HomeMy WebLinkAbout05-31-13 J 1505610105
REV-1500�x`°',°„�„d�l
PA Department of Revenue pennsyWania oFFICIAL uSE oNLv
o�.....�,a„�,..�� Count
Bureau of Individual Taxes � y Coda Year File Number
PO BOX a806oi INHERITANCE TAX RETURN �,�� ��� '� �� -� '``��
Harrisbu�PAi7izB-o6oi RESIDENT DECEDENT ��
ENTER DECEDENTINFORMATION BELOW
Social Security Number Date of Death MMpDYYVY Date of Birth MMD�VI'1^/
! 12/11/2012 12l05/1927
Decedents Last Name � ��� Suffix Decedents First Name � MI
�.. ..._ __. __ ._ . _.___ _., ,___ ____. .__.. .
'Neal ' Mrs , Grace _ , E
i
�If Applicable)Enter Surviving Spouse's Information Below �
Spouse's Last Name Suffix Spouse's First Name M�
Spouse's Social Searity Number � ���� � �� -�������� � � ����� � � � �
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
� 1. Original ReNm O 2. Suppiemental Return O 3. Remainder Re[um(Date of Death
Pnorto 12-13-82)
p 4. Limited Estate p qa. Future Interest Compromise(date o( O 5. Federal Estate Tax ReNrn Requiretl
tleath after 12-12-82)
O 6. Decetlent Diad Testate O 7. Decedent Mainqined a Living Trust 8. Total Number of Safe Deposi[Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
O 9. Litiga[ion Proceed5 Received O 10. Spousal Poverty Cretlit(Da[e of Death p 11, Election to Tax under Sec.9113(A)
Between 12-31-91 and 1-1-95� (Attach Schetlufe0)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIREC7ED T0:
Name Dayfime Telephone Number
Robert L. O'Brien, Esq. (717) 249-6873
REG�ER OF WILLS H3�ONLY -
C �^� � f
C_7 f�7
First Line of Address C -,, �' '�
' 19 West South Street rn _.::. �., -.-: vy %
. � ....r � �J �� �
. . ._ �.-, ' i
Secontl Line of Adtlress �"' .-.,
. . . . �_ ' - � �} k.
I � .
. .� ,-) _.�� ' .yi
City or Post OHice � � State ZIP Code �DATEfILe6' ._; �
. . _. . . . __ ... .. ._ . . ..� . �:J �_ itl
Carlisle i � �PA f 17013 �- �
.. . . . . ... . . __... ....__. .._. . ..._ . . :> F—+ Lo G
� �
Correspondent's e•mail adtlress:
Untlar penalnes ot per7ury,I deUare that I have examme0 this return,inclotling accompanying schetlWes entl sWtements,antl to Ihe 6est of my knowletlge antl belief,
it is Ime,wrrec[antl complete.Declaration of praparer othar than tha perspnal represente�ive is basetl on all informa�on of which preparer has any knowletlge
SIGNATUftE OF PERSON RESPONSIBLE FOR FILING RETURN DATE
ADDRE��—
�,�-�-- -sl��.��
SIGNATURE OF PREPARE�H R THAN REPRESE�TpT,y�E DAT�
I�i I.J,¢� S,.tT�-�4"�-�
ADDRESS �, ^ (�^ ,^���
wQ..J C. 1 d a' � �
PLEASE USE ORIGINAI FORM ONLY
Side 1
L 15056101D5 1505610105 �
�J�
� 1505610205
REV-1500 EX(FI)
DecedenYs Social Securiry Number
oeoeaa�rs Nema: Grace Elizabeth Neal
RECAPITULATION
1. Real Estate(Schedule A). ... .. . . . . . . .. . ... .. .. . .. .. ..... .. . .. .. . .. . .. t .
._...__. .__.... ...__. .__.
2. Stocks and Bonds(Schedule B) . .. ..... . .. . . ... .. . .. .. .. . .. . ... . ... .. . 2.
3. Closely Held Corporation, PaMership or Sole-Proprietorship(Schedule C) ... . . 3. �
4. Mortgages and Notes Receivable(SOhedule�) .. . .. . . . .. .. . .. .. . . . .. . .. .. 4.
__.__ __.__ _..... . ._ .. ...
5. Cash, Bank Deposits and Miscellaneous Personal Property(SChetlule E). . .. .. . 5. � 12,108.66
..__..._ .... . ._.. ... ...._.
6. Jointly Owned Property(Schedule F) O Separete Billing Requestetl . .. . .. . 6. �,
7. Inter-VivosTransfers&MiscellaneousNon-ProbateProperty ��---- -��-��� ����� � � ��-� ���
(Schetlule G) O Separete Billing Requested.. . . , . ., 7, �.,
._ __._.. __.__.�._..___...___.._......__.._____..
8. 7otal Gross Assets(total Lines 1 ihrough 7). .. . .. . .. .. .. . .. .. .. . .. . .. . .. 8. �� 12,108.66
9. Funeral Expenses and Administrative Costs(SChetlule H). .. . .... .. . .. . .. .. . & I 3,832.14 �
.. ..... .__. .___..._.......
10. Debts of Decedent, Morlgage Liabilities and Liens(Schedule I). .. . .. . .. .. . .. . 10. 186,386.49
' _' '._`_'_...._._...____.._.___..._._._...__.
71. 7otal Deductions(total Lines 9 and 10).. . .. ... .. .. . .. .... . .. . .. . .. . . . . . tt ' 190,278.63 �
..__.. ....._. ..._. ... _... ....
12. Net Value of Estate(Line 8 minus Line 11) . . . ... . .. . . . . . .. . .. . .. .. . . . . . . 12. 0.00
13. CharitableandGovernmentalBequests/Sec9713Trusisforwhich --� �-- �-�� ����� � � � � "� �� ��-
an election to tax has not been mede(Schedule J) . .. . . . .. .. . .. . . . .. .. . . . . 13.
_...._..... .._... _._.._ ._._..
14. Net Value SubJect to Tax(Line 72 minus Line 13) . .. . .. .. .. . .. .. ... .. . .. . 14. 0.00
TAX CALCULATION-SEE INSTRUCTIONS FOR APPIICABLE FiATES
75. Amount ot Line 14 taxable
at the spousal tax rate,or
transfers under Sec,9116 � �
(a)(12)X A_ �� 15. �
__..____.._.___...____..__._.......__._.,___.._.. ;___..___.___...._......__..__.._..__.__..._.,_.._.,._.
16. Amount of Line 14 taxable i �
at lineal rate X D_ 16. :
__,.___..__.. __.__._.._ . __._... .___.._. __.. ._.._.
17. Amount of Line 14 taxable ����-��-����� �� ��"'. � � - �
at sibling rate X.72 � , 17. ,
18. AmountofLinel4taxable ...... �..-_.....-------...-�-�--��----��1 . . ..-------_ .____. _.._..
...___ r_._.�__
at collateral rate X.75 _ i 18.
. __.._. _. _. ....__.. ._____..__.. __�._._...
.. �_'.._" "_ __._' .
19. TAX DUE . . . . .. . .. . . .. .. . .. . .. .. . .. . .. ... .. .. . .. .. .. . .. ..... .. . .. . 19. 1__ .... .... . . .. .. . 0.00
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p
Side 2
L 1505610205 15056102�5 �
REV4500E%(FI) Page3 FIIeNUmDer
DecedenYs Complete Address:
DECEDENTS NAME
Grace Elizabeth Neal
STREETADDRESS
Claremont Nursing
CITY STATE ZIP
Carlisle PA 17013
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1)
2. Credits/Payments
A.Pnor Paymenis
B.Discount
Total Credi45(A+g) (2)
3. Interesl
(3)
4. It Line 2 is greater than Line 1 +Line 3,enter ihe difference. This is ihe OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (A)
5. If Line 1 +Line 3 Is grealer than Line 2,enter Ihe difference.This is the TAX DUE. (5)
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 lransfer and: Yes No
a. retain the use or income of the property transfeved..............................................................._......................... ❑ �
b. retain lhe right to designate who shall use fhe property transferred or its income ........................................_.. ❑ �
c. retain a reversionary interest.................................................................................................................�............ ❑ �
d. receive ihe promise tor ilte ot either payments,benefts or care?...................................................................... ❑ �
2. If death ocarred after Dec. 12,1982,did decedent transter propedy within one year of death
without receiving adequate conside�alion?.............................................................................................................. ❑ �
3. Did decedent own an"in trust for'or payable-upon-death 6ank acrqunt or secunry al his or her death?.............. ❑ �
4. Did decedent own an individual retirement eccount,annuiry or other non-probate property,which
contains a beneficiary designafion? ........_..........................._.......,...........................,..................._................._..... ❑ �
IF THE ANSWER TO ANY OF THE AB04E QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates ot 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 iransfer to a surviving spouse from tax,and Ihe statutory requirements for disclosure of assets and
f ling a tax retum are still applicable even i(the surviving spouse is the only benefciary.
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 tq or for the use oi 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 iransfers io or for the use of the decedenPs lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)].
• The tax rate imposed o�the net value of kansfers to or for Ihe use of the decedenPS siblings is 12 percent t72 P.S.§9116(a)(1.3)].A sibling is defined,
under Section 9102,as an individual who has at least one parent in wmmon with the decedent,whether by blood or adoption.
.
REV4511 EX+ (10-09)
�pennsylvania SCHEDULE H
oEPAA*MF�r�FAE�E��E FUNERAL EXPENSES AND
INHERITANCE TAX RENRN ADMINISTRATIVE COSTS
0.ESIDENT DKE�ENT
ESTATE OP FILE NUMBER
Grace Elizabeth Neal 21-13-0102
Decedent's debts must be reported on Schedule I.
ITEM
NUMBEk DESCRIPTION AMOUNT
A. FUNERALEXPENSES:
t' Georges Flowers 73.84
z Janet L.Dove,reimburse 75278
6. ADMINISTRATIVE COSTS'.
1. Personal Representative Commissions: 1,020A0
Name(s)of Personal Representative(s) Jan2t L. Dove
Street nddress 505 North Pitt Street
Citv Carlisle State PA Z�p 17013
Year(s�Commission 7aid: 2013
1,020.00
2. Attorney Fees:
3. Family Exemption: (If decedent's address is not the same as daimant's,attach ezplanation.)
Claimant
Street Address
City State_ZIP_
Relationship of Claimant ro DeceOent
4. Probate Fees:
5. Accountant Fees�. 500.00
6. Tax Return Preparer Fees'.
� MetLife Shhareholder Services 110.02
e Gov.Services tax ID 147.00
a Cumberla�d County Register 108.50
Reserve for further Register fees 10�.00
TOTAL(Also enter on Line 9, Recapitulation) $ 3,832.14
lf more space is needed,use additional sheets of paper of the same size.
. _ . _ . _ . . . .. .
REV-i5o8 EX+(o8-u)
�pennsylvania SCNEpIlLE E
��� DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC.
wnea�raNCe rnx aeruarv PERSONAL PROPERTY
RESIpENT�ECEDENT
ESTATE OF: FILE NUMBER:
Grace Elizabeth Neal 21-13-0102
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned wlYh rlght of survivorship must be dlscloxd on Schedule F,
ITEM
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
1. Claremont Nursing resident account refund 2,154.04
2 MetLife #0061262253
2,01376
3 MetLife Policies 15067590A,515100603 7,656.29
q Met Life Thompson settlement
228.74
5 Optimum ins. refund
8.10
g Met Life dividend 10.55
7 Met Life misc. 37 �8
TOTAL(Also enter on Line 5, Recapitulation) ; 12,108.66
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+ (10-09)
�pennsylvania SCHEDULE H
oeeaarmer�roraevervue FUNERAL EXPENSES AND
wHeR�rnnceraxnEruRN ADMINISTRATIVE COSTS
RESIDENT DKEOENT
ESTATE OF FILE NUMBER
Grace Elizabeth Neal 21-13-0102
DecedanYs debts muct be reported on Schedule I.
ITEM
NUMBER DESCRIP710N AMOUNT
A, FUNERALEXPENSES:
1' Georges Flowers 73.84
z Janel L.Dove,reimburse 752.78
B. AOMINISTRATIVE COSTS'.
1. Personal Representative Commissions: 1,020.00
Name(s)of Personal Representative(s) Janet L. Dove
streec address 505 North Pitt Street
City Caflisle State?A Ztp 17013
Year(s)Commission Paid: 2013
1,020.00
2, Attorney Fees:
3. Family Exemption: pf decedent's atldress is not the same as daimant's,attach explanation,)
Claimant
Street Address
City State_ZIP_
Relationship of Claimant to Decetlent
4. Frobate Fees�.
5. Accouatant Fees�. 500.00
6. 7ax 0.eturn Preparer Fees�.
� Metlife Shhareholder Services 110.02
e Gov.Sen+ices taY ID 147.00
a Cumbedand County Register 108.50
Reserve for further Register fees t 00.00
TOTAL(Also enter on Line 9, Recapitulation) $ 3,832.14
!f more space is needed,use additional sheets ot paper of the same size.
REV-1512 E%+ (12-12)
�pennsylvania SCHEDULE I
oear,ArMENTOFAever+ue DEBTS OF DECEDENT,
'""E"'TA"�E T""RETU"" MORTGAGE LIABILITIES 8c LIENS
RESIDENT OEGEDENT
ESTATE OF IFILE NUMBER
peport debts incurred hy the decedent priur to dealh that remained unpald at the date oi deaSh,including unreimbursed medical expenses,
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 PA Dept.of Public Welfare CIS#040234910 186,386.49
TOTAL(Also enter on Line 30, Recapitulation) ; 186,386.49
If more space is needed,insert additional sheets M the same size.
REV-1513 EX+ (01-10)
�pennsylvania SCHEDULE ]
INHERITANCE TA%REfU0.N BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Grace Elizabeth Neal 21-13-0102
RElAT10N5HIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(5)RECENING PROPERN Do Not List Trustee(s) OF ESTATE
I 7AXABLE DISTRIBUTIONS[Include outright spousal distributions and t2nsfers under
� Sec.9116(a)(1.2).]
1 JanetL.Dove daughter �/3
2 Gary E.Neal son �/3
3 John R.Neal son �/3
ENTER DOLtAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON IINES 15 THROUGH IB OF REV-I500 COVER SHEEf,AS APP0.0PRIATE.
II NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 fOR WHICH AN ELECfION 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. j
If more s0ace is needed,use additional sheets of paper of Ihe same size.
pennsylvania
DEPAqTM�ENT OF PUBLIC WELFARE
March Z, 2013
' ROBERT L O'BRIEN ESQUIRE
19 W SOUTH ST
CARLISLE PA 17013-3445
Re: Grace Neal
CIS #: 044234910
SSN: ###-##-
Date of Death: 12/11/2012
Dear Attorney O'Brien:
Please be advised that the Department of Public Welfare maintains a claim in the
amount of S186.386.49 against the above-mentioned estate. This claim is for restitution
of inedical 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 ffi34.775.28, was incurred during the last
six months of the decedenYs 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 S151,631.21, 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,
�h , `�4} 1' `-.�f,
I ' �� !I l ll�l�►Z�l.�
Elizabeth M. Wilson
� TPL Progrem Investigator
717-214-1868
� 717-772-6553 FAX
Enclosure
cc: ]anet L Dove
505 N Pitt St
Carlisle PA 17013-1948
'�, eureau of Crogram Integrity � Divlsion of 7hird Party Liability � Recovery Sec[ion M��.X�.m.�.T���u�„Y,�.
� PO Box 8486 I Harrisburg, Pennsylvanla 17305-8486