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Home My WebLink About06-16-14 � �5�561D143 REV-�soo �{°�-�� OFFICU4L USE ONLY PA Department of Revenue pennsylvania c«�,y coae v� F�b r�.,r� Bureau of individual Taxes "�T�� o soX.28oso� INHERiTANCE TAX RETURN 21 �J�J Harriseur�,Pa »�Ze-oso� RESIDENT DECEDENT �� / / ENTER DECEDENT INFORMATION BELOW 09 14 2013 03 13 1919 DecedenYs Last Name Suffix DeoedenYs Frcst Name MI x�cs�ns r�Y v (H AppBcable)Enter Surviving Spouse's IMwmation Below Spouse's Last Name Suffix Spouse's First Name MI Spause's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS F1U.IM APPROPRIATE OVALS BELOW � 1. Oripinal Retum � 2. Suppl9mental Retum � 3. �� 4. Umited Esiate � 4a.{�� 5. Federal Eshate Tax R�Required � g �AOe�cedent��ate � 7, ��,��uvm9 Tn�st � B. Total Nurt�ber of Safe Deposit Boxes � s. ua�,�,P�ag R��a � 10.�i�"-�'-��`4°��°�' ❑ ».E�ro ax�s�.s��) ��scneau�e o� CORRESPONDENT-THIS SECTION MUST BE COMPLETED.AL!CORRESPONOENCE ANO CONFlDENTIAL TAX M►FORMATION St10ULD B�,�jIRECTED TO: Name Daytime Teleptsane Number� � � JESSICA FISHER GREENE ESQ 717 697��-,3�23 � � t.-�, �� c _.._ o --�—�� — > .�.� RE6ISTERf�YYltt.8U3E�LY �: t �,7 ...,,. �,, : a ca _. .. �,-� First Une of Addresa t-� c'� "'U --: `n 555 GETTYSBURG PIKE � � � � � _`' � c� Second Une of Address � � �"� ' � STE C100 '' � � DATE FILED City or Post Of�ce Stabe ZIP Code 1�CAANICSBtJRG PA 17055 CorrespondenYs e-mail address: )essica�keystoneelderlaw.com Ru�Uui�,oarect�a�anple6e�Da��ab'ton�W�rer�than�P��e au iM�o�d wh �prep�a�h�a�k�nowledg.�' SIGNATURE OF VER80N RESPONStBLE fOR FIUNG RETURN DATE ,�,�„ � �� Gregory L.Richards % — �L'� no�t 5518 Sihrer Creek Drive,Mechanicsbura,PA 17050 � SIGNATURE OF PREPARER OTHER TIWV REPRESENTATNE �� C��p;`�. ��,� Jessica F.Greene Esq. (o—��— �� ss 555 Getlysburg Pike,STE C700 Mechanicsburg,PA 17055 Side 1 � 15Q561D143 7�5�5610143 � � 1505610243 REV-1500 EX DecedenYs Social Security Number �e�ee�esNama: RiCha1'ds� M's1ry V. RECAPITULATION 1. Real Estate(Schedule A)....................................................................................... 1. 2. Stocks and Bonds(Schedule B)............................................................................. 2. 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C)......... 3. 4. Mortgages&Notes Receivable(Schedule D)........................................................ 4. 5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 5 90 . 5 6 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 2 , 105 . 24 7. Inter-Vivos Transfers&Miscellaneous�an;Probate Property (Schedule G) U Separate Billing Requested............ 7. g. Total Gross Assets(total Lines 1 through 7)........................................................ g. 2 , 695 . $� 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 2 , �93 • 98 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................ 10. 6 r S36. 00 11. Total Deductions(total Lines 9 and 10)................................................................ ��. 9, 62 9. 98 12. Net Value of Estate(Line 8 minus Line 11).......................................................... �2. -6, 934 . 1$ 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. -6, 93 4 . 18 TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 � . �0 (a)(1.2)X.00 15. 16. Amount of Line 14 taxable 0 . 0 0 16. 0 . 0 0 at lineal rate X .045 17. Amount of Line 14 taxable � . �0 at sibling rate X.12 � . �� 17. 18. Amount of Line 14 taxable O . O O 18. � . 0 0 at collateral rate X.15 19. TAX DUE................................................................................................................ 19. 0 . 00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. � Side 2 L 1505610243 1505610243 J REV-1500 EX Page 3 File Number 21-13 Decedent's Complete Address: DECEDENT'S NAME Richards, Mary V. STREETADDRESS 442 Walnut Bottom Road CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due(Page 2, Line 19) (1) 0.00 2. CreditslPayments A. Prior Payments B. Discount 0.00 Total Credits(A +g) (2) 0.00 3. Interest �3� 4, If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2,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. (5) Q.�Q Make Check Pa able 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:............................................................................... ❑ ❑X b. retain the right to designate who shall use the property transferred or its income:.................................. � �x c. retain a reversionary interest;or............................................................................................................... U 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 receivingadequate 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?.................................................................................................................. ❑ 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 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 percent [72 P.S.§9116(a)(1.1)(ii)J. 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 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 decedenYs sibiings 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-1508 EX+(11•10) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE INHERITANCETAXRETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Richards, Ma V. 21-13 Include the proceeds of litigation and the date the proceeds were received by the estate. All property Jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Century Link Telephone Utility Refund 18.36 2 United American Medical Insurance Refund 572.20 TOTAL(Also enter on Line 5, Recapitulation) 590.56 (If more space is needed,additional pages of the same size) Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev. 11-10) Rev-1509 EX+(07-10) pennsylvania SCHEDULE F DEPARTMENTOFREVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Richards, Ma V. 21-13 If an asset was made joint within one year oi the decedenYs data of death,it must be reported on schedule G. SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT A. Lester W. Richards 18 Rainwater Lane Son Bluffton, SC 29909 B. Gregory L. Richards 5578 Silver Creek Drive Son Mechanicsburg, PA 17050 C. JOINTLY OWNED PROPERTY: DESCRIPTION OF PROPERTY o�o OF DATE OF DEATH ITEM LETfER DATE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECD�S DECED NT'S NTEREST NUMBER FOR JOINT MADE NUMBER OR SIMILAR IDENTIFYING NUMBER.ATTACH DEED FOR VALUE OF ASSE INTEREST TENANT JOINT JOINTLY-HELD REAL ESTATE. 1 M 8�T Bank Checking Account XXXX8058 6,315.73 33.333% 2,105.24 TOTAL(Also enter on Line 6, Recapitulation) 2,105.24 (If more space is needed,additional pages of the same size) Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule F(Rev.01-10) REV-1511 EX+(10-09) pennsylvania SCHEDULE H DEPARTMENTOFREVENUE FUNERAL EXPENSES AND RESIDENTDECEDENTTURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Richards, Ma V. 21-13 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT MB q, FUNERAL EXPENSES: See continuation schedule(s)attached 293.98 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zio Year(s)Commission Paid Waived 2, Attorney's Fees Keystone Elder Law P.C. 2,500.00 3, Family Exemption: (If decedenYs address is not the same as claimanYs,attach explanation) Claimant Street Address City State Zio Relationshi�of Claimant to Decedent 4. Probate Fees 5. AccountanYs Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs TOTAL(Also enter on line 9, Recapitulation) 2,793.98 Copyright(c)2009 form software only The Lackner Group, Inc. FoRn PA-1500 Schedule H(Rev. 10-09) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Richards, Mary V 21-13 ITEM NUMBER DESCRIPTION AMOUNT Funeral Ex ep nses 1 Myers-Buhrig Funeral Home burial expenses 293.98 H-A 293.98 Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98) Rev-1512 EX+(12-08) � SCHEDULE 1 pennsylvania DEBTS OF DECEDENT, DEPARTMENT OF REVENUE INHERITANCETAXRETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Richards, Ma V. 21-13 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 Thornwald Nursing Home Cable Utility Bill 28.00 2 Thornwald Nursing Home Final Bill for Care 6,808.00 TOTAL(Also enter on Line 10, Recapitulation) 6,836.00 (If more space is needed,additional pages of the same size) Copyright(c)2008 form software only The Lackner Group,Inc. Form PA-1500 Schedule I(Rev. 12-08) REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OFREVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Richards, Ma V. 21-13 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (Words) ($$$) I� TAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116 a 1.2 Virginia L. Myers Daughter 30 Center Drive Camp Hill, PA 17011 Gregory L. Richards Son 5578 Silver Creek Drive Mechanicsburg, PA 17050 Lester W. Richards Son 18 Rainwater Lane BlufFton,SC 29909 Lewis A. Richards Son State College, PA Total Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet,as a ro riate. NON-TAXABLE DISTRIBUTIONS: II. A.SPOUSA�DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule J(Rev.01-10) _ _ _ _ _ � M&T Banlc 6560 Carlisle Pike-Suite 500,Mechanicsburg,PA 17050 777 795 1710 Helio Gregory, Per your request I have obtained the information for you.The account ending in-8058 has Mary V. Richards, Lester W. Richards,and Gregory L. Richards all titied as joint account hoiders. lester W. Richards and Gregory L. Richards were added to the account in 2002.After looking through your statements,which I have included, I see that on September 14,2013 the balance on the account was $6,315.73. If you require any additionai information please contact me. Have a nice day! � Paul Kaegei Relationship Banker 1 � M&T Ba Carlisie Pike 6560 Carlisle Pike Suite 500, Mechanicsburg, PA 17050 717-795-1710 � (F)717-795-9113 pkaeqelC�mtb.com �www.mtb.com NMLS ID: 1096136 tiu►R1►V.R�cHAans oe-e+ `�°""u 5 7 0 0 GREOORY L RN�IARD8 661B 91LVER CREEK DR. �y�,��. MECFUWICSBUR6.PA 17060 p,��T/� r✓"""� Et �t/ /� , G ` I ""oKOS�ia 4`-�r-r-,O�G3i�y" v�Yeen,�l E67we �-G-eM¢L�ow I $��Q3.Q�� . � '/ruK -- �/As��GV�.Qw� Q8 CI DOLLARS e �:: t �1r16Ci Bi1liK 1 � �rwaa�.+ •M� !�� '(/iG.J�/�4 r •�:03i302955�: 7�728058�' 700 ,,. .. ,_., G r � R . O , 7 . M. ID O 'T7 G+ H:. G a r ,. r>c'o v � rr �o m ov �oro am �oo . � "... . . 'C3 NON bd no O O F'• N N 1� fT ' a r• w x r* o �'' tn r �- '�tl _ H �t E; -. C �'".. � 1 of 1 MARYV.RICNARDS oe.ea °—�°"�" 5699 GREl30RY L pICHARD3 SSIB 61LVER CREIX OR. p � MECMANICSBURO.PA 17050 �� "„�,�'"t �Ya�7'��-e+�- �aw _ . 1 $ ��'oo��o �--i�" = �i1� s=�L� _ _ _ _ _DOI.LARS W L.. t /�'""_U�iIR w1r.�Mw MF?IO' � _ __ '_ ��I L!'�Y�f� M r;03i302955�: ?L728058�' 4 • f � { � � � � � � � � , � ? ' � F F i n 1 of 1 p '�a�Pqh"J7��C"Ri �.�'�'�'��i � - . MARYY.RICFiARD3 oe�ea�' °o-"'eiio 57�1 GREGOflY L RICHARDS � 5518 31LVER CAEEK DR. ' �y��y.. • ' MECHANICSBURO.PA 77050 • ' ��LO � � • • . . . . 'qtU[RM .. ., � ! � . . S DOLLARS 8•C• �� ' � . � . . . � ��.b��.B�. Y/-el3o ��,� , �•�-� �. �:�:0 3 i 30 29 5 5!: � ?i 7 280 58�M O 3 . ' . . .� ..- �r-��;... , .. . � ��_— . • � �� ' ;;�� o ,. .. : o �•• . .. , 'Fm=1� ' T ' '`1l r��,J t��' , e� . ' ' :.�'p-•G�i ii � ' :�;o::z�nz� 0 - . .. .j��3._.�.00fn • �.� - A-� � � -<">��m�-Y r ' � ' . ,T c• , .:�, �p2 '< : ;.� m " ;; - �"� c. ' ' I �. - . . i - �i. , �.� 1 of 1 STATEM ENT Thornwald Home Statement Date: 11/01/2013 442 Walnut Bottom Road Carlisle, PA 17013 Due Date: i l/25/2013 Telephone: (717) 249-4118 Amount Enciosed $ � �6 S',.00 Amount Due: $ 6,808.00 Account #: 20097 RE: Mary Richards Greg Richards 5518 Silver Creek Drive Mechanicsburg, PA 17050 I Days Date Descri tion uant Rate Char e5 Pa ments Balances Balance B/F 28.00 28.Oi 10/09/13 RICHARDS, GREG 28.00 .01 07/24/13 - 07/31/13COINSURANCE BILLED 2 148.00 296.00 296.01 08/O1/13 -08/08/13COINSURANCE BILLED 8 148.00 1,184.00 1,480.0f 08/16/13 -08/29/13COINSURANCE BILLED 14 148.00 2,072.00 3,552.0( 08/09/13 -OS/15/13COINSURANCE BILLED 7 148.00 1,036.00 4,588.0( 08/30/13 -08/31/13COINSURANCE BILLED 2 148.00 296.00 4,884.0( 09/O1/13 -09/07/13COINSURANCE BILLED 7 148.00 1,036.00 5,920.0( 09/08/13-09/13/13COINSURANCE BILLED 6 148.00 888.00 6,808.0( � I � I I I i � i - '----'--- —� -- - — � — ---'- - ---� Current 31-60 Days 61-90 Days � Over 90 Days Amount Due .00 1,924.00 4,588.00 296.00 6,808.00 Payments MUST be received BY the 25th of each month. Attention: MA recipients Statement Date: 11/01/2013 Documentation MUST be received in order to receive credit on a monthly Due Qate: 11/25J2013 basis. " Mary Richards - Account #: 20097 Thornwald Home 44Z Walnut Bottom Road Carlisle, PA 17013 Telephone: (717) 249-4118