HomeMy WebLinkAbout11-19-13 J
REV-1500 EX (01-10) 1505610140
OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 3 0 9 2 7
Harrisburg PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
0 7 2 5 2 0 1 3 0 3 2 3 1 9 5 1
Decedent's Last Name Suffix Decedent's First Name MI
CAL L A H A N P A T R I C I A A
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
C A L L A H A N THOMAS E
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
a 1.Original Return ❑ 2. Supplemental Return ❑ 3.Remainder Return(date of death
prior to 12-13-82)
Ej 4.Limited Estate ❑ 4a.Future Interest Compromise(date of ❑ 5.Federal Estate Tax Return Required
death after 12-12-82)
❑X 6.Decedent Died Testate ❑ 7.Decedent Maintained a Living Trust 0 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
J I L L M WI NE K ESQUI RE 7 1 7 2 34 41 7 8
REGISTEKOF WILLS USE_,RLY y
C w
o _ M
C C _ O
First line of address M z n c y
1 7 1 9 N O R T H F R O N T S T R E E T a
Second line of address O X O O
.cr�7 O O T T
Office
State ZIP Code '—D FILED
City or Post Oce
H A R R I S B U R G P A 1 7 1 0 2 3> (" o
co n
Correspondent's e-mail address: jyyinek8 pkh CODI
Under penalties of perjury,1 declare that 1 have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct an plete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATU B ETURN DATE
ADD RESS
Thomas E Callahan 93 Greenwood Circle Wormleysburg PA 17043
R SIG A UR OF PAR R HE REPRESENTATE / q //�
ADD SS /
Jill& Wineka Esquire 1719 N Front Street Harrisburg PA 17102
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610140 1505610140 ��`
1505610240
REV-1500 EX
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. 1 3 5 1 5 • 9 3
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested . . . . . . . 7.
8. Total Gross Assets(total Lines 1 through 7) 8. 1 3 5 1 5 . 9 3
9. Funeral Expenses and Administrative Costs(Schedule H) 9. 1 1 6 6 4 • 5 0
. . . .. . . . . . . . . . . . . .
10. Debts of Decedent, Mortgage Liabilities, and Liens Schedule I 10. 1 1 9 6 . 7 2
if. Total Deductions(total Lines 9 and 10) .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 1 2 8 6 1 . 2 2
12. Net Value of Estate(Line 8 minus Line 11) 6 5 4 . 7 1
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. 6 5 4 7 1
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.00_ 6 5 4 . 7 1 15. 0 . 0 0
16. Amount of Line 14 taxable 0 Q Q
at lineal rate X.0_ 0 • 0 0 16.
17. Amount of Line 14 taxable Q Q Q 17. Q • Q Q
at sibling rate X.12
18. Amount of Line 14 taxable Q Q Q 18. Q 0 0
at collateral rate X.15
19. TAX DUE 19. Q • Q 0
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Side 2
1505610240 1505610240
REV-1500 EX Page 3 File Number
Decedent's Complete Address: 21 13 0927
DECEDENTS NAME
PATRICIA A. CALLAHAN
STREET ADDRESS
93 GREENWOOD CIRCLE
CITY STATE ZIP
WORMLEYSBURG PA 17043
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 0.00
2. Credits/Payments
A.Prior Payments
B.Discount
Total Credits(A+B) (2) 0.00
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) 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; ...............................
c. retain a reversionary interest;or .....................................'......................................................... ❑El IX]
I]
d. receive the promise for life of either payments,benefits or care? .......................................................
2. If death occurred after December 12,1982,did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... ❑ I]
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?.................................................................................................. ❑ ]
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 172 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)[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,unde
Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
REV-1509 EX-(11-10)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE
CASH, BANK DEPOSITS, 8r MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
PATRICIA A. CALLAHAN 21 13 0927
Induce 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
1. Commonwealth of PA-gross proceeds received for Decedent's salary and 13,515.93
leave payouts post-death.
(See attached Deceased Payment Worksheet dated 9/4/13).
TOTAL(Also enter on Line 5,Recapitulation) $ 13 515.93
If more space is needed,insert 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
PATRICIA A. CALLAHAN 21 13 0927
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Musselman Funeral Home & Cremation Services, Inc. -funeral services 7,536.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Years)Commission Paid:
2. Attomey Fees: Purcell, Krug & Haller 500.00
3, Family Exemption:(If decedent's address is not the same as claimant's,attach explanation.) 3,500.00
Claimant Thomas E. Callahan
Street Address 93 Greenwood Circle
city Wormleysburg State PA ZIP 17043
Relationship of Claimant to Decedent Spouse
4. Probate Fees: Register of Wills 60.00
1 6 Accountant Fees:
6. Tax Return Pmparer Fees:
7. Register of Wills-JCS fee; automation fee; fees to file Inventory and Inheritance 68.50
Tax Return; Short Certificates
TOTAL(Also enter on Line 9,Recapitulation) $ 11 664.50
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+(12-08)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
PATRICIA A. CALLAHAN 21 13 0927
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. Deductions withheld from gross proceeds for Decedent's unpaid salary and leave 1,196.72
payouts.
TOTAL(Also enter on Line 10,Recapitulation) $ 1,196.72
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:
PATRICIA A. CALLAHAN 21 13 0927
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not ListTrustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1. Thomas E. Callahan Spousal
93 Greenwood Circle 100%of residuary
Wormleysburg, PA 17043
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.
IN RE: IN THE COURT OF COMMON PLEAS
CUMBERLAND CO., PENNSYLVANIA
ESTATE OF PATRICIA A. CALLAHAN, ORPHANS' COURT DIVISION
DECEASED NO. 2113-0927
TABLE OF CONTENTS
1. Last Will and Testament of Patricia A. Callahan dated July 11, 2012-
2. Deceased Payment Worksheet dated 9/4/13.
LAST WILL AND TESTAMENT
OF
PATRICIA ANN CALLAHAN
I, PATRICIA ANN CALLAHAN, of Wormleysburg, Cumberland County,
Pennsylvania, declare this to be my Last Will and Testament, and revoke any and all Wills and
Codicils previously made by me.
ITEM I: 1 direct that all my just debts and funeral expenses, including my
grave marker and all expenses of my last illness, shall be paid from my residuary estate as
soon as practicable after my decease, as a part of the expense of the administration of my
estate.
ITEM II: All federal, state and other death taxes payable because of my
death with respect to the property forming my gross estate for tax purposes, whether or not
passing under this Will, including any interest or penalty imposed in connection with such tax,
shall be considered a part of the expense of the administration of my estate and shall be paid
out of the residue of my estate, without apportionment or right of reimbursement.
ITEM III: I give, devise and bequeath all the rest, residue and remainder
of my Estate of every nature and wheresoever situate to my husband, THOMAS E.
CALLAHAN on the condition that he survive me by thirty days.
ITEM IV: In the event my husband, THOMAS E. CALLAHAN should
predecease me or fail to survive me by thirty days, I then give, devise and bequeath all the rest,
residue and remainder of my estate of every nature and wheresoever situate to be divided
equally among my three children, LAUREN E. CALLAHAN of Baltimore, Maryland; MICHAEL
T. CALLAHAN of Chicago, Illinois and DANIEL E. CALLAHAN of Hill Air Force Base in Utah,
or their issue, per stirpes.
ITEM V: In the event any of my children should predecease me and die
without issue, then such deceased beneficiary's residuary share of my Estate is to be divided
equally between my surviving children, or their issue, per stirpes.
ITEM VI: If at the time of my death any beneficiary of my Estate has not
attained the age of twenty-two, the share of such beneficiary shall be held IN TRUST for the
following uses and purposes:
A. If the beneficiary is under the age of twenty-two (22), to expend
and apply so much of the net income (any income not expended or applied to
be accumulated and added to the principal), and so much of the principal of the
Trust, as the Trustee shall consider advisable for the support, maintenance and
education of the beneficiary.
B. After the beneficiary attains the age of twenty-two (22), the
Trustee shall distribute to that beneficiary, the entire principal and accumulated
income then remaining in the Trust.
ITEM VII: I appoint my sons, MICHAEL T. CALLAHAN and DANIEL E.
CALLAHAN to serve as Co-Trustees for any Trusts that may be established for the issue of
my daughter, LAUREN E. CALLAHAN.
ITEM VIII: I appoint my son, DANIEL E. CALLAHAN and my daughter,
LAUREN E. CALLAHAN to serve as Co-Trustees for any Trusts that may be established for
the issue of my son, MICHAEL T. CALLAHAN.
ITEM IX: I appoint my son, MICHAEL T. CALLAHAN and my daughter,
LAUREN E. CALLAHAN to serve as Co-Trustees for any Trusts that may be established for
the issue of my son, DANIEL E. CALLAHAN.
2
ITEM X: I appoint my husband, THOMAS E. CALLAHAN to serve as
Executor of my Last Will and Testament. In the event my husband, THOMAS E. CALLAHAN
should predecease me, fail to qualify or cease to act as Executor, I then appoint my son,
MICHAEL T. CALLAHAN to serve as Executor of my Last Will and Testament.
ITEM XI: I direct that no Executor or Trustee be required to post bond or
enter security in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
day of aU L U 12012.
(SEAL)
PATRICIA ANN CALLAHAN
The preceding instrument, consisting of this and three other typewritten pages, was, on
the date thereof signed, published and declared by PATRICIA ANN CALLAHAN, the Testatrix
therein named, as and for her Last Will, 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 hereto.
Q ' residing at En D f'
residing at L S BEp- Y, I�/t
3
COMMONWEALTH OF PENNSYLVANIA
ss:
COUNTY OF DAUPHIN
WE, Patricia Ann Callahan, `1e W f rrrt� J and
5,TMINv I)ML (-P the Testatrix and the witnesses,
respectively, whose names are signed to the attached or foregoing instrument, being first duly
sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed
the instrument as her Last Will, and that she had signed willingly and that she executed it as
her free and voluntary act for the purposes therein expressed, and that each of the witnesses,
in the presence and hearing of the Testatrix, signed the Will as witnesses and that to the best
of their knowledge, the Testatrix was at that time eighteen years of age or older, of sound mind
and under no constraint or undue influence.
PATRICIA ANN CALLAHAN
_ qtr
Atriess
/SGr'2_�
Witness
Subscribed, sworn to and acknowledged before me by PATRICIA ANN CALLAHAN,
the Testatrix, 11 )� and subscribed and sworn to before me by
�e�{y VJI71/tIWC and STEKLiN6 PNNLAP
witnesses, this 1/ day of 2012.
Notary Public
COMMONWEALTH OFPENNSYLVANIA
NOTARIAL SEAL
BARBARA A.SHADEt,Notary Public
City of Harrisqul Dauphin County
My Commission Aires April 4,2015
BUREAU OF COMMONWEALTH PAYROLL OPERATIONS
DECEASED PAYMENT WORKSHEET
Date Submitted: 9/412013 -
Employee Name: Patricia A.Callahan
Personnel Number: 00541159
.TIN Number: 37-6554118
Payee Name: Estate at Patricia A.Callahan
Payee Address: 93 Greenwood Circle,Wonnleysburg PA 17043
Taxable Non Taxable
PPE Hours Gross Tatais PPE Hours I als
Salary/Overtimel
Miscellaneous Payments
'Salary 712612013 67.50 $2,048.63 - - $0.00
$0.00 $0.00 _
$0.00 $0.00
$0.00 $0.00
$0.00 $0.00
$0.00 $0.00
$0.00 - $0.00
Total Salary Due $2,048.63 $0.00
Leave Payouts
Annual 303.88 $9,222.76 $0.00
Personal 15.00 $455.25 $0.00
Sick 60.00 $1,821.00 $0.00
Holiday $0.00 $0.00
Comp $0.00 $0.00
$0.00 $0.00
Total Leave Payouts $11,499.01 $D.00
Less Gross Overpayments
Conversion Pay $0.00 $0.00
Salary/Overtime $0.00 $0.00
Pre Tax Medical $31.71 $0.00
Other $(100 $0.00
Total Gross Overpayments $31.71) $0.00
Deductions
Salary Overpayment-Net $0.00 $0.00
Medical Hospital Percentage $0.00 $0.00
Social Security/Medicare $1,033.97 $0.00
Union Dues $20.48 $0.00
Retirement $142.27 $0,00
Total Deductions Owed {$1,196.72} $0.00
Total Due Beneficiary/Estate $12,319.21 $0.00
Z1099 Adjustment Amount -
Total Deductions Owed $1,196.72
Total Adjustment Amount $1,196.72
1099 Amount $13,515.93 Non Taxable Amount $0.00
Revised W3/07
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LAW OFFICES
Purcell, Krug & Haller
HOWARD B.KRUG 1719 NORTH FRONT STREET HERSHEY
LEON P.HALLER HARRISBURG, PENNSYLVANIA 17102-2392 (717) 533-3836
JOHN W.PURCELL JR. TELEPHONE (717) 234-4178
.TILL M. WINEKA FAX (717) 783-4939 JOHN W. PURCELL(1924-2009)
LISA A.RYNARD
JOSEPH NISSLEY (1910-1982)
November 18, 2013
Register of Wills
Cumberland County Court House
One Courthouse Square
Carlisle, PA 17013
Re: Estate of Patricia A. Callahan
No. 21-13-0927
Dear Register of Wills:
Enclosed for filing, please find two originals and two copies of the Inheritance Tax Return in
the above-captioned matter. It is my understanding that when the Estate was opened, the fee to file
the Inheritance Tax Return was paid at that time. Please return two date-stamped copies of the
Return to me in the enclosed stamped, self-addressed envelope. Thank you.
Sincerely,
M. Wineka
JMW/bas
Enclosures
cc: Thomas E. Callahan, Exec. w/enc.
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