HomeMy WebLinkAbout12-28-12
EX (01-10)
REV-1500 1 1505610143
Wk OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania County Code Year File Number
Bureau of Individual Taxes DEPARTMENT OF REVENUE
PO BOx.280601 INHERITANCE TAX RETURN 21 12 1013
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
165 18 8552 08 04 2012 06 04 1922
Decedent's Last Name Suffix Decedent's First Name MI
BOHN JEAN M
(If Applicable) Enter Surviving Spouse's Information 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 ❑ 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
® 6 Decedent Died Testate ❑ Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
❑ 9. Litigation Proceeds Received ❑ 10. Sbetween pousal Poverty o91Cr dit'datge5)of death E] 11. Election to tax under Sec. 9113(A)
(Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORM,t&N SHOUJ;iD BE DIRECTED TO:
Name Same TeleiiR3i ne
BETSY H SPROW 1* 37 , 1R3
y
M C-> C~ t „f
r-FtWIpTER MWILIaS USE ONLY
First line of address j t
522 WASHINGTON STREET
Second line of address <.3
PO BOX 1179
DATE FILED
City or Post Office State ZIP Code
READING PA 19603
Correspondent's e-mail address:
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SI ATURE OF PERS N RES SIBLE FOR FILING RETURN DATE /°'ly
r Susan E. Randazzo
ADDRESS Donna J. Paff Judith Anne Morello
2000 Highland Avenue, Reading, PA 19606/~~ QV 4~:z SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
f Y J,/ ~J Betsy H Sprow
ADDRESS
522 Washington Street, Reading, PA 19603
Side 1
1505610143 1505610143 ,J
r ,
1505610243
REV-1500 EX
Decedent's Social Security Number
-
Decedent's Name: B O H N, JEAN M 165 18 8552
RECAPITULATION
1. Real Estate (Schedule A) 1.
2. Stocks and Bonds (Schedule B) 2. 211,471.92
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3.
4. Mortgages & Notes Receivable (Schedule D) 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 5. 54,829.14
6. Jointly Owned Property (Schedule F) ❑ Separate Billing Requested 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 4,319.15
(Schedule G) ❑ Separate Billing Requested 7, 8. Total Gross Assets (total Lines 1-7) 8. 27 0, 6 2 0. 2 1
9. Funeral Expenses & Administrative Costs (Schedule H) 9. 13 , 452 30
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule 1) 10. 1 , 775 . 11
11. Total Deductions (total Lines 9 & 10) 11. 15 , 227 . 41
12. Net Value of Estate (Line 8 minus Line 11) 12. 255 , 392 80
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. 255,392.80
TAX COMPUTATION - 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 .00 15.
16. Amount of Line 14 taxable
at lineal rate X .045 255,392.80 16. 11 , 4 9 2. 68
17. Amount of Line 14 taxable
17.
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15 18.
19. Tax Due 19. 11,492 . 68
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
1505610243 1505610243 J
REV-1500 EX Page 3 File Number 21 - 12 - 1013
Decedent's Complete Address:
DECEDENT'S NAME
BOHN, JEAN M
STREET ADDRESS
4837 E. Tindle Road
CITY STATE ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19) (1) 11,492.68
2. Credits/Payments
A. Prior Payments 11,000.00
B. Discount 574.63
Total Credits (A + B) (2) 11, 574.63
3. Interest (3) 0.00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) 81.95
Check 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. (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 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? ❑
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration? ❑ ❑x
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? 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 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) (n)]. 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 refurn 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)]. A
sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by bloodd or adoption.
i
WILL OF
JEAN M. BOHN
I, JEAN M. BOHN, of Spring Township, Berks County,
r-j
Pennsylvania, hereby revoke all prior Wills and Codicils areclecla'~ _
KM C/3
this to be my Will. `V
I. DISPOSITIVE PROVISIONS
A. Specific Bequest.
D CD
I give all my furniture, household goods, motor
vehicles and articles of personal use and ornament to such of my
children, Judith Anne Morello, Carol L. Bowman, Donna J. Paff and
Susan E. Randazzo, who survive me.
B. Pecuniary Bequest.
I give Two Thousand Dollars ($2,000.00) to each of
my grandchildren, Gregory Morello, Jennifer Morello, Brian Bowman,
Christopher Paff and Valeria Sabatini, who survive me.
C. Residue.
I give the residue of my estate in equal shares to my
children, Judith Anne Morello, Carol L. Bowman, Donna J. Paff and
Susan E. Randazzo.
II. ADMINISTRATIVE PROVISIONS
A. Funeral and Burial.
I direct that my funeral and burial expenses be paid
from my estate as soon as convenient after my death.
B. Death Taxes.
All estate, inheritance and other death taxes imposed
by reason of my death shall be paid at such time or times as my
Executors deem proper from the residue of my estate without right of
contribution or reimbursement.
C. Protective Provision.
No interest hereunder shall be assignable by the
beneficiary or available to anyone having a claim against the
beneficiary.
D. Powers of Executors.
In addition to powers granted by law and not by way of
limitation, my Executors shall have the following powers exercisable
without court approval until final distribution:
1. Sale. To sell real or personal property at public
or private sale upon such terms, including terms of credit, and
conditions as may be proper under the circumstances.
2. Investments. To hold, retain, invest and reinvest
in any form of property without being limited to trust investments
prescribed by law and without regard for any principle of diversi-
fication.
3. Distribution. To make distribution in cash or in
kind, or partly in each.
4. Bond. To serve hereunder without being required
to post bond or other security in any jurisdiction for the faithful
performance of fiduciary duties.
E. Appointment of Executors.
I appoint my children, Judith Anne Morello, Carol L.
Bowman, Donna J. Paff and Susan E. Randazzo, Executors of this my
Will.
IN WITNESS WHEREOF, I have hereunto subscribed my name and
affixed my seal this day of April, A.D. 2000.
(SEAL)
(Jean . Bohn)
Signed and Declared by JEAN M. BOHN to be her Will in the
presence of us, who at her request and in her presence and in the
presence of each other, subscribed our names as witnesses:
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF BOHN, JEAN M 21-12-1013
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM DESCRIPTION UNIT VALUE VALUE AT DATE OF
NUMBER DEATH
1 Merrill Lynch Wealth Management acct # 794-35792 210,974.07
(see attached breakdown)
2 15 sh Met Life 33.19 497.85
TOTAL (Also enter on line 2, Recapitulation) 211,471.92
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SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF BOHN, JEAN M 21-12-1013
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 PNC Bank checking acct ----6564 1,380.21
2 PNC Bank checking acct ----5749 10,446.67
3 accr int 0.06
4 PNC Bank CD ----9556 10,773.87
5 accr int 1.16
6 PNC Bank CD ----6402 8,017.31
7 accr int 9.99
8 Stoneridge Village - refund for apartment 24,130.00
9 PSERS - retirement benefit 17.82
10 Refunds 52.05
TOTAL (Also enter on Line 5, Recapitulation) 54,829.14
SCHEDULE G
COMINHERITANC OAXRETURN ANIA INTER-VIVOS TRANSFERS &
RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY
ESTATE OF BOHN, JEAN M FILE NUMBER
21-12-1013
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF EXCLUSION TAXABLE VALUE
NUMBER Include the name of the transferee, their relationship to decedent VALUE OF ASSET INTDECD'S EREST (IF APPLICABLE)
and the date of transfer. Attach a copy of the deed for real estate.
1 Merrill Lynch IRA acct # 794-82N66 4,319.15 4,319.15
est. 1989
benef. four daughters - Judith A. Morello, Carol L.
Bowman, Donna J. Paff, Susan E. Randazzo
TOTAL (Also enter on line 7, Recapitulation) 4,319.15
SCHEDULE H
FUNERAL EXPENSES &
COMMONWEALTH OF PENNSYLVANIA /
INHERITANCE TAX RETURN
RESIDENT DECEDENT ADMINISTRATIVE WJTS
FILE NUMBER
ESTATE OF BOHN, JEAN M 21-12-1013
Debts of decedent must be reported on Schedule I.
ITEM AMOUNT
NUMBER FUNERAL EXPENSES: DESCRIPTION
A. 1 Bean Funeral Home, Inc - balance due 598.74
2 Funeral lunch 546.76
3 Rev. Sutliff - funeral service 150.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission paid
2. Attorney's Fees Derr, Hawman & Derr Betsy H. Sprow 11,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 108.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1 Cumberland County Law Journal - estate notice 75.00
TOTAL (Also enter on line 9, Recapitulation) 13,452.30
Schedule H
Funeral Fxenses &
COMMONWEALTH C PENNSYLVANIA
INHERITANCE TAX RETURN AdminW ative Costs continued
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF BOHN, JEAN M 21 - 12 - 1013
2 Patriot News - estate notice 224.40
3 Witness fee - Shirley Sherman 35.00
4 Postage 204.75
5 Parking fees, Exec's (expenses in lieu of fee) 116.00
6 Merrill Lynch - fees on sale of funds 48.15
7 Register of Wills - additional fee for letters 290.00
8 Register of Wills - filing inheritance tax return and inventory 30.00
9 Register of Wills - filing releases 25.00
Page 2 of Schedule H
SCHEDULEI
DEBTS OF DECEDENT, MORTGAGE
COMMONWEALTH OF PENNSYLVANIA LIABILITIES & LIENS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF BOHN, JEAN M 21-12-1013
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM DESCRIPTION AMOUNT
NUMBER
1 Health Network Laboratories - unpaid bill 11.05
2 Country Meadows, West Shore - balance due for August 1,003.17
3 Azizhan Internal Medicine Assoc - balance due 29.98
4 Alpha Diagnostics, LLC - balance due 30.00
5 Diamond Pharmacy - bill for medications 100.91
6 Holy Spirit Hospital - balance due for admission 600.00
TOTAL (Also enter on Line 10, Recapitulation) 1,775.11
REV-1513 EX+ (11.08)
SCHEDULEJ
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF BOHN, JEAN M FILE NUMBER
21 - 12 - 1013
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words)
RECEIVING PROPERTY Do Not List Trustee(s)
ITAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116 (a) (1.2)]
1 Christopher Paff grandson 2,000.00
131 Thomas Drive
Wernersville, PA 19565
2 Valerie Sabatini granddaughter 2,000.00
1607 Westover Road
Yardley, PA 19067
3 Brian Bowman grandson 2,000.00
42 Dunlin Meadow Driv
The Woodlands, TX 77381
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet, as appropriate.
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11 - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
REV-1513 EX+ (9-00)
SCHEDULEJ
COMMONWEALTH SYLVANIA BENEFICIARIES continued
INHERITANCE TAX TAX RETURN
RESIDENT DECEDENT
ESTATE OF BOHN, JEAN M I FILE NUMBER
21-12-1013
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words)
RECEIVING PROPERTY Do Not List Trustee(s)
I, TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116 (a) (1.2)]
4 Jennifer Graf granddaughter 2,000.00
1709 Wyndham Road
Camp Hill, PA 17011
5 Gregory Morello grandson 2,000.00
2468 Forest Meadow Court SE
Grand Rapids, MI 49546
6 Susan E. Randazzo daughter 1/4 residue
2000 Highland Avenue
Reading, PA 19606
7 Donna J. Paff daughter 114 residue
14 Hemlock Circle
Wernersville, PA 19565
8 Judith A. Morello daughter 1/4 residue
908 Forbes Road
Carlisle, PA 17013
9 Carol L. Bowman daughter 114 residue
5802 Bob Bullock C-1
Unit 328 C-109
Laredo, TX 78041
Page 2 of Schedule J