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Home My WebLink About01-23-13 1505610105 REV-1500 at°Z_"'«' PA Department of Revenue pennsytvania OFFICUU_ USE ONLY Bureau of Individual Taxes °~~"""`"' County Code Year File Number Po Box 280601 ~ INHERITANCE TAX RETURN \ y ~/ Harrisburg, PA i~iz8-o6oi RESIDENT DECEDENT ~ ` ~ ~ I ~~ a ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 02/22/2011 09/09/1954 Decedent's Last Name Abraham Suffix Decedent's First Name Michael (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI B MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW t~ 1. Original Return O 2. Supplemental Retum O 3. Remainder Retum (Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Retum Required death after 12-12-82) O 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 T0: Name Daytime Telephone Number James W. Abraham, Esquire (717) 56~-9380 ; ~ ; First Line of Address Abraham Law Offices LLC Second Line of Address 45 East Main Street City or Post Office Hummelstown State ZIP Code PA 17036 Correspondent's e-mail address: abelaw@COmCast.net RE~T~R OF tNILL~iSE OWIYf-~ ::t r~7 FF_ ~'~ W'^ t; 3 ;~~ ~ „ ;: C~ .. : ~ .. „~ ~ ._ . ,. _ F .. ., _. -.~. i ~ G:D r,,~ w ~ ._. _' DATE FIC@p G7 ^~ under penalties of perjury, I deGare that I have examined this return, inGuding acx;ompanying schedules and statements, and to the best of my knowledge and belief, it is true, con'ect and complete. l~Claration of preparer other than the personal representative is based on all infom~ation of which preparer has any knowledge. SIGNATURE- P fRS~ N LE FOR FILING RETURN DATE ~- ~.i 01/22/2013 ADDRESS James W. ,Administrator, 45 E. Main St., Humelstown PA 17036 ER THAN REPRESENTATIVE DATE 01 /22/2013 ADDRESS James W. Abraham, Esq., Abraham Law Offices LLC, 45 E. Main St., Hummelstown PA 17036 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 J J 1505610205 REV-1500 EX (FI) Decedent's Social Security Number decedent's Name: RECAPITULATION 1. Real Estate (;Schedule A) ........................................ ..... 1. 0.00 2. Stocks and Bonds (Schedule B) .................................. ..... 2. 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 0.00 4. Mortgages and Notes Receivable (Schedule D) ...................... ..... 4. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).. ..... 5. 39,000.00 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .. ..... 6. 0.00 7. Inter-~lvos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested... ..... 7. 0.00 8. Total Gross Assets (total Lines 1 through 7) ........................ ..... 8. 39,000.00 9. Funeral Expenses and Administrative Costs (Schedule H) .............. ..... 9. 3,000.00 10. Debts of Decedent, Mortgage Liabilfies and Liens (Schedule I) ........... .... 10. 70,537.00 11. Total Deductions (total Lines 9 and 10) ............................. .... 11. 73,537.00 12. Net Value of Estate (Line 8 minus Line 11) .......................... .... 12. 0.00 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) .................... .... 13. 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13) .................... .... 14. 0.00 TAX CALCULATION -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 .0__ 15. 0.00 16. Amount of Line 14 taxable at lineal rate X .0 _ 16. 0.00 17. Amount of Line 14 taxable at sibling rate X .12 17, 0.00 18. Amount of Line 14 taxable at collateral rate X .15 18. 0.00 19. TAX DUE ..................................................... .... 19. 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 J REV-1500 EX (FI) Page 3 File Number Decedent's Comalete Address: DECEDENTS NAME Michael Burke Abraham - ___ STREET ADDRESS -- - 940 Walnut Bottom Road - -- - _ CITY Carlisle STATE _ ZIP PA 17015 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest 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. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (1) 0.00 Total Credits (A + B) (2) 0.00 (3) 0.00 (4) 0.00 (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? .................................................................................................................. ...... ^ 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 D 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)]. Asibling 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+ (08-12) ~'i ` Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEpVLE E CASH, BANK DEPOSITS SII MISC. PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Michael Burke Abraham 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. _~ ~~~~~~ ~Na~~ ~~ i~ccucu, use awmonai sneers or paper of the same size. REV-1511 EX+ (10-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Michael Burke Abraham Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City _ __ State ZIP Year(s) Commission Paid: Z• Attorney Fees: 3,000.00 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: 5• Accountant Fees: 6• Tax Return Preparer Fees: ~• Probate fees, Inheritance Tax Return preparation fees, all other fees, included in No. 2 Attorney Fees. 0.00 TOTAL (Also enter on Line 9, Recapitulation) $ 3,000.00 If more space is needed, use additional sheets of paper of the same size REV-1512 EX+ (12-12) Pennsylvania DEPARTMENT OF REVENUE INHERTfANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES 8r LIENS ESTATE OF FILE NUMBER Michael Burke Abraham Report debts incurred by the decadent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ~~ rnure space is neeaea, insert aaainonal sheets of the same size. ~~~' pennsylvania DEPARTMENT OE PUBLIC WELFARE -' ~`. March 28, 2012 ABRAHAM LAW OFFICES, LLC ATTORNEY AT LAW 45 EAST MAIN STREET HUMMELSTOWN PA 17036 Re: Michael Abraham CIS # : 030454399 SSN: ###-##-9471 Date of Death: 02/22/2011 Dear Mr. Abraham: Please be advised that the Department of Public Welfare maintains a claim in the amount of X70,537.85 against the above-mentioned estate. This claim is for restitution of medical assistance granted on behalf of the decedent for which the Probate Estate is now responsible to reimburse the Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as amended by Act 20-95, effective June 30, 1995. Enclosed is the Department:'s itemized statement of claim. A portion of this medical expense, namely $23.107.65, was incurred during the last six months of the decedent's life; therefore, it is a Class 3 claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $47,430.20, is to be entered as a priority Class 5.1 claim against the estate. Please acknowledge receipt of this letter and advise whether the Commonwealth's claim is admitted and when payment may be expected. If the estate accounting is complete, please provide a copy. If the estate contains real estate, please provide copies of the deed, the latest tax assessment, and a current appraisal, if available. Sincerely, Elizabeth D. James TPL Program Investigator 717-772-6397 717-772-6553 FAX Enclosure Bureau of Program Integrity ~ Division of Third Party Liability I Recovery Section REV-1513 EX+ (O1-10) Pennsylvania SCHEDULE ~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Michael Burke Abraham RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. Robert R. Hooton - Hummelstown, PA Brother 50% 2 James W. Abraham - Hummelstown PA Brother 50% 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. 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