HomeMy WebLinkAbout08-26-13 J 1505610143
REV-1500 EX�o2_„>
OFFICIAL USE ONLY
PA Department of Revenue pennsylvania County Code Year File Number
Bureau of Individual Taxes �P�TMENTOFREVENUE
Po Box.2aoso� INHERITANCE TAX RETURN 21 12 0052
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
164 60 0721 12 20 2011 07 09 1967
DecedenYs Last Name Suffix DecedenYs First Name MI
SPITZER IAN C
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Sociai 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
Priorto 12-13-82)
� 4. Limited Estate � 4a.Future Interesc Compromise � 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
� 6 Decedent Died Testate � �� (AttacheCo aof Trusd a Living Trust � 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) PY �
� 9. Litigation Proceeds Received � ���between PZ 31�J1 a dit�Da95�f Death � ��.Election to tax under Sec.9113(A)
(Attach Schedule O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
NEIL W YAHN �17 533:_3280,.,,,
�_�� ��'S �=��
�dISTER QF VI/ILL'S,USE ONLY
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First Line of Address --�- ;-;°� ,;�.
PO BOX 650 " ���
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c�. -r'a ;
Second Line of Address r-- f —�'
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DA�FIL@D `=�
City or Post Office State ZIP Code
HERSHEY PA 17033
Correspondent's e-mail address: nWY�1SdC.001'Tl
Under penalties of perjury,I declare that I have examined this retum,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,co ect and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNA UR OF PERSON R PO IBLE FOR FIIING RET DATE
' Gretchen L.S itzer 1
765 Vi a Dri am HiII�A 17011
SIGNATURE 0 PRE ER THER THAN REPRESENTATIVE DATE
Neil W.Yahn Esq. � � ,z � ,�
ADDRESS
134 Si e enued-I rshe �A 17033
Side 1
L 1505610143 1505610143 J
� 1505610243
REV-1500 EX
DecedenYs Social Security Number
Decedent'sName: SpItZ@r� lan C. 164 60 �721
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... 1. 1 H O , �0 0 . ��
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. 63, 484 . 14
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 111 . 73
7. Inter-Vivos Transfers&Miscellaneous I�nn;Probate Property
(Schedule G) U Separate Billing Requested............ 7.
g. Total Gross Assets(total Lines 1 through 7)........................................................ g. 243,595 . 87
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 2 8 ,2 4 9. 3 8
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................ 10. 17 4 , 9�1 . 63
11. Total Deductions(total Lines 9 and 10)................................................................ ��. Z O 3, 151 . �1
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 4O , 444 . 8 6
�3, 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. 4 O,4 4 4 . 8 6
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 15. 0 . 0 0
16. AmountofLine14taxable 40 , 444 . 86 16. 1 , 82� . �2
at lineal rate X .045
17. Amount of Line 14 taxable
at sibling rate X.12 0 . �� 17. � . ��
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 0� 18. � . �0
19. TAX DUE................................................................................................................ 19. 1 , 820 . �2
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. �
Side 2
L 1505610243 1505610243 �
REV-1500 EX Page 3 File Number 21-12-0052
Decedent's Complete Address:
DECEDENT'S NAME
Spitzer, lan C.
STREET ADDRESS
2210 Dickinson Avenue
C�N STATE ZIP
Camp Hill PA 17011
Tax Payments and Credits:
1. Tax Due(Page 2, Line 19) (1) 1,820.02
2. Credits/Payments
A. Prior Payments 8,100.00
B. Discount 0.00
Total Credits(A +g) (2) 8,100.00
3. Interest (3)
4, If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) 6,279.98
Check box on Page 2�ine 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)
Make Check Pa able 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;or............................................................................................................... ❑ ❑x
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
receiving adequate consideration?.................................................................................................................... ❑ ❑x
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 YESCJYOU 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 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(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 under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
Rev-1502 EX+(01-10)
SCHEDULE A
pennsylvania REAL ESTATE
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
S itzer, lan C. 21-12-0052
All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is d�ned as the price at which property would be
exchanged belween a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts.
Real property that is jointlyowned with right of survivorship must be disclosed on schedule F.
Attach a copy of the settlement sheet if the property has been sold
Include a copy of the deed showing decedent's interest if owned as tenant in common.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Real estate located at 2210 Dickinson Avenue,Camp Hill Borough,Cumberland County, PA- 180,000.00
valued per sales price
TOTAL(Also enter on Line 1, Recapitulation) 180,000.00
(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 A(Rev.01-10)
Rev-1508 EX+(11-10)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, 8� MISC.
DEPARTMENT OF REVENUE p E RSO NAL PRO PE RTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
S itzer, lan C. 21-12-0052
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointlyowned with the right of survivorship must be disclosed on schedule F.
i
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 PSECU Money Handler Account No.8821*-valued per letter dated 8/3/12 0.03
2 PSECU Savings Account No.8821*-valued per letter dated 8/3/12 4.50
3 Wells Fargo Business Checking Account No.*2657-valued per bank letter dated 7/26/12 2,892.42
4 Wells Fargo Business Savings Account No.*2288-valued per bank letter dated 7/26/12 510.62
5 Wells Fargo Certificate of Deposit No."3835-valued per bank letter dated 7/26/12 10,164.61
6 Wells Fargo Checking Account No.*3479-valued per bank letter dated 7/26/12 27,288.46
7 Wells Fargo Checking Account No."8463-valued per bank letter dated 7/26/12 1,010.06
8 Wells Fargo Savings Account No.*1114-valued per bank letter dated 7/26/12 2,835.07
9 Wells Fargo Savings Account No.*2888-valued per bank letter dated 7/26/12 398.08
10 2002 Chevrolet Suburban 1500-valued per Kelley Blue Book 3,877.00
11 America's Infomart,Inc.-funds due to decedent 275.00
12 First National Bank of PA-funds due to decedent 2,300.00
13 Highmark Blue Shield-refund of account 412.48
14 Nations Valuation Services, Inc.-funds due to decedent 225.00
15 Nations Valuation Services,Inc. -funds due to decedent 225.00
16 Spitzer Appraisal Service-final paycheck 1,160.81
Total of Continuation Schedule See attached page
TOTAL(Also enter on Line 5, Recapitulation) 63,484.14
(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)
Rev-1508 EX+(11-10)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, 8� MISC.
DEPARTMENT OFREVENUE
INHERITANCETAXRETURN PERSONAL PROPERTY
RESIDENT DECEDENT
continued
ESTATE OF FILE NUMBER
Spitzer, lan C. 21-12-0052
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
17 United States Treasury-refund of 2011 individual income tax 9,905.00
TOTAL(Also enter on Line 5, Recapitulation) 63,484.74
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev. 11-10)
Rev-1509 EX+(01-70)
pennsylvania SCHEDULE F
DEPARTMENTOFREVENUE JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
�
ESTATE OF FILE NUMBER
S itzer, lan C. 21-12-0052
If an asset was made joint within one year of the decedent's date of death,it must be►eported on schedule G.
SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Ava B. Spitzer 756 Vista Drive Daughter
Camp Hill, PA 17011
B.
C.
JOINTLY OWNED PROPERTY:
DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM LETTER DATE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECD�S DECE ENT'S NTEREST
NUMBER FOR JOIN MADE NUMBER OR SIMILAR IDENTIFYING NUMBER.ATTACH DEED FOR VALUE OF ASSE INTEREST
TENANT JOINT JOINTLY-HELD REAL ESTATE.
1 A 12/01/2004 Series EE US Savings Bonds-valued per US 61.44 50.000% 30.72
Savings Bond Wizard
2 A 07/01/2002 Series EE US Savings Bonds-valued per US 66.24 50.000% 33.12
Savings Bond Wizard
3 A 12/01/2002 Series EE US Savings Bonds-valued per US 32.54 50.000% 16.27
Savings Bond Wizard
4 A 12/01/2003 Series EE US Savings Bonds-valued per US 63.24 50.000% 31.62
Savings Bond Wizard
TOTAL(Also enter on Line 6, Recapitulation) 111.73
(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 F(Rev.01-10)
REV-1511 EX+�10-09)
pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
R SEDENTDEC ENT URN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
S itzerdan C. 21-12-0052
DecedenYs debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
q, FUNERAL EXPENSES:
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Gretchen L.Spitzer
Street Address 765 Vista Drive
City Camp Hill State PA Zio 17011
Year(s)Commission Paid 11[D00.00
2, Attorneds Fees James❑SmithCDietterick 8�Connellyti.LP 13m00.00
3, Family Exemption: (If decedenYs address is not the same as claimanYs,attach explanation)
Claimant
Street Address
City State Zi�
Relationshio of Claimant to Decedent
4. Probate Fees 383.50
5. AccountanYs Fees
6. Tax Retum Preparer's Fees
7. Other Administrative Costs 3[$65.88
See continuation schedule(s)attached
TOTAL(Also enter on line 9d2ecapitulation) 28C149.38
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
Spitzer, lan C. 21-12-0052
ITEM
NUMBER DESCRIPTION AMOUNT
Other Administrative Costs
1 Borough of Camp Hill -sewer service for residence 315.00
2 Camp Hill Borough-sewer charges(less refund) 46.63
3 Cumberland Law Journal-estate notice publication fee 75.00
4 James,Smith, Dietterick 8�Connelly, LLP-reimbursement for out-of-pocket expenses 26.01
5 Metro Bank-checkbook order fee 23.85
6 Michael J. Pykosh-notary fee 20.00
7 PA American Water-water service for residence 50.78
8 Penn Waste-trash service 101.50
9 PPL-electric service for residence 588.90
10 PPL-electric service for residence 109.48
11 Recorder of Deeds, Cumberland County-filing fee 50.50
12 Recorder of Deeds,Cumberland County-real estate transfer tax 1,800.00
13 Register of Wills,Cumberland County-short certificate 12.00
14 Register of Wills, Cumberland County-filing fee for Return 8�Inventory 30.00
15 Schultz's Landscaping LLC-landscaping services for residence 375.00
16 State Farm Insurance-homeowners premium 62.31
Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Spitzer, lan C. 21-12-0052
ITEM
NUMBER DESCRIPTION AMOUNT
17 The Sentinel-estate notice publication fee 178.92
H-B7 3,865.88
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98)
Rev-7512 EX+(72-08)
SCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF REVENUE
INHERITANCETAXRETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
S itzer, lan C. 21-12-0052
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 American Home Medical Equipment-unreimbursed medical supplies bill 42.80
2 Bank of America-credit card-claim�led 1,743.02
3 Bank of America-credit card 2,845.42
4 Camp Hill Fire Company No. 1 -unreimbursed ambulance bill 1,113.00
5 Check No. 116-issued prior to death; cashed in after death 310.00
6 Check No. 138-issued prior to death;cashed in after death 110.00
7 Check No. 144-issued prior to death;cashed in after death 166.50
8 Check No. 145-issued prior to death;cashed in after death 150.00
9 Check No. 146-issued prior to death; cashed in after death 200.00
10 Check No. 148-issued prior to death;cashed in after death 250.50
11 Check No. 149-issued prior to death;cashed in after death 2,160.00
12 Check No. 152-issued prior to death;cashed in after death 150.00
13 Cumberland County Tax Bureau-2010 individual income tax 1,185.00
14 Greater Baltimore Medical Center-unreimbursed medical bill 18.00
15 Greater Baltimore Medical Center-unreimbursed medical bill 456.87
16 Greater Baltimore Medical Center-unreimbursed medical bill 98.84
17 Greater Baltimore Medical Center Physician Billing-unreimbursed medical bill 133.55
Total of Continuation Schedules See attached
pages
TOTAL(Also enter on Line 10, Recapitulation) 174,901.63
(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-1512 EX+(12-05)
SCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF REVENUE
INHERITANCETAXRETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
continued
ESTATE OF FILE NUMBER
Spitzer, lan C. 21-12-0052
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
18 Gretchen Spitzer-child support arrears due 40,000.00
19 Harley Davidson-motorcycle loan payment 448.81
20 Heritage Medical Group-unreimbursed medical bill 78.00
21 John Hopkins Hospital-unreimbursed medical bill 152.89
22 John Hopkins University Clinical Practice Association-unreimbursed medical bill 20.00
23 MOED-City of Harrisburg loan 17,850.17
24 MSHMC-unreimbursed medical bill 104.78
25 MSHMC Physicians Group-unreimbursed medical bill 310.00
26 Oakwood Radiation Center-unreimbursed medical bill 1,338.50
27 PA Department of Revenue-2010 individual income tax 1,649.00
28 PA Department of Revenue-2011 individual income tax 8.00
29 Pathology Associates of Central PA-unreimbursed medical bill 155.20
30 Patrick S.Carroll-appraisal fees due and payable 150.00
31 Penn Waste-trash service 45.75
32 PSECU Auto Loan(L10)Account No.8821*-credit card-valued per letter dated 8/3/12 2,586.41
33 PSECU Auto Loan(L11)Account No.8821*-credit card-valued per letter dated 8/3/12 1,963.49
34 PSECU Visa No.8821*-credit card-valued per letter dated 8/3/12 16,880.96
Copyright(c)2008 form software only The Lackner Group, Inc. Form PA-1500 Schedule I(Rev. 12-08)
Rev-1512 EX+(12-05)
SCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF REVENUE
INHERITANCETAXRETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
continued
ESTATE OF FILE NUMBER
Spitzer, lan C. 21-12-0052
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
35 Robert C.and Beverly D.Spitzer-mortgage note 50,000.00
36 Schultz's Landscaping LLC-landscaping services for residence 1,025.32
37 Statewide Tax Recovery-2011 per capita tax 41.50
38 Student loan 175.00
39 Susquehanna Bank-loan-claim filed 6,951.96
40 United States Treasury-2007 individual income tax 8,328.54
41 United States Treasury-2010 individual income tax 7,231.00
42 United Telemanagment Corporation-telephone/television services at John Hopkins Hospital 78.75
43 Wells Loan No.6851238264-0001 -valued per statement ending 12/31/11 6,194.10
TOTAL(Also enter on Line 10,Recapitulation) 174,901.63
Copyright(c)2008 form software only The Lackner Group, Inc. Form PA-1500 Schedule I(Rev. 12-08)
_ e �_ . .,��. .K� �h�. �,�:-�� ��..�. �.-� �;p�. . � �,.��. . ,�
REV-1573 EX+�01-10)
pennsylvania SCHEDULE J
DEPARTMENT OFREVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
S itzer, lan C. 21-12-0052
RELATIONSHIP TO
NUMBER NAME AND ADDRESS OF DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE
PERSON(S)RECEIVING PROPERTY (Words) ($$$)
I� TAXABLE DISTRIBUTIONS [include outright spousal
distributions,and transfers
under Sec.9116 a 1.2
1 Ava B.Spi�er Daughter Joint Bonds 8 13,556.10
765 Vista Drive 1/3 of residue
Camp Hill, PA 17011
2 Barrett C.Spitzer Son 1/3 of residue 13,444.38
765 Vista Drive
Camp Hill, PA 17011
3 Elsie B.Spitzer Daughter 1/3 of residue 13,444.38
765 Vista Drive
Camp Hill, PA 17011
Total 40,444.86
Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet,as a ro 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)