HomeMy WebLinkAbout07-10-14 (2) � 1505610143
� REV-1500 �`�°,�,°, ,�
PA De artment of Revenue OFFICIAL USE ONLY
p pennsylvania CountyCode Year FileNumber
Bureau of individual Taxes �EPARTMEMOFREVENUE
Po Box.2soso� INHERITANCE TAX RETURN 2 1 14 0 0 0 7 7
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
O1 14 2014 05 28 1935
DecedenYs Last Name Suffix DecedenYs First Name MI
ZEIGLER RONALD P
(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 Retum � 3.Remainder Retum(date of death
priorto 12-13-82)
� 4. Limited Estate � 4a.Future Interest Compromise � 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
g Decedent Died Testate �. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
� (Attach Copy of Will) � (Attach Copy of Trust)
� 9. Litigation Proceeds Received � �p.Spousal Poverty Credit(date of death � ��.Election to tax under Sec.9113(A)
between 12-31-91 and 1-1-95) (AttBCh SCh.O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
SAMUEL L ANDES 717 76 5361 �M-
� �:.� ��
REGISTER O�I�S,USE�L.Y • _;`-'
�- '� ;�
First line of address �L a � Q ! � ` -r`
'C3�_. . � �,
{ ; � ..,
525 NORTH 12TH STREET �C' �' � _�`
= :�.� �� �:::' �:
Second line of address D""'' � r �
� � �
DATE FILED �'°'y
City or Post Office State ZIP Code
LEMOYNE PA 17043
CorrespondenYs e-mail address: �a W a n d@ S Ue a O I.C O I'n
Under penalties of perjury,I declare that 1 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.
NATURE OF PERSON RES NS FILINGRE URN � DATE
� � Nancy K.Zeigler
ADDRESS
9 West Broadway, Jim Thorpe, PA 18229
SIG F PREP OT AN EP SE ATIVE DATE
Samuel L Andes �
AD
525 North 12th Street, Lemoyne, PA 17043
Side 1
� 1505610143 1505610143 �
h
� 1505610243
�
REV-1500 EX
DecedenYs Social Security Number
�oeee�c'SNamB: ZEIGLER� RONALD P.
RECAPITULATION
1. Real Estate(Schedule A).......................................................................................... 1.
2. Stocks and Bonds(Schedule B)............................................................................... 2.
3. Closely Heid 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. 3 2 , 8 2 2 . 4 8
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6.
7. Inter-Vivos Transfers&Misceilaneous Non-Probate Property
(Schedule G) � Separate Billing Requested............. 7. 9 2 , 7 7 1 . 5 2
8. Total Gross Assets(total Lines 1-7)....................................................................... g. 1 2 5 , 5 9 4 . 0 0
9. Funeral Expenses&Administrative Costs(Schedule H)......................................... 9. 9 . 1 0 3 . 7 6
10. Debts of Decedent,Mortgage Liabilities,&Liens(Schedule I)................................ 10. 2 2 , 0 4 4 . 1 4
11. Total Deductions(total Lines 9&10)...................................................................... 11. 3 1 , 1 4 7 . 9 0
�2• Net Value of Estate(Line 8 minus Line 11)............................................................. 12. 9 4 , 4 4 6 . 1 0
13. Charitable and Govemmental 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. 9 4 , 4 4 6 . 1 0
TAX COMPUTATION-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.00 15.
16. Amount of Line 14 taxable
at�ineal rate X .oa5 9 4 , 4 4 6 . 10 �6. 4 , 2 5 0 . 0 7
17. Amount of Line 14 taxable
at sibling rate X .�2 17.
18. Amount of Line 14 taxable
at collateral rate X .15 �$•
19. Tax Due..................................................................................................................... 19. 4 , 2 5 0 . 0 7
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑
Side 2
� 1505610243 1505610243 �
� REV-1500 EX Page 3 File Number 21 - 1 4 - 00077
Decedent's Complete Address:
DECED NT'S NAME
Zeigler, Ronald P.
STREET ADDRESS
355 S. Sporting Hill Road
CITY STATE ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 4,250.07
2. Credits/Payments
A• Prior Payments 4,0 0 0.0 0
B. Discount 210.53
Total Credits(A +B) (2) 4,210.53
3. Interest (3) 0.00
q. 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) 3 9.Jr 4
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:.................................................................................. ❑ 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 December 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?......... � �
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.
, : , . ., . . , . .
- :... n
... , � N3
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)]. 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 re�urn 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 1.2)[72 P.S.§9116(a)(1)1•
•The tax rate imposed on the net value of transfers to or for the use of the decedenYs siblings is 12 percent[72 P.S.&9116(a)(1.3)1. A
sibling is defined under Section 9102,as an individual who has at least one parent in common with the decedent,w�ether by blood or adoption.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
COMMONWEALTHOFPENNSVLVANIA PERSONAL PROPERTY
INHERRANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Zeigler, Ronald P. 2t - �4-000�7
Include the proceeds of litigation and the date the proceeds were received by the estate.All property jointly-owned with the right of
survivorsh�p must be disclosed on schedule F.
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 M&T Checking Account No. 951133159 6,278.11
2 M&T Savings Account No. 4217284899 100.33
3 PSECU Share Account No. 0184 969.74
4 2011 Toyota Prius hatchback automobile in fair condition 14,677.00
5 Miscellaneous items of clothing, furniture, and other personal property 500.00
6 Refund from Country Meadows Rehabilitation Center 2,580.24
7 Comcast Cable refund 99•98
8 Horace Mann Insurance Company-auto insurance refund 141.30
9 American Ameriprise check for IRA distribution 5,525.00
10 Partial pension payment from Penna. Public School Employees Retirement System 1,697.97
11 Pennsylvania Turnpike(EZ Pass refund) 30.86
12 National Geographic(magazine subscription refund) 15.95
13 2013 Federal income tax refund 206.00
TOTAL(Also enter on Line 5, Recapitulation) 32,822.48
SCHEDULE G
COMMONWEALTHOFPENNSYLVANIA INTER-VIVOS TRANSFERS 8�
INHERITANCE TAX RETURN
RESIDENTDECEDENT MISC. NON-PROBATE PROPERTY
ESTATE OF Zeigler, Ronald P. FILE NUMBER
21 - 14-00077
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
ITEM DESCRIPTION OF PROPERIY DATE OF DEATH %OF EXCLUSION TAXABLE VALUE
NUMBER �nclude the name of the transferee,their relationship to decedent VALUE OF ASSET �T REST (IF APPLICABLE)
and the date of transfer. Attach a copy of the deed for real estate.
1 Ameriprise Individual Retirement Annuity Account s2,771.52 100% 0.00 92,771.52
TOTAL(Also enter on line 7, Recapitulation) 92,771.52
SCHEDU�H
FUNEFiAL D�ENSES 8�
GOMMONWEALTH OF PENNSVLVANIA
INHERITANCE TAX RETURN �������
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Zeigler, Ronald P. 21 - 14-00077
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT
A. 1 Parthemore Funeral Home 3,250.06
2 Suzanne Schwartz(organist for ceremony) 125.00
3 Photos, postage, and announcements for funeral service 45.69
4 Pealers Florist(flowers for funeral service) 241.83
B. ADMINISTRATIVE COSTS:
1. Personai Representative's Commissions
Name of Personai Representative(s)
Street Address
City State Zip
Year(s)Commission paid
2. Attorneys Fees Samuel L.Andes 5,000.00
3. Family Exemption: (If decedenYs address is not the same as claimanYs,attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Register of Wills 158.50
5. AccountanYs Fees
6. Tax Return Preparer's Fees David Trout(income tax preparation bill) 50.00
7. Other Administrative Costs
1 Cumberland Law Journal -advertising 75.00
TOTAL(Also enter on line 9, Recapitulation) 9,103.76
Sched�e H
Fu�eral E�es 8�
COMMONWEALTH OF PENNSYLVANIA w��M��
INHERITANCE TAX RETURN tz,�1�1 pYQYYc
RESIDENT DECEDENT
ESTATE OF Zeigler, Ronald P. FILE NUMBER
21 - 14-00077
2 The Sentinel -advertising 157.68
Page 2 of Schedule H
SCHEDULEI
DEBTS OF DECEDENT, MORTGAGE
COMMONWEALTHOFPENNSriVANIA LIABILITIES & LIENS
INHERITANCE TAX RETURN �
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Zeigler, Ronald P. 21 - 14 -00077
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM DESCRIPTION AMOUNT
NUMBER
1 Toyota Motors Finance (including monthly installment due on the date of death) 8,738.77
2 AAA Visa Card No. 1268 5,654.53
3 AAA Visa Card No. 6703 303.32
4 Community Life Ambulance Service 58.88
5 Hampden Township Ambulance Service 799.00
6 West Shore Emergency Medical Service 997.42
7 West Shore Emergency Medical Service 981.42
8 MSHMC Physicians Group 40.00
9 Diamond Pharmacy 316.12
10 Morgan Properties(Camp Hill Plaza Apartments-final bill with utilities) 914.74
11 Royers Florists 60.16
12 Azizkhan Internal Medicine 20.00
13 American Home Medical Equipment Co. (chair lift) 1,120.00
14 Pinnacle Health Cardiovascular-decedent's medical bill co-pay 10.00
15 Country Meadows Retirement Community-fee for January, 2014 2,029.78
TOTAL(Also enter on Line 10, Recapitulation) 22,044.14
.
� REV-1513EX+(11-08)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA B E N E F I CIARI ES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Zeigler, Ronald P.
21 - 14-00077
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY Do Not List Trustee�s)
I. TAXABLE DISTRIBUTIONS[include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
1 Nancy K. Zeigler Daughter Entire
9 West Broadway
Jim Thorpe, PA 18229
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate.
II. NON-TAXABLE DISTRIBUTIONS:
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 0.00