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Home My WebLink About02-07-14 (2) 1505610105 REV-1500 EX(02-11)(FI)1a!1lr OFFICIAL USE ONLY PA Department of Revenue pennsytvania AI ,u County Code Year File Number Bureau of Individual.Taxes INHERITANCE TAX RETURN -� — �- PO BOX PA Harrisburgrg,,RA 1 7128-o6oi RESIDENT DECEDENT I U ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY , 11/26/2013 05/18/1928 L_- - L.._ __� _ I I Decedent's Last Name Suffix Decedent's First Name MI Long ! Mr. Kenneth Kenneth I� (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number ,— -- -- ------ ----1 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW M 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) O 6, Decedent Died Testate O 7.Decedent Maintained a Living Trust 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 CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Robert L. O'Brien, Esq. 1(717 6942 873 REGISTER OF WILLS USE ONLY First Line of Address 19 West South Street Second Line of Address �_ 7 — ----- — -------' -—� CID O City or Post Office _ _ State ZIP Code a�PffE RtbED —4 Ci Carlisle sle j PA (17013 �" r I_._- Correspondent's e-mail address: , 1 Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to Mtobest of my know a ge and•beliet r it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of whbrpreparer has aayMowlettge.C7 SIGNATURE E FOR FILING RETURN DATE ADDRESS 19 West South Street, Carlisle, PA 17013 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610105 1505610105 J 1505610205 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: Kenneth W. Long RECAPITULATION _ -_-----.- 1. Real Estate(Schedule A). .......................... .................. 1. 2. Stocks and Bonds(Schedule B) ....................................... 2. 3. 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. 390,285.31 6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 8. Total Gross Assets total Lines 1 through 7 ............. 8. 390,285.31 9. Funeral Expenses and Administrative Costs(Schedule H)...... i 3,125.71 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1).............. . 10. 11. Total Deductions(total Lines 9 and 10)................................. 11. 3,125.71 ! 12. Net Value of Estate(Line 8 minus Line 11) ........................ ...... 12. 387,159.60 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. 387 159.60 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 17,422.18 at lineal rate X.0 45 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. 17,422.18 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 1505610205 1505610205 J REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Kenneth William Long STREETADDRESS 770 South Hanover Street Chapel Pointe CITY STATE ZIP 17013 Carlisle PA Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) 17,422.18 2. Credits/Payments X Prior Payments B.Discount 871.11 Total Credits(A+B) (2) 871.11 1 Interest (3) 4. If Line 2 is greater than Line I+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 I+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 16,551.07 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 ............................................ ❑ 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 without receiving adequate consideration?......... ............... ...... 3. Did decedent own an"in trust foe'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 containsa beneficiary designation? ....................................................................................................................... ❑ E 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 1,1194,and before Ian,1,1111,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 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)(11)(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-15o8 EX+(08-12) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Kenneth W. Long 21-13-1328 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. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Chapel Pointe resident account refund 1,448.33 2 M&T Checking#9856065520 14,891.33 3 M&T Savings#15004198507261 78,148.12 4 PNC Money Market#50-0569-2897 50,172.34 5 F&M Bank#30531000 163,183.93 6 Susquehanna Bank#111139 78,616.42 7 F&M Bank#0007087888 3,824.84 i i I TOTAL(Also enter on Line 5, Recapitulation) $ 390,285.31 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Kenneth W. Long 21-13-1328 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT. A. FUNERAL EXPENSES: 1' John Eppley VFW 486.60 2 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) commissions Waived Street Address City State ZIP Year(s)Commission Paid: 1,500.00 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation,) Claimant NA Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 463.50 5. Accountant Fees: 500.00 6. Tax Return Preparer Fees: 7. Millenium Pharmacy 34.61 8 Quantum Imaging 2.'85 9 Pinnacle Health 38.15 10 Reserve for further Register fees 100.00 11 Carlisle REgional Medical Center j TOTAL(Also enter on Line 9, Recapitulation) $ 3,125.71 If more space is needed,use additional sheets of paper of the same size. REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Kenneth W. Long 21-13-1328 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under Sec.9116(a)(1.2),] I. Ronald A.'Long,240 Easy Rd.,Carlisle,PA 17013 son 1/3 2 Debra A.Eppley,610 Somerset Drive,Mechanicsburg,PA 17055 daughter 1/3 3 Sandra L.Hellman,55 Diller Drive,Shippensburg,PA 17257 daughter 1/3 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS 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. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. f i TOTAL OF PART II— ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed,use additional sheets of paper of the same size. 30531000-Long, Kenneth W., IMA Check Number 411302 Gross Distribution $163,183.93 411302 Settlement Date 01/10/2014 Less: Description Distribution per signed Receipt/Release dated 1/3/2014 Net Distribution $163,183.93 Payee Kenneth W. Long Estate FBO Kenneth W. Long Estate Transaction Type Distribution-To Beneficiary FARMERS AND MERCHANTS TRUST COMPANY OF CHAMBERSBURG•P.O.BOX 6010•CHAMBERSBURG, PA 17201-6010 Check Susquehanna Official 110773986 MEMO: ACCOUNT CLOSE OUT BRANCII: 1183 ORIGINATOR: JBEL183324 TIME: 1:40:15 CK AN•1T: *****78, 616.42 DATE: 12/20/13 FEEANIT: $***********.00 TOTAL: $*****78, 616.42 TO: ESTATE OF KENNETH WILLIAM LONG NON-NEGOTIABLE B PNC BANK PNC Bank,National Association Cashier's Check No. 13279791 0 Date December 20, 2013 0 Pay to the Order of THE ESTATE OF KENNETH W LONG $ 50,172.34 X ° Fifty Thousand One Hundred Seventy-two Dollars And Thirty-four Cents w Non-Negotiable Customer Copy 5005692897 Remitter G 1 - 3 HOd )133H3 sm3unsv3�11. 0 3 b - S 119VU093NNOS 013,8W.t/d H etc In� °� aaulwaa a In .J �i i/ LOZLl dd`Bangsaagweg0 hails ulew 43nOS OZ S00003a ano k a03 NId138 M&TBank GF-269(8/10) WIP TRANSACTION DEBIT ORIGINATING COST CENTER EMPLOYEE NUMBER AUTHORIZATION DATE I t I ILI I x l ACCOUNT# 1 � CLST MER N ME(PRINT) �r �O I ` Y1'T1 t 1 DESCRIPTION: El PARTIAL WITHDRAWAL \C]-CLOSING WITHDRAWAL y-_ CUSTOMER ID: ^� LA c,`& jOriginal-Processing Work Copy-Branch CUSTOMER SIGNATURE:W �//�y-^✓'�^ ��,/,t /.- ��% _ SEQ.NO. 2 , 9 0 7 8 7 1 L Cl 1 (0 I ► M&TBank GF-269(6 U) WIP TRANSACTION DEBIT ( ORIGINATING COST CENTER EMPLOYEE NUMBER AUTHORIZATION DATE i ACCOUNT DE T# r� ' C/ r; f`� 6 j CUjTO AER NAME(PRtI-NT) 1tSCRIPTION: E] PARTIAL WITHDRAWAL NJCLOSING WITHDRAWAL 1 I CUSTOMER ID: i Original-Processing Work �,/ Copy-Branch CUSTOMER SIGNATURE�s� ��''�r`- "'�+r �/��' ? „' f •- G SEQ.NO. 21 907873S"ti1ci '� l °1 Gtr $ I