HomeMy WebLinkAbout11-30-12
1505610140
REV-1500
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number
PO BOX 280601 2 1 1 0 1 0 4 7
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
2 0 2 2 0 4 7 0 2 0 9 2 4 2 0 1 0 0 2 0 3 1 9 2 8
Decedent's Last Name Suffix Decedent's First Name MI
G 0 0 D L I N G E V E L Y N L
(If Applicable) Enter Surviving Spouse's Infonnetion Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number _
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS 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 0 7. Decedent Maintained a Living Trust 8. Total Number of Sate 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 Sch. O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOO E DWTIATO:
Name Daytime *phone NumbW M c-~,
M A R C U S A M c K N I G H T I I I 7 1 4 9 3U~
. M C, -.4 v
RE r*PLLS ON Cl! First line of address C-> K
j
6 0 W E S T P 0 M F R E T S T R E E T ca rte-" ~I ca
Second line of address `~-t N N
City or Post Office State ZIP Code DATE FILED
C A R L I S L E P A 1 7 0 1 3
Correspondent's 9-mall address:
Under penalties of pequry, I declare that I have examined this return, including accompanying schedules and statements, and tD the best of my knowledge and belief,
it is true, and corn b re r other than the personal representative In based on all Infomatlon of which
preparer has any knowledge.
(IGNATU TUR F PERSO ESPON F ILING RETURN DAT~ ,rye
DDR W I ~ I L- ; Z-E~ V-V ~-=D - 1 L-~ L
P ER E SENTATNE DATE
ADDRESS
60 WEST POMFRE REET CARLISLE PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610140 1505610140 J
` Continuation of REV-1500 Inheritance Tax Return Resident Decedent
EVELYN L. GOODLING 21 10 1047
Decedent's Name Page 1 File Number
Correspondents
Name Daytime Telephone Number
M A R C U S A M c K N I G H T I 1 1 7 1 7 2 4 9 2 3 5 3
First line of address
6 0 WE S T P O M F R E T S T R E E T
Second line of address -
City or Post Office State ZIP Code
C A R L I S L E P A 1 7 0 1 3
Comespondenfs e-mail address:
Under penalties of pery'ury, I declare that 1 have examined this rehrm, Including a=mpanying schedules and statsmerds, and to the best of kn Adg
it is hue, coed and complete. Dedarallon of preparer other then the personal representative is based on all krformadon of which preparer has any knowledge. belief,
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE
ADDRESS
365 W. NORTH STREET CARLISLE PA 17013
i
J 1505610240
REV-1500 EX
Decedent's Social Security Number
DecedentsHame: EVELYN L. GOODLING 2 0 2 2 0 4 7 0 2
RECAPITULATION
1 1. Real Estate (Schedule A) 7 4 7 0 0.0 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. 7 0 1 9. 6 8
6. Jointly Owned Property (Schedule F) ❑ Separate Billing Requested 6. 1 5 8 6. 5 6
7. Inter-Vivos Transfers & Miscellaneous N Probate Property
(Schedule G) Separate Billing Requested 7. .
S. Total Gross Assets (total Lines 1 through 7) 8. 8 3 3 0 6. 2 4
9. Funeral Expenses and Administrative Costs (Schedule H) 9. 1 3 4 8 0. 2 3
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule 1) 10. 3 3 2 7. 6 9
11. Total Deductions (total Lines 9 and 10) 11. 1 6 8 0 7. 9 2
12. Net Value of Estate (Line 8 minus Line 11) 12. 6 6 4 9 8. 3 2
13, Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) 14. 6 6 4 9 8. 3 2
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 0 15. 0. 0 0
16. Amount of Line 14 taxable
at lineal rate X .045 3 3 2 4 9. 1 6 16. 1 4 9 6. 2 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 3 3 2 4 9. 1 6 18. 4 9 8 7. 3 7
19. TAX DUE ......................................................19. 6 4 8 3. 5 8
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Side 2
L 1505610240 1505610240
REV-1hQ0 EX Page 3 File Number
Decedent's Complete Address: 21 10 1047
DECEDENTS NAME
EVELYN L. GOODLING
STREET ADDRESS
9 BALL PARK ROAD
CITY STATE ZIP
GARDNERS P117324
Tax Payments and Credits:
• Tax Due (Page 2, tine 19) (1) 6,483.58
2. CredWPayments
A, Prior Payments
B. Discount
Total Credits (A + B) (2) 0.00
3. Interest -
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This Is the OVERPAYMENT. (3) -
Fill In oval on Page 2, Line 20 to request a refund. (4) 0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 6,483.58
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 : ❑ 191
b. retain the right to designate who shall use the property transferred or its income; ❑ FX1
c. retain a reversionary interest; or ❑ FZ1
d. receive the promise for life of either payments, benefits or care? ❑
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ❑
3. Did decederd own an 'in trust for' or payable-upon-death bank account or security at his or her death? ❑ R
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) (1)].
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) (IQ]. 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 decedents 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)]. 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-1802 EX* (01-10)
pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
EVELYN L. GOODLING 21 10 1047
At real property owned solely or as a tenant In common must be reported at fair market value. Fair market value is defined as the price at which properly
would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevard facts.
Real property that Is Jointly-med with right of survivorship must be disclosed on Schedule F.
Attach a copy of the settlement sheet If the property has been sold.
ITEM Include a copy of the deed showing decedent's Interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1. S BALL PARK ROAD, GARDNERS, PENNSYLVANIA 74,700.00
TOTAL (Also enter on Line 1, Recapitulation,) : 74 700.00
if more apace is needed, use additional sheets of paper of the same size.
REV-1508 EX + (8-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCE
PERSONAL PROPERTY
RESIDENT DECEDENT RETURN
ESTATE 4F FILE NUMBER
EVELYN L. GOODLING 21 10 1047
Include thepr Beds of IRigalm and the date the proceeds were receW by the estate.
All property joMtlyownsd xdM right of sunfvorship must be disclosed os Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 1999 FORD ESCORT LX - VIN #1 FAFP10PBXW266601 450.00
2. CASH 341.00
3. M&T BANK - SAVINGS ACCOUNT #15004220948226 750.17
I
4. M&T BANK - SAVINGS ACCOUNT #15004200942561 4,44220
5. M&T BANK - CHECKING ACCOUNT #951595 585.83
6. M&T BANK - CHRISTMAS CLUB ACCOUNT 450.48
TOTAL (Also enter on line 5, Recapitulation) $ 7,019-68
(if more space is needed, insert additional sheets of the same size)
REV-1,509 EX+ (01-10)
pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
~ ESTATE OF: FILE NUMBER:
EVELYN L. GOODLING 21 10 1047
If an asset was made jointly owned within one year of the decedents dabs of death, It must be reported on Schedule Q.
SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A. CORBETT L. BAKER 365 WEST NORTH STREET GRANDSON
CARLISLE, PA 17013
B. HAILIE RENE BAKER NEED ADDRESS GRANDDAUGHTER
C.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FORJOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENTS VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST
1. A. 09/2007 JOINT CREDIT UNION 1,089.36 50. 544.68
(ACCOUNT NUMBER)
2. B. M&T BANK - SAVINGS ACCOUNT #15004211166861 2,083.76 50. 1,041.88
TOTAL (Also enter on Line 6, Recapitulatlon) $ 1,586.56
1 more speoe is needed, use additional sheNs of paperof the same siae.
REV-1.51 1 EX+ (10.09)
pennsylvania SCHEDULE H
DEPAM ENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCETAX
RESIDENT TURN
RESIDEtJ'r DKEDEEN NT ADMINISTRATIVE COSTS
DECE
ESTATE OF FILE NUMBER
EVELYN L. GOODLING 21 10 1047
DKedent's debts must be reported on Schedule L
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. HOLLINGER FUNERAL HOME 10,185.57
B. ADMINISTRATIVE COSTS:
1. Personal RWresentatlve Commissions:
Name(s) of Personal Represertatlve(s)
StmetAddrese
CRY State ZIP
Year(s) Commission Paid:
2. AtOomeyFeee: IRWIN & MCKNIGHT,P.C. 2,500.00
3. Family Exemption: (If decedents address Is not the same as dkwnts, attach exptanatlon.)
Clairmnt
Streat Address
City St* ZIP
Relationship of Claimant to Decedent
4. probeteFew: REGISTER OF WILLS 137.50
5 Accountant Fees:
6. Tax Return PreparerFees: PATRICIA A. ROSEN DALE, CPA 350.00
FINAL FIDUCIARY RETURN
7. REGISTER OF WILLS - FILING FEE 30.00
8. REGISTER OF WILLS - SHORT CERTIFICATE 4.00
9. THE SENTINEL - ESTATE NOTICE 198.16
10. CUMBERLAND LAW JOURNAL - ESTATE NOTICE 75.00
TOTAL (Also enter on Llne 9, Recapitulation) : 13 480.23
If more space Is needed, use additional sheets of paper of the some size,
REV4512 EX+ (12-08)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES, Si LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
EVELYN L. GOODLING 21 10 1047
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, Including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. PP&L - ELECTRIC 96.09
t
2. DIRECTV - CABLE UTILITY 77.66
3. CENTURYLINK - TELEPHONE 95.00
i
4. PECK'S SEPTIC SERVICE - MAINTENANCE 120.00
5. LOWE'S - CREDIT CARD 608.44
6. CAPITAL ONE - CREDIT CARD 584.92
i
7. PHYSICIANS MUTUAL INSURANCE - INSURANCE PREMIUM 33.95
8. REASSURE AMERICA LIFE INSURANCE - INSURANCE PREMIUM 12.80
9. STATE FARM INSURANCE - AUTO INSURANCE 150.00
10. BLAIR - CREDIT CARD 147.87
11. McDANNELL OIL - FUEL OIL 600.00
(ESTIMATE)
12. REAL ESTATE TAXES 750.00
(ESTIMATE)
13. 2010 CUMBERLAND COUNTY LOCAL TAX DELINQUENCY 50.96
TOTAL (Also enter on Line 10, Recapitulation) $ 3,327.69
If more spaoe is needed, Insert addMonal sheets of the some size.
REV-1&13 EX+ (01.10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
EVELYN L. GOODLING 21 10 1047
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trintee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include o pht s usal dietrbudons and transfers under
Sec. 9 6t
1. RUSSELL S. LIVINGSTON Collateral 33,249.16
659 N. CREEK ROAD 112 REMAINDER
EAST BERLIN, PA 17316
2. JAMES W. BAKER Lineal 33,249.16
365 W. NORTH STREET 112 REMAINDER
CARLISLE, PA 17013
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
19. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET, 5
If more space is needed, use additional sheets of paper of the same size.
Grandma's BMs/AccounA
1. Electric - MetEd Ac ct#100021111180. $96.09
2. Phone - Century Link Acct# 717-486-3898-936
3. DirecTv - Acct #45964232 $77.66
4. Septic - Peck's Septic Service 717-486-5548 $120;
5. Lowe's Account# 81933391655224 $ M1
6. CapitalOne Credit Card Acct#. f
3 7. Physicians Mutual Insurance - Policy #018-338-806
8. Reassure America Life Insurance - Policy #6921263
9. State Farm Auto Insurance - Policy #51-4690-8084
10. Blair Acct# 5780-9810-0856-6537
11. Ambulance Fee ?
12. Carlisle Sentinel -
13. Gettysburg Times - Cancelled 12 Oct 10
14. M&T Bank Accidental Insurance
15. Guarantee Reserve Life - Life Insurance on Hailie
16. Physician's Mutual - Coverage for hospital stay
17. Mutual of Omaha - Cancer insurance
18. Healthassurance Advantra Pro - #80208306201- Medicare
19. State Farm Homeowner's Insurance - Policy# 38-50-0717-6
20. State Farm Auto Insurance - Policy #51-4690-8084
21. AAA
$1831.73
Insurance/Joiat Accounts
1. Knouse Foods Nancy Baker $15,000
2. Monumental - Policy# 1014127645 - Nancy Baker $1000
3. Monumental - Policy# 1014594662 - Nancy Baker $700
4. Monumental - Policy# I010725734 - Nancy Baker $500
5. Aviva - Russell Livingston $5,000
6. Monumental - Policy #MM4863308 - Russell Livingston $1716
7. Monumental - Policy# 1017364358 - Russell Livingston $500
8. Monumental - Policy# 104983650 - Darrell Livingston $1000
9. Monumental - Policy# 1014678650 - James Baker $1000
10. Monumental - Policy #1010427878 - Corbett Baker $1000
11. UFCW Credit Union - Corbett's Account #600263 $1099.76
12. M&T - Corbett's Account #15004220948226 $750.18
13. M&T - Hailie's Account $1983.68
14. Reassure - Policy# 6921263 (Called 12 Oct 10; Awaiting claims forms)
11 &TBank
f 499 Ntchell Road, hlillsbor% DE 19%6 Adjustment services
Phone 888-S02-4349
Pax (302) 934-2955
October 26, 2010
Law Offices Irwin $ McSn*bt PC
West Pomfret Professional Building
60 West Pomfret Street RECEIVED
Carlisle, PA 17013-3222
OCT 2 8 2010
j ' IRWIN & McKNIGHT
Re: Estate of Evelyn L Goodling LAW OFFICES
Social Security: 202720-4702
Date of Death: September 24, 2010 -
Dear Sir or Madam:
Per your inquiry on October 18, 2010, please be advised that at the time of death, the above-named decedent
had on deposit with this bank the following:
i
i
1. Type of Account Scoring Account
AcaountNumber 15004220948226
Ownership (Names of) Evelyn L Gtg
Opening Date 0110
Balance on Date of Death $750.15
Accrued Interest $ .02
-
Total $750.17
2. TypeofAcaount Savings Account
Account Number 15004211166861
Ownership (Names of) Hadie Rene Baker, Minor
Evelyn L Gooefibig Custodian
Opening Date 07282004
Balance on Date of Death $2083.76
Accrued Interest $ .09
Total $2.083.85
,
3. Type of Account Savings Account
Account Number 15004200942561
J
Ownership {Names of} Evelyn L Good Ung
Opening Date 02f16/1987
Balance on Date of Death $4,442.14
Accruedlnterest $ .06
Total $4,442.20
4. Type ofAccow CheddngAccount
Account Number 951595
Ownership (Names of Evelyn L Goodling
Opening Date =90008
Balance on Date of Death $585.83
Accrued Interest 0.00
Total $58583
5. 7)pe of Account Chrisdnas Club Account
i
AccountNumber 25004920119507
Ownership (Names ofl Evelyn LGoodling
Opening Date 11/1311987
Balance on Date ofDeath $450.08
Accrued Interest $ .40
Total $45048 _ _
For farther Ramat tofmination, closures and/or rdmbnssement of funds pkm c00 the Mont Homy Sprlnp Ofce at #n74M 3008.
We were unable to locate any sate deposdt box for the abovomendoned. decedent
M& War does not hwhide may mcm, is in whhh the deceased may bm been Hded m Power of Attosvey, Custodian of Unffoam 7w, r
Reprtm Pn'etive PAM or ltnstee ceder a Wrbtgn Agreement
Surely,
Tammy R Spencer
Adjustme$t Services
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EP14FNovember20110 U.S. Postal Service
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Misuse maybe a violation of federal law. This packaging is not for resale. EP14F0 U.S Postal Service; November 2011, All rights reserved.