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HomeMy WebLinkAbout04-14-14 1 1505610140 �J REV-1500 EX (02.11)(FI) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 2 1 . Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDOYYYY Date of Birth MMDDYYYY 0 1 2 1 2 0 1 3 0 1 2 6 1 9 2 6 Decedent's Last Name Suffix Decedent's First Name MI D E I T Z L E R O Y E (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 © !.Original Retum 2.Supplemental Return n 3.Remainder Return(Date of Death Prior to 12.13.82) 0 4,Limited Estate 4a.Future Interest Compromise(date of n 5.Federal Estate Tax Return Required death after 12-12-82) ® 6.Decedent Died Testate n 7.Decedent Maintained a Living Trust, 0 8.Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) n 9.Litigation Proceeds Received 0 10.Spousal Poverty Credit(Date of Death n 11.Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1.95) (Attach Schedule 0) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number L I N U S E F E N I C L E 7 1 7 7 6 3 1 3 8 3 REGISTER OF 1MLLS USE ONLY _o } � 1 M First Line of Address cJ m <-> ' 2331 MARKET_ STREET m c> =0 _ � t l Second Line of Address 2 MIL Q N ; n City or Post Office State ZIP Code Co �T !o _n , P C= _ CAMP HI LL PA 17011 �( r ro r- M CT) CormspondenPs e-mail address: LFENICLE(CDREAGERADLERPC.COM Under penalties of perjury,1 declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, It is We,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SiGNAT E OF PE O RESPONSIBLE FO ILING RETURN DATE Al-11 -ADDRESS 453 MULBERRY DRIVE// MECHANICSBURG PA 17050 SIGNAT OF PREP R TlTA PRESENTATIVE ADORIES S 2331 MARKET STREET CAMP HILL PA 17011 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 1505610240 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: LEROY E. DEITZ 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. S. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). .. . . . . 5. 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . .. . . . 6. 1 5 0 5 3 0 , 2 7 7. Inter-Vivos Transfers&Miscellaneous N n-Probate Property (Schedule G) Separate Billing Requested . . . . . .. 7. 8. Total Gross Assets(total Lines 1 through 7) 1 5 0 5 3 0 , 2 7 9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . .. . . . . . 1 3 4 3 8 . 0 0 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) .. .. . . . . . . . . . 10. 3 1 1 0 1 . 8 6 11. Total Deductions(total Lines.9 and 10) . . . . . . . . . . . . . . . .. .. . . . . . . . . .. . . 11. 4 4 5 3 9 . 8 6 12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 1 0 5 9 9 0 , 4 1 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 0 5 9 9 0 . 4 1 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.0_ 0 . 0 0 16. 0 . 0 0 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 1 0 5 9 9 0 . 4 1 - 18. 1 5 8 9 8 . 5 6 19. TAX DUE . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . 19. 1 5 8 9 8 . 5 6 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑X Side 2 L 1505610240 1505610240 REV-1500 EX(FI) Page 3 Ftie Number Decedent's Complete Address: 21 0 0 DECEDENTS NAME LEROY E. DEITZ STREETADDRESS 453 MULBERRY DRIVE CITY STATE ZIP MECHANICSBURG I PA 17050 Tax Payments and Credits: I. Tax Due(Page 2,Line 19) (1) 15,898.56 2. Credits/Payments A,Prior Payments B.Discount Total Credits(A+e) (2) 0.00 3. Interest (3) 229.45 4. if line 2 is greater than lane 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) 16,128.01 Make check payable to: REGISTER OF WILLS, AGENT — - PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS I. 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 shalt use the property transferred or its income ............................... El c. retain a reversionary interest ..................................................................................................... ❑ d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ 2. If death occurred after December 12,1982,did decedent transfer property within one year of death without receiving adequate consideration? ....... ................................................................... ....... ❑ 3. Did decedenf own an trust for or payable payable-upon-death bank account or security at his or her death? .......:. ❑ MR 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation?.--. ......................................... -...--....................................... ❑ MX 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 A)(i)j. 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)(it)].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 stiff 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 172 P.S.§9116(a)(1.2)j. • 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 t72 P.S.§9115(a)(1)I. • 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-1509 EX+(01-10) Pennsylvania SCHEDULE F DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: LEROY E. DEITZ 21 0 0 If an asset was made jointly owned within one year of the decedents date of death,it must be reported on Schedule G. SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A.SARAH J. HOFFMAN (DEITZ) 453 MULBERRY DRIVE NIECE MECHANICSBURG, PA 17050 e. C. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY-HELD REAL ESTATE, VALUE OF ASSET INTEREST DECEDENTS INTEREST 1, A. 4/1992 451 MULBERRY DRIVE, MECHANICSBURG, PA 300,300.00 50. 150,150.00 FAIR MARKET VALUE AS OF 1/21/13 2. A. 5/2011 CORNERSTONE FEDERAL CREDIT UN.-CHECKING 554.90 50. 277.45 5 EAST GATE DRIVE, CARLISLE, PA 17015 3, A. 5/2011 CORNERSTONE FEDERAL CREDIT UN.-SAVINGS 205.63 50. 102.82 5 EAST GATE DRIVE, CARLISLE, PA 17015 TOTAL(Also enter on Line 6,Recapitulation) $ 150 530.27 It more space is neaded,use additional sheets of paper of the same size. REV-1511 EX-(06-13) Pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND RESIDENT DECEDENT ADMINISTRATIVE ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER LEROY E. DEITZ 21 0 0 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERALEXPENSES: I. MYERS BUHRIG FUNERAL HOME- PAID BY SARAH HOFFMAN 11,438.00 R ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Represernative(s) Street Address City State ZIP Year(s)Commission Paid: 2, Attorney Fees: REAGER &ADLER, PC -PAID BY SARAH HOFFMAN 2,000.00 3. Family Exemption:(If decedent's address is not the some as claimants,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4, Probate Fees: 5 Accountant Fees: 6. Tax Return Preparer Fees: 7. TOTAL(Also enter on Line 3,Recapitulation) $ 13 438.00 If more space is needed,use additional sheets of paper of the same size. REV-1512 EX-(12-12) pennsytvania SCHEDULE I DEPARTMENT of REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES&LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER LEROY E. DEITZ 21 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. PPL ELECTRIC- PAID BY SARAH HOFFMAN 82.90 2. CLARAMONT NURSING HOME-PAID BY SARAH HOFFMAN 230.00 3. VERIZON-PAID BY SARAH HOFFMAN 39.15 4. PERSONAL TAX- PAID BY SARAH HOFFMAN 9.80 5. PRIVATE CARE PROVIDERS-PAID BY SARAH HOFFMAN 3,300.00 6. 2012 TAX RETURN PREPARATION - PAID BY SARAH HOFFMAN 50.00 7. HOME INSTEAD SENIOR CARE -PAID BY SARAH HOFFMAN 2,774.61 8. MORTGAGE TO CORNERSTONE FEDERAL CREDIT UNION-BALANCE AT 24,615.40 DATE OF DEATH $49,230.79 DIVIDE IN HALF- LEROY DEITZ SHARE TOTAL(Also enter n Line 10,Recapitulation) $ 31 101.86 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: LEROY E. DEITZ 21 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 outd9htspousaldistribu6ons and transfemunder Sec.9116(a)(1.2).J 1. SARAH J. HOFFMAN-NIECE Co((ateral 105,990.41 453 MULBERRY DRIVE MECHANICSBURG, PA 17050 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 11-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. C cc;�12-1 I , LEROY E. DEITZ, of Silver Spring Township , Cumberland County , Pennsylvania , declare this to be my last will and revoke any will previously made by me . I . I devise and bequeath all of my estate of every nature and wherever situate to my niece , SARAH J. DEITZ, providing she shall survive me by thirty days. II . Should my niece, Sarah J . Deitz , predecease me or die on or before the thirtieth day following my death, I devise and bequeath all of my estate of every nature and wherever situate to Sarah J . Deitz ' issue per stirpes living on the thirty-first day following my death. III . I direct that all taxes that may be assessed in consequence of my death , of whatever nature and by whatever ,jurisdiction imposed , shall be paid from my residuary estate as a part of the expense of the administration of my estate . Iv . I appoint my niece , SARAH J. DEITZ, executrix of this my last will . If Sarah J . Deitz fails to qualify or ceases to act. as executrix , I appoint my grandnephew, DANIEL LYNN WENRICH, JR. , as executor of this my last will . V . I direct that my executrix or her successor shall not be required to give bond for the faithful performance of their duties in any jurisdiction . IN WITNESS .✓WHEREOF. I have hereunto set my hand this T J� day of �/y 1995 . LEROY E . DEI The preceding instrument , consisting of this and one other typewritten page identified by the signature of the testator , LEROY E . DEITZ , was on the day and date thereof signed , published and declared by LEROY E . DEITZ , the testator therein named, as and for his last will , in the presence of us , who , at his request , in his pr es c subscribed .our nam s as witnesses hereto . presence of each other have hereto . �� We are filing a Joint Return only no probate. The original death certificate is attached. To the return we attached has copy of the Will for the Department of Revenue. The client can only make a$500.00 payment at this time. ti C'7 0 c � rn o ni 0 m rn o M z c� cn mar- r-• rryron rn s cr) r a o O n O 1 T r� rrnn a cn crn o m �+ 4x., „' � _ - ; {„ . �,_ � ; ` �,: �., ... . � . �'. ' � C+"