HomeMy WebLinkAbout01-13-14 .J REV-1500EX(01-10) � 1505610143
'1►1T OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania county Cade year File Number
Bureau of Individual Taxes ^r•^a^^1m�a
PO BOX.280601 INHERITANCE TAX RETURN 21 13 00673
Harrisburg,PA 17128-0801 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
05 03 2013 10 15 1921
Decedent's last Name Suffix Decedent's First Name MI
KELLY HELEN Z
(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 ❑ 2. Supplemental Return ❑ 3.Remainder Return(date of death
prior to 12-13-82)
❑ 4. Limited Estate ❑ 4a.Future Interest Compromise ❑ 5. Federal Estate Tax Return Required
(date of death after 12-12A2)
® g Decedent Died Testale ❑ 7. Decedent Mainlathed a Living Trust 1 B. Total Number 0(Sale Deposit BOXBS
(AXech Copy of WM) (Aided,Copy of Trust) PD
❑ 9. Utigatlon Proceeds Received ❑ 1 D.Spwsm Poverty Credit(dale of Oath 11,Election to tax under Sec.9113(A)
behveen 1231-Bt and 1-1-95) ❑ (Attach SCI.O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
RICHARD E CONNELL ESQ 717 232 8731
REGISTER OF WILL$1YSE ONLY
First line of address c_ o
_.n
2303 MARKET STREET rn s c')
m w rno
Second line of address
T O O
O -� '1'I 'T1 ,
CI or Post Office c'o DATEEILE9 ^r
City Sfate ZIP Code :V 1-, r t7I
CAMP HILL PA 17011 —+ r-
N Cn �.
Correspondent's e-mail address: Connell @bmc-law.net
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 PERSON RESPONSIBLE FOR FILING RETURN DATE
7J Deidre K. Gannon
ADDRESS
858 - Road, Mechanicsburg, PA 17050
SIGNATURE OF PREP 0 ER RE IVE PATE
Richard E Connell Esq /�/t>/AZ T
ADDRESS
2303 Market Street, Camp Hill, PA 17011
Side 1
L 1505610143 1505610143 J
GO
1505610243
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: KELLY, HELEN I.
RECAPITULATION
1. Real Estate(Schedule A).......................................................................................... 1.
2. Stocks and Bonds(Schedule B).............................................................................. 2. 32 , 500 . 00
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C).......... 3.
4. Mortgages&Notes Receivable(Schedule D).......................................................... 4.
5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)................ 5. 4 , 369 . 71
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6. 153 , 244 . 98
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested............. 7_ 238 , 2 0 5 . 70
8. Total Gross Assets(total Lines 1-7)....................................................................... 8. 428 320 39
9. Funeral Expenses&Administrative Costs(Schedule H)......................................... 9. 15 , 308 . 21
10. Debts of Decedent,Mortgage Liabilities,&Liens(Schedule I)................................ 10. 998 0 0
11. Total Deductions(total Lines 9&10)...................................................................... 11. 16 , 306 . 21
12. Net Value of Estate(Line 8 minus Line 11)............................................................. 12. 412 , 014 . 18
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. 412 , 014 . 18
TAX COMPUTATION-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 15.
16. Amount of Line 14 taxable
at lineal rate X .045 412 , 014 . 18 16. 18 , 540 . 64
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. 18 , 540 . 64
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑
Side 2
L 1505610243 1505610243 J
REV-1500 EX Page 3 File Number 21 - 13 - 00673
Decedent's Complete Address:
DECEDENT'S NAME
Kelly, Helen I.
STREETADDRESS
Forest Park Nursing Home
700 Walnut Bottom Road
CITY STATE ZIP
Carlisle PA 17013
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 18,640.64
2. Cred'as/Payments
A. Prior Payments 18,000.00
B. Discount 927.03
Total Credits(A +B) (2) 18,927.03
3. Interest
(3) 0.00
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) 386.39
Check box on Page 2 Line 20 to request a refund
5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5)
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;............................................................. x
b. retain the right to designate who shall use the property transferred or its income;.................................... x
c. retain a reversionary interest;or.................................................................................................................. x
d. receive the promise for life of either payments,benefits or care?.............................................................. x
2. If death occurred after December 12, 1982,did decedent transfer property within one year of death without
receiving adequate consideration?....................................................................................................................... ❑ ❑x
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?...................................................................................................................... ❑x ❑
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)(1)].
For dates of death on or after January 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)(it)]. The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of
assets and fling a tax retturn 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 under Section 9102,as an individual who has at least one parent in common with the decedent,Jelher t y bloo�or adoption.
SCHEDULE B
COWONWEA.TH OF PENNSriVMIIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDEMOECEDENT
FILE NUMBER
ESTATE OF Kelly, Helen I. 21 - 13-00673
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM DESCRIPTION UNIT VALUE VALUE AT DATE OF
NUMBER DEATH
1 U.S. Savings Bonds-Series HH (see attached) 500.00 32,500.00
All issued 10/2001.
TOTAL(Also enter on line 2, Recapitulation) 32,500.00
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
DDMADNV(c/liH Or G NMVP PERSONAL PROPERTY
MN ffR TM RETURN
nE WDECEDENT
FILE NUMBER
ESTATE OF Kelly, Helen I. 21 - 13 -00673
Include the proceeds of litigation and the date the proceeds were received by the estate.All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM
NUM ER DESCRIPTION VALUE DAETADATE OF
1 "Safe Deposit Box: 369.18
Mens ring -21 grams 10kt gold anniversary NYC Police Department
2 Safe Deposit Box: 1,236.40
14kt gold bezel with a scalloped face complete with $20 Liberty gold double eagle pendant
1904
3 Safe Deposit Box: 21.00
1889 90% silver dollar
4 Safe Deposit Box: 21.00
1987 90% silver dollar
5 Safe Deposit Box: 21.00
1989 90% silver dollar
6 Safe Deposit Box: 23.60
1997 90% Silver dollar, commemorative National Law
7 Safe Deposit Box: 293.64
1989 3-coin set USA(1 90%silver dollar; 1 clad half dollar; 1 Congress Bicentennial gold$5)
8 Safe Deposit Box: 294.89
1987 3-coin set USA(1 90% silver dollar; 1 clad half dollar; 1 Congress Bicentennial gold $5)
9 Safe Deposit Box: 2,089.00
1986 4-coin set($50 gold coin; $25 gold coin; $10 gold coin; $5 gold coin)
10 'Safe Deposit Box- Rev. 485EX attached.
'Appraisal Form attached.
TOTAL(Also enter on Line 5, Recapitulation) 4,369.71
SCHEDULE F
COMMONWEALTH INNERrNCE TAX RETURN�'A JOINTLY-OWNED PROPERTY
RESIDENTOECEDENT
ESTATE OF FILE NUMBER
Kelly, Helen I. 21 - 13-00673
H an asset was made joint within one year of the decedent's date of death,it must be reported on schedule G.
SURVIVING JOINT TENANT(S)NAME . ADDRESS RELATIONSHIP TO DECEDENT
Deidre K. Gannon 858 Acri Road Daughterl
A Mechanicsburg, PA 17050
JOINTLY OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank account number DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT similar identifying number.Attach deed for jointly-held real estat S/ALUE OF ASSET INTEREST DECEDENT'S INTEREST
1 A 01/04/2010 Hudson City Savings Bank 106.676.04 50% 52,938.02
CD#1050618062
2 A 01/04/2010 Hudson City Savings Bank 22,270.43 50% 11,135.22
CK#1610505719
3 A Chevron Stock 168,679.48 50% 84,439.74
1372 shares at$123.09 per share
4 A PG&E Corporation 9.464.00 50% 4,732.00
200 shares at$47.32 per share
TOTAL(Also enter on line 6, Recapitulation) 153,244.98
COMMONWEALTH OF PENNSYLVANIA SCHEDULE G
INHERITANCE TAX RETURN INTER-VIVOS TRANSFERS &
RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY
ESTATE OF Kelly, Helen I. FILE NUMBER
21 - 13-00673
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF EXCLUSION
NUMBER Include the name of the transferee,their relationship to decedent VALUE OF ASSET INTEREST (IF APPLICABLE)
TAXABLE VALUE
and the data of transfer. Attach a copy of the deed for real estate.
1 Wells Fargo Checking#0724 21,519.18 21,519.18
2 Wells Fargo Savings#1609 169,422.81 169,422.81
3 Wells Fargo IRA#5840 24,89885 24,898.85
4 Wells Fargo#0052 22,364.86 22,364.86
TOTAL(Also enter on line 7,Recapitulation) 238,205.70
SCHEDULE H
FUNERAL EXPENSES&
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TM RETURN ADMINIS7R ME `( M
RESIDENr DECEDENT
FILE NUMBER
ESTATE OF Kelly, Helen I. 21 - 13 -00673
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT
A. 1 Myers-Hanna Funeral Home 13,590.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zip
Year(s)Commission paid
2. Attorney's Fees Ball, Murren &Connell 1,240.00
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 Cumberland County Register of Wills 450.58
5. Accountant's Fees
6. Tax Return Preparer's Fees
7, Other Administrative Costs
1 Ball, Murren &Connell -Costs Advanced 27.63
TOTAL(Also enter on line 9, Recapitulation) 15,308.21
SCHEDULEI
DEBTS OF DECEDENT, MORTGAGE
COMMONWEALTH OFPENNSnVMIIN LIABILITIES 8L LIENS
INHERITANCE TAX RETURN !
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Kelly, Helen I. 21 - 13-00673
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
1 Forest Park Health Center 998.00
TOTAL(Also enter on Line 10, Recapitulation) 998.00
REV-1313 EX-(1148)
SCHEDULEJ
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Kelly, Helen I. 21 - 13-00673
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) (sss)
RECEIVING PROPERTY Do Not List Tmo ee(s)
I TAXABLE DISTRIBUTIONS[include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
1 Deidre K. Gannon Daughter All
Enter dollar amounts for distributions shown above on lines 15 through 18 on 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
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
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LAST WILL AND TESTAMENT
OF ~
HELEN I. KELLY
I
I�
II I, HELEN I. KELLY, presently domiciled at 10
!1 Hummingbird Lane, Whiting, in the Township of Manchester,
j
County of Ocean and State of New Jersey, do hereby make,
publish and declare this instrument to be my Last Will and
ii Testament, revoking all former Wills and Codicils:
I
I!j FIRST: I direct that my just debts and funeral j
I
j expenses be paid as soon after my death as may be done
it conveniently. !
11, SECOND: Z give, devise and bequeath all the
i
�! rest; residue and remainder of my estate, be the same real,
i
I�! personal or mixed and wheresoever situate, to my husband,
i
FRANK X. KELLY. Should he predecease me, or fail to survive
j, me for a period of thirty (30) days after my death, then the
rest, residue and remainder of my estate shall be
distributed to my daughter, DEIDRE GANNON. Should she also j
ji have predeceased me, or fail to survive me for a period of
it
thirty (30) days after my death, then the rest, residue or !
iI
remainder of my estate shall be distributed, in equal li
ii shares, to my grandchildren, SARA HYLAND GANNON and THOMAS
'I FRANCIS GANNON, or the survivor of them.
1, THIRD: I nominate and appoint my husband,
FRANK X. KELLY as sole EXECUTOR of this, my Last Will and
i
Testament. Should he predecease me, or having qualified die,
',,i or become incapable of completing the administration of my
it estate, then I nominate and appoint DEIDRE GANNON as
i� successor EXECUTRIX. Should she also predecease me, or
having qualified die or become incapable of completing the
i! administration of my estate, then I' nominate and appoint my
�i I
PAGE ONE OF THREE
I
i
li I
i
II I
i
i
�I
II son-in-law, THOMAS P. GANNON, as successor EXECUTOR. I
direct that neither my EXECUTOR, nor his successor, shall be
I �
required to furnish any bond or other surety for the
Ifaithful performance of his or her duties in any
I jurisdiction whatsoever.
FOURTH: My fiduciary is directed to pay from j
i. the residue of my estate, all Transfer Inheritance Taxes,
I� Federal Estate Taxes, or other death duties that may be
i
imposed upon my estate by any jurisdiction, including such
LI taxes as may be imposed upon property passing outside the I
I I
I . terms of this Will.
I: FIFTH: I expressly authorize and empower my
EXECUTOR, or his successor, to sell, mortgage, lease, or j
is
�I develop any and all real estate of which I die seized or
i
j� possessed (including any condominium and/or cooperative of
which i die seized or possessed) , at such price, at such II
I
time and upon such terms as my EXECUTOR, or his successor,
determines to be appropriate.
I i
j I, HELEN I. KELLY, the Testatrix, sign my name to
i
ICI this instrument this 21.t day of February, 1989, and
I
being first duly sworn, do hereby declare to the undersigned
I i
!I authority that I sign and execute this instrument as my Last
I� will and Testament, and that I sign it willingly; that I
I!
it execute it as my free and voluntary act for the purposes
therein expressed and that I am eighteen (18) years of age i
or older, of sound mind and under no constraint or undue
influence. I
I
� I
i, L.S.
it I
HELEN I. KELLY
I I ii
it
I PAGE TWO OF THREE !
I
i'
it
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ii
it
I
Ii WE, tosePolge WA GA44 and WiWM C. CASH A
I
the witnesses, sign our names to this instrument, and being
i�
first duly sworn, do hereby declare to the undersigned
authority that the Testatrix signs and executes this
�I instrument as her Last Will, and that she signs it
i
jl willingly, and each of us, in the presence and hearing of
the Testatrix, hereby signs this will as witness to the
ji
�j Testatrix's signing, at 2.Qo v.m. , on the date and year
last above written, and that to the best of our knowledge,
!' i
I the Testatrix is eighteen (18) years of age or older, of
i
III sound mind and under no constraint or undue influence.
I,
II ms�ss[[ i
I ? 1�4 bJZdes residing at LU
WITNESS !
residing at
1 WITNESS -
Ii
STATE OF NEW JERSEY ) -
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II ICI 55. t
COUNTY OF OCEAN )
jl I
I� I
ii SUBSCRIBED, SWORN TO AND ACKNOWLEDGED before me by
HELEN I. KELLY, the Testatrix, and subscribed and sworn to
before me by RsMwe AjjV DA✓OA and
I
WIILIM C GkL?A ,r witnesses, this 21fi day
of February, 1989. -
NOTARY PUBLIC
A Md" C fow
� d N
II PAGE THREE OF THREE MY won EQka Odit&19M
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2303 Market Street
Camp Hill PA 17011 f
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MS GLENDA FARNER STRASBAUGH `
i CUMBERLAND COUNTY REGISTER OF WILLS
1 COURT HOUSE SO i
CARLISLE PA 17013-3301
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