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HomeMy WebLinkAbout12-31-13 J REV-1500 Ex(03.11)(FI) 1505610105+ enns lvania OFFICIAL USE ONLY Bu Department of Revenue Pennsylvania_Y County Code Year File Number Bureau 28o6vidualTaxes INHERITANCE TAX RETURN PO BOX a8o6ot Harrisburg PA 17128-0601 RESIDENT DECEDENT g l� 13 y ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 06/24/2013 11/20/1928 Decedent's Last Name Suffix Decedent's First Name MI Stumbaugh Eleanor E (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 Return O 2. Supplemental Return O 3. Remainder Return(Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 0 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 CONFIDENTIALTAX INFORM60N SHOULD BE DIRECTED TO:Z1 Name Daytim4_Tellshone Nulfibbr rn C-) n John C Oszustowicz (717) 43'��7437 m � � �y REGISFEfIt;QF WEW USCOON61 X G? -n First Line of Address 104 S Hanover St. �` cn m Second Line of Address i Q to 4 City or Post Office State ZIP Code DATE FILED Carlisle PA 17013 Correspondent's e-mail address:johno@carlislepalaw.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�P�RSON RESPONSIBLE FOR FILING RETURN DATE Yi/ A7/f�f .�✓ 30 /ao i3 ADDRESS 4895 Mary LanA Carlisle, PA 17013 SIGN V OF OTHER THAN REPRESENTATIVE DATE ADDWSS 1 Of S Hanover St. Carlisle, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 �Pi .J 1505610205 REV-1500 EX(Fl) Decedent's Social Security Number Decedent's Name: RECAPITULATION ...-.. _ - .............. 1. Real Estate(Schedule A). . ...... ...... .... ... ............... ... ... . .. i. 2. Stocks and Bonds(Schedule B) ..... . . .. . . . .. . . .. ... . .. . .. . .. . ... . .. .. 2. 1 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. 158,199.39 6. Jointly Owned Property(Schedule F) O Separate Billing Requested ... . ... 6. 313.98 7. Inter-vvos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested...... . . 7. 8. Total Gross Assets(total Lines 1 through 7)... .. . ....... ... ... . .. . . .. . .. 8. 158,513.37 9. Funeral Expenses and Administrative Costs(Schedule H)........ . .. .... .... 9. 6,249.13 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1).......... . ... . 10. 369.86 11. Total Deductions(total Lines 9 and 10) ........ ..... .... 11. 6,618.99 12, Net Value of Estate(Line 8 minus Line 11) . . ... ... . .. . .. . ... .... . .. . ... . 12. 151,894.38 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. 151,894.38 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 6,835.25 at lineal rate X.0 45 151,894.38 16. 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. 6,835.25 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT CZ) Side 2 L 1505610205 1505610205 J REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Eleanor E Stumbaugh STftEETADDRESS ----'— R ---- 422 Walnut Bottom Rd CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1} 6,835.25 2. Credits/Payments A.Prior Payments —. 6,440.00 B.Discount _ 339.00 Total Credits(A+B) (2) 6,779.00 3. Interest .- (3) 4. It 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) 5. if Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 56.25 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 b. retain the right to designate who shall use the property transferred or its income ......._.........................._.....- ❑ ■ c. retain a reversionary interest .................-................................................__....................................................... ❑ i J. receive the promise for life of either payments,benefits or care?..................................................................... ❑ 2. If death occurred after Dec. 12,1902,did decedent transfer property within one year of death without receiving adequate consideration?...............___............___...._...................._..............................._......... ❑ E 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? .........................._.........___...............__...........-------....____............___._.. EJ ■ 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 172 P.S.§9116(a)(1.1)(i)1. For dales 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 A)(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(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. REV-1508 EXs(oa-> ) to pennsylvania SCHEDULE E ft�7 DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Eleanor E. Stumbaugh 21-13-0794 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. REM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Refund from Thomwald nursing home 1,776.18 2 Morgan Stanley Account 410-059310-012 134,028.00 3 Memberstst Credit Union Checking Account 480894 18,285.03 4 Members 1st Credit Union Savings Account 480894 4,108.50 5 Interest on item 4 1.29- 6 Interest on item 3 0.39 TOTAL(Also enter on Line 5, Recapitulation) $ If more space is needed,use additional sheets of paper of the same size. REV-15O9 EX+(oi-io) pennsylvania SCHEDULE F DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Eleanor E. Stumbaugh 21-13-0794 If an asset became jointly owned within one year of the decedent's date of death,it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A.Jill E Harmon 1895 Mary Lane daughter Carlisle, PA 17013 B.Joan S. Clippinger 200 Zeigler Road daughter Dover, PA 17315 C. JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % DATE OF DEATH JTEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMIlA0. DATE OF DEATH OINTERE T VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTATE, VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 07127103 Americhoice FCU Checking Account 118553 936.81 33. 31227 1 A 07127103 Americhoice FCU Savings Account 118553 5.12 33 1.71 TOTAL(Also enter on Line 6, Recapitulation) $ 313.98 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+ (08-13) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Eleanor E Stumbaugh 21-13-0794 Decedent's debts must be reported on Schedule I. ITEM AMOUNT NUMBER DESCRIPTION A. FUNERAL EXPENSES: 1' Musselman Funeral Home 1,549.78 2 Food for funeral and memorial service 374.28 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address ----- Cite _—---- —-State_ZIP . Year(s)Commission Paid: - 3,650.00 2. Attorney Fees: 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: 363.50 5. Accountant Fees: 6. Tax Return Preparer Fees: 7• Advertising-Cumberland County Law Journal 75.00 a Advertising-The Sentinel 115.20 9 State Employees Retirement System-return of pension overpayment 121.37 TOTAL(Also enter on Line 9, Recapitulation) $ 6,249.13 If more space is needed,use additional sheets of paper of the same size. REV-1512 Ex+(1212) SCHEDULE I i penTns olvaENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT FILE NUMBER ESTATE OF 21-13-0794 Eleanor E. Stumbau h Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical UE AT DATE OF DEATH ITEM DESCRIPTION NUMBER 369.86 t Millennium Pharmacy TOTAL(Also enter on Line 10,Recapitulation) $ 369.86 If more space is needed,inseR additional sheets of the same size. REV-1513 EX+(01-10) `sjij; pennsytvania SCHEDULE ] 1 DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER: ESTATE OF: 21-13-0794 Eleanor E Stumbaugh RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustees) OF ESTATE ( TAXABLE DISTRIBUTIONS(include outright 916 50(]S2',.;istdhutions and transfers under 1. Jill E Hannon 1895 Mary Lane,Carlisle,PA 17013 Daughter 50% 2 Joan S Clippinger 200 Zeigler Rd.,Dover,PA 17315 Daughter 50% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. 11 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.