HomeMy WebLinkAbout12-05-13 1505610140
REV-1500 Ex (01.10)
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 3 1 0 3 2
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
0 8 3 1 2 0 1 3 0 8 0 2 1 9 3 1
Decedent's Last Name Suffix Decedent's First Name MI
D I L L A R D E T H E L P
(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)
4.Limited Estate 4a.Future Interest Compromise(date of El 5. Federal Estate Tax Return Required
death after 12-12-82)
QX 6.Decedent Died Testate 7. Decedent Maintained a Living Trust 8.Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
❑ 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 INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
C H R I S T A M A P L I N 7 ' 5 4" I5' 61 5 0
n
N15G tTpt OF*@ LS U$C QNLY
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First line of address Cn cn :a ca
8 4 5 S I R T H O M A S C 0 U R T c °
Second line of address `7 F'' " `•�
S U I T E 1 2 co V)
City or Post Office State ZIP Code DA�FILED
H A R R I S B U R G P A 1 7 1 0 9
CorrespondenPs e-mail address: CHRISTA&IJANBROWNLAW • 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.
SIGNATURE OF RVSONRESPONS113LE FOR F ING RETURN D TE
ADDRESS r
18 K-M-UL PLACE CARLISLE PA 17013
S TU PREP,A RyATAHER TtA1 f NTATIVE )\DtTE'I�
C ADDRESS
845 SIR THOMAS COURT, SUITE 12 HARRISBURG PA 17109
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610140 1505610140 J
_Ch
1505610240
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: ETHEL P • DILLARD
RECAPITULATION
1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 0 • 0 0
2. Stocks and Bonds(Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. 0 • 0 0
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. 8 6 1 5 4 . 3 6
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. 0 . 0 0
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested . . . . . . . 7. 2 8 9 9 7 . 6 9
8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 1 1 5 1 5 2 . 0 5
9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9. 1 5 3 7 3 . 4 7
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule I) . . . . . . . . . . . . . 10. 1 0 0 . 3 8
11, Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 1 5 4 7 3 . 8 5
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 9 9 6 7 8 . 2 0
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. 9 9 6 7 8 . 2 0
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 . 0 0 15. 0 . 0 0
16. Amount of Line 14 taxable
at lineal rate X.045 16. 0 . 0 0
17. Amount of Line 14 taxable
at sibling rate x.12 8 3 6 8 5 . 3 5 17. 1 0 0 4 2 . 2 4
18. Amount of Line 14 taxable
at collateral rate x.15 1 5 9 9 2 . 8 5 18. 2 3 9 8 . 9 3
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 1 2 4 4 1 . 1 7
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0
Side 2
L 1505610240 1505610240 J
REV-1500 EX Page 3 File Number
Decedent's Complete Address: 21 13 1032
DECEDENT'S NAME
ETHEL P. DILLARD
STREET ADDRESS
1000 CLAREMONT ROAD_
CITY STATE ZIP
CARLISLE PA 17013
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 12,441.17
2. Credits/Payments
A.Prior Payments 11,819.11
B.Discount 622.06
Total Credits(A+B) (2) 12,441.17
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) 0.00
5. If Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0.00
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; ........................................ ............................. ❑
b, retain the right to designate who shall use the property transferred or its income; ............................... E) ❑X
c. retain a reversionary interest;or .............................................................................................. . 1-1 ❑X
d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ ❑X
2. If death occurred after December 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? ......... ❑ ❑X
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
3 percent[72 P.S.§9116(a)(1.1)(1)].
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)[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, uncle
Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
REV-1508 EX-(08-12)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
ETHEL P. DILLARD 21 13 1032
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
t. Transamerica Non-Qualified Annuity#02MSF334946 65,573.19
2. Wells Fargo checking account#1000665449665 20,223.09
3. Claremont Nursing & Rehabilitation Center; patient care account 358.08
4. Tangible personal property had no material resale value 0.00
TOTAL(Also enter on Line 5,Recapitulation) $ 86 154.36
If more space is needed,use additional sheets of paper of the same size.
REV-1510 EX+(08-09)
pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ETHEL P. DILLARD 21 13 1032
This schedule must be completed and fled if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
DESCRIPTION OF PROPERTY
ITEM
INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % DECD'S EXCLUSION TAXABLE
NUMBER THEDATEOFTRANSFEa.ATTACHACOPVOFTHE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST IFAPFUnAPLH VALUE
1. WFNBA Custodian Traditional IRA Account#3579-7576 26,009.69 100.00 26,009.69
beneficiaries = 50 % Nancy Lindsey(sister) and
50%Cathy Lindsey(niece)
account consisted of the following:
Bank Deposit=$993.31
Blackrock Resources& Commodities Strategy TR SHS
(BCX), 1,071.747 shares @ $11.63/sh. = $12,464,42
Morgan Stanley Emerging Markets Domestic Debt Fund
(EDD), 942.339 shares @$13.321sh. = $12,551.96
2. Gift to Cathy Lindsey(niece) 5,988.00 100.00 3,000.00 2,988.00
($499/mo from September 2012 to August 2013 = $5,988)
TOTAL (Also enter on Line 7,Recapitulation) $ 28 997.69
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ETHEL P. DILLARD 21 13 1032
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERALEXPENSES:
1. Auer Cremation Services 1,806.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s) Cathy Lindsey 4,597.81
Street Address 18 Bentley Place
city Carlisle State PA ZIP 17013
Years)Commission Paid: 2013
2. Attorney Fees: Jan L. Brown &Associates 7,500.00
3, Family Exemption:(If decedents address is not the same as claimants,attach explanation)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: Register of Wills, Cumberland County 118.50
5 Accountant Fees: Parks & Company (estimated) 555.00
final individual income tax return &fiduciary income tax return
6. Tax Return Preparer Fees:
7. Cumberland Law Journal; legal advertising 75.00
8. The Sentinel; legal advertising 274.50
9. Register of Wills; FSA filing fee 20.00
10. Register of Wills, Cumberland County; additional probate fees 180.00
11. LISPS; Postage 18.63
12. Staples; supplies for administration 20.13
13. USPS; Certified mailing fees 7.17
14. Cathy Lindsey, Executrix; mileage 312.8 miles @ $.565/mile 176.73
15. Additional death certificates 24.00
TOTAL(Also enter on Line 9,Recapitulation) $ 15 373.47
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX*(12-12)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES& LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ETHEL P. DILLARD 21 13 1032
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. Alert Pharmacy; oustanding medical bill 45.38
2. Pinker&Associates; outstanding medical bill 15.00
3. Check#8852 wrote predeath and cashed after death; Wells Fargo IRA fee 40.00
TOTAL(Also enter on Line 10,Recapitulation) $ 100.38
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
ETHEL P. DILLARD 21 13 1032
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1. Nancy A. Lindsey, sister Sibling
1004 Dale Place 1/4 of residue&
Carlisle, PA 17013 50% IRA on Sch G
2. Brooke D. Brozio, sister Sibling
502 Warwick Circle 1/4 of residue
Fairless Hills, PA 19030
3. Sandra D. Bailey, sister Sibling
120 Steeplechase Way 1/4 of residue
Southern Pines, INC 28387
4. Mary D. Sewell, sister Sibling
99 Ege Drive 1/4 of residue
Carlisle, PA 17015-7622
5. Cathy Lindsey, niece Collateral 15,992.85
18 Bentley Place
Carlisle, PA 17013
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed,use additional sheets of paper of the same size.
REV-1500 Discount, Interest and Penalty Worksheet
Discount Calculation
Total Amount Paid within three calendar months of the decedent's date of death: 12 441.17
Discount: 622.06
Interest Table
Year Days Delinquent Balance Due Interest
this time period this year this period
Before 1981
1982
1983
1984
1985
1986
1987
1988 through 1991
1992
1993 through 1994
1995 through 1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011 through 2013
TOTALS
Penalty Calculation
If the decedent's date of death was on or before March 31, 1993, insert the applicable amount:
Total Balance Due on January 17, 1996:
Penalty:
Z:\EP\MILLS\Di11ard.ELhe1 (option 21 .wpd
LAST WILL AND TESTAMENT
OF
ETHEL P. DILLARD
I, ETHEL P . DILLARD, of Harrisburg, Dauphin County, Pennsylvania,
declare this to be my last will and revoke any will previously made by
MO .
ITEM I : I devise and bequeath all of my estate of every nature
and wherever situate to my following named sisters who survive me:
NANCY A. LINDSEY, MARY D. SEWELL, BROOKE D. BROZIO and SANDRA D. BAILEY .
ITEM II : I appoint my niece, CATHY LINDSEY, Executrix of this my
last will . Should my niece, CATHY LINDSEY, fail to qualify or cease to
act as Executrix, I appoint my sister, SANDRA D. BAILEY, Executrix of
this my last will .
ITEM III : No fiduciary acting hereunder shall be required to post
bond or enter security for the faithful performance of his or her duties
in any jurisdiction.
TT ..��:�"� 1"T T Ilu Di L it ll li e} h
IN S:IINESS EREO_ , 1 , ET. L P . L APP, _ ave hereunto _ my and
and seal this k—) day of t'�!!2 2012 .
1
r ETHEL P. ARD
1
Page 1 of 2
SIGNED, SEALED, PUBLISHED and DECLARED by ETHEL P. DILLARD, the
Testatrix above named, as and for her Last Will and Testament, and in
the presence of us, who at her request, in her presence and in the
presence of each other, have subscribed our names as witnesses .
414 Bridge St . , New Cumberland, PA
Witness Address
i
� 919 Bridge St . , New Cumberland, PA
Witness Address
Page 2 of 2
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