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HomeMy WebLinkAbout02-01-1315D561D143 Ex (02-11) OFFICIAL USE ONLY REV-1500 File Number PA Department of Revenue pennsylvania County Code Year Bureau of Individual Taxes DEPARTMENT OF REVENUE PO 60X.280601 INHERITANCE TAX RETURN 21 12 00916 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Date of Birth Social Security Number Date of Death 06 24 2012 02 05 1915 Decedent's Last Name WOOD S Suffix Decedent's First Name rTELLIE MI K (If Applicable) Enter Surviving Spouse's Information Below MI Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ^ ~ 3 Remainder Return (Date of Death 1. Original Return 2. Supplemental Return Prior to 12-13-82) 4. Limited Estate ^ 4a. Future Interest Compromise (date of death after 12-12-82) ~ 5. Federal Estate Tax Return Required 6 Decedent Died Testate (Attach Copy of Will) ^ ~ Decedent Maintained a Living Trust (Attach Copy of Trust) O 8. Total Number Of Safe Deposit Boxes ^ 10. betweeriP2v31 ~J1 audit Da95~ f Death ~ 11Attach S~hedule O) Sec. 9113(A) 9. Litigation Proceeds Received ^ CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIALD yt me Telephone Numbe BE DIRECTED TO: Name EDMUND G MYERS (717) 761 4540 First Line of Address 301 MARKET STREET Second Line of Address PO BOX 109 ~EGISTER OF~LLS USE~ONLY %~ r'ri ~~ o~ ~`~' m~ ~ ~ ~ cz~ ~ ~ ~~ ~ ~ DAT~FILE~D: ~`'~ City or Post Office State ZIP Code `~ ~ ~--~ ~: LEMOYNE PA 17 0 4 3 ~._~ ~.~ ~, e m dsw.com Correspon ent's a-mail address: 9 Under pe alf s of perjury,ledecDeclahatiohof preparer of th han thelpersonal aeprasentative Iscbased on au Info mat on~of wh~h prepare has any knowledge belief, it is true, o ect and comp DATE SIGNAT OF PERSON RE S14L ILI G RETU f ~~ Gregory E Woods l ADDRESS 122 Ashword Wa Cam Hill PA 17011 DATE SIGNATU F PREPARER OTHER THAN REPRESENTATIVE ' ~ I ~~~ /_ EDMUND G. MYERS 301 MARKET STREET, Lemo ne, PA L 1505610143 Side 1 1505610143 J 1505610243 REV-1500 EX Decedent's Social Security Number Woods, Nellie K Decedent's Name. RECAPITULATION .. 1. 1. Real Estate (Schedule A) ..................................................................................... 2. 2. Stocks and Bonds (Schedule B) ............................................................................. • 3. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......•• . 4. 4. Mortgages & Notes Receivable (Schedule D ........................... 10 945.69 5 Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... Cash 5 , . 6 2,049.91 . 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 7. Inter-Vivos Transfers & Miscellaneous Ilan; Probate Property ^J Separate Billing Requested............ 7. 1 4 67.7 6 ~ (Schedule G) 4 6 3. 3 6 14 ........................... 8. Total Gross Assets (total Lines 1 through 7) ............................. g , . 3,434.57 . 9. Funeral Expenses and Administrative Costs (Schedule H) .................................... 9 . 6, 639.92 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............................ 10 . 10 , 074.49 11. 11. Total Deductions (total Lines 9 and 10) ................................................................ 12 4, 3 8 8. 8 7 . ...................................... Net Value of Estate (Line 8 minus Line 11) ................... 12 . Charitable and Governmental Bequests/Sec 9113 Trusts for which 13. 13 . an election to tax has not been made (Schedule J) ....................... 4 , 388.87 • 14. 14. Net Value Subject to Tax (Line 12 minus Line 13) ............................................... TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or 0 . 0 0 transfers under Sec. 9116 15. (a>(1.2> x .o0 197.50 16. Amount of Line 14 taxable 4 ~ 3 $ $ , $ 7 16. at lineal rate X .045 Q . Q Q 17. Amount of Line 14 taxable 0 , Q Q 17. at sibling rate X .12 Q . Q Q 18. Amount of Line 14 taxable 0 , Q Q 18. at collateral rate X .15 197.50 19. .......... ............................... 19. TAX DUE ...................................................................... . ING A REFUND OF AN OVERPAYMENT. 20. FILL IN THE OVAL IF YOU ARE REQUEST 155610243 Side 2 1505610243 REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME Woods, Nellie K STREET ADDRESS Sarah Todd Memorial Home CITY Carlisle Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest STATE I ZIP - pq 17013 (1) 197.50 o.oo o.oo Total Credits (A + B) (2) (3) 4. If Line 2 is greater than Line 1 + Line 3, enteat efu aerence. This is the OVERPAYMENT. Check box on Page 2, Line 20 to request 5, If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (4) (5) 197.50 Make Check Payable to: REGISTER OF WILLS, AGENT. STIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS PLEASE ANSWER THE FOLLOWING QUE Yes No 1. Did decedent make a transfer and: ................... ^ ^^x^ 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;:....• :::::::::::::::::::•: ^ ^ ..... ^ o c. retain a reversionary interest; or ........................................................ ...................................... d. receive the promise for life of either payments, benefits or care • •~~~"'Within one year of death without ^ ^ 2. If death occurred after Dec. 12, 1982, did decedent transfer property x . ... ...................................... receiving adequate consideration? ............. • n "in trust for" or payable upon death bank account or security at his or her death?....... ^ x 3. Did decedent own a which ^ ^ 4. Did decedent own an individual retirement account, annuity, or other non-probate property x .............. . ............ . ............................. . .. contains a beneficiary designation? ..................... F THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RE IF THE ANSWER TO ANY O re Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving For dates of death on or after July 1, 1994 and befo spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. Janua 1, 1995, the tax rate imposed on the net value of transfers tX and the statut ryh equirelmentsf or disclosuee of For dates of death on or after rY [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from a , 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: et value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural paren , an .The tax rate imposed on the n adoptive parent, or a stepparent of the child is 0 percent [72 P.S. §9116 (a) (1.2) . the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in The tax rate imposed on [72 P.S. §9116 (a) (1)]. ed on the net value of transfers to or for the use of the decadent n colmmon wit the decedent whether by blood or adoption. . The tax rate impos sibling is defined under Section 9102, as an individual who has at leas o p File Number 21-12-00916 Rev-1508 EX+(11-10) gCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF 21-12-00916 Woods, Nellie K Include then nrtlceownedlwt hlthearidht of surv worship mu teberdi closed on schedule F. All property j Y- 9 VALUE AT DATE ITEM DESCRIPTION OF DEATH NUMBER 8,600.00 1 Genworth Annuity -Distribution to Decedent 53.72 2 Readers Digest Magazine -Refund of Subscription 1,767.80 3 Sarah Todd Memorial Home 524.17 4 U.S. Treasury -Refund received for 2011 individual income taxes I I 10,945.69 TOTAL (Also enter on Line 5, Recapitulation) (If more space is needed, additional pages of the same size) Form PA-1500 Schedule E (Rev. 11-10) Copyright (c) 2010 form software only The Lackner Group, Inc. Rev-1509 EX+(01-10) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN o~cinGnlT nFCEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF ILE NUMBER 21-12-00916 Woods, Nellie K 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 q. Gregory E Woods B. C. ADDRESS 122 Ashford Way Camp Hill, PA 17011 RELATIONSHIP TO DECEDENT Son JOINTLY OWNED PROPERTY: DESCRIPTION OF PROPERTY % OF ' DATE OF DEATH VALUE OF EST ' LETTER DATE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT TIFYING NUMBER. ATTACH DEED FOR S DATE OF DEATH DECD VALUE OF ASSE INTEREST S INTER DECEDENT ITEM FOR JOINT NUMBER TENANT MADE JOINT NUMBER OR SIMILAR IDEN JOINTLY-HELD REAL ESTATE. 000% 50 1 ,302.63 0110112008 Belco Federal Credit Union Checking . 2,605.25 1 A Account 2 I A 101101120081 Belco Federal Credit Union Savings Account ' TOTAL (Also enter on Line 6, Recapitulation) (If more space is needed, additional pages of the same size) Copyright (c) 2010 form software only The Lackner Group, Inc. 1,494.56 I 50.000%I 747.28 2,049.91 Form PA-1500 Schedule F (Rev. 01-10) Rev-1510 EX+(08-09) SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF 21-12-00916 Woods, Nellie K 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. OF DECD'S EXCLUSION TAXABLE ITEM DESCRIPTION OF PROPERTY DATE OF DEATH INTEREST IF APPLICABLE) VALUE NUMBER T E DATE OF TRANSFERSATTACNTA COPYEOF TIE DEIED ~OR REAL ESTATDE. VALUE OF ASSET ~ 1,467.76 1,467.76 1 Genworth Annuity -Beneficiary: Gregory E. Woods ~ I 1,467.76 TOTAL (Also enter on Line 7, Recapitulation) (If more space is needed, additional pages of the same size) Form PA-1500 Schedule G (Rev. 08-09) Copyright (c) 2009 form software only The Lackner Group, Inc. REV-1151 EX+(10-09) SCHEDULE H FUNERAL EXPENSES AND COM INO ERITANCEOTF/.~P RETURNANIA RESIDENT DECEDENT ADMINISTRATIVE COSTS FILE NUMBER ESTATE OF 21-12-00916 Woods, Nellie K Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A, FUNERAL EXPENSES: 2,641.07 See continuation schedule(s) attached g, ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address State Zip City Year(s) Commission Paid 750.00 2. Attorney's Fees JOHNSON DUFFIE 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's Fees 6. Tax Return Preparer's Fees 43.50 7. Other Administrative Costs See continuation schedule(s) attached 3,434.57 TOTAL (Also enter on line 9, Recapitulation) Form PA-1500 Schedule H (Rev. 10-09) Copyright (c) 2009 form software only The Lackner Group, Inc. SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued (FILE NUMBER ESTATE OF 21-12-00916 Woods, Nellie K AMOUNT ITEM DESCRIPTION NUMBER Funeral Expenses 1 Harrisburg East Cemetery 2 Remaining Balance of Funeral Home Services 3 Trinity Lutheran Church -Funeral Reception 210.00 2,134.00 297.07 H-A 2,641.07 Other Administra ive Costs 43.50 4 Cumberland County Register of Wills Office -Filing Fee for Petition for Small Estate H-B7 43.50 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX+(12-08) gCHEDULE ~ DEBTS OF DECEDENT, I. MORTGAGE LIABILITIES AND LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN oCelnGnl7 nFf:FI~FNT ESTATE OF Wnnr1S_ Nellie K FILE NUMBER 21-12-00916 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. VALUE AT DATE ITEM DESCRIPTION OF DEATH NUMBER 40.09 1 CenturnLink 66.59 2 Diamond RX -Pharmacy Services 64.14 3 Millinium RX -Pharmacy Services 9.17 4 PA Department of Revenue 8.63 5 R. Lynn Magargle MD 6,451.30 6 Sarah Todd Memorial Home ' TOTAL (Also enter on Line 10, Recapitulation) I 6,639.92 (If more space is needed, additional pages of the same size) Form PA-1500 Schedule I(Rev. 12-08) Copyright (c) 2008 form software only The Lackner Group, Inc. REV-1513 EX+ (01-10) COMMONWEALTCCH OFpp,,P~~ENNSUUYLVANIA IN RESIDENTEDECEDENTRN ESTATE OF SCHEDULE J BENEFICIARIES Woods, Nellie K NAME AND ADDRESS OF NUMBER PERSON(Sl RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)~___ Gregory E Woods 122 Ashford Way Camp Hill, PA 17011 FILE NUMBER 21-12-00916 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE DECEDENT (Words) ($$$) Son ~ Entire estate I ~ Total ~ Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet, as a ro r NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 4,388.87 4,388.87 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 FormEPA 1500 Schedule J (Rev. 01-10) Copyright (c) 2010 form software only The Lackner Group, Inc. ESTATE OF NELLIE K. WOODS SCHEDULE OF EXHIBI TS EXHIBIT A EXHIBIT B EXHIBIT C Last Will and Testament for Nellie K. Woods signed and dated September 21, 2007. Copy of Decree of Distribution showing values of Joint Account and Cash received. Genworth Date of Death Letter on Annuity 537290 Last Will and Testament OF NELLIE K. WOODS of the Borough of Camp Hill, County of Cumberland, I, NELLIE K. WOODS, t ~ ~~r ..~ 3- ~-~' do ll~ale, publish and declare this to be my Fast ~y`iil c.ild Ci`3ii~il=r~a~~7c,ait3`i i^.•t i .,~u'1:+}~1~~111a, revokin and making void ,any and all former Wills made by me. Testament, hereby g 11 m le al debts and funeral expenses, which my estate is ITEM 1. I direct that a y g ' feed b m Executor, as soon after my death as may be found obligated to pay, be paid and sates y y ~ convenient. e ueath all the rest, residue and remainder of my estate of ITEM 2. I give, devise and b q e tom son, GREGORY E. WOODS, and his then living every nature and wherever situat y issue, per stirpes. son GREGORY E. WOODS, Executor of this my Last Will. ITEM 3. I appoint my Executor shall not be required to give bond for the faithfu ITEM 4. I direct that my performance of their duties in any jurisdiction. J Q W ~~ W ~ •~ Q H J J Q m ~ hand and seal this=day of IN WITNESS WHEREOF, I hereunto set y Zoos. ~~:~ f~ (SEAL) NELLIE K. WOODS e • nned -:=~P~.~~e:d., Ll.~?li shed and declared b~T the abovL~named Testatrix, as and for her Last ~~~ p d Testament, in the presence of us, who at her request, in her presence and in the presence Will an of each other have hereunto subscribe 2 AFFIDAVIT AND ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND E K. WOODS, ~ ~~ ~ . ~~~ ~~~ and We, NELLI ,the Testatrix and the witnesses, respectively, ' ned to the att ched or foregoing instrument, being first duly sworn, do hereby whose names are sig declare to the undersigned authority that the Testatrix signed and executed the instruY~~erit as her Last Will and that she had signed willingly and that she executed it as her free and voluntary act for the oses therein expressed, and that each of the witnesses, in the presence and hearing of the P~ Testatrix, signed the Will as witness and that to the best of his/her knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. Testatrix Subscribed, sworn to and acknowledged before me by NELLIE K. WOODS, and and subscribed and sworn to before me by witnesses, this ~ ~ ~~ day of ~ ~..~ , 2007. . 1~J Notary ublic .~ ~!~1~?~-al Sri 310349 ~~t1~ L. ~,~~;~,~, i~4~t~iy s~~~fi~ L~~s~g~a ~~ra, Gr.~r~R~; ~~.m~~ ~~~t~~ r1~lero~~c~, r~nrZSyl~t~:s^:s~ anss~yiG~tior'e ~~ IR!s~e~sf~~ 3 l~ In the Court of Common Pleas of Cumberland Gounty, Pennsylvania Orphans' Court Division - C~ ~, IN RE: Estate of ~ ~' -~ ~ ~` r~' _ NELLIE K. WOODS, ~' ~"- ~ ~ ~~: Late of Carlisle, - ~ ~ --, Cumberland County, Pennsy{vania _.~ ~~~ o~`~ - NO. ~~ I ~ --< . ~. Deceased DECREE OF DISTRfBUTION .~s ~.~ r- a T~ ^~ r' _._ ~ ~-- ~ r~ . , `,~ ~ w --t-z c.~ And now, this day , 2012, upon consideration of the fore oing petition and on motion of the attorney for the Petitioner, it is Decreed that the g Petitioner distribute the property of the Decedent under Section 3102 of the Probate, Estate and Fiduciaries Code as follows Name Gregory E. Woods, Sole beneficiary Amount $1,758.00 (Refunds due from Reader's Digest and Sarah A. Todd Memorial Home) $1,500.00 (Checking Account at Belco Federal Credit Union) $3,258.00 TOTAL This decree of distribution shall constitute sufficient authority to all transfer agents, re istrars and others dealing with the property of the estate to recognize the persons named as 9 entitled to receive such property without administration, and shall in all respects have the same effect as a decree of distribution after an accounting by a personal representative. By the Co Judge A TRUE COPY FROMI he eoto ~ ~h O l~'1 a S A. ~ ~ a ~e}/ . In Testimony whera , ~ my hand and the seal ~~ m ~ O n PI ea s Judge of said Court at ~ttisl8, A J T d~Y _ w r 1 ~~ ~~ ~, /~.~ 5 w .,~~~ Q / C~irk ~t 1hM Orphans Court Cunnbar#ar+d County Q Genworth }t August 28, 2012 Gregory Woods 122 Ashford Way Camp Hill, PA 17011 Re: Deceased: Nellie Woods Contract Number: 706134321 Dear Mr. Woods, P,O. Box X3014 Lyn„tibury, VA <'4.iG6-~()1~'~ (8(~0} 635-805G (43Y) 5d8-5783 Fax gem,~o~1.i~.ccn~ n res onse to our inquiry, the account value of the above referenced contract as of June 24, 2012 was I p Y $1,467.76. s know if ou have any questions concerning the contract. You may contact us at 800 635.8056, Please let u Y Monday -Friday 8:30 a.m. to 5:00 p.m. Eastern Time. Sincerely, Claim Division MJH Qff~liated Companies: Genworth Life Insurance Company of New York, Genworth Life and Annuity Insurance Company, Genworth Life Insurance J Q J Q 1 I.I!.1f~F.~Ci- ).. '~,U~ I~l~ il~~i~l !~~ I~l~~l~-~11; it1H:~ :~ I.l~( l I~ ~ tilt } L~ LI)~li'V~l) (i , L ~~ t1 l) 1 F 1 { - --- --- . - _ --- - I!'1J:11.1~-III,LIP ~i,l!`~::~ ST1~I~l.ta~ ~l.~T~lllC:AC RII)-.E`~ ~LFI~R[a B. I;-~:~L~-~1(.; ~ - OF COU~SEI: ~c)-i~ I~. \1\c7Shti l l~)R:1~~E .~. Ji)li~stly 1f-:I1:vI~1. J. ('.1SS--)1 January 30, 2013 Register of Wills Office Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 RE: Estate of Nellie K. Woods ~; File No. 21-12-00916 c ~ ~ rn ~ Our File No. 15123-1 ~ ~ m ~ ~ ~~~:~ Dear Register: ~ ~'' '~ °'~` ~ `' ~v> ~ ~ ~~~, Enclosed for filing, please find the following: ~, ~ ,,~ -~ -~'~t "~~` ~ ~, w._:~ ~ .. 1. 2 Original Pennsylvania Inheritance Tax Returns. There is tax due in t~ ount of-$197 ~ ;~~~his Estate was not probated but a Petition for Small Estate was filed. ~~, ~~ ~~.», v~ 2. Inventory ~~ `~ 3. One copy of Page 1 of the Inheritance Tax Return that we ask that you time-stamp and return to us. 4. One copy of the Inventory that we ask that you time stamp and return to us. 5. Check in the amount of $30.00 representing the filing fees for the Inheritance Tax and Inventory Thank you for your assistance in this matter. Should you have any question or require any additional information, please contact the undersigned Very truly yours, J HNSON, D,I~FFIE, STEWART &WEIDNER ~~ ~~ r f~ Dana Wieseman Estate Administration Paralegal Enc. c: Gregory E. Woods :537298 X01 ~'I;~(ihET S"lE~f~.l~"f P.O. 13C?~ 10~i 1.I;11()1~I. Pt:'ti15111':1:ti1;~ 1 i0=17-Olllt) 1~~~~'~1'.Jl)Stl'.CO11 i 1 ".ih L~1 x=10 1~:~\: % l i . i f~ 1. x(11 ~1,111, ra (L~~I~.Cf)11 JOHNS01~, DUFFIE, STEWART &WEIDNER, P.C.