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HomeMy WebLinkAbout01-07-13 (2)1505610143 REV-1500 E~ Y~"' ~: OFFICIAL USE ONLY PA Department of Revenue Pennsylvania cc~~:v t,o~c rca~ Bureau o! tndrvidual Taxes ocYAi1Y!~l ptr FlNi Y.T PO BOK.280601 INHERITANCE TAX RETURN 21 12 Harrisburg, PA 17128.0601 RESIDENT DECEDENT 0486 ENTER OECEDEN7 INFORMATION BELOW Socral Security Number Date o1 Death 201 16 3084 04 07 2012 Decedent's Last Name WALMER (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Spouse's Social Security Numsrer FILL tN APPROPRIATE OVALS BELOW X t Orgmal Return ~, ~Imrted EStatC 9 l+t ;anon Proceeds 12ecetrF9 1 Date o! Birth 03 27 1924 Sutfrx QecedenCs Flrst Name MI JEAN E Sut1+z Spouse's first Name Mtl THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2 Sup,!emental Return i qa f t'u~a InS!~•n .; Ccxnprcrt..;e tCt:114 01 {!c arh 3114'.' ' ~- S «.9~ t :CC i•^) 1.1.1,1 j -{' :{ l . ''a T't.. d ~~ :1:.51 f~ i.i+!!t C'E~ 2: /t>>~C C~ t.Yi~,i'h . ^:~: n. r 1..' _' is-j .,.~ 3 Remainder Return 1Dale of Deatr•, Pncr to 12.13-82} ~ 5. Federal Estate Tax Return Requued _ t: Total Nun;~~f of Sate D?pc~~t Boxes t t EI~cGOr to tax under Se_ 9t 1's;At !httc.^,11 Srh£dU~e O- CORRESPONDENT -THIS SECTION h1UST 8E COh1PLETED. AlL CORRESPONDENCE AND CONFIDENTIAL. TAX INFORMATION SHOULD BE DIRECTED TO: Name (?aytime Telephone Number LINDA J OLSEN ESQ 717 540 4332 First Line of Address 2000 LINGLESTOWN RD Second Line of Address SUITE 202 City or Post Offic© HARRISBURG State 21P Code PA 17110 ~ _. .. -~ REGtSR~ WILLS SE OlerbY ~ -° ~, ~ ., r'~~ ~~ .~ ;..~ •~ _~. ~t . 4 ~p ,~4 ~ ~ ~ ~. x ~,~, `'~ ~ .. ~.. ~ a rk -'~1 K~ ) c.:. , _ ~ j ' °D TE FILE? '._d ~ y"J ' t ._..~ "t~l Correspondent's e-mail address: lolsen at~hazenelderlaw.com ---- ___ Under penaHres of perjury, f declafe that I have exarnrned thlS return. inctu(i~ng acrrampanymg schedules and statements, and to the hest of frry tcncs-v!eoge and t~~lir:f. it ~s true, correct and Complete D£c.aration of prepar~.f other thin the perserta! r~:prtsen•~tty£ ,s hase(± un a'i +nrgffnat.c~n Ct v.hict: prr_parer has any F.no•r::edye S!C~rr~UrZE C:r PlnSG'~ i~£SnC±'•S~t3lE FCs: i~:Ll.'J(i si? ilrti`r ~:,: i E. Verna 1. Call 3103 Kensington Ct., Renfrew, PA 16053 _ 51GN%~il.'n C~~REPARcR Hf:rt7N ~Rfi~riE$Ettt"t.}i•1E (J:.i~ ~ Linda J. Otsen, Esq. f ~. ~C~%j :,Gt)Ci 2000 Linglestown Road, Harrisburg, PA 17110 Side 1 L„~ 150561D143 1505610143 ~'~ PA Inheritance Tax Return Signature of Additional Fiduciaries ESTATE OF FILE NUMBER Walmer, Jean Elizabeth 2'1-12-0486 Under penalties of penury, 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. Signature #2 Name Address1 Address2 City, State, Zip Date James tJ. Walmer 122S Meadow l.n. Harrisburg, PA 17113 J REV-1500 EX Decedents -vame: V1/almer, Jean Elizabeth Decedent's Social Security Number 201 16 3084 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 & Notes Receivable (Schedule D) ....................:.......:.:................:........ 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5. 4 0 7 , 6 9 6 . 8 3 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers ~ Miscellaneous tyQn,-Probate Property (Schedule G) ~•'" ` ^ Separate Billing Requested............ 7. 3 , 4 93.00 8. Total Gross Assets (total Lines 1 through 7) ........................................................ 8. 411 , 18 9.83 9. Funeral Expenses and Administrative Costs (Schedule H) ..................................:. 9. 13 , 718.0 4 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............................ 10. 8 , 011.03 11. Total Deductions (total Lines 9 and 10) ................................................................ 11. 21 , 7 2 9 . 0 7 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 3 8 9 , 4 6 0 . 7 6 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. 3 8 9 , 4 6 0 . 7 6 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 3 8 9, 4 6 0. 7 6 at lineal rate X .045 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 OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 0.00 17,525.73 0.00 0.00 17,525.73 Side 2 1505610243 1505610243 J 1505610243 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-12-0486 DECEDENT'S NAME Walmer, Jean Elizabeth STREET ADDRESS 5225 Wilson Lane CITY Mechanicsburg STATE PA ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest 16,000.00 842.11 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. 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. (1) Total Credits (A + B) (2) (3) (4) (5) 17,525.73 16,842.11 683.62 Make Check Pa able 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 :.................................. ^ ^x c. retain a reversionary interest; or ............................................................................................................... ^ 0 d. receive the promise for life of either payments, benefits or care? ............................................................ ^ ^x 2. If death occurred after Dec. 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?....... ^ ^x 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-1508 EX+ (11-10) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Walmer, Jean Elizabeth 21-12-0486 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Refund -Bethany Village parking space 15,000.00 2 Refund -Federal tax 2011 return 4,000.00 3 Refund - PA Treasury 2011 tax return 245.00 4 Social Security benefits -checks not received before death 2,090.40 5 State Farm -final termination payment for James Walmer 1,116.03 6 PNC Acct. #10-4322-0737 James Walmer owner/Jean Walmer Benef. - -owner by operation of 1,974.90 law; spouse, James Walmer, died 4/3/2012 7 PNC CD # 31300215982 25,038.22 8 PNC checking acct. #1043220729 672.40 9 PNC checking acct. #5070072571 86,550.61 10 PNC Saving Acct. #5005798608 101,554.65 11 Sovereign CD #1685550517 25,031.21 12 State Farm Bank CD #1003936471 62,633.27 13 State Farm Bank CD #1015914193 81,425.64 14 Refund from Asbury Communities -living facility 305.03 15 Refund from Omnicare, Inc. overpayment of medicines for Jim Walmer 22.87 16 Refund from United Healthcare - Rx insurance premium 36.60 TOTAL (Also enter on Line 5, Recapitulation) I 407,696.83 (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) Rev-1510 EX+ (08-09) SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROP RTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Walmer, Jean Elizabeth 21-12-0486 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. ITEM NUMBER DESCRIPTION OF PROPERTY THE DATE OF TROANSFREAR.SATTAC}iTA COPY OF THE DEED FOOREREAL ESTATDE. DATE OF DEATH VALUE OF ASSET °i° OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 Auto - 2004 Buick Century KBB value -gifted to 6,493.00 3,000.00 3,493.00 grandson, Brian C. Walmer TOTAL (Also enter on Line 7, Recapitulation) I 3,493.00 (If more space is needed, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 08-09) REV-1151 EX+ (10-09) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES AND INHERITANCE TAX RETt~RN ADMINISTRATIVE COSTS RESIDENT DECEDEN ESTATE OF FILE NUMBER Walmer, Jean Elizabeth 21-12-0486 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: See continuation schedule(s) attached B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid 2,194.53 2. Attorney's Fees Hazen Elder Law 9,800.00 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 Register of Wills 373.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1,350.01 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 13,718.04 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 Walmer, Jean Elizabeth 21-12-0486 ITEM NUMBER DESCRIPTION AMOUNT Funeral Ex enses 1 Myers-Buhrig Funeral Home -balance remaining to be paid for funeral; funeral was prepaid. 2,194.53 H-A 2,194.53 Other Administrative Costs 2 Cumberland Law Journal -legal ad 75.00 3 James Walmer, Co-Executor -travel expenses 147.63 4 Sentinel -legal ad 232.02 5 Verna Call -expenses (travel, tolls, postage, notary, ink) 895.36 H-B7 1,350.01 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX+ (12-08) ~,. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS ESTATE OF FILE NUMBER Walmer, Jean Elizabeth 21-12-0486 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 Bethany Village/The Oaks -room/rent 3,763.45 2 Continuing Care Rx -Jean 76.98 3 Discover card 143.12 4 Home Medical Services -medical expense 3.87 5 McKesson Medsurg Medimart, Inc. - -medical expense of spouse, James Walmer 9.12 6 Myers Buhrig Funeral Home -remaining balance from funeral for spouse, James Walmer, 2,639.21 who died 4/3/12 7 Omnicare -medical - for spouse, James Walmer, who died 4/3/12 578.36 8 Omnicare -medical for Jean 76,92 9 Robert D. Welsh, CPA -fees for prep of 2011 personal tax returns 720.00 TOTAL (Also enter on Line 10, Recapitulation) I 8,011.03 (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. 12-08) REV-1513 EX+~01-10) ,. COMMONWEALTH OF PENN YLVANIA INHERITANCE T~ RET~RN RESIDENT DE EDEN SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Walmer, Jean Elizabeth 21-12-0486 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(Sl RECEIVING PROPERTY DECEDENT (Words) ($$$) Do Not List Trustee s I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)1 1 Verna T. Call Child 50% of the 3103 Kensington Court Residue Renfrew, PA 16053 2 James O. Walmer Child 50% of the 1225 Meadow Lane Residue Harrisburg, PA 17113 Total Enter dollar amounts for distributions shown above on lines 1 5 throu h 18 on Rev 150 0 cover sheet, as a r o riate. 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 II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright (c) 2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 01-10) State Farm Bank® Home Office, Bloomington, Illinois 61710 STATE^/FARM l~l ~ INSURANCE 0 P 0. Box 2316 Bloomington, Illinois 61702-2316 June 14, 2012 Hazen Elder Law 2000 Linglestown Rd Suite 202 Harrisburg PA 17110 ATTN: Corinne Eggers Woodhouse Re: Jean O Walmer, deceased Dear Corrinne: We recen#ly received your request regarding the account holder listed above. Our records indicate her date of death as April 7, 2012. Below is a list of all State Farm Bank deposit accounts owned by Jean, along with the date of death balances and interest earned by (but not paid to) the accounts, as of that date. Account No. Type Bal~„ance_ Interest ENP 1003936471 CD $62,633.27 $152.48 1015914193 CD $81,425.64 $3.33 Accounts were held jointly between James H Walmer (dod 4-3-12) and Jean O Walmer. No beneficiaries were listed on either account. If you have any questions, please contact State Farm Bank toll-free at 1-877-SF4-BANK (1-877- 734-2265). Sincerely, State Farm Bank Operations.-Center Special Accounts Unit/Iloy MEMBER FDIC ~~~~~~~~~~~r~r~~r~r~~~~~~ LEND R Jun. 20. 2012 1:26PM P~iC Bank . ~ ..:. . . June 20, 2012 Corinne E WOOdho~xse Hazen Elder Lam 2000 Linglestown Rd, Ste 202 Harrisburg,l'A 17110 RE: Jean. O 'VVa1rt'ier SSN: 201-1 ~-3 084 DOD: 04/07/2012 Dear Ms. 'V~1'oodhouse: No. 1$73 P. 1 bi respense tQ your request for .Date of Death (DOD) balances far the custan~er noted above, our records show the fallo~vin~: Certi~catc of 1~egosit Account # 31 ~ 00215982 JA.Iv1ES H ~l"AL1V1E1~. JEAN O wALMER DOD balance: $ 25,000.00 + 38.22 accrued interest Ynterest paid 0 X IO 112012 thnx 04/0712012 ~ 231.97 STD ~`~~~~~' ACC01Y11t Account # 1043220729 JEAN O W,~LMER 'V~RNA L CALL REF FA,YEE DOD balance: $ 672.40 non interest bearing Account # 5070072571 JA.1v1ES H WALMER JEAN O WA,L~ER DOTS balance: $ 86,550.12 + 0.49 accrued interest Interest paid 01/01/2012 thru 04/07/2012 $ 0.93 `Y"TD S~-'~.x~~s Acconnti Account # 5005798608 JAIV~S H WAL1v1E~ JEAN O 'WALMER DOD balance: $ 101,543.94 + 10.71 accrued interest Interest ~aad 01/01/2012 thr~ 04/07/2012 $ 43.14 `S'TD Established: 07/24/2001 Established: 03/20/2012 Established: 05/15/1992 Established: 0 8/ 17/2010 Page 1 of 2 Jun, 20. 2012 1:2bPM PNC Bank No. 1$73 P. 2 please note thax this of~iice pz'avides date of death balances far deposit accounts (~4s, C~7s, Checking and Savings). Vie do not ~racess any f~tiancial tr~a~sactians or provide statements. Yfyou need assistance with any ofthese items, please call 1-885-~'N'C~~A~ (1-8$$-7~2-~Z~5) or stop by youz iocai ~~IC Bank branch office. Sincerely, National financial Services Center PN''C dank, N'.A. member ~'DrC ?his message is intended for the use of `the individual or entity ra which it is addressed and may captain inform~tia~ that is privxlegec~ confidential and exempt, from d`isclasure ~nder~ applicable law. If the reader of this message is rzat the intended recipient yr the employee pr agent responsible far deliverxrzg this message t© the intended recxpierzt, you are hereby nati~ed that any dis.~emina7iari, distribution or capyipg of this cvm~urzications is str~ictly~prahibited. If ;you have received thzs ct?mtnunicatrop rrz err~ar, ,please notify rime immediately by reply ar by telephone at 800-7~2-.1775 and immediately destroy this faxed dvcumetat: Wage 2 of 2 Statement Period 1-01-12 To 4-30-17 INVEST CD 1004?83 -80 JAMES H WALMER JEAN O WALMER 3103 KENSINGTCaN CT RENFREW PA 16053-9265 For your convenience our Customer Contact Center is available from 7 am - 8 pm ESt, 7 days a week. Call us at ~-877-SOV-BANK M-877-768-2265). Hearing impaired ~-gOp-428-9721 ltTY/TDD). www. sovereignbank. com. It's always a great time to save with Sovereign! Choose from among our many options to grow your sa~rings. Y'ou can review our CTU rates and "lock. ii.~" the current rate for the term you choose. Or you can save in one of our money market savings accounts or savings accounts that offer greater flexibility than CDs with an attractive variable rate of return. Most important, all of these options are safe, secure, and FDIC-insured. Visit sovereignbank.com, stop by any of our local branches, or call us at the number at the top -of tr~is page for zrore i.rfor!nation. JAMES H WALMER ACCOUC7~ ~ ~6855505~7 Current rate 0.00% Interest Paid This Period $802.85 Maturity Date 2-22-13 Interest Paid This Year $802.85 Account Activity Date Description DepositslCredits WithdrawalslDebits Balance $25,031.21 1-41-12 Beginning Balance 12 $25 757 2-22-12 INTEREST EAR3~ED . $725.91 21 031 $25 ~ 2-22-12 INTEREST CHECK _~______ . , 725.91 --- _ $25,031.21 4-3~-12. LC7SE OUT iNTEREST PAYMENT $76.94; . PENALTY _ _ $.oo ~fVITMDRAWAL AMOUNT $25,108.15 $.00 4-30-12 Ending Balance L•- 4 ~,~ ' ~ ~ ~ ~ ~~+ ~ -~ • gage 1 of 1 DEYOS[T'S INSURI"D E3Y FD[C [:DUAL C7V1'oRT[I1~[TY [.EtiDER 1 S8SSSdSl7 2004 Buick Century Sedan 4D Trade In Values -Kelley Blue Book Page 1 of 4 ~ ~ __..~ ~.:i , ' Z!i' CODE: 17110 i sign in %;,! Siyn upl home ~ Car values ~ cars fir sa(e ~ Car rep^ew4 ~ Kbt} top pICk5 i re5earCh LOOiS aCr"'l~:iCti~^f:t tome ~ Car L'al(xr.; > 8(.€(:k > i'e~~;tirv > %Ct;9 > Oivs;,,~< > Sedan 4D BUICk Your Blue Book° Value s',°~~ tJsE~i : °. ,.. r~rlc Your r:fx, Car .................. ~ r ~, -; 2004 Buick Century ~° #h~y _ _ style: Sedan 4D ~ K _~ ~~ ji: Exfit Or){ign5 ~ Gikl.l(JE', >'ylE, .. .... ' Milea e: ', 13680 change `"' this car 9 Trade-ir, Value Private Party Value ', when trading in at a dealer*,hip when selling the car yax?rself r>rsr~t fiP.l)Ort Excellent $7,693 Shop for your next car pri; P .~ l,e~ car Very Good _. _.._ $7,393 _ ,_ Instant Trade-In Offer Good yet {t?e o"'car S7,218 Fair ~~rt. ~c .~.~ v_J e~ $6,493 Get atert 5 when fouow this car values change VerifyCorx~tia~? _, .,_ ... _... . .. :l~r•:. ~~,., V41 I {FC FQR.I I.IN.1 ~n'7.?. -. 'tl [t.l 7.7{1'11 nu~1,~.rAr(..~•~ow41.:)_. 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