HomeMy WebLinkAbout06-11-14 J 1505610105
REV-1500 EX(oi-n)(FI) l/j
OFFICIAL USE ONLY
PA Department of Revenue pennsylvania
Bureau of Individual Taxes County Code Year File Number
PO BOX28o6o1 INHERITANCE TAX RETURN --
Harrisburg,PA 17128-0601 RESIDENT DECEDENT d l y
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
12/20/2013 09/04/1936
Decedent's Last Name Suffix Decedent's First Name MI
Darby Inaclaire
(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
OD 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)
OD 6.Decedent Died Testate O 7. Decedent Maintained a Living Trust S. 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 TO:
Name Daytime Telephone Number
John C Oszustowicz
REGISTER OF WILLS USE ONLY
N
First Line of Address r C O --� m rrl
C_ n
104 S Hanover St ' -o _ — °
;;u
Second Line of Address
7r`
(7> C)
City or Post Office State ZIP Code DATE FILED
Carlisle PA 17013 1 F—
F r� m
Correspondent's e-mail address:john0 @Carlislepalaw.Com Co 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 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.
SIGNATURn NOF PrERS ESPOjJSIBLE FOR FILING RETURN ��,v Q O/z/
ADDRESS �Jr /�Q�'
35 Tri Vve., Mt. Holly Springs, PA 17065
SIGNAT E F HER THAN REPRESENTATIVE TE
6 ye
ADDR S
10 Hanover St., Carlisle, PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610105 1505610105
1505610205
REV-1500 EX(FI) Decedent's Social Security Number
Decedent's Name:
RECAPITULATION
1. Real Estate(Schedule A). .... . . . ..... . .... ..... .... ... ... ........ . ... 1. 180,000.00
2. Stocks and Bonds(Schedule B) ..... . ...... .... ........... ....... ..... 2. 6,925.60
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) ... . . 1
4. Mortgages and Notes Receivable(Schedule D).. ..... ... . ... ... ........ . . 4.
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). ... ... 5. 250,029.74
6. Jointly Owned Property(Schedule F) O Separate Billing Requested .... ... 6. 6,340.55 .
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. 443,295.89
9. Funeral Expenses and Administrative Costs(Schedule H)..... .... ... .... . .. 9. 29,355.49
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1).... . ... ...... . 10. 177.68
11. Total Deductions(total Lines 9 and 10).. . ..... ............ ... .... ...... 11. 29,533.17
12. Net Value of Estate(Line 8 minus Line 11) ..... ........... .... .... ... ... 12. 413,762.72
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. 413,762.72
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 ----- - - - -- _i
(a)(1.2)X.0- 15.
16. Amount of Line 14 taxable -
at lineal rate X.0 45 413,762.72 16, 18,619.32
19. 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. 18,619.32
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
1505610205 1505610205 J
REV-1500 EX(Fl) Page 3 File Number
Decedent's Complete Address:
DECEDENTS NAME
Inaclaire Darby
STREET ADDRESS
406 McLand Rd
crry ---- STATE
Mount Holly Springs PA 17065
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 18,619.32
2. Credits/Payments
A.Prior Payments 17,000.00
B.Discount 894.74
Total Credits(A+B) (2) 17,894.74
3. Interest
(3)
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) 724.58
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.......................................................................................... ❑ 0
b. retain the light to designate who shall use the property transferred or its income ............................................ ❑ 0
c. retain a reversionary interest.............................................................................................................................. ❑ E
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?.............................................................................................................. ❑ 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
contains a 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 3 percent[72 P.S.§9116(a)(1.1)(i)].
For dales 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
fling 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[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-1502 EX+(12-12)
VIpennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Inaclaire Darby 21-14-0009
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 OF DEATH
DESCRIPTION
1 406 McLand Road,Mount Holly Springs,PA 17065 180,000.00
TOTAL(Also enter on Line 1, Recapitulation.) $ 180,000.00
If more space is needed,use additional sheets of paper of the same size.
REV-i5o3 EX.(8-m)
1pennsytvania SCHEDULE B
DEPAMNEm OFREVENUE
INHERITANCE TAX RETURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Inaclaire Darby 21-14-0009
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Bank of America-440 shares common stock @$15.74 6,925.60
TOTAL(Also enter on Line 2, Recapitulation) $ 6,925.60
If more space is needed,insert additional sheets of the same size
REV-35o8 EX+(o8-u)
i pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Inaclaire Darby 21-14-0009
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. Refund of real estate taxes paid by seller(see HUD) 575.37
2 Sale of Personal Property at auction 828.48
3 Bank of America dividend 8.80
4 Refund from auto insurance cancellation 151.00
5 Comcast cable refund 3.09
6 Sprint cell phone refund 19.94
7 Members 1st Checking account 293203 155,219.05
8 Members 1st Savings account 293203 38,526.97
9 PNC Bank Checking account 5140425679 29,641.85
10 interest on item 9 0.25
11 PNC Bank Savings account 5005030412 20,486.89
12 interest on item 11 1.05
13 misc personal property 4,567.00
TOTAL(Also enter on Line 5, Recapitulation) $ 250,029.74
If more space is needed,use additional sheets of paper of the same size.
REV-rsog EX+(oi-Jo)
j, pennsylvania SCHEDULE F
DEPARTANCTAXRETURN IOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Inaclaire Darby 21-14-0009
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.John Darby 103 Adelbert Drive Son
McMurray, PA 15317
B.Eileen Mulroy 17 E Louther St.,Apt1 Daughter
Carlisle, PA 17013
C.
JOINTLY OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY % DATE OF DEATH
REM FOR JOINT MADE INCLUDE NAME OF RNANCIAL INSmUnON AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENTS VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY HEIR REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST
1. A. 09/18110 2010 Chevy Malibu 7,000.00 50 3,500.00
2 B 10/01/84 Citizens Bank Savings Account#6140175437 5,681.09 50 2,840.55
TOTAL(Also enter on Line 6, Recapitulation) $ 6,340.55
If more space is needed,use additional sheets of paper of the same size.
REV-1Si1 EXh(08d3)
M17pennsylvania SCHEDULE H
OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Inaclaire Darby 21-14-0009
Decedent's debts must be reported on Schedule I,
ITEM
NUM$ER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
t' Hollinger Funeral Home-Mount Holly Springs,PA 1,927.31
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: 12,000.00
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: 533.50
51 Accountant Fees:
6. Tax Return Preparer Fees:
7. Legal Advertising-Cumberland County Law Journal 75.00
a Legal Advertising-The Sentinel 116.20
9 Met-Ed 531.47
to Ibis Appraisal Services-personal property appraisal 600.00
11 Shane Bauder-trash removal 160.00
12 See Schedule H-Continued 13,412.01
TOTAL(Also enter on Line 9, Recapitulation) $ 29,355.49
It more space is needed,use additional sheets of paper of the same size.
Inaclaire Darby Schedule H Continued File#21-14-0009
Item Description Amount
13 Centurylink phone service $ 37.60
14 PowerNet Global -long distance service $ 7.95
15 Jennifer Varner,Tax Collector- Real Estate Taxes $ 527.46
16 Borough of Mount Holly Springs-water $ 11.00
17 SMTMA-sewer $ 106.66
18 Postmaster $ 13.34
19 Wolfe &Company Realtors-Sales commission $ 10,800.00
20 Deed Prep Fee $ 100.00
21 Transfer Tax $ 1,800.00
22 Final Sewer&Water $ 8.00
$ 13,412.01
REV-1512 EX+(1242)
pennsytvania SCHEDULE I
OEPARTMENTOF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Inaclaire Darby 21-14-0009
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. PowerNet Global-long distance phone service 10.37
2 SMTMA-sewer 40 2013 92.75
3 Borough of Mt.Holly Springs-water 4Q 2013 29.00
4 Sprint Cell Phone 45.56
TOTAL(Also enter on tine 10,Recapitulation) $ 177.68
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(01-10)
r2ji�? pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Inaclaire Darby 21-14-0009
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. Shelia Brown 214 W Darby Circle,Dover DE 19904 Daughter 1/8
2 Laura Dundorf 1100 Cranes Gap Road,Carlisle PA 17015 Daughter 1/8
3 Eileen Mulroy 17 E.Louther St,Apt 1,Carlisle PA 17013 Daughter 1/8
4 Barbara Beeman 3855 W Georgia Rd.,Pelzer SC 29669 Daughter 1/8
5 Karen Bream 35 Trine Ave,Mt Holly Springs PA 17065 Daughter 1/8
6 Mary Zaya-Bazan 228 S Pitt St.,Carlisle PA 17013 Daughter 1/8
7 Michael Darby 6711 W Desert Ln.,Laveen AZ 85339 Son 1/8
8 John Darby 103 Adelbert Dr.,McMurray PA 15317 Son 1/8
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:
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.
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jan, I). ZV14 11 : [081w riiu can K No. J9di Y. I
inacloorc. Darby 21-14-0009
9 .
MC
January 15, 2014
John Oszustowicz Esq
104 South Hanover St
Carlisle, PA 17013
RE: Name: Inaclaire Darby
SSN: 094-26-7543
DOD: 12-20-2013
Dear Sir/Madam:
In response to your request for Date of Death (DOD)balances for the customer noted above, our
records show the following:
Checking Account
Account# 5140425679 Established: 02-01-1983
INACLAIRE DARBY
DOD balance: S 29,641.85 + 0.25 accrued interest
Savings Account
Account# 5005030412 Established: 06-23-2008
INACLAIRE DARBY
DOD balance: S 20,486.89 + 1.05 accrued interest
Sate Deposit Box
The decedent maintained safe deposit box# 00018
INACLAIRE DARBY
located at: Mount Holly
2 W Pine St
Mt. holly Springs, PA 17065
(717) 486-3416
Please note that this office provides date of death balances for deposit accounts(IRAs, CDs, Checking and
Savings). We do not process any financial transactions or provide statements. if you need assistance with
any of these items,please call 1-888-PNC-BANK(1-888-762-2265) or stop by your local PNC Bank branch
office.
Sincerely,
National Financial Services Center
PNC Bank,N.A.
Member FDIC
Page 1 of 2
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9M.Hazard Insurance Premium for 14 years b
904.
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IOM RESERVES DIEPOSIIED 119M LENDER
1001.Hazard Insurance per
1002 mortgaits[wren" S par
1003 CounwWPAams It per
1004. School Tables
1005. Assessrtmnts 0 It per
1006.
1007- @ $ per
1006.
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1108. Title Irstranae to OM RepAric National Title kmgm e CQmMW I 13m,00i
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1109.[.enders Cex S
1110.Owners Cov $ 180,000.00 1,300AO
1111.
1112. DeadRepwationFee to Meem Law Olflices Ffle#156M.l 100.00
1113.
1204.Record Fees: Deed $ 67.01);mOrWam S 3 67,00
12W-CilyfiCounly DOW 1 M0,00,Madigage 1 ,00
12D3.State T Deed 1AGO.OMMorkpits I,00
1204.
1205.
1301. Survey to
1302. Pali Inspection to
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1400.TOTAL SETTLSIM11 CHARGES on LatBt SocdDniand Section 3,167.00 12.706.00
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11566al tnwtsov1151+5alotttsov1:2t
,ian. i). zvi4 i i : IaHrvi rim, banK No. J7d) P. 1/1
Inaclairc. Darby 21-N-0009
January 15, 2014
John Oszustowicz Esq
104 South Hanover St
Carlisle, PA 17013
RE: Name: Inaclaire Darby
SSN: 094-26-7543
DOD: 12-20-2013
Dear Sir/Madam:
In response to your request for Date of Death (DOD)balances for the customer noted above, our
records show the following:
Checking Account
Account# 5140425679 Established: 02-01-1983
INACLAIRE DARBY
DOD balance: S 29,641.85 + 0.25 accrued interest
Savings Account
Account# 5005030412 Established: 06-23-2008
INACLAIRE DARBY
DOD balance: $ 20,486.89 + 1.05 accrued interest
Safe Deposit Box
The decedent maintained safe deposit box#00018
INACLAIRE DARBY
located at: Mount Holly
2 W Pine St
Mt. Holly Springs, PA 17065
(717)486-3416
Please note that this office provides date of death balances for deposit accounts(IRAs,CDs, Checking and
Savings). We do not process any financial transactions or provide statements. If you need assistance with
any of these items,please call 1-888-PNC-BANK(1-888-762-2265) or stop by your local PNC Bank branch
office.
Sincerely,
National Financial Services Center
PNC Bank,N.A.
Member FDIC
Page 1 of 2