000.00 97
000.00
Value on date of gift is provided in the next column ,
4 Kirby Baer, grandson. Gift was made on 8/24/2010* 10,000.00 100.00 3,000.00 7
000
00
Value on date of gift is provided in the next column ,
.
5 Gregory Baer, grandson. Gift was made on 8/24/2010" 10,000.00 100.00 3,000.00 7
000
00
Value on date of gift is provided in the next column ,
.
6 Frank Thompson, grandson. Gift was made on 8/24/2010* 10,000.00 100.00 3,000.00 7
000
00
Value on date of gift is provided in the next column ,
.
7 Andrew Thompson, grandson. Gift was made on 8/24/2010* 10,000.00 100.00 3,000.00 7
000
00
Value on date of gift is provided in the next column ,
.
8 Meredith Walz, granddaughter. Gift was made on 8/24/2010'` 10,000.00 100.00 3,000.00 7
000
00
Value on date of gift is provided in the next column ,
.
9 Melanie Walz Scaringi, granddaughter 10,000.00 100.00 3,000.00 7
000
00
Gift was made on 8/24/2010* ,
.
Value on date of gift is provided in the next column
10 Scott Kemper, step-grandson. Gift was made on 8/24/2010'' 10,000.00 100.00 3,000.00 7
000
00
Value on date of gift is provided in the next column ,
.
11 Martha Kemper, step-daughter. Gift was made on 8/24/2010'' 10,000.00 100.00 3,000.00 7
000
00
Value on date of gift is provided in the next column ,
.
12 Trinity United Methodist Church, Port Charlotte, Florida 10,000.00 100.00 10
000
00 0
00
Gift was made 12/2010 ,
.
.
Value on date of gift is provided in the next column
(Tax exempt charity under 72 PS 9111(c)(1))
'`$3,000 exclusion pursuant to 71 PS 9107(c)(3)
TOTAL (Also enter on Line 7
If more space is needed, use additional sheets of paper of the same size.
n) $ 347,000.00
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
Ruth H. Simons 21 11 0802
Decedent's debts must be reported on Schedule t.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Larry Taylor Funeral and Cremation Services 820.00
Lighthouse Church and Pianist -donation 175.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s) of Personal Representative(s) John P Thompson, Executor 18,000.00
Street Address 7565 Morningstar Ave
city Harrisburg state PA zIP 17112
Year(s) Commission Paid:
2, AttomeyFees: Scaringi &Scaringi PC 18,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) 3,200.00
Claimant Barbara J. Baer
Street Address 100 Media Road
city Carlisle state PA zIP 17013
Relationship of Claimant to Decedent Daughter
4. Probate Fees: to Cumberland County Register of Wills (Advanced by Executor) 477.50
5 Accountant Fees:
6. Tax Return Preparer Fees: to Patricia A. Rosendale CPA LLC for 2011 income tax returns 310.00
7. Larry Taylor Funeral Home - Addf Death Certificates -Adv by Executor 85
00
8. Copy, Postage & Misc Admin expenses -Adv by Executor .
81 88
9. Cumb Cty Law Journal -Legal Notice -Adv by S&S PC
10.
The Sentinel -Legal Notice -Adv by S&S PC 75.00
11.
United Healthcare Premium Paid from M&T Bank Checking Acct 178 92
32
40
12. Advantage Partnership Board -Commissions & Transaction fees for sale .
340
00
of 1000 units of Boston Capital Tax Credit Fund 2LPS14 .
13. Advantage Partnership Board -Commissions & Transaction fees for sale 340
00
of 500 units of Boston Capital Tax Credit Fund 4LPS23 .
14. Advantage Partnership Board -Commissions & Transaction fees for sale
of 500 units of Boston Capital Tax Credit Fund 4LPS29 340.00
15. US Treasury Social Security Reverse Direct Deposit of late SS pa
ment
y 911.00
TOTAL (Also enter on Line 9 Recapitulation) I $ 44 141 01
If more space is needed, use additional sheets of paper of the same size.
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Ruth H. Simons 21 11 0802
Decedent's Name Page 2 File Number
Schedule H -Funeral Expenses 8 Administrative Costs - B7.
ITEM
NUMBER DESCRIPTION AMOUNT
16. Lehigh University Gift Annuity reimbursement check for July 2011 disbursement that 85.56
shouldn't have been paid.
17. Dickinson College reimbursement check for October 13, 2011 disbursement that 47,38
shouldn't have been paid.
18. Misc. administrative expenses advanced by S&S PC such as postage, photocopy, fax 201.37
expenses through 7/31/12 (listed as disbursements on invoices)
(Invoices are attached as Exhibits to Schedule H B-2)
19. Anticipated additional administrative expenses to conclusion of estate administration 200.00
20. Ibis Appraisal Services -personal property appraisal fee 240.00
SUBTOTAL SCHEDULE H-B7 ~ 774.31
REV-1513 EX+ (01-10)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF: FILE NUMBER:
Ruth H. Simons 21 11 0802
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustees) OF ESTATE
~ TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
1. Shaubut C. Walz, III, 201 Walz Road, Liverpool, PA 17045 Lineal 209,511.93
*of which $97,000 was within 1 yr of death
2. Barbara J. Baer, 100 Media Road, Carlisle, PA 17013 Lineal 209,271.93
*of which $97,000 was within 1 yr of death
3. Betsy L.Thompson, 7565 Morningstar Ave,Harrisburg,PA17112 Lineal 209,511.93
*of which $97,000 was within 1 yr of death
4. J. Scott Kemper,3E Manoa Road,Apt.4A,Havertown, PA19083 Collateral 34
415.24
*of which $7,000 was within 1 year of death ,
5. Harry J. Baer, 101 Sunset Dr., Carlisle, PA 17013 Collateral 27,415.24
6. Kirby Baer, 219 Haldeman Ave, New Cumberland, PA 17070
* Lineal 7,000.00
entire amount was within 1 yr of death
7. Gregory Baer, 703 Manor St, Columbia, PA 17512
* Lineal 7
000.00
entire amount was within 1 yr of death ,
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1. Trinity United Methodist Church
23084 Seneca Ave
Port Charlotte, FL 33980
*Exempt from tax pursuant to 72 PS 9111(c)(1)
$10,000 of which was a gift made in December, 2010 (within 1 year of death)
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I $
If more space is needed, use additional sheets of paper of the same size.
40,267.57
40.267.
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Ruth H. Simons 21 11 0802
Decedent's Name Page 3 File Number
Schedule J -Beneficiaries - 1
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT
Do Not List Trustees)
i TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).j
8. Frank Thompson, 8280 Creedmor Dr., Rural HaII,NC 27045 Lineal
*entire amount was within 1 yr of death
9. Andrew Thompson, 408 Southpoint Ct, McDonald, PA 15057 Lineal
*entire amount was within 1 yr of death
10. Meredith Walz, 2905 25th St NE, Washington DC 20018 Lineal
*entire amount was within 1 yr of death
11. Melanie Walz Scaringi, 215 N 24th St, Camp Hill, PA 17011 Lineal
*entire amount was within 1 yr of death
12. Martha Kemper, 337 2d floor, Beverly Blvd, Upper Darby, PA Collateral
19082 *entire amount was within 1 yr of death
AMOUNT OR SHARE
OF ESTATE
7,000.00
7,000.00
7, 000.00
7,000.00
7,000.00
REV-1500 Discount, Interest and Penalty Worksheet
Discount Calculation
Total Amount Paid within three calendar months of the decedent's date of death:
Discount: 2, 024.39
Interest Table
Year ;Days Delinquent ' Balance Due Interest
this time period this year this period
Before 1981
1982
1983
1984
1985
1986
1987
1988 through 1991
1992
1993 through 1994
1995 through 1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011 through 2012
TOTALS
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:
Penalty:
44,000.00
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