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Home My WebLink About01-08-13--~ REV-1500 Ex(oi-io> 1 50561 01 43 PA Department of Revenue OFFICIAL USE ONLY pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE PO 60X.280601 INHERITANCE TAX RETURN 2 1 1 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ~ C~ ~ ~~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 185 12 9800 08 07 2012 05 12 1923 Decedent's Last Name Suffix Decedent's First Name MI GRONINGER SARA C (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 Re uired (date of death after 12-12-82) ^ q ^ g. Decedent Died Testate ~ Decedent Maintained a Living Trust (Attach Copy of Will) ^ (Attach Copy of Trust) 8. Total Number of Safe Deposit Boxes ^ 9. Litigation Proceeds Received ^ 1 p, Spousal Poverty Credft (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 SHOULD BE DIRECTED TO: Name Daytime Telephone Number SAMUEL L ANDES 717 761 5361 First line of address 525 NORTH 12TH STREET Second line of address City or Post Office State ZIP Code LEMOYNE PA 17043 Correspondent's a-mail address: I a w a n d e s G a o l. c o m REG~9jTER OF WILLS ~1SE C Q <"y . m ,~-^~: ,~,_ i ._ _. _ .~ _ ~ ,~~ ~> f'DAT~ FILED: ,° _.::) a ~~ i~Cr Nenarues or pequry, I aeclare 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 inforrnation of which preparer has any knowledge. S_~GNATURE OF PERSON f1~SPONSIBLE FOR FILING RETURN DATE ~\ L/ ADDRESS ~\ 108 Clydesdale SIGN - t)1RE OF PB f Etters, PA 17319 N R PRESENTATIVE Cathy Krauuse Samuel L Andes `~ DATE 525 North 12th Street, Lemoyne, PA 17043 Side 1 L 1505610143 1505610143 J ~~ J 1505610243 REV-1500 EX Decedent's Social Security Number Decedents tvame: G R O N I N G E R, SARA C. 18 5 12 9 8 0 0 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 De osits & Miscellaneous Personal Pro e P p rty (Schedule E) ................ 5. 5 2 3 . 0 8 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............. 6. 6 9 , 7 21.9 2 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ............. 7, 8. Total Gross Assets (total Lines 1-7) ....................................................................... g. 7 0, 2 4 5. 0 0 9. Funeral Expenses & Administrative Costs (Schedule H) ............... .......................... g, 1 1 , 5 3 7 . 4 7 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10• 1 , 7 3 6 . 5 0 11. Total Deductions (total Lines 9 & 10) ...................................................................... 11. 13 , 2 7 3 . 9 7 12. Net Value of Estate (Line 8 minus Line 11) ............................................................. 12. 5 6 , 9 71.0 3 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, 5 6 , 9 71.0 3 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 linealrateX .045 56, 971.03 16• 2, 563 .70 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 ..................................................................................................................... 1 s. 2, 5 6 3. 7 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505610243 1505610243 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 - 12 Groninger, Sara C. STREET ADDRESS 824 Lisburn Road CITY Camp Hill STATE PA ZI P 17011 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19} 2. Credits/Payments A• Prior Payments B. Discount 3. Interest (1) 2,563.70 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. Total Credits (A + B) Make Check Payable to: REGISTER OF WILLS, AGENT. (2) 0.00 (3) 0.00 (4) (5) 2,563.70 n 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 :.................................... ^ a c. retain a reversionary interest; or .................................................................................................................. ^ d. receive the promise for life of either payments, benefits or care? .............................................................. ^ a 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................................................... ^ 0 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? ..........................................................:........................................................... ^ a IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. w -. ~ - . __ -~- - . ~:' .'< , " ~:r x.... ..~...:.~£.au.... _.;..~%'.. ..rw .. 2 .u..., <dw.~. >£3.. N .. =.mvea~.>:. ~.xw:.._~ ....a3 ....`Y' ,amz. k z:. ,~ :-.«..,'i c~~~' -a~e'~,x~~a~acn. ~_...:..;. , --. 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) 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 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)1. 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. SCHEDULE E ' ~ CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Groninger, Sara C. FILE NUMBER 21 12 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 Miscellaneous items of clothing and other personal property 300.00 2 ~ Final payment from Commonwealth of Pennsylvania State Employees Retirement System 223.08 ~ TOTAL (Also enter on Line 5, Recapitulation) ~ 523.08 ' SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF I FILE NUMBER Groninger, Sara C. 21 - 12 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT Cathy Krause 108 Clydesdale Court Daughter A Etters, PA 17319 JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT Include name of~ina vial ItlOSiliUilOn anOd ban account numbe or similar identi in number. Attach deed for'ointl -held real ~ 9 ~ y estate. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST 1 A 02/12/2009 Certificate of Deposit No. 3100391.9238426 62,176.91 50% 31,088.46 with M&T Bank (see attached letter) 2 A 02/12/2009 Power Checking account No. 38845849 with 6,181.31 50% 3,090.66 M&T Bank (see attached letter) 3 A 02/12/2009 Power Savings account No. 15004220420977 71,os5.ss 50% 35,542.80 with M&T Bank (see attached letter) TOTAL (Also enter on line 6, Recapitulation) ~ 69,721.92 SCHEDULE H ,,. COMMONWEALTH OF PENNSYLVANIA ~~~ ~~ INHERITANCE TAX RETURN /~r~A'AnL~TQ/f•T7\ /C /'~/1C~'K~ RESIDENT DECEDENT t'ti./nI~ ~ ~K.7 ~ ~ lA~ ~ Y G ~/V~7 ~ ~7 FILE NUMBER ESTATE OF Groninger, Sara C. 21 - 12 Debts of decedent must be reported on Schedule I. ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT A. 1 Musselman Funeral Home 8,747.47 2 Rolling Green Cemetery (grave opening) 285.00 3 Trinity Evangelical Lutheran Church 165.00 4 Paster David Shreffler 150.00 5 Old Town Florists 185.00 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 Samuel L. Andes 2,000.00 3. Family Exemption: (If decedent's address is not the same as claimants, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 Notary Fee 5.00 TOTAL (Also enter on line 9, Recapitulation) 11,537.47 SCHEDULEI ' ~ DEBTS OF DECEDENT, MORTGAGE COMMONWEALTH OF PENNSYLVANIA LIABILITIES, & LI ENS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Groningen, Sara C. FILE NUMBER 21 - 12 Report debts incurred by,the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 Pinnacle Health (final hospital bill) 100.00 2 Pinnacle Health Emergency Services, LLC 461.00 3 Hampden Physicians 20.00 4 Camp Hill Fire Company #1 (emergency ambulance service) 1 155.50 TOTAL (Also enter on Line 10, Recapitulation) I 1,736.50 REV-1513 EX+ (11-08) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Groninger, Sara C. SCHEDULE J BENEFICIARIES NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I~ TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 Cathy Krause 108 Clydesdale Court Etters, PA 17319 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Daughter FILE NUMBER 21 - 12 SHARE OF ESTATE (Words) entire estate Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet, as appropriate. Ili NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS AMOUNT OF ESTATE ($$$) TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEETI 0.00 1V~8cT I3anlc 1200 Market Street, Lemoyne, PA 17043 717 731 1730 Fnx 717 761 6497 September 21, 2012 Samuel L. Andes Attorney at Law 525 North 12th Street Lemoyne, PA 17043 RE: Estate of Sara C. Groninger Dear Mr. Andes, I have enclosed the information on Sara C. Groninger as requested. She had three accounts with M and T Bank. They are listed below. 1) A .Certificate of Deposit #31003919238426 B. Power Checking account #38845849 C. Power Savings account #15004220420977 2) A. Balance on Certificate of Deposit as of August 7, 2012 - $62,171.^~ B. Balance on the checking account as of August 7, 2012 -$6181.31 C. Balance on the savings account as of August 7, 2012-$71,085.59 3) All of these accounts (assets) were held jointly with Cathy Krause, Sara Groninger's daughter. 4) The accounts became joint on February 12, 2009 with the names reading as Sara C. Groninger or. Cathy Krause . If you need additional information or have any questions, please call meat 717-731-1730 or email at cweiseCc~mtb.com. Si