HomeMy WebLinkAbout03-08-13 (3),.
1505610140
-' REV-1500 ~` (°'-'°'
OFFICU\L USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
Po Box 2BOSOt INHERITANCE TAX RETURN
_ Harrisburg PA 17126-0601 RESIDENT DECEDENT 2 1 1 3 1 0 7
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYW Date of Birth MMDDVYYV
1 6 2 0 1 3 1 2 2 1 1 9 1 2
Decedents Last Name Suffix Decedent's First Name MI
A L L E M A N H E L E N 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 WELLS
FILL IN APPROPRIATE OVALS BELOW
O 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death
prior to f 2-t 3-82)
4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required
death after 12-12-82)
6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A)
between 12-37-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT - THIS SECTWN MUST BE COMPLETED. ALL CORRESPONDENCE AND GDNFIDENTIAL 7AX INFOHMAnUN SHDULD tie ulRt:c I I:u I D:
Name Daytime Telephone Number
C H A R L E S
First {ine of address
E P E T R I E
3 5 2 8 B R I S B A N S T R E E T
Second line of address
City or Post Office State ZIP Code
H A R R I S B U R G P A 1 7 1 1
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Correspondent's e-mail address:
Under penalties of perjury, I declare Mat I have examined this relum, Including accompanying schedules and statemenLS, and to the best of my knowledge and ballet,
it is true, correct and complete. Dedaredon o1 preparer other than Me personal representative is based on all Informadon of which preparer has any knowledge.
SIGNATURE DF PERSON RESAONSIPLE FOR FILING RETURN DATE
MUURCJJ
S7 l~Ja-~i PI,,R ~ - r /~} 17 ~ ~ L
SIGNATURRRJ:OFP SPAR ~Erj~AANN~EPRESENTATIVE 31612013
ADDRES/S~~-'/fy ~1J~
.~Y.?~ ~i^,,r ~c~ Jtiv~f /-r~G~r/s ~~rs /°~' /'iii/
PLEASE USE ORIGINAL F M ONLY
Side 1
1505610140 1505610140
1505610240
REV-1500 EX
Decedent's Social Security Number
Decedent's Hame: HELEN M. ALLEMA
RECAPITULATION
5. Real Estate (Schedule A) ......................................... .. 1.
2. Stodcsand Bonds(SChedule B) .................................... .. 2. 2 6 2 8 1 2 0
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3.
4. Mortgages and Notes Receivable (Schedule D) ........................ .. 4.
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. 1 1 0 0 8 0 1 6 7
8. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ..... .. 6.
7. toter-Vivos Transfers 8 Miscellaneous N n-Probate Property
(Schedule G) ~] Separate Billing Requested ..... .. 7.
8. Total Gross Assets (total Lines 1 through 7) ......................... .. 8. 1 1 2 7 0 8 2 8 7
9. Funeral Expenses and Administrative Costs (Schedule H) ................ .. 9. 3 7 9 6 . 0 9
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ........... .. 70. 1 0 8 6 2 . 8 8
~ ~. Total Deductions (total Lines 9 and 10) ............................. .. 11. 1 4 6 5 8. 9 7
12. Net Value of Estate (Line 8 minus Line i t) .......................... .. 12. 1 1 1 2 4 2 3. 9 0
13. Charitable and Governmental BequestslSec 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. 1 1 1 2 4 2 3 . 9 0
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
16. Amount of Line 14 taxable
at lineal rate X .0_ 0. 0 0 16. 0. 0 0
17. Amount of Line 14 taxable
at sibling rate X .t 2 0. 0 0 2 7. 0. 0 0
18. Amount of Line 14 taxable
at collateral race X .t 5 1 1 1 2 4 2 3. 9 0 18. 1 6 6 8 6 3. 5 9
19. TAX DUE .................................................... ..19. 1 6 6 8 6 3. 5 9
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
1505610240
150561240
REV-1500 EX Page 3
Decedent's Complete Address:
Flla Number
21 13 107
DECEDENT'S NAME
HELEN M.ALLEMAN
STREET ADDRESS ~,
1700 MARKET STREET
CITY ~ STATE ZIP
CAMP HILL PA 17011
Tax Payments and Credits:
~. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
3. Interest
8.343.18
4. If Line 2 is greater than Line 1 +Line 3, enter the dffference. Th1s is the ITrERPAYMENT.
FIII in oval on Page 2, Lina 20 to request a refund.
5. If Line 1 +Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
Make check payable to: REGISTER OF WILLS, AGENT
(3)
(4)
(5)
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 transfened : ................................................................. ..... ^ Q
b. retain the right to designate who shall use the properly transferred or its income : ......................... ...... ^
c. retain a reversionary interest; or ........................................................................................... ..... ^
d. receive the promise for life of either payments, benefits or care7 .................................................. ..... ^
2. If death occuned after December 12,1982, did decedent transfer property within one year of death
without receiving adequate considera0on? .................................................................................. ..... ^
3. Did decedent own an'In trust for" orpayable-upon-death bank account or secudty at his or her death? -... ..... ^
A. Did decedent own an individual retirement arxount, annuity or other non-probate property, which
contains a beneficiary designation9 ............................................................................................. ..... ^
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 spc
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 Vansfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets
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 benefidaries 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 fransfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined,
SecOon 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
Total Credits (A + B) (2)
_ _ _ ~ ~ _
R£V-1508 EX + i6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDU4E E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
HELEN M. ALLEMAN 21 13 107 i
InGude the proceeds of litigation and the date the proceeds were received bl the estate.
All properyjointy~ovmed vMh right of survivorship must be dlscbsed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. CHECKING ACCOUNT AT WELLS FARGO BANK 25,849.34
2.
SAVINGS ACCOUNT AT WELLS FARGO BANK I
25,125. 3
3. CERTIFICATES OF DEPOSIT AT WELLS FARGO BANK 33,199. 3
4. CHARNEY INVESTMENTS 1,010,682. 6
5. CAPITAL BLUE CROSS REFUND 432. 6
6. MANOR CARE REFUND 5,081. 5
7. HIGHMARK BLUE CROSS REFUND 58. 0
8. IRS REFUND 373. 0
TOTAL (Also enter on line 5, Recapitula0on) S 1 100 801.6
(If more space is needed, insert additional sheets 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
1
Daedent's debts must be reported on Schedule Y.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. BLUE RIDGE MEMORIAL GARDENS 187 59
8.
1. ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City State _
Year(s) Commission Paid:
y. AttomeyFees: CHARLES E. PETRIE
3, Family Exemption: (If decedenYS address is net Ne same as daimenYS, attach explanation.}
Claimant
Street Address
City State _
Relationship of Claimantta Decedent
4. Prohate Feas~.
5 AaountantFees:
6. Tax Retum Preparer Fees:
7
ZIP
ZIP
858.
TOTAL (Also enter on line 9, Recapitulation} I E
If more space is needed, use additional sheets of paper of the same size.
REV-1512 FXi (12-0e)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, 8 LIENS
es I a I t ur FILE NUMBER
HELEN M ALLEMAN
21 13 107 ~
i
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, Including unroimburoed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. MANOR CARE NURSING HOME 10,517. 5
2. PA STATE INCOME TAXES 2012 236. 0
3. HEARTLAND PHARMACEUTICAL gg, g
4. MUTUAL OF AMERICA OVERPAYMENT FOR FEBRUARY 21. 5
TOTAL (Also enter on Line 10, Recapitulation) S 10 862.88
If more space is needed, insert additional sheep of iha same size.
_I
REV-1513 E%+101-10)
Pennsylvania ~ SCHEDULE J
DEPARTMENT OF REVENUE I BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
HELEN M. ALLEMAN
21 13 107
RELATIONSHIP TO DECEDENT AMOUNT OR SHAR
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Llst Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include ouhy~htspousel d~stdDutions and transfers under
Sec. 91 f6 (a) (1.2).J
1. DAVID & PATRICIA LIFTMAN Collateral 1,112,423 90
57 WALSH ROAD
HALIFAX, PA 17032
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18 OF REV-1500 COVER S HEET, 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.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. E
Ir more space rs needetl, use atltlitronal sheets of paper of the same size.
h
LAST WILL AND TESTAMENT
I, HELEN E. ALLEMAN, of 1700 Market Street, Camp Hill, County of
Cumberland, Pennsylvania, do hereby make, publish, and declare this to be my
LAST WILL AND TESTAMENT, revoking any and all prior wills and codicils, in
manner following, that is to say,
FIRST, that I direct that my Personal Representative shall pay all of my
just debts and funeral expenses as soon as this shall be practicable.
SECOND, that upon my death, I give, devise, and bequeath all of my
property, real, personal, and mixed to DAVID and PATRICIA LIFTMAN, or to
the survivor of them.
THIRD, that I hereby appoint DAVID and PATRICIA LIFTMAN, as the Co-
Executors of my Estate. If either is unable or unwilling to perform in this
capacity, then I hereby appoint the other as the Executor of my Estate. I direct
that my personal representative shall not be required to post bond in this or in
any other jurisdiction.
IN WITNESS WHEREOF, I have hereunto mafi. this
~ ~f
14th day of January, 2013. ~~ ~~ `~'~~~
HELEN E. ALLEMAN
cam.-~~~
WITNESS
~-l=> !1 ems" C~i ( ~S~''lrA.~._--
WITNESS
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF DAUPHIN
I, HELEN E. ALLEMAN, testatrix, whose name is signed to the attached
or foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I have signed and executed the instrument as my Last Will
and Testament; that I signed it willingly and that I signed it as my free and
voluntary act for the purposes therein expressed.
Sworn or affirmed to and acknowledged before me by HELEN E.
ALLEMAN, the testatrix, this 14~ day of January, 2013.
Y ~~///'~~\\ ,/1/~/f/'J/
~V
HELEN E. ALLEMAN
Cf",.d110NV~~ EALT'i QF !'ENNSYLV ANIA
!~~ ~_ i~'%TaRiAL SEAL
f cl L~ ~ s ~ r-RTS, ti,,rsiti~ Putr41c
N,xtani Coro DaupninCounfy
t If om nis o« _~s J nuary 27, 2013
,~
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF DAUPHIN
WE, CHARLES E. PETRIE and PATRICIA LIETMAN, the witnesses whose
names are signed to the attached or foregoing instrument, being duly qualified
according to law, do depose and say that we were present and saw testatrix
sign and execute the instrument as her LAST WILL AND TESTAMENT; that
HELEN E. ALLEMAN signed willingly and that she executed 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; and that to the best of
our knowledge the testatrix was at that time 18 or more years of age, of sound
mind and under no constraint or undue influence.
Sworn or affirmed to and subscribed before me by CHARLES E. PETRIE
and PATRICIA LIETMAN, witnesses, this 14~ day of January, 2013.
L~- ,.-4-.,.G~.L~
WITNESS
~~_=A%~LtC~,
COMMONWEALTH OF PENNSYLVANIA
NOTARIAL SEAL
KELLY P. ROBERTS, Notary Public
Paxtang Boro., Dauphin Cowity
I My Commission Expires January 27, 2013