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HomeMy WebLinkAbout09-26-13 J 1505610143 REV-1500 EX(02-11) PA Department of Revenue OFFICIAL USE ONLY p Pennsylvania County Code year File Number Bureau of Individual Taxes OEPARrMEM EMI OF REVE PO 60X.260601 INHERITANCE TAX RETURN 21 13 0021 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 12 26 2012 08 30 1949 Decedent's Last Name Suffix Decedent's First Name MI SHOPE JANET (If Applicable)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 1243-82) ❑ 4. Limited Estate 4a Future Interest Compromise (date of death after 12-12-92) 5. Federal Estate Tax Return Required ❑ ❑ g Decedent Died Testate 7 Decetlennt Maintainetl a Living Tmst 0 8. Total Number Ot Safe De (Attach Copy of Will) ❑ (Attach Copy of Trust) posit Boxes ❑ 9. Litigation Proceeds Received ❑ 10.Spousal Po 31�1 anditl(Da95�f Death ❑ 11.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 JOHN S DAVIDSON 717 533 5101 REGIS R OF WILLS USE ON�L.Y Iz 7 b First Line of Address r - s 320 WEST CHOCOLATE AVE !" 1: , , _C1 Second Line of Address �` w PO BOX 437 :m DATE FILED City or Post Office State ZIP Code : v, c, HERSHEY PA 17033 ca Correspondent's e-mail address: ldavidson@yostdavidson.cotn 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 OF PERSON RESPONSIBLE FOR FILING RETURN DATE Kathryn N Smith ADDRESS 509 McKinley Drive, Elizabethtown, PA 17022 SIGNATUR OF PREPA ER OTHER THAN REPRESENTATIVE DATE A,�, John S. Davidson . ADD SS 3 West Chocolate Ave., Hershey, PA 17033 Side 1 L 1505610143 1505610143 r� J 1505610243 REV-1500 EX Decedent's Social Security Number oecetlenrs Name: Shope, Janet RECAPITULATION 1. Real Estate(Schedule A)................................................:...................................... 1. 284 , 000 . 00 2. Stocks and Bonds(Schedule B)............................................................................. 2. 79, 428 . 92 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. 812 , 762 . 02 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers&Miscellaneous Nt Probate Property (Schedule G) a Separate Billing Requested............ 7. 8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 1 , 176, 1 1 90 . 94 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 91 , 119 . 73 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 18 , 0 96. 89 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 109 ,216 . 62 12. Net Value of Estate(Line 8 minus Line 11)... - - - - ...... 12. 1 , 066, 974 . 32 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, 1 , 066, 974 . 32 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 . 00 16. Amount of Line 14 taxable at lineal rate x .045 394 , 780 . 50 16. 17 , 765 . 12 17. Amount of Line 14 taxable at sibling rate x.12 672 , 193 . 82 17. 80 , 663 . 26 18. Amount of Line 14 taxable at collateral rate X.15 0 . 00 18. 0 . 00 19. TAX DUE................................................................................................................ 19. 98 , 428 . 38 20, FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑ Side 2 1505610243 1505610243 ,� REV-1500 EX Page 3 File Number 2143-0021 Decedent's Complete Address: DECEDENT'S NAME Shope,Janet STREETADDRESS 555 S. Third Street CITY STATE ZIP Lemoyne PA 17043 Tax Payments and Credits: I. Tax Due(Page 2,Line 19) (1) 96,426.38 2. Credits/Payments A. Prior Payments B. Discount 0.00 Total Credits(A +B) (2) 0.00 1 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 i +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 98,428.38 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;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?.................................................................................................................... ❑ 3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?....... ❑ Q 4. Did decedent own an individual retirement account,annuity,or other non-probate property which contains a beneficiary designation?..................................... ............................................................................ ❑ M 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 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 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. Rev-1602 EXa(01-10) SCHEDULE A Pennsylvania REAL ESTATE DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Shope,Janet 21-13-0021 All real Property owned solely oras a tenant In common must be reported at fair market value,Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller,neither being compelled to buy or Sell,both having reasonable knowledge of the relevant fads. Real property that la jointly-owned with right of survivorship must be disclosed on schedule F. Attach a copy of She semmur eat shoot 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 1 517 Mountainview Rd,,Middletown-vacant real estate-sale price 41,000.00 2 555 South Third Street,Lemoyne-decedent's principal residence 243,000.00 TOTAL(Also enter on Line 1,Recapitulation) 284,001 (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-1603 EX-(6-99) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Shope Janet FILE NUMBER 21 -13-0021 All property jointlyaWned with right of survivomhip must be disclosed on Schedule F. ITEM CUSIP NUMBER NUMBER DESCRIPTION VALUE AT DATE UNIT VALUE OF DEATH 1 6,491.142 shares of Columbia US Government Management 5.64 36,610.04 Fund A 2 United States Series EE Savings Bonds-see attached 15,325.00 inventory 3 United States Series EE Savings Bonds -see attached 3,900.00 inventory report Accrued interest on Item 3 through date of death 13,893.98 Accrued interest on Item 3 through date of death 9,699.90 TOTAL(Also enter on Line 2, Recapitulation) 79,428.92 (If more space is needed,additional pages of the same size) Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B(Rev.6-98) Rev4508 EX.(11AD) SCHEDULE E Pennsylvania CASH, BANK DEPOSITS , , DEPARTMENT OF REVENUE f � MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Shape Janet 21 13 0021 Include the proceeds of litigation and the date the proceeds were received by the Ones. All property lointlyowned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 American Express Gift Cheque 50.00 2 Cash-found in decedent's home 125.00 3 Belco Community Credit Union-members savings account 28,742.95 4 Belco Community Credit Union-member checking account 4,052.64 5 Wells Fargo Savings Account-account#3083391417041 1,003.11 6 2005 Pontiac Bonneville-Kelly Blue Book value 5,102.00 7 insureco Agency-insurance premium refund 47.00 I 8 Belco Traditional IRA Account-payable to decedent's estate 27,936.53 9 Morgan Stanley-Rollover IRA brokerage account#410-030046-003 paid to the estate by 745,702.79 virtue of a qualified disclaimer filed by the named beneficiary, Kathryn N. Smith.The value of this asset represents 63%of the Total Gross Assets,thus 63%of the residue of the estate is distributable by the estate to decedent's intestate heirs,determined as if her mother,Kathryn N.Smith,had predeceased her.Those intestate heirs are the decedent's sisters,Karen Smith, Diane Smith and Carol Stoffel,who take as a result of the qualified disclaimer of Kathryn N. Smith. TOTAL(Also enter on Line 5,Recapitulation) 812,76102 (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-1511 EX.(10.09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN RESIDENT DECEDENT ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Shope Janet 21 13-0021 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: See continuation schedule(s) attached 9,522.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zio Year(s)Commission Paid 2. Attornev's Fees Yost& Davidson 15,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zio Relationshio of Claimant to Decedent 4. Probate Fees 393.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 66,204.23 See continuation schedule(s) attached TOTAL(Also enter on line 9, Recapitulation) 91,119.73 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 Shope,Janet 21-13-0021 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Matincheck Funeral Home 9,522.00 H-A 9,522.00 Other Administrative Costs 2 Bob Ott Painting-55 S.Third St. 1,300.00 3 Bob Oft Painting-555 S. Third St. 2,500.00 4 Coldwell Banker Homestead Group-commission on sate of 555 South third St.,New 14,580.00 Cumberland real estate 5 Comcast 94.40 6 Comcast 160.85 7 Cumberland County Recorder of Deeds-realty transfer tax on sale of 555 S.Third St. 2,430.00 8 Cumberland Law Journal-estate advertisement 75,00 9 Dan Epler-partial payment for work at Mountain View road property 6.354.00 10 Dan Epler-roof replacement for Mountain View Road 615W00 11 Dan Epler-final payment for restoration work for Mountain View Road 3,176.00 12 Dauphin County Treasurer-2013 county and township real estate taxes for 517 Mountain 677.81 View Road 13 Erie Insurance-homeowner`s insurance for 555 S.Third St.,Lemoyne 229.00 Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1600 Schedule H(Rev.6-96) i SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Shope,Janet 21_13-0021 ITEM NUMBER DESCRIPTION AMOUNT 14 Erie Insurance 160.50 15 Faith Nicola Tax Collector-2013 county and borough taxes for 555 S.Third St.Lemoyne 1,090.59 16 Faith Nicola Tax Collector-2013 school real estate tax for 555 S.Third St.,Lemoyne 2,162.15 17 Freedom Systems Corp. -Lemoyne sewer service 40.00 18 Freedom Systems Corp. -Lemoyne sewer service 40.00 19 Freedom Systems Corp.-Lemoyne sewer service 1130 20 Freedom Systems Corp.-Lemoyne sewer service 40.00 21 Freedom Systems Corp.-Lemoyne sewer service 41.90 22 Gary Stump-labor and materials for maintenance and repairs for 555 S.Third St., Lemoyne 1,045.58 23 Gary Stump-materials and labor to repair and paint 555 S.Third St. 4,200.00 24 Hixon&Simko,LLC-decedents final life income tax returns 180.00 25 Hixon&Simko,LLC-preparation of fiduciary income tax returns 450.00 26 Home Paramount-termite treatment 238.50 27 Karen Smith-cleaning services and trash removal at 555 S.Third St. 1,819.12 28 Karen Smith-cleaning and preparation of 555 S. Third St.for sale 1,387.75 29 Lemoyne Borough Sewer Bill 80.00 30 Lower Swatara Township Authority 44.75 Copyright(c)2002 form software only The Lackner Group,Inc. Form PA4500 Schedule H(Rev.6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF Shope Janet FILE NUMBER 21-13-0021 ITEM NUMBER DESCRIPTION AMOUNT 31 Lower Swatara Township Authority 44.75 32 Lower Swatara Township Authority 44.75 33 Lower Swatara Township Authority 44.75 34 PA American Water 21.73 35 PA American Water 19.95 36 PA American Water 38.30 37 PA American Water 65.70 38 PA American Water 30.36 39 Penn Waste, Inc. 52.66 40 Penn Waste, Inc. 53.50 41 Penn Waste, Inc. 33.50 42 Penn Waste, Inc. 52.91 43 Penn Waste,Inc. 43.50 44 Pincin Plumbing -plumbing repairs to 555 S.Third St., Lemoyne 126.25 45 Pincin Plumbing -plumbing work for 555 S.Third St. Lemoyne 105.00 46 Pinewedge Villa Condominium Assoc. 550.00 47 Pinewedge Villa Condominium Assoc. 550.00 Copyright(c)2002 farm 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 Shope,Janet 21-13-0021 ITEM NUMBER DESCRIPTION AMOUNT 48 PPL Electric Utilities 153.15 49 PPL Electric Utilities 33.23 50 PPL Electric Utilities 140.02 51 PPL Electric Utilities 32.00 52 PPL Electric Utilities 72,08 53 PPL Electric Utilities 60.00 54 PPL Electric Utilities 78.06 55 PPL Electric Utilities 60.00 56 PPL Electric Utilities 113.93 57 PPL Electric Utilities 360.91 58 PPL Electric Utilities 130.93 59 PPL Electric Utilities 65.66 60 Register of Wills-short certificates 30.00 61 Stovers Pool&Spa -repairs to jacuzzi tub at 555 S. Third St., Lemoyne 266.26 62 TC Settlement Services-closing costs on sale of 517 Mountain View Road real estate 6,358.71 63 The Carpet House 1,400.00 64 The Carpet House 2,746.00 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 Shope Janet 211-13-0021 ITEM NUMBER DESCRIPTION AMOUNT 65 The Patriot News-estate advertisement 204.44 66 UGI 150.29 67 UGI 137.17 68 UGI 60.18 69 UGI 32.42 70 UGI 8.62 71 UGI 8.51 72 UGI 8.51 73 United Water 11.45 74 United Water 11.32 75 United Water 11.32 76 United Water 23.49 77 United Water 11.36 78 United Water 11.36 79 Verizon 64.13 80 Verizon 35.91 81 Vital Records-death certificates for Clark A. Smith 27.00 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 Shope, Janet 21-13-0021 ITEM NUMBER DESCRIPTION AMOUNT 82 Vital Records -death certificates for Clark A.Smith 27.00 83 W.S. Carey Electric-electric repairs in garage at 555 S.Third St., Lemoyne 165.00 84 W.S. Carey Electric-electric repairs at 555 S.Third St., Lemoyne 115.00 H-B7 66,204.23 Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev. 6-98) Rev-1612 E%.(12.00) SCHEDULE 1 pennsylvania DEBTS OF DECEDENT DEPARTMENT OF REVENUE f INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Shape,Janet 2t-13-0021 Report debts incurred by the decadent prier to death that remained unpaid at the date of death,Including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Belco community Credit Union-checks paid after death from decedent's credit union 383.95 account 2 Belco Visa Account 671.58 3 Capital Cardiovascular Assoc. 16.90 4 Comcast 141.13 5 Freedom Systems Corp.-Lemoyne sewer service 120.00 6 Green Tree 1,348 58 '7 Green Tree Servicing, LLC-mortgage loan secured by 555 S Third St., Lemoyne, PA real 5,486.38 estate 8 Harrisburg Gastroenterology Ltd. 50,50 9 Lower Swatara Township Authority 147.66 10 Moores Mountain Mechanical, Inc. 75.00 11 PA American Water 12.75 12 Pathology Assoc.of Central PA 2.85 13 Penn Waste, Inc. 53.50 14 Penn Waste, Inc. 118.62 15 Pinewedge Villa Condominium Assoc. 550.00 16 Pinnacle Health Hospitals 15.00 Total of Continuation Schedule See attached page TOTAL(Also enter on Line 10,Recapitulation) 18,096.89 (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-0612 rX+jig-0e) SCHEDULE I pennsylvania DEBTS OF DECEDENT, DEPARTMENT Of REVENUE INHERITANCE TAX RE TURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT' continued ESTATE OF FILE NUMBER Shope,Janet 21-13-0021 ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 17 Pinnacle Health Hospitals 109,06 18 Pinnacle Health Hospitals 344.05 19 Pinnacle Health Hospitals 150.00 20 Pinnacle Health Medical 149.40 21 PPL Electric Utilities 97.63 22 PPL Electric Utilities 449.14 23 Quantum Imaging 780.57 24 Riverside Anesthesia 79.63 25 UGi 282.83 26 United Consumer Financial Services 1,220.58 27 United States Treasury-2012 form 1040 tax 2,594.00 28 United Water 11.55 29 Verizon 141.50 30 Verizon-health insurance premium 66.25 31 Wells Fargo Home Mortgage-mortgage loan secured by 517 Mountain View Road 2,415.30 I TOTAL(Also enter on Line 10, Recapitulation) 18,096.89 Copyright(c)2008 form software only The Lackner Group, Inc. Form PA-1500 Schedule 1(Rev. 12-08) REV-1513 EX.(01-10) pennsybaniN SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF Sho e, Janet Isharee E NUMBER -13-0021 NUMBER NAME AND ADDRESS OF RELATIONSHIP TO TATE AMOUNT OF ESTATE PERSON(S)RECEIVING PROPERTY DECEDENT TAXABLE DISTRIBUTIONS DO ° is e s ($$$) j, [include outright spousal distributions,and transfers under Sec.9116 a 1.2 Diane K.Smith Sister f 2687 Glenglye Dr. 224,064.61 Vienna,VA 22180 Karen S.Smith Sister f 52 N. Conley Lane 224,064.61 Etters, PA 17319 K athryn N.Smith Mother 37%share of 509 McKinley Drive 394,780.50 Elizabethtown, PA 17022 residue Carol Ann Stoffel Sister 21%share of 224,064.61 5350 Elizabethtown Rd. residue Palmyra, PA 17078 Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet, as a ro ate. X066,974.33 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)