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Home My WebLink About10-28-13 � � � �` � 1505610140 REV-1500 � �01-10) PA Department of Revenue t�F�1C{f�L USE QWLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERfTANCE TAX RETURN Harrisbur ,PA 17128-0601 RESIDENT DECEDENT 2 1 1 2 � 1 2 3 9 ENTER DECEDENT INFORMATION BELOW Social Securit�r Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 0 9 1 4 2 0 1 2 0 4 2 3 1 9 4 3 Decedent's Last Name Suffix Decedent's First Name . M� N e m i r f� i c h a e 1 A (If Applicabie)Enter Surviving Spouse's Information Below Spouse's Last Name Su�x Spouse's First Name M� Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW Q 1.Original Return � 2.Supplemental Retum � 3.Remainder Return(date of death prior to 12-13-82) � 4.Limited Esfate � 4a.Future Interest Compromise(date of � 5.Federal Estate Tax Return Required death after 12-12-82) QX 6.Decc�dent Died Testate � 7.Decedent Maintained a Living Trust 1 8.Total Number of Safe Deposit Boxes (Attach Copy of�Wili) (Attach Copy of T�ust) � 9.Litigation Proceeds Received � 10.Spousal Poverty Credit(date of death � 11.Election to tax under Sec.9113(A) between 12-31-91 and 1-1-95) (Attach Sch.O),.. CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX 1 RMATION SF�..D B�IF�TED T0: Name Daytim� hone N er � � P a u 1 T - S c h e ''�`� � � `� m e 1 ,�, � � -� �� r �a �,, r- ;� --� � ��+f�'erG E F US�1�1' (+!A��.. W � �+xJ W tir� !°"R � � First line of address � �� ,�,�,& � � � � f"""^' 44'»�:i,� r.+� iW �w..v � 1 ], 9 E • B a 1 t i m o r e S t r e e t `.� "—�� '�" �.: � Second line of address �. � crn ,,,�� City or POSt OffiCe State ZIP Code DATE FILED G r e e n c a s t 1 e \ P A 1 7 z 2 5 Correspondent's e-mail address: pauldsslaw(c�pa.net Unde�penalties of pe�jury,I deGare that I have examined this retum,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. SIGN RE dF PERSON R ON IBLE FOR FILI�RETURN DATE /- i ADDRESS 15019 Hicksville Road Clear Sprinq MD 21722 SIGNAT OF PR A AN PRESENTATIVE DATE ADDRESS — 119 E• Baltimore Street Greencastle PA 17225 . � PLEASE USE OR(GINAL FORM ONLY � Side 1 � 1,505610140 '` 15056],01,40 � � , �- � 1505610240 REV-1500 EX Decedent's Social Security Number DecedenYs Name: M 1 C I'1 a 21 A . N e m i r RECAPITULATION 1. Real Estate(Schedule A) ......... ... .... . . ...... ......... .... .... . . 1• • 2. Stocks and Bonds(Schedule B) ...... ... .. . .. ..... . ........ .. ...... 2. • 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) . .. .. 3. • 4. Mortgages and Notes Receivable(Schedule D) .............. ............ 4. • 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. 2 � 4 6 4 6 . 9 3 6. Jointiy Owned Property(Schedule F) ❑ Separate Biiling Requested ... ... . 6. • 7. Inter-�vos Transfers&Miscellaneous Non-Probate Property (Schedule G) � Separate Billing Requested . . . .... 7. . 8. Total Gross Assets(total Lines 1 through� ........... ............. . . . 8. 2 � 4 6 4 6 . 9 3 9. Funeral E�enses and Administrative Costs(Schedule H) ......... ....... .. 9• 2 9 2 9 � . � 3 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule I) . 10. 7 7 3 5 7 8 . 9 4 11. Total Deductions(total Lines 9 and 10) ................ . . .. .... .. .. . . . 11. 8 0 2 8 6 8 . 9 � 12. Net Value of Estate(Line 8 minus Line 11) .................. .......... �2. - 5 9 8 2 2 2 . � 4 -- 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. - 5 9 8 2 2 2 . � 4 TAX CALCULATION-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.0 � . � 0 15. � . � 0 16. Amount of Line'(�4 taxable at lineal rate X.045 � . 0 0 �g. 0 . � 0 17. Amount of Line 14 taxable at sibling rate X.12 0 • � 0 17. 0 . � 0 18. Amount of Line 14 taxable at collateral rate X.15 0 • 0 0 1 g, 0 • � 0 19. TAX DUE ......... ........... . ... ... . ..... ...... . . ..... . .. . . ... 19. � • � 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Side 2 _ ___� ],5056-10240_ _ _ _____ __. _-- _____ __ 15�-561,�2-40- t . _ _ _ . REV-1508 EX+(11-10) - , pennsylvania SCHED!/LE E DEPARTMENT OF REVENUE INHERITANCETAXREfURN CASH, BANK DEP�StTS, & MISC. RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: Michael A. Nemir FILE NUMBER: InGude tfie proceeds of litigation and the date the proc�eds were received by the estate? 01239 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE �• Sentry(nsurance, long term disability check(prorated thru 9/14/2012) OF DEATH 41.67 2� Sentry Insurance, long term disability check(August benefit) 1,250.00 3• Bank of America, Interest Checking Account#....0588 Principal$6,084.53; accrued interest$0.03 6,084.56 4• Columbia Bank, Checking Account#0155000742 Principal$322.99; accrued interest$0.00 322•99 �• Susquehanna Bank, Checking Account#1203070801 Principal$185,117.18; accrued interest$23.49 185,140.67 6• Uncashed check from LLARM Venture Partnership 7,500.00 7• LLARM Venture Partnership, final payment 652.74 8• United HealthCare Services, Inc., refund 76.30 9• US Treasury, 2008 Individual (ncome Tax Refund 2,322.00 10. Maryland Comptroller, 2008 Individual Income Tax Refund 1,256.00 _ - __ ___ __ ___ ___ ._ _._-----__---__-- - --_____---__-- -----__________--___.-- _.___ TOTAL(Also enter on Line 5,Recapitulation) $ 204 646.93 If more space is needed,insert additional sheefs of paper of the same size . • REV-1511 EX+(�a09) . pennsylvania SCHEDULE H � °EP,�T"'E"T oF R�""E FUNERAL EXPENSES AND INHERITANCETAXRETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Michael A. Nemir 21 12 01239 Decedent's debts must be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Rest Haven Funeral Chapel, funeral services 5,222.00 2. Rest Haven Cemetery, headstone placement/engraving 1,917.78 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Per�onal Representative(sj Diane M. Estep 10,175.00 StreetAddress 15019 Hicksville Road �;ty Clear Spring State M� Z1P 21722 Year(s)Commission Paid: 2013 2, Attomey Fees: Dick, Stein, Schemel,Wine&Frey, LLP 10,175.00 3. Family Exemption:(lf decedenYs address is not the same as claimant's,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Dec.edent 4. Probate Fees: Cumberland Couniy Register of Wills 403.50 5 Accountarrt Fees: 6. Tax Retum Preparer Fees: Albright Crumbacker Moul&Itell, LLC, income tax preparation 1,200.00 7. Joseph F. Silek, Jr., attorney's fee 168.75 8. Dick, Stein, Schemel, Wine& Frey, LLP, reimburse postage/notary expenses 25.00 9. Susquehanna Bank, bank statement fee 3.00 _ _ ____- ------._-------------------------- ----- --._ _ -_-_---------------------T-O-T-AL-(Also-enter-on-L-ine-9;-Reeapitulation)--$-..--------- - - - 29�2�0:03 _ If more space is needed,use additional sheets of paper of the same size. k � REV-1512 EX+(12-08) . � pennsylvania SCHEDULE 1 DEPARTMENT OF REVENUE DEBTS�F DECEDENT, INHERITANCETAXRETURN MORTGAGE LIABILfTIES, &LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Michael A. Nemir 21 12 01239 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. Checks and debits issued prior to death not clearing the account until after death 1,220.75 (see attached bank statement) 2. Medical Express Ambulance Service, Inc., ambulatory services 61.25 3. West Shore Emergency Medical Services, ambulatory services 98.65 4. Pinnacle Health Hospitals, medical services 26,694.34 5. Pinnacle Health Medical Services, medical services 210.75 6. AAA Financial Services, credit card balance due on account#....4264 5,911.51 7. Quantum Imaging and Therapeutic Associates, medical services 10.28 8. Alpha Diagnostics, LLC, medical services 29.53 9. Albright Crumbacker Moul &Itell, LLC, income tax preparation 890.00 10. USAA Visa, credit card balance due on account#....9775 7,203.99 11. Fox Subacute at Mechanicsburg, subacute nursing care services 670,179.74 12. Holy Spirit Hospital of the Sister of Christian Charity, nursing care services 60,772.68 13. Ljubisa M. Stankovic, MD, medical services 151.92 14. Medical Express Ambulance Services, ambulatory services 61.25 15. Lawall at Hershey, medical services 82.30 _ ____ _ _ _____ TOTAL(Also enter on Line 10,Recapitulation) $ ?7�578.94 If more space is needed,insert additional sheets of the same size. � • _ _ _ Sc,�squehr�hhc� ' Ba�k Date 9/26/12 Page 2 Primary Acct # 1203070801 Enclosures MICHAEL A NEMIR 15019 HICKSVILLE ROAD CLEAR SPRING MD 21722-1229 - RELATIONSHIP CHECKING: SENIOR 1203070801 (Continued) WITHDRAWALS AND DEBITS Date Description Amount Reference 9/05 GOLD'S GYM - HAG Club Dues 18 . 00- 057843700 PPD 1201761406 � 9/12 AT&T SERVICES CHECKPAYMT 225. 03- .112902167 ARC 4930 1742782655 9/14 FOOD LION POP 4864 141.74- 661432326 GE MD 9/17 THE GUARDIAN INSUR PREM 100. 00-�' 360819643 pPD 9555845001 9/17 FIA CardServices CHECK PYMT 450. 00-� 000408103 ARC 4867 2200000005 9/18 POTOMACMD BILL PYMT 376. 99-,� 7�9559047 ARC 4869 2258580009 SUMMARY BY CHECK NUMBER Date Check No Amount Reference Date Check No Amount Reference 8/27 4836 245. 00 001518910 9/10 4860 95.00 000302090 8/27 4838* -See above- 941798407 9/14 4861 1, 011. 00 0 3990 8/27 4841* 400. 00 000240050 9/14 4862 372 . 06 000344420 8/31 4842 -See above- 301440213 9/12 4863 400. 00 000381350 8/31 4843 690. 00 000105780 9/14 4864 -See above- 661432326� 9/04 4844 -See above- 534903893 9/18 4866* 200.00 000248780 9/05 4845 563. 84 000151330 4867 - ee a ove- 9/10 4846 109. 00 000543470 9/18 68 45.00 000305780 9/OS 4853* 707. 00 00022529� -See above- 8/31 4854 400. 00 000198440 �9�6 4926* 134. 78 002741370 9/07 4856* 186. 95 000148480 9/12 4928* 7, 274. 91 000247140 9/06 4857 239.25 000302770 9/12 493 * - e above- 112902167 9/06 4858 5, 335. 00 004334340 9/17 4931 48.76 00029046 9/06 4859 400. 00 000323760 9/07 4934* 760. 68 000214680 * Indicates Skip in Check Numbers �'C�2�.�s c�l�.�i� !.� a�{� a�CG�� r r ' •`^-LI T` �� . 7 SUNi.M1�.kY uF DAILY ALAidCES Date Balance Date Balance Date Balance $�24 196, 235.25 9/06 195, 693.55 9/17 184, 518. 42 $�27 203, 003 .27 9/07 194, 745. 92 9/18 183, 896. 43 8/31 203, 457 . 13 9/10 194,541.92 9/26 183, 932.22 9/04 203, 091. 42 9/12 186, 641. 98 9/OS 201, 802.58 14 185, 117 .1�8 � � ��.��'an - R�V-1513 EX+(01-10) � � ; pennsylvania DEPARTMENT OF REVENUE S C H E D U L E J INHERITANCE TAX RETURN BENEFiCIARiES RES(DENT DECEDENT ESTATE OF: Michael A. Nemir FtLE NUMBER: 21 12 01239 NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY RELATIONSHIP TO DECEDENT AMOUNT OR SHARE j, TAXABLE DISTRIBUTIONS [Include o�ht spousal distributions and transfers under �O Not List Trustee(s) OF ESTATE Sec.91 6(a)(1.2).j 1• Diane M. Estep 15019 HicksviHe Road Collateral Clear Spring, MD 21722 25% 2• Mary Lou Hauver 410 S. Potomac Street Lineal Hagerstown, MD 21740 25% 3• Christina Nemir 50 South Cannon Avenue Lineal Hagerstown, Mp 21740 25% 4- Andrea L. Nemir 1005 Lindsay Lane Lineal Hagerstown, MD 21740 25% ENTER DOLLAR AMOUNTS FOR DlSTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV 1500 COV II. NON-TAXABLE DISTf�IBUTIONS: ER SHEET,AS APPROPRIATE. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B,CNARITABLE AND GOVERNMENTAL DISTRIBUTIONS: �- 1. _ ----_ __. - -----__OTAL OF PART.II_-ENiEftSOSAL_NQDL-TAX,9gL�Dl_SIf3JBUTLO S 0 LINE 13_OF REV 1500 COVER SHEET.___ $ ------------___--- - If more space is needed,use additional sheets of paper of the same size. � �� - �. -�- _-��,��,�,�,��,� DICK, STEIN, SCHEMEL , WINE & FREy, LLP ��ATTORNEYS AT LAW WILLIAM S.DICK J0�W.F�Y JA�s M. STEIN(�mo admitted in uq JOSEPH L.DOYLE 13 W MAIN STREET�SUITE 21 O 119 E.BALTIMORE STREET PAU�.T.SCHEMEL�n�o a�ea r,u,w�uw� ELIZABETH A.CLARK Nmo�e;,n�,�a� wA�SBORO,PA 17268 G�ENCASTT,E,pA 1']225 J.EDGAR WINE (717)762-1160 (717)597-0200 F�c(717)762-6040 FAx(717)597-2542 Cumberland County Register of Wills �ctober 23, 2013 1 Courtliouse Square,Room 102 Carlisle,PA 17013 RE: Estate of Michael Nemir Dear Sir or Madam: Please find inclosed the inheritance tax return and inventory for the above r esta.te, together with a check for the filing and probate fees. If you have an uesti eferenced these documents please contact me at 597-0200 or auldsslaw a.net . �q ons regarding attenhon to this matter. — �you for your Very truly yours, .. . , Paul T. Schemel PTS/ — enclosures c� �==> C ::i �a � � � � � .... C�3 '```I ..� � � � � � � ,�;: C`� ---�i {,� � � }:a; t'�' N �� .,�, ,«�,`�-.. i`�"'6 P'�"'1 �'�"# ...�, � ..�a � :� C7 � ° �c - � � a,'� ..�,.�.� `�"t `�"'B � C9 ,.�,� „�;... "�"1 C� � .;�; —.-» - : ::,:+ � "`..' C? '..�3 `� i"" �"�'1 = b- t'V CJ� c� � "�1 0 � � �� d � � � o ,r� t� O "_ y t�i N o � t� � G� � � Z � �► e� � � � n z o b � � O tx w � � � � � � y � r � '"d O y � a � r � � � � N y � � _�,�,..�_ vi � � " O � ,. �! y � �;_: � ,,� y �-, � r � b y . �� ..«� ��- k.'� �� s'"�,: � .,, � �� .'�F: ; r+, . - , �r.w.'�: «►: � � . } ` :_�, v��; s �,y � `r F � ��'�T - !iMy4 q!wrM4 �L �. a. �a- " �.� :l: �2 �' �A' �a �TC�!a r�� ___�_:C'},�.{a&�:i__