The URL can be used to link to this page

Home My WebLink About02-22-13 (2)J 1505610143 REV-1500 Ex (d2-"' I'' OFFICIAL USE ONLY PA Department of Revenue pennsylvania coumy code veer File Number Bureau of Individual Tazes ac""arasa,er asvexue Po Box.zaosol INHERITANCE TAX RETURN 21 12 1338 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 0 02 2012 O1 11 1922 Decedent's Last Name EVANS Suffix Decedent's First Name MARGARET (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI W 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 Retum (Date of Death Prior to 12-13-82) q. Limited Estale ~ qa. Future Interest Compromise ~ 5. Fetleral Estate Tax Return Required (date of death attar 12-12-82) I~ 6 Decedent Dietl Testate ~ ~ Decedhent Maintained a Living Trust O a. Total Number of Sa(e De L.~J (Attach Lopy of Wily (Aaec GopY or Tnisy p051t BOXaS 9. Litigation Proceeds Received ~ 10. y~u~i Pg~N~crae~ll(Da~ee~ f Deem ~ 1f,Eleclion to tax under Sec. g113(A) (Attach Schedule 0) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephon@.Number GREGORY K RICHARDS ESQ 71~ 533 32$0 ~t ~ First Line of Address 134 SIPE AVENUE Second Line of Address City or Post Office HUMMELSTOWN Correspondent's a-mail address: Under penalties of periurv. I declare that I State ZIP Code PA 17036 examined this return, including accompanying schetlules t reparer other than the personal representative Is based on Gregory K. Richards Aven Side 1 R~ISSERIDF VVt~LS UQE ~LY ` N Y h Z m r V -, u~ ~ r "' :c, .:~ p -'~ '~ G b ' ` car `n P, ~ rr +r _ '4t ty L ~( ~ '' rYT ?1 Y' 2s Ln Cn d r1AT~l Ffl 'rl belle(, L 1505610143 1505610143 J 1505610243 REV-1500 EX Decedent's Social Security Number oa~de~rsuama. Evans, Margaret W. 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. 6. Jointly Owned Property {Schedule F) ^ Separate Billing Requested............ 6. 7 , 512.37 7. -Probate Property Inter-Vivos Transfers & Miscellaneous (Schedule G) (J Separate Billm9 Requested............ ~ 7, 431 , 348.28 g, Total Gross Assets (total Lines 1 through 7) ........................................................ 8. 438 , 860.65 9. Funeral Expenses and Administrative Costs iSchedule H) .................................... 9. 13 , 532 .41 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............................ 10. it. Total Deductions (total Lines 9 and 10) ............................................................... . 11. 13 , 532.41 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 425 , 328.24 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. 425 , 328.24 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 . 0 0 (a)(1.2) X .00 i6. Amount of Line 14 taxable 425 , 328 .24 i6. 19 ,139.77 at lineal rate X .045 17. Amount of Line 14 taxable 0 . 0 0 17. 0.00 at sibling rate X .12 18. Amount of Line 14 taxable 0.00 t8. 0.00 at collateralrateX.tS 19. TAX DUE ............................................................................................................... . 19. 19,139.77 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 '„~ 1505610243 1505610243 REV-1500 Ex Page 3 File Number 21-12-1338 Decedent's Complete Address: DECEDENT'S NAME Evans, Margaret W. STREET ADDRESS 824 Lisburn Road CITY STATE ZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 19,139.77 2. Credits/Payments A. Prior Payments 18,101.25 B. Discount 952.70 Total Credits (A + g) (2) 19,053.95 3. Interest [3) q. 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 W request a refund 1. Dld 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 :.................................. c. retain a reversionary interest; or ............................................................................................................... x 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? .................................................................................................................... ^ 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 designatlon? ..............................................................................._................................. ^ 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 disWosure 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 rata 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-1509 E%« (07-00) ~.,....,,u,~.~ n ~~ oFUN~~~ ~.u~< SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF ( FILE NUMBER Evans Margaret W 21-12-1338 If an aeeet was matle joint within one yearof the decedenre date or eealh, II must bs reportee on echetlule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Barbara A. Fleck 3308 Moravian Court Daughter Bethlehem, PA 18020 B, William J. Evans 419 Carmella Drive Son Mechanicsburg, PA 17050 C. JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTRUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSE % OF DECD'S INTEREST DATE OF DEATH DECEDENT'S INTEREST 1 A, B 07/13!2011 Sovereign Bank Certificate of Deposit # 6,949.11 33.333°!° 2,316.37 1055539702 -valued per letter dated November 28, 2012 2 A, B 07/13/2011 Sovereign Bank Checking Account# 8,324.93 33.333% 2,774.98 2331032416 -valued per statement dated October 31, 2012 3 A, B 07/1312011 Sovereign Bank Savings Account # 7,263.06 33.333°/° 2,421.02 574175946 -valued per letter dated November 28,2012 TOTAL (Also enter on Line 6, Recapitulation) I 7,512.37 Ili more space is needed, aeditional pages of the same size) Copyright (c) 2010 form software only The Lackner Group, Inc. FDmi PA•1500 Schedule F (Rev. 01-10) Rev-1510 FX~ (08-09) SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TA%RETIIRN RESIpENT pEGEOENT NUMBER ESTATE OF This schetlule must Oe completed and filed rt the answer to any of questions t through 4 on page three of the REV-1500 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY 7HE DATE OF TROP.NSFER.SA 7ACHTA COPyEOF TIHE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET ~ of oew~s INTEREST ( EXCLUSION IF APPLICABLEI TAXABLE VALUE 1 3,250 shares of BlackRock Municipal Inc. Quality - 54,827,50 54,827.50 titled in the Daniel R. Evans (deceased 02/26/2005) and Margaret W. Evans Living Trust dated 11101/1995; held in the NPC Brokerage Account # 4NR•097839; valued per letter dated November 8, 2012 and public listing 2 227.5 Cash -titled in the Daniel R. Evans (deceased 227.50 227.50 02/26/2005) and Margaret W. Evans Living Trust dated 11/01/1995; held in the NPC Brokerage Account # 4NR -097839; valued per letter dated November 8, 2012 3 966 shares of Dow Chemical Co -titled in the Daniel R. 28.236.18 28.236.18 Evans (deceased 02/26/2005) and Margaret W. Evans Living Trust dated 11/01/1995; held in the NPC Brokerage Account # 4NR-097839; valued per letter dated November 8, 2012 and public listing 4 350 shares of Enterprise Products Partners LP Com - 18,970.00 18,970.00 titled in the Daniel R. Evans (deceased 02/26/2005) and Margaret W. Evans Living Trust dated 1110111995; held in the NPC Brokerage Account # 4NR-097839; valued per letter dated November 8, 2012 and public listing 5 3,451.068 units of Federated Prudent Bear Fund Class 12,837.97 12,837.97 A -titled in the Daniel R. Evans (deceased 02126/2005) and Margaret W. Evans Living Trust dated 11/01/1995; held in the NPC Brokerage Account # 4NR-097839; valued per letter dated November 8, 2012 and public listing Total of Continuation Schedules See attached a es TOTAL IAISO enter on Line 7, Recapitulation) (M more space is neetle4 adtlitional pages of the same size) Copyright (c) 2009 form soRware only The Lackner Group, Inc. 431,348.28 Fonn PA-1500 Schedule G (Rev. 08-09) Rev-0570 E%+(08-09) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ITEM NUMBER DESCRIPTION OF PROPERTY THE DATE OF TEROANSFER SATTACFi A CIOPV OF THE DEED FOR REAL E5T TE. DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 6 1,700 shares of General Electric Co Common -titled in 38.845.00 38,845.00 the Daniel R. Evans (deceased 02/26/2005) and Margaret W. Evans Living Trust dated 11/01/1995; held in the NPC Brokerage Account # 4NR-097839; valued per letter dated November 8, 2012 and public listing 7 4,317.187 units of Harbor Bond Fund Instl Class - 56,209.77 56,209.77 titled in the Daniel R. Evans (deceased 02/26/2005) and Margaret W. Evans Living Trust dated 11/01/1995; held in the NPC Brokerage Account # 4NR-097839; valued per letter dated November 8, 2012 and public listing 8 1,960.04 NPC Account Brokerage Money Market - 1,960.04 1,960.04 titled in the Daniel R. Evans (deceased 02/26/2005) and Margaret W. Evans Living Trust dated 11/01/1995; held in the NPC Brokerage Account # 4NR-097839; valued per letter dated November 8, 2012 9 5,630.968 units of Oppenheimer International Bond 36,882.84 36,882.84 Fund Class A -titled in the Daniel R. Evans (deceased 02/26/2005) and Margaret W. Evans Living Trust dated 11/01/1995; held in the NPC Brokerage Account # 4NR -097839; valued per letter dated November 8, 2012 and public listing 10 Personal Property 1,000.00 1,000.00 11 400 shares of Praxair Inc. -titled in the Daniel R. 41,548.00 41,548.00 Evans (deceased 02/26/2005) and Margaret W. Evans Living Trust dated 11/01/1995; held in the NPC Brokerage Account # 4NR-097839; valued per letter dated November 8, 2012 and public listing SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY continued Copyright (c) 2009 form software only The Lackner Group, Inc. Forth PA-1500 Schedule G (Rev. 08-09) Rav-7510 E%~ (09-09) SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY COMMONN£ALTH OF PENNSYLVANIA INMERITANCETPX RENRN continued RESIDENT OEDEOENT ESTATE OF FILE NUMBER Evans, Margaret W. 21-12-1338 ITEM NUMBER DESCRIPTION OF PROPERTY THE DAT O RANSFERSATTACNTA COPVEOF THE DEIED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST ExausloN lip gpPLICABLE) TAXABLE VALUE 12 1,000 shares of Tortoise Energy Infrast. Corp. Com - 40,620.00 40,620.00 titled in the Daniel R. Evans (deceased 02/26/2005) and Margaret W. Evans Living Trust dated 1 1101 /1 9 9 5; held in the NPC Brokerage Account # 4NR-097839; valued per letter dated November 8, 2012 and public listing 13 3,941.977 units of Vanguard Inflation Protected 58,853.72 58,853.72 Securities Fund -titled in the Daniel R. Evans (deceased 02/26/2005) and Margaret W. Evans Living Trust dated 11/01/1995; held in the NPC Brokerage Account # 4NR-097839; valued per letter dated November B, 2012 and public listing 14 3,432.32 units of Vanguard PA Long-Term Tax Exempt 40.329.76 40,329.76 • titled in the Daniel R. Evans (deceased 02/26/2005) and Margaret W. Evans Living Trust dated 11/01/1995; held in the NPC Brokerage Account # 4NR-097839; valued per letter dated November 8, 2012 and public listing TOTAL (Also enter on Line 7, Recapitulation) 431,348.28 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. OS-09) REV-1151 EX+110-09) SCHEDULE H CDMM~Af~~f,1,~P RN ANIA FUNERAL EXPENSES AND ^~'"R``~E I ``ff~~DE'Z~~f- ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Evans, Margaret W. 21-12-1338 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT _ NIIMRFR A, FUNERAL EXPENSES: See continuation schedule(s) attached B. I ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zio Year(s) Commission Paid 2, Attorney's Fees James, Smith, Dietterick & Connelly, LLP 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 5. Tax Return Preparer's Fees 7. Other Administrative Costs 5,488.91 8,000.00 43.50 TOTAL (Also enter on line 9, Recapitulation) I 13,532.41 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 Evans, Margaret W. _ 21-12-1338 ITEM NUMBER DESCRIPTION AMOUNT 1 Funeral Exggpses Connell Funeral Home Inc. -funeral 4,447.79 2 Culhane's Inc -meal after service 872.81 3 Royer's Flowers and Gifts -Flowers for funeral 168.31 H-A 5,488.91 4 Attorn~ees James Smith Dietterick & Connelly LLP 8,000.00 H-B2 8,000.00 5 probate Fees Cumberland County Register of Wills -probate fee 43.50 H-B4 43.50 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) REV-061I E%. )0740) SCHEDULE J COM ~N~ESVNT DTECEDENTRNANIA BENEFICIARIES ESTATE OF FILE NUMBER Evans, Mar aret W. 21-12-1338 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(Sl RECEIVING PROPERTY DECEDENT (Words) ($$$) I TAXABLE DISTRIBUTIONS [include outright spousal • distributions, and transfers under Sec. 9116 a 1.2 1 Richard J. Evans Son 25°/, of residue 104,453.96 4 Boss Drive East Berlin, PA 17316 2 William J. Evans Son 25% of residue, 108,210.15 419 Carmella Drive 50%joint Mechanicsburg, PA 17050 accounts 3 Barbara A. Fleck Daughter 25°/, of residue, 108,210.16 3308 Moravian Court 50%joint Bethlehem, PA 18020 accounts 4 Susan J. Werner Daughter 25°!° of residue 104,453.97 10490 SW Miller Ct. Tualatin, OR 97062 Total 425,328.24 Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 15 00 cover sheet as a ro riate. NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 8. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEETI Copyright (c) 2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 01-10) February 21, 2013 THE Glenda Fazner Strausbaugh ESTATE Register of Wills & SECURITY Clerk of Orphans' Court ~ "ORMtJLA .. 1 Courthouse Squaze Cazlisle, PA 17013 RE: TRUST ESTATE OF MARGARET W. EVANS, DECEASED FILE N0.21-12-1338 Dear Ms. Strausbaugh: Enclosed are the following documents to be filed in the above-referenced Estate: 1. An original and two (2) copies of the Pennsylvania Inheritance Tax Return. 2. A check made payable to the "Register of Wills, Agent" in the amount of Eighty Five Dollazs and Eighty Two Cents ($85.82) representing the balance of Pennsylvania Inheritance Tax due. 3. A check made payable to the "Register of Wills" in the amount of Fifteen Dollars ($15.00) representing the filing fee. Please time-stamp the additional copy of the Return and return to me in the en`e~os~ed self-~ addressed, stamped envelope. ~ ~ ~,-~ rn=~ m If you have any questions, please feel free to give me a call. n Z m N ~ ~ Sf •x Sincerely, o ~ o ~ r--~ JAMES, S ITH, DIETTERICK Bc ^C/~IOr//NKN~ELLY, LLP b "~ ~" '/j/~~, C//, V C17 /'/ ~ Denise M. Long Cc: Bazbaza A. Fleck William Evans Denise M. Long dml@jsdc.com a~ m 'T' ~~ 0 ~ ~ fri t1'F 17 b ao -+v -n ~ ~ r ~ r ~ Cn O 134 SIPE AVENUE HUMMELSTOWN, PA 1]036 MAILING ADDRESS P.O. BOX 650 HERSHEY, PA 1]033 TOLL FREE 1.800.942.3660 TEL. ]1].533.3260 FAX ]1].533]]]1 wwwjstlc.can a41 f'.~ ~~1 { (J '.: C"' Y tU ;'til ~~;~ ~'~3 ~a ~~ RECORDS ~it~F; "E 0~ REGlSTE~ ~~ 4 ": i3 E,EB 2~ fi~1 . ' S6 :"~ ~ (l CC ~{ t V ~3Y ~31 V~ ~ w pc~ uu ORI'fiHNS~~C'li (~ ~,' ~?,~: CUMBERLAND CC., aQ ~ ~, d T N O C l~tpI O O Uo~ °~~o V X ~ ~ma C 71 ~ ~ T ~ C4 mar d is ~ ~ E ~ = ~ (C m~U ~M ~ N C ~ ~ -° ~ ~ N T N m~ ~ o a ~ LL ~ ~ N C6 .4! ~ ~ N ~a~Um ~ y ~~c~~-c~