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HomeMy WebLinkAbout04-11-13 (3) REV-1 500 Ex(o1-ta> 1505610 140 OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number PO Box 280601 2 1 1 3 � Ham -060 .PA 171281 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW 07162012 032619 36 Decedent's Last Name Suffix Decedent's First Name MI N E W C O M E R V I O L E T G (If Applicable)Enter SurWving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI, N E W C O M E R J 0 H N W Spouse's Sodas Security Number 2 0 2 2 0 1 0 1 5 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 Return(date of death prior to 12-13-82) 4.Limited Estate 0 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 0 8.Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) C] 9.Litigation Proceeds Received 10.Spousal Poverty Credit(date of death 0 11.Election to tax under Sec.9113(A) between 12-31-91 and 1-1-95) (Attach Sch.O) CORRESPONDENT-TINS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number S E T H T M 0 S E B E Y 7 1 7 2 4 3 3 3 4 1 c1b F=ItyR OF WW1 US0N CD t:? First line of address c. cm x.1 0 E A S T H I G H S T R E E T ZCnn � t `' = Q x • Second line of address t Te .� O � n -7:9 �y r" Put� C'3 City or Post Office State ZIP Code —f DATED b .0 Cn C� C A R L I S L E P A 1 7 0 1 3 Ca Correspondenrs e-mail address: 9MOSEBEY(OLARTSONLAW.COM Under penatties of perjury,I declare that 1 have examined this return,including accomparrying schedules and statements,and to the best of my knowledge and belief, it is true,correct and ccomplete.,094anstIon of preparer other than the personal representative Is based on all Information of which preparer has any knowledge. SIG2=X?=FILING RETURN OATS f� �J1 ADDRESS 861 E. LOUTHER STREET CARLISLE PA 17013 SIGQTURf OFPPEPARE OTHER TbIAN REPRESENTATIVE DATE g111113 ADDRESS 10 EAST HIGH STRE T CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 MOM 1505610240 REV-1500 EX 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 and Notes Receivable(Schedule D) ..... ... ...... ......... . .. 4. 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E).... . .. 5. 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested ... . . .. 6. 7. Inter-Vivos Transfers&Miscellaneous N -Probate Property (Schedule G) � Separate Billing Requested ..... .. 7. 5 6 3 0 0 , 9 5 8. Total Gross Assets(total Lines 1 through 7) . ..... ...... ........... .... 8. 5 6 3 0 0 . 9 5 9. Funeral Expenses and Administrative Costs(Schedule H) ... ....... .... .... 9• 1 4 2 3 9 . 7 3 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) .... ..... ... . 10. a . 0 0 11. Total Deductions(total Lines 9 and 10) ..... ..... .... ....... ...... .. .. 11. 1 4 2 3 9 . 7 3 12. Net Value of Estate(Line 8 minus Line 11) . .............. ......... .. 4 2 0 6 1. 2 2 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. 4 2 0 6 1 . 2 2 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 _ 0 . 0 0 15. 0 , 0 0 16. Amount of Line 14 taxable at lineal rate X.045 4 2 0 6 1 . 2 2 16. 1 8 9 2 . 7 5 17. Amount of Line 14 taxable at sibling rate X.12 0 . 0 0 17. 0 . 0 0 18. Amount of Line 14 taxable at collateral rate X.15 0 . 0 0 18. 0 . 0 0 19. TAX DUE ...... .. ........... ...... .. ... ... ...... . .... ... ....... 19. 1 8 9 2 . 7 5 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Side 2 1505610240 1505610240 J REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 13 0 DECEDENTS NAME VIOLET G.NEWCOMER STREET ADDRESS 861 E.LOUTHER STREET CITY STATE ZIP CARLISLE PA 17013 Tax Payments and Credits: I. Tax Due(Page 2,Line 19) (1) 1,892.75 2. Credits/Payments A.Prior Payments B.Discount Total Credits(A+B) (2) 0.00 3. Interest (3) 4. If Line 2 is greater than Line 1+Line 3,enter the difference.This is the OVERPAYMENT. FIN In oval on Page 2,Line 20 to request a refund. (4) 0.00 5. If Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 1,892.75 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; ...................................................................... ❑ Q b. retain the right to designate who shall use the property transferred or its income; ............................... ❑ c. retain a reversionary interest;or ................................................................................................ El d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ 2. If death occurred after December 12,1982,did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ❑ El 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 3 percent[72 P.S.§9116(a)(1.1)(1)]. 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(1.2)[72 P.S.§9116(a)(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,unde Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. REV-1510 EX+(08-09) pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER VIOLET G.NEWCOMER 21 13 0 This schedule must be completed and teed I the answer to any of questions 1 through 4 on page three of the REV-1 500 Is yes. DESCRIPTION OF PROPERTY ITEM INCIUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER.ATTACH ADM OMIE DEED FDRREALSTATE VALUE OF ASSET INTEREST (IF APPUCAM VALUE 1. Members 1st Federal Credit Union,savings acct.#49688-00, 3,530.86 100.00 3,530.86 Beneficiary: Ronald L.Dick,Jr.,son 2. Members 1st Federal Credit Union,checking acct.#49688-11, 611.87 100.00 611.87 Beneficiary: Ronald L.Dick,Jr.,son 3. Members 1st Federal Credit Union,investment acct.#49688-05, 10,960.63 100.00 10,960.63 Beneficiary: Ronald L.Dick,Jr.,son 4. Hartford Investor,annuity contract#712393117, 41,197.59 100.00 41,197.59 Beneficiares:Ronald L.Dick,Jr.,son,Karen K.Bailey,daughter, and Rhonda D.Newcomer,daughter TOTAL Also enter on Line 7,Reca tulation $ 56 300.95 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND RESIDENT DECEDENT ADMINISTRATIVE COSTS RESIDEtR DECEDENT ESTATE OF FILE NUMBER VIOLET G.NEWCOMER 21 13 0 Decedents debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Ewing Brothers Funeral Home 6,430.73 2. Cumberland Valley Memorial Gardens 1,826.00 3. Headstone 3,997.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Sheet address City State ZIP Years)Commission Paid: 2. Attorney Fees: Martson Law Offices(Fee paid outside of Estate.) 1,971.00 3. Family Exemption:(If decedents address is rat the same as claimants,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. Register of Wills,filing fee of Inheritance Tax Return(Fee paid outside of Estate.) 15.00 TOTAL(Also enter on Line 9,Recapitulation) S 14 If more space is needed,use additional sheets of paper of the same size. REV-1512 EX+(12-12) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES&LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER VIOLET G.NEWCOMER 21 13 0 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Members 1st Federal Credit Union,vehicle loan account number 49688-03 ($7,065.10) 0.00 *Paid by spouse outside of Estate. 2. Members 1 st Federal Credit Union,VISA account number**8061 ($13,263.50) 0.00 *Written off by Members 1 st. No payment due. TOTAL(Also enter on Line 10,Recapitulation) $ 0.00 If more space is needed,insert additional sheets of the same size. REV-1513 EX-(01-10) , pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: VIOLET G.NEWCOMER 21 13 0 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include oftht I dlsftudm and transfers under Sec.91%(a (12)] 1. *Ronald L.Dick,Jr. Lineal 21,871.82 861 E.Louther Street Sch.G,Items 1,2 and 3 Carlisle,PA 17013 1/2 of Sch.G,Item 4 2. *Karen K.Bailey Lineal 10,094.70 3 Hazelwood Path 1/4 of Sch.G,Item 4 Mechanicsburg,PA 17050 3. * Rhonda D.Newcomer Lineal 10,094.70 404 Croghan Drive 1/4 of Sch.G,Item 4 Carlisle,PA 17013 * Sch.H expenses were paid with proceeds of Sch.G assets. 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. TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed,use additional sheets of paper of the same size. rVI St MEMBERS In PBDBRAI,CRBDrI'UNION REGULAR SAVINGS ACCOUNT: Account Number/Suffix 49688-00 Date Account Established 04/07/1986 Principal Balance at Date of Death $3,530.47 Accrued Interest to Date of Death $39 M Total Principal and Accrued Interest $3.15".66 s(�, l� Name of Beneficiary Ronald L.Dick Jr. CHECKING ACCOUNT: Account Number/Suffix 49688.11 Date Account Established 04/07/1986 Principal Balance at Date of Death $611.87 Accrued Interest to Date of Death $,00 _ Total Principal and Accrued Interest $611." !'G 1/�.3, Name of Beneficiary Ronald L.Dick Jr. INVESTMENT SAVINGS ACCOUNT: Account Number/Suffix 49688-05 Date Account Established 04110/2006 Principal Balance at Date of Death $10,959.28 'p 2 Accrued Interest to Date of Death $1.35 (( Total Principal and Accrued Interest $10,960.03 CICAN- �x Name of Beneficiary Ronald L.Dick Jr. LOAN ACCOUNT: Account Number/Suffix 49688-03 Date Opened 01101/2009 Principal Balance $7,065.10 Loan Type Used Vehicie/Contractual Pledge of Shares Collateral Secured 2007 Ford Explorer Interest Rate 6.35% Name of Co-Borrower None *Loan does not have life Insurance. VISA ACCOUNT: Account Number/Suffix 4872090000338061 Date Account Established 11/29/1996 Principal Balance at Date of Death $13,263.50 Name of Joint Owner Cardholder None E JERSI'T.E� DIT'UNION anA. lin 1l Q Lending Insurance Support Specialist January 9,2013 Estate of:VIOLET NEWCOMER Data of Death:0 711 8/2 01 2 Social Security Number:194-28-8796 3 5000 Louise Drive • P.O. Box 40 • Mechanicsburg,Pennsylvania 17055 (800) 283-2328 www.memberslst.org Annuity Contract Access - Historical Values Page 1 of 1 Historical Values Tlit NAai/Oa0 Hartford Investor IReturn[o Reeults� Return to Search Contract Oetall Manage Contract Performance&Prices Transaction History Online Documents Historical Values contract Owner:Vlolet a Newcomer Contract Number:712393117 Contract Value:$41,838.21 as of July 31,2012 Please Read To compare historical values select a date and click'GO'. ' If date selected is a non business day,the prior business day's value will be displayed. Printer Friendly July 1e ..2JI2012:-3 J Value as of July 31,2012 Investment Investment Investment Choice Abbreviation Unit Value Choice Value Unit Value Choke Value American Funds International Fund 13.098834 ;2,058.09 13.430093 $2,110.14 Templeton Foreign Securities Fund 10.701067 $4,123.30 10.961804 $4,231.48 American Funds Growth Fund 13.014809 $2,872.59 13.104134 $2,892.31 American Funds Growth-Income Fund 11.918775 $4,939.53 12.179358 $5,047.53 Franklin Large Cap Growth Securities Fund 10.153575 $1,658.23 11.097781 $1,695.54 MFS Investors Trust Series 9.213475 $5,365.10 9.44489 $5,520.36 MFS New Discovery Series 15.915166 $4,818.35 16.198287 $4,904.06 MFS Total Return Series 13.774446 $3,318.31 13.930721 $3,355.95 MFS Value Series 16.026224 $2,070.92 16.339745 $2,111.44 Franklin Strategic Income Securities Fund 19.039733 $1,244.02 19.221692 $1,255.91 Invesco V.I.Government Securities Fund 1.323444 $7,463.83 1.323279 $7,452.90 MFS Research Bond Series 12.760906 $1,245.32 12.814892 $1,250.59 Total $41,197.59 Total $41,838.21 Total percent change from July 16,2012 to July 31,2012 Is 1.55%. the values are defaulted to since inception and the current date. 'Within the selected umeframe,the contract values used include all premium payments and Surrenders(surrenders include Contingent Deferred Sales Charges and Annual Maintenance,if applicable).PAST CONTRACT VALUES ARE NOT INDICATIVE OF FUTURE RESULTS.The investment return and principal value or an investment will fluctuate so that an nlvestors shares,when redeemed,may be worth more or less than their original investment. All Information about your variable annuity,including charges and expenses,Is described In your prospectus.Please read R carefully and keep it for your records.If you have additional questions,or for further mfdrmatlon please call the Investment Products Services Center using the telephone number listed within the"Contact Us"section of this site. Privacy Policy Legal Notices Security 0 Copyright 2012 The Hartford Financial Services Group,Inc.An Rights Reserved, https:Hfinancialprofessional.hartfordinvestor.com/aab/ContractBalances 8/1/2012