HomeMy WebLinkAbout11-13-13 (3) REV-1500 EX(02-11), " 1505610143
PA Department of Revenue y OFFICIAL USE ONLY
p penes Ivania County Code Year File Number
Bureau of Individual Taxes DEPARTMENT OF REVENUE
PO BOx.280601 INHERITANCE TAX RETURN 21 13 0396
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
02 20 2013 01 17 1940
Decedent's Last Name Suffix Decedent's First Name MI
TODD PATRICIA J
(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)
F-1 4. Limited Estate ❑ 4a.Future Interest Compromise 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
❑ 6 Decedent Died Testate 7• Decade poMaiotThud a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) GG pY )
9. Litigation Proceeds Received 10.Spousel Poverlv credit Date of Death 11.Election to tax under Sec.9113(A)
❑ ❑ between 12-31 91 and -1-95) ❑ (Attach Schedule 0)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Dayylime TelephotL1 Vumber
MARK A MATEYA 71= 41 65 0 Of', rn
r1
;:Z1 ca
C_
I�tEPOF V�I LS USEVNLY
rrt GJ 17
First Line of Address G) GJ
55 W CHURCH AVENUE c7 a :2
Second Line of Address Cfl
CO
City or Post Office State ZIP Code DATE FILED
CARLISLE PA 17013
Correspondent's e-mail address: mam @mateyalaw.com
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.
SIGNAT PERSON RESPONSIBLE FOR FIL G RETU DATE
( ��GC, Edward C Todd
ADDRESS
864 Carlwynne Manor,Apt B 303, Carlisle, PA 17013
SIGNATURE OF PREPARER THER THAN REPRESENTATIVE DAT
M G-.�IJ/)„ Mark A. Mateya
ADDRESS
55 W. Church Avenue, Carlisle, PA
Side 1
1505610143 1505610143
1505610243
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: Todd, Patricia J
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&Notes Receivable(Schedule D)........................................................ 4.
5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 375, 793 . 86
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 5 , 416 .41
7. Inter-Vivos Transfers&Miscellaneous -Probate Property
(Schedule G) � Separate Billing Requested............ 7. 102 , 172 . 15
8. Total Gross Assets (total Lines 1 through 7)........................................................ 8. 483, 382 . 42
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 21, 807 . 81
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 19. 80
11. Total Deductions(total Lines 9 and 10)................................................................ 11. 21f827 . 61
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 461, 554 . 81
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. 461, 554 . 81
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 191f649. 32 15. 0 . 00
16. Amount of Line 14 taxable 269, 905. 49 16. 12 ,145 . 75
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. 12 ,145 . 75
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 21-2013-0396
Decedent's Complete Address:
DECEDENT'S NAME
Todd, Patricia J
STREET ADDRESS
864 Carlwynne Manor,Apt B 303
CITY STATE ZIP
Carlisle PA 17013
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 12,145.75
2. Credits/Payments
A. Prior Payments 7,650.00
B. Discount 402.63
Total Credits(A +B) (2) 8,052.63
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) 4,093.12
Make Check Pa able 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?............ ....................................................................................................... ❑ ❑x
3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?....... ❑ ❑
4. Did decedent own an individual retirement account,annuity,or other non-probate property which
contains a beneficiary designation?.................................................................................................................. ❑x ❑
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-1508 EX+(11-10)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Todd, Patricia J I21-201 013_0-0396
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with the right of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Citizens Bank-Circle Gold Checking Account-No. 383-1 53,181.05
2 Citizens Bank-Circle Gold Money Market Account No. 221-5 107,395.07
3 Citizens Bank-Certificate of Deposit-Account No. 5188 5,005.10
4 Citizens Bank-Certificate of Deposit-Account No.9359 20,000.95
5 Citizens Bank-Certificate of Deposit-Account No.3519 51,620.67
6 Citizens Bank-Certificate of Deposit-Account No.2677 10,022.35
7 Citizens Bank-Certificate of Deposit-Account No.5013 5,003.12
8 Citizens Bank-Certificate of Deposit-Account No.9480 5,868.15
9 Citizens Investment Services-Investment Account-No. L7K-340766 4,751.37
10 HSBC-Certificate of Deposit-Account No. 062-50434-7 48,813.39
11 Citizens Bank-IRA CD-Account 6884 5,978.23
12 Citizens Bank-IRA CD-Account 2685 58,154.41
TOTAL(Also enter on Line 5, Recapitulation) 375,793.86
(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-1509 EX+(01-10)
pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Todd, Patricia J 21-2013-0396
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. Edward C Todd 864 Carlwynne Manor Apt B 303 Spouse
Carlisle, PA 17013
B.
C.
JOINTLY OWNED PROPERTY:
LETTER DATE INCLUDE NAME OF DE$NRAL INSTITUTION OFON AND BANK ACCOUNT % D' DATE OF
E OF
ITEM FOR JOINT MADE NUMBER OR SIMILAR IDENTIFYING NUMBER.ATTACH DEED FOR DATE OF DEATH DECD$ DECEDENT'S INTEREST
NUMBER TENANT JOINT JOINTLY-HELD REAL ESTATE. VALUE OF ASSE INTEREST
1 Automobile-1996 Nissan-Jointly owned 500.00 50.000% 250.00
with spouse-Kelly Blue Book value-See
attached
2 Fidelity Investments-Mutual Funds jointly 9,843.42 50.000% 4,921.71
owned with Spouse -with rights of
survivorship-Account No. 2BE-610488
3 PNC Bank-Joint checking account 489.39 50.000% 244.70
#5140193003
TOTAL(Also enter on Line 6, Recapitulation) 5,416.41
(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 F(Rev.01-10)
Rev-1510 EX+(08-09)
SCHEDULE G
pennsylvania INTER-VIVOS TRANSFERS AND
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Todd, Patricia J 21-2013-0396
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % DECD'S EXCLUSION TAXABLE
NUMBER THE
INCLUDE
ATE OF TROANSFER. ATTACH A COPY O
F THE DEIED FOR DECEDENT AND REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1 Citizens Bank-IRA Account No. 6244692573 2,022.68 2,022.68
2 Citizens Bank-IRA CD-Account 6247705749 5,945.71 5,945.71
3 Citizens Bank-IRA Acct. No. 6250436155 5,710.28 5,710.28
4 Citizens Bank-IRA Account No. 6250437097 4,910.90 4,910.90
5 Citizens Bank-IRA Account No. 6261-834667 27,142.10 27,142.10
6 Citizens Bank-IRA Account No. 6261-834675 27,142.10 27,142.10
7 Citizens Bank-IRA Account No. 6261-834659 27,142.10 27,142.10
8 Philippine National Bank-Checking account No. 2,156.28 2,156.28
94003696000025
TOTAL(Also enter on Line 7, Recapitulation) 102,172.15
(If more space is needed,additional pages of the same size)
Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule G(Rev.08-09)
REV-1511 EX+(10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX
RESIDENTDECEDENTTURN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Todd, Patricia J 21-2013-0396
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 5,544.16
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State ZiD
Year(s)Commission Paid
2. Attornev's Fees Mark A. Mateya 15,500.00
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation)
Claimant
Street Address
City State ZiD
RelationshiD of Claimant to Decedent
4. Probate Fees 313.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 450.15
See continuation schedule(s) attached
TOTAL(Also enter on line 9, Recapitulation) 21,807.81
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
Todd, Patricia J 21-2013-0396
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Ex ep nses
1 Ewing Brothers Funeral Home-Funeral Services 5,544.16
H-A 5,544.16
Other Administrative Costs
2 Citizens Bank-Monthly service fee on estate checking account 10.00
3 Citizens Bank-Monthly service fee on estate checking account 2.00
4 Citizens Bank-Monthly service fee on estate checking account 2.00
5 Citizens Bank-Monthly service fee on estate checking account 10.00
6 Citizens Bank-Monthly service fee on estate checking account 2.00
7 Citizens Bank-Service fee on estate account 2.00
8 Citizens Bank-Monthly service fee on estate checking account 2.00
9 Citizens Bank-Monthly service fee on estate checking account 2.00
10 Cumberland County Register of Wills-Filing Fee for Amended Petition for Grant of Letters 20.00
11 Cumberland Law Journal-Legal Advertisement of Estate 75.00
12 Ewing Brothers Funeral Home-Corrected Death Certificates 36.00
13 The Guide-Legal Advertisement 50.00
14 The Patriot News-Legal Advertisement for Estate Admin. 221.40
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
Todd, Patricia J 21-2013-0396
ITEM
NUMBER DESCRIPTION AMOUNT
15 U.S. Postmaser-postage to mail Citizens Bank account info to beneficiaries 15.75
1-1-137 450.15
Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98)
Rev-1512 EX+(12-08)
SCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Todd, Patricia J 21-2013-0396
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 Carlisle Borough Tax Collector-Per Capita Tax for 2013 4.90
2 Citi Cards-Personal credit card account No. 9833 14.90
TOTAL(Also enter on Line 10, Recapitulation) 19.80
(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-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Todd, Patricia J 21-2013-0396
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (Words) ($$$)
Do Trustee(s)
I� TAXABLE DISTRIBUTIONS [include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
Anne Katrine J Chanco Child One-third(1/3)of 27,142.10
PO Box 75735 one-half share of
Jufair,The Kingdom of Bahrain residual estate
Michael J Chanco Child One third(1/3)of 27,142.10
7765 St Paul Road,San Antonio Village one half share of
Makati City, Philippine residual estate
Marie Terese C Pajarillo Child One third(1/3)of 29,388.38
80 Lt Antiaga St one-half of
San Juan City, Philippine 1500 residual estate
Edward C Todd Spouse One-Half of
864 Carlwynne Manor residual estate
Apt B 303
Carlisle, PA 17013
Total 83,672.58
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)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule J(Rev.01-10)
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