HomeMy WebLinkAbout04-16-14 -� REV-1500 1505610143
EX(02-11)
' OFFICIAL USE ONLY
PA Department of Revenue pennsylvania County Code Year File Number
Bureau of Individual Taxes DEPARTAAENTOFREVENUE
PO BOX.280601 INHERITANCE TAX RETURN 21 13 0 4 3 4
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
03. 27 2013 02 17 1928
Decedent's Last Name Suffix DecedenYs First Name MI
ZINN V 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
� 1. Original Return ❑ 2. Supplemental Return � 3.Remainder Return(Date of Death
Priorto 12-13-82)
� 4. Limited Estate � 4a.Future Interest Compromise � 5. Federal Estate Tax Retum Required
(date of death after 12-12-82)
� g Decedent Died Testate � � Decedent Maintained a Living Trust � 8. Total Number of Safe Deposit Boxes
(Attach Copy of Wilq (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
HAMILTON C DAVIS ESQUIRE 717 5� t5713o h„
3' � ° �
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REGISTE�bf��U O� �
r— .l�i c5� O
First Line of Address �'`" `�� �`"' `� �'
PO BOX 40 �� ���`� � � �
:•:; �,
Second Line of Address � �� � � '-►�� "s7
l�.a
20 EAST BURD STREET � � '��i �-+ �� '�
City or Post Office State ZIP Code �TE FIL�fiC
SHIPPENSBURG PA 17257
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Correspondent'se-mailaddress: hdavisa�zullinger-davis.COm
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 representative is based on all information of which preparer has any knowledge.
SI NAT���RSON RES NSIBLE FOR FILING RETURN pATE
(� ' Barbara M. Laughlin �T "����
ADDI�ESS
14 Laug lin Lane, Newburg, PA 17241
SIGNATU PREPARER OTHER THAN REPRESENTATIVE DATE
Hamilton C Davis Esquire �
AD SS
Zullinger-Davis, P.C.
P.O. Box 40, Shippensburg, PA 17257
Side 1
� 1505610143 15U5610143 J
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ADDITIONAL Personal Representatives
Zinn, V Jane SS# 211-22-6540 3/27/2013
Under penalties of perjury, the undersigned declare that they have examined this return,
including accompanying schedules and statements, and to the best of their knowledge and
belief, it is true, correct and complete.
2 Signature ��/ " / ��''- � �
Name Marvin J. Zinn
Address 248 Whiskey Run Road
City,State,Zip Newville PA 17241
Date N���^J�
3 Signature
Name
Address
City,State,Zip
Date
4 Signature
Name
Address:
City,State,Zip
Date
5 Signature
Name
Address:
City,State,Zip
Date
6 Signature
Name
Address:
City,State,Zip
Date
REV-1500 EX Page 3 File Number 21 - 13 - 0434
Decedent's Complete Address:
D DENT'
Zinn, V Jane
STREET ADDRESS
Sarah Todd Nursin Home
1000 W. South Stre t
CITY STATE ZIP
Carlisle PA 17013
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 0.00
2. Credits/Payments
A. Prior Payments
B. Discount
Total Credits(A +B) �2) 0.00
3. Interest (3) 0.0 0
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4)
Check box on Page 2,Line 20 to request a refund
5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. �5) 0.��
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:.................................................................................. ❑ ❑X
b. retain the right to designate who shall use the property transferred or its income:.................................... ❑ Ox
c. retain a reversionary interest;or.................................................................................................................. ❑ ❑X
d. receive the promise for life of either payments,benefits or care?.............................................................. ❑ �
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?....................................................................................................................... ❑ �
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
containsa beneficiary designation?...................................................................................................................... ❑ ❑X
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.§9196(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 percent
[72 P.S.§9116(a)(1.1)(n)]. 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 refurn 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 decedenYs lineal beneficiaries is 4.5 percent,except as noted in
[72 P.S.§9116(a)(1)].
•The tax rate imposed on the net value of transfers to or for the use of the decedenYs siblings is 12 percent[72 P.S.59116(a)(1.3)1. A
sibling is defined under Section 9102,as an individual who has at least one parent in common with the decedent,wFether by blood or adoption.
,._. .... .. . .:..: ,..;_ -.,. y ,.,... ... . . ....... . ..:... . .__. .:-;..., , .. .:;., - .... . .. .. ... . . .
� 1505610243
REV-1500 EX
DecedenYs Social Security Number
DecedenYs rvame: Z I N N� V J A N E
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&Notes Receivable(Schedule D).......................................................... 4.
5• Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)................ 5. 6 , 3 2 8 . 0 7
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested............. 7.
8. Total Gross Assets(total Lines 1 through 7).......................................................... g, 6 , 3 2 8 . �7
9. Funeral Expenses and Administrative Costs(Schedule H)..................................... 9. 2 , 2 0 5 . 1 3
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................. 10. 2 9 8 , 914 . 1 0
11. Total Deductions(total Lines 9 and 10).................................................................. ��. 3 0 1 , 1 1 9 . 2 3
12• Net Value of Estate(Line S minus Line 11)............................................................. 12. -2 9 4 , 7 9 1 . 1 6
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. -2 9 4 , 7 9 1 . 1 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)(1.2)X.00 15.
16. Amount of Line 14 taxable
at lineal rate X .045 16.
17. Amount of Line 14 taxable
atsiblingrateX ,12 ��•
18. Amount of Line 14 taxable
at collateral rate X .15 �8�
19. TAX DUE................................................................................................................... 19. 0 . 0 0
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. �
Side 2
� 15U5610243 1505610243 �
�'° pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CAS H
INHERITANCETAXRETURN , BANK DEPOSITS AND MISC.
RESIDENTDECEDENT PERSONAL PROPERTY
FILE NUMBER
ESTATE OF Zinn, V Jane 21 - 13-0434
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 DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 ACNB Bank Checking Account#136042 6,328.07
TOTAL(Also enter on Line 5, Recapitulation) 6,328.07
REV-1611 EX+(�0-08)
pennsylvania SCHEDULE N
DEPARTMENT OF REVENUE �N�_p�g qND
INHERITANCE TAX RETURN �'����
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Zinn, V Jane 21 - 13-0434
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER � FUNERAL EXPENSES: DESCRIPTION i AMOUNT
A. 1 � Ewing Brothers Funeral Home, Inc. - Balance due on prepaid account � 496.63
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2 Dean &Susan Zinn -Meal after Funeral Services i 200.00
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B. ADMINISTRATIVE COSTS: I
1. Personal Representative's Commissions �
Name of Personal Representative(s) !
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Street Address �
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City State Zip
I Year(s)Commission Paid �
2. � Attorney's Fees Hamilton C. Davis, Esquire 1,000.00
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 Cumberland County Recorder of Deeds i 158.50
Filing Fee Reserves � 100.00
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5. AccountanYs Fees �
6. Tax Return PreparePs Fees
7. Other Administrative Costs
� Advertising Costs-Cumberland County Legal Journal & Public Opinion 250.00
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TOTAL(Also enter on line 9, Recapitulation) 2,205.13
°����'� � pennsylvania
SCHEDULEI
DEPARTMENT OF REVENUE DE BTS O F D EC E DE NT
INHERITANCE TAX RETURN , MORTGAGE
RESIDENTDECEDENT LIABILITIES & LIENS
ESTATE OF Zinn, V Jane FILE NUMBER
21 - 13-0434
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM DESCRIPTION AMOUNT
NUMBER
1 Final invoice due nursing home-Sarah A. Todd Memorial Home 34.65
2 Department of Public Welfare Lien - Estate Recovery Section 298,879.45
TOTAL(Also enter on Line 10, Recapitulation) 298,914.10
REV•7613 EX+(01•70) �
pennsylvania SCHEDULE J
DEPARTMENT OFREVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Zinn, V Jane
21 - 13-0434
, RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NAME AND ADDRESS OF PERSON S i
NUMBER RECEIVING PROPERTY � � poDE C�EDEN 8($, (Words) ($$$)
I� TAXABLE DISTRIBUTIONS[include outright spousal �
distributions and transfers i
under Sec.�116(a)(1.2)]
1 Barbara M. Laughiin � DAUGHTER 1/6 of residue-
14 Laughlin Lane INSOLVENT
Newburg, PA 17241
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2 John S. Zinn ( SON 1/6 of residue-
227 Whiskey Run Road ' INSOLVENT
Newville, PA 17241 ;
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3 Marvin J. Zinn SON 1/6 of residue-
248 Whiskey Run Road i INSOLVENT
Nevwille, PA 17241
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Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate.
II. NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET O.00
REV•1519 EX+(01-70)
pennsylvania SCHEDULE J
DEPARTMENT OFREVENUE
INHERITANCETAXRETURN BENEFICIARIES continued
RESIDENT DECEDENT
ESTATE OF Zinn, V Jane FILE NUMBER
21 - 13-0434
RELATIONSHIP TO � SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) � DECEDENT (Words) ($$$)
RECEIVING PROPERTY Do Not List Trustee(s)
I� TAXABLE DISTRIBUTIONS[include outright spousal
distributions,and transfers ;
under Sec.9116(a)(1.2)] ;
4 Victori E. Burnside ; DAUGHTER � 1/6 of residue-
Newville, PA 17241 i INSOLVENT
5 Dean E. Zinn , SON 1/6 of residue-
250 Whiskey Run Road ; ; INSOLVENT
Newville, PA 17241 j
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6 Delmar A. Zinn ; SON 1/6 of residue-
224 Whiskey Run Road INSOLVENT
Newville, PA 17241 ;
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Page 2 of Schedule J
FILE COPY
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On May 16, 1994, V. Jane Zinn, Vivian J. Cohick and Janet P. VanScyoc appeared before
me and signed this document.
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; p�nnsylvania
DEDqqTMENT Of CUBLIC WELFARE
]uhe 3, 2013
LAW OFFICES OF ZULIINGER-DAVIS
HAMILTON C DAVIS, ESQUIR�
PROFESSIONAL CORPORATION
PO BOX 40
SHIPPENSBURG PA 17257
Rec V�ane zinn
CIS #: 410368558
SSN: ###-##-6540
bate of Death: 03/27/2013
ESTATE �2ECOVERY STATEMENT OF CLAIIV�
bear HAMILTON C DAVIS:
Under State and Federal law, the Department of Public Welfare (the Depattment) is
required to recover medical asslstance (MA) reimbursemeht from the probate estates of
deceased indlviduals who were over age 55 when s�ch asslsYance was received, 42 U,S,C.
�1396p(b)(1). 62 P,S. § 1412. This letter sets forth the amount of the Departmeht's claim
�gainst the estate of the above referenced indfvldual and explains the obligations of
executors, administrators, and persons receiving estate property.
Although the amount in the estate may be considerably less thah that whlch
(s owed to the Department� our c(alm Is against the estate, no one else.
Statement or Claim Amount
The Department maintains a claim in the amount of �298,8y9.45 against the
above-mentioned estate, This claim Is for repayment of MA granted on behalf of the
decedent. Ehclosed Ps the Department's itemized statement of claim.
A portion of this medical expense, namely �27.779.�1, was incurred during the last
six months of the decedent's Ilfe; therefore, It is a Class 3 claim pursuant Eo Sectfon 3392 of
the Decedenfs, Estates, and Fiduclarles Code, z0 Pa. C.S.A. 3392(3). The balance of the
claim, namely �2i1.099.54, is to be entered as a priority Class 5,1 claim against the
estate. You should refer to Section 3392 for a more complete explanation of the priority
rules.
If a lawsuit is filed Por injurles sustained by the decedent ptior to death, then the
Department may also have a Ilen against the personal inj�ry actlon. A statement of claim
for thaC injury-related lien must be requesEed separarely.
.�._..--- ..._.�_.W......,.���:���_. _.�_......�....�.w..��..r��.�,-..,-u._.._..�_ .._..�
Bureau of Program in[egrlty � Dl��:ion of Thlyd Darty llablliry�Recovery Sectlon
PO Box 8486 �Narrlsburg,7ennsylvanla 17105-8486
A�; 13. 23�3 2: 29��`4' ;�, '2��; ?, 3
�
�'� pennsy[vania
qE��RTMEN7 OF PU9L1C WBLFqqE
Your Responsibility to Provide Ynformation to the Department
Piease acknowledge receipt of this letter and advise whether the Department's claim
is admitted and when payment may be expected. When the esCate accounting is complete,
please provlde a copy,
The Department audits al) estate recovery claims and therefore we tequlre
documenCatlon to substantlate all deductions from the gross estate. The regulations
governing how the Department computes iCs estate recovery claim are found in 55 Pa. Code
Chapter 258, These regulafions are readlly available on the Internet, in addition to being
carried in most local law librarles.
In order to document computatPon oF the amount due the pepartment, the following
Items should be submitted to the address below;
i. For real estate:
a. Copy of the deed
b. Copy of Ehe latest tax assessment
c. Copy of a current appraisal, if available
2. Copy of the funeral blll
3. Copy of tihe statement of the burial account If one exlsted
4. Copy of the statement of the personal care account balance at date of death, if the
decedent was in a nursing home
5, Copies of origina( and updated Ilfe insurance policy forms nam(ng beneflclarles
6. Copies of any and all stocks and bonds
7. Coples of bank statements showing balances on the date of death
8, Copies of signature cards or other proof of when accounts were made�olnt
9. A list of ahy glfts or other transfers for less than fair market value made by the
decedent (personally or under a power of aEEorney)
Your Responsibilities tio the Department
Under State law, exetutors or administrators may be personally liable to pay the
Department's estate recovery claim if they transfer estate property wlthout the
Department's claim being paid. Persons who recelve that property without paying valuab(e
and adequate consideration to the estate may also be personafly liable. 7he responsiblfitles
of the primary next of kln/administrator/executor, is to advise the Depattmenr of any assets
in the estate and to ensure that the remaining money, after all funeral and administrative
cosCs are deducted, Is sent to the Deparfinent. Accordingly, you must ensure the
Department's claim is satisfied before making distribution of assets to heirs.
Burea�of Program InCegrlly I Dlvlslon of Thlyd Varty Liabllity� Recovery Settlon
PO Box 8486 �Narr156urg,Oennsylvanla 17105-8486
a��. � 3 . 2a�3 2: 29-"r ,`y, ,L;f} ; ,
� � pennsy[vania
D�PARThENT OF7UBLIC WELiARE
Insolvent Estatas and tha Ftduclary Responslblllty to Creditors
If there are not ehough estate assets to pay the claims of all creditors in full, then
the executor or adminlstrator has a duty to act In the best tnterest of creditors when
administering the estate, If you must spend the estate's rnoney to administer it, you must
act prudently and make purchases as if the money were coming out of your own pocket,
'The department's approval is required if you expect the legal fees to exceed more than the
Qreater of 6% of the estate assets or$1,000. Contingent fees Por estate administration wili
general(y not be approved, If you do not obtaln approval, the Department may consider the
excessive fees to be a transfer for less than valuable and adequate consideration,
Sincerely,
���:.�,ti., �,
Marianne Meckley
7PL Program Investigator
717-772-6246
717-772-6553 FAX �
�n closure
�— .��..�...�.,.a..._,.......�...._.�..,.....y,w....._�.�..- __..�......_.....__......._,_._. ___�.�.__�
Bureeu of Aroflram In[egriry� Division of Third Per[y Llability�Recovery SecCion
PO BoX 8486 �Harr(sburg,Pennsylvanla 17105-8486
LAW OFFICES OF
ZULLINGER-DAVIS
PROFESSIONAL CORPORATION
JOEL R.ZULLINGER SUZANNE M.TRINH HAMILTON C.DAVIS
jzullin er zullinQer-davis.com strinh�a zullin�,er-davis.com hdavis zullinger-davis.com
14 North Main Street,Suite 200 20 East Burd Street,P.O.Box 40
Chambersburg,PA 17201 Shippensburg,PA 17257
717-264-6029 717-532-5713
717-264-1884(FAX) 717-530-5222(FAX)
April 14, 2014
_ N
�
� s � rn
� ° � u�-� �
Register of Wills �" -- °
Cumberland County Courthouse �, D � � -�'�'-� �
1 Courthouse Square �.,, x, rn �
� rn ;:� v
Carlisle,PA 17013 -�' G� �"� r� °
c� C, Q � -� -n
ca o -� � ;� �
RE: Estate of V. Jane Zinn °' � ►—" r=- �
Est.No. 21 13 0434 � � � � �
�
Dear Sir or Madam:
Enclosed herewith please find an inheritance tax return, filed in duplicate for the above estate to
be filed immediately in your office. We have verified with your office that no filing fee is due. A
review of the enclosed return will show that the Estate is insolvent and therefore no tax is due.
If there are any questions or concerns,please contact me at the Shippensburg office. Thank
you.
Sincerely yours,
'�C,
Hamilton C. Davis
for Zullinger- Davis
Professional Corporation
HCD/tlb
Enclosures
Reply to: Hamilton C.Davis,Esquire
� P.O.Box 40
Shippensburg,PA 17257
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