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Home My WebLink About05-01-14 � 1505610105 REV-1500 EX(o�-ii)(FI) . p enn5 OFFICIAL USE ONLY PA De artment of Revenue P ylvania oEP�*E�*�f wE�F��E Counry Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN ; ,� ; � PO BOX 28o6oi , Harrisburg,PA 1��z8-o6o� RESIDENT DECEDENT � /"i�� < ( �� ( �� ; ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY . . _ _ _ ; � 11/14/2013 � ; 08/31/1965 __ ____� _.. _. . :_ _. �.___. _ _ ___ . _ DecedenPs Last Name Suffix Decedent's First Name MI ' HELMAN ' JEFFREY T (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI . ,.__...�. .. ..._ �__�.. � �.___ � --- __ -- - ; ? ; t ....,. ' i ' � _ __ .... ,. .._ _ . .. . __._ ._. ... ._ , .... .... ..- , ..._ ___ __ _ �._ . ........,.�. . Spouse's Social Security Number - - THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW C� 1.Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death Prior to 12-13-82) O 4.Limited Estate O 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Return Required death after 12-12-82) � 6.Decedent Died Testate O 7.Decedent Maintained a Living Trust � 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9.Litigation Proceeds Received O 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 Schedule O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number • j .�.. .._� ..-- --- � .W__. ..._,__- —� _ �_ . _ _.. _ ____ __ _... —�— ... �DAVID P. PERKINS, ESQUIRE �(717)532-9a37 � � � � � � _ _ — ___ .� .__ __._ — _ ... _�,_.___ ___ __.. __ _ �_.._ — � _. �_�_�� __ �___� .� REGISTE �F�GILLS USE Y � � � (Tl � C'? "G t:> r�.J e,4� r N _. ' ('l First Line of Address �"~ -,= r��! f"'' ' `•°' 4 James Circle . Y� ��, --� � _ . ` _;N _ c::,7 C", ,,__, � � ��_.__.__.___ �____ � .___.._._ ,-- �_ _�---�_ _ _.. _..�. __ — � _ Second Lme of Address � � �� c-> ___.._.__ ..___.._____— _ ..... . . -- ___ _�._._____ �__._. � �7 CD t ' t"�i ' "'� f O _�..______—�__..�_.._� .... --- _._, __ _._ . . __ _..� E FILED —� 'Ti City or Post Office State ZIP Code Shippensburg PA ; 17257 CorrespondenYs e-mail address: DPPESQ@GMAIL.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. SIGN�OF PERSO�SPONSI�F I�NG��2N,,,Z� � 13� �� .fy,.,� d � �� ADDRESS 2966 JEFFERSON DRIVE, CHAMBERSBURG, PA 17201 SIGNAT E OF EPAR . T�SENTATIVE � ��E /�� ADDRESS 4 JAMES CIRCLE, SHIPPENSBURG, PA 17257 PLEASE USE ORIGINAL FORM ONLY Side 1 � 1505610105 1505610105 � � � ,� �`: `� � 15056b02�5 REV-1500 EX(FI) DecedenYs Social Security Number DecedenYs Name: � RECAPITULATION ___ _.. � _ �_.� _, 1. Real Estate(Schedule A). ..... .... ........ .......... ........ . .... .... 1. 0.00 i 2. Stocksand Bonds(Schedule B) .... ... ..... .......... . ................ 2. : 0.00 ! 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. ; 0.00 � 4. Mortgages and Notes Receivable(Schedule D)........................... 4. ; 0.00 ; 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)...... . 5. ' 9,828.43 ; �_ �,.. . e�. _�..w�. ....�; 6. Jointly Owned Property(Schedule F) O Separate Billing Requested ...... . 6. 3,373.75 ( .__.. _..._. _ _.._ __. __.___ : 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested... ..... 7. 28,694.25 i _w� e e�� , �...a��. �� 8. Total Gross Assets(total Lines 1 through 7)..... ..... ................... 8. ( 41,896.43 ; � ; 9. Funeral Expenses and Administrative Costs(Schedule H). ............ . ..... 9. , 12,301.78 _.._.�_�... �ee� 10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule I)..... ........ .. 10. � 893 02 11. Total Deductions(total Lines 9 and 10). ....... . .................... .... 11. ` 13,194.80 ' 12. Net Value of Estate(Line 8 minus Line 11) .... . ......................... 12. ' 28,701.63 ! 13. Charitable and Govemmental BequestslSec 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. ' 28,701.63 i TAX CAICULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or - � __._... _ _. __ __ .__. _ __�_ _. �m�__ _.. , trans ers under Sec.9116 ��" (a)(1.2)X.0_ 15. ' 0.00 ' 16. Amount of Line 14 taxable _` a �' _" �__"" " �.`� _ °°m .°� ""m"� �°��"".�'_°m�� '°`m�ee`.""'; at Iineal rate X.0 45 28,701.63 ` 16. 1,291.57 ; 17. Amount of Line 14 taxable � ��"�_ � �� '��"'� ��"`�`�„ . ��w �-,....,w n�_....__ .�� .,.1 at sibling rate X.12 �7, ,' 0.00 ': 18. Amount of Line 14 taxable -�� .�� `�`� �� . `_ "�" ""�°�` �°`° " � at collateral rate X.15 �g, ! 0.00 ___ ___ ._--- __ _._... _` __._ _� �. ___ _� M�e_�._..�..�a.a � i 19. TAX DUE . .... ... . .. .. . ....... ... .. . ............ . ................. 19.;; 1,291.57 � 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p Side 2 � 15�5610205 1505610205 � REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME JEFFREY TODD HELMAN STREETADDRESS 203 Senior Drive CITY STATE 21P Shippensburg PA 17257 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 1,291.57 2. CreditslPayments A.Prior Payments B.Discount Total Credits(A+g) (2) 0.00 3. Interest f3) 0.00 4. If Line 2 is greater than Line 1 +Line 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) 1,291.57 Make check payable to: REGISTER OF WILLS, AGENT. _ ..,,I„ac.�`�� '�°.�� ta,�. ;�4 iraa ��- �t t;�� au�,�•- R'.,�u�" �'r " �tiLu"i�3.'*..g�'S'-°�t�a �- "�l!k � . � �'.> �.,. �u�.�.�i�� ua«�, ��"�'"��r� � � 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 .............................................................................................................................. ❑ � 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?.............. ❑ � 4. Did decedent own an individual retirement account,annuity or other non-probate property,which containsa beneficiary designation? ........................................................................................................................ � ❑ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. �•�.m , - . °.• u� � °o ` � r�"'� :��1�r� '„ ��'� . � ,��,� "� G i �. ,- �� , ,. ,-�,., r, m , h _ ...n_ .. '� ,.� �k��m�-. � �-a;��.:-�� ..�..��,�""nv v�re�rr�+r-r:��av�.. ... .. . 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)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)(ii)].The statute does not exempt a transfer to a surviving spouse ftom 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(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. §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. FtEV-15o8 EX+(o8-i2) j� pennsylvania SCHEDULE E L� DEPARTMENT OF REVENUE � �K DEP�IT'S&�NQSC..' INHERITANCE TAX RETURN � ^��ER,Y RESIDENT DEGEDENT ESTAI'E OF: FILE NIA�BER: HELMAN, JEFFREY TODD 21-13-1252 Indude tlie proceeds of litigation arxl ti�e date the prooeeds were received by the estate. All propeity jdrrtfy owned vuitl�right of survivaship niust be disdosed on Sd�adule F. ITB�1 VAWE AT QA'TE NUNBER DE.SCRIP'fION OF DEAII-I �, Patriot Federal Credit Union,P.O.Box 778,Chambersburg,PA 17201 Acct#0002427430-40 3,919.08 2, Automobile-2001 Pontiac Grand Prix-sale proceeds 3,100.00 . 3, Household goods and furnishings-public sale proceeds 1,913.97 4,, Comcast-cable N refund 143.19 ;' 5, Century Link -telephone refund 9,83 g, First Energy-electric refund 21.83 7, ,U S Treasury-2013 federal income tax refund 695.00 g, State Farm Insurance-renter's insurance refund 25.53 TOTi4�(Also enter on Line 5, Recapitulation) $ 9,828.43 If more space is r�eeded,��e additional sheets of paper of tt�e same size. REV-i5og EX+(oi-io) � pennsylvania SCHEDULE F DEPARTMENT OFREVENUE INHERIfANCE TAX RETURN 70INTLY-OWN ED PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: HELMAN,JEFFREY TODD 21-13-1252 If an asset became jointly owned within one year of the decedent's date of death,it must be reported on Schedule G. SURVIVING]OINT TENANT(S)NAME(S) ADDRE55 RELATIONSHIP TO DECEDENT A•,BONITA R. PLASTERER 2966 JEFFERSON DRIVE, CHAMBERSBURG PA MOTHER 17201 B. C. - JOINTLY OWNED PROPERTY: �R oA� DESCRIPTION OF PROPERN %oF DATE OF DEATH ITEM FOR]OINT MADE INCLUDE NAME OF FINANCIAL 1NSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT"S VALUE OF NUMBER TENANT ]OINT IDENTIFYiNG NUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSEf INTEREST DECEDENT'S INTEREST 1' A' Patriot Federal Credit Union,P.O.Box 778,Chambersburg,PA 17201 'Acct# 0002427430-00 234.35 50' 117.18 ' 2. ' A. Patnot Federal Credit Union,P.O.Box 778,Chambersburg,PA 17201 Acct# 0002427430-25 6,513.14 50 3,256.57 TOTAL(Also enter on Line 6, Recapitulation) �, 3,373.75 If more space is needed,use additional sheets of paper of the same size. REV-1510 EX+(OS-09) � pennsylvania SCHEDULE G DEPARTMENT OF REVENUE IIVTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDEfYT DECEDEfYT 6TATE OF FII.E I��BBt HELMAN, JEFFREY TODD 21-13-1252 This sdiedule m�st be c�onpleted and filed if the ar�swe�-to arry cf questias 1 ti�ra�4 on page three af the RBF1500 is yps. D�Q2IFfICN OF PR�PBiTY � wa��rr,nfcFnf�aar�s�,m�r�aana,s��vraw L�{TECFCEAl}i %CF�S DC41�pV TAXABLE I�� ll-E D�IE CFIiuV�Ht A7iPOi A¢W ff lFE[�RR RFAL.gTAIE UPI1 E OF ASSEr IIYf6�ST a�caa� VPII� 1• THRIFT SAVINGS PLAN DEATH BENEFIT Acct# 5706775044691 2g,694.25 100 28,694.25 federal employee retirement plan beneficiary: BONITA R.PLASTERER relationship:mother date of death: 11114/2013 'ii0i'I1L(Also e�er on Line 7,Recapitulakion) $ ' 28,694.25 If rrYxe spaoe is needed,use adcitiaial sheets af pe�-of the s�ne size. REV-1511 EX+(10-09) � pennsylvania SCHEDULE H DEPARTMENT OFREVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT E�TATE OF FlLE I��BHt HELMAN, JEFFREY TODD 21-13-1252 Deoeclat's deJ7Fs niat be t+epo�ted on Sdted�e L ITBN ��`'� �IPfICN p►vp�� A Ft�B�L p�6�S; 1' Thomas L.Geisel Funeral Home,Inc. funeral and burial expenses 6,073.60 333 Falling Spring Road Chambersburg,PA 17201 2. Parklawns Memoriai Garden&Mausoleum grave opening 895.00 ' 3218 Philadelphia Avenue Chambersburg,PA 17201 3.' 'Parklawns Memorial Garden&Mausoleum grave monument 1,941.68 ' 3218 Philadelphia Avenue Chambersburg,PA 17201 B, ACNIIMSTRATlVE O�STS: 1. �Repr��e Garrrissiors: 0.00 ' Nxr�(s)of R�sa�al Re�tiue(s) • S�t Address �tY State ZIP Year(s)Carrrission Paid: 2 ��: 3,000.00 ' 3. Farrily 6cer�tion:(If deoec�nt's addigs is not the s�re�dairrant's,��lar�atlon.) 0.00 ' a��,e s�t addr�s �tY -- _ State ZlP---.._. Relakior�ship of Clairrart to Daoede* 4. Rnbete Far: 203.50 5. a000utant r�ees: 0.00 ` 6. Taoc R�un Pre�arer r�s: 0.00; �• Legal Advertising Cumb Law Joumal/Shippensburg News-Chronicle 113.00 s Legal Advertising Cumberland Law Joumal 75.00 s.' �o. '��.' 12. TDTAI.(Also�te-on Line 9,R�it�.laaki�on) $ 12,301.78 ' If rrore spaoe is neecled,use addtia�sl�eets af papg-of ti�e s�re sire. REV-1512 EX+(12-12) SCHEDULE I �'!i j pennsylvania � DEPARTMENT OF REVENUE DE��7-��/ ��+ INHERifANCE TAX RETURN �rJ��L.Ll�LL�iES�C L�IEI V RESIDEMT DECEDENf �E(1��11�t ��►�� 21-13-1252 HELMAN, JEFFREY TODD i�e�xxt cld�hs inarned bf/tt�e deoadat Priar tio cl�rtl�tf�eit rerr�ined�+id at ti�e date af deatl�indutin9 urerrlxrsed med�d e�r� � OF DE4l}i ��t D6CRIPilCN 613.00 1• The Cottages of Shippensburg-finai rent payment 66.79 2. Comcast-cable N intemet ' 43.07 ; 3.; Century Link-telephone 99.14 4 UGI-natural gas 71.02 5�! Penelec-electricity 893.02 �rort�L(aso�-on une io,�p��«,) $ If rrore s�oe is neecled,in9ert adcGtiaial stieets cB tf�e sarre siae. �EV-1513 EX+(01-10) � pennsytvania SCHEDULE ) DEPARTMENT OF REVENUE INHERITANCE TAX REfURN BE N E FICIARI ES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: HELMAN, JEFFREY TODD 21-13-1252 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 outright spousal distributions and transfers under Sec.9116(a)(1.2).] 1• BONITA R.PLASTERER MOTHER 100%0 ' 2966 JEFFERSON DRIVE,CHAMBERSBURG PA 17201 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. # 0 If more space is needed,use additional sheets of paper of the same size.