HomeMy WebLinkAbout03-16-05 (2)
REV.15OO EX + (6-lK>) .
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV -1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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FILE NUMBER
2 1 -05 0 0 4 6
COuNTYCciiiE -YEAR- - - NuMBER- -
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DECEDENfS NAME (LAST, FIRST, AND MIDDLE INITIAL)
Thorn son William B
DATE OF DEATH (MM-DD-Year)
SOCIAL SECURITY NUMBER
DATE OF BIRTH (MM-DD-Year)
1 92- 1 4 - 2 1 9 4
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
12/20/2004 01/09/1921
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
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[Xl 1. Original Retum
o 4. Limited Estate
[Xl 6. Decedent Died Testate (Allach copy of Wdl)
o 9. Litigation Proceeds Received
o 2. Supplemental Retum
o 4a. Future Interest Compromise (dale of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (AllachcopyofTrust)
o 10. Spousal Poverty Credit (dale 0/ death between 12-31.91 and 1-1-95)
o 3. Remainder Retum (daleo/death prior to 12-13-62)
o 5. Federal Estate Tax Retum Required
_ 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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THIS SECTION MUST BECOMPl,;.ETED. AL.L. CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
Jan L Brown
FIRM NAME (If Applicable)
Jan L Brown & Associates 845 Sir Thomas Court Suite 12
TELEPHONE NUMBER
717 -541-5550 Harrisbur P A 17109
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
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OFFICIAL USE ONLY
27,912.31
200,641.25 L-.,- .
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(8)
228,553.56
11,608.87
1,609.08
(11)
(12)
(13)
13,217.95
215,335.61
14. Net Value SUbJect to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14)
215,335.61
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15. Amount of Line 14 taxable at the spousal tax
rate. or transfers under See. 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
19. Tax Due
0.00 X _(15) 0.00
215,335.61 X .045 (16) 9,690.10
0.00 X .12 (17) 0.00
0.00 X .15 (18) 0.00
(19) 9,690.10
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
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ece en 5 omple e ress:
STREET ADDRESS
1416 Brandton Road
Mechanicsburg Borough
CITY I STATE I ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1 )
9,690.10
484.50
Total Credits (A + 8 + C)
(2)
484.50
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E ) (3)
4. 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 (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58)
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; ........................................................................... 0 00
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 00
c. retain a reversionary interest; or ...................................................................................................... 0 00
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 00
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration?.................... ..... .......... ............... ................. ........................... 00 0
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. 0 00
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... 00 0
0.00
0.00
9,205.60
9,205.60
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 penalties of pe~ury, I declare that I have examined this return, includilll1 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 a1llnforrnation of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE
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ADDRESS 1416 Brandton Road
Mech . sbur
SIGNATURE OF PREPA E OTH
3/15/2005
ADDRESS
PA 17055
DATE
3/15/2005
PA 17109
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[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% [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 twenty-one 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% [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%, 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% [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.
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SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Thomoson William B
FILE NUMBER
21 05
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.
0046
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
27,075.31
M&T Bank
Checking Account 11065166
2
PSERS prorated pension payment
401.25
3
Haar's Auction; household goods auction proceeds
435.75
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
27912.31
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SCHEDULE G
INTER.VIVOS TRANSFERS &
MISC. NON.PROBA TE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Thomoson William B
FILE NUMBER
21 05
.0046
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER ATTACH A cOPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST VALUE
(IF APPLICABLE)
1. Transfers/gifts to Nancy J Dobi, daughter, 100,000.00 100. 3,000.00 97,000.00
beginning 12/24/2003 and ending 12/19/04
2 Transfers/gifts to Mary Ann McCammon, daughter, 99,000.00 100. 3,000.00 96,000.00
beginning 12/24/2003 and ending 12/19/04
3 Symetra Annuity LP1023723 7,641.25 100. 7,641.25
Nancy J Dobi and Mary Ann McCammon, daughters
are the beneficiaries
TOTAL (Also enter on line 7 Recapitulation) $ 200 641.25
(If more space is needed. insert additional sheets of the same size)
REV-i511 EX + ('12-99)
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SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Thomoson William B
FILE NUMBER
21
05
0046
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Jones Funeral Home 253.15
2 Calvary Family Services; tombstone engraving 75.00
3 Hoss's Steak & Seafood; funeral luncheon 311.72
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attomey Fees Jan L Brown & Associates 6,857.00
3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) 3,500.00
Claimant Mary Ann McCammon
Street Address 1416 Brandton Road
City MechanicsburQ State P A Zip 17055
Relationship of Claimant to Decedent dauQhter
4. Probate Fees Register of Wills, Cumberland County 187.00
5. Accountanfs Fees
6. Tax Retum Prepare(s Fees Cohick & Associates 425.00
7.
TOTAL (Also enter on line 9, Recapitulation) $ 11 608.87
(If more space is needed, insert additional sheets of the same size)
ATTACHMENT TO SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Thompson, William B
FILE NUMBER
21-05 -0046
Legal fees reflected on Schedule H were incurred in connection with the decedent.
The attorney's fees are reasonable in amount considering the legal time required and
expense involved in these matters.
REV-1512 EX + (6-98)
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SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Thomoson William B
FILE NUMBER
21
05
Include unreimbursed medical expenses.
0046
VALUE AT DATE
OF DEATH
ITEM
NUMBER DESCRIPTION
1. Check 9869 to Leechburg Museum;
Written 12/14/05; cashed after death
2 Check 9873 to Home Instead;
Written 12/19/05; cashed after death
3 Bankcard; outstanding credit card balance
4 Mid Penn Urology Inc; medical bill
5 Family Home Health Care; lift chair
110.00
275.55
147.18
27.35
1,049.00
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
1 609.08
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
T . . R ?1 05 004R
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
1. TAXABLE DISTRIBUTIONS ~ndude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Nancy J Dobi, daughter Lineal
250 W 94th St 11 K, New York NY 10025 1/2 residue and Sch G
2 Mary Ann McCammon, daughter Lineal
1416 Brandton Rd, Mechanicsburg, PA 17055 1/2 residue and Sch G
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
LAST WILL AND TEST AMENT
OF
WILLIAM B. THOMPSON
I, WILLIAM B. THOMPSON, of Cumberland County, Pennsylvania, declare this to be my
Last Will and Testament. I revoke all other Wills and Codicils that I may have previously made.
Article I
My just debts and expenses of my last illness, funeral, and administration of my estate shall
be paid by my Executor from the principal of my residuary estate as soon as practicable after my
death.
Article IT
All inheritance, estate, and succession taxes (including interest and penalties thereon, but not
including any generation skipping tax) payable by reason of my death shall be paid out of and be
charged generally against the principal of my residuary estate without reimbursement from any
person. This provision is not a waiver of any right which my Executor has to claim reimbursement
for any such taxes which become payable as the result of any property over which I have the power
of appointment.
Article VI
In addition to the powers conferred by law, I authorize my Executrices in her absolute
discretion:
(a) to retain in the form received and to sell either at public or private sale, any real estate
or personal property except that which I specifically bequeath herein,
(b) to manage real estate,
(c) to invest and reinvest in all forms of property without being confined to legal
investments, and without regard to the principal of diversification,
(d) to exercise any option or right arising from the ownership of investments,
( e) to compromise claims without court approval and without consent of any beneficiary,
(f) to file any federal income tax return for any year for which I have not filed such return
prior to my death,
(g) to make distributions in cash or in kind, or in both, and to determine the value of any
such property,
(h) to employ any attorney, investment advisor, or other agent deemed necessary by my
Execut*; and to pay from my estate reasonable compensation for all their services,
(i) to conduct alone or with others, any business in which I am engaged in, or have an
interest in at time of my death, and
(j) to receive reasonable compensation in accordance with their standard schedule of fees
in effect while their services are performed.
- 3 -
I, WILLIAM B. THOMPSON, Testator, who signed the foregoing instrument, having been
duly qualified according to law, acknowledge that I signed and executed this instrument as my Will,
and that I signed it willingly as my free and voluntary act for the purposes therein expressed.
Sworn to or affirmed and
acknowledged before me by
WILLIAM B. THOMPSON, the Testator,
on <g . ,:;;( 5' , 2003.
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We, the undersigned witnesses who signed the foregoing instrument, being duly qualified
according to law, depose and say that we were present and saw the Testator sign and execute this
instrument as his Will; that he signed and executed it willingly as his free and voluntary act for the
purposes therein expressed; that each of us in his sight and hearing signed the Will as witnesses, and
that to the best of our knowledge, that he was at that time eighteen (18) years or more of age, of
sound mind, and under no constraint or undue influence.
Sworn to or affirmed and
subscribed to before me
b UnJt{L J: - Y)D,-<t-
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and ~~ 9J/v~ o.)flJ1/}u~~
witnesse , on ~- 2< ,2003.
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Witness
- 5 -
N TA I L EAt
JAN L BROWN NOTARY PUBlIC
lOWER PAXTON TWP. DAUPHIN COUNTY
MY COMMISSION EXPIMS MARCH 29 2004
BEFORE THE REGISTER OF WILLS, CUMBERLAND COUNTY, PENNSYLVANIA
INVENTORY
Estate of Thompson William B
No. 2005
00046
, Deceased
Date of Death 12/20/2004
Social Security No. 192142194
also known as
William B Thompson
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the
personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation
placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no
real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We
verify that the statements made in this inventory are true and correct. I/We understand that false statements herein made are subject to the
penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Personal Representative:
Name of
Attorney: Jan L Brown
Mary Ann McCammon
1.0. No.: 67993
Address: 845 Sir Thomas Court Suite 12
Dated 3/15/05
Harrisburg
Telephone: 717-541-5550
PA 17109
Description
Value
M& T Bank
Checking Account 11065166
27,075.31
PSERS prorated pension payment
401.25
Haar's Auction; household goods auction proceeds
4~5.75
Cy\
Total
27,912.31
(Attach Additional Sheets if necessary)
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
include the value of each item, but such figures should not be extended into the total of the Inventory.
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