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HomeMy WebLinkAbout06-07-13 REV-1500 EX(02-111 1505610143 ti OFFICIAL USE ONLY Department of Revenue pennsylvania County Code year File Number Bureau of Individual Taxes ^e^^^*•Fa*o<REVENUE PO BOX.280601 INHERITANCE TAX RETURN 21 12 1061 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW 05 06 2012 08 01 1920 Decedent's Last Name Suffix Decedent's First Name MI PENNER ESTHER K (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI PENNER SR. LLOYD E Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 0 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 death after 12-12-82) ❑ 5. Federal Estate Tax Return Required 8 Decedent Died Testate 7 Decedent Maint fined a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) ❑ (Attach Copy of Trust) P ❑ 9. Litigation Proceeds Received ❑ 10.Sppousal Poverty Creditl(Data of Death 11.Election to to der G� 3 A b9hvean 12-31-17 and -1-95) ❑ ��ttpp y' t ) C7 (Attach Schl 0) m n C CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX WFORMATIOIRSHOE;l DIRECTED TO: Name DA'qT&ph cl NumlyePl JAMES D HUGHES ESQ '4',&9 -63 0 a Cn o 0 RMVEMOF Il USEZJLY First Line of Address 354 ALEXANDER SPRING RO y cNf1 Second Line of Address City or Post Office DATE FILED State ZIP Code CARLISLE PA 17015 Correspondent's e-mail address: jhughes @salzmannhughes.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 OF PERS2k5SPONSIBLE FOR FILING RETURN DATE Lloyd E. Penner,Jr. ADDRESS 1 Moore n ve. o Holly S rin s PA 17065 SIGNATUR FP PARER HE EPRESENTATIVE DATE James D. Hughes Esq. �3 ADDR s 3 4 Alexander pring Road, Suite 1, Carlisle, PA 17015 Side 1 1505610143 1505610143 1505610243 REV-1500 EX RECAPITULATION 1. Real Estate(Schedule A)............................................................ 2. Stocks and Bonds(Schedule B)............................................................................. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C)......... 3. 4. Mortgages&Notes Receivable(Schedule D).. - .. - . . ............................. 4. 5. Cash, Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 17 , 141 . 20 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers&Miscellaneous Probate Property (Schedule G) a Separate Billing Requested............ 7, 8. Total Gross Assets (total Lines 1 through 7)........................................................ 8. 17 , 141 . 20 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 5 , 786 . 66 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 40 , 043 . 01 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 45 , 829 . 67 12. Net Value of Estate(Line 8 minus Line 11)... - - - ....... 12. -28 , 688 . 47 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. -28 , 688 . 47 TAX COMPUTATION-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.00 0 . 00 15. 0 . 00 16. Amount of Line 14 taxable 0 . 00 16. 0 . 00 at lineal rate X .045 17. Amount of Line 14 taxable at sibling rate X.12 0 . 00 17. 0 . 00 18. Amount of Line 14 taxable at collateral rate X.15 0 . 00 18. 0 . 00 19. TAX DUE................................................................................................................ 19. 0 . 00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 L 1505610243 1505610243 J REV-1500 EX Page 3 File Number 21-12-1061 Decedent's Complete Address: DECEDENT'S NAME Penner, Esther K. STREET ADDRESS 1000 S. 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 0.00 Total Credits(A +B) (2) 0.00 3. Interest (3) 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2,Line 20 to request a refund —� 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. _ 7, 11 ' ,r ,. � ., i • .. s c:, .. +/ .. �....:_- . 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.............. -.........................................................................-............__. ❑ d. receive the promise for life of either payments,benefits or care?............................................................ ❑ ❑x 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receivingadequate consideration?..._.................................._._......_...........................-................_.._.............. ❑ 0 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?,...-......._................-....................__..................... .............. ❑ 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[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after January 1, 1995,the tax rate imposed on the net value of transfers to or for the use of 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 adaptive 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 P.S.§9116(a)(1)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-1608 EX-(11-10) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & Misc. DEPARTMENT OF REVENUE INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Penner, Esther K. 21-12-1061 hedude the proceeds of iiNgahon and the date the Proceeds were received by the estate. All property Joirdlyrowned with the right of survivon:hip must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH I 1 Mass Mutual -final pension check 67.49 2 The Prudential Insurance Company of America,Life Insurance Contract No.80 862 689- 9,270.90 cash surrender value submitted prior to date of death 3 The Prudential Insurance Company of America, Life Insurance Contract No.17 017 135- 2,624.48 cash surrender value submitted prior to date of death 4 M&T Bank, Free Checking Account No.9856466967 4,971.93 5 Capital Blue Cross-refund of unearned premium 206.40 TOTAL(Also enter on Line 5,Recapitulation) 17,14110 (if more space is needed,additional pages of the same Size) Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev. 11.10) REV4511 Ex.(10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERI TANCE TAX RE RESIDENT DEC ENTTURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Penner, Esther K. 21-12-1061 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Lloyd E. Penner,Jr. Street Address 1 Mooreland Ave. City Mount Holly Springs state PA zip 17065 Year(s)Commission Paid u 850.00 2_ Attorney's Fees Salzmann Hughes, P.G. 1,000.00 3, Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) 3,500.00 Claimant Lloyd E. Penner,Sr. Street Address 1000 S. Street City Carlisle state PA zip 17013 Relationshio of Claimant to Decedent Spouse 4. Probate Fees 111.50 5, Accountant's Fees 6. Tax Return Preparers Fees 7. Other Administrative Costs 32516 See continuation schedule(s)attached TOTAL(Also enter on line 9, Recapitulation) 5,786.66 Copyright(c)2009 form software only The Lackner Group, Inc. Form PA•1500 Schedule H(Rev. 10-09) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Penner, Esther K. 21-12-1061 ITEM NUMBER DESCRIPTION AMOUNT Other Administrative Costs 1 Cumberland Law Journal-probate expenses Legal advertising 75.00 2 Patricia A. Rosendale,CPA-preparation of 1099 tax form for the executor 20.00 3 Register of Wills -filing fees 30.00 4 The Sentinel-Legal advertising 20016 H-B7 325.16 Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98) Rev-1512 EX.(12-08) SCHEDULE i pennsylvania DEBTS OF DECEDENT, DEPARTMENT OF REVENUE MHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Penner, Esther K. 21-12-1061 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbumed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Binger&Sons-lawn mowing service, check written prior to death and cleared after death 100.00 2 Pennsylvania Department of Public Welfare-incurred during the last six months of the 32,063.56 decedent's life; a Class 3 claim 3 Pennsylvania Department of Public Welfare-balance of claim entered as a priority Class 5.1 7,879.45 claim TOTAL(Also enter on Line 10, Recapitulation) 40,043.01 (If more space is needed,additional pages of the same size) Copyright(c)2008 form software only The Lackner Group,Inc. Form PA-1500 Schedule I(Rev. 12-08) REV-1513 EX.(0140) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Penner, Esther K. 21-12-1061 NUMBER NAME AND ADDRESS OF DECEDENT RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE PERSON(S)RECEIVING PROPERTY s stee (Words) ($$$) I TAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.91 16 a 1.2 1 Lloyd E. Penner,Sr. Husband Entire Estate 1000 S.Street Carlisle, PA 17013 Total Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as approp riate. NON-TAXABLE DISTRIBUTIONS: II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev. 01-10) WILL OF ESTHER K. PENNER I, Esther K. Penner, of Cumberland County, Carlisle, Pennsylvania, declare this to be my last Will and hereby revoke all prior Wills and Codicils. 1. I direct that all my just debts, funeral expenses, gravemarker and administrative expenses shall be paid from my residuary estate as soon as practicable after my death. 2. 1 direct that all inheritance, estate, transfer, succession and death taxes of any kind whatsoever which may be payable by reason of my death shall be paid out of my residuary estate. 3. 1 direct that my entire estate be distributed as f C@Rus Fn m c QD-0 M f A. I direct that my entire estate go to my huakt,, lv Lloyd E. Penner, Sr. C'S 'I B. Should my husband predecease me, I di- c` hat IF- my entire estate go to my children, Dorot 'P. N BCD Morrison, Marjorie P. Burkhart and Lloyd E. Penner, Jr., in equal shares. C. Should any of my children predecease me their share shall lapse and be divided into equal shares between their children. 4. 1 appoint Lloyd E. Penner, Jr., as Executor of this my last Will. Should Lloyd E. Penner, Jr., predecease me or cease to act in such capacity, I appoint Dorothy P. Morrison and Marjorie P. Burkhart, jointly, as alternates. 5. The Executor of this Will shall have the power to distribute my estate in kind or in cash, or partly in either. 6. 1 direct that no Executor acting under this Will shall be required to enter bond in any jurisdiction. IN WITNESS WHERE097 I have hereunto set my hand this l day of 2009. LAW OFFICES OF 'EPHEN J. HOGG Esther Penner 3 S. HANOVER STREET SUITE 101 CARLISLE,PA 17013 The preceding instrument consisting of this and one other page was on the day and date hereof signed, published and declared by Esther K. Penner as and for her last Will in the presence of us, who at her request, in her presence and in the presence of each other have subscribed our names as witnesses hereto. WITNESS. Wi NES LAW OFFICES OF rEPHEN J. HOGG 9 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 ACKNOWLEDGMENT State of Pennsylvania ss County of Cumberland I, Esther K. Penner, the 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 as my free and voluntary act for the purposes therein expressed. Esther K. Penner Sworn to or affirmed a d acknowledge e re me b>y tIn er K. Penner, the Testatrix, this day of �? E'? 2009, 1 >rrul u , 'Notary Public/Attorney - = AFFIDAVIT State of Pennsylvania ss County of Cumberland �) / We, c�t r01 S t vLS and the witnesses whose n mes are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the instrument as her last Will; that the Testatrix signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testatrix signed the Will as a witness; 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 pr undue influence. worn to or affir eland subscrjbed to before me by witnesses, this day of � '� 2'P9. G � LAW OFFICES OF y ' Notary P _ is/Attorney "7 Notary J. HOGG ! >, ? .9S.HANOVERSTREET >-!3r�`)3) SUITE 101 CARLISLE, PA 17013 �- © M&T Bank 499 Mitchell Street, Millsboro, DE 19966 October 9, 2012 Salzmann Hughes,P.C. Attorneys at Law 354 Alexander Spring Road Suite 1 Carlisle, PA 17015 RE: Estate of Esther Penner Date of Death: May 6, 2012 Social Security Number: 205-07-0200 Dear Mr. Hughes: In response to your request, please be advised that at the time of death, the above- named decedent had on deposit with this bank the following accounts. 1. Account Type........................... Checking Account Account Number....................... 723797 Ownership(Names oj).............. Esther Penner, Lloyd Penner Opening Date...........................09/01/67 (account closed 05/31/12) Balance on Date of Death.........$0.00 Accrued Interest $ 0.00 Total.......................................$0.00 2. Account Type........................... Checking Account Account Number....................... 9856466967 Ownerslnp(Names ofl.............. Esther Penner Opening Date...........................l l/14/11 (account closed 09/28/2012) Balance on Date of Death.........$4,971 .93 Accrued Interest $ 0.00 Total.......................................$4,971 .93 • Page 2 October 9, 2012 The above named decedent did not have a safe deposit box. * If upon reviewing the information above, you believe there are additional accounts not referenced, please provide us with an account number and/or the name of any possible joint account holder. For any additional information on the above accounts, including ownership and any changes, closures and/or reimbursement of funds, please contact our High Street Carlisle branch at 1 West Carlisle Street, Carlisle, PA 17013 or N 717- 240-4536. Sincerely, Charlene Warrington, Adjustment Services 1-888-502-4349 ± , pennsylvania DEPARTMENT OF PUBLIC WELFARE August 16, 2012 SALZMANN HUGHES PC JAMES D HUGHES ESQUIRE STE 1 354 ALEXANDER SPRING RD CARLISLE PA 17015 Re: Esther Penner CIS #: 038078858 SSN: ###-##-0200 Date of Death: 05/06/2012 Dear Mr. Hughes: Please be advised that the Department of Public Welfare maintains a claim in the amount of $39.943.01 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 $32,063.56, 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 $7.879.45, 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. / S, cerely� �/ Nicole L. Lipscomb TPL Program Investigator 717-772-6606 717-772-6553 FAX Enclosure Bureau of Program Integrity I Division of Third Party Liability I Recovery Section PO Box 8486 1 Harrisburg, Pennsylvania 17105-8486