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HomeMy WebLinkAbout05-08-14 (2) � 15�5610140 REV-1500 EX (02-11)(FI) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number Po eox 2soso� INHERITANCE TAX RETURN 2 1 1 3 1 1 0 9 Harrisburci, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MnnDDYYYY Date of Birth MMDDYYYY 1 0 1 3 2 0 1 3 D 2 2 1 1 9 3 0 DecedenPs Last Name Suffix DecedenYs First Name MI Z I M M E R M A N D 0 L 0 R E S L (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 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) QX 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 u�r Sec.9113(A) Between 12-31-91 and 1-1-95) (AQ�ch Schedul� � CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INE�RI�iION SH(�D BE41R ED T0: Name Daytime�leRhone NuA�ber � � � c'? "'� =:n � D A V I D H S T 0 N E , E S Q U I R E 7 1 ;'� �7�7 4� 7f;:W ,`� 5 ' U _,M� ..,. �7 .. � ,-.., _, R�IS�ER`t1F WILLS USC-`ONIC.YS <"a C7 � � ..',vi � 1 First Line of Address � � ►—+ --= c� ...o —i N rr.�.'_ ►'�'1 4 1 4 B R I D G E S T R E E T � a � Q � � Second Line ofAddress City or Post Office State ZIP Code DATE FILED N E W C U M B E R L A N D P A 1 7 0 7 0 CorrespondenYs e-mail address: D S T 0 N E a�S T 0 N E L A W • N E T 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 befief, it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowiedge. SI ATU E OF P RSON RESPONSIBLE FOR.FILING RETURN DATE ...-.--- --� � ADDRESS 54 IVE MECHANICSBURG PA 17050 SIGNAT E OF P E E OTHER THAN REPRESENTATIVE DATE � � ADDR 414 BRIDGE TREET NEW CUMBERLAND PA 1707D PLEASE USE ORIGINAL FORM ONLY Side 1 � 150561D14� 1,505610140 J � � � J 150561�240 REV-1500 EX(FI) DecedenYs Social Security Number �ecedent'sName: DOLORES L • ZIMMERMAN 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. 2 0 8 0 5 1 . 4 0 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. • 7. Inter-Vivos Transfers&Miscellaneous N n-Probate Property (Schedule G) � Separate Billing Requested . . . . . . . 7. 3 4 5 5 4 � 9 7 8. Total Gross Assets(totai Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 2 4 2 6 � 6 . 3 7 9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9. 2 4 3 6 2 . 3 1 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule I) . . . . . . . . . . . . . 10. 1 6 2 � . 4 4 11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 2 5 9 8 2 . 7 5 12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 2 1 6 6 2 3 . 6 2 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 1 6 6 2 3 . 6 2 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 � 15. � . � � 16. Amount of Line 14 taxable at�inea�rate X .045 2 1 6 6 2 3 . 6 2 16. 9 7 4 8 . 0 6 17. Amount of Line 14 taxable at sibling rate X.12 0 . � � 17. Q . 0 Q 18. Amount of Line 14 taxable at collateral rate X.15 0 . 0 0 18. 0 . 0 0 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 9 7 4 8 . 0 6 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT � Side 2 � 150561024� 1505610240 J REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: 21 13 1109 DECEDENT'S NAME DOLORES L • ZIMMERMAN STREETADDRESS 375 CLAREMONT DRIVE CITY STATE ZIP CARLISLE PA 17013- Tax Payments and Credits: �• Tax Due(Page 2,Line 19) (1) 9,7 4 8 • 0 6 2, Credits/Payments 8,5 0� • 0 0 A.Prior Payments B.Discount 4 4 7 • 3 7 Total Credits(A+g� �2� 8,9 4 7 • 3 7 3. Interest (3) 0 • 0 0 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 • 0 0 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 8�� • 6 9 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 ............................... ❑ �X c. retain a reversionary interest ..................................................................................................... ❑ ❑X 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? ....................................................................................... ❑ Q 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? ......... ❑ Q 4. Did decedent own an individual retirement account,annuity or other non-probate property,which containsa 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 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 decedenYs lineal beneficiaries is 4.5 percent,except as noted in p2 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. REV-1508 EX+(08-12) pennsylvania SCHEDULE E DEPARTMENTOFREVENUE CASH, BANK DEPOSITS 8� MISC. INHERITANCE TAX RETURN RESIDENTDECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: DOLORES L • ZIMMERMAN 21 1,3 1109 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 �. Americhoice FCU-Checking Acct #0011 12,771 . 77 2 Americhoice FCU-Money Market Acct #0018 185,649 • 36 3 Americhoice FCU-Regular Savings #0001 5 • 00 4 Homesteaders Life Company-Certificate held for 9,�45. 27 funeral purposes 5 US Treasury-refund on 1040 2013 tax return 580 • 00 TOTAL(Also enter on Line 5,Recapitulation) S 2 0 8,0 51 • 4 0 If more space is needed, use additional sheets of paper of the same size. REV-1510 EX+(08-09) pennsyivania SCHEDULE G DEPARTMENTOFREVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER DOLORES L • ZIMMERMAN 21 13 1109 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH %OF DECD�S EXCLUSION TAXABLE NUMBER THEDATEOFTRANSFER.ATTACHACOPYOFTHEDEEDFORREALESTATE. VALUEOFASSET INTEREST �iFqapucne�e� VALUE � Vanguard Voyager Serv- Vanguard Life 34 ,554 • 97 100 • 00 34 ,554 • 97 Strategy Conservative Growth Fd- IRA Acct #0724-09937139346 w/ Paula Zimmerman and Jay Zimmerman as beneficiaries TOTAL (Also enter on Line 7,Recapitulation) $ 3 4,5 5 4 • 9 7 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(08-13) pennsylvania SCHEDULE H DEPARTMENTOFREVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER DOLORES L • ZIMMERMAN 21 13 1109 DecedenYs debts must be reported on Schedule I. �TEM NUMBER DESCRIPTION AMOUNT A, FUNER,4L EXPENSES: �. Paula Zimmerman-Reimb for Malpezzi Funeral exp 9,716 • 17 2 Rolling Green Cemetery-services rendered 1,295 . 00 B. ADMINISTRATIVE COSTS: 1, Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: 2, AttomeyFees: David H Stone, Esquire 12,130 • 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: S e e #3 b 2 1 0 W 5 Accountant Fees: 6. Tax Return Preparer Fees: �. PA Dept of Revenue-payment of PA40 2013 taxes 5 • 00 2 Stone LaFaver & Shekletski-Reimb for advertising 317 • 64 3 Paula Zimmerman-Reimb for probate & filing returns 403 • 50 4 Susquehanna Financial-prep of 2013 taxes 295 • 00 5 Reserve for closing expenses 200 • 00 TOTAL(Also enter on Line 9,Recapitulation) $ 2 4 ,3 6 2 • 31 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� INHERITANCETAXRETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER DOLORES L • ZIMMERMAN 21 13 1109 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 i Holy Spirit Hospital-debt of decedent 201 • 28 2 CitiCard-credit card balance due 57 • 00 3 Claremont Nursing Home-final paymt due 270 . 00 4 Camp Hill Physcians-debt of decedent 6 • 66 5 Quantum Imaging-debt of decedent 5• 55 6 Alert Pharmacy-medications at nursing home 47 • 64 7 Claremont Nursing Home-July and August serv 481 • 89 8 Pinnacle Health-debt of decedent 21 • 61 9 Pinnacle Health-debt of decedent 13 • ],5 ],0 Cumberland Goodwill Fire Rescue EMS-ambulance 209 • 20 11 Cumberland Goodwill Fire Rescue Ef1S-ambulance 306 • 46 TOTAL(Also enter on Line 10,Recapitulation) S y,6 2 0 • 4 4 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: DOLORES L • ZIMMERMAN 21 13 1109 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).] � JAY ZIMMERMAN Lineal 86,649 • 45 90 CAMP GETTYSBURG ROAD GETTYSBURG PA 17325- 2 PAULA ZIMMERMAN Lineal 129,974 • 17 54 KESWICK 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 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. Continuation of REV-1500 Inheritance Tax Return Resident Decedent DOLORES L. ZIMMERMAN 21 13 1109 DecedenYs Name Page 1 File Number Correspondents Name Daytime Telephone Number J A Y Z I M M E R M A N First line of address 9 0 C A M P G E T T Y S B U R G R 0 A D Second line of address City or Post Office State ZIP Code G E T T Y S B U R G P A ], 7 3 2 5 - CorrespondenYs e-mail address: 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 i$_true,correct and complete. laration of preparer other than the personal representative is based on all information of which preparer has any knowledge. `SIGM�1 RE OF PERSON SPONSIBLE FOR FILING RETURN DATE ` � � �/ ��� 1�0 � r� 5 � 1.91 �� <�3�2.5� . � �TO:VF„ L.�F:�VF.R �ie SHEKLETSKI AT70RNEY5 A7 LAW ` ""���� 4ia BRIDGE STREET - JIEW CiIJtBERL:tND PA 1707p LAST WILL AND TESTAMENT OF DOLORES L. ZII��RMAN I, DOLORES L. ZIMMERMAN, of Middlesex Township, Cumberland County; Pennsylvania, declare this to be my last will and revoke any wi�1 previously made by me . I 'FM I : I direct that my Co-Executors hereinafter named shall �ay a1i my just debts and funeral expenses as soon as conver�iently may be done after my decease from the residue of my estate. I"EM II : I devise and bequeath all the rest, residue and remain�er of my estate, of every nature and wherever situate, as Col�o� � : �'�. �i�:ty ( 60'�) �ercent thereof to my daughter, PAULA ZIMMERfIAN, should she survive me . B. Forty (40° ) Percent thereof to my son, JAY ZIMMERi �AN, should he survive me . I : e.ither PAULA ZIMMERMAN or JAY �IMMERMAN, fail to survive rne, I ;->equeath r_'�e �nare ur sucn deceas�d ��hild to r_heir issue, ;�er sti ��pes; and in default thereof to my issue, per stirpes . 'rEM III : I appoint :ny Co-Executors and �heir successors guardi� n of any property which passes, either under this will or other�,�;_ se, to a minor and with respect to which I am authorized to �ppoir.�_ a guardian and have not otherwise specifically done so, providE�d that this appointment of a guardian shall not subersede Page 1 o f � � the ri�ht of any fiduciary in its discretion to distribute a share IIwhere z�ossible to the minor or to another for the minor ' s benefit . Such guardian sha11 have the ower to us P e principal as well as I income from time to time for the minor ' s support and education I i I (including college education, both graduate and undergraduate) i I without regard to his or her arent ' s abilit to � P y provide for such isuppor- and education, or to make payment for these purposes, i ! without further responsibility, to the minor or to the minor ' s � i ! parent or to any person taking care of the minor. � , � , � I`1'EM IV: I appoint my children, PAULA ZIMMERMAN and JAY i i � ZIMMERMAN, Co-Executors of this my last will . � � i � I i'1'EM V: No fiduciary acting hereunder shall be required to ! I i i post t�.�nd or enter security for the faithful performance of � his/her duties in any jurisdiction. ; ; I�� WITNESS WHEREOF, I, DOLORES L. ZIMMERMAN, have hereunto � � set my hand and seal this � da of ' Y �� �- , , 2012 . i i . � !'_- . ,,�.,� �, b �i —— ' v'" � `� I ; DOLCRES L. ZI[�MERMAN SIGNED, SEALED, PUBLISHED and DECLARED by DOLORES L . � ZIMMER:IAN, the Testatrix above named, as and for her Last Will and � j TestamF-nt, �and in the presence of us, who at her request, in her : ; presence anjd in the presence of each other, have subscribed our ' n�A� us wi,'tn�sses . r �,.�.:_..__._ � i _� _ � � �_ ` ` � � (S � ,.< < ;; i Wit�s.,� Address � � . r-����+� �/lYl��i/1/'�— ��' !��'f`t%�iC/'C_ ,�J C,u,, , � a �r / �, /L�is �/� ' r�Jitnes, i .'�ddress ' , ,1 ; i /7�-s"v I Paqe 2 of 2 � �meriC�oice � � FEDERAL CREDIT UNION Building Relationships For Life November 5, 2013 Stone LaFaver& Shekletski Attorneys at Law 414 Bridge Street PO Box E New Cumberland, PA 17070 Re: Estate of Dolores L Zimmerman Attorney Stone: The decedent had one member number, 46691; titled Dolores Lee Zimmerman. This was individual account held solely by Ms. Zimmerman. Account 46691 Regular Savings (suffix 0001) —opened 8/12/2010 Checking (suffix 0411) —opened 8/12/2010 Money Markey (suffix 0018) —opened 6/28/2013 Date of death balances are as follows: Balance Dividends earned from 1/1/13 to DOD 0001 - $ 5.00 $ 0.00 0011 - $ 12,771.77 $ 0.00 0018 - $ 185,649.36 $ 176.97 Ms. Zimmerman did not have a safe deposit box or an IRA with AmeriChoice I have enclosed Ms. Zimmerman's most recent statement for your records. Please feel free to contact me directly with any questions you may have. Sincerely, �o�..,..,-�_ �� �� Bonnie R. Seagraves " Operations Specialist Phone (717) 591-1282 Fax (717) 697-3713 Email bsea�raves r(�americhoice o� Main Office:2175 Bumble Bee Hollow Road •Mechanicsburg, PA 17055 •Phone: (717) 697-3474 • Fax: (717) 697-3713 Website:www.americhoice.org �� � � Equal � r7- � � �PPartunity � . ,, L E N D E R Enuu xw5��5 CREDIT UNIONS' LENDER Iill III IIII illllli IIIiI III illllll Iiiil IIIII Iilll IIIII iilii IIIII Iilll IIIII Iliii Illh�, c ��o�si eesc e �is�we5�sea��i:>sie � , m � � ° L- � 0 � `° � ° —i � � -� �a °N' ° cA � 0 °� � .� o , a , � c �, � w �; � N o > > cn -� m �• r-. O. iv a o y � � � � o �• � c�u d �C � N � w ,� � 3 � � 3. � al� � o < � � _ � �. � � > j y' � -^ �° � � e�s °'I=• � 03i C� Q' � � � n n � � ?. � ? 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