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Home My WebLink About05-01-14 1505611185 REV-1500 EX102-11)(FU PA Department of Revenue OFFICIAL USE ONLY Bumsu of Individual Tans County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 21 13 1191 Harrisburg.PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 09162013 07041931 Decedent's Lest Name Suffix Decedent's First Name MI GARLAND DORIS L (if Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M I Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW ❑' 1.Original Return ❑ 2. Supplemental Return ❑ 3. Remainder Return(Date of Death Prior to 12-13-82) ❑ 4. Limited Estate ❑ 48. Future Interest Compromise(date of ❑ S. Federal Estate Tax Return Required death after 12.12.82) ❑ 8. 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 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 MARY ANN PLANKINTONI ESQ . 610-444-3180 REGISTER OF WILLS USE ONLY �..' ry n o r 77 m First Line of Address Z�3 c o 211 E - STATE STREET Second Line of Address r— Ts r rn D Z Fn F-"s 73 I= lJ P - O - BOX 363 o v City or Post Office Slate ZIP Code L -*r KENNETT SQUARE PA 19348 rr m s Corr ndent'e allaedrase: MPLANKINTON@MACELREE -COM MA'DOR y,I declare that I have examined this return,Induding accompanying schedules and statements,and to the best of my knowledge and belle(, ate.Declaration of preparor other then the woonal representative U based on an information M.which prepamr has any kno lodge. RESPONSIBLE FOR FILING RETURN D E vi YORKLIN, DE 19736 ESENTATNE ' ATE dE STREET, P . BOX 363 KENNETT SQUARE, PA 19348 PLEASE USE ORIGINAL FORM ONLY Side 1 1505611185 OM46473.OW 1505611185 J 1505611285 REV-1500 EX(Fl) Decedent's Social Security Number Decedent's Name CARL AND DORIC RECAPITULATION 1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 0 . 00 2. Stocks and 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. 901886 • 63 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested , , . . 6, 0 • 00 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested . . . . 7. 0 • 00 8. Total Gross Assets(total Lines 1 through 7) , , , , , , , , , , , , , , , , , , 8 90,886 - 63 9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . 9, 10,345. 35 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule 1) , , . . . , , . . 10 21306 - 43 11. Total Deductions(total Lines 9 and 10), , , , , , , , , , , , , , , , , , , , , 11 121651 -78 12. Net Value of Estate(Line 8 minus Line 11) , , , , , , , , , , , , , , , , , 12 781234 • 8 5 13. Charitable and Governmental Bequests/Sec 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, 781234 • 85 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 lJ_ (3 - 00 15. 0 . 00 16. Amount of Line 14 t xable atlinealrateX.o 4� 78 ,234 . 85 16. 3,520 . 57 17. Amount of Line 14 taxable at sibling rateX.12 0 . 00 17. 0 .00 18. Amount of Line 14 taxable at collateral rate X.15 0 . 00 18. 0 . 00 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 31520 . 57 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Side 2 1505611285 1505611285 6M4646 3.666 REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: 21 13 1191 DECEDENTS NAME 6ARLAND S L STREET ADDRESS 940 WALNU-T—BOTTOM ROAD CUMBERLAUD CITY STATE ZIP CARLISLE Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 3,520 . 5? 2. Credits/Payments A. Prior Payments B - 00 B. Discount Total Credits(A+B) (2) 0 .00 3. Interest (3) 0 . 00 4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT. Fill in box 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) 3,52n - 57 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 . . . . . . . . . . . . . . . . . . . . . . . . E] 7 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 pre? . . . . . . . . . . . . . . . . . . ❑ 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 a security at his or her death? ❑ 4. Did decedent own an individual retirement account,annuity,or other non-probate property,which contains a 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)1. For dates of death on or after Jan. 1, 1995. the lax rate Imposed on the net value of transfers to or for the use of the surviving spouse Is 0 percent 172 P.S.§9116 (a)(1.1)(it)1.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 decedent's lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)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 defined, under Section 9102,as an Individual who has at least one parent In common with the decedent,whether by blood or adoption. OM4671 2.000 REV4506 E%-(0&12) pennsylvania SCHEDULE E EPARTNENTOF REVENUE CASH, BANK DEPOSITS 8r MISC. RESI EWEE ENTNRN PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Doris L. Garland 2113 1191 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of suwivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Susquehanna Bank — acct #146004514 90,876.72 Interest accrued to 9/16/2013 9.91 TOTAL(Also enter on line 5,Recapitulation) $ 90,886. 63 2W4eAD 2.000 If more space is needed,use additional sheers of paper of the same size. REV-1511 EX+(10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RE TURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Doris L. Garland 21 13 1191 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Clyde Robison Reimbursement for Memorial Service 2,323.49 Total from continuation schedules . . . . . . . . . 2,417.12 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: 2. Attorney Fees: 5,000.00 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: 293.50 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. 1 William J. Mansfield, Inc. 311.24 TOTAL(Also enter on Line 9,Recapitulation) $ 10 345.35 9w46AG 2.000 If more space is needed, use additional sheets of paper of the same size. Estate o£: Doris L. Garland 21 13 1191 Schedule H Part 1 (Page 2) Item No. Description Amount 2 Hoffman-Roth Funeral Home & Crematory, Inc. 2,417.12 Total (Carry forward to main schedule) 2,417.12 REV-1512 EX,(12-12) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Doris L. Garland 21 13 1191 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 ADS final medical bill 765.00 2 Carlisle Regional Medical Center final medical bill 1,184.00 3 Heartland final medical bill 52.07 4 Hospitalists of Central PA final medical bill 119.74 5 Quantum Imaging & Therapeudic Assoc. final medical bill 5.55 6 Darryl Guistwite DO final medical bill 100.25 7 Cumberland Goodwill Fire Rescue EMS 79.82 TOTAL(Also enter on Line 10,Recapitulation) $ 2,306.43 2W46AH 2.000 If more space is needed, insert additional sheets of the same size. REV-1513 EX+( SCHEDULE J penns nsylvania DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Doris L. Garland 21 13 1191 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. Clyde Robison P.O. Box 243 Yorklyn, DE 19736 100% of Residue: 78,234.85 Son 78,234.85 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. 11 NON-TAXABLE DISTRIBUTIONS A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: t. B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 0.00 9W46AI 2.000 If more space is needed, use additional sheets of paper of the same size. 1422761_1 804399.09653 Estate of Doris L. Garland File No. 2113-1191 Social Security No. 193-24-0225 Date of Death: September 16, 2013 TABLE OF CONTENTS Pennsylvania Inheritance Tax Return (Form REV-1500) 1. Death Certificate..................................................................................................... Exhibit A 2. Valuation — Susquehanna Bank acct#146004514 (Sch. E) ....................................Exhibit B MacElree 4' . Harvey 1422761_1 804399.09653 Estate of Doris L. Garland Exhibit B Valuation Susquehanna Bank acct #146004514 (Sch. E, Item 1 ) MacElree r ' Harvey Susquehanna January 27, 2014 Susquehanna Bancshares,Inc. 26 North Cedar Street P.O. Box 1000 Lititz,PA 17543-7000 MacEKREE HARVEY Tel 1.800.311.3182 17 WEST MINER STREET Fax 717.625.4478 POST OFFICE BOX 660 WEST CHESTER PA 19381-0660 RE: Doris L Garland Estate DOD: September 16,2013 SS#: Tracking# 353694 To Whom It May Concern: In response to your letter of January 8, 2014, here is the above customer account information as of September 16, 2013. Account#1 • Account Title: Doris L Garland Clyde G Robinson POA • Account Type/# Checking/146004514 • Date Opened/Maturity 6/24/04 • Interest Rate: .150% • Account Balance*: $90,876.72 • Accrued Interest: $9.91 • YTD Interest: $62.71 *Account balance does not include accrued interest. ® There is no safe deposit box in the name of the decedent. ❑ There is a safe deposit box# 0 in the name of the decedent located at the branch name. If I can be of further assistance, please feel free to call. Dawn M Berrier Susquehanna Bank Deposit Research - Reporting Department Lead 1-717-625-6546 DMB/jran