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Home My WebLink About06-20-14 � 150561D143 REV-1500 EX(02-11) OFFICIAL USE ONLY PA Department of Revenue pennsylvania councy code Year File Number Bureau of Individual Taxes �EVARTMENTOFNEVENUE Po Box.28oso� INHERITANCE TAX RETURN 21 13 1072 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 09 03 2013 OS 30 1942 DecedenYs Last Name Suffix DecedenYs First Name MI WARNER BARBARA L (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 � 1. Original Return � 2. Supplemental Return � 3. Remainder Return(Date of Death Priorto 12-13-82) 4. Limited Estate � qa. Future interest Compromise � 5. Federal Estate Tax Return Required ❑ (date of death after 12-12-82) � g Decedent Died Testate � � (AttacheCopy�of Tn Sd�a Living Trust � 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) � 9. Litigation Proceeds Received � 10.Spousal Povert Credit�(Date�f Death � 11.Election to tax under Sec.9113(A) between 12-31�J1 and -1-95 (qttach Schedule O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number MARK A MATEYA 717 2 41 6 5�QlJ ,� � �.s .� ' p „_;'; t7 REGI37E+�,OF WILI�l1SE,�(3Nk;� U'' -L7 � f,% -;J i'"+'I --- i_'? ._ t.-T First Line of Address r = ,�= r N� '-�; 55 W CHURCH AVENUE � , � `-�' .. ,. _ ' _,., i c�..� �..� r::� � __r Second Line of Address �-, c:�� -�y — <_� C�.": ..,...: �'� _ � C,D f'— f�'1 -p �TE FIL � a City or Post Office State ZIP Code ...� CARLISLE PA 17013 CorrespondenYs e-mail address: mam mateyalaw com 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,corre t and complete.Deciaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE O ERSON RESPO L FOR FILING RETURN DATE ' (�U�, Donald L Warner � � ADDRESS 309 W. First Street Boilin S rin s PA 17007 SIGNATURE 0 RE R OT ER TH REPRESENTATIVE ATE � Mark A. Mateya � �� `� ADDRESS 55 W. Church Avenue, Carlisle, PA � Side 1 � 15D5610143 15D561D143 � 15�5610243 REV-1500 EX DecedenYs Social Security Number DecedenrSName: y�/arner, Barbara L RECAPITULATION 1. Real Estate(Schedule A)....................................................................................... 1. 2. Stocks and Bonds(Schedule B)............................................................................. 2. 34 ,538 . 77 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C)......... 3. 4. Mortgages 8�Notes Receivable(Schedule D)........................................................ 4. 5. Cash, Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 537 . 87 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 78 , 641 . 04 7. Inter-Vivos Transfers 8�Miscellaneous�nq-Probate Property (Schedule G) U Separate Billing Requested............ 7. 69, 133 . 20 g. Total Gross Assets(total Lines 1 through 7)........................................................ g. 182 , 850 . 88 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 6, 900 . O1 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................ 10. 9,2 90 . 91 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 1 G, 19 0 . 92 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 16 6, 65 9. 9 6 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. 16 6, 65 9. 9 6 TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 13 7 , 62 4 . 8 6 15. O . 0 0 (a)(1.2)X.00 16. Amount of Line 14 taxable 2 9� 035 . 10 �s. 1,30 6 . 58 at lineal rate X .045 17. Amount of Line 14 taxable at sibling rate X.12 0 . 0 0 17. 0 . 0 0 18. Amount of Line 14 taxable at collateral rate X.15 0 . 0 0 18. 0 . 0 0 19. TAXDUE................................................................................................................ 19. 1,306 . 58 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. � Side 2 L 1505610243 1505610243 � REV-1500 EX Page 3 File Number 21-13-1072 Decedent's Complete Address: DECEDENT'S NAME Warner, Barbara L STREETADDRESS 309 First Street PO Box 194 C�Ty STATE ZIP Boiling Springs PA 17007 Tax Payments and Credits: 1. Tax Due(Page 2, Line 19) (1) 1,306.58 2. Credits/Payments 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) ��306.5$ 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............................................................................................................... ❑ ❑X d. receive the promise for life of either payments,benefits or care?............................................................ ❑ �x 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.................................................................................................................... ❑ ❑X 3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?....... ❑x ❑ 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)]. For dates of death on or aRer 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)�. 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 retum 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 siblings is 12 perceni[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-1503 EX+�6-98) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENTOECEDENT ESTATE OF FILE NUMBER Warner, Barbara L 21-13-1072 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 U Financial Group-Mutual Funds-Account No. 81570189 34,538.77 TOTAL(Also enter on Line 2, Recapitulation) 34,538.77 (If more space is needed,additional pages of the same size) Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B(Rev.6-98) Rev-1508 EX+(11-10) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENTOFREVENUE pERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Warner, Barbara L 21-13-1072 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 F&M Trust-Checking Account No. 3467805 537.87 TOTAL(Also enter on Line 5, Recapitulation) 537.87 (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) r ert Ma er Po v Cumberland County, PA � � P'ERf�Y�C?�h�TY - �'Y4 �,. rh-�- �i J � ..�' .. � � � t r . 7' iY_ � i `��y� L �..{j- `-�,.G-� . � j.r�S�,(.r �,�{P� �. '"„y, _ �� ,!'J ,ti+� ^� �� Y , S1 � '(:�`� r S y� }. ,. F •. o � .f Y ., r .--��.� �, ' � r �.��' ' � k ,�'l�§ � �"��r� �., � �.� �� ; ��" - ��. r�, 7�� , ,.�� .9� ��t�� 4�{�� i . � � �' _f ti tk .c'� r� �f - i � . � � .,-s'f. , �� '"'.` rv_ ,rf�4 }.-' , ` h . . 1.�J.'_ �L4�'�, 'ra� , , 5 '��' F �` - " �� {�{+:• :i : . -- ti `�-,� _ t 7 �" ��— ' ' �+, _ °-w . ��-1 £'` > '`."_ '� 'ti i r�'r.' � � ~ 1.. ' . �� `t _,,. "t'`+"- r M1 -J l+' ' -_`'"`� �"��,,,��3- �_� '�ry `.,�. b. r� -- � 1'' rt^� . s4 ',-, �,� 4 4� . �,if \ �'� '�ti�` �"i.=•� t ...�`� t ' ; ~ } r .' i, G �+ r*: Y .Y t . _ , • , , , , '4�.' �f � � -i `` '�• 1 _}, F�� '.f ' � i � �-. l, 7 ,1� �' . ' �� yrt� ti r j �_�t� `_i' `� x `i f 7 ��.� � t:...�,. .,y. � r...r-^"'. �j^.. 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Wed Oct 9 2013 02:28:16 PM. 309 W FIRST STREET PIN: 40-29-2484-035 Deedbook: 0027V-00098 Owner: WARNER, DONALD L & BARBARA L Land Use Code: 101 Property Type: R Acreage: 0.14 Square Feet: 1572 Taxable Status: T Clean & Green Status: Land Assessed Value $: 33500 Building Assessed Value $: 123100 Total Assessed Value $: 156600 Sale Price $: 30000 Sale Date: Wed May 31 1978 08:00:00 PM Year Built: 1920 Municipality: SOUTH MIDDLETON TWP Height in Stories: 2 Type of Dwelling: DETACH Primary Exterior: Aluminum Basement Percentage: 75 Air Conditioning: NO Total Rooms: 8 Bedrooms: 4 Full Bath: 1 Half Bath: Rev-1509 EX+(01-10) pennsylvania SCHEDULE F DEPARTMENTOFREVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Warner, Barbara L 21-13-1072 If an asset was made joint within one year of the decedenYs date of death,it must be reported on schedule G. SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT A. Donald L Warner 309 W. First Street Spouse Boiling Springs, PA 17007 B. C. JOINTLY OWNED PROPERTY: DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM LETTER DATE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANKACCOUNT DATE OF DEATH DECD�S DECE EN S NTEREST NUMBER FOR JOINT MADE NUMBER OR SIMILAR IDENTIFY�NG NUMBER.ATTACH DEED FOR VA�UE OF ASSE INTEREST TENANT JOINT JOINTLY-HELD REAL ESTATE. 1 F&M Trust-Checking Account#3401634- 579.52 50.000% 289.76 Jointly owned with spouse 2 F�M Trust-Savings Account No. 6200575- 102.56 50.000% 51.28 Jointly owned with spouse 3 Real Estate-Jointly owned with spouse-309 156,600.00 50.000% 78,300.00 W First Street, Boiling Springs, PA-See attached assessed valuation TOTAL(Also enter on Line 6, Recapitulation) 78,641.04 (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-1510 EX+(08-09) SCHEDULE G pennsylvania lNTER-VIVOS TRANSFERS AND DEPARTMENT OF REVENUE INHERITANCETAXRETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Warner, Barbara L 21-13-1072 This schedule must be completed and f led if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %6 OF DECD�s EXCLUSION TAXABLE NUMBER THE DATE OF TR,4NSFERSATTACN A CO Y OF TI�E DEIED OR REAL ESTAT�E. VALUE OF ASSET �NTEREST (IF APPLICABLE) VALUE 1 U Financial Group-Annuity-Account No. 72,133.20 3,000.00 69,133.20 RE501010750-Monthly payment of$400.74 per month for 15 years TOTAL(Also enter on Line 7, Recapitulation) 69,133.20 (If more space is needed,additional pages of the same size) Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule G(Rev. 08-09) REV-1511 EX+(10-09) SCHEDULE H pennsylvania DEPARTMENTOFREVENUE FUNERAL EXPENSES AND INHERITANCETAXRETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Warner, Barbara L 21-13-1072 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT N MBER q, FUNERAL EXPENSES: See continuation schedule(s) attached 4,198.09 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zio Year(s)Commission Paid 2. Attorney's Fees Mateya Law Firm, P.C. 2,000.00 3. Family Exemption: (If decedenYs address is not the same as claimanYs,attach explanation) Claimant Street Address City State Zi� Relationshio of Claimant to Decedent 4. Probate Fees 348.50 5. AccountanYs Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 353.42 See continuation schedule(s) attached TOTAL(Also enter on line 9, Recapitulation) 6,900.01 Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev. 10-09) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Warner, Barbara L 21-13-1072 ITEM NUMBER DESCRIPTION AMOUNT Funeral Ex ep nses 1 Hollinger Funeral Home-Funeral Services 4,198.09 H-A 4,198.09 Other Administrative Costs 2 Cumberland Law Journal-Legal Advertisement 75.00 3 The Sentinel -Legal Advertisement for Estate 278•42 H-B7 353.42 Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98) Rev-1512 EX+(�y-08) SCHEDULE 1 pennsylvania DEBTS OF DECEDENT, DEPARTMENT OF REVENUE INHERITANCETAXRETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Warner, Barbara L 21-13-1072 Report debts incuned 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 F�M Trust-Loan-Revolving Credit Account No. 571993;Joint with spouse. Date of death 9,290.91 balance due was$18,581.82 TOTAL(Also enter on Line 10, Recapitulation) 9,290.91 (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-OS) REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Warner, Barbara L 21-13-1072 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(Sl RECEIVING PROPERTY o DECEDEN e S (�/ords) ($$$) I� TAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116 a 1.2 1 Brian Warner Child 349 Old Stonehouse Road Boiling Springs, PA 17007 2 Donald L Warner Spouse 309 W. First Street Boiling Springs, PA 17007 3 Jeanette Warner Child 329 Chestnut St Mount Holly Springs, PA 17065 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.SPOUSAL 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)