HomeMy WebLinkAbout10-02-13 —. _��.
; 1 15D5610101
' 'J REV-15o0 �`<°'.'�, �
'�� PA DepartmgM of pevenue p�nsyLvaMa aFPICiAL uSE ONLY
Bureau of Indfvtduet Taxes `""�"` E�h�e Year We Numbq'
� Po spx zsosoi INHERITANCE TA7C RETURN � 1 p-7
( Harrtsbum.PAz��as-ofwi RESIQENTQEGEDENT °"'1 ' �� b�Q t `
IENTER DEGEDENT INFORMATION BEL6W .
Social Security Number Date of Deati� MMD4YYYY Date of 8�rth MMDDYYYY
' 01/OSl2013 04H2/1942
IDecedent s Last Name .. Suffix Decedent s Frst Neme MI
�_ __. .__. _._._ . . , ___,. . �... ... ..._,..__ _.. �.. . .,...__.. . ...
Meivin � ' Geraidine M ',
(IfApplieable}EotarSurvirinpSpouse'slnWrmation�Beiow ..... .... ..... . .�.... . ..... ..... ...
Spousa's Last Name 5uffx Spouse's FtrsC Name MI
, ._.. _ ..... .. _..,. ....._. , ��:... ....... ..._ ..... .._......
Spouse's Social Sacuriry Number
THIS RETURN MUST 9E FILED IN DUPLICATE WITH THE
_ REGtSTER OF W�LLS
FILL IN APPROPRiATE OVALS BE�OW
C� 1. Original Retum O 2.Supplamental Return q 3. Remainder Retum{dake of tleatb
priorto 12-'13-82}
O 4. Limited Esiate O 4a. FuWre Interest Compromiae(date of O 5. Federel Estate Tex Return Required
tleath efter t2-12-82)
q 6. Decedent Dietl T�state O 7. pecetlent Maiotained a Living Trust _ 8. Total NumUer of Safe Oeposit Bozes
(Attach Copy of W iY) {Attach Copy ai Tntst}
O 9. LitlgaUon Proceads Received O 10.Spousel Poverly Credit(date of death O 11. ElecUon to tax under Sec.9113(A)
betwegn 12-$1-9t antl t-i-45} (AttBCh SCh,O}
CORRESPONDENT- THIS SECTION MUST BE COMPLEfED.ALL COR'RESP4NDENCE AND CONFIpENTIAL TAX INFORMATIOM SHOULD B8 DIREC7ED T4:
Name Oaytime Teiephone Number
_... _ . ..._ .... .. ... .� ,,.___ . ..-- . .__ . ... . ...,_.... .
James W. Koilas {717}731Q800 '
_. . .... _. _ _. _ .. . _..._.�_� ..,.._�. � ,�
�a� takntisue�,aN�
-r, c� �
� ^�- �y "'� V3
First Ime of eddress r � ~ �"�
.,.. . . ..._. _.., __ ... .. .. ..... . . "t r'T� r
...
1104 Femwaod Ave�ue � cn �� rv N' �
.�
.
_.cond Ime of address ._ _.. _ ... _.. , � �' c? � "�`2 " .
__. __ , . . _ .._ �..... . .. .. ..... . p
. . _ _. . ..._ � ���:
�s�ae �oa _ � � ,;' ;:� �
ity or Post Office � State 21P Cod¢ A DATE fl r`"
. __ ._. ,. � . ... .._... _ _.._.,. . .... _.... . ... ... .. .... ... ._....._..,.. , ...._..,. .. . .,. W -rt
Camp Hi0 PR 17011
orrespondern�s wmaii aderess:james�lkollassndkennedy.com
�nder peneltles of peryury.I declare Ihat I heve enaminetl this reWm,includirg earompeirying schetlules and stefemeMS,entl W the best ot my knowledge and 6elief,
i is We,cortect and cnmpbta,Declaratbn M P�ePSrer othar Nan the personal repraseniattvs Is baestl on aY��rmaUOn�which praparer has amf knowbdge_
�6'NA RE OF P 90N RES SIBLE FOR FILING RE7URN DA�/��`j
/�-y"
OpRESS
926 PrinceEon Avenue, Gamp Hill, PA 17011
IGNATU ER OTHER THAN REPRESENTATIVE DAT
��'�
E
144 Femwood Avenue, Camp HiH, PA 17011
PLEA#E U8E ORIOINAL FQRM ONLY
Side 1
15[7561!]YOJ, 150561�101 �
��
� �sas6loLOs
REV i500 EX
OeceQenPs Social Security Number
�ecedanrsName: C30faldins M. AAm1Vin !
RECAPNTULA710N �
1. Reai EsWte(ScheduVe A). . . .. . .. ... . . ................................ t. ' 4.OQ�
. .... . _ . ._ ... ,,.. ,. _<......_..
2. Stooks antl Bonds tSchadula 6} ....... ... .... ... .... .. . ...... .. .. 2.i O.�Q �..- .
3. Cioseiy Heid Gorporatian,Partnership w Saie-Proprie#orship(Sched�de C} .,,.. 3. : 4��Q ���
4. Mortgagas arni Notes Reoeivabie{Scheduia D}.. ........ .. .. ... ..... ..... 4. Q.OQ'�
. . .. .__ . ... .. .. ,.. .
5. Cash, Bank Deposits and Miscetianaous Personai Property(Scheduie E}.. ..... 5. �� ��,���;
6. 3ointly Owned Property.(SChertuka F) . O Separgte B�Rng Requesied ....... 6. : 0.09�
7. Inter-Vivps Transfers&Miscallarreous NomPmbate Proparty ' �������� � ��� ������� �� ������ '
(Sbhaduie G} O Separate BiHirx,7 Requested...... . 7 0.00 :
8. Totai Gross Aueia(Wtai Lines i through 7}..... .... ..... . . ..... ..... . .. 8. � 14,6D6.6B!
9. Funerai Expenses antl Admirnsfrative Costs(Scheduie ti}..... .............. 9. { 10,439.61 �
10. D¢bis of pecedent,Mortgaga li&bilHieS,and l.iens(Scheduie I}.. ............ 10. .: 9,175.53 �:
N. TotBt DBd�cNOns(tcdal ttnes 9 and 10}.. . ..... . .... ...... . ._......._.. 11.'� '(S�$15.'�4�;
t2. Net Ya7us o3�Es�ta(Une$mirws Lina YI}..... . ..... ..... . ..... ....... . 12.' '5��.$6 r
13. Charftable and Govemmentel BequesteJSec 9ri 3 Tmsts for which `�' ��� �"� ' �� °"°' ' "°' '�""''
an eiection to tax tras raf been made(Saheduia d} . .. . . . ... ..... .......... 13. �.- 0.{}0 i
. 'la:. NMRV+due�.suqjA�pR.to Tuc jLine a2 minus Cirme i3} ...... ... ......... . .. ic. �: O.QO:;
TAX CAl6U1.1kTtblt-SEE iMSTRUCT10H8 FOR APPUCABLE�RkTfS
15. Amount of Line 14 4axeble
at the spousai tax rate,ar
trsnafersunderSec.9176 , . .." -..-_ , ___ , . ...._ _, . ...,. .,.._.....,_.- _. , . _,
{a){72)X.O� ' 15.! ��
18. Amount ot Line 14 taxable .__.... . _.._. .. ._._. ..; ___. _ . ._....... ,_.._._..,... . . � . ;
ak linsal rate X 9� � � i 6.-" �
17. Amount af LirHI 94 taxable . ..�... . ._ . _..- .. . .��,_ . , . ...., _ .... ...w.. � .:_�.... .. � -
at sfbting rate X.12 � 17.: ���.
1p. Amounto4Line 14i9xable '�� � . .� � � �� " . .����. � _���� .� ���� .. �.
at cdlaterat rete X.15 " � i8_ ': '
._.. . .._...�. .,.,..... . .._...
19. TAXDUE ....__............._......_.__......_.._.......... 75.; OAO,i
2p. FILL IN TH@ OVAI IF YOU ARL�REQt1EffiTTNO�R REPUND tlF AN OVEIIRAiRABMI' p
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REV-i50p EX Page 3 Ffla Num6er
Dec nt's Campiete Address:
oecE Hrs�nnte
Ger idine M. Melvin
STREE ADDRESS �. ..,—. i
57 puth 39th Street
CITY �i � � STATE �'... ZIP
Ca p Hill PA ;; 17Q11
Taac yments and Credits:
t. Tax ue(Page 2,Line 19) (1} 0.4d
2. Cre 'tstPayments
A.P inr Payments __ �
B. scowt
_— —._ ro+��c�a��a+e y �z> o.00
3. Inte st
{3} Q.QO
d. !i li e 2 is greater than Line t+�ine 3,en#er ihe ditference. This is the BVERPAYMEN7.
FIII io oval on Page 2,Line 2Q to requss!a refund. (4} 0.00
5. If Li 1 +Line 3 is greater than Line 2,enter ihe difference.This is the fAl(DUE. (5) � 0.04
Make check payab(e ta: REGISTER OF WILLS,AGENT.
; � ��? 'm,��'�4��� .� �����'�. ��;, ,. h�t�E'����P�t�� . ' ti �,.,., •�l�!��1���', . . :,4��� a ' , �,�� ; �;
PIEASE ANSWER THE FOlL04YlNG QUESTIONS BY PLACING AN "X" EN THE APPR4PRIdTE BLf3CKS
1. Did decedent make a trensfer and: Yes Na
e. reiain tha use w irwane�the property fransfsrted�......................... ,,................... ❑ QK
.................................
I b, retain the dght to designate who shall use the property transferted or its income............._..............,...........__ ❑ XQ
s. retain e reversionary interest;or............................................................................................................._........... ❑ �
d. receive the promise tor li(e of either payments,6errefiis or rare?............_......_......................_........................ ❑ Q
I 2. It death occurred atter pec.12, 1982,did decederrt transfer property within one yaar otdeath
without receiving adequate cansideration?...............:................_............................................................................ ❑ 0
I 3. Ditl decedent own an"in trust foP or payable-upondeath bank accnunt or securiry at hia or her death?.............. ❑ 0
4. Did decedent own an ind'ividual retirement acwunt,annuify a other non-probate property,which
contains a beneficiary designation? ........._............................................................................................................. � ❑
IF THE NSVMER TO ANX Qf tHE AB04E QUESTI4NS IS YE3,YQU NUS7 GQMPIETE SCHEt1ULE G AND F�E IT AS PAR7 4F TNE BETURN.
� .�t ������;%��1�� . ��;� a��k!�����, �°��M`; , "������_. � ��
For dates f death a�or after July 1, 1994,and befare Jan.t, 1995,the tax rate imposad on the net value at transiers to or for the use of ihe surviving spouse is
3 percent 2 P.S.§9118 (a)(1.1)(i)].
For dakes f deattr on or after Jan. 1, 9995, the tex rate imppsed an the net velue of transfers to or for the use of the surviving spouse is 0 percent
[72 PS.§9 16{a) (t.t)(ii)�.Tt�statute does not euempt a transfer to a surviving spouse from tax,and#hs s#z#utary requirements for disclosure of assets and
fling a iax turn are still applicable even if the surviving spouse is the only benefciary.
For dates o death an or afler July t,2000:
. The ta rate imposed o� the ne1 value of transfers irom a deceased shik! 21 years of age or younger at death ta a far the use of a natarai parent, an
adoptiv parenf or a stepparent of the child is 0 perceni{72 P.S.§9116�a)(i2)].
• The rate imposed oo the net vaiue of iransfers to or far the use af the decede�rt's 6neai beneflciaries is 4.5 percent, except as noted in
72 P.S. 9116(1.2)(72 P.S.§911$(a)(111.
• The taz rate imposad a�the net value of transfers to or for the use af t�e decedenfs siblings is 12 perceni[72 P.S.§9116(a)(1.3)j.A sibling is deflned,under
Section 9102,as an individual wha hae at least one parent in eommpn with the decedent,whether by blood or adopGon.
I
,
REA/-7508 EX+(6-98)
scN�ou�.� E
-�. C6MMONWEALTHOFPENNSYLVANIA �SFI� BANIC DEPOSITS� �[ MItJC.
'�.. INHERITANCE TAX RETURN pERSONAI PROPERTY
' RESIDENTDECEDEN7
ES ATE OF Fii.E NUM6ER
G raidine M. Meivin 21-13-0387
InGude tM proceeds af Iitlgalion and ttw date the proceeds were received by dre estete.
All property JoMNyawngd w(th�t u}turvivonhip�st 6e dirdocad or�Schaduie F.
ITEM VALUE AT pATE
N MBER DESCRIPTION OF DEATH
1 Belco Community Bank,Checking,no.766790 7,169.&8
2 Cash dn hand 20.00
3 leopoid St�kley Woodsn Bench 250.04
4 Misa Fumiture(Plant stand, Leaf-pattemed cheir,Sofa} 150.00
5 hiisc.Bedroom ltems 74.Q0
6 4 Fosbxia wine glasses 15.00
7 3 pcs 8eileek Iretand 61ass items 60.00
8 Lenox bawl and ashtray 40.00
9 GhairandTat�elamp 50A0
10 Misc.Rcwm ttems(Bros.sewing mach.,alerm dodc,wall dock,mircor,8 wall hangings) 50.00
11 3 iramed mirras 15.00
12 Cedar Chest 100.00
13 Misc.Costume Jewelry 194.00
14 Misc.Jewelry(4 chains and 3 braceletsj 1,800.00
( 15 Cain Coilection of Pennies{122 in number) . : 15.00
16 Can CWleefiion of Nidcels(39 in number) 10A0
i
17 Singer Sewing tabie 3p.00
18 Cherry vrood table : 154.Q0
i _
19 Washer&Dryer(-8 yrs oid) 3p0.00
( 20 Misc.Colfectibies(Milk giass items,X-mas decmatiars,�) 204.00
21 31 inch LG Flatscreen N 150.00
22 Me�ry S�le autanobile,Year 2Q00,lS Sedan 9,500.46
23 Belco Community Bank Savings 27�,gg
TOTpL(Also arder orr lins 5,Recapitulation) ; t4,606.58
(tt more space ie nesded,insart additional sheafs of tAe same size)
(
_
RE�-S530 E%+ (08-py)
', pennsylvania SCHEDULE G
', UEVRRTMENTOFFEVENUE INTER-VIVOS TRANSFERS AND
�NHea,TnNCernxaFruan MISC. NON—PROBATE PROPERTY
RES3DENT DECEDENT
E ATE OP PILE NUMBER
G raldine M. Melvin 21-13-0387
This schedule must be completed and filed if the answer to any of questions i through 4 on page three of the REV-1500 is yes.
I EM DESCRIPTION OF PROPERTY
iNUUOernexnneor�x�TUnrvsrEn�e,rxe�aaeunoxsmvrooeceo�rcrnxo DATEOFDEATH °kOFDECD'S EXCLl15lON TAXABLE
NU BER iHfORTE0F1MN5FER. ARqCHACOPYOFiryEDH�FO0.0.EPLESiATE. VALUEOFASSET INTEREST IFqPPLICRBLE VALUE
Valene M.Grcen, Daughter,July 2013(1l3 of IR4,see 72 P.S.9111(r)) 13,40871 ' 0 13,408.71 0.00
Z Jordon T.Connelty,Grandson,July 2013(1/3 of IRA,see 72 P.S.9111(r)) 13,40871 0 13,408.71 0.00
3 Elaine Connelly,Daughter,July 2013(1/3 ot IRA,see 72 P.S.9111(r)) �3,408.71 0 13,408.71 0.00
TOTAL(Also enter on Line 7, Recapitulation) ; 0.00�.
if more space is needed,use additional sheets of paper oF the same size.
_ .
RE�-75ll EX+ (30-09)
pennsylvania SCHEDULE H
oernH�Mrr��ar HeveHUe FUNERAL EXPENSES AND
���. INHERITqNCE TqX RETURN qDMINISTRATIVE COSTS
' ' 0.ESIDENT DECEDENT
E ATE OF FILE NUMlER
G raldine M. Melvin 21-13-0387
DecedenPs debts must be reported on Schedule I.
ITEM
UMBER DESCRIPTION AMOUNT
FUNERAL EXPENSES:
1' Malpeai Funeral Home,Funeral services
5,860.97
2 Mechanicsburg Club,Repast provider 503.69
ADMINISTRATIVE COSTS: � � � �
1. Personal Representative Commissions � � � ��� �
900.00
Name(s)of Pereonal Representative(s) Valetie M. Green
street nddress 1926 Princeton Avenue
City Camp Hill State PA itp 17011
Year(s)Commission Paid: 2013
Z Attorney Fees: 800.00
3� Family Exemption; (If decedent's address is not the same as daimant's,attach explanation.) 0.00 I�
Claimant
Street Address
City State ZIV
Relationship of Claimant to Decedent
4 Probate fees: 399.95
5 Accountant Fees 0.00
6� Tax Retum Preparer fees � 0 00
� CordierAucfans Appraisal Services 475.00
e Storage fees for personal property(5 months) 1,500.00
T07AL(Also enter on Line 9, Recapitulation) ¢�� 10,439.61 �
[f more space is needed,use additional sheets of paper of the same size.
_
a�r-rsrz ex+ �iz-oe�
, pennsylvania SCHEDULE I
I oernn,neH.orHFVer�oE DEBTS OF DECEDENT,
'""E0.'T""`E'A""�r°R" MORTGAGE LIABILITIES & LIENS
�� RESIDENT DKEDENT
E ATE OF FILE NUNBER
G raldine M. Melvin 21-13-0387
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbuned medial expensea.
ITEM
UMBER DESCRtPTION VALUE AT DATE
OF DEATH
1' Debts Associated with last illness(See attached)
2,052.03
2 Final living expenses(See attached) 7,123.50
TOTAL(Also enter on Line 10, Recapitulation) ¢�. 9,175.53 �
If more space is needed,insert additional sheetr of the same size. �
_ _ _ _ _ _ _
°• * o• *
139•35 + 170•46 +
ea.00 +
154•50 + 161•20 +
(�u�(p f. yy� pr•f��� 1'54•50 + . 13•07 +
� � JW 1 ��+ 177•00 + 29•73 +
156•0p + Q�1`�, (1�_� 53.i7 ,+
334•5� + pLJ111J� �"(.�.1 � c?_•16 +
72•00 + V�CA.VT �c1J 155•05 +
84•n0 + � 55r.�0 +
168•00 + ��1� g 875•fi6 + �:
- m��. �,�I^„ '�,S : 39�80 +
199•50 + "
82•50 + � 28•55 +
1�•50 + 145•21 +,
84•�JO +
28•00 + 34•g0 + '
49•28 +
68•68 + 1,548•32 +
•_ 5(3•00 + : 1,76?_•00 +
2i052•03 *' '9•�3 +
172•10 +
. 17•86 +
45•23 +.
...:. ,._ .,. .;: ......_.. ............ . 1'.):7•00 + -
1•;0, +
37+p7 +
19•85 + ;
°9•28. +
- 521•85 +
74•21 +
26•OB. +
1�5•05 +
2�5•33 +
1•pp +
1fi•08 +
24•2fl '+
7,123•50 *
�
;
ke�-isis ex+(ai-io>
; pennsylvania SCHE�UI.E �
� OEPAPtMENTOFNEVENUE � .
'I INNE0.ffANCE TqX RETU0.N BENEPICIARIES
' RESI�ENT DKEDENT �
E ATE OF: FItE NUNBER:
G raldine M. Melvin 21-18-0387
RELA.TIONSH[P TO DECEDENT AMOUNT OR SHARE
N MBER NAME AND AQDRESS OP PERSOk(S)RECESVIN6 RR4PERTY Do Nat 6at Ttustae{s} OF ESTATE
I 7AXABtE D[STRIBUTIONS[IncWde outright spousai d(strLutions and transfers under
Sec.9i16(a)(1.2),j
1. None nta O.Q4
_
ENTEA DOLLAR AMOUNT5 FOR D15TRIBlfTI0N5 SHOWN�ABOVE ON LINES IS 7HROUGH IB OF REWI500 COVER SHEET,AS APPROPRIATE.
II NON TAXABtf DISTRSBUT20N5
A. SPOUSA4 DISTRIBUTIONS UNDER 5ECTION 9113 FOR WHICH AN ELECT]pN 70 TAX IS NOT TAKEN:
i.
� _
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: �
i. . . . .. . . . . . . . . . . . .. . . . .
TOTAL OF RART II-ENTfR TOTAL NON•TAXABLE DISTRIBUTIONS ON LINE 13 OF ftEVd500 COVER SHEEL # � .
If more space is needed,use additional sheets of paper of the same size.