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Home My WebLink About08-12-13 � ��I��.. t 1 1 3 1,50561,01,�5 � ��y��(1(� EX{02-11){FI) V� t3FFIGIAL USE aNLY PA De artment of Revenue p�nnsylvania P OEPARTMENTOFREVENUE County Code Year File Number Bureau of Individual Taxes �(`]HERITANGE TAK RETURN �� 0�.,.�J /`-�- PO BOX 280601 + t�a r r i s b u r�,P A 1 7 1 2 8-0 6 0 1 R E S I D E N T D E C E D E N T ! ENTER DECEDENT INFORMATION BELOW Socia!Securi#y Number Date of Death MMDDYYYY Date of Birkh MMDDYYYY 051?201,1, 061],1925 Decedent's Last Name Suffix Decedent's First Name MI FOX EVA S , (If Appticable}Ente�Surviving Spouse's Information Below Spouse's Last Name SufFix Spause's First Name MI { , a Spause's Saciaf Security Number TH1S RETURN MUST BE FI�ED IN DUPLICATE WITH THE REGISTER OF WILLS FI�I.IN APPR{3PRIATE BC.�XES BE�C}W � 1. Original Return Q 2. Supplemental Return Q 3. Remainder Return(Date af Death � Peiar to 12-13-82) , Q 4. Limited Estate Q 4a. Future Interest Compromise(date of � 5. Federal Estate Tax Return Required desth after 12-12-82} ' Q 6. Decedent Died Testate Q 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes � {Attaah Copy of Vttll} (Attach Capy af Trust.} � Q 9. Litigation Proceeds Received Q 10. Spousal Poverty Credi#(Date of Death Q 11. Election to Tax under Sec.9113(A) ; Between 12-31-91 and 1-1-95} {Attach Schedule O} , � C4RRESPONDENS-THIS SECTION MUST BE COMP�ETED.ALL CORitESPONDENCE AND CONFIDENTIAI TAX INF4RMATIQN SHOU�E}B E DIRECTED T4: � � Name Daytime Tele�ane Number c::_,., f � � � � � GALEN M. MARTIN 71?-86�.�1,�C ,.�.� r� � � �� REG1 �F�ILLS QSf C3Nt� � � � ;� �r..M �.,� �e� �'� ; �, � :,,,,3 ..�4.x f�� 5 First Line of Address � =� � � ; � �r��, � �m� � a ?2], E LINCQ�N AVE � ��.. �'� `� �- �"� � Second Line of Address ` "� —� �°°= �� , �� 4 a Y^^�++ :� � � �� s � City or Post Office St��@ ZIP COd£'. DATE FILED p � �1YERSTOWN PA 17067 � Carrespandent's e-mait address: G A L E N a�CI A C C T.C 0�1 � Under penalties af perjury,I declare that 1 have examined this return,inGuding accompanying schedules and statements,and to the best of my knowledge and beliet, � it is true correct and com lete.Decla�ation of re arer ther than the ersonaf re resentative is based on all information af which re arer has an knowled e. � � SIGNATURE RESPONSI ETURN DATE � — �"'" � � RESS ? 721, E LINCOLN AVE, MYERSTOWN., PA 17067 � ..._� , �,�.� � SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ; ADDRESS 9 ` PLEASE USE 4RIGiNAL F4RM tJNLY � = Side 1 z ; , � �„� 150561,D1,�5 1,50561,�1�05 � � � � � i � 1505610205 � REV-1500 EX(FI) Decedent's Social Security Number DecedenYs Name: E V A S F 0 X RECAPITULATION 1. Real Estate(Schedule A). ... . . .. . . . . .. ... . ... ....... .. .. ... . ... . . . 1. N 0 N E >; 2. Stocks and Bonds(Schedule B). .. . . . . . . ... . .. . . . .. .... . .. ... ... . ... 2. N 0 N E 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C). .. 3. N O N E ; 4. Mortgages and Notes Receivable(Schedule D). . . . .. . .. . . .. .. . .. . . . . . . . 4. N 0 N E 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). . . .. 5. 12 9 9 9 . �� ' 6. Jointly Owned Property(Schedule F) 0 Separate Billing Requested.. . .. . . 6. N 0 N E ;, 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property : (Schedule G) 0 Separate Billing Requested. ... . . . 7. N 0 N E � 8. Total Gross Assets(total�ines 1 through 7). .. . .. ....... .. ... .. . . ... . 8. 12 9 9 9 . 0 0 ' 9. Funeral Expenses and Administrative Costs(Schedule H). . . . .. ... ... ... . . 9. 10�0 . 0 0 :� 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I). .. . .. . ... . ..10. N O N E ; 11.T otal Deductions(total Lines 9 and 10).. . . .. . .. . .. .. .. ... .. ... . .. . . . 11. 1,0 0 0 . �0 '_' 12.Net Value of Estate(�ine 8 minus�ine 11). ... ... .... ... .. ... .. . . ... . .12. 119 9 9 . 0 0 !? 13.Charitabl e and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J).. .. .. ... .. .. . . ... . ... 13. � . 0 0 � 14 Net Value Subject to Tax(Line 12 minus Line 13). ... .. .. .. . .. . . . . ... . .14. 119 9 9 . 0 0 `� 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 0 1 5. 0 . 0 0 ; 16. Amount of Line 14 taxable at�inea�rate x.0 4 5 119 9 9 . 0 0 �6. 5 3 9 . 9 6 t 17. Amount of Line 14 ' taxable at sibling rate X . 12 17. 0 . 0 0 18. Amount of Line 14 taxable at collateral rate X . 15 18. 0 . 0 0 ; 19. TAXDUE..... ... . .. . . . . . . . . . . . . . .. . . . . .. . .. . .. .. .. .. . . . . . .. . . .. . 19. 539 . 96 , '{ ; 20.FI LL IN THE BOX F YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0 ; � s , 3 Side 2 � 1505610205 1505610205 � � ti r REV-1500 EX(FI) Page 3 File Number 161-30-5251 Decedent's Complete Address: 21-11-1252 DECEDENTS NAME EVA S FOX STREET ADDRESS 2033 RITNER HIGHWAY CITY STATE ZIP SHIPPENSBURG PA 17257 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 539.96 2. Credits/Payments A.Prior Payments B.Discount Total Credits(A+B) (2) 0.00 3. Interest (3) 23.86 4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT. Fill in box 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) 563.82 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......................................................................................... ❑ X❑ b. retain the right to designate who shall use the property transferred or its income............................................ � X❑ c. retain a reversionary interest............................................................................................................................. ❑ 0 d. receive the promise for life of either payments,benefits or care?..................................................................... ❑ XQ 2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death without receiving adequate consideration?............................................................................................................. ❑ � 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?........................................................................................................................ ❑ � 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 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 sunriving 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 decedent's lineal beneficiaries is 4.5 percent,except as noted in[72 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. 1 � REV-1508EX+(08-12) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OFREVENUE P E RS O N A L P RO P E RTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: 21-11-1252 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. EPHRATA NATIONAL BANK TIME DEPOSIT#768116 12,999 TOTAL(Also enter on line 5, Recapitulation) $ 12,999 If more space is needed, use additional sheets of paper of the same size. � . REV-1511 EX+(10-09) pennsylvania SCHEDU LE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND R SIDENT DEC DENTTURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER 21-11-1252 Decedent's debts must be reported on Schedule i. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: 2. Attorney Fees: 3. Family Exemption:(If decedenYs address is not the same as claimanYs,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 5. Accountant Fees: 1,000 6. Tax Return Preparer Fees: 7. TOTAL(Also enter on Line 9, Recapitulation) $ 1,000 If more space is needed,use additional sheets of paper of the same size. � . REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: 21-11-1252 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE � TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under Sec.9116(a)(1.2).] � SEE DETAIL ATTACHED 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. i a I � � � TOTAL OF PART II—ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ � 0.00 If more space is needed,use additional sheets of paper of the same size. ; ; l • Schedule J — Beneficiaries Estate of Eva S. Fox SSN: 161-30-5251 Name Relationship Share l. Walter Fox Son 1/1 lth 1104 Briggs Spicer Rd, Himrod,NY 14842 2. John David Fox S on 1/11 tn 408 Hill Rd, Denver, PA 17517 3. Aaxon Fox Son 1/11 tn 14336 Savannah-Spring Lake Rd, Savannah,NY 13146 4. Elizabeth Zimmerman Daughter 1/11 th 3086 Rte 414, Clyde,NY 14433 5. Susan Martin Daughter 1/11 tn 64756 Cty Rd 3, Wakarusa, IN 46573 6. Lydia Shirk Daughter 1/11 th 2033 Ritner Hwy, Shippensburg, PA 17257 7. Mary Ella Martin Daughter 1/11 tn 509 Reidenbach Rd,New Holland, PA 17557 8. Eva Jane Horst Daughter 1/11�' 1743 Himrod Rd, Penn Yan,NY 14527 9. Weaver Fox Son 1/11 tn 622 Chestnut Hill Rd, Denver, PA 17517 10. Verna Nolt Daughter 1/1 ltn W4634 Willow Rd, Owen, WI 54460 11. Ervin Fox Son 1/1 ltn 1026 Steffy Rd, Stevens, PA 17578 , . � Ephrata National B ank August 2,2013 Galen Martin Martin Accounting Services 721 East Lincoln Avenue Myerstown,PA 17067 c�ear�Jlr.��+latti�, In response to your inquiry concerning deposit accounts of the decedent named below,Ephrata National Bank is providing the following information as of the date of death. If any changes were made to the decedent's accounts between the date of death and the date your letter was received,additional information may be required. If you have any questions,piease contact the Deposit Services Department at(717)733-4181. Name: Eva S.Fox Social Security Number: 161-30-5251 Date of Death: 5/17/11 Age: 85 As of date of death,5/17/11,Eva S.Fox, Decedent,had the following personal accounts/balances with Ephrata National Bank: Time Deposit Account#768116,opened 8/15/03 Registration: Eva 5.Fox,Individual Owner Balance: $12,998.51 YTD Interest: $265.31 Accrued Interest: $4.47 Interest Rate: 4.1896 Ephrata National Bank has no record of a Safe Deposit Box registered in the personal name of Eva S.Fox. Weaver S. Fox was added as POA on 4/26/04. Sincerely, Mark Thompson Deposit Services www.epnb.com