HomeMy WebLinkAbout11-20-13 1505610101
REV-1500 a(or-rot
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania
Bureau of Individual Taxes County Code Year File Number
PO BOX 2806o' INHERITANCE TAX RETURN
Harrisburg,PA'7128-0601 RESIDENT DECEDENT 2 1 1 3 7 4
ENTER DECEDENT INFORMATION BELOW -
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
10161 2 52. 0 1 3, 1 01 71 2 41 1 9'M23.
Decedent's Last Name Suffix Decedent's First Name MI
K L E F F E L I I I I ® FjL ' Z A B E T H I I.
(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
I 9 1 9 1 1 1 1 REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
® 1.Original Relum O 2.Supplemental Return O 3. Remainder Return(date of death
prior to 12-13-82)
O 4.Limited Estate O 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
O 6. Decedent Died Testate O 7.Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust) r
O 9. Litigation Proceeds Received O 10.Spousal Poverty Credit(date of death O 11. Election to tax under Sec.9113(A) r
between 12-31-91 and 1-1-95) (Attach Sch.O)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMAT16WSHOULD BE DIRECTED TO:�
Name Daytime T ptIbne Numb`€t' m mm
D E N N I S H A R T RAN F T J R• ESQ 7 1 rj1 q3_1 2I s'r
REPMT WILL3JUSE '
C7 O O
First line of address C -n j
I-
1115111 <�
E 4AI I I N1 I SITI I I I I I � �t m
Second line of address } rn o
C77 -T7
City or Post Office - State ZIP Code DATE FILED
E JP I H R I Al T A I I I I I I I I P A L11715L2121A III
Correspondent's e-mail address:
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 We,coned and complete.Declaration of preparer other than the personal representative Is based on all Information of which preparer has any knowledge.
SIGNATURE OF PER ON RE O L•E FOR FILING RETURN ATE
r 3
ADDR
It er 3
SIGNATURE OF PREPAR R OT THAN PRESENTATI E DATE
ADDRESS
i5'i m1r� s� r,h� PA ns'az H Isli3
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610101 1505610101
REV-1500 EX Page 3 File Number
Decedent's Complete Address: 2113-774
DECEDENT'S NAME
Elizabeth L. Kleffel
STREET ADDRESS
608 Whitefield Drive
CITY STATE ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 3,356.55
2. Credits/Payments
A.Prior Payments 3,0.00..0.0
B.Discount 150.00
Total Credits(A+B) (2) 3,150.00
3. Interest
(3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4)
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 206.55
Make check payable 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;......................................................................................... ❑ 0
b. retain the right to designate who shall use the properly transferred or its income;............................................ ❑ 91
c. retain a reversionary interest;or.......................................................................................................................... ❑ 91
d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ FLI
2. If death occurred after Dec.12, 1982,did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................................. ❑ KI
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? ........................................................................................................................ I] ❑
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 Jan. 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(1.2)F2 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.
1505610105
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: Elizabeth L. Kleffel
RECAPITULATION
ua p.�i i��glP�r�sM�
1. Real Estate(Schedule A). . ... . . .. .. .... ... . .... ... ... . .. .... .. .. ..... 1.
�hYA1St�l NI 1
2. Stocks and Bonds(Schedule B) . . ... ... ... . .... . ... .. .... ... .. .. . ... . . 2. 8 E 8 4 9
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. 7 1 7 6
6. Jointly Owned Property(Schedule F) p Separate Billing Requested .. ..... 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested..... . . . 7. 7 3 4810 6
8. Total Gross Assets(total Lines 1 through 7).... . ... .. . .. ... .... .. .. .. ... 8. 8 9 8
9. Funeral Expenses and Administrative Costs(Schedule H).. .... ..... . . . .... . 9. .� + 2 2 0 0
10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule 1) ... .. .. . .... . . 10. 1 0 6 2 7
11. Total Deductions(total Lines 9 and 10). .. . .. .. ... ... ... .. . ... .. . .. ..... 11. ? 3 8 2 8
12. Net Value of Estate(Line 8 minus Line 11) .. . ... . ... ... .. .... . . .. .... . . . 12. '] ¢ 5 0 0 3
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. 7 5 0 0 3
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- 1 15.
16. Amount of Line 14 taxable "to
at lineal rate X.045 M 7 4 r9 9 0 3 16. 313 5 6 5
IT Amount of Line 14 taxable
at sibling rate X.12 17.
18. Amount of Line 14 taxable
at collateral rate X.15 18.
19. TAX DUE ... .. .. . . . . ... .. .. . .. .... ... ..... . .. ... .. .... . .. ........ . 19. 3 3 5 6 5 5
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
1505610105 1505610105
SCHEDULE`B"
STOCK AND BONDS
Estate of Elizabeth L. Kleffel 2113-774
1. Putnam Investments Money Market Fund
#0339051271 $ 1,808.49
TOTAL $ 1,808.49
SCHEDULE"E"
CASH, BANK DEPOSITS AND
MISCELLANEOUS PERSONAL PROPERTY
Estate of Elizabeth L. Kleffel 2113-774
1. MT& Checking Account#51647354 $ 871.76
2. 1996 Oldsmobile,101,000 miles 1,900.00
TOTAL $ 2,771.76
SCHEDULE "G"
INTER-VIVOS TRANSFERS & MISCELLANEOUS
NON-PROBATE PROPERTY
Estate of Elizabeth L. Kleffel 2113-774
1. Jan Hancock Annuity #2642115 $ 77,348.06
TOTAL $ 77,348.06
SCHEDULE"H"
FUNERAL EXPENSES, ADMINISTRATIVE
COSTS, AND MISCELLANEOUS EXPENSES
Estate of Elizabeth L. Kleffel 2113-774
ITEM NO. DESCRIPTION AMOUNT
Funeral
1. Geisel Funeral Home, Chambersburg, PA $ 4,938.83
2. Funeral Meal 891.45
Probate Expenses
1. Letters Testamentary 118.50
2. Dennis M. Hartranft, Jr., Esq., attorney fees 1,000.00
Miscellaneous
1. PP&L—utility expense 68.36
2. Lower Allen Township—utility expense 65.00
3. PA Water—utility expense 25.67
4. Internists of PA—medical expense 123.61
5. Travellers of PA—medical expanse 33.00
6. Bethany Village—medical expense 64.61
TOTAL $ 6,242.01
SCHEDULE"P'
DEBTS OF DECEDENT
Estate of Elizabeth L. Kleffel 2113-774
ITEM NO. DESCRIPTION AMOUNT
1. Bon Ton Credit Card #2117010007138139 $ 165.68
2. Bethany Village at Home—nursing home exp. 1,602.00
3. Bethany Village—nursing home expense 732.39
4. Chase Credit Card 44266841297422659 182.18
TOTAL $ 1,096.27
SCHEDULE "J"
BENEFICIARIES
Estate of Elizabeth L. Kleffel 2113-774
ITEM NO. NAME AND ADDRESS RELATIONSHIP AMOUNT OR
OR BENEFICIARY SHARE OF ESTATE
1. Jody Lee K. Dixon
113 Wheatland Road 50% of residue
Lewisberry, PA 17339 Daughter 50%of Schedule G annuity
$38,674.03
2. Yvonne L. Hazen
225 Browwood Rd. 50% of residue
Reisterstown, PA 21136 Daughter 50% of Schedule G annuity
$38,674.03
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LAST WILL AND TESTAMENT
1.
t
OF
,t
ELIZABETH L. KLEFFEL
I, ELIZABETH L. KLEFFEL, of Cumberland County and Commonwealth of Pennsylvania,
declare this to be my last Will and Testament and hereby revoke all former Wills and Codicils.
ITEM I. I direct the payment out of my estate of the my legally collectible debts and expenses
of my last illness, funeral, and burial.
ITEM IL I give, devise, and bequeath all the rest, residue and remainder of my estate of
whatever nature and wherever located to my daughters, YVONNE L. HAZEN and JODY LEE K.
DIXON, in equal shares,per stirpes. That is, if a daughter does not survive me, I direct that her
share be given to her children, in equal shares.
ITEM 111. In the event any of my grandchildren beneficiaries have not attained the age of
eighteen(18) years, i give such beneficiary's share to his or her father, In Trust, for his or her use
and benefit until he or she attains the age of eighteen (18).
ITEM IV. I nominate,.constitute and appoint my daughters,YVONNE L. HAZEN,and JODY
LEE K. DIXON, or the survivor of them, as my Co-Executrices. I further direct that no bond be
required by my Executrices.
I
IN WITH SS WHEREOF, I have hereunto put my hand and seal this Gq day of
6" r Z , 2444.
J
ELIZA- -TH L. KLEFFEL
Signed, sealed, published and declared by the above Testatrix, ELIZABETH L. KLEFFEL, as
and for her last Will and Testament, in the presence of us, who,at her request,in her presence, and
e presence of ea h other, have hereunto subscribed our names as witnesses thereto.
I
@Putnam 2013 YEAR-TO-DATE STATEMENT
INVESTMENTS 01/01/2013 - 06/30/2013
CONTACT INFORMAI ION
JI�111'�11��11111111114 P,11H1111110111-11.11111111111111111 INVESTMENTS: ACCOUNT:
LAMAR WEAVER Putnam Investments
>09212 3383204 001 092033 002995188 AMERITAS INVESTMENT- 1-800-225-1581
ELIZABETH T KLEFFEL CORP putnam.com
608 WHITEFIELD DR 1-800-283-3842
MECHANICSBURG PA 17055-4383
SL V l
YOUR PORTFOLIO VALUE as of 06/30/2013 YOUR PORTFOLIO HISTORY
Current
quarter Year to date
(04/01/2013-06/30/2013) (01/01/2013-06/30/2013) $1.900 $$°1^808 $180e
Beginning value $1.808.49 $1.808.49 s's�
{1
Additions(+) 0.00 0.00 $1.140 I� •+ - '
Withdrawals(-) 0.00 0.00 $760
Change in value(+/-) $0.00 $0.00
-- $380 t -'
Ending value. $1,808.49
iz•ava�»: oc�so,�oia
SUMMARY OF ACCOUNTS
Account Beginning value Additions/ Change in value nding value
Name number (01/01/2013) withdrawals (+/-) ( 6/&/2013)
ELIZABETH T KLEFFEL INDIVIDUAL ACCOUNT 0339051271
PUTNAM MONEY MARKET FUND-A $1 .808.49 $0.00 $0.00 $1 ,808.49
Value of Putnam portfolio $1,808.49 $0.00 $0-00 $1,808.49
AIM Timely account information. Less paper. With access to all your account information online, do you
ILA V
�
V really need a paper statement? Log in at putnam.com/individual and click the "Go paperless" link. Or
"'T Aw scan this code using the Microsoft Tag application (available at gettag.mobi). We will alert you by
VrT A e-mail when your latest statement is available to view, download, or print.
VwV
This is a summary of your year-to date statement.Additional details are available at the secure account section 01 puma mcom.
PAGElOF2
09212 3383204 009213 018424 00001100001
MM&TBank Gh
499 Mitchell Road,Millsboro,DE 19966 Adjustment Services
Phone 302)888-502-4349
4-295 y,
Fax (302)934-2955
July 22,2013
Dennis M. Hartranft,Jr.Esq.
151 E. Main Street
Ephrata,PA 17522
Re: Estate of Elizabeth Kleffel
Social Security: 183-12-7726
Date of Death: June 25 2013
Dear Sir or Madam:
Per your inquiry on July 16,2013,please be advised that at the time of death,the above-named decedent had on
deposit with this bank the following:
1. Type of Account. Checking Account
Account Number 51647354
Ownership(Names ofi Jodylee K Dixon(POA)
Elizabeth T. Kleffel
Opening Date 0812811964
Balance on Date ofDealh $871.75
Accruedlnterest $ .01
Total $871.76 ---� - --�-
For any additional information on the above accounts,including ownership and any changes,closures and/or reimbursement of funds,
please call the Mechanicsburg at 717697-1515.
We were unable to locate any safe deposit box for the above-mentioned decedent-
This letter does not include any amounts in which the deceased may have been listed as Power of Attorney,Custodian of Uniform Transfers,
Representative Payee,or Trustee under a Written Agreement
incerely,
rie Mercer
tment Services
k
Venture ® Annuity
Transaction Confirmation
Issued by John Hancock Life Insurance Company(U.S.A.)
Produced on: 06/25/2013
Your Financial Representative:
Steven M Zeigler
Prepared For: John Hancock Financial Network
ELIZABETH sH T KLEFF 4909 Louise Drive
ELIZABETH T KLEFFEL � Suite 104
608 I DR Mechanicsburg PA 17055
MECMANIC HANICSBUR URG PA 17055
For Questions about your Contract:
1.800-344-1029
www.jhannuities.com
Your Activity Summary Your Account Information
Year to Date Since Inception Account Number: 2642115
Owner: Elizabeth T Kleffel
Total Premiums $0.00 $83,662.02 Annuitant: Elizabeth T Kleffel
Total Withdrawals $600.00 $6,900.00 Plan Type: Non-Qualified
Value as of June 25,2013 577,348.06
Inception Date: 10/02/2007
Your Transaction Detail
Transaction Description Number Transaction Transaction
Date Fund Name of Units Unit Value Amount —
Transfers and Exchanges
06125/13 Portfolio Rebalancing
From American Growth -64.7905 14.671445 -$950.57
From American Growth-Income -80.7950 14.750299 -31,191.75
To American International 30.1505 12.864458 $387.87
To JHAM Bond 137.7350 12.737869 $1,754.45 F S
Your Holdings Summary
Future Number Unit Value as Market Value K
Allocation' of Units of 06/25/13 as of 06125/13
Capital Research and Management N
083 American International 15.0% 901.8812 12.864458 $11,602.21
084 American Growth 25.0% 1,318.0028 14.671445 $19,337.01 o
086 American Growth- Income 25.0% 1,310.9576 14.750299 $19,337.02 o
John Hancock Asset Management z
201 Bond 35.0% 2,125.3021 12.737869 $27,071.82
Total Account Value as of June 25, 2013 100.0% $77,348.0
Your future aNOCation Indicates where subsequent payments wm be Invested.You must no*us in wdting or by phone it you would like your payments '
directed to otherinvestment options. m
4
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John Hancock Annuities Service Center
P.O.Box 55444,Boston,MA 022055444
Produced on: 06/252013 Account#2642115 Page 1 of 2
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PLEASE DETACH AND RETURN UPPER PORTION WITH YOUR REMITTANCE
Kleffel, Elizabeth BV Inside Clients 07/08/2013
cc- - Descnpbon;Y Urnis v. Un k. «. ti='Balance.
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RESIDENT RESPONSIBIL ITY
5/31/2013 Balance Forward $40.50
6/15/2013 6/15/2013 Companion 3.00 Hour 18.0c 54.00 $94.50
6/16/2013 6/16/2013 Companion 3.00 Hour 18.00 54.0 $148.50
' 6/17/2013 6/17/2013 Companion 3.00 Hour 18.0c 54.0 $202.50
6/18/2013 6/1812013 Companion 3.00 Hour 18.0 54.0 $256.50
6/1912013 6/19/2013 Companion 11.00 Hour 18.0c 198.00 $454.50
6/20/2013 6/20/2013 Companion 11.00 Hour 18.00 198.00 $652.50
L 6//21/2013 6/21/2013 Companion 11.25 Hour 18.0 202.5 $855.00
/22/2013 6/22/2013 Companion 7.00 Hour 18.0 126.0 $981.00
23/2013 6/23/2013 Companion 10.50 Hour 18.00 189.00 $1,170.00
/24/2013 6/24/2013 Companion 24.00 Hour 18.00 432.00 $1,602.00
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7
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Please make check payable to Bethany Village at Home and return to 325 Wesley Drive, Mechanicsburg, PA 17055.Should you have any
i questions regarding this statement please contact Sharon Cramer at 717-591-8498 or 1-866-705.6154.Thank youl
f
TOTAL
TOTAL RESIDENT RESPONSIBILITY $1,602.0