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HomeMy WebLinkAbout05-13-13 J �� 1505610101 REV-1500 EX(oa-to) L17 PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes . ° County Code Year File Number PO BOX28o6o1 INHERITANCE TAX RETURN Harrisburg PA 17128-0601 RESIDENT DECEDENT r�-,l �,3' 900(,b ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 05/01/2005 07/11/1939 Decedent's Last Name Suffix Decedent's First Name MI DONMOYER THOMAS g (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 (31D 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) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 0 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 pTglephone Number Elizabeth B. Place, Esq (717) 2 32000 "I R4 SfERp WILLS USE Qt L r^ (i7 t5 First line of address 'I- _. ZZ) 1 17 S. 2nd Street c, CD _, 5 - Second line of address = 1 t—` �- n 1-rt Sixth Floor 2> Cn Q .t 7r! City or Post Office State ZIP Code DATE FILED Harrisburg PA 17101 Correspondent's e-mail address:_ebp @Skarlatoszonarich.Com 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 LN-R OFOR FILING RETURN DATE AD S EI' beth B. Place, Esquire- 17 S. 2nd Street, 6th Floor, Harrisburg, PA 17101 SIGNATURE OF PREPABFR OTHER THAN REPRESENTATIVE DATE A DORE A' Eliz th B. Place, Esquire- 17 S. 2nd Street, 6th Floor, Harrisburg, PA 17101 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610101 1505610101 J ne J 1505610105 REV-1500 EX Decedent's Social Security Number Decedent's Name: THOMAS B. DONMOYER 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 j 4. Mortgages and Notes Receivable(Schedule D)._... ... ... ..... ... . ..... . 4. 0.00 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E).. ... .. 5. 0.00 . 6. Jointly Owned Property(Schedule F) O Separate Billing Requested .. .. ... 6. 4,230.00 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested.. . .... . 7. 0.00 8. Total Gross Assets(total Lines 1 through 7)... . ... .... ... .... ..... ..... . 8. 4,230.00 9. Funeral Expenses and Administrative Costs(Schedule H)...... . ... . .. ... .. . 9. 4,659.00 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule 1)... . ... ...... . 10. j 11. Total Deductions(total Lines 9 and 10)... . .... .... ........ .. . ... . .... .. 11. 4,659.00 _.__...____._,....."",...�.�.__,..__.....00 1 12. Net Value of Estate(Line 8 minus Line 11) ... ..... . .. ........ .... .... ... 12. ! -429.00 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. -429.00 , 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. 0.00 ! 16. Amount of Line 14 taxable at lineal rate X.0 45 0.00 16.' 0.00 17. Amount of Line 14 taxable at sibling rate X.12 p, 0.00 i.,.......__......._......_,._,..,""".."'_.._.._....,._.._.,.__._...._,� .__.....,_.,,._._.____.._.___......"...._..�.......__.__..._._.., 18. Amount of Line 14 taxable at collateral rate X.15 18, 0.00 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 J REV-1500 EX Page 3 File Number a I V 00&D Decedent's Complete Address: DECEDENT'S NAME Thomas B. Donmoyer STREETADbREss --- - ------- 304 Bahama Circle Cumberland County CITY ........... STATE Carlisle PA 17015 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) 0.00 2. Credits/Payments A.Prior Payments B.Discount 3. Interest Total Credits(A+B) (2) 4. If Line 2 is greater than Line I+Line 3,enter the difference. This is the OVERPAYMENT (3) Fill in oval on Page 2,Line 20 to request a refund. (4) 5. If Line I +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 "Xu IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;.......................................................................................... F] b. retain the right to designate who shall use the property transferred or its income;........................................... ❑ c. retain a reversionary interest;or........................................................................................................................ F-1 RX d. receive the promise for life of either payments,benefits or care?­...........................-..................1.1.1-............ ❑ ] 2. If death occurred after Dec. 12,1982,did decedent transfer property within one year of death without receiving adequate consideration?............................................................................................................ ❑ FRI 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)(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 RS.§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)F2 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-1509 EX.(690) SCHEDULE F COMMONWEALTH IIETFANE TAXXRRE URNANw JOINTLY-OWNED PROPERTY RESIDBtr DECEDENT ESTATE OF FILE NUMBER Thomas B. Donmoyer Al - /3 ` OUo If an asset was made joint within one year of the decedents data of death,it must be reported on Schedule G SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT A Dell, Cheryl 304 Bahama Circle, Carlisle, PA 17015 None JOINTLY-OWNED PROPERTY: t ER DATE DESCRIPTION OF PROPERTY % DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAMEOF FINANCIALINSTITUTION AND 9ANKACCOUNT DATEOFDEATH DECDS VALUEOF NUMBER TENANT JOINT NUMBER OR SMIUVR REAL ESTAREATTACH DEED FOR VALUEOFASSET INTEREST DEDEOBJT'S INTEREST 1 A 1985 Zimmer Mobile Home VIN 37354205602 (one-half interest) 8,460 50.0000 4,230 TOTA 4,230 IN more space is needed,insert additional sheets of the Sarre size) 3W46AE 1,000 REV-1511 EX (12-99) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE DECEDENT ADMINISTRATIVE COSTS RESIDENT DECEDEM ESTATE OF Thomas B. DOnmO er FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION A. FUNERAL EXPENSES: AMOUNT t. None B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representatives) — — Street Address City State Zip Year(s)Commission Paid: 2. Attorney Fees 2,000 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 112 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Cumberland Law Journal — Estate Advertisement 75 2 The Sentinel — Estate Advertisement 147 3 SkarlatosZonarich LLC — Costs 5 Total from continuation schedules . ' 2,320 TOTAL(Also enter on line 9,Recapitulation) $ 4 659 3w46AC 1.000 (If more space is needed,insert additional sheets of the same size) Estate of: Thomas B. Donmoyer 186305614 Schedule H Part 7 (Page 2) 4 Leiby's MHC, LLC - mobile home lot rent, water, sewer, fees 1,980 5 PPL - electric 320 6 NADA - Mobile valuation report 20 Total (Carry forward to main schedule) 2,320 IdQQAi NADAguides.com Value Report Gufpes (THIS IS NOT AN APPRAISAL FORM) Date 02/15/2013 Reference Number 336713 Office Location Costa Mesa Guide Edition Jan-Apr 2013 Year Mfg'd Manufacturer Trade Name State Region 1985 ZIMMER Unknown PA MA Floor Areas: Single-Wide Width Length Total Value Main Floor Area: 12 x 60 $4,116.70 1. Base Structure Value 2. State Location Adjustment $4,116.70 3. Total Guide Book Retail Value (in average condition) x 102 $4,199.03 4. Condition Adjustment Excellent ❑ Good ❑ Fair ❑ Poor x 61 5. Condition Adjusted Value 6. Total Adjusted Value of Home $2,561.41 $2,561.41 7. Total Additional Features + $4,362.52 8. Total Adjusted (Retail)Value of Home and Optional Equipment $6,923.93 Completed By: Online Summary Comments:This is a base retail value(without inspection) based on information supplied by the customer. Copyright©2013 National Appraisal Guides Inc. All rights reserved. Page 1 of 3 NADAguides.com Value Report 1° (THIS IS NOT AN APPRAISAL FORM) Date 02/15/2013 Reference Number 336713 Office Location Costa Mesa Guide Edition Jan-Apr 2013 Year Mfg'd Manufacturer iYTrade Name State Region 1985 ZIMMER Unknown PA MA ADDITIONAL FEATURES Unit of Description Quantity Measure Age Unit Price Total Value Components BATH FIXTURES Fiberglass Tub-Combo 1 ea. 5+Yrs $191.00 $191.00 Total BATH FIXTURES $191.00 DOORS Storm Doors-Single-wide 1 all 5+Yrs $71.00 $71.00 Total DOORS i $7100 ELECTRICAL Electric Home-Total 1 ea. 5+Yrs $363.00 $363.00 Total ELECTRICAL $363.00 FAN Ceiling Paddle Fan 1 ea. 5+Yrs $78.00 $78.00 Total FAN $78.00 HOUSE TYPE ROOFING ' Single-wide 1 home 5+Yrs $396.00 $396.00 Total HOUSE TYPE ROOFING $396.00 HOUSE TYPE SIDING Single-wide 1 home 5+Yrs $397.00 $397.00 Total HOUSE TYPE SIDING $397.00 MISCELLANEOUS Clothes Washer 1 ea. 5+Yrs $190.00 $190.00 Clothes Dryer 1 ea. 5+Yrs $145.00 $145.00 Total MISCELLANEOUS $335.00 Copyright O 2013 National Appraisal Guides Inc.All rights reserved. Page 2 of 3 NADA' NADAguides.com Value Report cu'aes (THIS IS NOT AN APPRAISAL FORM) Date 02115/2013 Reference Number 336713 Office Location Costa Mesa Guide Edition Jan-Apr 2013 Year Mfg'd Manufacturer Trade Name State Region 1985 ZIMMER Unknown PA MA Components PLUMBING Stainless Steel Sink 1 ea. 5+Yrs $92.00 $92.00 Total PLUMBING i� $92.00 Total Components $1,923.00 Accessories CENTRAL AIR CONDITIONING SYSTEM(By Ton, 12,000 BTU = 1 Ton) 2 Ton Electric 1 ea. 5+Yrs $703.00 $703.00 Total CENTRAL AIR CONDITIONING SYSTEM (By Ton, 12,000 BTU = 1 Ton) $703.00 PORCHES/DECKS(Measure Width x Length Including Carpet 8 Rails) Y Wood w/Rails 100 sq.ft. 5+Yrs $9.55 $955.00 Total PORCHES/DECKS(Measure Width x Length Including Carpet&Rails) $955.00 SKIRTING TO 30"HIGH (Measure Around Perimeter) Metal or Vinyl(Vertical) 144 lin.R 5+Yrs $2.08 $299.52 Total SKIRTING TO 30"HIGH (Measure Around Perimeter) $299.52 STEPS Wood-3 Steps 2 ea. 5+Yrs $241.00 $482.00 Total STEPS $482.00 Total Accessories $2,439.52 Total Additional Features $4,362.52 Copyright O 2013 National Appraisal Guides Inc. All rights reserved. Page 3 of 3 INVENTORY REGISTER OF WILLS OF CUMBERLAND COUNTY,PENNSYLVANIA COMMONWEALTH OF PENNSYLVANIA I SS 2I -2013-00060 COUNTY OF CUMBERLAND File Number Personal Representative(s)of the Estate of THOMAS B.DONMOYER deceased,depose(s)and say(s)that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent,that the valuation placed opposite each item of said inventory represents its fair value as of the date of the decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I verify that the statements made in this Inven- tory are true and correct. I understand that false state- ments herein are made subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities. Attorney-- (Name) Elizabeth B.Place,Esquire (Supreme Court I.D. No.) 44682 (Address) 17 S.2nd Street,6th Floor,Harrisburg,PA 17101 (Telephone) 717-233-1000 DATE OF DEATH LAST RESIDENCE DECEDENT'S SOC.SEC.NO, 05101/2005 304 Bahama Circle,Carlisle,PA 17015 186-30-5614 FIGURES MUST HE TOTALED One half value of mobile home valued at$8,460 C'> ;XI ;t230.00 0 w rn G O tn'! C7 CD T CD M Fri M n W C C3 --• �' O r3 C> CJ Z Z3 -:� -v7 CD — C> r— Fri r_ L:D (Attach additional sheets as needed) TOTAL: 4,230.00 NOTE- The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative include the value of each item,but such figures should not be extended into the total of the Inventory. (See 10 Pa.C.S.§3301(6)) Form RW-04 rev.10.13.06 MM 06250006654622 NLW co a 40 IZ:5 a ;z rig %Oa- E9EOE _ f0 U M j M a NE � o 3 N co = ow oQ o o U L Of O UO J J J LL x ,x (O`� Z LU Q O LU L1 <z° mm � N x 1 � � CO r 2