HomeMy WebLinkAbout05-08-13 1505610101
REV-1500 E 01 '
5 vanld OFFICIAL USE ONLY
PA Department of Revenue P enn�w ri County Code Year File Number
Bureau of Individual Taxes -�3
PO Box 280601 INHERITANCE TAX RETURN ^� �` i bo SJ��
Harrisburg PA 17128-0601
RESIDENT DECEDENT I°�� 0 _
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY .Date of Birth MMDDYYYY
02/19/2009 1 09/1411920
Decedent's Last Name Suffix Decedent's First Name MI
EARLY RUBY J❑
(If Applicable)Enter Surviving Spouse's Information Below J
lSpouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
F F REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
M 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 O 5. Federal Estate Tax Return Required
death after 12-12-82)
QD 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 Sch.O)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name _ Daytime Telephone Number
THOMAS E. FLOWER 1A243-5513.1-Z-1
3RE TER OF wrcLS USE O Y
r.1
ED .cn �
First line of address w t CO �O
FLOWER LAW, LLC I U' 7 o 0
Second line of address
10 W. HIGH ST = %A r Q
State ZIP Code -� DATE FRED T' O cn
City or Post Office y O
�I CARLISLE PA 17013
Correspondent's e-mail address: Tom @Flower-law.com
Under penaftles of perjury.I declare the have examined this return.Including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true nd Iete d n of proparer other than the personal representative Is based on all Information of which preparer has any knowledge.
S N U N PO LE FOR FILING RETURN ?jjATEj 13
ADORE S
PATRICK M. EARLY, 409 CROGHAN DR., CARLISLE, PA 17013
SI�'.�IPiLE fFpR6ppU22R OTHER THAN REPRESENTATIVE
ADDRESS
FLOWER LAW, LLC, 10 W. HIGH ST., CARLISLE, PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610101 1505610101 J
lob
J 1505610105
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: RUBY J. EARLY
RECAPITULATION
1. Real Estate(Schedule A). .. 1. 0.00
. .. .. ... . . .. . . ... . ... . .. . ... . .. . . . .... . .
2. Stocks and Bonds(Schedule B) ... ... . .. .. . .. . ... . .. . ... . .. . .. .. . ... . . 2. 0.00
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ... . . 3. 0.00
4. Mortgages and Notes Receivable(Schedule D) ... .... .. ..... . .. . ... ..... . 4. 0.00
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E).... . .. 5, 1,048.07
6. Jointly Owned Property(Schedule F) O Separate Billing Requested .... . .. 6. 0.00
7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested.. ... . .. 7. 0.00
S. Total Gross Assets(total Lines 1 through 7). ... . . .. . .. ... .. .. . .. . .. .. . . 8. 1,048.07
9. Funeral Expenses and Administrative Costs(Schedule H). . ... . .. . . . . . .... . . 9. 6,284.37
10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule I) ... . .. . . .... . . 10. 54,290.08
11. Total Deductions(total Lines 9 and 10).. . ... . ... . ... . .. . .. . .... .. . . . ... 11. 60,574.45
12, Net Value of Estate(Line 8 minus Line 11) ... . .. ..... . .. ... . ..... .. . ... . 12. 0.00
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) ... .. ...... . ..... .. . ... . 13. 0.00
14. Net Value Subject to Tax(line 12 minus Line 13) . .... .... .. . ... . .. . . . .. . 14. 0.00
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_ 16.
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. 0.00
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
L 1505610105 1505610105
REV-1500 EX Page 3 File Number 21 i oO S 5/
Decedent's Complete Address: l
DECEDENTS NAME
RUBY J. EARLY
STREET ADDRESS
SARAH TODD MEMORIAL HOME
1000 W. SOUTH STREET
CITY STATE ZIP
CARLISLE PA 17013
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 0.00
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) 0.00
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;,......................................................................................... ❑ 0
b. retain the right to designate who shall use the property transferred or its income;........................................... ❑ 0
c, retain a reversionary interest;or......__....-..............__...................__............_.................____............_...._ ❑ 0
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?.............................................................................................................. ❑ 0
3. Did decedent own an'in trust for'or payable-upon-death bank account or security at his or her death?...,..,....... ❑ 0
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
containsa beneficiary designation? ........................................................................................................................ ❑ 0
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 172 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 decedent's lineal beneficiaries is 4.5 percent, except as noted in
72 PS.§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-*08'EX+(11,10)
. ; pennsylvania cu SCHEDULE E
DEPARTMENT OF REVENUE CASH BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
RUBY J. EARLY 21-10-0055
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.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Estate Account Funds-Fulton Bank Acct#3622-93798 1,048.07
TOTAL(Also enter on Line 5, Recapitulation) $ 1,048.07
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(10-09)
j7pen'tt�7�
nsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDEM DECEDENr
ESTATE OF FILE NUMBER
RUBY J. EARLY 21-10-0055
Decedent's debts must be reported on Schedule I.
REM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. EWING BROS.FUNERAL HOME,PROFESSIONAL SERVICES 1,250.00
2. VEHICLE TO TRANSFER REMAINS TO FUNERAL HOME 250.00
3. DEATH CERTIFICATE RETRIEVAUFILING 125.00
4. CREMATION 315.00
5. CERTIFIED COPIES DEATH CERTIFICATE,CORONER'S FEE AND CREMATION POUCH 80.00
6. OBITUARIES AND DEATH NOTICE 372.67
7. WESTLAWN MEMORIAL PARK,INTERMENT,OPENING AND CLOSING BURIAL VAULT 1,401.70
B. ADMINISTRATIVE COSTS:
1. 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.)
Claimant
Street Address
City _ _ _ . . . . _ State _ _ ZIP
Relationship of Claimant to Decedent
4. Probate Fees:
5. Accountant Fees:
6. Tax Return Preparer Fees:
7• AIR TRANSPORT OF REMAINS TO NEBRASKA FOR INTERMENT IN FAMILY BURIAL VAULT 975.00
8. REGISTER OF WILLS,INHERITANCE TAX RETURN FILING FEE 15.00
9. CLEARING OUT AND HAULING REFUSE FROM STORAGE UNIT 1,500.00
TOTAL(Also enter on Line 9, Recapitulation) $ 6,284.37
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
RUBY J. EARLY 21-10-0055
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 DESCRIMON OF DEATH
1. DEPARTMENT OF PUBLIC WELFARE,M A ESTATE RECOVERY,CLASS 3 CLAIM 9,189.89
2. DEPARTMENT OF PUBLIC WELFARE,M A ESTATE RECOVERY,CLASS 5.1 CLAIM 27,719.06
3. SARAH TODD MEMORIAL HOME,CLASS 3 CLAIM 17,381.13
TOTAL(Also enter on Line 10, Recapitulation) $ 54,290.08
If more space is needed,insert additional sheets of the same size.
WOFURwD Memorial park /NTAMAWN7 YENTONOM£N7',(VTHORtUNONAND MDENNIFICA71ON
3874 W.Stollcy Park Road SURIALNa. CONTRACTNO. TVDAYE DATE; PHIUdIT No,
Gernel Island.Ne 68807
308-361.7470 4 N°_ 3181
AYBORMATION ABOUT DECEASED
NAME: ' DATE OA BIRTH:
TEOF D
1MEATH:
FLACEOP TH: A Ei Sax: V ` Z BRANCH:
Ov IW
LLRECRIVED DY: rnn DATE: _Ijf O TIM& I1• PREPARED by-
IN FORIVIATION ABOUT NEXT OF MNI OR REPRESENTATIVE
NA E: 91ATIRSHIP. PHONL•:'7f 1.. 40�
ADDRRTS:
'71-7• CC
g ro �
114MfIMA NAROU7 PROPERTY OWIh'ER
ME RELAYIONSFIIP: PNONE: .7
ADDRESS: 7/Intl
MTERMENTlENTOMDMENTANURNNIZITT INFORMATION
b TIME: RATS: ARRIVAr:
FtMbRAL NOME: F. .CONTACT:
ERAL LOCATION: MINSTER:
C
OF DUR{AL: (DDTTiR CONTAINER)
OR VAULT: O 9 r
LOCATION FOR OMAUSOLEUM ONICBE
BLDG.Na FACE LEVEL: CRYPT Nw
No:
LOCATION FOR OTRADITIONAL GROUND BURIAL ODOUBL6 LAWN CRYPT OBIDE BY SIDE LAWN CRYPr
SECTION GARDEN N ROW: LOT,. synca
cnRDEN
MSMORIAL JALDATESO READ. NOTES!
INSTALLED: Ukay ftA 10411
IURENT CRARGES AND FREF INFORMATION
PRt7aEPA CONTRACT DATE NUMBER SELLING PRICE AMOUNTDUE
PENIN'OCLOSINO
AULT JI 5
VAULTINSTALIATTON Lie a N
ARKER BASS
PROPGR'rY ,t •a ,�
OTHEREnNhL DATE ,aI!
MOUNT DUE TO BE RCEIVEDFROM: PAMILYIIUEPRESENTA7iVE _FUNERALHOME TOTAL
AMOUNT PAID CHECK CASH
AID: 1� b I r BY: Me: y�s REC.OY:
The uncludgnd hereby certifies they Iuve the Nit legal authority to direct the InQ6,d,anrotnbmant,or Inumtaent of the renains of the derAamd,end
hmcby tlrlhor&c the eemaery to make dlipoeltion Of Ibe reAUins of the daowxd as indieA W.The emdaniend hereby further certify and rapreacet that they
em ownw(s)or sud arizd repuemative(s)oflhe awnm(a)of the abort described Intemrht Rlgha ad hereby authorize m of msid Interracial Rlltha of the
Intemlmt,Emombnrem,m Inurnment of the emanates of the herein named deotaad.The cemelary h hereby directed b aupwiae insalhtion or install any
artier burial container,to the extent required by law,purchaeed in connection with thit Intarltwm and The Inlermant Righudescribd herein.
The undersigned hereby agree m indemnify and hold harmless the amctery,let agents and employe Dorn any and all LIABILITY,Including reatoruble
altarne's fun,and against any loss it or they may waalb In connecilon with the Inlennenl,Entombment,or inumment,authorized hereunder.The eemekry
ukcs p"M a voi arron, the event an inadverienl me dealt occur.The utTwary ehall have the right to caacct any ermr in the Intennenl.
0 I Mb e e ecpense,without any liability for such mmr.
nncd rlaa itd ftrc:cdaare Sbaatva vIFamYScr4ot Olwgm
band DIM SGa + S
st8tamadtnt oanerrnvrotRea RgasanBMO s dcare yAdmt,lrnatpr
SPACE VERIFICATION AUDIT AND RECORDKEFPING CHECK
PnMrLV VcR101npr INT, LRCM co e r$761
SURVEYED BY: MT.CARD COMPLETRDIFILm
CHECKED BY: MASTBR CARD UPDATED
PLAT BOOK(LOT MAPS UPDATED N
BURIAL PERMIT
RECEIVSNPILED 3
ALLCOMPUTTIR UPDATED
b 'd E40 'ON Wait,FTe•Yeaew-Gauds•PBaPamal' AHA. 3 NMV11S3M WVlEI 0106 'OEUP
Ewing Brothers Funeral Rome, Inc.
630 South Hanover Street
Carlisle, PA 17013-
(717)243-2421
June 30. 2010
Patrick M. Early
409 Croghan Drive
Carlisle, PA 17013
The Funeral Service for Ruby J.Ewly
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please
feel free to contact us if you have any questions in regard to this statement.
THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES,FACILITIES,AUTOMOTIVE EQUIPMENT,
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
1. PROFESSIONAL SERVICES
Sen6ces of Funeral Director/Slaff . . . . . . . . . . . . . . . . . . . $i250.00
3. AUTOMOTIVE EQUIPMENT
Vehicle to transfer remains to Funeral[iome. . . . . . . . . . . . . . . . $250.00
Utility Car/Death Cort. Retrieval/Filing . . . . . . . . . . . . . . . . . 5125.00
C. SPECIALCHARGES
Direct Cremation . . . . . . . . . . . . . . . . . . . . . . . . $315.00
FUNERAL HOME SERVICE CHARGES . . . . • . • • • . • • 51940.00
THE COST OF OUR SERVICES,EQUIPMENT,AND MERCHANDISE
THAT YOU HAVE SELECTED . . . . . . . . . . . . . . . 51940.00
Cash Advances
Certified Copies of the Deett Cenificate . . . . . . . . . . . . . . . . . 530.00
Coroners Fee . . . . . . . . . . . . . . . . . . . . . . . . . $25.00
Cremation Pouch . . . . . . . . . . . . . . . . . . . . . . . . . $25.00
The Sentinel with photo . . . . . . . . . . . . . . . . . . . . . . $118.80
Topeka Journal . . . . . . . . . . , . . . . . . . . . . . . . $210.61
The Sentinel 2nd run announcement . . . . . . . . . . . . . . . . . . $43.26
TOTAL CASH ADVANCES AND SPECIAL CHARGES . . . . . . . . $452.67
Total
Total Cost . . . . . . . . . . . . . . . . . . . . . . . . . . 52392.67
SUB-TOTAL $2392.67
INITIAL PAYMENT l DISCOUNT/CREDITS 2392.67
TOTAL AMOUNT DUE 50.00
The unpaid halance over 30 days is subjected to a 1.50%service charge per month-16.0000%per annum.
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF PROGRAM INTEGRITY
DIVISION OF THIRD PARTY LIABILITY
ESTATE RECOVERY PROGRAM
PO BOX 8486
HARRISBURG,PA 17105-8486
December 7, 2010
FLOWER LAW LLC
THOMAS E FLOWER ESQUIRE
10 WEST HIGH ST
CARLISLE PA 17013
Re: Ruby Early
CIS #: 820206747
SSN: 4##-##-0229
Date of Death: 02/19/2009
Dear Attorney Flower:
Please be advised that the Department of Public Welfare maintains a
claim in the amount of $36,908.95 against the above-mentioned estate. This
claim is for restitution of medical assistance granted on behalf of the
decedent for which the Probate Estate is now responsible to reimburse the
Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as
amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's
itemized statement of claim.
A portion of this medical expense, namely $9,189.89, was incurred during
the last six months of the decedent's life; therefore, it is a Class 3 claim
pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries Code, 20
Pa. C.S.A. 3392 (3) . The balance of the claim, namely $27,719.06, is to be
entered as a priority Class 5.1 claim against the estate.
Please acknowledge receipt of this letter and advise whether the
Commonwealth's claim is admitted and when payment may be expected. If the
estate accounting is complete, please provide a copy. If the estate contains
real estate, please provide copies of the deed, the latest tax assessment,
and a current appraisal, if available.
Sincerely,
• fit
Angela S. Bonner
Claims Investigation Agent
717-705-9701
717-772-6553 FAX
Enclosure
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Fitt
t'
OF
RUBY JANE EARLY
I, RUBY JANE EARLY, of 2D Melron Court, Carlisle, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do make,
publish and declare this as and for my Last Will and Testament, hereby revoking and
making void any and all former Wills, Codicils, or writings in the nature thereof, by me at
any time heretofore made.
FIRST: I hereby order and direct my Executor, hereinafter named, to pay
all my just debts, funeral expenses, testamentary expenses and all Inheritance, Estate,
Transfer and Succession Taxes, as soon as may be conveniently done after my death,
out of my residuary estate.
SECOND: I give my entire estate to my son, PATRICK M. EARLY, OF
6265 Haydon Court, Mechanicsburg, Pennsylvania, provided he survives me. If he fails
to survive me, I give my entire estate to my daughter-in-law, ANNE R. EARLY, of 6265
Haydon Court, Mechanicsburg, Pennsylvania.
LASTLY: I nominate, constitute and appoint my son, PATRICK M. EARLY,
to be the Executor of this my Last Will and Testament. In the event that my said son,
PATRICK M. EARLY, shall be unable or unwilling to serve as Executor for any reason,
- � 3 17
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1
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I appoint, my daughter-in-law, ANNE R. EARLY, as Executrix. No Executor or Executrix
shall be required to file bond in this or any other jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
r
—[� syt day of 1998.
ane Early
SIGNED, SEALED, PUBLISHED and
DECLARED in the presence of:
2
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COMMONWEALTH OF PENNSYLVANIA
ss
COUNTY OF CUMBERLAND
I, RUBY JANE EARLY, Testatrix, whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as my Last Will; that I signed it
willingly; and that I signed it as my free and voluntary act for the purposes therein
expressed.
Sworn or ffirmed to and acknowle ed befpr me, by RUBY JANE EARLY,
the Testatrix, this day of a 1998.
bF ne Early,a tatrix
Notary Publi
..,..�.... NOTARIALSEAL
4IERLEENE MARNEVKA Notary Z'
Cad'sla,Cum
baAond Coumy,Pa
......_m ICY Comm," Env,0: 0P
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COMMONWEALTH OF PENNSYLVANIA
ss
COUNTY OF CUMBERLAND
We, _James.D.._Flower,_. Jr. . .._ and . .James D. Flow
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; that she 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 signeU 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 to before me by James_ D. Flower
and James_ .D_.. .Flower Jr_. - this day of _ ._ 1998.
Witness
att!4
Witness
Nota Public
NOTARIAL SEAL
MEHIENE kA No"Notary Plblic
Carrmle,CemheAend Coumy,Pa
-__, MY COmmeebn Etylrea6/8g8
4