HomeMy WebLinkAbout03-22-13 (3) 1505610105
REV-1500 EX(02-11)(FI) it OFFICIAL USE ONLY
PA Department of Revenue pennsylvarda File Bureau of Individual County Code Year le Number Taxes ,
PO BOX 280601 INHERITANCE TAX RETURN
Harrisburg,PA 17128-o6oi RESIDENT DECEDENT I 7j O D
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
12/30/2012 09/16/1930
Decedent's Last Name Suffix Decedent's First Name MI
Foote Flordella V
(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
QD 1.Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death
Prior to 12-13-82)
O 4.Limited Estate O 4a.Future Interest Compromise(date of p 5. Federal Estate Tax Return 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 To:
Name Daytime Telephone Number
Deena M. Engle (717)385FU84 w :x1
r'r'1
REGIO#FCW WILLS USBONLY'?
-(T -"
First Line of Address
r „ rTi
614 Forge Road rT
Second Line of Address
F i;
City or Post Office State ZIP Code DATE FILED
1 J
Carlisle PA 17015
Correspondent's e-mail address:deenaengle@embargmail.com
Under penalties of perjury,I declare that 1 have examined this return,including accompanying schedules and statements,and to the hest of my knowledge and belief,
is true,correct and complete.Wa of preparer other than the personal representative is based on all information of which preparer has any knowledge.
t SIGNATURE O PE SON ABLE FOR FILING RETURN jDATE
ADDRESS
614 Forge Road, Isle, PA 17015-4366
SIGNATURE OF PREPA OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610105 1505610105
1505610205
REV-1500 EX(FI)
Decedent's Social Security Number
Decedent's Name: Flordella V. Foote
RECAPITULATION
1. Real Estate(Schedule A). ............................................ 1.
2. Stocks and Bonds(Schedule B) ....................................... 2. 908.70
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. 3,367.00
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. 5,213.31
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested........ 7.
8. Total Gross Assets(total Lines 1 through 7)............ ................. 8. 9,489.01
9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. 6,131.88
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............... 10.
11. Total Deductions(total Lines 9 and 10)................................. 11. 6,131.88
12. Net Value of Estate(Line 8 minus Line 11) ........... .......... ......... 12. 3,357.13
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. 3,357.13
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.
16. Amount of Line 14 taxable
at lineal rate X.0 45 16. 151.07
17. Amount of Line 14 taxable
at sibling rate X.12 17.
18. Amount of Line 14 taxable
at collateral rate X.15 18.
19. TAX DUE ...... .... . .............................. ............ .... 19. 151.07
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p
Side 2
L 1505610205 1505610205 J
REV-'1500 EX(FI) Page 3 File Number .t JT
Decedent's Complete Address:
DECEDENTS NAME
Flordella V. Foote
STREETADDRESS
614 Forge Road
CITY STATE ZIP
Carlisle PA 17015
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 151.07
2. Credits/Payments
A.Prior Payments
B.Discount
Total Credits(A+B) (2)
3. Interest
(3)
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. (4)
5. If Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 151.07
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.......................................................................................... El
b. retain the right to designate who shall use the property transferred or its income............................................ ❑ N
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?.............................................................................................................. ❑ N
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 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 decedents lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(x)(1)].
• The tax rate imposed on the net value of transfers to or for the use of the decedents 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 Food or adoption.
REV-1503 EX+(8-12)
10 pennsylvania SCHEDULE B
DEPARTMENT REVENUE STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Flordella V. Foote 21-13-0084
All property jointly owned with right of survivorship must be disclosed on Schedule F.
— VALUE AT DATE
ITEM
NUMBER DESCRIPTION OF DEATH
I' Fifteen(15)shares Genesco Inc(GCO)-common-mean price per share$54.32 814.80
2 Five(5)shares Finish Line Inc(FINE)-common-mean price per share$18.78 93.90
TOTAL(Also enter on Line 2, Recapitulation) $ 908.70
If more space is needed,insert additional sheets of the same size
REV-i5o8 EX+{o8-i2}
pennsylvania SCNEOIILE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS &MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Flordella V. Foote 21-13-0084
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.
REM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Household goods and furnishings 1,000.00
2. Clothing and shoes 500.00
3. 1994 Oldsmobile sedan,VIN 1 G3HN52L6R4806584,tide#47056103902 FO 1,867.00
I
TOTAL(Also enter on Line 5, Recapitulation) $ 3,367.00
If more space is needed,use additional sheets of paper of the same size.
REV-:Lpg EX+(os-Lo)
pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER;
Flordella V.Foote 21-13-0084
If an asset becarne jointly owned within one year of the decedent`s data of death,It must be reported on Schedule G.
SURVIVING]DINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A•Deena M. Engle 614 Forge Road,Carlisle, PA 17015-4366 Daughter
B.
C.
JOINTLY OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND RANK ACCOUNT NUMBER DR SIMILAR DATE OF DEATH DECEDENTS VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER,ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDERM INTEREST
1. A. 12/01/11 Checking Acct#1041130011,Members 1st 3,393.96 100 3,393.96
2. A. 12101111 Savings Acct#10411300 00,Members 1st 1,471.59 100 1,471.59
3. A. 1201111 Money Management Acct#1041130005,Members 1st 347.76 100 347.76
Address of Accounts Holder; 5000 Louise Dr,Mechanicsburg,PA 17055
TOTAL(Also enter on Line 6, Recapitulation) $ 5,293.31
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(10-09)
pennsy(vania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF PILE NUMBER
Flordella V. Foote 21-13_0Q84
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' Ewing Brothers Funeral Home,Inc. 1,640.00
2. Honoraria for Memorial Service,January 13,2013,Otterbein UM Church(organist,soloist,celebrant)** 300.00
3. Refreshrnents for post-service reception-paid to Deena M.Engle 83.73
4. Matting/frame for picture,sign-in book for memorial service-paid to Deena M.Engle 15.00
**Organist Ms.Patti Strickler,soloist Ms.Deb Hancock,celebrant Rev.Daniel Dennis
B. ADMINISTRATIVE COSTS:
11 Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City _.. State ZIP
Year(s)Commission Paid:
2. Attorney Fees:
3. Family Exemption:(If decedent's address is not the same as claimant's,attach explanation.) 3,367.00
Claimant Deena M. Engle
Street Address 614 Forge Road
City _Carlisle _-_- - _ _ state PA ZIP 17015
Relationship of Claimant to Decedent daughter
4. Probate Fees: 123.50
5. Accountant Fees:
E• Tax Return Preparer Fees:
7. Legal notice run in the Sentinel on 2/6,2/13,and 2/20-paid to Stephen Nedimyer 88.65
B. Engraving for headstone-Cumberland Valley Memorial Gardens 499.00
TOTAL(Also enter on Line 9,Recapitulation) $ 6,131.88
If more space is needed,use additional sheets of paper of the same size.
PROOF OF PUBLICATION
State of Pennsylvania, County of Cumberland
Jackie Cox, Sales Director, of The Sentinel, of the County and State aforesaid,being duly
sworn, deposes and says that THE SENTINEL, a newspaper of general circulation in the
Borough of Carlisle,County and State aforesaid,was established December 13th, 1881,
since which date THE SENTINEL has been regularly issued in said County, and that the
printed notice or publication attached hereto is exactly the same as was printed and
published in the regular editions and issues of
THE SENTINEL on the following day(s):
February 6, 13 &20, 2013
COPY OF NOTICE OF PUBLICATION
LOAM
Affiant further deposes that he/she is not
eMne; interested in the subject matter of the
to fit_ '
aforesaid notice or advertisement, and that
all allegations in the foregoing statement as
►.► to time, place and character of publication
e. n
ft-4bra; ar e.
Sworn to and subscribed before me this
1 J
Notary Public
My commission expires:
NOTARIAL SEAL
BAMBI ANN HECKENDORN
Notary Public
CARLISLE BOROUGH, CUMBERLAND CNTY
MY �C,"?"rriSSf00 �rni rP,S .)�
7. 2014