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Home My WebLink About12-19-12 11 1505610105 REV-1500 EX (OZ-ii) (FI) 6 ~1 PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau Individual Taxes e s T Code Year File Number INHERITANCE TAX RETURN PO BOX 28o6o1 ~ Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 217-54-6661 03/17/2012 09/04/1952 Decedent's Last Name Suffix Decedent's First Name MI Neilson James D (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Neilson Betsy C Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 226-60-4557 REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW CMD 1. Original Return O 2. Supplemental Return O 3. Remainder Return (Date of Death Prior to 12-13-82) C= 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) Op 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 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 Betsy C. Neilson (717) 737-1362 C7 ~D §3I5ER OF WILLS US416NLjF 1-0 G> 1'tl ~ G'7 n ~ , First Line of Address 5257 Terrace Road A C = c1D' . 7c C> Second Line of Address C-> -4'i . t7 C City or Post Office State ZIP Code .+a DATE F ED g Mechanicsburg PA 17050 w Correspondent's e-mail address: bneilSOn@comcast.net 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 base n all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN D TE ADDRESS 5257 Terrace Road, Mechanicsburg, Pa 17050 ^ l `►7 SIGNA R PRE~RE~' E/ REPRESENTATIVE DAT1J~~ ADDRESS ~ 3100 Gettysburg Road, Camp Hill, Pa 17011 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610105 1505610105 .1 1505610205 REV-1500 EX (Fl) Decedent's Social Security Number Decedent's Name: James D. Neilson 217-54-6661 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. 4. Mortgages and Notes Receivable (Schedule D) 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 72,713.00 6. Jointly Owned Property (Schedule F) O Separate Billing Requested 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 29,849.49 8. Total Gross Assets (total Lines 1 through 7) 8. 102,562.49 9. Funeral Expenses and Administrative Costs (Schedule H) 9. 7,859.50 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule 1) 10. 31,544.28 11. Total Deductions (total Lines 9 and 10) 11. 39,403.78 12. Net Value of Estate (Line 8 minus Line 11) 12. 63,158.71 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. 63,158.71 TAX CALCULATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 33,309.22 (a)(1.2) X .0 0 15. 0.00 16. Amount of Line 14 taxable at lineal rate X .0 45 29,84949 16. 1,343.23 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE .........................................................19. 1,343.23 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: DECEDENTS NAME James D. Neilson STREETADDRESS 5257 Terrace Road CITY STATE ZIP Mechanicsburg PA 17050 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 1,343.23 2. Credits/Payments A. Prior Payments - 1,343.23 B. Discount Total Credits (A+ B) (2) 1,343.23 3. Interest (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 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 ❑ 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? ❑ 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 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)]. 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-15o8 EX+ (o8-i2) i pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: James D. Neilson Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PSECU Bank Account - Checking Account 688.00 2 Final paycheck from Commonwealth of Pa. - vacation/sick pay 60,275.00 3 Consulting Fee paycheck 4,500.00 4 2006 Chysler Sebring Touring Model 5,500.00 5 1988 GMC Sonoma 1,750.00 TOTAL (Also enter on Line S, Recapitulation) $ 72,713.00 If more space is needed, use additional sheets of paper of the same size. RSV-1513 )8.09` pennsylvania SCHEDULE G DEPARTMENT of REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER James D. Neilson This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH °/a OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1. Wells Fargo IRA account # 4734-8102 - Benficiary is James Robert Neilson 29,849.49 100 29,849.49 (Son of decedent) 2413 Aspen Way, Harrisburg, Pa 17110 TOTAL (Also enter on Line 7, Recapitulation) $ 29,849.49 If more space is needed, use additional sheets of paper of the same size. REV-1511 EXr 0-04) pennsyLvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER James D. Neilson Decedent's debts must be reported on Schedule I, ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Church - Silver Spring Presbatrian 600.00 2 Auer Cremation Services of Pennsylvania 2,127.00 3 Flowers, Music 127.00 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: 768.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) 3,500.00 Claimant Betsy C. Neilson Street Address 5257 Terrace Road city Mechanicsburg State Pa zip 17050 Relationship of Claimant to Decedent Spouse 4. Probate Fees: 137.50 5. Accountant Fees: 6. Tax Return Preparer Fees: 600.00 7. TOTAL (Also enter on Line 9, Recapitulation) $ 7,859.50 If more space is needed, use additional sheets of paper of the same size. REV-1512 EX4. ;'12-08) pennsytvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER James D. Neilson 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. Springleaf 4,950.00 2 Mastercard 1,758.75 3 Mastercard 6,955.65 4 PSECU Visa 6,763.02 5 Home Depot 2,433.80 6 Kohl's 353.27 7 Medical Expenses - Andrews & Patel 250.00 8 Medical Expenses - 56.00 9 PSECU - Auto Loan 8,023.79 TOTAL (Also enter on Line 10, Recapitulation) $ 31,544.28 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) pennsylvania SCHEDULE DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: James D. Neilson 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 [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] I. Betsy C. Neilson , 5257 Terrace Road, Mechanicsburg, Pa 17050 Spouse 100% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF 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: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed, use additional sheets of paper of the same size. N!EILSON .l 1. JAMES DANIEL NEILSON, residing at MECHANICSBURG, PENNSYLVANIA, being o =,r:t-nd mind and in the contemplation of the, ei...' f_, o be b~? certainty of death, do r;+:1°r-s by C[_..... al ~ t1hiis it-tss:'~:1`f~_if: :`4"!'I: 'to my last will and testament. I n #lr_t'-rb ,1'e';,.vke all nre,.rious i-d ;.t?+ 1_... .l cs1 direct that the disposition of my remains be as follows: Lit) S.. IN ERUST BUFZG a 111D IV I rive all the rest and residue 4 "my nstato to my spouse, BETSY HARRIS 'CREWS N IL S~:~N,l {r.l~}Ci(uld they survive m for 60 ,days. If my' spouse, t.Ei -iY .--t!C"~RI`J Cl~_ii~+S li(EIL=tONp does not survive me,. give all the rest and residue of my estate to jAMES ROBERT NEILSON. If neither BETSY HARRIS CREWS NE. I LSC: N nor JAMES RfJatERT NEIL-Sr t N. survives me, I give all the rest and residue o y estate to my heirs as determined by the laws of the State of PENNSYLVANIA, relating to descent and distribution. v , I appoint JOHN CE,NNELL_Y, to act: as the executor of this Will, '1.o fuGS`'tL': tht9.'.EI:out bond.. S!"pou+d JOHN (.:ONNEL:LY be r...llic3L.,'le or unwillin- g to serve, t1Ften I appoint DAVID L..I.[ ii= BERG to act a__ the em .':;lA'i:or of this will. herewith affix signature tr Will on this i day of at d c ~I•dtJ?r{ C i yr _ _ _ _ in the tai e'is ance 01- the falLowing witnevdds, who witnessed and subzcribed this will at t-~~ek~L I jo ATTIESTATD-T,Ni CLAUSE On the dat a-,oQ written, „f;MES DANIEL WILSON, ...1 rFl._d. {-:down. to us declared 7 us, and in our presence, that this instrument, c oTlx:Y5ti ng o ...52_. aC;i:= is their last will i1,i-',d t_^s:.';, a:.ent7 and :!i=MES DANIEL NE ;__Si: N, ?hen signed rtiR, iv:_,: riument :iri. oux f ra-i, rtcEe , and a -74i';ES DANIEL NEil.SON' y request we !'i..w sign this will as witnesses in each other's presence. Further that JAMES DANIEL NEILSON, appeared to us tv be of seund mind and lawful age, and under no undue influence. Wi}'its' : - Ad>r``re.._ss M 5:_55_,L~.s.LM~_.__f~~*.~_.r.._._.._1~~~~'✓LC.S~w~~Su.._~._~Z.L.~...•....,_....... Address: December 12, 210 12 1Z1;: l state of,lames D, Neilson D: 17'-,'01' Dear N,,Ir. Pivonka: Please be advised flint Nt the time of Mr. Nelson's death on March 17, 2012_ the maintained a Traditional IRA 1CCOLIM 'A Wells Fargo AckTISCIrs. Tithe: Jarnes 1), Ne;lson fR,-V F'C'C as Custodian Opened: 7. 1097 Accoutlt:t'#: 4734-8102 DOD VIALIC: $29,S'49,49 ~is~ce~•c~lti°. ' o ~ dv Heitz: C;lu:sat Associate z STATE OF Pennsylvania IN RE: ESTATE OF IN THE REGIS'T'ER OF WILLS JAMES D NEILSON CUMBERLAND COUNTY CASE#: 21-12-0454 STATEMENT OF CLAIM American InfoSource, servicer on behalf of [lank of America I. hereby presents for filing against the above estate this statement of claim in the amount of $ $1,758.75 2. The basis for the claim is account number 5329063999404081 which was open on 12/8/2003 . 3. The name and address of the claimant is American InfoSource, servicer on behalf of [lank of America ' P.O. Box 248852, Oklahoma City, OK 73124 4. This claim IS NOT contingent 5. This claim IS NOT secured 6. The last payment made on the account was $ $150.00 on 3/12/2012 7. Please send payments to American InfoSource, servicer on behalf of Bank of America P.O. Box 248852 Oklahoma City, OK 73124 1-888-221-4299 Please write the above account number on your check. Under penalties of perjury, I declare that I have read the foregoing, and the facts alleged are true, to the best of my knowledge and belief. Executed this 23 day of may 2012 American InfoSource, servicer on behalf of Bank of America Claimant Name: Jon McCleskey ~G Claimant Signature: 7 STATE OF Pennsylvania IN RE: ESTATE OF IN THE REGISTER OF WILLS JAMES D NEILSON CUMBERLAND COUNTY CASE#: 21-12-Q454 STATEMENT OF CLAIM American InfoSource, servicer on behalf of Bank of America 1 • hereby presents for filing against the above estate this statement of claim in the amount of $ $6,955.65 2. The basis for the claim is account number 5490357999984636 which was open on 2/9/I993 3. The name and address of the claimant is American InfoSource, servicer on behalf of Bank ofAmerica P.O. Box 248852, Oklahoma City, OK 73124 4. This claim IS NOT contingent 5. This claim IS NOT secured 6. The last payment made on the account was $ $533.00 on 3/2/2012 7. Please send payments to American InfoSource, servicer on behalf of Bank of America P.O. Box 248852 Oklahoma City, OK 73124 1-888-221-4299 Please write the above account number on your check, Under penalties of perjury, I declare that I have read the foregoing, and the facts alleged are true, to the best of my knowledge and belief. Executed this 23 day of May 2012 American InfoSource, servicer on behalf of Bank of America Claimant Name: _ Jon McCleskey Claimant Signature: 4*dg45~~r ti. RE""OV_r" SERVICES, LLC 200 Coon Rapids Blvd., Suite 200 Coon Rapids, MN 55433-5876 Phone: 888-420-2510 Fax: 763-235-4055 6/27/2012 To Whom It May Concern: We are filing a claim on a probate/estate fled in reference to the individual listed below. AscensionPoint Recovery Services, LLC is filing this claim on behalf of Citibank, N.A., Assignee of THE HOME DEPOT. Please see our claim form (enclosed) for details. Decedent Information: Case Number: 2012-00454 Balance: $2,433,80 Date of Death: 03/17/2012 Name: JAMES D NEILSON If you have any questions please feel free to contact our office at your convenience. Respectfully, AscensionPoint Recovery Services, LLC --------------------------------------------------------detach coupon--------------------------------------------- Reference No: 915847 PLEASE SEND PAYMENTS & CORRESPONDENCE TO: GARY L. JAMES 134 SIPE AVE. ASCENSIONPOINT RECOVERY SERVICES, LLC HUMMELSTOWN, PA 17036 200 COON RAPIDS BLVD. SUITE 200 COON RAPIDS, MN 55433-5876 , C%j r- IS room LLI O y L LL ~~V Cl-I U. co. o ti4 00 r vr-. - - tB SS r 0 C 0 CL ° •7C s O 1 - Jw spa j [ '-rC r.o 41 0 - - { cr r 1 4 1 f 4 CA. a, tZ Z <x V (=6 e 4 - - A .L t ~ n r N Q) (N CD t11 3 a