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HomeMy WebLinkAbout01-03-14 (2) t , J /� 1505611185 REV-1500 EX OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes PO BOX 280601 INHERITANCE TAX RETURN 21 13 0768 Harrisburg,PA 17128.0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 06102013 09151919 Decedent's Last Name Suffix Decedent's First Name MI CLEMM ANNE A (If Applicable) Enter Surviving Spouse's Information Below f Spouse's Last Name Suffix Spouse's First Name M I Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW ® 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 ❑ 5. Federal Estate Tax Return Required death after 12-12-82) IT 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 Schedule 0) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORM IO SHOULD 9€DIR EBTO; Name Daytime Tel Do`a�Number c- PETER � � O PETER J . RESSLER , ESQUIRE 717-29-zl5g110 G w REGIS_TFW WILLS tUSEOONLY' C, ' �c CS t G7 -?3 'F1 First Line of Address b c -1 23 t TT 3401 NORTH FRONT STREET Second Line of Address v� PO BOX 5950 City or Post Office State ZIP Code DATE FILED HARRISBURG PA 171100950 Correspondent's e-mail address: PJRESSLER@METTE-COM 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 and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN �"�j�/ + DATE SUSQUEHANNA TRUST & INVESTMENT CO . �j rilu �;• luy jZ/aJ��3 ADDRESS 1570 MANHEIM PIKE, PO BOX 3300 LANCASTER, PA 17604-3300 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVEQ DATE METTE, EVANS & WOODSIDE « ,cam 2-1 ADDRESS 3401 N. FRONT STREET, PO BOX 5950 HARRISBURG, PA 17110-0950 PLEASE USE ORIGINAL FORM ONLY Side 1 1505611185 OM46471000 1505611185 1505611285 REV-1500 FCC(FI) Decedent's Social Security Number Decedents Na CLEMM ANNE A RECAPITULATION 1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 0 • 00 2.' Stocks and Bonds(Schedule B). . . . . . . . . . . . . . . . . . . . . . . . . 2, 0 . 0 0 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C), , , , , 3, 0 . 00 4. Mortgages and Notes Receivable(Schedule D) , , , , , , , , , , , , , , , , , 4. 0 •00 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E) , , . . . 5. 47,185. 0 2 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested , , , , 6. 0 • 00 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) FI Separate Billing Requested . . . . 7. 118,785 - 56 8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . 8, 1651940 • 58 9. Funeral Expenses and Administrative Casts(Schedule H). . . . . . . . . . . . . 9. 141405 •14 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule 1) , , , , , , , , , 10. 51397 .77 11. Total Deductions(total Lines 9 and 10). . . . . . . . . . . . . . . . . . . . . 11. 191802 • 91 12. Net Value of Estate(Line 8 minus Line 11) , , , , , , , , , , , , , , , , , , , 12. 14 6,137 .67 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J), , , , , , , , , , , , , , , , 13. 0 • 00 14. Net Value Subject to Tax(Line 12 minus Line 13) , 14. 1461137 .67 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers un er Sec.9116 (a)(1.2)x.o$ 0 . 00 15. 0 .00 16. Amount of Line 14tOxable at lineal rate X.0- 1461l37 - 66 16. 61576 - 19 17. Amount of Line 14 taxable at sibling rate X.12 0 . 00 17. 0 .0 0 18. Amount of Line 14 taxable at collateral rate X.15 0 . 00 18. 0 .00 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 61576 -19 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT El Side 2 1505611285 1505611285 OM4648 3.000 REV-1500 EX(FI) Page 3 File Number DecedenYs Complete Address: 21 13 0768 DECEDENTS NAME CLEMM ANNE A STREET ADDRESS 1524 WOOD CRFFK DRTVE CUMBERLAND TY CITY STATE ZIP MECHAN CSBUR PA 17055- Tax Payments and Credits: 1. Tax Due(Page 2, Line 19) (1) 6.576 . 19 2. Credits/Payments A. Prior Payments 5,700 - 00 B. Discount 300 - 00 Total Credits(A+B) (2) 61000 - 00 3. Interest (3) 0 . 00 4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT. Fill in box 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) 576 - 19 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 El b. retain the right to designate who shall use the property transferred or its income . . . . . . . . . . 0 El 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 property within one year of death El without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . ® El 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)(11)(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 172 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 172 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. OM4671 2.000 REV-1509 FJN(09-12) pennsylvania SCHEDULE E DEPARTNIENT OF REVENUE CASH, BANK DEPOSITS & MISC. RESIDENTIECEDEN;'uR" PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Anne A. Clemm 21 13 0768 Inclutle the proceeds of litigation and the date the proceeds were received by the estate. All ro ert 'ointl owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Metro Sank Checking Account #552009748 47,184.06 Interest accrued to 6/10/2013 0.96 TOTAL(Also enter on line 5,Recapitulation) $ 47,185.02 2W46AD 2.000 If more space is needed,use additional sheets of paper of the same size. REV-1510 EX (08-09) SCHEDULE G pennsylvania DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC.NON-PROBATE PROPERTY RESIDENTDECEDENT ESTATE OF FILE NUMBER Anne A. Clemm 21 13 0768 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. DESCRIPTION OF PROPERTY ITEM wni E!4w,EOF7FE aSFEREE,T,1EiR REUTIONS„PTO DECEDEKTAW DATE OF DEATH %OF DECO'S EXCLUSION TAXABLE NUMBE TOEMW OE TRAASFER ATTncH Awry of TIFE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST IF APPLICABLE VALUE 1 Assets held in the Anne A. Clean Revocable Trust U/A dated 09/20/1991, as amended: 19,953.25 100.0000 0.00 19,953.25 19,953.250 units Federated Government Obligations Money Market Fund, CUSIP 60934N849; see attached correspondence Interest accrued to 6/10/2013 0.05 100.0000 0.05 2 Assets held in UBS Resource Management Account #RU5048784 consisting of the following: 98,802.26 100.0000 0.00 98,802.26 8,076.568 shares Lord Abbett Short Duration Income Fund C at $4.63 per share - $37,394.51 4,575.535 shares Pimco Total Return Fund C at $10.97 per share - $50,193.62 Cash - $11,214.13 TOD designation to Patricia C. O'Neill and Sandra C. Ressler; see attached correspondence 3 State Employees' Retirement System - final accrued pension payment 266.02 100.0000 266._02 0.00 Exempt from PA Inheritance Tax TOTAL(Also enter on line 7,Recapitulation)S 118,755.56 If more space is needed,use additional sheets of paper of the same size. 9W46AF 2000 REV-1511 Ex.(10.09) pennsylvania SCHEDULE H DEPARTMENTOF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENTDECEDENT ESTATE OF FILE NUMBER Anne A. Clemm 21 13 0768 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 Hoover Funeral Homes & Crematory, Inc. 2,358.00 2 Pastor honorarium 125.00 Total from continuation schedules . . . . . . . . . 105.47 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 5,000.00 Name(s)of Personal Representative(s)Susquehanna Truat & Investment Co. Street Address 1570 Manheim Pike, PO Sox 3300 City Lancaster State PA ZIP 17604-3300 Year(s)Commission Paid: 2014 2. Attorney Fees: Mette, Evans & Woodside (estimated) 6,000.00 3, Family Exemption:(If decedent's address is not the same as claimant's,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 243.50 5. Accountant Fees: 350.00 6. Tax Return Preparer Fees: 7. 1 Cumberland Law Journal Legal advertisement 75.00 2 The Patriot News Legal advertisement 148.17 TOTAL(Also enter on Line 9,Recapitulation) $ 14,405.14 9w46AG 2.000 If more space is needed,use additional sheets of paper of the same size. REV-1512 Ex.(12-12) SCHEDULE pen nsylvania DEPARTNENTOF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENTDECEDENT ESTATE OF FILE NUMBER Anne A. Clemm 21 13 0768 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 Bethany Skilled Nursing Nursing home services 5,156.37 2 Omnicare Ring oP Prussia Pharmacy bills 241.40 TOTAL(Also enter on Line 10,Recapitulation) $ 5,397.77 2 W46AH 2.000 If more space is needed,insert additional sheets of the same size. REV-1513 EX.( SCHEDULE J penns nsylvania DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Anne A. Clemm 21 13 0768 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECENING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under Sec. 9116(a)(1.2).] 1. Cami Ressler 1524 Woodcreek Drive Mechanicsburg, PA 17055 15% of Residue to Cami Ressler 1524 Woodcreek Drive Mechanicsburg, PA 17055: 7,100.31 Granddaughter 7,100.31 2 Kevin Ressler 107 Butterfield Court Chapel Hill, NC 27516 15% of Residue to Kevin Clemm: 7,100.31 Grandson 7,100.31 ENTER DOLLAR AMOUNTS FOR DISTRIBUTONS 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.CHARITABLEAND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 0.00 swasAl z.aoo If more space is needed, use additional sheets of paper of the same size. Estate of: Anne A. Clemm 21 13 0768 Schedule J Part 1 (Page 2) Item No. Description Relation Amount 3 Patricia C. O'Neill 147 Blue Water Point Holly Lake Ranch, TX 75765 Assets held in UBS Resource Management Account #RU5048784 consisting of the following: Inventory Value: 49,401.13 35% of Residue: 16,567 .39 Daughter 65, 968.52 4 Sandra C. Ressler 1524 Woodcreek Drive Mechanicsburg, PA 17055 Assets held in DES Resource Management Account #RU5048784 consisting of the following: Inventory Value: 49,401.13 35% of Residue: 16,567.39 Daughter 65,968.52 NOTE: Per Paragraph 2 of the decedent's Will, the residue of her estate pours into the Anne A. Clemm Trust U/A dated 09/20/1991, as amended. Per Paragraph 3.(e) of the Agreement of Trust, her Trust is then paid over to the James T. Clemm Trust of the same date. Per Paragraph 3. (e) of the Agreement of Trust for the James T. Clemm Trust, the Trust terminates and the balance of the Trust is to be distributed as follows: Kevin Ressler, Grandson - 15Z; Cami Ressler, Granddaughter - 15Z; Patricia O'Neill, Daughter - 35%; and Sandra Ressler, Daughter - 352. By way of further information, James T. Clemm predeceased Anne A. Clemm, having died on March 27, 2000. An Inheritance Tax Return for his estate was filed under State File Number 21-00-0529. All Pennsylvania Inheritance Tax applicable to the James T. Clemm Trust was paid at that time.