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HomeMy WebLinkAbout01-22-13 (2) REV-1500 EX (02-11) 1505610143 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 0900 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 174 20 8201 07 19 2012 05 30 2027 Decedent's Last Name Suffix Decedent's First Name MI DAILEY RACHEL 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 XD 1. Original Return 2. Supplemental Return E] 3. Remainder Return (Date of Death Prior to 12-13-82) q. Limited Estate 4a. Future Interest Compromise 5. Federal Estate Tax Return Required (date of death after 12-12-82) 6 Decedent Died Testate 7. (Attach Copy oMaintained t a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) PY ) g. Litigation Proceeds Received 10. between P2 31 yJCr dit (Date of f Death 11 Election to tax under Sec. 9113(A) 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 MICHAEL L BANGS 717 730 7310 R@ISTER OF Vill" UM 91`1LY Q f 7"t ca 1 a c° a y First Line of Address rn~-c y 429 SOUTH 18TH STREET rte) Second Line of Address M'ti c DATE _ILED City or Post Office State ZIP Code CAMP HILL PA 17 011 (7) Correspondent's e-mail address: mikebangs@,verizon.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, rrect and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNAT E OF PEON SPONSIBLE FOR FILING RETURN DATE 22 L/ A, Gail T. Gillis -0 ADDRESS 1114 Cocklin Street, Mechanicsburg PA 17055 SI N RE OF PREPARER OTHER AN REPR TATIVE DATE Michael L. Bangs - ~r3 AD RESS 429 South 18th Street, Camp Hill, PA Side 1 L 1505610143 1505610143 1 1505610243 REV-1500 EX Decedent's Social Security Number Decedent's Name: Dailey, Rachel M. 174 20 8201 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. 21,363.95 6. Jointly Owned Property (Schedule F) ❑ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers & Miscellaneous ion Probate Property (Schedule G) u Separate Billing Requested............ 7. 717,055.96 8. Total Gross Assets (total Lines 1 through 7) 8. 738,419.91 9. Funeral Expenses and Administrative Costs (Schedule H) 9. 14,568 . 51 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule 1) 10. 1 , 394 . 85 11. Total Deductions (total Lines 9 and 10) 11. 15 , 963. 36 12. Net Value of Estate (Line 8 minus Line 11) 12. 722 , 456 . 55 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. 722,456.55 TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15 0.00 (a)(1.2) X.00 16. Amount of Line 14 taxable 0.00 16. 0.00 at lineal rate X .045 17. Amount of Line 14 taxable 0.00 17. 0.00 at sibling rate X .12 18. Amount of Line 14 taxable 722,456.55 18. 108,368.48 at collateral rate X .15 19. TAX DUE 19. 108,368.48 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 L 1505610243 1505610243 J REV-1500 EX Page 3 File Number 21-12-0900 Decedent's Complete Address: DECEDENT'S NAME Dailey, Rachel M. STREET ADDRESS 4905 E. Trindle Road CITY STATE ZIP Mechanicsburg PA 17050 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 108,368.48 2. Credits/Payments A. Prior Payments 102,000.00 B. Discount 5,368.42 Total Credits (A + B) (2) 107,368.42 3. Interest (3) 4, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) 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) 1,000.06 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; ❑ lxl b. retain the right to designate who shall use the property transferred or its income; ❑ ❑ x c. retain a reversionary interest; or 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? 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... ❑ ❑x 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) (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 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-1508 EX+(11-10) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Dailey, Rachel M. 21-12-0900 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 BNY Mellon - direct deposit (7/31/12) 21.92 2 Citizens Bank - Circle Checking Account 2,485.00 3 Citizens Bank - Circle Checking with Interest 16,701.45 4 Citizens Bank - Circle Savings 10.00 5 Mellon Bank - Retirement benefit payment (8/1/12) 160.99 6 Refund - PA Department of Revenue (2011 tax return) 52.00 7 Refund - Country Meadows West Shore 4 1,780.07 8 TransAmerica Life Insurance - annuity premium payment (8/6/12) 152.52 TOTAL (Also enter on Line 5, Recapitulation) 21,363.95 (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 PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Dailey, Rachel M. 21-12-0900 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 DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE RELA P TO EDENT AND NUMBER TINC HELDA E OFMTRANSFERSATTACH A CEIR OPY OF THHE DEIED FFOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1 Merrill Lynch - Non-IRA. The beneficiaries of this 310,454.48 310,454.48 asset are the decedent's nieces and nephew listed on Schedule J. 2 Merrill Lynch - IRA account. The beneficiaries of this 380,114.02 380,114.02 asset are the decedent's nieces and nephew listed on Schedule J. 3 TransAmerica Life Insurance Company - Secure Path 26,487.46 26,487.46 Annuity. The beneficiaries of this annuity are the decedent's nieces and nephew listed on Schedule J. TOTAL (Also enter on Line 7, Recapitulation) 717,055.96 (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 COMMONWEALTCryEDECOFp,~PENNgUYLVANIA FUNERAL EXPENSES AND INRESIDENTEDENTRN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Dailey, Rachel M. 21-12-0900 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached 8,274.01 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zio Year(s) Commission Paid 2. Attornev's Fees Michael L. Bangs 5,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zio Relationship of Claimant to Decedent 4. Probate Fees 119.50 5. Accountant's Fees 950.00 6. Tax Return Preparer's Fees 7. Other Administrative Costs 225.00 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 14,568.51 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 Dailey, Rachel M 21-12-0900 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Gail T. Gillis - reimbursement for memorial dinner 507.70 2 Neill Funeral Home, Inc. 5,964.31 3 R. J. Romberger & Sons - placement of memorial at cemetery 575.00 4 Romberger Memorials - Memorial marker inscription 350.00 5 St. Catherine Laboure Church - funeral luncheon 165.00 6 Woodlawn Memorial Gardens, Inc. 712.00 H-A 8,274.01 Other Administrative Costs 7 Cumberland Law Journal - estate advertising 75.00 8 The Sentinel - estate advertising 150.00 H-67 225.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX+(12-08) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Dailey, Rachel M. 21-12-0900 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 Diamond Medical Supply 12.70 2 Diamond Pharmacy 181.78 3 Diamond Pharmacy 1,000.32 4 Highmark Blue Sheild 200.05 TOTAL (Also enter on Line 10, Recapitulation) 1,394.85 (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) op SCHEDULE J COMMONWEALTH ANIA R NTD NCED&RET~RN BENEFICIARIES EDEN ESTATE OF FILE NUMBER Dailey, Rachel M. 21-12-0900 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) Do DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] 1 Gail T. Gillis Niece one-quarter 1114 Cocklin Street Mechanicsburg, PA 17055 2 Gabriel Lucisano Nephew one-quarter 909 Lafayette Street #701 Denver, CO 80218 3 Sharon R. Lucisano Niece one-quarter 429 Sample Bridge Road Enola, PA 17025 4 Brenda Tusing Niece one-quarter 2233 Powhatan Avenue Virginia Beach, VA 23455 Total Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet, as appropriate. NON-TAXABLE DISTRIBUTIONS: II. 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) Citizens Bank- One Citizens Drive ROP112 Riverside, RI 02915 October 3, 2012 Bangs Law Office, LLC Attn: Michael L Bangs 429 South 18th Street Camp Hill, PA 17011 Estate of RACHEL M DAILEY Date of Death: Jul 19, 2012 SSN: 174-20-8201 Dear Sir/Madam: In accordance with your request, the attached information sheet has been provided in the above decedent's name as of his/her date of death. Per your request accounts ending in 0248 and 3055 were open within one year of the date of death; both accounts were opened with cash deposits. For Installment Loans or Line of Credit accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries, please call 877-579-2667 option 2. Sincerely, V:,~oko Kim A. Botelho Decedent Account Processing REF#: 559391 Citizens Bank- Account Number 6234870248 Account Title GAIL T GILLIS REP PAYEE FOR RACHEL M DAILEY Date Opened 3/30/2012 Account Type Checking Prinei al Balance as of DOD $2485.00 Interest from Last Posting to DOD $.00 Account Balance as of DOD $2485.00 YTD Interest to DOD $.00 Citizens Bank Account Number 6257893055 Account Title GAIL T GILLIS REP PAYEE FOR RACHEL M DAILEY Date Opened 3/30/2012 Account Type Savings Princi al Balance as of DOD $10.00 Interest from Last Posting to DOD $.00 Account Balance as of DOD $10.00 YTD Interest to DOD $.00 ILSLAW Citizens Bank- Account Number 6100676722 Account Title RACHEL M DAILEY Date Opened 12/8/1972 Account Type Checkin Princi al Balance as of DOD $16701.45 Interest from Last Posting to DOD $.03 Account Balance as of DOD $16701.48 YTD Interest to DOD $4.18 ce: _ TRANsA EwCA Administrative ROffi on jvl~! 4333 Edgewood Rvad NE 0 LIFE INSURANCE COMPANY Cedar Rapids, 1A 52499 wwti Aransamericaannuities.com November 8, 2012 Estate of Rachel M Dailey c/o Michael L Bangs 429 South 18th Street Camp Hill PA 17011 --------RE: Annuity Numberts-}- 26-148304 Dear Estate of Rachel M Dailey: We have received your request regarding this annuity policy. The date of death value for the above listed contract, as of 07/19/2012, is $26,487.46. If you have questions, please contact your financial professional or call us at 1-800-553-5957 Monday through Thursday between 7:00 a.m. and 5:30 p.m. and Friday between 7:00 a.m. and 4:30 p.m. Central time. We appreciate your business. 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(D C C z N Cl) 0 j M a) x CL Ol ? _ j C fD O m y ° m m 9 ro D =T 0 5' 03 0 m =F (n 'a m =r (D 0; 3 a to (a m 0 q 0 0° C0 ro i m vi 7 0_ c m 7 m 7 f 0 CD o 0 O^ Q O .O m 7, N (D (n a m K 7 CD N N d ~ ~p O y i D a m m 0 p O a s o 2 A C - CD C Cmn V7i O 0 O ro O a x `G N 7 0 I (D 3 0 m 'G 7 m CD X i O 7 O Q T CD O C i CD fD O N 7 70 0 a o I CD =r 3 01 m d 3 7a i 2 00 N m < 0 m O _ 3 m 7 7 0 CD 0) 0 0 O CD (n (D -D CD 00 CD m CD ° X 3 m o e 3 ro -0 v ° I CD 0 0 i 0~ 3 y 2: 7 m (n 7 m I v m CD CD °o Doi C) CL i I Er 0 CD 7• Q A 0 CD o (D fn C y X II { T m T ro O ro Q (QD ! 1 Z C m o oO CD ; I ~N 0 (D w CL 169 OM D s 3 a rn a • ( -4 ft~ CD O v ~ = U3 I CL I 3 Cl) 7 ° o° W 00 CD n m m m Cn (o I i o m I ] m CD 0 CL CL 69 O m a N < W ° o d x ("D io (D (D (<D y x 16 0 N LAST WILL AND TESTAMENT OF RACHEL M. DAILEY I, RACHEL M. DAILEY, of Hampden Township, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will II previously made by me. ITEM I: I direct that my Executrix hereinafter named shall pay all my just debts and funeral expenses as soon as conveniently may be done after my decease from the residue of my estate. ITEM II: I devise and bequeath all the rest, residue and remainder of my estate of every nature and wherever situate in equal shares to my sisters, THERESA LUCISANA and SANDRA SECOR, or survivor of them. ITEM III: Should my sisters, THERESA LUCISANA and SANDRA SECOR, fail to survive me, I devise and bequeath all the rest, residue and remainder of my estate, of every nature and wherever situate, in equal shares to my nieces and nephews, GAIL GILLIS, SHARON' LUCISANO, GABRIEL LUCISANO, and BRENDA TUSING, who survive me. ITEM IV: I appoint my niece, GAIL GILLIS, Executrix of this my last will. Should my niece, GAIL GILLIS, fail to qualify or cease to act as Executrix, I appoint my niece, SHARON LUCISANO, Executrix of this my last will. Page 1 of 4 i ITEM V: No fiduciary acting hereunder shall be required to post bond or enter security for the faithful performance of his or her duties in any jurisdiction. IN WITNESS WHEREOF, I, RACHEL M.D~AILEY, have hereunto set my hand and seal this day of 2006. ~i v { CHEL M. DAILEY Page 2 of 4 i SIGNED, SEALED, PUBLISHED and DECLARED by RACHEL M. DAILEY, the Testatrix above named, as and for her Last Will and Testament, and in the presence of us, who at her request, in her presence and in the presence of each other, `subscribed our names as witnesses. 414 Bridge St., New Cumberland, PA F! Witness Address 414 Bridge St., New Cumberland, PA i; Witness Address COMMONWEALTH OF PENNSYLVANIA: SS: COUNTY OF CUMBERLAND I, RACHEL M. DAILEY, the Testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law do hereby acknowledge that I signed and executed this instru- ment as my last will; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein contained. w RACHEL M. DAILEY Sworn to or affirmed to and acknowledged before me by RACHEL M. DAILEY, the Testatrix, this a of~ , 2006. COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL CAROL L.TROXELL, Notary Public Notary Public New Cumberland Boro. Cumberland Co. MY Commission Expires Dec. 27, 2009 Page 3 of 4 COMMONWEALTH OF PENNSYLVANIA 'a SS: COUNTY OF CUMBERLAND c We, C~`~~~! f ~C and ' Vl V~'Lol the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw-Testatrix sign and execute the - her last will; that Testatrix signed willingly and that she executed f~ it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the will as witnesses; that to the best of our knowledge, the Testatrix was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. i Witnes C-~c Witness Sworn to orrj affirmed ~tto ,and acknowledged before me by. and 11(.li~trt 1/\f' witnesses, this\_ day of 2006. Notary Public COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL CAROL L. TROXELL, Notary Public New Cumberland Boro' Cumberland Go. commission Page 4 o f 4