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HomeMy WebLinkAbout05-30-14 �Ty� 1505610105 REV-1500 EX(eaal)(F1) 1!j] r� OFFICIAL USE ONLY PA Department of Revenue Pennsylvania Bureau of Individual.Taxes `""""`" "`""°` County Code Year File Number _ INHERITANCE TAX RETURN POBOurg,PA1 �1 14 0321 J Harrisburg PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Dale of Birth MMDDYYYY —— 03/20/2014__J 10/O9/1923 Decedent's Last Name _ _ Suffix Decedent's First Name _ _ I�MI Williams _ _ �i Laura I C J (If Applicable)Enter Surviving Spouse's Information Below �� L 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 CID 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 C= 5. Federal Estate Tax Return Required death after 12-12-82) Cp 6. Decedent Died Testate C1, 7.Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) C=:) 9. Litigation Proceeds Received C= 10.Spousal Poverty Credit(Date of Death CZD 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 Robert P. Grubb _ — (717) 824-4838 0 -M REGIST RAIC.P/ILLS USE C4LY I C7 - LJ 70 First Line of Address rr 9 - Central PA Estate& Eld Second_Line_of Address tD n ^� o PO Box 11W4 N (TT City or Post Office _ State ZIP Code DAT-E{FILED N O Lancaster PA 117605 c a T Correspondent's e-mail address:Grubb @cpaeel.com Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best oral knowledge and belief, it is true,correct and complete.Declare lion of preparer other than the personal representative is based on all information of which preparer has any knowledge, SIGN A UR F PERSON SPONSIBLE FOR FILING RETURN OAT k EnA� 1�Ill a 'A ADDRESS- (J N L. AAA f_ w vc) SIGNATURE OF P PA O AN REPRESENTA IVE DATE -�z ADDRESS Robert P. ub , Centr I PA Estate& Elder Law, PO Box 10574, Lancaster, PA 17605-0574 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610105 1505610105 1505610205 REV-1500 EX(Fl) Decedent's Social Security Number Decedenrs Name: Williams, Laura C. RECAPITULATION 1. Real Estate(Schedule A). . . _ . .. . ... .. . .... ... . .. ..... ... .. ... . .. . . .. t. 146,179.00 2. Stocks and Bonds(Schedule B) . 2. 79,507.74 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) .... . 3. 4. Mortgages and Notes Receivable(Schedule D) .. .... ....... ...... ... ... . . 4. 5, Cash,Bank Deposits and Misccllnneous Personal Property(Schedule E).. . . . .. 5, 2,343.48 6. Jointly Owned Property(Schedule F) O Separate Billing Requested ... .. . . 6. 56,428.89 7. Inter-Vivos Transfers& Miscellaneous Non-Probate Property 143,857.41 (Schedule G) O Separate Billing Requested... . ... . 7. 8. Total Gross Assets(total Lines 1 through 7). .. ... . .. ....... .. . S. 428,316.52 9. Funeral Expenses and Administrative Costs(Schedule H)... .. ...... ... ... . . 9. 11,888.91 10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule 1)..... ...... . . .. 10. 909.91 11. Total Deductions (total Lines 9 and 10).. . .... ... . .... ..... . .. ... . .. . .. . 11. 12,798.82 12, Net Value of Estate(Line 8 minus Line 11) . . .. . .. . .. . .. . .. .. ....... .. . . 12. 415,517.70 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. 415,517.70 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 45 415,517.70 16. 18,698.30 IT Amount of Line 14 taxable at sibling rate X.12 17. 18, Amount of Line 14 taxable at collateral rate X.15 18. 19, TAX DUE ... . .......... . ..... . .. . . .... .... ...... ..... ...... ... . .. . 19. 18,698.30 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O6D Side 2 1505610205 1505610205 REV-1500 EX(A) Page 3 File Number 2114-0321 Decedent's Complete Address: DECEDENT'S NAME Laura C. Williams STREETADDRESS 306 Mt.Allen Drive Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 18,698.30 2. Credits/Payments A.Prior Payments ---- ___ 17,763.81 B.Discount 934.94 —- --- Total Credits(A+g) (2) 18,698.75 3. Interest (3) 0.45 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) 0.00 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 properly transferred or its income ............................................ ❑ c. retain a reversionary interest ...............................--........................................................................................... ❑ d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ d 2. If death occurred after Dec. 12, 1982,did decedent transfer property within one year or death without receiving adequate consideration?.............................................................................................................. ❑ 0 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 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 lax 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 decedent's siblings is 12 percent 172 P.S. §9116(x)(1.3)1.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-1502 Ex+(12-12) fib pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INRERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Williams, Laura C. 2114-0321 All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 All that real property known and numbered as 306 Ml.Allen Drive,Mechanicsburg Post Office, 146,179.00 Upper Allen Township,Cumberland County,PA 17055 also known as tax parcel no. 42-28-2423-021. Property titled as tenants by the entireties between decedent and her husband,Robert D.Willams,who predeceased her on March 3,1994. Property valued as per tax assement of$150.700 x CLR of.97 for a FMV or$146,179.00 TOTAL(Also enter on Line 1, Recapitulation.) $ 146,179.00 If more space is needed,use additional sheets of paper of the same size. REV-1503 EX.(8-13) Upennr� sylvania SCHEDULE B DEPARTMENT OF REVENUE INHERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF FILE NUMBER Williams, Laura C. 2114-0321 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 49 Shares of Alcatel-Lucent Cc (ALU)Stock. Average DOD Stock price of$3.94 per share 193.06 2 872 Shares of AT&T Co. (T)Stock. Average DOD stock price of$33.58 per share 29,277.40 3 150 Shares of Comcast Co.(CMCSA)Stock. Average DOD stock price of$50.43 per share 7,563.75 4 169 Shares of Frontier Communications(FTR)Stock. Average DOD stock price of$5.35 per share 904.15 5 255 Shares of USG(USG)Corp Stock. Average DOD stock price of$22.57 per share 8,560.35 6 706 Shares of Verizion Communications(VZ)Stock.Average DOD stock price of$46.76 per share 33,009.03 TOTAL(Also enter on Line 2, Recapitulation) $ 79,507.74 If more space is needed,insert additional sheets of the same size REV-15o8 E%+(08-12) ji�►j pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Williams, Laura C. 2114-0321 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 1, Country Meadows-Refund 2,343.48 TOTAL(Also enter on Line S, Recapitulation) $ 2,343.48 If more space is needed,use additional sheets of paper of the same size. REV-1509 EX+(01-10) j e�7 pennsylvania SCHEDULE F DEPARTMENT OF REVENUE INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Wlliams, Laura C. 2114-0321 If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A.L.Anne Lehmer 145 Spring Drive daughter Dillsburg, PA 17019 B.Nancy E.Zentmeyer 25 Chestnut Street daughter Mt. Holly Springs, PA 17065 C. JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % DATE OF DEATH REM FOR 301M MADE INCLUDE NAME OF FINANCIAL INSTITUTION M40 BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEAJII DECEDENTS VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER,ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST 1. A. 01101157 PNC Bank Checking Account No.5140069205. As valued by PNC. 95,398.75 50 47,699.38 2. A 05/01/78 PNC Savings Account No.2130163193.As valued by PNC 717.97 50 358.99 3. B. 05/28/94 Members 1st Life Savings Act.No.14879-04.As valued by Members 1st 4,000.00 50 2,000.00 4. B. 05128/94 Members 1st MM Account No.14879-05. As valued by Members 1st 12,741.03 50 6,370.52 TOTAL(Also enter on Line 6, Recapitulation) $ 56,428.89 If more space is needed,use additional sheets of paper of the same size. REV-1510 EX+ (08-09) JL1F e�7 pennsylVvania SCHEDULE G 1 DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Williams, Laura C. 2114-0321 This schedule must be completed and filed if the answer to any of questions I through 4 on page three of the REV-1500 is yes. DESCRIPTION OF PROPERTY DATE OF DEATH %OF DEED'S EXCLUSION TAXABLE ITEM INCWDETHE NAME OF THETRANSFUREE,TIEIR RE IIONSHIPTO DEEEDENTAND NUMBER niE On+E OE TRnNSFER. Anna+A COavorniEOEEO mR Re a ESTATE. VALUE OF ASSET INTEREST RFAMUOALE) VALUE I. Ameriprise,Columbia Tax-Exempt Find,Account No.020148069469002 6,644.61 100 0.00 6,641,61 as valued by Amerprise,valuation attached. 2 Ameriprise,RiverSource Defferred Annuity,Account No.9300781887500004 116,724.53 100 0.00 116,724.53 as valued by Ameriprise,valuation attached. 3 Metlife Investors USA Annuity Contract No.A2073646 20,491.27 100 0.00 20,491.27 as valued by Metlife,valuation attached. TOTAL(Also enter on Line 7, Recapitulation) $ 143,857.41 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ (10-D9) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Williams, Laura C. 2114-0321 Decedent's debts must be reported on Schedule I. ITEM AMOUNT NUMBER DESCRIPTION A. FUNERAL EXPENSES: 1. Neil Funeral Home 4,573.41 2. Rev.Linda Kent-Honorarium 150.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State—ZIP Year(s)Commission Paid: 6,000.00 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: 433.50 5. Accountant Fees: 6. Tax Return Preparer Fees: 175.00 2 Cumberland Co. Recorder of Deeds 69.00 s. Central PA Estate&Elder Law-Postage,Copy,Misc.Expenses 15.00 e. State Farm-Horne Owners Ins. 473.00 TOTAL(Also enter on Line 9, Recapitulation) $ 11,888.91 If more space is needed,use additional sheets of paper of the same size. REV-1512 EX+ (12-12) i Pennsylvania SCHEDULE I DEPARTMENTOFREVENUr: DEBTS OF DECEDENT, INHERITANCE TAX REPURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Williams, Laura C. 2114-0321 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 1, West Shore EMS-medical debt 290.97 2. Republic Services-trash collection debt 39.03 3. Diamond Pharmacy-medical debt 189.23 4. SECCO-maintance contract debt 12.95 5. PA Dept.of Revenue-2013 Income Tax Liability 117.00 6. PPL-electric utility debt 148.73 7. Upper Allen Township-sewer utility debt 112.00 TOTAL(Also enter on Line 10, Recapitulation) $ 909.91 If more space is needed,insert additional sheets of the same size. REV-1513 EXa(0140) pennsylvanEa SCHEDULE J 1 BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Williams, Laura C. 2114-0321 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).] I. L.Anne Lehmer, 145 Spring Dr.,Dillsburg,PA 17019 daughter 50% 2. Nancy E.Zentmeyer,25 Chestnut St.,Mt.Holly Springs,PA 17065 daughter 50% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. 3I 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 n - 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.