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Home My WebLink About10-22-12 (2)1505611185 -' REV-1500 EX (02-11) (FI) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN 21 12 0 8 0 0 Po sox 2eosot Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 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 DUPLICATE 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 (date of ^ 5. Federal Estate Tax Return Required death after 12-12-82) ® 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 Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number HOWELL C• METTE, ESQUIRE ?17-232-5000 __ REGISTER OF W~~BE ONLY ~-~ ~l r~ -~ '~ ~7 a ~ ~ r" ~ "^'t ~ A~ ~ First Line of Address 1V __~ 3401 NORTH FRONT STREET ~~'~ - r t '`' ~~' c~v ~ `: Second Line of Address ~ `~ - t:i -_ _...` =1 _ D y ~ .~, ~ '~'-' PO BOX 5950 `- City or Post Office State ZIP Code DATE FILED ~ ~~ ~ Tt HARRISBURG PA 171100950 Correspondent's e-mail address: H C M E T T E a M E T T E- C O M Under penalties of perjury, I declare that I have examined this return, induding accompanying schedules and stet ants, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the pe prase is aced on in of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ~~ ~ 2 DAVID W• WALTERS ADDRESS 242 RIDGE ROAD MECHANICSBURG, PA 17050 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE f METTE, EVANS & WOODSIDE / r~i Ala ~~ 7~' DATE Q ~~ ~ ~ 4 ~ o ~a 3401 N• FRONT STREET, PO BOX 5950 HARRISBURG, PA 17110-0950 PLEASE USE ORIGINAL FORM ONLY 1505611185 Side 1 OM4847 3.000 1505611185 ~..,I 1505611285 REV-1500 EX (FI) Decedent's Social Security Number Decedent'sName• WALTERS ELIZABETH S RECAPITULATION 1. Real Estate (Schedule A) 1. 0 • D 0 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 Deposits and Miscellaneous Personal Property (Schedule E) 5. 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested g, 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested 7. 8. Total Gross Assets (total Lines 1 through 7) . . . . g, 605,670.44 0.00 0.00 70,861.29 0.00 0.00 676,531.73 9. Funeral Expenses and Administrative Costs (Schedule H). s. 2 2 , 912.2 5 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) 10. 0 • 0 0 11. Total Deductions (total Lines 9 and 10) , 11. 2 2 , 912.2 5 12. Net Value of Estate (Line 8 minus Line 11) . 12, 6 5 3 , 619.4 8 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) , , 13. 6 5 3 , 619.4 8 14. Net Value Subject to Tax (Line 12 minus Line 13) , 14, 0 , 0 0 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 0 • 0 0 15. 16. 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 0 • 0 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 0 • 0 0 18. 19. TAX DUE 19. 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505611285 1505611285 OM4648 3.000 0.00 0•DO 0.00 0.00 0.00 REV-1500 EX (FI) Page 3 File Number Decedent's Com lets Address: C Ja Ja C u n u u DECEDENTS NAME STREET ADDRESS CITY STATE ZIP Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments 0 • 0 0 e. Discount 0 •0 0 (1) 0.00 Total Credits (A + B) (2) 0 • 0 0 3. Interest (3) 0.00 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 ' 0 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, 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 Vansferred .... .. .. ....... .. .... .: ^ 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? .. 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death ^ without receiving adequate consideration? . .... " " ^ or payable-upon-death bank account or security at his or her death9 in trust for 3. Did decedent own an 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 transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. Far 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(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)j. 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. OM4671 2.000 REV-1503 EX * (9.98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS OF NUMBER Sliaebeth s welters al 1a o800 All property jointly-owned with right of survivorship must be disclosed on Schedule F. VALUE AT DATE ITEM DESCRIPTION of DEATH NUMBER 1.2,782 Shares AT&T, Inc. common stock CIISIP: 002068102 2,782 shares at $35.035 per share 2 800 Shares Exelis, Inc. common stock CIISIP: 30162A108 800 shares at $9.53 per share Dividend accrued on 6/23/2012 3 400 Shares ITT Corp. New common stock CIISIP: 450911201 400 shares at $17.825 per share Dividend accrued on 6/23/2012 4 400 Shares Johnson & Johnson common stock CIISIP: 478160104 400 shares at $66.565 per share 5 800 Shares Xylem Inc. common stock CIISIP: 98419M100 800 shares at $23.82 per share 6 1,950 Shares Blackrock Muniyield PA Quality Fund - mutual fund CIISIP: 092556107 1,950 shares at $15.47 per share Dividend accrued on 6/23/2012 7 517.866 Shares Capital world Growth & Income Fund Class A - mutual fund CIISIP: 140543109 517.866 shares at $33.05 per share 8 7,887.437 Shares The Investment Compaay of America Class A - mutual fund CIISIP: 461308108 7,887.437 shares at $28.56 par share 97,467.37 7,624.00 82.64 7,130.00 36.40 26,626.00 19,056.00 30,166.50 144.30 17,115.47 225,265.20 Total from continuation schedules 174,956.56 TOTAL (Also enter on line 2, Recapitulation) $ 605, 670.44 3W 4898 7.000 (If more space is needed, insert additionalsheets of the same size) 8state of: 8liaabeth 3. Halters 21 12 0800 Schedule B (Page 2) Item Value at Date No. Description of Death 9 6,400 Shares Nuvean Municipal Value Fund - mutual fund CIISIPs 670928100 65,232.00 6,400 shares at $10.1925 per share Dividend accrued on 6/23/2012 249.60 10 7,488.568 Shares Thornburg Limited Term Municipal Fund Clasa 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•150ti EX+ (11-10) Pennsylvania SCHEDULE E DEPARTMENTOF REVENUE CASH, BANK DEPOSITS, 8 MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT --- ESTATE OF: FILE NUMBER: Elizabeth 3. Walters 21 12 0800 OwasAD 2.000 Ii more space is needed, use additanal sheets of paper of the same size. REd/,•1511 EX+ (atF09) Pennsylvania DEPARTMENTOF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER ~'~ s --~^~~~ 3 Walters 21 12 0800 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~. Malpeasi Funeral Home 2 Grave marker 7,500.00 3,500.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid: 2. Attorney Fees: 7 , 5 0 0.0 0 3. Family Exemption: (If decedent's address is not the same as claimants, attach explanation.) 3, 500 .00 Claimant Jav F. Walters Street Address 222 Messiah Circle City Mechanicsburg State PA ZIP 17055 Relationship of Claimant to Decedent SPOIISL 4. Probate Fees: 6 0 5.5 0 5. Accountant Fees: 6. Tau Retum Preparer Fees: 7. 1 Cumberland 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) $ 2 2 , 912 .2 5 awasnc 2.00o If more space is needed, use additional sheets of paper of the same size. Estate of: Elizabeth S. Walters 21 12 0800 Schedule H Part 7 (Page 2) 3 Estate Valuations & Pricing Systems, Inc. Date of death valuation of securities 17.05 Total (Carry forward to main schedule) 17.05 REV-1513 EX+(01-10) Pennsylvania DEPARTMENT OF REVENUE INHERRANCETAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES OF: FILE NUMBER: Elizabet h 3. Walters al la 800 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 [InGude outright spousal distributions and transfers under SeC. 9116 (a) (1.2).) 1. Jay F. Walters 22a Messiah Circle Mechanicsburg, PA 17055 Surviving Spouse 0.00 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APP ROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1• See Attached 1 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. S 6 5 3 , 619 .4 8 9W46AI 2.000 If more space is needed, use additional sheets Of paper of the same size. 8state of: Elizabeth 3. Walters 21 12 0800 Schedule J Part 2A (Page 1) Item No. Description Amount 1 Testamentary Trust FBO Jay F. Walters 653,619.48