HomeMy WebLinkAbout05-27-14 � 1505610105
REV-1500 EX(02-11)(FI) � '
1if OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania County Code Year File Number
Bureau of IndividualTaxes INHERITANCE TAX RETURN
Po Box zsosoi RESIDENT DECEDENT �I I� U ���
Harrisburg PA 1�iz8-o6oi
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
01/13/2012 ' 11/30/1926
DecedenYs Last Name Su�x DecedenYs First Name MI
SHANDELMIER JEAN O '
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name Ni�
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
p 1.Original Return C� 2. Supplemental Return O 3. Remainder Return(Date of Death
Prior to 12-13-82)
p 4. Limited Estate O 4a.Future Interest Compromise(date of p 5. Federal Estate Tax Return Required
death after 12-12-82)
O 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
rv
Edmund G. Myers (717) 761�40 � �a �
. . .. . .. . . . . . ............ . . .... . � �7 .. . . ... .. . �"Y-2� Crn-.�
REGIS 6�WILLS U NLYt'�`' C�.7
r77 � E-y —C C,�-a �'7
._...� � .....�! ':.',;�4
.,_+ �...�y, �" ^� �..,,..'
First Line of Address t'� -.J �r c::7
,,.. ° _.,
301 Market Street � � "
_ ,, , c-a
E_:. �.j 'C1 i `;'1
:; �
Second Line of Address � � ;,..� � . �
PO Box 109 ' � +� �--
City or Post Office State ZIP Code `�DA7E FI�ED (�
�
Lemoyne PA ' 17043
CorrespondenYs e-mail address:egtll jdSw.COPYI
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.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE
���, �q � ,��+l�su.,l; �, Susan A. Lindsev 5 ������
DDRESS
935 Old Quaker Road. Etters,, PA 17"�19
SIGNAJdJRE OF PR PARTcR TH�AN REPRESENTATIVE ,pDATE��` � 1�'I
3��n �i F�IC0.111C� G• MYPx'S w�7�t� J!L3 I�y
ADDRESS
301 Market Street, Lemoyne, PA 17043
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 1505610105 1505610105 �
� 15056102�5
REV-1500 EX(FI)
DecedenYs Social Security Number
oecedenrs Name: SHANDELMIER, Jean O.
RECAPITULATION
__ _ _ _
1. Real Estate(Schedule A). .................. .......................... 1.
2. Stocks and Bonds(Schedule B) ... .................................... 2. 9,725.29 :
_ _ . _ _
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. '
_ _.__. _ __
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested........ 7.
8. Total Gross Assets(total Lines 1 through 7)............................. 8.
9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. 15.00 :
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............... 10.
11. Totai Deductions(total Lines 9 and 10).............. ..... .............. 11.
12. Net Value of Estate(Line 8 minus Line 11) .............................. 12.
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which .
an election to tax has not been made(Schedule J) ........................ 13.
_ __
14. Net Value Sub"ect to Tax Line 12 minus Line 13 14. 9,71�.29 !
� { ) ........................
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_ 15. '
___ ,. _...� . ._
16. Amount of Line 14 taxable
at lineal rate x.0 45 9,710.29 ' �g, 436.96
17. Amount of Line 14 taxable '
at sibling rate X.12 , ��•
_ _
18. Amount of Line 14 taxable .
at collateral rate X.15 �$•
19. TAX DUE ......................................................... 19. 436.96 '
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
$ide 2
� 1505610205 1505610205 J
REV-1500 EX(FI) Page 3 File Number !�
Decedent's Complete Address: .�.�- �z-~ v��'�-
DECEDENTS NAME
SHANDELMIER, Jean O.
STREETADDRESS
130 Hummel Avenue
CITY STATE ZIP
Lemoyne PA 17043
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 436.96
2. CreditslPayments
A.Prior Payments
B.Discount
Total Credits(A+B) (2)
3. Interest
(3) 21.03
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)
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 457.99
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...................................................:...................................... ❑ ❑
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.
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 suroiving 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 tleceased 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 decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is tlefined,
under Section 9102,as an individuai who has at least one parent in common with the tlecedent,whether by blood or adoption.
Personal Income Tax e-Services Center Page 1 of 1
Penalty and Interest Calculations
CALCULATION DATES-
10/13/2012 TO 5/23/2014
TAX DEFICIENCY $ 436.96
CALCULATED INTEREST $ 21.03
BALANCE AS OF 5/23/2014 $ 457.99
Start Over
https://www.doreservices.state.pa.us/pitservices/Default.aspx 5/23/2014
REV-15o3 EX+(8-iz)
� pennsylvania SCHEDULE B
�EPARTMENT OFREVENUE
INHERITANCETAXRETURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
SHANDELMIER, Jean O. 21-12-0152
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1' 202 Shares-Dupont Stock Cusip No.263534109
A copy of the EstateVal Date of Death Valuation is Attached 9,725.29
TOTAL(Also enter on Line 2, Recapitulation) $ 9.�25.29
If more space is needed,insert additional sheets of the same size
Estate Valuation
Date of Death: O1/13/2012 Estate of: Shandelmier, Jean 0. Estate
Valuation Date: Ol/13/2012 Account: 17653-1
Processing Date: OS/23/2014 Report Type: Date of Death
Number of Securities: 1
File ID: Shand2
Shares Security Mean and/or Div and Int Security
or Par Description High/Ask Low/Bid Adjustments Accruals Value
1) 202 DU PONT E I DE NEMOURS & CO (263539109)
COM
New York Stock Exchanqe
O1/13/2012 48.95000 47.84000 H/L
96.145000 9,725.29
Total Value:
59,725.29
Total Accrual: 50.00
Total: $9,725.29
Page 1
This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions,
please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.3.1)
REV-1511 EX+ (OS-13)
� pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
SHANDELMIER, Jean O. 21-12-0152
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A, FUNERAL EXPENSES:
1,
e. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions;
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
2. Attorney Fees;
3, Family Exemption; (If decedent's address is not the same as claimant's,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• Cumberland County Register of Wills-Filing Fees 15.00
TOTAL (Also enter on Line 9, Recapitulation) $ 15.00
If more space is needed,use additional sheets of paper of the same size.
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MAtt[�C. DL�}F�i�:
���2���;,�;����y��y OF COUNSEL
NIiC`tl,aEL(.CASSIDT � HOh SCG,A.JOH.ti{SON
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May 23, 2014
Register of Wills Office
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
RE: Estate of Jean 0. Shandelmier
Date of Death: January 13, 2012
Your File No. 21-12-0152
Our File No. 16820-1
Dear Register:
Enclosed for filing, please find the following:
1. 2 Original Pennsylvania Supplemental Inheritance Tax Retums. These Returns are being filed due to an
additional asset that came to the Estate. A check in the amount of$457.99 is attached to the Return.
2. One copy of Page 1 of the Inheritance Tax Return that we ask that you time-stamp and retum to us.
3. Check in the amount of$15.00 representing the filing fee is attached to this Retum
Thank you for your assistance in this matter. Should you have any questions, please contact the undersigned.
Very truly yours,
JOHNSON, DUF IE, STEWART&WEIDNER
Dana Wieseman
Estate Administration Paralegal
Enc.
c: Susan Lindsey, Executrix
:626470
)O1 \1:1RIiE"[ SIREf;T' P.U. B0:\ IO�a L11105\1 Pl:�\til[�!1�(�1 li(1�_i-OlU9
11'tt'�1.JDS11'.CO11 %17.iii1.4�40 F:a\: ili.ibl.i01� �IAIt.@JDS��'.0011
JOHNSON, DUFFIE, STEWART & WEIDNER, P.C.