HomeMy WebLinkAbout10-03-13 � 150561�14�
��Y� 1VLV EX (61.10)
PA pepartment o1 Revenue OFFI4IAL U8E ONLY
eureau ot IndWidua�Taxes �NHERITANCE TAX RETURN County Code vear Fie Numher
ao sox zaosaT 2 1 1 2 a 1 1 3 5
Harrrobu Pn t7t28-t76ot RESIDENT DECEDENT
EN R DECEDENT INFORMATIpN BELOW
5ocial Security Number pate of Death MM04VWY Data of Birth n�MDpv`m
tI 9 2 3 2 � 1 2 � $ 1 � 1 9 9 1
Detedenfs l.ast Neme Sut�x DecedenPa First Name MI
tt E !. M A N J E N N I F E R K
�1T I�pplic�bla)Entar Survlving Spouas's IrvformaUOn 6slow
Sp�use's Last Name SufFlx Spouse'e Firat Neme - MI
N• 0 N E
Sp�uae's Sacial Security Numbar
' THIS RE7URN MUST BE FI�HD IN DUPLICATE W4TH TNE
REGIBTER C}F WI�I�S
PiL�IN APPROPRIATE OVALB BELOW
�� 1.Original Retum � 2.Supplementel Retum � 3. Remaindar Retum(date of death
priar to 12•13-82}
❑I 4.Umded fiafata Q 4a,Future intereaf Compmmiae(dste ot � 9.FeGerai EstaGe Tax Retum Requfred
�� daath after 12-12-82)
�li 8. Dacedent dMM Testete � 7. DeCedent Maintained a Living Truat � B.Total Number of Safa Depoait 9ox8a
{Attach Copy of Wi8) (Rttsch Gopy oi Trust}
�; 9.Lftipation PrpCeads Re�Wed Q �0.Spousal Poverty Crgtlit{tlate of de8th � 1 t.Ebctiorr to tax ur�r$mc.9113(A)
� belvroen 12-31-91 and 1-1-96) (Attach Sch.O)
COI RE$PONDENT-THIS BECTWN MUST BE CqMPLETEO.AlL CORRESPONDENCE AND CONFIDENTIAI TAX INFORMATKNi EHOULO BE�IRECTED T�:
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ATURE F Pgqp�R O'[MER TNAN REVRESENTATNE . �' 36 /3
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3631 N FRONT ST NARRISBURG PA 17110
� PIEASE USE ORIdINAL FORM ONLY
Sld�a 1
� 1505610140 1505610140 �
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__ __ _
_ - _ _ _
J 1505610240
REV-1500 EX
DacedenYs Soeial Sscurity Number
oecsaem'awame: JENNIFER K. HELMAN
R�CAPITUTATION
1. Real EState(Sthedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. .
2. Stocka and Bonda(Schedula B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. .
3: Closely Held Corporetion,Partnership or Sob-Proprietorship(Sehedub C) . . . . . 3. .
4; Mortgages and Nofas Receiveble(Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . 4. .
5.'�. Cash,Bank Deposita and Miscelleneous Peraonal Property(Schedule E). . . . . . . 5. $ 7 5 6 6 , 0 �
6!, Jointy Owned Property(Schedule F) ❑ Separate Billing Requeated . . . . . . . 6. .
7 i, Inter-Vivos Trenafere 8 Miaeellaneoua N�Probate PropeAy
� (Schedule G) Separete Bllliog Requested . . . . . . . 7. ,
s.; Toql 6ross Mf�b(total Linea 1 throuph 7) . . . . . . . .. . . . . .. . . . . . . .. . .. . 8. 5 7 5 6 6 , 0 0
9.���, Funerol Expensea and Administrative Coats(Schedule H) . . . . . . . . .. . . . . . . . . 9. 2 2 2 3 0 . 9 2
101 Debta ot Decedent, Motlgage Liabililies,and Liens(Sthedule p . . . . . . . . . . . . . 10. 1 1 3 7 6 . $ 6
1 L! Total Dsducdons(total Lines 9 end 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 3 3 6 0 7 . 4 8
12i� Nat Value ot Esmte(Line 8 minua Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 2 3 9 5 8 . 5 2
13i Chadtabb and Govemmental Bequesta/Sac 9113 Truata for which
���, an election to tax has not been made(Schedule J) . . . . . . . . . . . . . . . . . . . . . . 13. ,
ia.� Nst Value SubHct to Tax(Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . 14. 2 3 9 5 8 . 5 2
TAp(CALCULATION-SEE INSTRUCTIONS FOR APPUCABLE RATES
15.i Amount of Line 14 taxable
! at the spousal tax rote,or
'��, trenafers under See. 9116
' (a���.2>x.00 2 3 9 5 8 . 5 2 is. 0 . 0 �
16� Amount of llne 14 laxable
�', at lineal rate X.0_ 0 . 0 � 18. 0 . 0 0
17�, Amount of�ine 14 taxabb
��.. at sibling rate X.12 0 . � 0 17. Q , Q Q
78.�, Amount af Line 14 taxable �
����, et collateral rote X.15 � . � � �g, 0 . � 0
19.����,, TAX DUE . . . . . . . . . . . . . . . .. . .. . . . . . . . . . .. . .. . . . .. . .. . . . . . . . . . . . . 19. � • 0 0
20.�'. FILL IN TFiE OVAL IF YOU ARE REGUESTINf3 A REFUND OF AN OVERPAYMENT �
Side 2
� 1505610240 1505610240 �
_ _ _
REV-1500 E7( Page 3 Flla Numbar
Decedent's Complete Address: 2� �2 01135
DECEDENT'S NAME
JENNIFER K. HELMAN
STREETADDRESS
9 LOUIS LANE
CITY STATE ZIP
ENOLA PA 17025
Tax Paynhents and Credits:
�. Tarz Due(Page 2,Line 19) (1) 0.00
2. Credits/Payments
A.Pnor P2ymenis
B.Discount
Total Credits(A+g) (p) 0.00
3. Interest '
4. If Line 2 islgreffier than Line 1 +�ine 3,enter the difference.This is the OVERPAYMENT. (3)
I FIII in owl on Page 2,Line 10 to request a rclund. (4) 0.00
5. If Line 1 +ILine 3 is greater than Une 2,enter the diHerence.This is the TAX DUE. (5) 0.00
', Make check payable to: REGISTER OF WILLS, AGENT
i ,�;i ,>s�,'s`�;I!'1't ,4�tiS�{IiII�II��I4lqiilil�'i1��3jiiYil,I�ii4i'i�j�I�lil�'!�i{I{Ii�I, �•i IiEllfl;ilil �i�p'�CI!�tM(� ,,is�+�i�i�j�l�i���i`!' i 'wdi � .;:
� Ia �'II11 I� �.I6 {E.�r�,�a=, � � �4 ,�� �.
P�.EASE 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 incortre of the property lransferred: ...................................................................... ❑ �
b. retain the nght to designate who shall use the property transferred or its income; .......................... ❑ Q
c. retain a reversionary interest,or ................................................................................................ ❑ �
d. receive the promise for lite ot either payments,benefits or care? ....................................................... ❑ �
2. If death occurted after December 12,1982,did decedent hansfer propeAy within one year of death
without receiving adequate consideration7 ....................................................................................... O �
' 3. Did decedent own an'in trust for'or payaNe-upon-death bank account or security at his a her death7 ......... ❑
4. Did decedent own an individual retirement account,annuity or other non-probate propeAy,which
contains a beneticiary designation7.................................................................................................. ❑ �
IF THE ANS�VER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
. � . .'i t� i (� n�hi.(.t ' '; i� � .t�..� � , l i�: y . ..
For dates of d ath on or after July 1, 1994,and before Jan. 1, 1995,the tax rate imposed on lhe net value of transfers to or for the use of ihe surviving spouse is
3 percent[72�.S.§9116(a)(t.t)(i)].
For dates of d$ath on or after Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of fhe surviving spouse is 0 percent
[72 P.S.§911�(a)(1.1)(ii)].The statute does not exempt a hansfer to a surviving spouse hom tax,and the statutory requirements for disdosure of assets and
filing a tax retuVn are still applicable even if the surviving spouse is the only beneficiary.
For dates of d�ath on or afler July 1,2000:
• The tax rat imposed on the net value of Gansfers fram a deceased child 21 years of age or younger at death to or for the use of a natural parent,an
adoptive pa ent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)].
• The tax rat 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.§91�6(1.2)[72 P.S.§9116(a)(1)1.
• The tax rat�imposad on the net value of hansfers to or for the use of the decedenPs siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is defined,under
Secdon 910�,as an individual who has at least one parent in common with the decedent,whether by blood or adop6on.
_ __ _ _
REV-150B EX+(OB-12)
pennsylvania SCHEDULE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC.
RESIDENTDECEDENTTURN pERSONAL PROPERTY
ESTATE OF: FILE UMBER:
JENNIFER K. HELMAN 21 12 01135
Include 1M proceeda ot Iltigetion and the dete the proceeds wero roceNed by the eatate.
All prop�rly Jolndy own�d with right of survivorship must M dlselo�W on SeMduN P.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Litigation proceeds received under the survival action pursuant to Cumberland County 57,500.00
Court of Common Pleas Order dated September 11, 2013. A copy of this Order is
attached.
2. Ambulance refund 36.00
3. ' 2012 Federal Income Tax refund 30.00
TOTAL(Also enter on Line 5,Recapituladon) S 57 566.00
If moro space is needed,use addkbnal aheeta ot peper of tM same aize.
_._._ _''_ ..... _ . .__. . ....._ . _,... _ ._.—__. . .. .. .. .
REV-iS11 EXr{tb-08}
pennsylvania SCHEDULE H
�EPqi2TMEMT OF REVENUE FUNERAL EXPENSES APID
�"Er��"�cETr�r�TUa�'' ADMINISTRATIVE COS7S
RESIDENT CIECEOENT
ESTATE pF FILE NUMBER
JE{VfViFEf� K. HE�MAP! 2f 12 41135
, DeeedrnYe debb mutt M roportW on&h�dale I.
ITEM
NUMBER pESCRIPTIpN AMOUNT
A. FUNERAL�XPENSES:
t. Meat after funerei 2,512.54
B. i ApMINISTRATIVECOST5:
1. Ferson�Representative Gammissiarrs:
' Name(s)ot Pernunel RepraseMatWe(s)
' StraetAddrsss
�.. CMy SiaM ZIP
� Yeer{a)Commbeion Paid:
2. Anomoy Pees:
3, ', FamWyEzemplMn:(ItdecedeaPeaddresaYanmthesameasdaimenYa,aHact�explaneGon.}
qeknar�
�� StroetAddrass �
�:. Cky SWte 2!P
- Reiatbnship of CleimaM M 6aCederif
4. PmbakFees: 198.50
5 Axountant Feas:
8. � Tmc Retum Prepererfees;
7. Attomey fees for personal injury case apportioned 50/50 helween wrongful death and 19,166.50
survivar actions
8. Legal advertising in The Sentinet and Cumberiand Couniy Law Joumai 353.42
TOTA1.(Also entar on Une 9,RecapitulaNan) S 22 230.92
It mo�e space b needed use addWonal aMets nf ppper ot the same alze.
ttEU-1512 EX*(12t2}
pennsylvania SCHEDULE I
OEPARTMENT OF REVENUE DfBTS 4F DECEDENT�
itixeairnNCeT,vcReruwy MORTGAGE 11ABILITIES&11ENS
RESIDENT OECEDEN7
ESTATE OF PIlE NUt�ER
JENN1FEFt'K. NELMAN 21 12 01135
Report debb Incurted 6ylha deeadent prlor tc deeth thst remainad unpeld at the date of dath,Ineluding unrNmbuned medical expen�n.
ITEM VA�UE AT DATE
NUMBER DESCRIPTION OF DEATH
�. TCS I�c:Metro Bank 61.25
2. NCO Financial Systems-Sprint 92.76
3. Car loan with Christiana R. Noel 11,222.55
TdTAL{Aisa eM�on line 10,Recapituiatipn) S 11 376.58
It more apaco ia needed,inaert additional sheeh of the eame sae.
ftEV-05t3 EX3{4?-f0}
pennsylvania SCHEDULE J
�EPARTMENT OF REVENUE gENEFf CIARIES
INHEiGTANCE TAX RETURN
RESIDENT DECEDENT
ESTATE dP: FILE NUMBER:
JENNIPER I{. HE�AAAfd 21 12 01135
REL4TIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME ANO A�DRESS OF PERSON($)RECEIVING PROPERTY Do Npt LIM Tnl�t��) OF ESTATE
j AXABLE DISTRIBUTIONS (ir�ie a�iant apawa�d�utb�ar�d aamk(s u�
Sec.9t�9(a}{t.2}.)
�. Christiana R. Nael Spousal ane-half
9 Loula Lane
Enola, PA 17025
2, Kenneth Helman Spousal ane-half
644 Mountain Street
Enola, PR 17425
6NTER C�LLAR AMOUNTS FOR DISTRI9U'tiONS SH(7WN A@QVE QN LINES 15 THRQUGH t$OF RfY-15dQ CQVER SHEET,A8 APPRQPRIATf.
II. ON-TAXABLE DiSTRI8U73QNS;
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN;
1.
9.CHARITABLE AND GOVERNMENTAL DISTR�BUTIONS:
t.
TOTA4 OF PARt II-ENTER T07AL NON•TAXABIE OISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. S
K rtwre space is needed,use addi�onal sheets N peper of the same size.
_ __ __ . __,
. �
IN RE: ESTATE OF JENNIFER K. HELMAN, : IN THE COURT OF COMMON PLEAS
DECEASED : CUMBERLAND COUNTY,
: PENNSYLVANIA
: ORPHANS' COURT DIVISION
: NO. ,ZI' IZ' I I��
ORDER
1h
AND NOW, this �� day of S c�. 2013, upon consideration of the Petition to
Approve Settlement, Apportionment, and Distribution of Wrongful Death and Survivor Action,
IT IS HEREBY ORDERED that the $115,000.00 settlement is approved and shall be
' apportioned $57,500.00 to the wrongful death claim and $57,500.00 to the survivor claim.
Christiana R. Noel, as Administratrix of the Estate of Jennifer K. Helman, is authorized
to distribute $57,500.00 to the Estate of Jennifer K. Helman, Deceased, and distribute the net
proceeds equally between the intestate beneficiaries, Christiana R. Noel and Kenneth P. Helman,
Sr.
BY THE COURT:
DISTRIBUTION:
Elizabeth H. Feather, Esquire, Caldwell & Kearns, P.C., 3631 N. Front Street, Harrisburg, PA
17110; efeather u,cklegal.net; phone—(?17) 232-7661; fax—(717) 232-2766
c,
. . . ...�. P�.
- ` " A 7RU€ COPY FROM RECORC
'_' `_� In Tesdmony wherof;l hereunto
` :: > �.� ��; set my hend and the seai
�r� �; of sa�C Court .t Csulisle, PA
; � _., ie„� day q, 20-�
.- . , � c= �.
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;.� -- �.i
r� .°'_ Clerk of tfie ns Cour
;;; `.'- ° � Cum rl d CounP.
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CALDWELL & KEARNS
Ju�u R.Cuw�xo[n
lu�c�L Ooiuwnx A PROPESSIONAL CORPORATION Op COU�SFy
SnwuvlA l.wcwn�u liwee D.Gwre[u,1R.
oouow x.�w.wo AITORNEYS AT LAW �s��.i�i
BnEiT M.WoaoYwu
Mcru[�D.R¢o � -
MeNUtA FuMF11 TxpMB D.GIDW[L4 JP.
T"°'"^'M.F""^c�w 3631 NORTH FRONT STREEf �i94a]OOi)
�"`"M'400D HARRISBURG,PENNSYLVANIA 1711P1633
Eywflx X.FGix[n fML�.W�Vs
Gxroarc D.Gnss
T�s.�E 717-232•7681 Ila3�-smo)
oh�o L e�nxua FAX:717-232-2766 rsiau�o�Munw
JFfsirw E.M�nev
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THEFIRM�CKLEGAL.NEf
October 4, 2013
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Glenda Farner Strasbaugh, Register of Wills � -�o —�-, cn �
Cumberland County Courthouse � Z m � m� o
One Courthouse Squaze a v, � o 0
Cazlisle, PA 17013-3387 0 � � �+ -^
� � � � � �
a � r-• - �
Att: Diane . � N ,'-- m
A C'J U� �
N
Re: Estate of Jennifer K. Helman
File No. 2012-01135
Dear Diane:
Enclosed please find a check payable to yow office in the amount of$15.00. This check
represents the filing fee for the Pennsylvania lnheritance Tax Retum which was previously
mailed to your office.
I have also enclosed a check payable to your office in the amount of$115 for the
additional Letters fee which is due.
Thank you for your assistance with this matter.
Very tnily yours,
�� � ��
Elizabeth H. Feather
CALDWELL & KEARNS, P.C.
efeather@cklegal.net
EHF:nb
lEnclosures
12364-OOl/207369
_ . . _ .
CALDWELL & KEARNS
I��MFS R.CurnxoEn
���ao++�� A PROFESSIONAL CORPORATION OF COUNSEL
Siwxcvl.A Wxowwl
oaaw K.ntwrco ATTORNEYS AT LAW w,ae o.cwweu.m.
eimr M.w000wnx cw�in.e l.oown,m
IMmui[�D.Ihso — —
MkwietA F�x�FLL
T"°'"n°M.F""^`Ew 3831 NORTH FRONT STREET T�����"'�"'
Pa`"M.a°°° HARRISBUR6,PENNSYLVANIA 171163633 Ilaza-�aoi�
�""'°EM M.Fuixcx
OREeoar D.Cmf ��'W'w
TMO�w S.ltE 71��Z�2-�661 (1937•Y030)
wun�.flsnwun FAX:717-232-2766 nxau�o�Kunw
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October 2, 2013 0 �, �; �i ;�, �
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Glenda Famer Strasbaugh, Register of Wills � � � �
Cumberland County Courthouse
One Courthouse Square
Cazlisle, PA 17013-3387
Re: Estate of Jennifer K. Helman
File No. 2012-01135
Deaz Ms. Strasbaugh:
Enclosed please find the original and one (1) copy of the Pennsylvania lnheritance Tax
Return. Please file the same. I have also enclosed a copy of the front page of the Inheritance
Tax Return for you to time-stamp and retum to me in the enclosed self-addressed, stamped
envelope.
A check payable to your office in the amount of$15.00 is enclosed for the Inheritance
Tax Return filing fee.
Thank you for your attention to this matter. If you have any questions, please contact me.
Very truly yours,
��� �r ��.
Elizabeth H. Feather
CALDWELL &KEARNS, P.C.
efeather@cklegal.net
EHF:nb
/Enclosures
cc: Christiana R. Noel w/enclosure
12364-IX11/207302
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