HomeMy WebLinkAbout11-21-13 � 1505610143
EX(02-11) r�:
REV-1500 � OFFICIAL USE ONLY
PA Department of Revenue pennsylvania County Code Year File Number
Bureau of Individual Taxes DEPARTMENTOFREVENUE
PO BOX.280601 INHERITANCE TAX RETURN 21 12 00624
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
214 34 5753 05 11 2012 05 09 1937
DecedenYs Last Name Suffix DecedenYs First Name MI
SPRIGGS JOHN L
(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
�' 1. Original Return i ' 2. Supplemental Return �', 3. Remainder Retum(Date of Death
Priorto 12-13-82)
� � 4. Limited Estate ' I 4a.Future Incerest Compromise �l, 5. Federal Estate Tax Return Required
. J (date of death after 12-12-82)
I-,I g Decedent Died Testate ��,--J'I � Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
-h� (Attach Copy of W ll) (Attach Copy of Trust)
� 9. Liti ation Proceeds Received �p, Spousai Povert Credit(Date of Deam ' ��,Election to tax under Sec.9113(A)
�_J 9 � between 1231�J1 and 1-1-95) L__!
(Attach Schedule 0)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SMDULD BE DIRECTED TO:
Name Dayti�Telephone�N�mbe,� -�
JEFFREY R BOSWELL ESQUIRE 71'� �6 9�'�7 � n�
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First Line of Address �'� c7 c-�, "� '7-� `�M
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315 NORTH FRONT STREET �':� �= °w: �`;,
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Second Line of Address � � �
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DATE FILED
City or Post Office State ZIP Code
HARRISBURG PA 17101
CorrespondenYs e-mail address: JbOSwell@btpalaw.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 prepa er other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBj E R F G TURN / DATE
c�.cc,.,.l!/�, < Elaine M. Spriggs �� �/�C�
ADDRESS �(�„� �jy,1 ��.,�+K�, p,�
j
1039 Countrv Club Road, Camp Hill, PA 17011
SIGNATURE OF PREPARER OTH R THAN REPRESENTATIVE DATE
,L� Jeffrey R. Boswell, Esquire ��`�-/'��'>3
ADDRESS
315 North Front Street, Harrisburg, PA 17101
Side 1
� 1505610143 1505610143 �
�
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� 1505610243
REV-1500 EX
DecedenYs Social Security Number
oe�ede�rSName: Spriggs, John L. 214 34 5753
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&Miscelianeous Personal Property(Schedule E)............... 5. 2� , 674 . 94
6. Jointly Owned Property(Schedule F) L_ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers&Miscellaneous�n,-Probate Property
(Schedule G) I, � Separate Billing Requested............ 7. 113 , 4 91 . 6 6
g. Total Gross Assets(total Lines 1 through 7)........................................................ g. 134 , 166 . 60
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 25 , 7 84 . 2 7
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................ 10. $ ,205 . 67
11. Total Deductions(total Lines 9 and 10)................................................................ 11. 3O , 989 . 94
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 1 O3 , 17 6 . 66
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J)............................................... 13.
14. Net Value Subjectto Tax(Line 12 minus Line 13)............................................... 14. ZO3 , 17 6 . 66
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxabie
at the spousal tax rate,or
transfers under Sec.9116 10 3 , 17 6 . 6 6 15. O . 0 0
(a)(1.2)X.00
16. Amount of Line 14 taxable � . ��
at lineal rate X .045 0 . 0 0 16.
17. Amount of Line 14 taxable 0 . 0 0
at sibling rate X.12 � . �� 17.
18. Amount of Line 14 taxable � . �0
at coliateral rate X.15 � . 0 0 18.
19. TAX DUE................................................................................................................ 19. � . ��
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. �
Side 2
� 1505610243 1505610243 J
REV-1500 EX Page 3 File Number 21-12-00624
Decedent's Complete Address:
DECEDENT'S NAME
Spriggs, John L.
STREET ADDRESS
1039 Country Club Road __
_ — - - - -- _
CITY STATE ZIP
Camp Hill PA 17011
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�
q. 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) Q.��
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:............................................................................... � ;�
�-
b. retain the right to designate who shall use the property transferred or its income:.................................. � �]
c. retain a reversionary interest;or............................................................................................................... �� �
d. receive the promise for life of either payments,benefits or care?............................................................ ❑ C
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without r�1
receivingadequate consideration?.................................................................................................................... � u
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?.................................................................................................................. U ❑
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 decedenYs 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 decedenYs 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 OFREVENUE p E RS O NA L P RO P E RTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Spriggs, John L. 21-12-00624
Include the proceeds of litigation and the date the proceeds were received by the estale.
All property jointly-ownedwith the right of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Members 1st Federal Credit Union -regular savings no.0000 25.56
2 Members 1st Federal Credit Union -money management no.0005 16,818.07
3 USAA-Subscriber Account No.640102(close account) 3,048.30
4 John Hancock-LTC policy refund 419.56
5 Seways Publishing -subscription refund 61.95
6 USAA-Subscriber Account-refund 160.44
7 Verizon -credit refund 41.06
8 Veteran's Administration-burial benefit 100.00
TOTAL(Also enter on Line 5, Recapitulation) 20,674.94
(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-1510 EX+(08-09)
SCHEDULE G
pennsylvania lNTER-VIVOS TRANSFERS AND
DEPARTMENT OF REVENUE
INHERITANCETAXRETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF IFILE NUMBER
Spriggs, John L. 21-12-00624
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 %OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFERSATTACN A CO Y OF TI�E DEED�OREREAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1 U.S.Treasury -CSF Annuity 8,142.73 8,142.73
2 Wells Fargo Advisors-IRA Acct. No.4271-0254 105,348.93 105,348.93
TOTAL(Also enter on Line 7, Recapitulation) 113,491.66
(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-1577 EX+(10-09) gC H E D U L E H
pennsylvania
DEPARTMENT OFREVENUE F U N E RA L EXP E N S E S A N D
� RESIDENTDEC ENT URN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Spriggs, John L. 21-12-00624
DecedenYs debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
q, FUNERAL EXPENSES:
Parthemore Funeral Home -funeral
10,170.17
B. ADMINISTRATIVE COSTS:
1. Personai Representative's Commissions
Name of Personal Representative(s)
Elaine M. Spriggs
StreetAddress 1039 Country Club Road
City Camp Hill State PA zio 17011
Year(s)Commission Paid Waived
2, Attornev's Fees Boswell, Tintner 8� Piccola 10,394.52
3. Family Exemption: (If decedenYs address is not the same as claimant's,attach explanation) 3,500.00
Claimant
Street Address
City State Zip
Relationshio of Claimant to Decedent
4. Probate Fees Cumberland County Register of Wills 119.50
5. AccountanYs Fees
6. Tax Return Preparer's Fees Boswell,Tintner 8� Piccola 1,000.00
7. Other Administrative Costs 600.08
See continuation schedule(s) attached
TOTAL(Also enter on line 9, Recapitulation) 25,784.27
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
Spriggs,John L. 21-12-00624
ITEM
NUMBER DESCRIPTION AMOUNT
Other Administrative Costs
1 Boswell, Tintner&Piccola-disbursements 38.85
2 Boswell,Tintner&Piccola-Closing Costs 286.07
3 Cumberland Law Journal-advertising 75.00
4 The Sentinel -legal advertising 200.16
H-B7 600.08
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98)
Rev-1512 EX+(�2�08)
SCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF REVENUE
INHERITANCETAXRETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
ESTATE OF (FILE NUMBER
Spriggs,John L. 21-12-00624
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 Bon Ton 49.98
2 Capital One-credit card 274.53
3 Capital One-credit card 2•$5
4 Caremark-pay and close account 150.00
5 Comcast 156.27
6 Craig Miller-lawn 190.80
7 Holy Spirit Hospital -medical 108.20
8 PNC Bank-mortgage payment 1,494.73
9 PPL-electric 155.49
10 TJX Rewards -credit card 44.98
11 USAA-Auto Insurance-policy no. 7101699 527.37
12 USAA-credit card 1,494.86
13 Verizon 204.66
14 Verizon 113.01
15 VISA-Members 1st credit card 237.94
TOTAL(Also enter on Line 10, Recapitulation) 5,205.67
(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+(01-70)
pennsylvania $CHEDULE J
DEPARTMENT OFREVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Spri s, John L. 21-12-00624
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT ��/ards) ($$$)
Do Not List Tru s
I� TAXABLE DISTRIBUTIONS [include outright spousal
distributions,and transfers
under Sec.9116 a 1.2
Elaine M. Spriggs Spouse 100% of 103,176.66
1039 Country Club Road residuary estate
Camp Hill, PA 17011
Total 103,176.66
Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet,as a ro riate.
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)
St
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MEMBERS 1St
FEDERAL CREDIT[JNION
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix 295593-00
Date Account Established 11/13/2006
Principal Balance at Date of Death $25.56
Accrued Interest to Date of Death $0.00
Total Principal and Accrued Interest $25.56
interest Rate 0.23°/o -
�
Name of Joint Owner None
INVESTMENT SAVINGS ACCOUNT:
Account Number/Suffix 295593-05
Date Account Established 11/17/2006
Principal Balance at Date of Death $16,816.96
Accrued interest to Date of Death $1.11
Total Principal and Accrued Interest $16,818.07
Interest Rate 0.3%
Name of Joint Owner None
VISA ACCOUNT:
Account Number/Suffix 4672090000224782
Date Opened 09/05/2007
Principal Balance at Date of Death $0.00
Name of Joint Cardholder Elaine Spriggs
Date Closed 05/11/2012
SAFE DEPOSIT BOX: YES
Date Established 02/22/2008
Branch Location Camp Hill
Name of Leasee John L Spriggs and Elaine M Spriggs
Box Number 88
MEMBERS 1ST FEDERAL CREDIT UNION
Te�KI���
Lending Insurance Support Specialist
June 13,2012
Estate of:JOHN L SPRIGGS
Date of Death:5/11/2012
Social Security Number: 214-34-5753
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5000 Louise Drive • P.O.Box 40 • Mechanicsburg,Pennsylvania 17055 • (800) 283-2328 • wwwmemberslst.org
MAIL DIR
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ELAINE M SPRIGGS
1039 COUNTRY CLUB RD
CAMP HILL, PA 17011-1049
0000013069
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� � PO Box 33490
U��� $an Antonio, TX.78265
Ol/11/2013
$**3 , 048 . 30
Memo: As requested, please find a check enclosed for the final payout of
your spouse' s Subscriber ' s Account . Thank you for allowing USAA to serve
your needs. Please call a member service representative at 1-800-531-8722,
if we can be of further assistance.
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STATEMENT CE-1 130 110
1'�`, 9800 Fredericksburg Road � ;. usaa c
� San Antonio, Texas 78288 NUMBER o
U$��' Visit us at usaa.com - oos�� �� os s
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04462.V72J.JSS580055604.01.01.130
TO UPDATE POLICIES GO TO
USAA.COM OR CALL
1-800-531-8722
FOR BILLING AND PAYMENT
INQUIRIES GO TO USAA.COM OR CALL
ELA I NE M SPR I GGS 1-800-531-8722
1039 COUNTRY CLUB RD TO REPORT A CLAIM, CA�L
CAMP HILL PA 17011-1049 1-800-531-8722
i MONTHLY ACT I V I TY
BALANCE ON LAST STATEMENT $ .00
CREDIT TRANSFERRED FROM ANOTHER MEMBER 02-12-2013 160.44 CR
REFUNO CHECK ISSUED 02-28-2013 160.44
ACCOUNT BALANCE AS OF 02-28-2013 $ .00
Pf)L�CTES �BTT�TG BTLLE�
! PAYbAEN7' PLAN dP7'IOt�lS ::
EFF£GTIV£ t#ATE BALANCE REGUL�R':PLAN ' EXT�NaED PL.At+E :!
TOTALS $ .00 $ .00 $ .00
YOUR REFUND CHECK IS ATTACHED.
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