HomeMy WebLinkAbout08-30-13 1505610143
REV-1500 Ex(°'-'°'
PA Department of Revenue OFFICIAL USE ONLY
P Pennsylvania County Code Year File Number
Bureau of Individual Taxes 0EP4iTMm*OFPEVOwE
PO BOx.260601 INHERITANCE TAX RETURN 21 13 0672
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
03 21 2013 09 18 1931
Decedent's Last Name Suffix Decedent's First Name MI
POIARANING DOROTHY E
(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
X] 1. Original Return 2. Supplemental Return 3, Remainder Return(date of death
prior to 12-13-82)
4. Limited Estate ❑ 4a Future Interest Compromise 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
❑ 6 Decadent Testate 7. (Attach Copy ioofTed)a Living Trust S. Total Number of Safe Deposit Boxes
Attach copyofwipe
9. Litigation Proceeds Receivetl 10 gms ni PovertyV Cre lit ldate of death 11,Election to tax under Sec.9113(A)
between 12-31-Jl and -1-95) (Attach Sch.O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION3}fOULDUB rr IRECTED TO:
Name DayLle�'T2elephor"umber c�
BRADLEY L GRIFFIE 71� X043 5 51� ro
C") r
REGSJj 'OF WILTS USE ONLY
D rn a3 p cD
a. • n -� -�I -n
First line of address U n C?
.200 NORTH HANOVER STREE a C: �1 r rn
Second line of address -o tv 01 0
D W
City or Post Office DATE FILED
State 21P Code
CARLISLE PA 17013
Correspondent's e-mail address: bgriffie @griffielaw.com
Under penalties o perjury,I did a the have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct 1d wmplet . eclarat n of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE F ES 0 SIBLE R FILING RETURN DATE
Keith L. Pomranin
ADDRES
298 A McAlister Church Road, Carlis e, PA 17015
SIGNATURE OF PR OTHER THAN REPRESENTATIVE DATE
Bradley L Griffie 3
ADDRE
200 NoPffi Hanover Street, Carlisle, PA
Side 1
L 1505610143 1505610143
J 1505610243
REV-1500 EX
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... 1.
2. Stocks and Bonds(Schedule B)............................................................................. 2. 344 . 40
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. .938 .17
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 20 . 83
7. Inter-Vivos Transfers&Miscellaneous N a Probate Property
(Schedule G) Separate Billing Requested............ 7,
8. 'Total Gross Assets(total Lines 1-7)..................................................................... 8. -1 , 303 . 40
9. Funeral Expenses&Administrative Costs(Schedule H)....................................... 9. 8 , 416 . 48
10. Debts of Decedent,Mortgage Liabilities,&Liens(Schedule 1).............................. 10. 42 ,961 . 61
11. Total Deductions(total Lines 9& 10)................................................................... 11. 51 , 378 . 0.9
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. -50 , 074 . 69
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. -50 , 074 . 69
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 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. El
Side 2
L 1505610243 1505610243 J
REV-1500 EX Page 3 File Number 21-13-0672
Decedent's Complete Address:
DECEDENT'S NAME
Pomraning, Dorothy E.
STREET ADDRESS
Thornwald Home
442 Walnut Bottom Road
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) U.UO
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 December 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?.................................................................................................................. ❑ 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 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 1.2)[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-1503 EX.(6-98)
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENTDECEDENT
ESTATE OF FILE NUMBER
Pomraning, Dorothy E. 21-13-0672
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 871829107 10 shares of Sysco Corporation Stocks- 34.44 344.40
(See attached statement)
TOTAL(Also enter on Line 2, Recapitulation) 344.40
(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)
Rev-1508 EX-(6-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENTOECEDENr
ESTATE OF FILE NUMBER
Pomraning, Dorothy E. 21-13-0672
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointlyo nedl with the right of survivormlp must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Wells Fargo Checking Account#XXXXXXXXX9781 - 856.66
(See attached statement)
2 Commonwealth of PA- 81.51
Public School Employees' Retirement System
Final benefit
TOTAL(Also enter on Line 5, Recapitulation) 938.17
(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 E(Rev. 6-98)
Rev-1509 EX-(6.98)
SCHEDULE F
COMMONWEALTH OF PENNSYLVAN,A JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RE6IDENTDECEDENT
ESTATE OF FILE NUMBER
Pomraning, Dorothy E. 21-13-0672
If an asset was made joint within one year of the decedent's date of death,It must be reported on schedule G.
SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Keith L. Pomraning 298 A McCalister Church Road Son
Carlisle, PA 17015
B.
C.
JOINTLY OWNED PROPERTY:
DESCRIPTION OF PROPERTY aka OF DATE OF DEATH
ITEM LETTER DATE INCLUDE
NUMBER OR SIMILAR DENTIFYING INSTITUTION
NUM ER.ATTACH DEED DATE OF DEATH DECD$ DECEDENTS INTEREST
NUMBER FOR JOINT MADE VALUE OF ASSE
TENANT JOINT JOINTLY-HELD REAL ESTATE. INTEREST
1 A 04/13/2009 F&M Trust Checking Account No.XXX7120- 41.66 50.000% 20.83
(See attached statement)
'TOTAL(Also enter on Line 6, Recapitulation) 20.83
(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 F(Rev.6-98)
REV-1151 EX-(10-06)
SCHEDULE H
CONWONWEALT�,OF PENNSYLVANIA FUNERAL EXPENSES &
IN RESIDENT DECEDENTRN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Pomraning, Dorothy E. 21-13-0672
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 6,207.98
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State .Zip
Year(s)Commission paid
z. Attornev's Fees Griffie &Associates, P.C. .2,000.00
3, Family Exemption: (If decedent's address is not the same as claimant's,attach explanation)
Claimant
Street Address
City State Zio
Relationship of Claimant to Decedent
4. Probate Fees 173.50
5. Accountant's Fees
6. Tax Return Preparers Fees
7. Other Administrative Costs 35.00
See continuation schedule(s) attached
TOTAL(Also enter on line 9, Recapitulation) 8,416.48
Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev. 10-06)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Pomraning, Dorothy E. 21-13-0672
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Expenses
1 Egger Funeral Home 3,590.98
2 Prospect Hill Cemetery- 1,770.00
(Internment fees, grave opening,etc.)
3 Tim Barrick(Music) 50.00
4 Judi Crum (Music) 50.00
5 Cathy Hartsock(Music) 50.00
6 Big Spring Presbyterian Church (Service/wake) 220.00
7 Blue Mountain Blooms(Flowers) -477.00
H-A 6,207.98
Other Administrative Costs
8 Bank Fees 35.00
H-B7 35.00
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98)
Rev-1612 EX+(12-08)
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENTDECEDENT
ESTATE OF FILE NUMBER
Pomraning, Dorothy E. 21-13-0672
Report debts incumed 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 Thornwald Home(Nursing Home) 4,134.92
2 Commonwealth of Pennsylvania- 38,826.69
Department of Public Welfare
Third Party Liability(Medicaid Claim)
TOTAL(Also enter on Line 10, Recapitulation) 42,961.61
(If more space is needed,additional pages of the same size)
Copyright(c)2009 form software only The Lackner Group, Inc. Forrn PA-1500 Schedule I(Rev. 12-08)
REV-1513 EX.(11418)
SCHEDULE J
COMMONWEALTH TAE /PENNSYLVANIA BENEFICIARIES
RESIDENT OE EDEN
ESTATE OF FILE NUMBER
Pomranin , Dorothy E. 21-13-0672
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (Words) ($$$)
Do NotList`rrusteelsl I TAXABLE DISTRIBUTIONS [include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
Mary L.Geiswe[t Daughter Fifty percent of
50 East Water Street net distributable
Middletown, PA 17057 estate
Keith L. Pomraning Son Fifty percent of
298 A McAlister Church Road net distributable
Carlisle, PA 17015 estate
Total
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate.
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)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev. 11-08)
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Historical quote for: SYY
Thursday,March 21,2013 - - 3e
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