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HomeMy WebLinkAbout11-13-12' 1505610143 J REV-1500 ~"°~-"' PA Department of Revenue Pennsylvania Bureau of Individual Taxes OW"pT1e1Oi R"~NY° PO 80X.280601 INHERITA Harrisburg, PA 17128-0601 RESIDE ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 02 13 2012 Decedent's Last Name Suffix WALLACE (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Secudty Number OFFICIAL USE ONLY County Cade Veer File Number TAX RETURN 21 12 0246 )ECEDENT Date of Birth 04 OS 1941 Decedent's First Narne MI SHIRLEY A Spouse's First Name THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS MI FILL IN APPROPRIATE OVALS BELOW turn l R t ^ 3. Remainder Retum (Date of Death ^ 1. Original Relum e a 2 Supplemen Pnor to 12-13-82) ^ 4. Limitetl Estate ^ 4a. (mte of seem ekern1212-a2) ^ 5. Federal Estate Tax Return Required g Decedent Died restate ^ or Wilp h C ^ ~. Dace antoPYe~heB1)a Living rmet ( G ~ 8. Total Number of Safe Deposit Boxes opy (Atlec ^ ^ 9. Litigation Proceeds Received 1g g~~ai pgw~t red~t oa of Death ~~ d {- ~a5) ^ 11.Election to tax under Sec. g113(A) (Attach Schedule O) SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND BE DIRECTED T0: CONFIDENTIAry ~ flJ CORRESPONDENT -THIS e TBlepho e Numbe rf Name (717) 234 2401 HEATHER D ROYER ESQ First Line of Address 4431 N FRONT ST 3RD FL Second Line of Address City or Post Oifice HARRISBURG Correspondent's e-mail address: nndar penalties of cedurv. I tleclare that, State ZIP Code PA 17110 REGISTER OF WILLS USE O~J4Y ' C ~ ~ CJ .:.w w'- ' ~:.ri ~ _ G~- ._. C~ <::.... :r-. Qci__ ~. co is basetl on a0 In~forrnaGOo D. Royer Esq. 1I/~Z/IZi ~~ r7 ~` 't7 C"7 ,.-, ~t _~i `R ~~ _~ --i 4431 N Front Street 3rd Floor Harrisburg PA 17110 Side 1 1505610143 1505610143 ^ Alisa 1505610243 REV-1500 EX Decedent's Social Security Number Decedents Name' Wallace, Shirley Ann 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. 600.00 4. Mortgages & Notes Receivable (Schedule D) ........................................................ 4. 27,683.98 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5. 6. Jointly Owned Property (Schedule F) ^X Separate Billing Requested............ 6. 0.00 7. Inter-Vivos Transfers & Miscellaneous I~oq-PSroePatraterBileng Requested............ u 7. O . OO (Schedule G) 6 28,283.98 g. Total Gross Assets (total Lines 1 through 7) ................................................ , 17,906-87 9. Funeral Expenses and Administrative Costs (Schedule H) .................................... 9. 10 10,798.91 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............................ . 28 , 705.78 11. Total Deductions (total Lines 9 and 10) ................................................................ 11. 12 -421.80 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... . 13. Charitable and Governmental BequestslSec 9113 Trusts for which 13 an election to tax has not been made (Schedule J) ....................... . 14. Net Value Subject to Tax (Line 12 minus Line 13) .............................................. . 14. -421.80 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or 00 0 transfers under Sec. 9116 15. . (a)(1.2) X .00 0.00 16. Amount of Line 14 taxable 0.00 16. at lineal rate X .045 OO O 17. Amount of Line 14 taxable 0.00 17. ' at sibling rate X .12 00 0 18. Amount of Line l4 taxable 0.00 18. . at collateral rate X .15 19 0.00 19. TAX DUE ............................................................................................................. ... 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505610243 1505610243 REV-1500 EX Page 3 File Number 21-12-0246 Decedent's complere waaress: DECEDENT'S NAME Wallace, Shirley Ann STREETADDRESS 14 Hathaway Drive STATE ZIP CITY pA 17015 Carlisle Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 0.00 3. Interest q. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Cheok box 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) Total Credits (A + B) (2) (3) (4) (5) 0.00 0.00 ~.0~ 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 :.............................................................................. x b. retain the right to designate who shall use the property transferred or its income :.................................. ^^ c. retain a reversionary interest; or ............................................................................................................... d. receive the promise for life of either payments, benefits or care? ............................................................ ^ ^x 2. If death oxurred after Dec. 12, 1982, did decedent transfer property within one year of death without ^ ^ receiving adequate consideration? .................................................................................................................. . 3. Did decedent own an' in trust far" 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 ^ ^ wntains 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 January 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 (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)]. A sibling 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-1507EX~18-ael gCHEDULE D MORTGAGES 8L NOTES RECEIVABLE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TPX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Wallace Shirley Ann 21-12-0246 pll propxly JoiMlyownetl with dghl of survivorship must be tlbclosetl on Sehetlute F. VALUE AT DATE ITEM DESCRIPTION OF DEATH NUMBER 1 Promissory Note from Autumn Rhoads dated 1N6N2 600.00 TOTAL (Also enter on Line 4, Recapitulation) I 600.00 (If more space is nestled, adtligonal pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Forth PA-1500 Schedule D (Rev. 6-98) Rw-150! EX+(11-10) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TA%RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Include th ap„I ~a tlla~^i~~ Neh1l ~ s~rviv°nhipmust ea ei: ioda oh Kn e~I. F. aI prupaM 7 NUMBER ITEM DESCRIPTION NUMBER 1 PSECU Checking Account - No. 0198XXXXXX 2 PSECU Savings Account - No. 0198XXXXXX 3 1969 Glendale Mobile Home -Value per sale 4 2006 Kia Spectra -Value per sale 5 Dresser & lamp -Value per sale 6 Mattress, dresser & gold jewelry -Value per sale 7 Various items of personal property -Proceeds of sale of the following items: LoveseaUchair, coffee/end tables, kitchentable/4 chairs, dresser, bed frame, dishes/set 6, wall mirrors/2, lamps/2, wall pictures/5, misc. glassware, VHS tapes 8 throw rugs/6 g AAA Central Penn -Refund of membership dues 9 Andrews & Patel Associates -Refund of overpayment 10 Comcast -Refund 11 Commonwealth of Pennsylvania -Rent rebate 12 Foremost Insurance Agency -Pro-rated homeowners insurance refund 13 Holy Spirit Hospital -Refund of overpayment on medical bill 14 Ladies Home Journal -Pro-rated subscription refund 15 Patriot News -Pro-rated subscription refund VHLUC HI ui1lc OF DEATH 65.47 5.24 20,000.00 5,500.00 38.00 125.00 580.00 40.67 11.82 9.87 69.00 27.00 475.07 1.09 19.40 Total of Continuation Schedule See attached page TOTAL (Also enter on Line 5, Recapitulation) 27,683.98 (If more space is needed, additional pages of the same size) Copyright (c) 2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 11-10) "°"'~8~'"'-'D' WMMONWEALTHOi PENNSVLVFNIP INHERITPNDE TP% RETN RN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY continued FILE NUMBER ESTATE OF 21-12-0246 Wallace, Shirle Ann VALUE AT DATE ITEM DESCRIPTION OF DEATH NUMBER 0.01 16 Principal Financial Group -Balance of account 70.00 17 Proration of Lot Rent 31.32 18 Proration of Real Estate Taxes 19 Regency South Trailer Park -Refund of security deposit 300.00 11.02 20 Verizon -Refund 21 Westfield Insurance - Sportage premium refund 146.00 22 Westfield Insurance -Spectra premium refund 158.00 TOTAL (Also enter on Line 5, Recapitulation) I 27,663.98 Copyright (c) 2010 form software only The Lackner Group, Inc. Forrn PA-1500 Schedule E (Rev. 11-10) Rav-1509 EX~ (07-10) COMMONWEALTH OFPENNSVLVANIA INHERITANCE TA% RETU RN RE910ENT OECEOENr ESTATE OF SCHEDULE F JOINTLY-OWNED PROPERTY M wiMln ons year °f ttla aeeeaenra aata or Meth, it muse be rap°naa on ADDRESS 2 Thyme Court Mechanicsburg, PA 17050 98 Vasilios Drive Carlisle, PA 17015 NUMBER SURVIVING JOINT TENANT(S) NAME A. Alisa M. Norton g- Theresa A. Verm C. RELATIONSHIP TO DECEDENT Daughter Daughter JUlrvrLr ITEM NUMBER uWNE6 r LETTER FOR JOINT TENANT nvr ter., , DATE I MADE JOINT DESCRIPTION OF PROPERTY NCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER Oft SIMILAR IDENTIFYING NUMBER. ATTACH OEEO FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH ALUE OF ASSE % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1 B 01N2/2011 2009 Kia Sportage -DOD Value - $13,347.00 50.000% 0.00 DOD Value of Decedent's Interest - $6,673.50 SEPARATE BILLING REQUESTED 2 A O6N6/2004 MembeyslstFCUlnvestmentSavings 50.000% 0.00 Account-No.XXXX54-05 DOD Value - $0.88 DOD Value of Decedents Interest - $0.44 SEPARATE BILLING REQUESTED 3 A O6N6/2004 Members 1st FCU Savings Account - No. 50.000°~ 0.00 XXXX54-00 DOD Value - $121.19 DOD Value of Decedent's Interest - $60.60 SEPARATE BILLING REQUESTED TOTAL (Also enter on Line 6, Recapitulation) I u.uu (If more space is nestled, atltlirional pages of the same size) Copyright (c) 2070 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 01-10) Rev-1910 FX+(09-09) LOMMONWEALTHOP PENNSYLVANIA tNHERITANOE TPX RETURN RESIOENL DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF NUMBER This schetlule must t» completetl end filed d the answer m any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY THE GATE OF TROANSFERSATfACFiACOPV OF THE GEED F00R REAL ESTATE. DATE OF DEATH VALUE OF ASSET w of oeco~s INTEREST ( EXCLUSION IF APPLICABLE) TAXABLE VALUE 1 Theresa Verm -Daughter 1 00.000°k 0.00 98 Vasilios Drive, Carlisle, PA 17015 $5,452.15 total gift $3,000.00 exclusion $2,452.15 taxable SEPARATE BILLING REQUESTED TOTAL (Also enter on Line 7, Recapitulation) (If more space is needed, atlditional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. 0.00 Form PA-1500 Schedule G (Rev. OB-09) REV-0ib1 EX+110-09) SCHEDULE H FUNERAL EXPENSES AND COM IN~W ~D~S~L~ANIA ADMINISTRATIVE COSTS ~` FILE NUMBER ESTATE OF 21-12-0246 Wallace Shirley Ann Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBE p, FUNERAL EXPENSES: See continuation schedule(s) attached g, ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Alisa M. Norton Street Address 2 Thyme Court Ciry Mechanicsburg state PA zio 17050 Year(s) Commission Paid 2, Attarnev's Fees Smigel, Anderson 8 Sacks, LLP 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address - Ciry State Zio _ Relationshio of Claimant to Decedent 4. Probate Fees Alise M. Norton 5. Accountant's Fees 6. Tax Return Preparer's Fees Alan J. Ceperich and Associates 7. Other Administrative Costs See continuation schedule(s) attached 4,979.95 1,390.00 7,185.00 148.50 300.00 3,903.42 TOTAL (Also enter on line 9, Recapitulation) I 17,906.67 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-09) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF (FILE NUMBER Wallace. Shirley Ann 21-12-0246 ITEM DESCRIPTION AMOUNT NUMBER 1 Funeral Exp~pses Alisa M. Norton -Reimburse funeral bill 1,857.05 2 Jeffrey Harvey -Reimburse funeral bill 1,657.05 3 Malpeui Funeral Home -Balance due 408.80 4 Theresa Verm -Reimburse funeral bill 1,257.05 Other Administrative Costs 5 Alisa M. Norton -Reimburse postage/mileage 8 Cumberland Law Journal -Legal advertisement 7 Foremost Insurance Agency -Homeowners insurance premium 8 Frank Roberto -Tax Collector - 2012 ColTwp real estate taxes 9 Frank Roberto -Tax Collector -Tax certification 10 PP&L 11 PPB:L 12 PP&L 13 PSECU Checking Account -Dormant fee 14 Regency Parks -March/April lat rent H-A 4,979.95 117.82 75.00 93.25 35.63 10.00 53.88 21.99 18.13 2.00 800.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Wallace Shirley Ann 21-12-0246 DESCRIPTION AMOUNT NUMBER 15 ReMax Delta Group -Broker fee 195.00 16 ReMax Delta Group/Century 21 A Better Way -Commission on sale of mobile home 2,000.00 17 Suburban Propane 133.00 16 Suburban Propane 288'84 19 Suburban Propane 68.92 20 The Sentinel -Legal advertisement 210.78 H-67 3.903.42 Copyright (c) 2002 form software only The Lackner Group, Inc. Fonn PA-1500 Schedule H (Rev. 6-98) Rsv-1512 EX+ (12-08) COMMON WEALTH OF PENNSYLVANIA INHERITANCE TAx RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS ESTATE OF (FILE NUMBER Wallace. Shirley Ann 21-12-0246 RapoR debh incurred by the decadent pdor to death That remalnetl unpeld rt the tlals of death, Including unroimbunatl metlical expamas. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Citi Mastercard -Credit card acct. na. xxxx xxxx xxxx 9280 1,985.19 2 Esoterix Genetic Laboratories, LLC -Medical bill - 8131111 date of service 108.25 3 Internists of Central PA -Medical bill -1/13/12 date of service 25.25 4 PA Department of Revenue - 2011 State Income Tax due 225.00 5 Quest Diagnostics -Medical bill - 6/07N 7 date of service 5.82 6 QVC 94.82 7 United States Treasury - 2011 Federal Income Tax due 351.00 8 Verizon -Final bill 656.31 9 Walmart -Credit card acct. no. xxxx xxxx xxxx 8380 14.02 10 Wells Fargo Dealer Services -1/2 debt on Kia Sportage held jointly 7,333.25 TOTAL (Also enter on Line 10, Recapitulation) I 10,798.91 (If more space is needed, additional pages of the same size) Copyright (c) 2008 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-OB) REV-1510 EX+ (01-10) SCHEDULE J COMM t~F PE~ft.~VL~ANIA BENEFICIARIES ~~I ECED FILE NUMBER ESTATE OF Wallace, Shirle Ann 21-72-0246 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NAME AND ADDRESS OF DECEDENT NUMBER PERSON(Sl RECEIVING PROPERTY (Words) ($$$) T AXABLE DISTRIBUTIONS [include outright spousal I, distributions, and transfers under Sec. 9116 a 1.2 Jeffrey B. Harvey Son One-third 2024 Deer Path Drive Harrisburg, PA 17770 Alisa M. Norton Daughter One-third 2 Thyme Cort Mechanicsburg, PA 17050 Theresa A. Verm Daughter One-third 98 Vasilios Drive Carlisle 17015 ~ Total ~ Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 1500 cover sheet as a ro r NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION'TO TAXIS NOT TAKEN CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF YAM C. 11-gym rn iv~r,~,...~.-~~.... ~-.---•- -- - -- - Copyright (c) 2010 form sottware only The Lackner Group, Inc. Form PA-7500 Schedule J (Rev. 01-10)