HomeMy WebLinkAbout03-12-14 J 1505610101
REV-1500 �`�O1_1O, : �
OFFICIAI USE ONLY
PA Department of Revenue pennsytvania
Bureau of Individual Taxes �f��niMEMiOPN[Y8llVE County Code Year Fle Number
PO BOX 28o6oi
INHERITANCE TAX RETURN
Harrisburg,PA i�12&p6o1 RESIDENT DECEDENT v�� � �
ENTER DECEDENT INFORMATION BEL�W
Sociai Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
;
172-36-7824 06/13/2013 11/01/1944
. ........ ... . _.
__ _
_ _ __ __._ ___
Decedent's Last Name Suffix DecedenYs First Name M�
__ .
_.... _....._ _........ __...
_G '
` FLEMING
' EVELYN
_ _ _ __ _...:
(if Applicabls)E�ter Surviving Spouse's information Beiow
Spouse's Last Name __ ___ _ Suffix _ Spouse's First Name MI
__.. __.... _. _.__ _
__
Spouse's Soaal Security Number '
` THIS RETURN MUST BE FILED IN DUPLICATE WiTH THE
;
__ _ _ ; REGISTER OF WILLS
FIU.IN APPROPRIATE OVALS BELOW
� 1.Original Retum p 2.Suppiementat Return p 3. Remainder Retum(date of death
prior to 12-13-82)
O 4.Limited Estate p 4a.Future interest Compromise(date of p 5. Federal Estate Tax Retum Required
death after 12-12-82}
O 6.Decedent Died Testate O 7.Decedent Maintained a�iving Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
O 9.Litigation Proceeds Received Q 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 Sch.O)
CORRESPONt1ENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTEO T0:
Name Daytime Telephone Number
___ _ ._ _ _...__ _ _ _ _.._.__.._...._....
THOMAS E FLOWER (717)243-5513
. _ .. _ __ _ _ ;
____ _
_ _ __ _
_ _
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REGISTE LLS USE�LY
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Frrst line of address C`�:.
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..................... ..................... ... ___...... .....__...
_ __. . _....__ __ _.__.. _..... _
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FLOWER LAW, LLC �_
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... . _ _ .�
_ __ _
___ __ . _
Second hne of address _ i�s..: � �g��
... _ .....». .... ._. �,�
..,. .,
' 10 W HIGH ST `•�'� �
. ,�....
, •-,� �p , _._.
City or Post Office _ _ _ State ZIP Code �E FILED .��.
__. _ _ _
.�
_.. _ ., -
CARLISLE PA 17013
Corres�ndent's e-mail address:TOM a�FLOWER-LAW.COM
Untler penalties of perjury,l declare that I have examined this retum,including accompanying schedules and statements,and to the best of my knowledge and belief,
�t�s co�ed and axr►p�ete•Decla ' n of praparer other the personal representative is based on all iMormation of which preparer has any knowledge.
SIG A O FOR IU G TUR DATE
�woRESs
03/11/14
CONNIE S BARBER, 502 N.WALNUT S ., MT. HOLLY SPRINGS, PA 17065
SIG R AN REPRESENTATIVE pA�
��ss
03/O6/13
FLOWER LAW, LLC; 10 W. HIGH ST., CARLISLE, PA 17013
PI.EASE USE ORIGINAL FORM ONLY
Side 1
� 15�5610101 1505610101
�
J 1505610105
REV 1500 EX
DecedenYs Social Security Number
oecedent's Name: EVELYN G. FLEMING
RECAPITULATION
_ _ _ _ _ _ . _ __.
1. Reai Estate(Schedule A). ....... ..................................... 1. 0.00.
2. Stocks and Bonds(Schedule B) .............. ......................... 2. 0.00
3. Closely Heid Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. : 0.00;
4. Mortgages and Notes Receivabie(Schedule D)........................... 4. 0.00 :
5. Cash,Bank Deposits and Misceilaneous Persanal Property(Schedule E)....... 5. ; 0.00;
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. ' 5,059.39 ;
7. Inter-Vvos Transfers 8 Miscellaneous Non-Probate Property °"° ` °`°' "'°° `
(Schedule G) O Separate Biliing Requested........ 7. 94,085.19
8. Total Gross Assets(totai Lines 1 through 7)....................... ..... . 8. 99,144.58
9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. 7,340.00;
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule I).............. 10. '
11. Total Deductions(total Lines 9 and 10)................................. 11. 7,340.00:
12. Net Value of Estate(line 8 minus l.ine 11) ....................... . 12. ' `''.. ''
...... 91,804.58
13. Charitabie and Govemmental Bequests/Sec 9113 Trusts for which ° " °° °�� -�°°°
an election to tax has not been made(Schedule J) ........................ 13. ; 0.00
14. Net Value Subject to Tax(Line 12 minus Line 13) ........................ 14. 91,804.58 ;
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 ___ _ _ __ _ _ _ ___.
, __ __... _...._....._..
(ax1.2)X A.___ 15.
16. Amount of Line 14 taxable
.� ,......,,...........:.::........,.
at Iineai rate X.0 45 91,804.58 ; �6. ' 4,131.21 '
...... :. __ _
17. Amount of Line 14 taxable : ... ,�... .;
at sibling rate X.12 , �7 ;
.: : i
18. Amount of line 14 taxable ___ _ _ _ . .
at coilaterai rate X.15 ; �8 I
_.__ _ _ .._ _._..... _. . _.__._..:
19. TAX DUE........ ............................................. .... 19.i 4,131.21
_ _ _
_ __ .._ _
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT �
Side 2
L 1505610105 1505610105
�
REV 1500 EX Page 3 File Number
Decedent's Compiete Address:
D CE NTS NAME
EVELYN G. FLEMING
........................__.._._...__.... ....... ....._. ..... ...... -...... _ ____ _...... __ _.. . ____ ___.
STREET ADDRESS
_.. __ _.... _-- ___. . ._..__ ......... ..................
502 N.WALNUT ST
; .... ... _.._. _._ __._. __. _. __ -...
___._ __.. .__..__.._ _....._._ _..___... _STATE _ .._.___._.. _._ ZIP. . . ........... ...._...........
CITY . .
MT. HOLLY SPRINGS PA � 17065
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 4,132.21
2. Credits/Payments
A.Prior Payments
B.Discount
_.._....._.__..............__......_..__......._ __.__._.....___........_.__......___
Total Credits(A+B) (2)
3. interest
�3)
4. if Line 2 is greater than Line 1+Line 3,enter the di�erence. This is the OVERPAYMENT.
Fill in oval on Page 2,Line 2Q 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) 4,131.21
. , �� ,
Make check payab
le to REGISTER OF WILLS,AGENT
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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;or.......................................................................................................................... ❑ �
d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ 0
2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death
without rec:eiving adequate cansideration?.............................................................................................................. ❑ 0
3. Did decedent own an"in trust for"ar payable-upon-death bank account or security at his or her death?.............. ❑ x0
4. Did decedent avm an individual retirement account,annuity or othe�non-probate property,which
contains a beneficiary designation? .................................................................... ................................................ 0 ❑
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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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 perc�nt[T2 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 af transfers to or for the use of the sunriving spouse is 0 percent
[72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt a transfer to a sunriving spouse from tax,and the statutory requirements for disclosure of assets and
filing a tax retum are still applicable even if the sunriving 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 ftom a deceased child 21 years of age or younger at death to or for the use of a natural parent, an
adop6ve parent w 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(1.2)[72 P.S.§9116(aj(1)j.
• 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)J.A sibling is defined,under
Sectwn 9142,as an individuai who has at least one parent in common with the decedent,whether by blood or adoption.
REV-isog D(+(ot-1o)
� pennsylvania SCHEp1�1LE F
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN �4INTLY-OWNED PROPERTY
RESIDEIYT DECEDENT
ESTATE OF: FILE NUMBER:
EVELYN G.FLEMING 21-13-
If an asset became jointly owned within one year of the decedent's dabe of death,�t must be report�!on ScNedule G.
SURVMNG]OINT TENANT(S)NAME(S) ADDRESS RElATIONSHIP TO DECEDENT
.,,.... .. __
_ _ _ _ _ __ _
A•CONNIE BARBER 502 N.WALNUT STREET DAUGHTER
MT HOLLY SPRINGS, PA 17065
B. :
.
C. . _ _ _
]OINTLY OWNED PROPERTY:
�� �� DESCRIPTION OF PROPERTY qb pp p,q�0�pEqTM
IT� �OR lOINT MADE INCLUDE NAME OF FINANQAL INSTlTUTION/WD B/WK ACCOUNT NUMBER OR SIMIIAR DATE OF DEATH DECEOENT'S VALUE OF
NUMBER TENANT ]OINT IDENTIF1'!NG NUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTA�E. VALUE OF ASSET INTEREST DE�tT'S IM'ERE$T
_
__ __.. .
1. A. : _ .
03/30/99 M&T BANK SAVINGS ACCOUNT#15004201390363 8,599.42 50% 4,299.71
2.: A '03/30/99 PATRIOT FEDERAL CREDIT UNION ACCT.#5570 1,519.35 °` 50% 759.68
__.---.—
__.
TOTAL(Also enter on Line 6, Recapitulation) $ 5,059.39
If more space is needed,use additionai sheets of paper of the same size.
499 Mitchell Road,Millsboro,DE 19966 Adjustrnent Services
Phone 888-502-4349
F ax (302)934-2955
July 3,2013
Connie S.Barber
502 N.Walnut Street
Mt.Holly Springs,PA 17065-1509
Re: Estate of Evelvn G.Flemins
Social Security: 172-36-7824
Date of Death:June 13,2013
Dear Sir or Madam:
Per your inquiry on June 27,2013,please be advised tha.t at the time of death,the above-named decedern had on
deposit vvith this bank the following:
1. Type of Accourtt Savirtgs Account
Accou»t Number 15004201390363
Ownership(Names o,� Con»ie,�Bcu�ber
Evelyn g.Fleming
Opening Date 03/30/1999
Balance on Date ofDeath $8,599.36
Accrued Interest $ .06
............_............_........._._....................................._......_................_............_......_.._..._......
Total ,$8,599.42
For any additional information on the above accounts,including owners6ip and any c6anges,closures and/or reimbursement of funda,
plaise call the Mount H�y Spring at 717�86�0�.
We were unable to locate any safe deposit boz for the above-mentioned decedent
" TLia ktter does not indude any�ocounb in w�c6 the da�,ased may have been listcd ns Power of At�ornry,Custodinn�Uniform Transters,
� Represe�tive Paya,or Tn�sbx ander a Writ�en E1gr+eement
S111CC1Y'�,
Valarie Merc�r
Adjustment Services
� , � MEMBER'S STATEMENT OF ACCOUNT# �'
� � �
Send Inquiries to: �
FEDERAL CREDIT UNION P•o.Box 77s
Catch the Spirit of Financial Freedom Chambersburg,PA 17201
�or tJ�+M�I�
20696 1 AT 0.384 28190-20696-52
*�� ��I����1�'��I���1��1�1�1����1��1�1����11�1���1�1���1�'I���I�'���I '`.�
N� EVELYN G FLEMING ~�
� 502 NORTH WALNUT ST ��
"'� MOUNT HOLLY SPRINGS PA 17065-1509 v,�
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o� °�
�� *�
. ���.■�� �,+....��.......*�.�r�
www.patriotfcu.org.Patriot Federal Credit Union.717-263-4444.SMARTLine: 717-263-8468
Have a summer vacation, a remodel or other large
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SUMMARY OF YOUR STATEMENT INFORMATION
PRIME SHARE ACCOUNT-00 141.56 ACCUMULATIVE IRA-36 33.88
DRAFT ACCOUNT-25 531.92
PRIME SHARE ACCOUNT-00
Joint Owner:CONNIE S BARBER
Posf Eff - . . _ _ � Batance
Date D�g Transaction Descri tion h n New Balance
06-01 Balance Forward .............................................................................................................. 141.51
06-30 Deposit Dividend DIVIDEND ................................................................................. 0.05 141.56
Annual Percentage Yield Earned 0.140%from 04/01/13 through 06/30/13
06-30 Ending Balance ................................................................................................................ 141 56
DRAFT ACCOUNT-25
Joint Owner:CONNIE S BARBER
Post Eff Balance
� Date Transaction Descri t� Chanae New Balance
06-01 Balance Forward .............................................................................................................. 1,8f8.01
06-11 Draft 001784 Tracer 9707831583 .......................................................................... -440.17 1,377.84
Processed Check-SEARS PAYMENT
TYPE:CHECK PYMT
06-18 Draft 001785 Tracer 0015109912 .......................................................................... -245.01 1,132.83
Processed Check-MET-ED
TYPE: BILL PYMT
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_ '� �rr■..``""\ 28191 -20696-52
- � / • �'''� Account Number: XX�J(XX5570
� Statement Period: 06/01/2013-06/30/2013
O Pa e2of2
9
FEDERAL CREDIT UNION
DRAFT ACCOUNT-25(Continued)
Post Eff � Balance
Date Date Transaction Description Change New Balance
*� 06-18 Draft 001786 Tracer 0021940258 .......................................................................... -535.00 597.83 �
N� 06-20 Draft 001787 Tracer 3618565364 ................. : =
......................................................... -65.91 531.92 N
N� Processed Check-CAPITAL ONE AR C N-==..
�+�� TYPE:GHECK PYMT ---
�� 06-30 Endin Balance �' _
g ................................................................................................................ 531.92 ��-_
�� Check Summary o =
*� Number Amount Number Amount Number Amount Number Amount *__ `
1784 440.17 1 7 8 5 2 4 5.0 1 1786 535.00 1787 65.91
*Asterisk next to number indicates skip in number sequence
ACCUMULATIVE IRA-36
Pos# Eff Balance
Date Date Transaction Description h n New Balance
06-01 Balance Forward .............................................................................................................. 33.87
06-30 Deposit Dividend DIVIDEND ................................................................................. 0.01 33.88
Annual Percentage Yield Earned 0.120%from 04/01/13 through 06/30/13
06-30 Ending Balance ................................................................................................................ 33.88
Current Year IRA Contributions 0.00
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y
REV-15f0 EX+(�$-09)
� pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIV4S TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBfR
EVELYN G. FLEMING 21-13-
This schedule must be compieted and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
�M DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S EXCLUSION TAXABIE
rnauoe n�roar+�oF n��,n��R aaanoHSrar ro oECEOeJr�wo
NUMBER T}�DATE OF 1RANSFBt.AlTi4(]i A COPY OF THE�FOR REAL ESTATE. VALUE OF ASSET INTEREST �� VALUE
i� PSERS DEFERRED COMPENSATION RETIREMENT ACCOUNT
94,051.30 ' 100 94,051.30
2. PATRIOT FCU IRA 33.88 ` 100 33.88
Tt?TAL(Also enter on Line 7, Recapitulation} $ 94,085.18 :
If mare space is needed,use additional sheets of paper of the same size.
Commonwealth of Pennsylvania
State Employees' Retirement System „
� '` 30 North Third Street,Suite 150 � -
'i Harrisburg,Pennsylvania 17101-1716 �
www.sers.state.pa.us R
' ' Telephone:i-800-fi33-5461 ,
Fax:717-787-5866
August 16, 2013
CONNIE BARBER
502 N WALNUT ST �
MT HOLLY SPRING PA 17065
Member SSN: XXX-XX-7824
Dear Beneficiary: Beneficiary SSN/EIN: XXX-XX-2874
� � A check in the amoun#of$75,337.52 will be mailed to you within two weeks. If you have elected to
. rollover your final settlement payment, the amount listed below will be transferred to your qualified
plan within two weeks. This payment represents your designated share of 100.00% in the final.
settlement of the account of EVELYN G FLEMING.
� � Breakdown of Payments:
Non-Taxable: $482.38
Taxable: $93,568.9�
Gross Amount: $94,051.30
Federal Withholding Tax: $18,713.78
Non-Taxable Contributions to IRA Rallover: $0.00
Non-�axable Contributions to Roth FRA Rollover: $0.00
Taxable Contributions to �RA Rollover: $O.Ob
Taxable Contributions to Roth IRA Rollover: $0.00
Total Deduction Amount: $18,71'3.78
Net Amount Paid to You: $7�,337.52
If the individual listed above was a member of the Retirement system before January 1, 1982,their
: .
contribt�tions prior to that date were taxed as part of their gross income at that time. Therefore, no
taxes are bein withheld on that portion of their contributions. The difference between the amount of
__.----_ ----- --�---,---_.�----_-- -_ ___ - --- ------ _ - -- ---- __��_-- -- ____----__�-_�_ ____ __-_�-,�.�_ ______-_----- - _—-_-_.--_-.-
your payment a�nd your share of the deceased member's non-taxable contributions, ifi any, is
taxable for federal income tax purposes.
This payment will be reported to the Internal Revenue Service. You will receive a 1099R form prior _
to January 31 of next year along with necessary tax information regarding this payment. Under
current law there are no Pennsylvania state or local taxes on any benefits paid from this system.
�his letter and the 1099R form that you receive sl�ould be kept in a safe place, as you will need the
information when fil�ng your Federal Income Tax Return. This is the only notice you will receive.
Sincerely,
� , ��
�
Debra G. Murphy, Director
Benefit Deterrnination Division
BEN31 FSL I IIII II III II III II III II IIIII III II III II III II III II III II III II III II IIII IIII
REV-I511 EX+(10-09}
� pennsylvania SCH E DU LE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
EVELYN G. FLEMING 21-13-
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A• FUNERAL EXPENSES:
1. : _. ___ _ _ _ _ _ _ __ _ __ _ _
HETRICK-BITNER FUNERAL HOME,INC.,CREMATION CHARGES 1,995.00
_ _ _ _ _
2•° MERCHANDISE AND FACLIITIES '
295.00 '
, _
3.' TRANSPORT,DEATH CERTIFICATES,CORONER'S FEE,OBITS,ETC. 800.00
B. ADMINISTRATIVE COSTS:
i. Personai Representative Commissions:
Name(s)of Personai Representative(s) ''
Street Address
....__......................_........._....__._................_......._.._................__..........__._.............._......_........._....._.........__.__ ..._____.._---.._......_._._.........._..._..
City State ZIP
Year(s)Commission Paid:
Z• Attomey Fees: 750.00
3� Family Exemption:(If decedent's address is not the same as claimant's,attach expianation.) 3,500.00 `
Claimant CUNNIE S. BARBER
Street Address 502 N. WALNUT ST
City__MT H4LLY SPRINGS __ _ State PA... ZIP.1701_3
...._.... _... ... _.... _._..._____.....
Relationship of Claimant to Decedent DAUGHTER
4• Probate Fees:
5� Accountant Fees:
6� Tax Return Preparer Fees:
7. _ _ _ _ _ _ _ _ _ _
_ <.;,
TOTAL(Also enter on Line 9,Recapitulation) $; 7,340.00 '
If more space is needed,use additional sheets of paper of the same size.