HomeMy WebLinkAbout02-15-05
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OFFICIAL USE ONLY
FILE NUMBER
21
2005
0032
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE DEPT.
280601 HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
COUNTY CODE
YEAR
NUMBER
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DECEDENT'S NAME (LAST, FIRST, ANO MIDDLE INITIAL)
Baughman, Patricia A.
DATE OF DEATH (MM-DD-YY)
11/26/2004
(IF APPLICABLE) SURVIVING SPOUSE'S NAME
SOCIAL SECURITY NUMBER
159-24-8996
THIS MUST BE FILED IN DUPLICATE
WITH THE REGISTER OF WILLS
SOCIAL SECURITY NUMBER
I
Xl 1. Original Return 0 2. Supplemental Return 0 3. Remainder Return
T- 4. Limited Estate 0 4a. Future interest Compromise D 5. Fed. Est. Tax Return Req'd
~ 6. Decedent Died Testate D 7. Decedent had living Trust 0_ 8. Total number of SOB's
I 9. Lit'g'tion Proceeds Rec'd n 10. Spousal Poverty Credit n 11. Election to tax wI Sec. 9113(A)
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NAME: COMPLETE MAILING ADDRESS:
Ronald E. Johnson, Esquire
FIRM NAME:
Ronald E. Johnson, Esq.
Andrews & Johnson
78 W. Pomfret St.
Carlisle, PA 17013
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$0.00
$0.00
OFFICIA~ USE OI\l~Y
DATE OF BIRTH (MM-DD-YY)
10/19/1928
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Andrews & Johnson
TELEPHONE NUMBER
717243-0123
$0.00
$5,506.87
$0.00
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3.Closely Held Corporation, Partnership or Sole-Prop.
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Misc. Personal Prop.(Sch.E)
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Misc. Non-Propate Prop.
8. Total Gross Assets (total lines 1-7)
9. Funeral Expenses & Administration Costs (Sch H)
10. Debts of Decedent, Mortgage liabilities, & Liens
11. Total Deductions (total lines 9&10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts
for which an election to tax has not been made (13)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Arnnt of Line 14 taxable at the spousal rate,
or transfers under Sec.9116(a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
.
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(1)
(2)
(3)
(4)
(5)
(6)
(7)
(9)
(10)
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$0
$0
$0
19. Tax Due
20 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
$5,506.87
en
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(8)
$12,254.97
$0.00
$12,254.97
($6,748.10)
(11)
(12)
($6,748.10)
x.O_
x.045
x.12
x.15
$0.00
$0.00
$0.00
$0.00
$0.00
(15)
(16)
(17)
(18)
(19)
I}EJiiiF"I;bliiim;:]$!1ill:itjji;~liI(iWim)Attlilii~WQliIllJ@Mi~$Mljt\~iil!lli~pB!i\fjJiiMiiWiWij::;"j::;:
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-Decedent's Complete Address:
~TREET AqORESS
1700 Market Street
CITY STATE ZIP
Carlisle PA 17013
Tax Payments and Credits:
1. Tax Due
2 Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discounts
Total Credits (A+B+C)
3. Interest/Penatty if applicable
D. Interest
E. Penalty
4.
Total InterestJPentalty (D+E)
If Line 2 is greater than Line 1 + line 3, enter the difference This is the OVERPAYMENT.
Check box on Page 1 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.
A. Enter the interest on the tax dUe.
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
Make Check to: REGISTER OF
AGENT
(1)
(2)
(3)
(4)
(5)
(SA)
(56)
$0,00
$0,00
$0,00
$0,00
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS
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 !ranserred or its income:
c. retain a reversionary interest: or
d. retain the promise for life of either payments or care?
2 If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?
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 disignation?
D
D
D
D
D
D
D
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IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under pel\~lties of !}eljJry, I declal0 that I have examinetl this retum, including accompanying schedules and statements, and to the best'of my knowledge and belief, it is true, correct
and complete
mationofwh!ch re arerhasan knowted e.
ADDRESS
ADDRESS
DATE
DATE
For dates of death on or after July 1, 1994 and belore January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72P,S. Sec,
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 orfor the use of the surviving spouse is 0% [72 p,s, Sec. 9116(a}(1.1)(ii)]
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory re-quirements for disclosure of assets and filing a tax return are still applicable even if the
surviving spouse is the
only beneficiary
FOldatesofdeathonorafterJuly1,2000:
The tax rate imposed on the net value of trilnsfers from a deseased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or II stepparent of the child is 0% [12 P.S, See 9116(a)(1.2)).
The tax rate imposed on the net value of transfers to orforthe use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. Sec. 9116(1.2) (72 P,S. Sec,9116(a)(1).
The tax rate imposed on the net value of transfers to ortor the use of the decedents siblings is 12% 172 P.S. Sec.9116(a)(1.3)) A sibl'ing is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
LAST WILL AND TESTAMENT
OF
PATRICIA A. BAUGHMAN
I, PATRICIA A. BAUGHMAN, of Lower Allen Township, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby
make, publish and declare this as and for my Last Will and Testament, hereby revoking all
other wills and codicils heretofore made by me.
FIRST: I direct that all my just debts and funeral expenses, including my
grave marker, shall be paid from the assets of my estate as soon as practicable after my
decease.
SECOND: I give, devise and bequeath the residue of my estate, of every
nature and wherever situate, to my Wife, PATRICIA A. BAUGHMAN, providing she shall
survive me by thirty (30) days. Should my Wife, PATRICIA A. BAUGHMAN, predecease
me or die on or before the thirtieth day following my death, I give, devise'and bequeath the
residue of my estate, of every nature and wherever situate, to my neice, KIM KELLY
providing she shall survive me by thirty (30) days. Should my niece KIM KELLY
predecease me or die on or before the thirtieth day following my death, then and in that event,
I give, devise and bequeath the residue of my estate, of every nature and wherever situate, to
my grand-neice and LEXA TURNER.
TIllRD; I direct L1}at all taxes that may' be assessed in consequence of my
death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my
residuary estate as a part of the expense of the administration of my estate.
FOURTH: nominate, constitute and appoint my Husband, GEORGE
L. BAUGHMAN, Executor of this my Last Will and Testament. Should my Husband,
GEORGE L. BAUGHMAN, fail to qualify or cease to act as Executor, I appoint my Neice,
KIM KELLY, Executrix of this my Last Will and Testament. Should my Neice, KIM
KELLY, fail to qualify or cease to act as Executrix, I appoint my grand-neice, LEXA
TURNER, Executrix of this my Last Will and Testament.
FIFTH: I direct my Executor and his successors shall not be required to
give bond for the faithful performance of their duties in this or any other jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last
Will and Te~ent, consisting of two (2) typewritten pages, each identified by my signature,
this If' day of December, 1998.
(jp~ A I ~ (SEAL)
PATRICIA A. BAUGHMA
Signed, sealed, published and declared by the above-named Testatrix, PATRICIA A.
BAUGHMAN, as and for her Last Will and Testament, in the presence of us, who, at her
request, in her sight and presence, and in the sight and presence of each other, have hereunto
subscribed our names as wi s
COMMONWEALTH OF PENNSYLVANIA )
: SS.
COUNTY OF CUMBERLAND )
I, PATRICIA A. BAUGHMAN, Testatrix, whose name is signed to the attached or
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.
Sworn or affirmed to and acknowledged before me by PATRICIA A. BAUGHMAN,
the Testatrix, this / 'if- day of December, 1998.
j- NOTARIAL SEAL -.,\ .. ~ AL)
I SHELLYD SEXTON,NOTARYPUBLlC PATRICIA A BAUGHMAN .
CARLISLE BORO, CUMBERLAND COUNlY . , statrIX
MYCOMMISSIONEXPIRES~PRIL26.19~9,: <;:;;::; ~ (' --;I-
1 tlemiler. ~!lSV1~~la~SOCla~.o~Ol No?1' le~ UJ....I ..:x A 1/LtJ'y\../
No Public7
AFFIDAVIT
)
: SS.
COUNTY OF CUMBERLAND )
We, RONALD E. JOHNSON and r-:: 7Af'tf2.t. J.... ~~., the witnesses
whose names are signed to the attached or foregoing instrument, being duly qualified
according to law, do depose and say that we were present and saw Testatrix sign and execute
the instrument as her Last Will and Testament; that PATRICIA A. BAUGHMAN, signed
willingly and that she executed it as her free and voluntary act for the purpose therein
expressed; that each of us in the hearing and sight of the Testatrix signed the Will as
witnesses; and that to the best of our knowledge the Testatrix was at that time 18 or more
years of age, of sound mind and .under no constraint or undue influence.
Sworn or affirmed to and subscribed to before me by RONALD
JDd ~ 'l~i' 1;/_ Lg~ ,w' esses, this l~ d 0
COMMONWEALTH OF PENNSYLVANIA
NOTARIAL SEAl
SHELLYD. SEXTON, NOTARY PUBLIC
CARLISLE BORO, CUMBERLAND COUNTY
MY COMMISSION EXPIRES APRIL 26, 1999
tlenber, Pennsylvania Association .01 Notar!
JOHNSON
ecember, 1998.
( )
(SEAL)
....."-~;:::>...~~.........
_~_'='_.._. __~____~n~
'J\IAflN~NG: It is illegal "lo duplicate this copy by photostat or photo~waph.
Fee for this certificate, $2.00
p
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10688621
No.
ah? _ J~ ~lV'y~~
Local Registrar r,
NUV ~ 9 2004
Date
,}H.v2!87
COMMONWEALTH OF PENNSYlVANIA. OEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
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UNDER I DAY
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Bau hman
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76 y,.
UNDER I YEAR
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DATE 01' B1ATH 8lATHPt..toCE;C....._ PlACEOFDEA1"Ho..c~"""~"__'''''''''I'''''''''''''''_''''''_1
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DECEDENl'S USUAl OCCUMIOH
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DECEDEHrSJU..IUNG ADORESSjSll_. CoIyI~.SlMo..l'PC_1
1700 Market Street
Camp Hill, PA 17011
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FRHEA'SH.UcE IF''I, /ol""".l.lSlj
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KlNDOF IlUSIHESSllNOUSTRY WASOECEDENT EYERItI DECEDENT'S EOUC~tlClN_
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,~. 914 Maplewood Lane, Eno a, PA 17025
PlACEOF OlSPOSlTIOH. Pol-. otc-...... c,....UD<y lOCATIOH. CiIyITgwn. ~.Zrlleoa.
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SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANIOUS PERSONAL PROPERTY
ESTATE OF
FILE NUMBER
Patricia A. Baughman
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
DESCRIPTION
21-05-0032
ITEM
NUMBER
VALUE AT DATE
OF DEATH
Checking account no: 500002963 - Waypoint Bank
(See letter attached)
$5,506.87
TOTAL (also on line 5, Recapitulation)
$5,506.87
t"l Way~qi!lt
1/24/2005
ANDREWS & JOHNSON
78 W POMFRET ST
CARLISLE P A 17013
The information which you requested on the account(s) of PATRICIA A BAUGHMAN
(Social Security Number 159-24-8996) is/are as follows:
Account Number
Class of Account
Date Opened
Principal Balance
Accrued Interest
500002963
CHECKING
032681
5506.79
.08
5506.87
Balance at Date of
Death
Account Ownership ITO
Name ofJoint GEORGE L
Owner, ifany BAUGHMAN
Date Ownership 032681
Was Established
Account Number
Class of Account
Date Opened
Principal Balance
Accrued Interest
Balance at Date of
Death
Account Ownership
Name ofJoint
Owner, if any
Date .ownership
Was Established
Additional
Information
Requested
~~
~WATTS .
SENIOR SERVICES REP.
P.O. Box 1711. HARRISBURG. PENNSY1YANIA 17105-1711
T"n c:...e_ I t:!~r \.,........-...- II ~,-- ,...,...,...... _eo ......\ IR, 'V'........._. A~,...... "'71"'7"011:: .Jtc:nn . '~!'lA"JUH"':::Iolll"'tni"+h::l!nlt'r'nm
SCHEDULE H
FUNERAL EXPENSES, ADMINISTRATIVE
COSTS AND MISCELLANEOUS EXPENSES
ESTATE OF
FILE NUMBER
Patricia A. Baughman
21-05-0032
A.
ITEM DESCRIPTION AMOUNT
NUMBER
Funeral Expenses:
I Myers-Hamer Funeral Home, Inc. $4,025.00
2
Administrative Costs:
I Personal Representive Commissions
Name of Personal Representative(s)
Social Security Number of Personal Representative:
Street Address:
City: State: Zip:
Year(s) commissions paid:
2 Attorney fees to Andrews & Johnson $800.00
3 Faotily Exemption
Claimant
Street:
City: State & Zip
Relationship of Claimant to Decedent:
4 Probate Fees to Register of Wills $79.00
5 Register of Wills - filing fee $10.00
6 Commonwealth ofP A - Department of Welfare (see attached) $7,240.97
7 Reserve for closing $100.00
8
9
10
II
12
13
14
15
16
17
18
19
TOTAL (also on line 9, Recapitulation) $12,254.97
Debts of decedent must be reported on Schedule I.
B.
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
DIVISION OF THIRD PARTY lIABIUTY
ESTATE RECOVERY PROGRAM
PO BOX 6486
HARRISBURG. PA 17105.8466
January 14, 2005
ANDREWS & JOHNSON
RONALD E JOHNSON ESQUIRE
78 WEST POMFRET STREET
CARLISLE PA 17013-3216
Re: PATRICIA BAUGHMAN
CIS #: 030379017
SSN: 159-24-8996
Da,e of Death: 11/26/2004
Dear Attorney Johnson:
Please be advised that the Department of Public Welfare maintains a
claim in the amount of $7,240.97 against the above-mentioned estate. This
claim is for restitution of medical assistance granted on behalf of the
decedent for which the Probate Estate is now responsible to reimburse the
Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as
amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's
itemized statement of claim.
A portion of this medical expense, namely $7/~40~97, was incurred during
the last six months of the decedent's life; therefore, it is a Class 3 claim
pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries Code, 20
Pa. C.S.A. 3392(3). The balance of the claim, namely $..00, is to be entered
as a priority Class 6 claim against the estate. ----
Please acknowledge receipt of this letter and advise whether the
Commonwealth's claim is admitted and when payment may be expected. If the
estate accounting is complete, please provide a copy. If the estate. contains
real estate, please provide copies of the deed, the latest tax assessment,
and a current appraisal, if available.
Sincerely,
f~.-K~
patricia Nace
Claims Investigation Agent
717-772 ~6616
717-705-8150 FAX
Enclosure