HomeMy WebLinkAbout04-05-05
REV-1500 EX (6.001
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPl 2l\OG01
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REV-1500
OFFICIAL USE ONLY ~~
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FILE NUMBER
INHERITANCE TAX RETURN
RES'DENT DECEDENT
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DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
ZUE/[El1MAN Edna n.
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
SOCIAL SECURITY NUMBER
195 07 - 6007
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
[i] 1. Original Return
o 4. Limited Estate
o 6. Decedent Died Testate (Mach copy of Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copy of Trust)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
o 3. Remainder Return (date of death prior to 12-13-82)
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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i\,:1'tll$;SECTlotfMU8'tfSe;cOMPLETED:' All:. CORRE$PONDENCE~AN' l'CCNFID' ~.
NAME COMPLETE MAILING ADDRESS
J. Robert Stauffer Att .
FIRM NAME (If Applicable)
c-t ,.
Harlmt Square B1d8.
Hechanicsburg, PA 17055
TELEPHONE NUMBER
71 -766-967
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
(1)
(2)
(3)
(4)
(5)
0.00
0..00
0.00
0.00
15,360.94
OFFICIAL USE ONLY
3. Closely Held Corporation, Partnership or Sole-Proprietorship
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4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
(8)
11,358.32
0.00
45,833.21
.'CJ
(6)
30,1.~72.21
c::>
(7)
0.00
(9)
(10)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
(11)
(12)
(13)
11.1c;8..12
14.474.89
0.00
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(14)
3}t,LI74.89
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
o x .0 ~ (15)
0.00
0.00
4.136.99
0.00
4,136.99
x .OL (16)
16. Amount of Line 14 taxable at lineal rate
o
34,474.89
o
x .15 (18)
17. Amount of Line 14 taxable at sibling rate
x .12 (17)
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
(19)
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Decedent's Complete Address:
STREET ADDRESS 0 I
U2'L Lisburn naad
CITY
I STATE
PA
17011
Camp Hill, PA
Tax Payments and Credits:
1. Tax Due (Page 1 line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
I ZIP
4,136.99
0.00
0.00
206.8L
Total Credits ( A + B + C ) (2)
206.~
3.
InteresVPenalty if applicable
D. Interest
E. Penalty
(3)
(4)
(5)
(5A)
(5B)
0.00
0.00
4.
TotallnteresVPenalty ( D + E )
if line 2 is greater than line 1 + line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
5.
If line 1 + line 3 is greater than line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of line 5 + 5A. This is the BALANCE DUE.
0.00
0.00
3,930.15
0.00
3t930.1~
Make Check Payable to: REGISTER OF WILLS, AGENT
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PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred;.......................................................................................... D
b. retain the right to designate who shall use the property transferred or its income; ............................................ D
c. retain a reversionary interest; or.......................................................................................................................... D
d. receive the promise for life of either payments, benefits or care? ...................................................................... D
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. D
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ D
No
[X]
Ii]
Ii]
IX]
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lXJ
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IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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, correcl
and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
ON ESPONSIBLE FOR FiLING RETURN ~ '\J ~
Drive, Camp IIill, PA and 51 (;aro1 St.
R THAN REPRESENTATIVE
DATE
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New Cumberland PA
DATE
i1:... Hechani csbur!J:. PA 170SS
c
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. ~9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)).
The statute does not exemot 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 twenty-one 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% [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%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)J.
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [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.
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m1M&rBank
499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12
Phone (888) 502-4349
Fax (302) 934-2955
March 18, 2005
J Robert Stauffer
Attorney At Law - Market Square Building
1 West Main Street
Mechanicsburg, Pennsylvania 17055
Re: Estate or- Edna M Zimmerman
Social Security: 195-07-6007
Date of Death: Januarv 07, 2005
Dear Sir or Madam:
Per your inquiry received March 18, 2005, please be advised that at the time of death, the above-named decedent had on
deposit with this bank the following:
1.
Type of Account
Checking Account
Account Number
511897
Ownership (Names oj)
Edna M Zimmerman *
Betty L Gagnon, POA
Opening Date
11/01/75
Balance on Date of Death
$12,830.94
Accrued Interest
$
0.00
Total
$12,830.94
2.
Type of Account
Savings Account
Account Number
015004204077033
Ownership (Names oj)
Betty L Gagnon, Joint Owners *
Edna M Zimmerman, Joint Owners *
Opening Date
6/19/03 Closed 2/17/05
Total
$60,886.25
$ 16.89
--$60~90ij4-----------------------------------------------------------------------.
Balance on Date of Death
Accrued Interest
REV-l508 EX +(1-91)
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ED NA H. ZnmERHAN
FILE NUMBER 21-05-00130
ESTATE OF
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jolntly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
2.
VALUE AT DAT~
DESCRIPTION OF DEATH
r'1Qi:T Bank, Checking Account No. 511897. $ 12,830.94
The Hoods at Cedar Run, reimbursement f'or prepayment
of' care. 2,530.00
TOTAL (Also enter on line 5, Recapitulation) $ 15 , :3 60 . 94
(If more space is needed, insert additional sheets of the same size)
RE\l.1509 EX. 112.881
*'
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
EDNA 11. ZIHNEHI1AN
21-05-00130
Joint tenant(s):
ADDRESS
07 Kensington Drive
Camp Hill, PA 17011
RELATIONSHIP TO DECEDENT
NAME
A. BETrry L. GAGNON
Sister
B.
C.
Jointly-owned property:
ITEM LETTER DATE
FOR TOTAL VALUE DECD'S DOLLAR VALUE OF
NUMBE~ JOINT MADE DESCRIPTION OF PROPERTY OF ASSET % INT. DECEDENT'S INTEREST
TENANT JOINT
1. A. 6/19/ H&T Bank, Savings
2003 Account Ho. 150042040770
33 J> 60,944.53 S~ 30,472.27
.,)
TOTAL (Also enter on line 6, Recapitulation) $ 30,LI-72.27
(If more space is needed insert additional sheets of same size)
REV-1511 EX+ (12-99) t
,.~
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
21-05-00130
FILE NUMBER
EDNA H. ZIHHERf.'IAN
ITEM
NUMBER
A.
B.
1.
7.
8.
9.
10.
11.
Debts 01 decedent must be reported on Schedule I.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
Stone &~ Hurray Puneral Horne, t1-08 TJ:1ird Street, Nev'
Cumberland, Pennsylvania, Ii'uneral Expenses.
th
,~
8,259.00
ADMINISTRATIVE COSTS:
Personal Representative's Commissions - None
0.00
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City
State _ Zip
Year(s) Commission Paid:
2.
Attorney Fees J. Robert Stauffer and John H. Eakin,
Attorney Fee.
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
2,280.00
3.
Street Address
City
State _ Zip
Relationship of Claimant to Decedent
4.
Probate Fees Register of Hills of Cumberland County,
Pennsylvania, Letters Testamentary.
132.00
5. Accountant's Fees
6. Tax Retum Preparer's Fees
Alert Pharmacy Services, Inc., medications.
Cumberland Law Journal, Estate Notice.
The Sentinel, Estate Notice.
Register of Wills, filing Inventory and Pennsylvania
Inheritance Tax Return.
Register of Wills, filing Account.
352.55
7-5 . 00
129.77
30.00
130.00
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
11,358.32
REV-1513 EX+ (9-00)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
EDNA 1'1. ZHIHERHAN
21-05-00130
RELATIONSHIP TO DECEDENT
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s)
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. BETTY L. GAGNON
87 Kensington Drive
Camp Hill, PA 17011 Sis ter
2. ESTHER V. TROUP
514 Carol Street
New Cumberland, PA 17070
AMOUNT OR SHARE
OF ESTATE
One-half of
Estate.
One-half of
Estate.
Sister
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE. ON REV-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
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, insert additional sheets of the same size)
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
1.
J
55:
Betty L. Gagnon and Esther v. ~roup
being duly sworn according to law, deposes and says that theY: are the Executrices
of the Estate of Edna 11. Zimmerman
late of __ LOHG l' in J~nn '1' 01,~ns l~~l~___ , Cumberland County, Pa., deceased and that the
rl' D
within is an inventory made by _~t t:J L. Gagnon aruLli;_:Dill~ V. r o';-"'the said Exe c u tr ice s
of the entire estate of said decedent, consisting of ail liL personal propo!rty and real estate, except real estate outside
the Commonwealth of Pennsylvania. and that the figures opposite each item of the Inventory represent it's fair value
" of 'he dele of decede.", deeth. 1.3".itt!:i g./-/'~ ,.,
SHorn and subscribed before me, ~ ~ ~ _
Executor - Adm inistrator
07 leens lngton Drive, Camp Hill, PA 170J
S14 Capol St.. Hew Cumberland, PA l707C
Address
Date of Death
27th
Day
January
Month
2005
Yeer
INSTRUCTIONS
I. An inventory must be filed within three months after appointment of personal representative.
2. A supplement inventory must be filed within thirty days of discovery of additional assets.
3. Additional sheets may be attached as to personalty or realty
4. See Article IV, Fiduciaries Act of 1949.
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