HomeMy WebLinkAbout04-23-13 J (01-10' 1505610140
REV-1500 Ex
OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 3 0 2 5 8
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
0 1 2 7 2 0 1 3 0 5 2 9 1 9 1 7
Decedent's Last Name Suffix Decedent's First Name MI
F U R R Y L E 0 N A E
(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
❑X 1.Original Return 2. Supplemental Return 3.Remainder Return(date of death
prior to 12-13-82)
D 4. Limited Estate 4a. Future Interest Compromise(date of 5.Federal Estate Tax Return Required
death after 12-12-82)
❑X 6.Decedent Died Testate Ej 7.Decedent Maintained a Living Trust 0 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 12-31-91 and 1-1-95) (Attach Sch.O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
R o b i n H o l m a n L o y 7 7 5 &-a 2 4 1 0
c ::0_m
� B
E TER OF LS 19 Y
7
rn z ca c4
First line of address Z m
1 6 E M a i n S t Cn z o
x o 0
Second line of address :> O o �
P O B o x 9 7 v rn
City or Post Office State ZIP Code D ____ DA : fILE%o O
N e w B l o o m f i e l d P A 1 7 0 6 8
Correspondent's e-mail address:
Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERS N RESPONSIBLE FOR FILING RETURN 4 DATE
ADD SS
PO Box 65 Grantham PA 17027
SI AO THETHAN REPRESENTATNE DATE
ADDRESS
PO Box 97 New Bloomfield PA 17068
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610140 1505610140 J
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. 9 1 9 4 9 . 2 3
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . &
7. Inter-Vivos Transfers&Miscellaneous N -Probate Property
(Schedule G) t Separate Billing Requested ... .... 7.
8. Total Gross Assets(total Lines 1 through 7) 8. 9 1 9 4 9 • 2 3
9. Funeral Expenses and Administrative Costs(Schedule H) . . . . ..-- . ...... 9. 1 3 6 8 6 . 3 8
10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule 1) . . . .. . .. . .... % 1 7 9 4 0 . 6 4
1 t. Total Deductions(total Lines 9 and 10) ... . . . . ...... . .. ...... .. . ..... . 11. 3 1 6 2 7 . 0 2
12. Net Value of Estate(Line 8 minus Line 11) .. . . . ...... .. . . ... .. .. . . .... 12. 6 0 3 2 2 . 2 1
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) . . . .. . . . . . .. . ... . . . . .. 13.
14. Not Value Subject to Tax(Line 12 minus Line 13) ..... . ....... . ..... ... 14. 6 0 3 2 2 . 2 1
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 6 0 3 2 2 . 2 1 16. 2 7 1 4 . 5 0
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 0 0 IT 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. 0 • 0 0
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Side 2
L 1505610240 1505610240
REV-1500 EX Page 3 File Number
Decedent's Complete Address: 21 13 0258
DECEDENTS NAME
LEONA E. FURRY
STREET ADDRESS
100 Mount Allen Drive
CITY STATE I ZIP
iMechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 2,714.50
2. Credits/Payments
A.Prior Payments
B.Discount 135.73
Total Credits(A+B) (2) 135.73
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) 0.00
5. If Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 2,578,77
Make check payable to: REGISTER OF WILLS, AGENT
Ru
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; ...................................................................... ❑ X❑
b. retain the right to designate who shall use the property transferred or its income; ............................... ❑ ❑X
c. retain a reversionary interest:or ................................................................................................ ❑
d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ ❑X
2. If death occurred after December 12,1982,did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... ❑
3. Did decedent own an"in trust for'or payable-upon-death bank account or security at his or her death? ......... ❑ ❑X
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation?.................................................................................................. ❑ ❑X
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
`IS•'i .Kn . r,
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)(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
172 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 decedent's 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 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-1508 EX+(11-10)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE
CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
LEONA E. FURRY 21 13 0258
Include the proceeds of litigation and the date the proceeds were recelved by the estate.
All property Jolntty owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Members 1st Federal Credit Union - Regular Savings Account 309.72
2. Members 1st Federal Credit Union-Checking Account 2,913.07
3. Members 1st Federal Credit Union-Investment Savings Account 8,271.43
4. Invesco-Comstock Fund-Class A(1737)-951,376 shares @$19.005 mean 18,080.91
5. Eaton Vance National Municipal Income Fund Class A-5,946.053 shares @ 10.49 62,374.10
TOTAL(Also enter on Line 5,Recapitulation) $ 91 94923
If mom space s needed,Insert additional streets of paper of the same size
REV-1511 EX-(10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
LEONA E. FURRY 21 13 0258
Decedenits debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERALEXPENSES:
1. John C. Bolger Funeral Home- Funeral and burial 9,284.00
2. Williamsburg Church of the Brethren - Funeral meal, pastor honorarium and organist 540.00
3. Monument engraving 125.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Years)Commission Paid:
2, Attorney Fees: Holman & Holman 3,000.00
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: Register of Wills of Cumberland County, PA 308.50
5 Accountant Fees:
6. Tax Return Preparer Fees:
7. The Sentinel - Estate Notice 263.88
8. Cumberland Law Journal - Estate Notice 75.00
9. Clerk of the Orphans' Court-Family Settlement Agreement 90.00
TOTAL(Also enter on Line 9,Recapitulation) E 13 686.38
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX-(12-08)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
LEONA E. FURRY 21 13 0258
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unrelmbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Messiah Village-final bill 16,989.90
2. Alert Pharmacy-final prescriptions 950.74
TOTAL(Also enter on Line 10,Recapitulation) b 17 940.64
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:
LEONA E. FURRY 21 13 0258
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 outr'ghlspousal distributions and transfers under
Sec.9116(a)(1.2),I
1. Romayne E. Reeser Lineal
PO Box 65 20%
Grantham, PA 17055
2. Mary Jane Holman Lineal
1506 South Market Street 20%
Mechanicsburg, PA 17055
3. Martha Jean Sproat Lineal
905 Derbyshire Avenue 20%
Mechanicsburg, PA 17055
4. Sharon W. White Lineal
8000 West Crestline Avenue, Apt#1138 20%
Littleton, CO 80123
5. Lewis C. Furry, Jr. Lineal
110 Watson Lane 20%
New Bloomfield, PA 17068
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
Il. 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 11-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.
r 6^
4
of
LE,ONA E. FUIMN
1, LEONA E. 141HRY, of 510 Wes( "Chita Sbreet, Williamsburg, Pennsylvania, do uvikc
this lily Last Will aucl '1'eslament, hereby revoking any and'atl Wills al any time hetetorore. made. by
ate.
HIM,: l hereby diiect. that my l,Xedlntoi hcmin named shall pay at] of my ju,'t dcbb�
and Contra[ expenses as soon after my death as may be convenient.
SECOND: Ml the rest, residue mid remainder or ury Fsiale, I give, devise and bequeath
to my husband, L. CARL FURRY.
thereby nominate, constitute and appoinl.ray said husband to act as l xeeutor of this illy
east Will and Cestanlcu(;directing that tto borid be required ill any jurisdiction ill which be may
acL.
T)IIRD: Should lily said husband predecease rue or fail to survive me, by ,it least
thirty (30) days or in the event of our lriuttlat or simultaneous cleaths, I hereby give, devise and
bequeath lily entire estate, in.equal shares, to my children, HOMAYNIi; E. imrI,SIR, MARY
JANE HOLMAN, MAR UA JEAN SPROAT, SHARON W. WHITE and LEWIS C.
FURRY, ,IR.
In the event that tmy or my children should predecease me leaving child of issue, 1 hereby
give. to said child or issue the share to which his or her parent would have been entitled, jf eg
slimes.
POUR,F11: Should lily said husband predecease nee, 1 hereby nominate and appoint.
ROMAYNE E. RE,ESER and LEWIS C. FURRY, JR. to act as Co Fxecutots ill his place or
I
,toad, directing hereby turd( no hoed he required of theta in lily jurisdiction in which they may act..
IN '44'fl"t>ES v NVIIIE+RIMIt', 1, J-XONA E. RAMY, Tastatrix, have hereunto 1.0 this my
C,:i 1, Will and Testameu[, written on two pages of typewritten paper, subscribed my name to Brach
sheet fmccof, and to this, the last sheet, sulM(ribezl my name and affixed my seal, this I _ `ti clay
f
oil ),.Ir,L A.r" 2001
i
17-O'NA l FURRY
The writing conwhed in, lhis vud the preoedbg sheet was signed, staled, published and
declared by the above-ntirzted "feslaL ix as .Ind for her Last Will and Testament in the presence of us,
who, in her presence, at her rtcquvsi,and it)the presence of each other, have hereunto subscribed our
nm , ts wrrt wSea, dila da y of
74 l �',�1.1�\P Jt),r�._ 2002.
t
i t + 1E
St
MEMBERS 1"
FEDERALCREDIT UNION
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix 250943-00
D-ate Account Established 09/13/2004
Principal Balance at Date of Death $309.68
Accrued Interest to Date of Death $0.04
Total Principal and Accrued Interest $309.72
Name of Joint Owner None
CHECKING ACCOUNT:
Account Number/Suffix 250943-11
D-ate Account Established 09/13/2004
Principal Balance at Date of Death $2,812.97
Accrued Interest to Date of Death $0.10
Total Principal and Accrued Interest $2,813.07
Name of Joint Owner None
INVESTMENT SAVINGS ACCOUNT:
Account Number/Suffix 250943-05
D-ate Account Established 01/20/2006
Principal Balance at Date of Death $8,270.25
Accrued Interest to Date of Death $1.18
Total Principal and Accrued Interest $8,271.43
Name of Joint Owner None
MCE`MMBERSS 1IT FEDERAL CREDIT UNION
Tessa lugh C
Lending Insurance Support Specialist
March 15, 2013
Estate of: LEONA E FURRY
Date of Death: 01/2712013
Social Security Number: 174-38-1319
5000 Louise Drive • P.O. Box 40 • Mechanicsburg,Pennsylvania 17055 • (800) 283-2328 • www.memberslst.org
��1V @SCO Invesco Investment Services, Inc.
PO Box 219078
Kansas City,Missouri 64:121-9078
www.invesco.com
March 20, 2013
ROBIN HOLMAN LOY
HOLMAN & HOLMAN
PO BOX 97
NEW BLOOMFIELD PA 17068
Correspondence ID:00824151
Dear Robin Holman Loy:
Thank you for doing business with Invescoll. We recently received the enclosed request regarding
Leona Furry's individual account number 6910209534.
As of January 25, 2013, the Invesco Comstock Fund - Class A (1737) in this account had a balance of
951.376 shares with a market value of $18,104.69 at $19.03 per share at net asset value.
In addition, as of January 28, 2013, the Invesco Comstock Fund - Class A (1737) in this account had a
balance of 951.376 shares with a market value of $18,057.12 at $18.98 per share at net asset value.
Our funds are priced daily and the value of the account is subject to change.
Because January 27, 2013 was not a regular business day, we have supplied the balance as of June
25, 2013 and June 28, 2013, the business day prior to the date of death and the next available
business day, respectively.
Additionally, there has not been any accrued interest on the account. We were unable to locate any
additional accounts registered with Leona Furry as a joint or Individual owner.
Please reference the Correspondence ID listed above on any future inquiries regarding this request.
If you have any questions regarding the above information, please call one of our Client Services
Representatives toll free at 1-800-959-4246 from 7:00 A.M. to 6:00 P.M. Central Time. We will be glad
to answer any questions you may have.
Sincerely,
a4
Anita Stansell
Correspondence Representative
Enclosure(s): Copy of Request
EatonVance
Iq IM Investment Managers
March 21,2013
HOLMAN&HOLMAN
ATTORNEY AT LAW
ATTN ROBIN HOLMAN LOY
16 EAST MAIN STREET
PO BOX 97
NEW BLOOMFIELD PA 17068
RE: EATON VANCE NATIONAL MUNICIPAL INCOME FUND
CLASS A
ACCOUNT#: 0501-XXXXXX2661
REGISTRATION: LEONA E FURRY
REFERENCE#: 9598895812
Dear Attorney Loy:
We are writing in regard to the enclosed copy of your letter dated March 12,2013.
As of the close of business on January 25,2013,the above referenced account was valued at
$62,374.10. This value is based on a balance of 5,946.053 shares at the Net Asset Value(NAV)price
of$10.49 per share. Changing market conditions may cause the NAV price to fluctuate on a daily
basis. Therefore,the account value is subject to change,
January 27, 2013 was not a valid business day. The price we gave was for the previous close of
business,January 25, 2013.
We hope this information is helpful. If you have any questions or require assistance,please contact
one of our Investor Services Associates toll-free at 1-800-262-1122. Our associates are available
Monday through Friday 8 a.m.to 6 p.m.,Eastern Time.
Sincerely,
Kelley B ian
Investor, vices Specialist V
Enc.
pennsylvania
DEPARTMENT OF PUBLIC WELFARE
March 25, 2013
HOLMAN & HOLMAN
ROBIN HOLMAN LOY ESQUIRE
16 E MAIN ST
PO BOX 97
NEW BLOOMFIELD PA 17068
Re: Leona Furry
SSN: ###-##-1319
Dear Attorney Holman Loy:
Pursuant to your letter dated March 12, 2013, the Department's, Estate Recovery
Program, has reviewed the information you provided regarding the above-referenced
individual.
It has been determined that this individual did not receive any type of assistance
during the questioned period.
Therefore, according to the information you provided, the Department's Estate
Recovery Program will not seek any recovery from this estate. If your client applied for
Medical Assistance and had an application and/or hearing pending at the time of death,
please advise us and provide any additional information that may affect a recovery by our
Department.
Thank you for your cooperation in this matter. If you have any questions, please
contact me.
Sincerely
Vince A. Porter
Recovery Section Manager
(717)772-6604
Bureau of Program Integrity Division of Third Party Liability i Recovery Section
PO Box 8486 I Harrisburg, Pennsylvania 17105-8486