HomeMy WebLinkAbout07-01-13 J + 1505610140
R�V� t�OO EX (02•71j{Fp
FA Departmsnt of Revenue oFFict�u.u3e o�l�v
Sureau of Ittdlviduai Taxes Couniy Code Year File Number
Po aox 2aoso� INHERITANCE TAX RETURN �� _�j{3���3.7
Harzisburg PA 1772&0641 RESIDENT DECEDENT
ENTER REGEDENT INFORMATION BELOW �
Social Security Number Date of Death MMt�DVYYY Date of Birth MMDDYYVY
� 4 D 2 2 d 1 3 1 2 1 8 1 9 2 1
DecedenYs Last Name Sa�x DecetlenPS First Name MI
B A R L 0 W N A R R Y R
Qi Applicahle)Enter Surviving Spouse's Informatbn Below
Spouse's Last Name SuHiz Spouse's Firsi Name MI
Spouse's Social Sewrity Nvmber �
THIS RETURN MUST BE FIIED IN pUPUCATE�NITH THE
REGISTER OF WILLS
FiLL IN APPROPRIATE OVALB BEIOW ,
o 1.Original Retum � 2.Supplemental Return � 3. Remainder etum iDa#e af 6eath
Arwr to 12-�3-82}
� 4.Limited Estate � 4a.Puture interest Gompromise(date aP � 5. Feder�7 Est#te Tax Retum Required
death after 12-12$2} �.
� 6.Decedent Died Testate ❑ 7.DecedertY Maintainetl a Living Trust _ 8.Totai Numb@r of Safe Deposit Boxes
� (ACtaoh Copy pf Will) (Attach Copy of Trust-) '�
� � 9.Litigation Proceeds Receivetl � 70.Spousa!Paverty Credif(Date of Death � 11. Election to'�ax under Sec.9113(A)
8etween 12-3t-91 and 1•7•95) {Aitach Sctt�duie 4)
� CORRE8PONDENT-THIS SECTION MUST 8E COMPLETfp.ALL C6RRESPONDENCE AND CONPIDENTIAL TAX INFORMATIO SHOULD BE DIRECTED T0:
� Name Dayti�Telephon��ber� r
J A C a U E L Z N E A K E L L Y 7 � �' 5 u� � b� 5 0
7IE1"�TlR Op WILIS U�QNtV
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. A � � �,� .w> ��.
First Line of Address '� ^s n ,_ �� „ µ`c ,
_T.�
8 4 5 S I R T H 0 M A S C 0 U R T o r�—' �� =~ �`'
� c� "" rn
Second Line of Address ' ..ry � ��.. � � o �.
suzTe � e " `..' �'
City or Post Oifice 5tate 2IP Cade DA'f�PILED iI
H A R R I S B U R G P A 1 7 1 0 9
Corceapondenese-malladdress: JAGKlEJLBCtDVERfZON.NET i
Under penaities of perjury,l declare that i have examined this retum.inclutling eccompanying schetlules antl atatemeota,aM to 4he best my kxrowletlge aml belief,
N ts Uue,Co(�'eCt a(M COmpiete.DBCIer6tion of pr9parer er th8n the pel8onel repre39nt8tiv9 is basetl On all inMfmation of whith prepare has 8ny knpWletlge.
�`�RE OF PERSO RESPON FOR FILI RETURN ATE
�.s�-"..� �--�- ;�h� Jr.�
ADORESS �, �
4b9 OLD STAGE ROAD LEWISBERRY PA! 17339
SI ATURE OF P PARER T T N REPRESENTATNE ATE
!���
A RES
845 SIR TH4MAS C4 T, SUITE 12 HARRISBURG PA ' 17104
PtEA5E USE ORfGINAL FORM ONLY '
Side t
� 150561d140 150561f114�1 J
J 1505610240
REV-1500 EX(FI)
DecedenYs Social Security Number
oeceae�ee Name: H A R R Y R. B A R L 0 W
RECAPITULATION .
t. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1. ,
2. Stocksand Bonds(Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.
3. Closely Heltl Coryoration, Partnership or Sole-Proprietorship(Schedule C) . . . . . 3. ,
4. Mortgages and Notes Receivable(SChedule D) . . . . . . . . . . . . . . . . . . . . . . . . . .
4. ,
5. Cash,Bank Deposits and Miscellaneous Pereonal Property(Schedule E). . . . . . . 5. � 4 7 6 , � �
6, Jointly Owned Property(SChedule F) ❑ Separate Billing Requested g. �7 '] $ g � 7 5
7. Inter-Vivos Transfers 8 Miscellaneous N Probate Property �
(Schedule G) � Separate Billing Requested . . . . . . . Z 1 0 � 1 0 3 , 5 5
8. Total Gross Asaeta(total Lines t through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 1 1 b 3 6 8 , 3 0
9. Funeral E�cpenses and Administretive Costs(Schedule H) . . . . . ]i 2 9 2 . 5 0
. . . . . . . . . . . . . 9.
10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule q . . . . . . . . . . . . . 10. �, 2 3 8 . 7 3
i 1. Tofal Deductiona(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. L�i 5 3 1 . 2 3
12. Net Value of Estate(Line 8 minus Line 71) . . . . . . 8 3 7 . � 7
�2. 1 1 4
13. Charitabla and Governmental Bequests/Sec 9113 Trusts for which ��
an election to tax has not been made(Schedule J) . . . . . . . . . . . . . . . . . . . . . . 13. '
ta. Net Value SubJect to Tax(Line 12 minus Line 13) . . . . . . . . . . . . . . . 1a. 1 1 4�!, 9 3 7 . 0 7
� TAX CALCULATION•SEE IN3TRUCTIONS FOR APPLICABLE RATES '
15. Amount of Line 14 taxable
at the spousal tax rete,or
transfers under Sec. 9116 �.
(a)(12)X.0 _ � . � 0 15. , � . � �
i6. Amount of Line 14 taxable �
at lineal rate X.0 0 . � � 16 . 0 . O a
17. Amount of Line 14 taxable
at sibling rata x.�z 1 0 9 6 4 1 . 7 7 n. 1 3 ' 1 5 7 . 0 1
18. Amount of Line 14 taxable ��
atcollateralratex.�s 5 1 9 5 . 3 0 �e. '�� 7 7 9 . 3 0
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 1 3 '..9 3 6 . 3 1
20. FILL IN THE OVAL If YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT � �
Side 2
L 1505610240 1505610240I �
REV-1500 EX{R} Page 3 . File Num6er
Decedent's Complete Address: o 0
DECEOENT'S NAME
HARRY R. BAR�4W
STREETADDRESS
4905 East Trindle Road
CITY STATE ZIP
MeChanicsbur PA 17Q50
Tax Fayments and Credits:
� Tau�ue(Page 2,Line 19) (1) 13 936.31
2 Cradits/Payments
A.Pria Payments
B.Discount 69679
Totai Credits(A+g� �p� fi96.79
3. interest !
4. If Line 2 is greater than Line 1 +Line 3,enter the diHerence.This is the OVERPAYMENT.
t3� 'i
Fill I�oval on Pege 2,Line 20 to requeat a refund. (4) ; Q.00
i
5. if line 1+une 3 is greater than Line 2,enter the difference.7his is the TAX DUE. (5) i 13 239.52
Make check payable to: REGISTER OF WILLS, AGENT '
i
PLfASE ANSWER THE FOLLOWfNG QUESTIONS BY PLACING AN "X" IN THE APPRO�RIATE BLOCKS
1. Rid decedent make a Uansfer and: y' Np
a. ret�n the use or inmtt�e aF the Property transferr� ...................................................................... �
b. retain the right to designate who shall use the property transferred or its income .............................. �X
c. retain a reversionary interest ....................................................__......................._.................... �
d. receive the promise fw life of either paymerrts�be�its w care? .................._................................... ' Q
2. if death occurred after December 12,1982,did decedent transfsr propeAy within one year o(death r�,
without receiving adequate consideration? ....................................................................................... � ❑
3. Did decedent own an'in trust fo�'or payabie-upon-death bank account a security at his or her death? ......... �
4. did decedenf awn an individaal retitement account,annuity or ofhw oon•probate property,which I
contains a beneficiary designation?.................................................................................................. � ❑
!F THE ANS4UER TO ANY OF THE ABOVE QUESTtONS IS YES,Y4U MUST GOMPIETE SCNEdU�E G AND F1lE IT�.S PART OF THE RETURN.
For dates of death on or after July 1,1994,and before Jan. 1, 1996,the tax rate imposed on the net value of transfers to or f�r the use of the surviving spouse is
�s s�ercent�rz�.s.§s��s ta���.�}{��3.
For dates of death on or after Jan. 1, 1995,the tax rate imposed on the net value of transfers to or fpr the use af the survivin 9I,spouse is 0 percent
p2 P.S.§91 i6(a)(1.1)(ii)].The statute does not exempt a transfer to a surviving spouse ftom tax,and the statutory requirenhents for disclosure of assets and
filing a tax relum are sti#t applic�aie even if the surviving spouse as the only i�neficiary.
For dates of death on or after July 1,2000:
• The tax rate imposed on the net value of Vansfers from a deceased child 21 years of age or younger at death to or for the�se of a natural parent,an
adoptive parertt or a steppazent of the chiid is 0 percent[72 P.S.§9i 16{a}{12}�.
• The tax rate imposed on the net value of transfers to or for the use of the decedenPs lineal benefiaiaries is 4.5 percent,exdept as npted in�2 P,s.§siis�a)�t}a.
• The tax rate imppsed on the net value of hansfers tp or for the use of the decedenYs siqlings is 12 percent(72 P.S.§9116(�)(1.3)].A sibling is defined,
under Sectio�91 Q2,as an individuaf who has at least o�e parent in commo�with the decedent,whether by biood or adap�on.
Rev-�sos�.{os-�z)
pennsylvania SCHEDULE E
OEPARTMENTOF0.EVENUE �ASH, BAN#C DEPOSITS & MISC.
RESIDENTDEC DEN�TT�� PERSONAI. PROPERTY
ESTATE OF: FILE NUMBER:
HARRY R. BARLOW 0 p
include the proceeds of litigation and the date the proceeds were received by the estate. ,
All proparty jointly owned with right of aurvivonhip must be disclosed on Schedule F.
ITEM VALUE AT OATE
NUMBER L}ESCRIPTION OF DEA7N
t. US Treasury; tax refund 1,476.Q0
TOTAL(Also enter on Line 5,Recapitolatio ) S 1 476.OQ
if mare space is needed,use additionai sheets of paper of the same size.
i
REV-t 549 EX+{01-10}
pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE ,�{}�NTLY-QWNEd PROPERTY
MHEPoTANCETAXRETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
HARRY R. BAR�OW 0 0
If an asset was made�ointty owned within one year of the decedenPs date of death,R must be reported o�1 Schedule G.
StfRVNINCa JptNF TENANT{S}NAME{S} ADpRESS . REIATtONSHiP T6 DECEDENT
A. Dennis K. Monighan 469 Old Stage Road nephew
Lewisberry, RA 17339
s.Olga Monighan 731 Elkwood Drive sister
New Cumberland, PA 17470
c.
JOINTLKOWNED PROPERTY:
LEF7ER DATE DESGRIPTION OF PROPERTY %OF DATE OF OEAiN
ITEM FOR J41NT MAEif INGI.U�FtAME OF FXNANGAk.tNS7tTULIQN AND BANK ACCtX}N7 NUMBER OR SIMItAR OATE OF DEA7H DEGEOEMT'S VAIUE OF
NUMBER TENANT JOINT 1DENTIFYINGNUMBEft. ATTACHDEEDFORJOINT4Y-NELOREALESTpTE. VALUEOFASSET INTEREST DECEDENT'SINTEREST
1. A, 1976 Wells Fargo savi�gs account 1,846.80 50. 923.40
Account#8083365129064
2. A 2010 Wells Fargo checking account 11,481.81 I 50. 5,740.91
Accaunt#1Q14296d59&54
3. A, B 1997 Wells Fargo Crown Classic Benking account 377.08 I� 33. 124.44
Account#1014157391783
i
II
TOTAL(Also enter on Line 6,Recapitulation) , E g 788.75
N mwe space rs needed.use adiitionai sheets of papet W!ha same size.
_
_ _ _
T
REV-1510 EX+(OB-09)
pennsylvania SCHEDULE G
DEPAftTMENTOFREVENUE INTER-VIVOSTRANSFERSAND
INHERITANCEiA%RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
HARRY R. BARLOW 0 0
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-15tl�0 is yes.
ITEM DESCRIPTION OF PROPERTV
INCLUDETHENNAEOFTHETRANSFEREE,THEIRRELATIONSHIPTODECEDENTpN� DATEOFDEATH °�OFDECD'S EXCLUSION TAXABLE
NUMBER THEDATEOFTRPNSiER.ATTqCHACOPVOFTHEDEEOFOPREAIESTATE. VALUEOFASSET IN7EREST ��rer�uv,eie� VALUE
1. Gift to sister, Olga Monighan, in December 2012 98,000.00 100.00 3,000.00 95,000.00
2. WesternNationalAnnuity; Contract#4FW55137 13,103.55100.00 13,103.55
beneficiary is sister, Olga Monighan
TOTAL (Also enter on Line 7,Recapitulation) S 108 103.55
i(more space is needed,use additional sheets of paper o(the same size. ''�,
_ . .__ . . . ._._ . ._ _ . . ..__ .. . . ...
REV-1511 E%+(10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE7AXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OP FILE NUMBER
HARRY R. BARLOW 0 0
Deeedent's debts must be reported on Schedule L '�.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERALEXPENSES
1. Romberger Memorials; inscription of gravemarker 207.50
B. ADMINISTRATIVE COSTS '
1. Personal Representative Commissions �����.
Name�s)ot Personal Representative(s) �'
Street Address �'�
Ciry Stete ZIP�_
YeaQs)Commission Paid: �
z, n�romeyFees: Jan L. Brown &Associates 1,000.00
3. Family Ezemption:(If decedenYs address is not me same as claimanPs,attach explanation.) '�
Claimant '�
Street Address ���
City State ZIP �.. .
T
ReWtionship of Claimant to Decedent '��
4. Proba�eFees: Register of Wills; Inheritance Tax Return filing fee ' 35.00
5 Accountant Fees: �'�.
6. raxaemmareParerFees: Donna B. Campbell, CPA; 2012 Income Tax Return 50.00
z I
TOTAL(Also enter on Line 9,Recapiiulatioh) S 1 292.50
If more space is needed,use additional sheets of paper of Me same size. ��
.. _._. . _ __ . . . . __._. . i
REV-1512 EX+(12-12j
pennsylvania SCHEDULE I
DEPARTM£NT OF REVENUE p�gTS OF DECEDENTa
iNHEar�arac�rAxaeTUrw MORTGAGE lIABILtTiES 8 11ENS
RESIDENT DECEDENT
ESTATE OF Fl�E NUMBER
HARRY R. BARLOW d 0
RepoR debta incurred by the decedent priar to death that remained unpaid atthe date of death,including unreimhu{aed medioal e�enaes.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF pEATH
t. West Shore EMS; outstanding bili 175.28
2. Azizkhan Intemal Medicine Associates; outstanding medical bill 63.45
tUTAL{Also enter on Line 10,Recapitulakiqn) S 238 �a
It more space is needed,insert additional sheets of the same size,
REY-15�3 EX+;Ot40}
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
iNHERITANGE TAx RETURN
RESIbENTDECEDENT
ESTATE OF: FI�E NUMBER:
HARRY R. BARLOW p p
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME ANp ADDRESS OP PERSON(S)RECEIVING PRpPERTY Dp Not List Truatee(s) OF ESTATE
I TAXABIE DiSTRIBUTI4NS pr�tlu�oufipM spousai distributians and trznsfers under �
Sec.91i${a}(12}.]
1. Olge Monighan Sibling 1p9,641.77
731 Elkwood Drive Sch. E, F and G property
New Cumberland, PA 1707d
2. Dennis K. Monighan Collateral 5,195.30
469 Old Stage Road Sch. F and G property
Lewisberry, PA 17335
ENTER OOlL4R AMOUNTS FOR 61STRIBUTIQNS SH01YN A60VE ON LINES 15 7HR4UGH 19 4f REV-1500 C4VE SHEE7,AS APPR4PRIATE.
II. NdN•TAXABLE DISTRIBUTIQNS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B.CHARITABLE AND GOVERNMENTAL pISTRIBUTIqNS:
t.
TOTAt,OF PART Ii-ENTER TOTAL NON•fAXABLE pISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEEL E
If more space is needed,use additional sheets of paper of the same size.
.. ¢
,.�'m',
JAN L. BROWN & ASSOCIATES
ATTORNEYS AND COUNSELORS AT LAW
IAN L. BROWN,ESQUIRE BRENDAF. KEPHART,LEGALASSISTANT
]ACQUELINE A. KELLY,ESQUIRE IUDITH A. EBERSOLE,ADMMIST0.AT1 VE ASSISTANT
CHRISTA M. APLIN.ESQUIRE MELISSA L. SMITH,LEGALASSISTANT
June 28, 2013 � �; �
C w S R1
� � L_ � �
Register of Wills rn -c �_ —
Dauphin County Courthouse � n ,-�-' �; c`
101 Market Street, Room 103 Z � � ''' �� � �
• x cc>
Hazrisburg,PA 17101 0 � � � _,� �r�
o c '
Re: Estate of Harry R. Barlow, deceased � � N � r".-,
D� F-��-� N '�*1
Gentlemen or Ladies:
Enclosed please find the following items for filing with the Register of Wills:
1. An original and two copies of the Inheritance Tax Return.
2. Check payable to Register of Wills, Agent in the amount of$13,239.52 representing the
inheritance taY liability shown to be due.
3. Check payable to Register of Wills in the amount of$35.00 representing the filing fee for
the Inheritance Taac Return.
Please time stamp and return our file copy of the Inheritance Tax Return. Also, please
provide us with the appropriate receipt.
If you have any questions, feel free to contact this office.
Sincerely,
�/�l�� /
acqu ine A. Kelly
JAK/mis
Enclosures
cc: Dennis K. Monighan
Olde English Gap • 845 Sir Thomas Court • Suite 12 • Harrisburg, PA 17109
Telephone(717)541-5550 • Fax(717)541-9223 • Email:jlbassoc@verizon.net • www.janbrownlaw.com
JAN L. BROWN BL ASSOCIATES
ATTORNEYS AND COUNSELORS AT LAW
.TAN L. BROWN,ESQNftE BRENDAF. KEPHART,LEGALASSISTANT
JACQUF.LINE A. KELLY.ESQUIRE IUDITH A. EBERSOLE,ADMINISTRATI VE ASSISTANT
CHRISTA M. APLIN,ESQUIRE MELISSA L. SMITH,LEGALASSISTANT
July 2, 2013
Register of Wills
Attn: Diane
Cumberland County Courthouse
One Courthouse Square
Cazlisle, PA 17013
Re: Estate of Harry R. Barlow, deceased
Deaz Diane:
Enclosed please find a check payable to Register of WiRs in th�amount d€$15�0�;
representing the filing fee far the Inheritance Taac Return. � � � _, �,
� � c_ ,;a r,
Please return the check in the amount of$35 to our office withipinz��ies�of ther:;, ��
Inheritance Tax Return and appropriate receipts. Thank you. rv N ^, �^' a Y?
z �`` —o -+'� -,,
If you have any questions, feel free to contact this office. ° " ° � `= '
o -,-, _. c�
c� c r-' r=. m
Sincerely, �� � � U' -�n
v
��� a �i �
Jacqueline A. Kelly
JAK/mis
Enclosure
cc: Dennis K. Monighan
Olde English Gap • 845 Sir T'homas Court • Suite 12 • Harrisburg,PA 17109
Telephone(717)54t-5550 • Fax(717)541-9223 • Email:jlbassoc@verizon.net • www.janbrownlaw.com
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$1.72 08250007824167
US POSTAGE flRSi-CtAfiS tdAil FROM 17109
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USPS F1RST CLASS MAI�O
JAN L. BROWN
845 81R THOMAS COURT,SUITE'!2
HARRISBURG PA 17109
SHIP Register of Wills
ro: Cumberland Coun#y Courthouse
1 Court House Square
Carlisie PA 17013-3323
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