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Home My WebLink About02-24-14 ex�oz-„� 15 0 5 61014 3 -� REV-1500 . PA De artment of Revenue � OFFICIAL USE ONLY P pennsylvania Bureau of Individual Taxes DEPARTMENTOFREVENUE County Code Year File Number Po eox.2soso� INHERITANCE TAX RETURN 21 14 / �� Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 11 30 2013 03 26 1915 Decedent's Last Name Suffix DecedenYs First Name MI LANG ALBERTA M (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�nterest Compromise � 5. Federal Estate Tax Return Required (date of death aker 12-12-82) � g Decedent Died Testate � 7 Decedent Maintained a Living Trust � e. Total Number of Safe Deposit Boxes (Attach Copy of Wilp � (Attach Copy of Trust) � 9. Litigation Proceeds Received � 10.Spousal Poverty Credit(Date of Death � ��.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 GERALD J BRINSER 717 83�; 6348 - - -- -a_7 - - i'T� '. � REGISTER OF WILLS USE-ONLY ' : First Line of Address ,_-, _ . _ 6 E MAIN STREET _, ; Second Line of Address -�.� - ' ' ' .- _ ,- �-,,. PO BOX 32 3 --• _ DATE FILED City or Post Office State ZIP Code PALMYRA PA 17078 CorrespondenYs e-mail address: y j b f i n@ a o I.C O Rl 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 representatroe is based on all information of which preparer has any knowledge. ��SIG TURE OF PERSON RESPO�SIBLE FOR FILING RETURN DATE ��G��j��;�,� Barbara Martin �.��$/j� ADDRESS 420 Woodlawn Lane, Carlisle, PA 17015 SIGNATU @ OF PREPARER OTHER THAN REPRESENTATIVE DATE Gerald J Brinser � �� A ESS � Brinser, Wagner&Zimmerman 6 E. Main Street, Palmyra, PA 17078 Side 1 � 1505610143 1505610143 J J 1505610243 • REV-1500 EX DecedenYs Social Security Number oe�eee�e5 Name: L A N G� A L B E RT A M. RECAPITULATION 1. Reai Estate(Schedule A).......................................................................................... 1. 2. Stocks and Bonds(Schedule B)............................................................................... 2. 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. 5 5 0 . 0 7 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6. 7 2 r 2 8 1 . 1 8 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested............. 7. g, Total Gross Assets(total Lines 1 through 7).......................................................... g. 7 2 , 8 3 1 . 2 5 9. Funeral Expenses and Administrative Costs(Schedule H)..................................... 9. 1 , 657 . 32 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................. 10. 9 , 553 . 67 11. Total Deductions(total Lines 9 and 10).................................................................. ��. 1 1 , 2 1� . 9 9 . 61 , 620 . 26 �2 Net Value of Estate(Line 8 mmus Line 11)............................................................. 12. �3. 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. 6 1 , 6 2 0 . 2 6 TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(12)X .00 15. 16. Amount of Line 14 taxable 6 1 6 2 0 . 2 6 �6• 2 � 7 7 2 ' 9 1 at lineal rate X .045 r 17. Amount of Line 14 taxable at sibling rate X .12 �7� 18. Amount of Line 14 taxable at collateral rate X .15 18� 19. TAX DUE................................................................................................................... 19. 2 � 7 7 2 . 9 1 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. � Side 2 � 15U5610243 1505610243 � ---� REV-1500 E"�o2-„' 1505610143 ,., PA Department of Revenue � OFFICIAL USE ONLY pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMEMOFREVENUE Po Box.2sosol INHERITANCE TAX RETURN 21 14 / �� Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 168 28 7175 11 30 2013 03 26 1915 DecedenYs Last Name Suffix DecedenYs First Name MI LANG ALBERTA M (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Su�x 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. Suppiementaf Return � 3.Remainder Return(Date of Death Pnor to 12-13-82) 4. Limited EState 4a.Future Interest Compromise ❑ � 5. Federal Estate Tax Return Required (date of death after 12-12-82) � g Decedent Died Testate � 7 Decedent Maintained a Living Trust � 8. Total Number of Safe De osit Boxes (Attach Copy of Wilp (Attach Copy of Trust) P ❑ 9. Litigation Proceeds Received � 10.Spousal Poverty Credit(Date of Death � ��.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 GERALD J BRINSER 717 838� 6348 — - :.z, . � _ ._7'i �.T„ _ � REGISTER OF WILLS US�-ONLY "__ :-� �,! - _ First Line of Address _ �.-, _ 6 E MAIN STREET �% - ;_. . ; : Second Line of Address -n - _ - - :i� �.-.' c�; PO BOX 323 '- -_ , DATE FILED City or Post Office State Zip Code PALMYRA PA 17078 CorrespondenYs e-mail address: g j b r i n@ a o I.C O rl'1 Under penalties of peryury,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 representatrve is based on all information of which preparer has any knowledge. SIG TURE OF PERSON RESPO�SIBLE FOR FILING RETURN DATE ��jQ�� Barbara Martin Z��g/�� ADDRESS 420 Woodlawn Lane, Carlisle, PA 17015 SIGNATU OF PREPARER OTHER THAN REPRESENTATIVE DATE Gerald J Brinser � � r A ESS Brinser,Wagner 8 Zimmerman 6 E. Main Street, Palmyra, PA 17078 Side 1 � 1505610143 1505610143 J r� pennsylvania SCHEDULE E �� DEPARTMENT OF REVENUE CASH INHERITANCETAXRETURN , BANK DEPOSITS AND MISC. RESIDENTDECEDENT PERSONAL PROPERTY ESTATE OF Lang, AIb@I�a M. FILE NUMBER 21 - 14 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 NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Blue Cross-Medical Reimbursement 172.31 2 "365"Travel - Refund 27.35 3 Aflac- Medical Reimbursement 5.84 4 Aetna - Refund 2�9 23 5 Humana- Refund 18.50 6 Mid-Atlantic- Insurance Premium Refunds 46.84 TOTAL(Also enter on Line 5, Recapitulation7 550.07 REV-1509 EX+(01-10) ;�r; pennsylvania �� DEPARTMENT OF REVENUE SC H E D U L E F INHERITANCETAXREfURN JOINTLY-OWNED PROPERTY � RESIDENT DECEDENT ESTATE OF FILE NUMBER Lang,Alberta M. 21 - 14 If an asset was made joint within one year of the decedenYs date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT Barbara Martin 420 Woodlawn Lane Daughter A Carlisle, PA 17015 JOINTLY OWNED PROPERTY: DESCRIPTION OF PROPERTY o ITEM LETTER DATE DATE OF DEATH �OF DATE OF DEATH FOR JOINT MADE Include name of financial institution and bank account number DECD'S VALUE OF NUMBER TENANT JOINT similar identifying number.Attach deed forjointly-held real estat�ALUE OF ASSET �NTEREST DECEDENTS INTEREST 1 A 1990's PNC Bank-Bank Account#51-4024-1888 �aa,562.36 50% 72,281.18 TOTAL(Also enter on line 6, Recapitulation) 72,281.18 REV-1511 EX+(�0-09) 4�, pennsylvania SCNEDULEN ��: DEPARTMENT OF REVENUE �J�E��S`Fi� INHERITANCE TAX RETURN w�Aw"C�A�M�.,.,., RESIDENT DECEDENT i��r��r��w��rvi t..Vp I J FILE NUMBER ESTATE OF Lang, Alberta M. 21 - 14 DecedenYs debts must be reported on Schedule 1. ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT A. 1 Auer Cremation Society 89.00 2 Rolling Green Cemetery 225.00 3 Pastor Horner 150.00 4 Pastor Brook 100.00 5 Obituaries 129.12 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 Brinser, Wagner&Zimmerman --Gerald J. Brinser 680.00 3. Family Exemption: (If decedenYs address is not the same as claimanYs,attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. AccountanYs Fees 6. Tax Return Preparer's Fees Hamilton Musser 260.00 7. Other Administrative Costs 1 Register of Wills- Inheritance Tax Filing Fee 15.00 TOTAL(Also enter on line 9, Recapitulation) 1,657.32 Schedule H Funeral Exper�ses& COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN �q,dminisfiativ�e Cos1s cor�tinued RESIDENT DECEDENT ESTATE OF Lang, Afberta M. FILE NUMBER 21 - 14 2 Postmaster- Stamps 9.20 Note: All expenses were paid from joint account. Page 2 of Schedule H .-� ; pennsylvania SCHEDULE I ��' DEPARTMENT OF REVENUE INHERITANCE TAX RETURN DEBTS OF DECEDENT, MORTGAGE RESIDENTDECEDENT LIABILITIES & LIENS FILE NUMBER ESTATE OF Lang, Alberta M. 2� - �4 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 Mount Holly Pharmacy- Prescriptions 58.37 2 Messiah Lifeways @ Messiah Village 9,313.70 3 Capital Area Associates 84.60 4 PA Department of Revenue-2013 Income Tax 97.00 Note: All expenses were paid from joint account. TOTAL(Also enter on Line 10, Recapitulation) 9,553.67 REV-1513 EX+(01-10) -� ; pennsylvania SCHEDULE J '�` DEPARTMENT OF REVENUE . INHERITANCE TAX REfURN BEN EFICIARIES RESIDENT DECEDENT ESTqTE OF I FILE NUMBER Lang,Alberta M. 21 - 14 NAME AND ADDRESS OF PERSON S RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER RECEIVING PROPERTY � � DECEDENT (Words) ($$$) Do Not List Trustee{s) I. TAXABLE DISTRIBUTIONS[include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] 1 Barbara Martin Daughter Balance of Joint 61,62026 420 Woodlawn Lane Account Carlisle, PA 17015 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 II-ENTER TOTAL NON-TAXABLE D15TRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 Performance Checking Stat��g�-� Forlhs p�riod 11/15l2013 to 1?J73/2013 �For 24hour information,sign on to PNC Bank Online Banking ALBERTA M LANG on pnc.00m. Primary accour�number.51-4Q241888 Account nvmher:51-4424-1888-contmued Page 2 of 5 ACbVI� ��s�i� Deposils a11� v'st"i3a5= �t�dhtloltS There were 41?epasits and Other Additions Date Amount Descriptian totaling�7.737J3. 11/29 408.41 Direct Deposit-Payn�ent H J Heinz Emp Re Hl$Q1Mhoab9A6P6 12/03 1,156.Q0 D'u-ect Deposit-\xsoc;Sec SSA Treas 310�1�15575D 12 jll 17?.31 Deposit Refereuce No. 454757590 12/13 LOl Intet-est Pa}'�uetit Cheeks and Substitut� ��eeks p� Refereiue Check Date Reference Gheck numDer Amount paid numbec number A�u� paid number 2,U04.t30 12�06 0�� I181 i�9.I? ��06 oz�7�•L 1172 * 61.50 11/15 �i.�lss 118`? 100.0(3 12/1? ai�►a�.,��s 117�4* 9,951.�U 11C�7 or�;i�`,7 11�( � �14.85 12j09 o��i�si 1�`f'j* j,(}(}Q_Q{} 1�f 09 U35�►059G3 1185 ??�J.00 1j�EXJ tk355`��+� 117J* 2r,,00fl.OQ 1�/OJ oa5aari�► 1187* T 9_20 19/lU o5`L5�';t�� 1I84 ?�i,WO.(?(? 12/Q6 ot#�74847 "Gap in check seq�rxe 'T'Teller Cashed Check There were 1 t checks listed totaling $6Z.SZ0.��. - .� — �=jo�A�G cr Etectronic Banidng Onhne a�__ .,.,. -_ �d .�..�; ....:�......:;o n._ Date '� A ,.., ..c r,�ion !�P�t ot�nns Lota6rtg�33,261.95. 1�U3 �5,(�(?.O(? O��tine Transfer T'o (�100000150286059 1��Q3 °y.+f�3 Ouline Tru�sfer To OOOO��OI�O`�59� 1�Q5 16.95 Duect Payxnenc-Pre�nium Unitedl�ealthr.�-e?�?��.�56K 1 12/06 1,15f.0(1 Du•ect Payment-Reversal SSA Treas 310 a�i�i.l'1557KD 12f 12 7,U00.00 Ontine Tt�isfer To OU(}OU00150�36059 Daily Balance ��e��ii Date 6alar�r.e �a:e 3alance Date Balance Oate Balance 111i5 154,10525 ;;';�r',3 I?(3,c��9.36 I:,';:'('r9 67,t357.�t� l�;`l� 60,1?�.55 ll��.,�� ;`�,.`G5 1;'(�,6I?.�3 I�;'I(i fii,i�8?� �121i3 60,121.56 � 1`?�'Ufi 93,32'3.`?9 1`>�'11 67�y0-.5!"i � � 1 v LAW OFFICES BRINSER,WAGI�ER&ZIMMERMAN A Professional Corporation 6 EAST MAIN STREET-SECOND FLOOR (EAST MAIN&SOUTH RAILROAD STREETS) P.O. BOX 323 PALMYRA,PA 17078 PHONE: (717)838-6348 FAX: (7l7) 838-6912 MECHANICSBURG OFFICE GERALD J. BRINSER MESSIAH VILLAGE KEITH D. WAGNER 100 MT.ALLEN DRIVE JOHN M.ZIMMERMAN MECHANICSBURG,PA 17055 CALEB J.ZIMMERMAN PHONE: (7l7)697-4666 C`? February 21, 2014 -- - -�� :'�� - -�'; ; . �, , - � .-'. Glenda Farner Strasbaugh, Register of Wills Cumberland Co Courthouse = � 1 Courthouse Square . -' ��'-' Carlisle PA 17013 �'-� � �� `"�� In Re: Alberta M. Lang Estate (Not Probated) Dear Register of Wills: Enclosed you will find two (2)copies of the Inheritance Tax Return for the Estate of Albert M. Lang, which was not probated due to the fact that the only asset on hand was a jointly-held account. Also enclosed are two(2)checks: one in the amount of$2,634.26 in payment of inheritance tax due, and one in the amount of$15.00 for the filing fee. If you have any questions,please feel free to contact me. � Thank you. V ery truly yours, BRINSER,WAGNER& ZIMMERMAN . �� Gerald J. Brinser GJB/wlc Enclosures c: file (") Fj C7 Z7 -.� y C fTl __l � c� 3L7 ) ro �oH � cmcn � N � � --i i� r --�rm , m = a � ' o z c o 0 � N �T1 A m c� o � (n H ,�,o c� r v o r o c cn t--� � w --� s 0 c N m _ - �',