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HomeMy WebLinkAbout11-13-13 (2) 1505610140 � EX (02-11)(FI) REV-1500 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 8 2 0 Hanisbum,PA 1712&0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW � Soaal Security Number Date of Death MMDDYYYY Date of Birth MMDDYWY 0 7 1 1 2 0 1 3 0 3 0 2 1 9 2 7 Decedent's Last Name Suffix Decedent's First Name MI D 0 R N N E L L I E M (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 Retum � 2.Supplemental Retum � 3.Remainder Retum(Date of Death Prior to 12-13-82) � 4.Limited Estate � 4a.Future Interest Compromise(date of � 5.Federal Estate Tax Retum Required death after 12-12-82) � 6.Decedent Died Testate � 7.Decedent Maintained a Living Tnast 8.Total Number of Safe Deposit Boxes (Attach Copy of Will) (Athach Copy of Trust.) � 9.Litigation Proc�eds 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 Schedule O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTE T0: Name Daytime Telephone I�ber� � M U R R E L W A L T E R S I I I , E S Q 7 �?a 6 9 ��r 5 �1 � �, � ..�..`�' - It4G �F w�Cs us�i� � ': , � � � W � C� First Line of Address � � ?�'� ,� .,�h � C7 � � � '� 5 4 E - M A I N S T R E E T � � -� "'.� �, Second Line of Add�ess : � �'"� � � � � � City or Post Office State ZIP Code DATE FILED M E C H A N I C S B U R G P A 1 ? 0 5 5 cornespondent's e-mail address: murrel _waltersgallowav.com Under penaltfes of perjury,I declare that 1 have examined this retum,inciuding accompanying schedules and statements,and to the best of my kno�wledge and belief, it is true,c�omect and compiete.Declaratbn parer other than die personal representative is based on all i�ortna�on of which preparer has any krwwledge. SIGNATU PE R IBL OR FI G RETURN DATE � ADDRESS WENDY J • S , 6 FARMINGTON LANE ELIZABETHTOWN PA 17022 SIGNATURE O A E N REPRESENTATNE �DA�,� � � �� ADDRESS MURREL WAL ERS III, ESQ 54 E•__ MAIN ST MECHANICSBURG PA 17055 PLEASE USE ORIGINAL FORM ONLY Side 1 � � 1505610140 1505610140 J � _ � 1505610240 REV-1500 EX(FI) DecedenYs Social Security Number �ecedenes Name: N E L L I E M• D 0 R N RECAPITULATION . 1. Real Estate(Schedule A) ........................................... 1. • 2. Stodcs 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 De sits and Miscellaneous Personal Pro e 1 0 4 9 7 2 . 5 2 Po p rty(Schedule E)....... 5. 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested ....... 6. 1 9 9 1 2 6 . 8 7 7. Inter-vvos Transfers 8 Miscellaneous N�Probate Property (Schedule G) U Separate Billing Requested ....... 7. . s. Total Gross Assets(total Lines 1 through 7) ........................... s. 3 0 4 0 9 9 . 3 9 9. Funeral Expenses and Administrative Costs(Schedule H) .................. 9. 1 6 6 0 S . 5 0 10. Debt�s of Decedent,Mortgage Liabilities,and Liens(Schedule i) . 10. 4 5 2 3 . 3 5 11. Total Deductions(total Lines 9 and 10) ............................... 11. 2 1 1 2 8 . 8 5 12. Net Value of Estate(Line 8 minus Line 11) ............................ 12. 2 8 2 9 7 0 . 5 4 13. Charitable and Govemmental 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. 2 8 2 9 7 � . 5 4 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (ax1.2)X•0 0 . 0 0 15. Q . Q Q 16. Amount of Une 14 taxable at lineal rate X.0 0 . 0 0 16. 0 . 0 0 17. Amount of Line 14 taxable at sibling rate X:12 . 17. 0 . 0 � 18. Amount of Line 14 taxable at co��atera�rate x.�s 2 8 2 9 ? 0 . 5 4 �8. 4 2 4 4 5 . 5 8 �s. TAX DUE ...................................................... �s. 4 2 4 4 5 . 5 8 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT � Slde 2 � 15�5610240 1505610240 J REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: 2� 13 os2o DECEDENTS NAME NELLIE M. �ORN STREET ADDRESS 100 MT.ALLEN DRIVE CITY STATE ZIp MECHANICSBURG PA 17055 Tax Payments and Credits: �• Tax Due(Page 2,Line 19) (1) 42,445.58 2. Credits/Payments A.Prior Payments 40,000.00 B.Discount 2,000.00 Total Credits(A+B) (2) 42 000.00 3. Interest (3) 4. If Une 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) 445.58 Make check payable to: REGISTER OF WILLS, AGENT �.. ,i ,,..� ,.�„�'. , -; .�"�, ,a,: � ; '�' � � �" e��a +�z:���,.�,��-�,��`� z-r �� t„ , "- - __ le' ,��r.� : �` - .. . _ r� _ �_„ . . . . , ...„ , .. „�F" _, y ,. _ . . > _ .,. .x�, ,,�f ,, _<.�.�:� _.��i' ,�,_�` �,, �g�`�.-�,�., ,..,,_,_. . 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? ....................................................... ❑ Q 2. If death occurred after December 12,1982,did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ❑ Q 3. Did decedent own an"in trust for"or payable-upon-death bank acxount or security at his or her death? ......... ❑ QX 4. Did dec�dent 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. .� 1 � 7�'���*�`f����"�`'`"� -.,� .�r �� � ..� .., r , 'a �` ,�%.-:� .:,`- � "� .s,:. �� , �s r"" , ,'-.:. �'.: " �-.. '�:. :; .,,.:: ' x � �'.�f,�:.0 ��% �-� �:,��,'�`.�` �.�.�.K a . ..a�.�����r`,3�..�.�fi,�- �s�-v-r._ ,n>...��__s�� s „ , .., ,. ,,. ,.�.. ,-�.a>.-z ,.,�.t�...- _ ": �a � � .� �` ..��- . , , __ . _ _, ... . __x�,-_. ��������,s�r`'.�`-.� .�_ ���" '�x`�.v=. _ For dates of death on or after July 1, 1994,and before Jan. 1, 1995,the tax rate imposed on�e net value of transfers to or for the use of the surviving spouse is 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 disdosure of assets and filing a tax retum are still applicable even if the surviving spouse is the only benefiaary. 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 p2 P.s.§9116(aj(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. REV-1508 EX+(pg-12) __ _ _ _ _ - pennsyivania SCHEDULE E - DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: NELLIE M. DORN 21 13 0820 Indude the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be dlsclosed on Schedule F. ITEM NUMBER DESCRIPTION v OF DEA DH TE 1• SUSQUEHANNA BANK 25.00 CHECKING 2• SUSQUEHANNA BANK 104,932.52 CD 3• MESSIAH VILLAGE 15.00 REBATE TOTAL(Also enter on Line 5,Recapitulation) s 104 972.52 If more space is needed,use additional sheets of paper of the same size. _ _ _ _ _ _ REV-1509 EX+(01-10) pennsyivania SCHEDULE F DEPARTMENT OF REVENUE INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY RESIDENT DECEDENT ESTATE OF: NELLIE M. DORN FILE NUMBER: 21 13 0820 If an asset was made jointly owned within one year of the decedenYs date of death,it must be reported on Schedule G. SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A.WENDY L.ALSPAUGH 46 FARMINGTON LANE NIECE ELIZABETHTOWN, PA 17022 B. C. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY 96 OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTfTUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENTS VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST 1. A. 1/22/07 METRO BANK 97,700.88 50. 48,850.44 SAVINGS 2. A 1/22/O7 METRO BANK 28,948.64 50. 14,474.32 CHECKING 3. A T/29/71 MEMBERS 1ST FEDERAL CREDIT UNION 1,211.14 50. 605.57 REGULAR SAVINGS 4. A 7/29/71 MEMBERS 1ST FEDERAL CREDIT UNION 4,000.10 50. 2,000.05 LIFE SAVINGS 5. A 10/2/97 MEMBERS 1 ST FEDERAL CREDIT UNION 47,664.73 50. 23,832.37 MONEY MANAGEMENT 6. A 8/22/11 MEMBERS 1 ST FEDERAL CREDIT UNION 218,728.23 50. 109,364.12 CD TOTAL(Also enter on Line 6,Recapitulation) s 199126.87 If more space is needed,use additional sheets of paper of the same size. _ _ REV-1511 EX+(�p_pg� - pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER NELLIE M. DORN 21 13 0820 DecedenYs debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A• FUNERAL EXPENSES: 1. MYERS-BUHRIG FUNERAL HOME&CREMATORY, MECHANICSBURG 10,692.00 2• FAMILY MEAL WEGMANS/SUBWAY 210.00 B• ADMINISTRATIVE COSTS: �• Personal Representative Commissions: Name(s)of Personal ReprBSentative(s) WENDY J.ALSPAUGH StreetAddress 46 FARMINGTON LANE City ELIZABETHTOWN State P,A_Z�p 17022 Year(s)Commission Paid: (RENOUNCED) 2, Attomey Fees: MURREL R.WALTERS, III 5,200.00 3. Family Exemption:(If decedenYs address is not the same as daimanYs,attach explanation.) Claimant Street Address �� State __,ZIP Relationship of Claimant to Decedent 4• Probate Fees: CUMBERLAND COUNTY REGISTER OF WILLS 503.50 5 Aocountant Fees: 6. Tax Retum Pr�parer Fees: 7. TOTAL(Also enter on Line 9,Recapitulation) S 16 605.50 If more space is needed,use additional sheets of paper of the same size. � REV-1512 EX+(12-12) pennsylvania SCHEDULE I DEPARTA�NT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES�LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER NELLIE M. DORN 21 13 0820 Report debta incurred by the decedent prior to death that remained unpaid at the date of death,including unreimburaed medical expenses, ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH �. ALERT PHARMACY 131.85 MEDICAL 2• MESSIAH VILLAGE 4,391.50 RESIDENTIAL CARE TOTAL(Also enter on Line 10,Recapitulation) S 4 523.35 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: NELLIE M. DORN 21 13 0820 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(sj OF ESTATE I. TAXABLE DISTRIBUTIONS [Indude outr�ght spousal di�tributions and transfers under Sec.91'�6(a)(1.2).] 1. WENDY J.ALSPAUGH Collateral 46 FARMINGTON LANE ELIZABETHTOWN, PA 17022 2. GEORGE W. HOY Collateral 1110 E.COOVER STREET MECHANICSBURG, PA 17055 3. CARRIE A. HOY Collateral 71 DOGWOOD ROAD HAMBURG, PA 19526 4. DANIEL B. HOY Coliateral 309 BRANDY LANE MECHANICSBURG, PA 17055 5. LYNNE L.LANDI Collateral 607 BRAD STREET SHIPPENSBURG, PA 17257 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. s If more space is needed,use additional sheets of paper of the same size.