The URL can be used to link to this page

Home My WebLink About12-12-13 ' J 1505610105 REV-1500 EX(oz-ii)(FI) � en lv�Ilia OFFICiAL USE ONLY PA Department of Revenue p ^�Y County Code Year File Number Bureau of Individual Taxes `��`M�Fp�"�` Po Box zsosoi INHERITANCE TAX RETURN i Harrisburg,PA 1�128-o6oi RESIDENT DECEDENT 2 � I� �(�'�J ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 187-16-6761 7/3/2013 11/19/23 DecedenYs Last Name Suffix DecedenYs First Name MI Zeiders Donaid D (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 G'� 1. Original Return p 2.Supplemental Return p 3. Remainder Return(Date of Death Prior to 12-13-82) p 4. Limited Estate Q 4a.Future Interest Compromise(date of p 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.) O 9. Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 11. Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Steven Howell, Esquire 71�770-1277��7 � � C �� C"� "R4�ISTER O ILLS-liS NLY fTl �� C7 � .._.� C.a � � .`"CT �,. F`_' P �..,,�.� f-�'1 First Line of Address i"'� � r'�� N .�" �===- �r w �� ;.:; � �-� r�, Howell Law Firm ,�-J �� `, � ,, q i Second Line ofAddress '�' `'�= � _ � �, �.._ � �_� ,-..� 619 Bridge Street � �� ' �� City or Post Office State ZIP Code DAT ILED � New Cumberland PA 17070 CorrespondenYs e-mail address: Under penalties of peryury,I declare that I have examined this retum,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete.Deciaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SI ATU PERSON RESPONSIBLE FOR FILING RETURN D TE -�� C•�c„��,D��-C.� la,�s/�oi� AD SS �6ts"tlr�-z�Lwoo.� �.�. L.,� r�s�c� �A��6o� ;3 C�T��k.�� P `�,'�-175� f�`��1.0'� SIGNATURE OF PREPARER O TIVE DATE �2 � ADDRESS �l�l �7�� c��P ��'eP�- /I/�w�u�rr �e�11/�(� ��- l70?O PLEA E USE ORIGINAL FORM ONLY Side 1 L 15�5610105 1505610105 � �' s� � � 1505610205 REV-1500 EX(FI) DecedenYs Social Security Number �ecede�rs r,ame: Donald D. Zeiders 187-16-6761 RECAPITULATION 1. Real Estate(Schedule A). .. ........ .. ............ . .. .. ..... ..... . .. . . 1. 0 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. 268,938.98 6. Jointly Owned Property(Schedute F) O Separate Billing Requested ... . .. . 6. 25,000.00 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property O (Schedule G) O Separate Billing Requested... . . .. . 7. 8. Total Gross Assets(total Lines 1 through 7). ...... .. .. ..... . .. .. .. .... .. 8. 293,938.98 9. Funeral Expenses and Administrative Costs(Schedule H). .. ......... ...... . 9. 18,019.99 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)..... .... .... .. 10. 4,140.29 11. Totai Deductions(total Lines 9 and 10). .. . .... .. .. .... .. . ... .... ... .. .. 11. 22,160.28 12. Net Value of Estate(Line 8 minus Line 11) . . .. .. .. .. .... .. . ... .... ..... . 12. 271,778.70 13. Charitable and Governmental BequestslSec 9113 Trusts for which an e�ection to tax has not been made(Schedule J) ... ..... .. .. . .. ........ . 13. � 14. Net Value Subject to Tax(Line 12 minus Line 13) .. .. .... ..... . .... ... ... 14. 271,778.70 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_ 15. 16. Amount of Line 14 taxable at�inea�rate X.0 45 271,778.70 �g. 12,230.04 17. 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. 12,230.04 20. FILI IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p Side 2 � 1505610205 1505610205 J Decedent's Complete Address: DECEDENT'S NAME Donald D. Zeiders STREETADDRESS 450 North Bethany Drive CITY STATE ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 0 2. Credits/Payments A.Prior Payments B.Discount Total Credits(A+g) (2) 0 3. Interest (3) 0 4. If Line 2 is greater than Li�e 1 +Line 3,enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2,Line ZO 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) 12,230.04 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 .............................................................................................................................. ❑ � d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ � 2. If death occurred after Dec. 12, 1982,did decedent transfer properry within one year of death without receiving adequate consideration?.............................................................................................................. ❑ � 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? ........................................................................................................................ ❑ � 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 suroiving 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 decetlenYs siblings is 12 percent[72 P.S. §9116(a)(1.3)].A sibling is defined, under Section 9102,as an intlividual who has at least one parent in common with the decedent,whether by blood or adoption. . � pennsylvania SCNEpt�LE E � DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC. INHEWTANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: n�r�-\c� 7 2-e ��ers 2.0�3 -00 � 6 � Inciude the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disctosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. pY-�e�e c!� S �� TOTAL(Also enter on Line 5, Recapitulation) $ SCHEDULE E-ESTATE OF DONALD D. ZEID�RS CASH, BANK DEPOSITS&MISCELLANEOUS PERSONAL PROPERTY FILE NUMBER 2013-00766 1. United States Currency $ 24,428.12 2. PNC Accounts &Certain Certificates of Deposit $ 89,765.48 PNC Certi�cate of Deposit#31100363992 PNC Certificate of Deposit#31400213831 PNC Certificate of Deposit#31800274836 3. PNC Checking/Savings Account $ 5,006.00 4. Sovereign Bank Certificates of Deposit $ 120,802.29 Sovereign Bank Certificate of Deposit#16$5293563 Sovereign Bank Certificate of Deposit#1685553115 Sovereign Bank Certificate of Deposit#2313726917672472305 5. Sovereign Bank Checking/Savings Account $ 2,156.00 $ 21,206.98 5. Pontiac Grand Am (Appraisal Attached) $ 4,500.00 6. State Farm Insurance Refunds $ 115.75 $ 3.18 $ 110.29 7. Verizon Refund $ 21.47 8. PA Media Group (Newspaper Refund) $ 23.66 9. UNUM Refund (Long Term Care Insurance) $ 610.24 10. 1/3 of Interest on Jointly Owned Certi�cate of Deposit issued by United Methodist Church (Letter Attached from Susquehanna Conference of the United Methodist Church) $ 86.64 11. American Income Life (Refund llnearned Premium) $ 102.88 $268,938.98 Sue Adams<sadams@susumc.org>c� � '>, � . _ . _ _ Donald Zeider or Fay E Royer or Cynthia A Hess Atty.Steve Howell, Enclosed is our first record of the three names shown above that matches the account name in our computer files(see copy of CD 29743 enclosed which was issued on January 13,2009). Our software does not provide a "history"of account changes. Have a blessed day! Sue Sue Adams Susquehanna Conference The United Methodist Church Finance Office 303 Mufberry Drive PO Box 2053 Mechanicsburg,PA 17055-2053 717-766-5275 x3504 Email: sadams@susumc.org -----Original Message----- From:noreply@susumc.org[mailto:noreply@susumc.org] Sent:Friday, December 06,2013 2:43 PM To:sadamsQsusumc.org Subject:Scanned image from MX-M453N Reply to:noreplyQsusumc:org<noreplyQsusumc.org>Device Name:Not Set Device Model:MX-M453N Location:Not Set File Format:PDF MMR(G4) Resolution:200dpi x 200dpi Attached file is scanned image in PDF format. Use Acrobat(R)Reader(R)or Adobe(R)Reader(R)of Adobe Systems Incorporated to view the document. Adobe(R)Reader(R)can be downloaded from the following URL: Adobe,the Adobe logo,Acrobat,the Adobe PDF logo,and Reader are registered trademarks or trademarks of Adobe Systems Incorporated in the United States and other countries. http:/lwww.adobe.com/ �---�„t,�—.,,y,�—.,�,,,.._.,_��.y --,o,.— ..�,---,.,�,.—_..,�,,.__..,�—,..,y�_ ..,,�-_;,s,,—...,y,;_��,�1►,� � i y +�: � �� 303 Mulberry Drive,P.O.Box 2053,Mechanicsburg,PA 17055-2Q53 � Na. 29743 Da� JANUARY 13,2009 On dema�d we promise to pay to tfie order � of DONALD D.ZEfDERS OR FAY E,ROYER OR CYNTHIA A.HESS $ *13,000.00 � � �"'""T IRTEENTHOUSANDAN 00100-- --- ---- - --------------------------------------Dollara Without de(alcation or y of ex ution,for v lu recei ed,wi int r yt 5_SO� per annum,waiving iaquisition and exempGon Iaws,and ofcas j dgment fo a e su wiW o set,witli interest and costs of suit,and witL five percent for eollection fees.Then is a 1%penal o all m ies nt in t e tund for a period of one year. . THE C PENNSYL AN A CO ENCF.COMMITTEE ON LO S THE U TE METHODIST C CH Attest: ' . ; .,�� V TR SURE --�OF THE E ON LOAK3`_'" � wi �°�"'�__/'f'�,_�iQ`,.V�l�._�.-A..,` .^!-.,��__�,^t, _ � -?�..,._,?...-�.�"�'�_-'...:'q". .---,?�. ��"��._-i O1B9�f i,T4 �tlHW�RwwwU +�u.c9l.-1�kc�t.Cwa.eQ. '7�3�13 ' SUSQUEHANNA CD�IFERENCE .�i A PENNSYLVANIA CONFERENCE C?F THE UNITED METHODIST GHURCH 303 MULBERRY DRIVE• P.O, BUX 2053* MECHANICSBURG, PA 17055-2053•TELEPHONE(717}76$-5275 August 8,2013 — ___.. —�'�,°�,�p-�c*veirI�e�e�l---- .____._—. Howell Law Firm w 619 Bridge Street New Cumberland, PA 17070 RE: Estate of Donald D.Zeiders Account Number: 2-13060 Dear Attorney Howe1L• In response to your request,the account for ponald S.Zeiders has been changed to names of his heirs. The new account name is Fay E. Royer and Cynthia A.Hess. The principal balance on the Estate of Donald D. Zeiders, at the time of his death on July 3,2013,was $75,000. Interest earned as of the time of his death for the period of May 1, 2013 to July 3,2013 was$259.94. The interest payment will be payable to the new account name shown above and will be mailed to Fay's address on or about November l, 2013. Additional interest in the amount of.$107,88 has accrued until the account was closed on August 8, 2013. _ _ _ __..___ _ _____ _ If you should have turther questions,please contact me at 717-766-5275, extension 3504. Si erely, ,�.e �G��L�=��'� Sue Ellen Adams Administrative Accounting Assistant cc: Fay E. Royer Cynthia A. Hess COUNCIL�N FlNANCE AND ADMINISTRATION � � � � PONTIAC $11ICK � �N�n�� FREYSINGER PONTIAC, GMC, BUICK, MAZDA, HYUNDAI, INC. 6251 CARLISLE PIKE/MEGHANICSBURG, PA 17050 • TEL.717-766-8422 OWNER OF VEHICLE: �C��i� � Z��ch� VEHICLE IDENTIFICATION NO. : ��N 1=��r��/�'1�� 7'-�"�'�' YEAR/MAKE/MODEL: ��.%a t ��-°s�+•�t� �fc;.�..t tt�^� St:" ..�.�-. FAIR MARKF.T VALUE AS OF � $ � -�� COMMENTS : W,d'�1 Iuc �� c» I�� ILt� ABOVE INFORMATION PROVIDED BY: �� /'►'1�4''��1C i� 1��/'x.c_ �j`�;,"iec� /��i�,�rYr.�' . �, i �ry pennsylvania SCHEDULE F ��#�� DEPARTMENT OF REVENUE _ INHEKITANCE TAX RENRN �OINTLY OWNED PROPERTY RESIDENT DECEDENT fSTATE OF: , FILE NUMBER: 'n o�.�- �_ 2.e�(�.�r� 20�3 - o o�6 � It an asset became joirrtiy owned within one year of the dece!denYs date of death,it must be reported on Schedule G. SURVNING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. 1 S Q e ��-�..° cJl B. C. ]OINTLY OWNED PROPERTY: �ErrER DATE DESCRIPTION OF PROPERTY %oF DATE OF DEATH ITEM FOR lOINT MADE INCWDE NAME OF fINANCL41.INSTITUTION AND BANK ACCWNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER.ATTACH DEED FOR lOINTLY HELD REAL ESTATE. VALUE OF ASSET INiEREST DKEDEM"S INTEREST 1. A. S2G �QCY TOTAL(Also enter on Line 6, Recapitulation) � � SCHEDULE F-ESTATE OF D011IALD D. ZEIDERS JOINTLY OWNED PROPERTYU FILE NUMBER 2013-00766 SURVIVING JOINT TENANT NAMES ADDRESS RELATIONSHIP Cynthia Hess 350 Duke Street Daughter Ephrata, PA 17522 Fay Royer 2615 Hazelwood Road Daughter Lancaster, PA 17601 JOINTLY OWNED PROPERTY The Decedent and both daughters owned 1/3 of a series of Certificates of Deposit issued by the United Methodist Church. The accounts were made joint between the Decedent and his daughters on January 13, 2009. Description of Property DOD Value %Interest Decedent's Value United Methodist Church Certificates of Deposit No. 193 $ 500.00 1/3 No. 240 $ 500.00 1/3 No. 20049 $10,000.00 1/3 No. 10693 $10,000.00 1/3 No. 21265 $12,000.00 1/3 No. 29743 $13,000.00 1/3 No. 19871 $20,000.00 1/3 No. 10733 $ 5,000.00 1/3 No. 10402 $ 2,000.00 1/3 No. 10352 $ 2,000.00 1/3 $75,000.00 $25,000.00 . � pennsylvania SCHEDULE H DEPARTMENTOFREVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER "l� e w. w.�. �, Ze��V S 2013 -- O U-1 6� Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. See l��r�--�.� . B. ADMINISTRATIVE COSTS; 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City _ State ZIP Year(s)Commission Paid: 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's,attach exp�anation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent __ 4. Probate Fees: 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. TOTAL(Also enter on Line 9, Recapitulation) $ SCHEDULE H -ESTATE OF DONALD D.ZEIDERS FUNERAL EXPENSE5 AND ADMINISTRATIVE COSTS FILE NUMBER 2013-00766 ITEM NO. DESCRIPTION AMOUNT A.1 Funeral Expenses $ 8,173.07 B.2 Attorn�y Fees Steven Howell, Esquire Howell Law Firm 619 Bridge Street New Cumberland, PA 17070 $ 9,160.00 4. Probate Fees Register of Wills Probate $ 393.50 USPS Certified Mail $ 6.11 Patriot News Advertising Estate $ 130.31 Cumberland Law Journal Ad Estate $ 75.00 Additional Probate Fees Fee In Excess of Initial $200,000 Estimate $ 50.00 Family Settlement Agreement $ 20.00 7. Bank Fees ($3.00 Per Month) $ 12.00 $18,019.99 . � pennsylvania SCH E DU LE i DEPARTMENTOFREVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER n o,�,a�.�LL �� 2.-e �dL-er S rz.�t3 - o o l 6 �6 Re�►ort debts lncurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM UALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. S�e� 1�-��,�e�-ec� , TOTAL(Also enter on Line 10, Recapitulation) $ � SCHEDULE I -ESTATE OF DONALD D. ZEIDERS DEBTS OF THE DECEDENT FILE NUMBER 2013-00766 ITEM 1V0. DESCRIPTION AMOUNT 1. Bethany Village At Home $ 2,499.00 2. Harrisburg Pharmacy $ 54.20 3. Community Life Ambulance $ 104.80 4. PPL Electric Service $ 132.84 5. Verizon Wireless $ 42.21 6. PA Auto Broker(Transfer Grand Am) $ 85.00 7. Home Instead Senior Care $ 209.50 8. PA American Water $ 43.26 9. Bethany Village Service Fee $ 959.48 10. Caremark CVS $ 10.00 $ 4,140.29 � � pennsylvania SCHEDULE � DEPARTMENT OFREVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEOENT ESTATE OF: FILE NUMBER: Donald D. Zeiders 2013-00766 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 spousai distributions and transfers under Sec.9116(a)(1.2).] 1. Cynthia Hess,350 Duke Street,Ephrata,PA 17522 Daughter 50% Fay Royer,2615 Hazelwood Road,Lancaster, PA 17601 Daughter 50% 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: i. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II — ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $