HomeMy WebLinkAbout01-14-14 1505610143
REV-1500 Ex(o2_„>
PA Department of Revenue y OFFICIAL USE ONLY
p Penns Ivania County Code Year File Number
Bureau of Individual Taxes DEPARTMENT OF REVENUE
PO BOX.280601 INHERITANCE TAX RETURN 21 13 0474
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
04 06 2013 05 14 1943
Decedent's Last Name Suffix Decedent's First Name MI
KIRK CAROL O
(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
X 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 12-12-82)
O 6 Decedent Died Testate ❑ 7 eceder t Maiof ned a Living Trust 0 B. Total Number of Safe Deposit Boxes
(Attach Copy of Will) CC pY
9. Litigation Proceeds Received 10.S ousal PovertY Credit(Date of Death 11,Election to tax under Sec.9113(A)
❑ ❑ b�tween 12-31. 1 and 1<-1-95) (Attach Schedule 0)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone}+t nber,
JERRY R DUFFIE (706 761 '4540
rn
REGI�'E�-0�I111LlrSUSE
A c�
First Line of Address
301 MARKET ST *C
►-' f. fq
Second Line of Address n
PO BOX 109 y
DATE FILED
City or Post Office State ZIP Code
LEMOYNE PA 170430109
Correspondent's e-mail address:
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.
SIGNATUVOF PERSON RES NSIBLE F R FILI TURN DATE
f 44 AA Peter D Kirk
ADDRESS
5155 K lock Road Mechanicsburg, PA 17055
SIGNAT PREP R TH HA REPRESENTATIVE DATE
JERRY R. DUFFIE
ArDSM AR KET ST., LEMOYNE, PA
Side 1
1505610143 1505610143
1505610243
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: KIRK, Carol O
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... 1.
2. Stocks and Bonds(Schedule B)............................................................................. 2. 36, 572 . 97
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. 354 , 893 . 12
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) Separate Billing Requested............ 7. 106, 397 . 61
8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 497 , 863 . 70
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 5 , 624 . 74
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 12 , 935 . 16
11. Total Deductions(total Lines 9 and 10)................................................................ 11. 18 , 559 . 90
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 479, 303 . 80
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. 479, 303 . 80
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 .00 479, 303 . 80 15. 0 . 00
16. Amount of Line 14 taxable 0 . 00 16. 0 . 00
at lineal rate X .045
17. Amount of Line 14 taxable
at sibling rate X .12 0 . 00 17. 0 . 00
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 00 18. 0 . 00
19. TAX DUE................................................................................................................ 19. 0 . 00
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑
Side 2
1505610243 1505610243 J
REV-1500 EX Page 3 File Number 21-13-0474
Decedent's Complete Address:
DECEDENT'S NAME
KIRK, Carol O
STREETADDRESS
5155 Kylock Road
CITY STATE ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 0.00
2. Credits/Payments
A. Prior Payments
B. Discount 0.00
Total Credits(A +B) (2) 0.00
3. Interest (3)
4, If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4)
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) 0.00
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;.................................. ❑ ❑x
c. retain a reversionary interest;or................................................................. .............................................
❑ I x,
d. receive the promise for life of either payments,benefits or care?............................................................ ❑ u
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?.................................................................................................................... ❑ 0
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 El
abeneficiary 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)(i)].
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)(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-1503 EX+(6-98)
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
KIRK, Carol O 21-13-0474
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 354723801 3,356.561 shares of Franklin Tax Free Trust-PA Tax Free 10.89 36,552.95
Income A
Estate Val Valuation is Attached
Accrued dividend on Item 1 through date of death 10.89 20.02
TOTAL(Also enter on Line 2, Recapitulation) 36,572.97
(If more space is needed,additional pages of the same size)
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B(Rev.6-98)
Rev-1508 EX+(11.10)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
KIRK, Carol O 21-13-0474
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 VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
Estate of Harold E.Ocker
LINE ITEMS 1 THROUGH 8
1 Hartford Annuity 8,901.17
2 M&T Bank Individual IRA-Beneficiary: Peter D. Kirk 60,543.50
3 Residue of Estate 49,875.00
4 Wells Fargo Payable Upon Death Account 102,592.71
5 Wells Fargo Payable Upon Death Account-Final Account Payout 310.85
6 Western National IRA-Beneficiary: Peter D. Kirk 91,637.32
7 Orrstown Bank Cd 22,711.85
8 Cash 455.88
9 Metro Bank Checking Account No. 82000647 -Date of Death Letter is Attached 821.42
10 Metro Bank Savings Account No. 82000647-Date of Death Letter is Attached 17,028.00
11 Quantum Imaging -Refund of Overpayment 15.42
TOTAL(Also enter on Line 5, Recapitulation) 354,893.12
(If more space is needed,additional pages of the same size)
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev. 11-10)
Rev-1510 EX+(08-09)
SCHEDULE G
pennsylvania INTER-VIVOS TRANSFERS AND
DEPARTMENT OF REVENUE �+
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
KIRK, Carol O 21-13-0474
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.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER.SATTACH A CORELATIONSHIP O T ED FODECEDENT EAL ESTATE. VALUE OF ASSET INTEREST (1F APPLICABLE) VALUE
1 Deblin Inc-401 K Profit Sharing Plan through First 16,819.72 16,819.72
Savings -Beneficiary: Peter D. Kirk
2 T. Rowe Price Individual IRA Account 52813130-9- 1,126.97 1,126.97
Beneficiary: Peter D. Kirk
3 T. Rowe Price Individual Roth IRA Account 670740784 16,245.03 16,245.03
-5 -Beneficiary: Peter D. Kirk
4 T. Rowe Price Individual Traditional IRA Account 72,205.89 72,205.89
1018515845-6 -Beneficiary: Peter D. Kirk
TOTAL(Also enter on Line 7, Recapitulation) 106,397.61
(If more space is needed,additional pages of the same size)
Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule G(Rev.08-09)
REV-1511 EX+(10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
DECEDENT URN
RESIDENT ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
KIRK, Carol O 21-13-0474
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
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 JOHNSON, DUFFIE, STEWART&WEIDNER 5,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State ZiD
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 624.74
See continuation schedule(s) attached
TOTAL(Also enter on line 9, Recapitulation) 5,624.74
Copyright(c)2009 form software only The Lackner Group, Inc. Form PAA500 Schedule H(Rev. 10-09)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
KIRK, Carol O 21-13-0474
ITEM
NUMBER DESCRIPTION AMOUNT
Other Administrative Costs
1 Cumberland County Register of Wills Office-Probate Fees 403.50
2 Register of Wills-Short Certificate 5.00
3 The Cumberland Law Journal -Notice of Estate Administration 75.00
4 The Patriot News Company -Notice of Estate Administration 141.24
1-1-137 624.74
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98)
Rev-1512 EX+(12-08)
SCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
KIRK, Carol O 21-13-0474
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 Chase Card Services 11,737.73
2 Holy Spirit Hospital 1,197.43
TOTAL(Also enter on Line 10, Recapitulation) 12,935.16
(If more space is needed,additional pages of the same size)
Copyright(c)2008 form software only The Lackner Group, Inc. Form PA-1500 Schedule I(Rev. 12-08)
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
KIRK, Carol O 21-13-0474
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (Words) ($$$)
Do of List rusteels)
I TAXABLE DISTRIBUTIONS [include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
Peter D Kirk Spouse Entire Estate
5155 Kylock Road
Mechanicsburg, PA 17055
Total
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate.
NON-TAXABLE DISTRIBUTIONS:
II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev. 01-10)
ES TA TE OF CAR OL O. KIRK a/k/a CAR OL ANN KIRK
SCHEDULE OF EXHIBITS
EXHIBIT A Last Will and Testament for Carol O. Kirk signed and dated
December 30, 1987
EXHIBIT B Estate Val Valuation of Franklin Templeton PA Tax Free
Investment Account
EXHIBIT C Metro Bank — Date of Death Letter for Decedent's 21ndividual
Accounts/Checking & Savings Accounts
:599699
kirk.wl
T'Laot Bill anb CJTI OOtm t
of
CAROL O. KIRK
I, CAROL O. KIRK, of Upper Allen Township, Cumberland County, Pennsylvania,
declare this to be my Last Will and revoke any will previously made by me.
I.
I bequeath my automobiles, household and personal effects and other tangible
personalty of a like nature (not including cash or security), together with any
existing insurance thereon, to my husbank, PETER D. KIRK, provided he shall
survive me by thirty (30) days. Should my husband, PETER D. KIRK predecease me
or die on or before the thirtieth (30th) day following my death, I bequeath such
tangible personalty and the insurance thereon to my children, LAURI ANN KIRK,
WENDY LYNN KIRK and BRADLEY DAVID KIRK, as are living on the (31st) day
after my death, to be divided among them by my Executrix with due regard for
their personal preferences in as nearly equal shares as practical.
II.
I devise and bequeath the residue of my estate of every nature and wherever
situate to my. husbank, PETER D. KIRK, provided he shall survive me by thirty.(30)
days. Should my husbank, PETER D. KIRK, predecease me or die on or before the
thirtieth (30th) day following my death, I devise and bequeath the residue of my
estate and every nature and wherever situate, in equal shares, to my children,
LAURI ANN KIRK, WENDY LYNN KIRK and BRADLEY DAVID KIRK. In the event
that any of my said children, LAURI ANN KIRK, WENDY LYNN KIRK or BRADLEY
DAVID KIRK, should not be then living, then I devise and bequeath his or her share
to his or her then living issue, per stirpes, and in default of said issue said share
or shares shall be added to the share or shares of my surviving child or children or
his, her or their issue, per stirpes, as applicable.
EXHIBIT A
kirk:wl
III.
I appoint COMMONWEALTH NATIONAL BANK, of Harrisburg, Pennsylvania
guardian of any property which passes, either under this will or otherwise, to a
minor and with respect to which I am authorized to appoint a guardian and not
otherwise specifically done so, provided that this appointment of a guardian shall
not supercede the right of any fiduciary in its discreation to distribute a share
where possible to the minor or to another for the minors benefit. Such guardian
shall have the power to use principal as well as income from time to time for the
minor's support and education (including trade school and college education, both
graduate and undergraduate) without regard to his or her parent's ability to provide
for such support and education, or to make payments for these purposes, without
further responsibility, to the minor or to the minor's parent or to any person taking
care of the minor.
IV.
I direct that all taxes that my be assessed in consequence of my death, by
whatever nature and by whatever jurisdiction imposed, shall be paid from my
residuary estate as part of the expense of the administration of my estate.
V.
I appoint my husband, PETER D. KIRK, Executrix of this, my last Will. Should
my husband, PETER D. KIRK, fail to qualify or cease to act as Executrix, I appoint
my daughter, LAURI ANN KIRK, Executrix of this, my last Will.
VI.
I direct that my Executrix, or his successor shall not be required to post bond
for faithful performance of their duties in any jurisdiction.
- 2 -
kirk.wl
•�v
IN WITNESS WHEREOF, I hereunto set my hand and seal this 3 day of
December, 1987.
r �
. (SEAL)
Carol O. Dirk
Signed, sealed, published and declared by the above-named Testatrix, as and for
her Last Will and Testament, in the presence of us, who, at her request, in her
presence and in the presence of each other have hereunto subscribed our names as
witnesses.
e
C--(SEAL)
^' �SEAL)
- 3 -
kirk.wl
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
ss:
COUNTY OF CUMBERLAND
I, CAROL 0. KIRK, Testatrix, whose name is signed to the foregoing
instrument, having been duly qualified according to law, do hereby acknowledge that
I signed and executed the instrument as my Last Will and Testament; that I signed
it willingly; and that I signed it as my free and voluntary act for the purposes
therein expressed.
Carol 0. Kirk '
Sworn to or affirmed and acknowledged before me, by Carol 0. Kirk, the
Testator, this 3 �-,�'�day of �_ vY,,; 198-L
Notary Ik is
My commission expires:
DW416, notary Public
My Commission Expires Dec. 21. 1389
Lemoyne, PA Cumberland County
— 4 —
Estate Valuation
Date of Death: 04/06/2013 Estate of: Estate of Carol Kirk
Valuation Date: 04/06/2013 Account: 7411-3
Processing Date: 01/07/2014 Report Type: Date of Death
Number of Securities: 1
File ID: kirk
Shares Security Mean and/or Div and Int Security
or Par Description High/Ask Low/Bid Adjustments Accruals Value
1) 3356.561 FRANKLIN TAX FREE TR (354723801)
PA T/F INCM A
Mutual Fund (as quoted by NASDAQ)
04/05/2013 10.89000 Mkt
10.890000 36,552.95
Daily Div. Accrual as of 04/06/2013 20.02
Total Value: $36,552.95
Total Accrual: $20.02
Total: $36,572.97
Page 1
This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions,
please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.3.1)
EXHIBIT B
METRO
BANK 3801 Paxton Street 888.937.0004
Harrisburg, PA 17111 mymetrobank.com
RE'CEIVE'D
DEC 0 5 2013
JOHNSON DUFFLE
12/2/13
Dana L. Wieseman, Estate Administration Paralegal
Law Offices of Johnson Duffie
301 Market St.
P.O. Box 109
Lemoyne, PA 17043
RE: Estate of: Carol O. Kirk a/k/a Carol A. Kirk
Tax Identification Number: 217-42-7510
Date of Death: April 6, 2013
To Whom It May Concern:
This letter is in reference to decedent account information you requested for the
individual listed above.
We are able to provide the following:
,Account Type: CK`
Account Number: 82000647
Date Opened: 09/29/1997
Date Closed: 06/25/2013
Primary Owner: Carol A. Kirk
Accrued Interest: ** $0.17
Date of Death Balance: $821.42
Account Type: CK
Account Number: 82000654
Date Opened: 09/29/1997
Primary Owner: Peter D. Kirk
Secondary`;Owner: Carol A. Kirk
Accrued Interest: **$4.27
Date of Death.Balance: $70,550.16
EXHIBIT C
METRO
BANK 3801 Paxton Street 888.937.0004
Harrisburg, PA 17111 mymetrobank.com
Account Type:SV
Account Number: 480000857
Date Opened: 09/29/1997
Date Closed: 06/25/2013
Primary Owner: Carol A. Kirk
Accrued Interest: **$0.65
Date of Death Balance: $17,028.00
** Please note: The accrued interest will not be paid if the account is closed prior to the
date the interest is scheduled to post.
In addition to the accounts listed above the decedent also has a joint safe deposit box
#122 with Peter D. Kirk, at our Simpson Ferry branch location. Please feel free to
contact us at 1-888-937-0004 if we may be of further assistance.
Sincerely,
Jenn der Jacobs
Research Associate
Metro Bank