HomeMy WebLinkAbout03-25-14 REV-1500 EX 101-10' 1505610140
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
1 2 2 5 2 0 1 3 0 5 0 8 1 9 4 9
Decedent's Last Name Suffix Decedent's First Name MI
J U M P E R M I R I A M J
(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
❑X 1.Original Return ❑ 2.Supplemental Return 3.Remainder Return(date of death
prior to 12.13-82)
4.Limited Estate 4a.Future Interest Compromise(date of ❑ 5.Federal Estate Tax Return Required
death after 12-12-82)
F1 6.Decedent Died Testate 7. Decedent Maintained a Living Trust _ 8.Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
9.Litigation Proceeds Received 10.Spousal Poverty Credit(date of death ❑ 11.Election to tax under SeM113(A)
between 12-31-91 and 1-1.95) (Attach Sch.O) o
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMA7M&1 OULD BE IRECTE- T .
Name Daytime Teleph Admber 0
U WW
D O U G L A S G M I L L E R 7 1 7 wt4D9� 2A 540 rn
REGISTERff t,'S;JSE ONLY O
0 O O -M -T1
O O ,TI 3 T1
First line of address C> m
I R W I N & M c K N I G H T P C o CJ
Second line of address
6 0 W E S T P 0 M F R E T S T R E E T
City or Post Office State ZIP Code DATE FILED
C A R L I S L E P A 1 7 0 1 3
Correspondent's e-mail address:
Under: allies of perjury,I declare that 1 have examined this retum,Including accompanying schedules and statements,and to the best of my knowledge and belief,
it Is true nect and com ere.D ration of preparer other than the personal representative is based on all Information of which preparer has any knowledge.
SI F PER1RE1§PfiNSIB4 FOR FILING RETURN DATE
3 � iy
ADDRESS /
201 UNION HALF ROAD CARLISLE PA 17013
SIGNA OF P �E TH T EPRESENTATNE DATE _-/
J S Y
ADDRLiS
60 WES POMFRET STREET CARLISLE PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610140 1505610140 J
J 1505610240
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: MIRIAM J . JUMPER
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. 5 8 8 2 , 2 1
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested .. . . . . . 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested . . . . . . . 7. 1 3 2 8 8 . 0 0
8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 1 9 1 7 0 , 2 1
9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9. 5 2 4 3 . 5 0
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) . . . . . . . . . . . . . 10. 1 0 8 9 . 4 6
11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 6 3 3 2 . 9 6
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 1 2 8 3 7 . 2 5
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. 1 2 8 3 7 . 2 5
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 _ 0 , 0 0 15. 0 . 0 0
16. Amount of Line 14 taxable
at lineal rate x.045 1 2 8 3 7 . 2 5 16. 5 7 7 . 6 8
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 0 0 17. 0 . 0 0
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 0 0 18. 0 . 0 0
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 5 7 7 . 6 8
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Side 2
1505610240 1505610240
REV-1500 EX Page 3 File Number
Decedent's Complete Address: 0 0
DECEDENT'S NAME
MIRIAM J. JUMPER
STREET ADDRESS
51 MOUNTAIN STREET LOT 3
CITY STATE LP
MT. HOLLY SPRINGS I PA 17065
Tax Payments and Credits:
1. Tax Due(Page 2,Une 19) (1) 577.68
2. CreditslPayments
A.Prior Payments
B.Discount 28.88
Total Credits(A+B) (2) 28,88
3. Interest
(3)
4. If Line 2 is greater than Line 1 +Une 3,enter the difference.This is the OVERPAYMENT.
Fill In oval on Page 2,Line 20 to request a refund. (4) 0.00
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 548.80
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
b. retain the right to designate who shall use the property transferred or its income; ............................... ❑ 0
c. retain a reversionary interest;or ................................................................................................ ❑ ❑X
d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ 0
2. If death occurred after December 12,1982,did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... ❑ ❑X
3. Did decedent own an'in trust for'or payable-upon-death bank account or security at his or her death? ......... ❑ ❑X
4. Did decedent own an individual retirement account,annuity or other 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.
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 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)(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 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(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 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-1508 EX+(08-12)
pennsylvania SCHEDULE E
DEPARTMENT
INHERITANCE AX
CASH, BANK DEPOSITS & MISC.
RESIDENT DECEDENT PERSONAL PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
MIRIAM J. JUMPER 0 0
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. MBT BANK-CHECKING ACCOUNT#9838248277 2,198.21
2. PERSONAL PROPERTY-APPRAISAL ATTACHED 3,684.00
TOTAL(Also enter on Line 5,Recapitulation) $ 5,882.21
If more space is needed, use additional sheets of paper of the same size.
REV-1510 EXa(09-09)
pennsylvania SCHEDULE IS
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MIRIAM J. JUMPER 0 0
This schedule must be completed and filed d the answer to any of questions 1 through 4 on page three of the REV-1500 Is yes.
REM DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % DECUS EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER.ATTACH A COPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST OFAPRIGTSD VALUE
1. KNOUSE FOODS 401(k) 13,288.00100.00 13,288.00
BENEFICIARIES: REBECCA J. GRAHAM
JOSHUA J. TRAXLER
TOTAL (Also enter on Line 7,Recapitulation)) $ 13 288.00
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
RESIDENT DECEDENT ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
MIRIAM J. JUMPER 0 0
Decedent's debts must be reported on Schedule 1.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. HOLLINGER FUNERAL HOME 3,865.00
B. ADMINISTRATIVE COSTS:
I. Personal Representative Commissions:
Names)of Personal Representative(s)
Street Address
City State ZIP
Years)Commission Paid:
2. Attorney Fees: IRWIN & MCKNIGHT, P.C. 1,250.00
3. Family Exemption:(If decedenfa address is not the same as claimant's,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees:
6 Accountant Fees:
6. Tax Return Preparer Fees:
7. REGISTER OF WILLS - FILING FEE 43.50
8. ROY D. GOTTSHALL -APPRAISAL ON PERSONAL PROPERTY 85.00
TOTAL(Also enter on Line 9,Recapitulation) $ 5,243.50
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+(12-12)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES&LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MIRIAM J. JUMPER 0 0
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. MET-ED - ELECTRIC 366.05
2. SUBURBAN PROPANE - PROPANE 78.41
3. DENNY LEBO - LOT RENT (3 MONTHS) 645.00
TOTAL(Also enter on Line 10,Recapitulation) $ 1,089.46
If more space is needed, insert additional sheets 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:
MIRIAM J. JUMPER 0 0
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 outri ght spousal distributions and transfers under
Sec.9196(a)(1.2).]
1. REBECCA J. GRAHAM Lineal 6,418.63
201 UNION HALL ROAD 1/2 REMAINDER
CARLISLE, PA 17013
2. JOSHUA J. TRAXLER Lineal 6,418.62
51 MOUNTAIN STREET#3 1/2 REMAINDER
MT. HOLLY SPRINGS, PA 17065
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.
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.
MM&TBank
499 Mitchell Road,Millsboro,DE 19966 Adjustment Services
Phone 888-502-4349
F ax (302)934-2955
February 7,2014
Law Offices
Irwin & McKnight,P.C.
West Pomfret Professional Building
60 West Pomfret Street
Carlisle,PA 17013-3222 FEB 16 2014
RMN&McKNIGNA
9 AWOFRO
Re: Estate of Miriam J.Jumper
Social Security: 162-42-5877
Date of Death: December 25,2013
Dear Sir or Madam:
Per your inquiry on January 27,2014,please be advised that at the time of death,the above-named decedent had
on deposit with this bank the following:
1. 7)pe of Account Checking Account
Account Number 9838248277
Ownership(Names ofi Miriam J.Jumper
Opening Date 0211712005
Balance on Date of Death $2,198.20
Accrued Interest $ .01
._.°----------------------
Total $2,198.21
For any additional information on the above accounts,including ownership and any changes,closures and/or reimbursement of funds,
please cell the Mount Holly Springs at 717-486-3038.
We were unable to locate any safe deposit box for the above-mentioned decedent.
This letter does not include any accounts in which the deceased may have been listed as Power of Attorney,Custodian of Uniform Transfers,
Representative Payee,or Trustee under a Written Agreement
Sincerely,
Valarie Mercer
Adjustment Services
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0- * ---
January 14, 2014
Rebecca Graham
201 Union Hall Rd.
Carlisle, PA 17013
Dear Rebecca:
Please allow us to take this means to extend to you and your family our sincere sympathy on the
death of your mother.
Mim was a participant in the Knouse Foods Cooperative, Inc. Retirement Savings and
Investment Plan (401k). She named you as the beneficiary of a portion of the funds invested in
the plan. At the close of business on January 7, 2014 the value of your portion of the account
was $6,644.00. The amount in the account can change daily. The funds are invested in various
mutual funds and are subject to changes in the stock and bond markets. Enclosed is an
"Application for Benefits" and a notice entitled "Your Rollover Options." Since you are a
beneficiary other than a surviving spouse if you elect to rollover the funds in the account the
funds would need to be rolled into an Inherited IRA. Please read the information carefully and
inform us of your distribution choice by completing the application.
Please return the completed application in the enclosed self-addressed envelope at your earliest
possible convenience. If you have any questions you are welcome to contact me at (717)-677-
8181 Ex. 1330.
at
Sincerely,
OUSE COOPERATIVE, INC.
hn H. Eisele
enefits Administration
L w
F.
\ .c._�\
Hollinger Funeral Hone & Crernotory l n c.
Elic L. Hollinger Sypervisoc
D'ecember25 20
13
Rebecca Graham. ,
'Union-Hall Rd.
Carlisle, PA 17013
Funeral Serylce for Miriam d Jumper,
We sincerely.appreciate the confidence you have placed in
-us and will continue to assist you irrevery
Way We can. Please feel free to contact us if you have any questions in regard to'this statement.
THE FOLLOWING IS AN ITEMISED STAT EMENT OF THE SERVICES, FACILITIES;AUTOMOTIVE EQUIPMENT,
AND MERCHANDISE THATYOU SELECTE:q WHEN MAKING THE.FUNERALARRANGENIENTS.
Professional.$61M e=Crematibn Package C $ 3045:06
Merchandise,5_Keepsakes'urns 375:00
Reg. Book, Folders and:fhank you Notes 175.00
ATTHE TIME FUNERAL ARRANGEMENTS WERE MADE,WE ADVANCED CERTAIN PAYMENTS TO OTHERS
AS AN ACCOMMODATION. THE FOLLOWING IS'AN ACCOUNTING FOR THOSE CHARGES.
Cash Advances
Dea.th_Certificates,(20X 6.00).__ - 120:00. .
_ -'CUmbe�l"a`nd County CoPoner Fee' -• 30.00 - -
Gettysburg Times 120.00
Total Charges. . $3865.00
.Minus Check#286 of$1000.0012/26/2013
Balance Q $ 2865:00'
VP
pia
�
501 NORTH BALTIMORE AVENUE • MOUNT HOLLY SPRINGS. PENNSYLVANIA 17065 a (717) 486-3433 ° FAX(717)
www.hollingerfuneralh6me.com
PO BOX J
WHIPPANY NJ 07981
December 27, 2013
MIRIAM J JUMPER
51 MOUNTAIN ST LOT 3
MOUNT HOLLY SPRINGS PA 17065-1431
RE: ACCOUNT # 2113-217514
Dear Customer:
Our records indicate that your account is past due according to the terms and
conditions of your agreement with Suburban Propane.
Please remit your payment of $77.27 now. If a check for this amount has been
mailed, please accept our thanks.
We appreciate your prompt attention to this matter. We value your business and
look forward to continuing to service your energy needs.
Sincerely,
Customer Service Center Manager
Suburban Propane
717-264-7184
As an added convenience, you may make a payment by visiting our website at
www.suburbanprooane.com or by calling us at 1-866-350-7638 to utilize our free
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