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HomeMy WebLinkAbout06-27-13 . y � 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 Harrisbur4, PA 17128-0601 RESIDENT DECEDENT 2 � � � � � 5 6 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth nnMDDYYYY 1 2 2 8 2 0 1 1 0 6 0 7 1 9 2 8 DecedenYs Last Name Suffix DecedenYs First Name M� C L A R K D E A N E p (If Applicabie)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 � 1.Original Return � 2.Supplemental Return � 3. Remainder Return(date of death prior to 12-13-82) � 4. Limited Estate � 4a. Future Interest Compromise(date of � 5. Federal Estate Tax Return Required death after 12-12-82) � 6. Decedent Died Testate � 7.Decedent Maintained a Living Trust 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 T0: Name Daytime Telephone Number R . MARK THOMAS , ESQUI RE 71 7 7 :�,6 2� 00 -� ��, CR�f'qISTER OF,WILLS�I���LY i - _._ G7 � .!> First line of address �'� �':� `-� - '" 7a ,-,� r-° rv ; �"�t 1 0 1 S OUTH MA RK ET ST REET � �:�� -�-; � ` � ' �� ,, � �'. ., 4 Second line of address w� r-, ,- �? � •. � , �. ' �,; c_1 � . —� °,..> <� �- - ►--- �.� City or Post O�ce State ZIP Code � --4 DAT �jLeo` ,y c� z MECHANI CSBURG PA 1 70 55 �� � CorrespondenYs e-mail address: RMARKTHOMASna,GMAILCOM Under penalties of peryury,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. SIGNAT,!?�EQF PE�N ONSI LE FOF;/FILING RETURN y� /fi'F:vt � �o%�S'/� ADDRESS 417 L EY STREET MECHANICSBURG PA 17055 SIGNATU ARE T N REPRESENTATIVE DATE�� �D _ ADDRESS J 101 SOUTH MARKET STREET MECHANICSBURG PA 17055 PLEASE USE ORIGINAL FORM ONLY Side 1 � 1505610140 1505610140 J ' � � 1505610240 REV-1500 EX . DecedenYs Social Security Number DecedenYs Name: DEANE D. CLARK RECAPITULATION 1. Reai Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. • 2. Stocks and Bonds(Schedule B) 2. 3 6 4 6 � � � 3 . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . 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. • 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. • 7. Inter-Vivos Transfers&Miscellaneous N n-Probate Property (Schedule G) � Separate Billing Requested . . . . . . . 7. . 8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 3 6 4 6 0 , 0 3 9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9• 6 2 � . 9 7 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule I) . . . . . . . . . . . . . 10. • ��. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. G Z � . 9 7 12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12• 3 5 8 3 $ . 0 6 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. 3 5 8 3 $ . � 6 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_ � . 0 O 1g. O . Q Q 17. Amount of Line 14 taxable at sibling rate X.12 � . 0 � 17. � . � 0 18. Amount of Line 14 taxable at co��atera�rate X.15 3 5 8 3 8 . 0 6 �8. 5 3 7 5 . 7 1 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . 19. r'J 3 7 5 . 7 1 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT � Side 2 � 1505610240 1505610240 � � REV-1�00 EX Page 3 File Number ►�eceder�t's Comple#e Adslres�: 2� 1�. 0056 DECEDENT'S NAME DEANE D. CLARK STREETADDRESS 2912 MERION ROAD CITY STATE � ZIP CAMP HILL ' PA ' 17011 Tax Payments and Credits: 1� Tax Due(Page 2,Line 19) (1) 5,375.71 2. Credits/Payments A.Prior Payments B.Discount Total Credits(A+g) �2� 0.00 3. Interest 4. If�ine 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT. �3� 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) 5,375.71 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: ...................................................................... ❑ XQ b. retain the right to designate who shall use the property transferred or its income; ............................... ❑ XQ c. retain a reversionary interest�or ................................................................................................ ❑ 0 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? ....................................................................................... ❑ Q 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?.................................................................................................. ❑ 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 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 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 decedenYs lineal beneficiaries is 4.5 percent,except as noted in 72 P.S.§9116(1.2j[72 P.S.§9116(a)(1)], • The tax rate imposed on the net value of transfers to or for the use of the decedenYs siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is defined, undE Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. REV-1�03 EX+(8-12) I pennsyivania SCHEDULE B DEPARTMENT OF REVENUE INHERITANCETAXRETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF FILE NUMBER DEANE D. CLARK 21 1 0056 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. AMERICAN BUSINESS FINANCIAL SERVICES, INC-(SEE EXHIBIT"A") 7,275.39 ACCOUNT#151773858 2. AMERICAN BUSINESS FINANCIAL SERVICES, INC-(SEE EXHIBIT"A") 17,096.54 ACCOU NT#151773920 3. AMERICAN BUSINESS FINANCIAL SERVICES, INC-(SEE EXHIBIT"A") 6,579.00 ACCOUNT#151774005 4. AMERICAN BUSINESS FINANCIAL SERVICES, INC-(SEE EXHIBIT"A") 5,509.10 ACCOUNT#151619980 TOTAL(Also enter on Line 2,Recapitulation) $ 36 460.03 If more space is needed, insert additional sheets of the same size � REV-1511 EX+(�0-09) pennsyivania � �CHEDUL.E �-i DEPARTMENTOFREVENUE FUNERAL EXPENSES AND INHERITANCETAXRETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER DEANE D. CLARK 21 1� 0056 DecedenYs debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTR,4TIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address ���Y State ZIP Year(s)Commission Paid: 2, ,4ttomey Fees: R. MARK THOMAS, ESQUIRE 621.97 3. Family Exemp6on:(If decedenYs address is not the same as claimanYs,attach explanation.) Ciaimant Street Address City State ZIP Relationship of Claimant to Decedent 4• Probate Fees: 5 Accountant Fees: 6. Tax Retum Preparer Fees: 7. TOTAL(Also enter on Line 9,Recapitulation) $ 621.97 If more space is needed,use additional sheets of paper of the same size. ,REV-15�13 EX+(Ot-10) I pennsyivania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: DEANE D. CLARK 21 1'L 0056 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 [Inciude outright spousai distributions and Vansfers under Sec.9116(a)(1.2).] 1. ROBERT D. BRILLHART Coilateral 100.00 417 VALLEY STREET Residuary Estate MECHANICSBURG, PA 17055 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. II. 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 II-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. FROM: LAW DEBENTURE TRUST COMPANY OF NEW YORK and 53969 WELLS FARGO BANK, NATIONAL ASSOCIATION, as INDENTURE TRUSTEES AMERICAN BUSINESS FINANCIAL SERVICES, INC. SENIOR COLLATERALIZED SUBORDINATED NOTES REVISED ACCOUNT INFORMATION STATEMENT AS OF DISTRIBUTION RECORD DATE OF OCTOBER 15, 2011 YOUR ACCOUNT INFORMATION STATEMENT HAS BEEN REVISED TO REFLECT AN INCREASE IN YOUR DISTRIBUTION AMOUNT DUE TO ADDITIONAL FUNDS RECEIVED BY THE INDENTURE TRUSTEES FOR DISTRIBUTION TO ACCOUNT HOLDERS. THE ENCLOSED CHECK(S) INCLUDES THIS INCREASE IN YOUR DISTRIBUTION. ESTATE OF DEANE D.CLARK ROBERT D.BRILLHART,EXECUTOR 417 VALLEY STREET MECHANICSBURG,PA 17055 Account EPIQ ID Indenture Trustee Principal Interest Total Principal Distribution Number Number Amount as of Amount as of and Interest as Amount 1/21/2005 1/21/2005 ofi/21/2005 151773858 53969 Law Debenture Trust $32,750.00 $319.95 $33,069.95 $7,275.39 Company of New York 151773920 53970 Law Debenture Trust $76,750.00 $961.54 $77,711.54 $17,096.54 Company of New York 151774005 53971 Law Debenture Trust $29,698.30 $206.26 $29,904.56 $6,579.00 Com an of New York Total: 3 $139,198.30 $1,487.75 $140,686.05 $30,950.93 Account EPIQ ID indenture Trustee Principal Interest Total Principal Distribution Number Number Amount as of Amount as of and Interest as Amount 1/21/2005 1/21/2005 ofl/21/2005 151619980 57747 Welis Fargo Bank, $30,000.00 $269.78 $30,269.78 $5,509.10 National Association Total: 1 $30,000.00 $269.78 $30,269.78 $5,509.10 �XY1�� I � '`� t( STATEMENT R. MARK THOMAS Attorney at Law 101 S.Mazket Street Mechanicsburg,PA 17055 DATE June 11, 2013 717-796-2100 fax 717-796-3600 CUSTOMER ID ESTATE OF DEANE D.CLARK B���TO: BOB BRILLHART 417 Valley Street Mechanicsburg, PA 17055 DATE DESCRIPTION Hours Rate AMOUNT $200 2/25/13 letter to Register of Wills-Short Certificate 0.15 2/28/13 Pick up Short Certificate-Courthouse 0.20 3/18/13 Review of Epiq B.R. Solutions Forms 0.75 Dictate Letter to Epiq 0.25 5/2013 P/C to dinet N/C 6/11/13 review file in preparation for meeting with client 0.60 6/11/13 meeting with dient 0.50 6/12/13 Prepped Amended/Supplemental Retum 0.60 Total Hours 3.05 $ 610.00 1 -Short Certificate $ 5.00 Mailing to Epiq-Certified Mail ft Return receipt $ 6.97 1-30 DAYS 31-60 DAYS 61-90 DAYS OVER90 DAYS NRRENT PAST DUE PAST DUE PAST DUE PAST DUE AMOUNT DOE $621.97 $621.97 ---------------------------------------------------------• REMITTANCE Statement� ESTATE OF DEANE D. CLARK �are 6/11/2013 ,4mount�ue $621.97 Amount Endosed Make all checks payable to R. MARK THOMAS Thank you.