The URL can be used to link to this page

Home My WebLink About09-22-121505611185 -' REV-1500 EX (02-11)(FI) OFFICIAL USE ONLY PA Department of Revenue County Code Yeer File Number Bureau of IndiNdual Taxes INHERITANCE TAX RETURN 21 12 0800 Poeox2eosol Harrisburg, PA 17128-0801 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDVYVV Date of Birth MAADDYVYY 06232012 04071932 Decedent's Last Name Suffix Decedent's First Name M I WALTERS ELIZABETH S (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M I WALTERS JAY F Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLXCATE WITH THE - - REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW ® 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (Date of Death Prior to 12-13-82) ^ 4. Limited Estate ^ 4a. Future Interest Compromise (dale of ^ 5. Federal Estate Tax Return Required death after 12-t2-82) ® 6. Decedent Died Testate ^ 7. Decedent Maintained a LINng Trust - 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) ^ ^ th ^ 1 t T ntl r Sec 9113(A) El ti t 10 C i D f D 9. Litigation Proceetls Received . . ec on o ax u e . Spousal Poverty red t ( ate o ea Between 12-31-91 and 1-t-95) (Attach Schedule 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Dayllme Telephone Number HOWELL C• METTE, ESQUIRE 71i'-232-5000 ti REOISTEROF W fCDeE ONLY r.~ ~7 ~'h l ' ~ ..ry ~ C-'J ~ -t First Line of Address h7 ` om ~ 3401 NORTH FRONT STREET '_, ; N o, _'' `-' cad -o '? ~~, Second Line of Atldress U~ --~ ~ ~ =~ PO BOX 5950 vy r' r^ City or Post Offce DATE FILED ~ State ZIP Code ~~ ~ 'n HARRISBURG PA 171100950 CorrespondenCse-mailaddress: HCMETTEaMETTE•COM Under penalties of perjury, 1 declare that I have examined this return, intluding accompanying schedules end stet ante, end to the beet of my knowletlge end Delief, it Is true, correct and complete. Declaration of preperer other then the perso prose is seed on In Ion of which preperer hae any knowledge. SIGNANRE OF PERSON RESPONSIBLE FOR FILING RETURN DATE DAVID W• WALTERS ~~ ~~ ~ Z 42 RIDGE ROAD MECHANI METTEEDEVANSE & WOODSIDE ESENTATIVE /~Ati /Q~ ~/ /~1( ~LJO /~o DATE lOl I o I I~ 3401 N• FRONT STREET, PO BOX 5950 HARRISBURG, PA 17110-0950 PLEASE USE ORIGINAL FORM ONLY Side 1 1505611185 OM46473.000 1505611185 J 1505611285 REV-1500 EX (FI) Decedent's Social Secudty Number 223-40-2625 Decedenfa Name LA TERS ELIZABETH S RECAPITULATION 1. Real Estate (Schedule A) ............... 1, Q . Q Q 2. Stocks and Bonds (schedule B) ................. 2, 605 , 6 7 O • 4 4 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) , 3, Q . Q Q 4. Mortgages and Notes Receivable (Schedule D) 4. Q • Q Q 5. Cash, Bank Deposits and Miscellaneous Personal Properly (Schedule E) 5. 7O , 8 61.2 9 8. Jointly Owned Property (Schedule F) ~ Separate Billing Requested g, O • O O 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested .... 7. 0 • 0 0 8. Total Gross Assets (total Lines 1 through 7) ..... g. 676 , 531 • 73 9. Funeral Expenses and Administrative Costs (Schedule H) ............. g, 2 2 , 912.2 5 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) 10, 11. Total Deductions (total Lines 9 and 10) , - 11. 12. 13. 14. Net Value of Estate (Line 8 minus Llne 11) , Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been made (Schedule J) , Net Value SubJect to Tax (Line 12 minus Line 13) 12, , 13, , 14, TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers un er Sec. 9116 (a)(1.2)X.0 O.OQ 15. 18. Amount of line 14 xable at lineal rate x .0 4 0.0 0 16. 17. Amount of Line 14 taxable at sibling rate X .12 Q . Q Q 17. 18. Amount of Line 14 taxable at collateral rate X .15 O • Q Q 18 19. TAX DUE .. .............. 19. 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505611285 1505611285 OMdada 3.000 0.00 22,912.25 653,619.48 653,619.48 0.00 0.00 o.QQ Q•OQ Q•QQ REV-1500 EX (FI) Page 3 File Number Address: STREET Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) - ~ • ~ 0 2. Credits/Payments A. Prior Payments ~ • ~ ~ B. Discount ~ • ~ ~ Total Credits (A + B) (2) _ ~ • ~ 0 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (4) _ ~ ' (] 0 5. If line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) _ ~ • ~ ~ Make check payable to: REGISTER OF WILLS, AGENIf. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a Vansfer and: a. retain the use or income of the properly transferred ....................... .~ b. retain the right to designate who shall use the property transferred or its income ........ . c. retain a reversionary interest ................................. . d. receive the promise for life of either payments, benefits or care? .................. Yes ^^ ^ No 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ............................. 3. Did decedent own an "in trust for" or payable-upon-death 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? ................................ ^ 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 transfer:'. 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 antl filing a tax return are still appllceble 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 peraml, except as noted in [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. §9118(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in wmmon with the decedent, whether by blood or adoption. OM46]i L000 REV4503 FX. (698) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS p~'°-bath 3 waiters _ 21 12 0800 All property Jointly-owned with dght of survivorship must ba disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTON OF DEATH ,.x,782 shares AT&T, Inc. common stOCk CIISIP: 002068102 97,467.37 2,782 eharea at $35.035 per share 2 800 Shares 8xelis, Inc. common stock CIISIP: 30162A108 7,624.00 800 eharea at $9.53 per share Dividend accrued on 6/23/2012 82.64 3 400 Shares ITT Corp. New common stock CIISIP: 450911201 7,130.00 400 shares at $17.825 per share Dividead accrued on 6/23/2012 36.40 4 400 Shares Johnson & Johnson common stock CIISIP: 478160104 26,626.00 400 shares at $66.565 per share 5 800 Shares Xylem Inc. common stock CIISIP: 98419N100 19,056.00 800 eharea at $23.82 per share 6 1,950 Shares Slackrock Nuniyield PA Quality Fund - mutual fund CIISIP: 092556107 30,166.50 1,950 shares at $15.47 per share Dividend accrued on 6/23/2012 144.30 7 517.866 Shares Capital world Growth & Income Fund Class A - mutual fund CIISIP: 140543109 17,115.47 517.866 shares at $33.05 per share 8 7,887.437 Shares The Investment Company Of America Class A - mutual fund CIISIP: 461308108 225,265.20 7,887.437 eharea at $28.56 per share Total from continuation schedules 174,956.56 TOTAL (Also enter on line 2, Recapitulation) $ 605, 670.44 awae9s i.ooo (If more space is needed, insert additional sheets of the same size) 8etate of: Eliasbeth 3. Halters 21 12 0800 Schedule B (Page 2) Item Value at Date No. Description of Death 9 6,400 Shares Nuveen Municipal Value Fund - mutual fund CIISIP: 670928100 65,232.00 6,400 shares at $10.1925 per share Dividend accrued on 6/23/2012 249.60 30 7,488.568 Shares Thornburg Limited Term Municipal Fund Class A - mutual fund CIISIP: 885215459 109,333.09 7,488.568 shares at $14.60 per share Dividend accrued on 6/23/2012 141.87 Total (Carry forward to main schedule) 174,956.56 REV-15D8 EX+ (11-10) pennsylvania DEPARiMENi OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER: ow46AD 200o If more apace is needed, use add'dional sheets of paper of the same sae. REV-7511 EX. (1608) Pennsylvania OEPPR1MENi OF REVENUE SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF ri~c mlmocrt tti a aabeth S 4Pal tera 21 12 0800 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~ Malpeasi Funeral Home 7,500.00 2 Grave marker ~ 3,500.00 B. ADMINISTRATNE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address Ciry State ZIP Year(s) Commission Paid: 2. Attorney Fees: 7,500.00 3. Family Exemption: (If decedent's adtlress is not the same as GaimanTS, attach expanation.) 3 , 500.00 Claimant JaY F. V7alters Street Address 222 Messiah Circle Ciry Mechanicebura State PA ZIP 17055 Relationship of Claimant to Decedent SPOIISS 4. Probate Fees: 605.50 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. 1 l:ttatberland Law Journal Legal advertisement 75.00 2 The Sentinel Legal advertisement 214.70 Total from continuation schedules 17.05 TOTAL (Also enter on Line 9,Recapitulation) $ 22 912.25 9Wd8AG 2.088 If more space is needed, use additional sheets of paper of the same slze. Estate of: Elisabeth 3. ~altera Schedule H Part 7 (Page 2) 3 Estate Valuations & Pricing Systems, Inc. Date of death valuation of securities zl la oeoo 17.05 Total (Carry forward to main schedule) 17.05 REV-1513 EX+(01-10) SCHEDULE J Pennsylvania DEPAATMENTOF REVENUE BENEFICIARIES INHERRANCE TAX RETURN FILE NUMBER: 8lisabeth 3. 9Paltera 2112 OB 0 RELATIONSHIP TO DI=CEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Llst Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS (Inclutle outright spousal tlisldbutions end trensfere antler Sec. 9118 (a) (1.2).] t, Jay F. 4Pal tera 222 Messiah Circle Mechanicsburg, PA 17055 Surviving Spouea 0.00 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 TiROUGH 1 9 OF REV-1500 COVER SIIEET, AS APP ROPRIATE. II NON-TAXABLE DISTRIBUTIONS A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO 7AX IS NOT TAKEN: t~ 3ee Attached 1 B. CHARRABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVEF; SHEET. S 6 53 , 619 .48 eWO6Al 2.000 If more space is needed, use additional sheets of paper of the same size.