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Home My WebLink About07-11-14 (2) � 1505611185 REV-1500 EX(02-11)(FI) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes PO BOX 280601 INHERITANCE TAX RETURN 21 14 0 410 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 12042013 09211921 Decedent's Last Name Suffix Decedent's First Name M I SCHMIDT ANN L (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M I Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - - REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW � 1. Original Return � 2. Supplemental Return � 3. Remainder Return(Date of Death Prior to 12-13-82) ❑ 4. Limited Estate ❑ 4a. Future Interest Compromise(date of ❑ 5. Federal Estate Tax Return Required death after 12-12-82) � 6. Decedent Died Testate ❑ 7. Decedent Maintained a Living Trust — 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) ❑ 9. Litigation Proceeds Received ❑ 10. Spousal Poverty Credit(Date of Death ❑ 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 JEFFREY A • ERNICO, ESQ • 717-232-5000 REGISTER OF WILLS USE ONLY n ��; r-- �;"._ � First Line of Address �� .`^� CJ'J-;3 � :,�;�;--�, �r►_�� :; t__ C.�:-_t,= 3401, NORTH FRONT STREET z+ �r�, , _ L ,_: `- ' � Second Line of Address �f- -, — - {_.. `"°� �i.i,,.....��.. PO BOX 5950 c�� y' ' -�-: DA_ D "r-'- C�� City or Post Office State ZIP Code � .� ^. �� ;-� HARRISBURG PA 171100950 �' � `�'� Correspondent's e-mail address: J A E R N I C O a M E T T E - C 0 M 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 re entative is based n all information of which preparer has any knowledge. SIGNAIURE OF PERSON RESPONSIBLE FOR FILING RN • DATE JACQUELINE A • BEST _ - — ADDRESS 509 ELLEN ROAD CAMP HILL, PA 17011 SIGNATURE OF PREPARER OTHER T EPRES TATIVE � ATE �1ETTE , EVANS & WO IDE 7 � � ADDRESS 3401 N - FRONT STREET, PO BO 5950 HARRISBURG, PA 17110-0950 PLEASE USE ORIGINAL FORM ONLY Side 1 � 15�5611185 OM46473000 15�5611185 � J 1505611285 REV-1500 EX(FI) Decedent's Social Security Number oe�ede�t's Name $C H M I D T A N N L RECAPITULATION 1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 0 • �� 2. Stocks and Bonds(Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . 2 � • �Q 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C), , , , , 3. � - Q Q 4. Mortgages and Notes Receivable(Schedule D) , , , , , , , , , , , , , , , , , q. � • �� 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E) , _ , , , 5. 7 9], • 8� 6. Jointly Owned Property(Schedule F) � Separate Billing Requested , , , , g. 12 7,8 9 7 • 5� 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) � Separate Billing Requested . . . . 7. 11,818 • 21 8. Total Gross Assets(total Lines 1 through 7) , , , , , , , , , , , , , , , , , , g ],4 Q�,rj�'7 • 51 9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . g. ],�,2 01 • 2� 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule I) , , , , , , , , , �p. 8 7,7],7 • 8� 1 1. Total Deductions(total Lines 9 and 10), , , , , , , , , , , , , , , , , , , , , ��. `I 7,919 • 0 0 12. Net Value of Estate(Line 8 minus Line 11) , , , , , , , , , , , , , , , , , , , �2. 4 2,588 • 51 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J), , , , , , , , , , , , , , , , �3. � • �Q 14. Net Value Subject to Tax(Line 12 minus Line 13) , , , , , , , , , , , , , , , 14. 4 2,5 8 8 • 51 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers un�er Sec.9116 (a)(1.2)X.0- � • �0 1 5. � • 0� 16. Amount of Line 14 t xable at�inea�rate x.0 4� 4 2�5 8 8 • 51 �s. 1,916 • 4 8 17. Amount of Line 14 taxable at sibling rate X.12 0 • 0 0 ��. 0 • 0 0 18. Amount of Line 14 taxable at collateral rate X.15 � • �0 18. 0 • �� 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 1,916 • 4 8 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ $ide 2 � 1505611285 1505611285 � OM4648 3.000 REV-1500 EX(FI) Page 3 File Number DecedenYs Complete Address: 21 14 0 410 DECEDENTS NAME SCHMIDT ANN L STREEf ADDRESS CUMBERLAND COUNTY CITY STATE ZIP CAf1P HILL PA 17011- Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 1�916 • 4 8 2. Credits/Payments A. Prior Payments � • �� B. Discount � • �� Total Credits(A+g) (2) � • �� 3. Interest (3) � • �� 4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (4) 0 ' �� 5 If Line 1 + Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 1�916 • 4 8 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 . . . . . . . . . . . . . . . . . . . . . . . : � � b. retain the right to designate who shall use the property transferred or its income . . . . . . . . . c. retain a reversionary interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . � � 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . � � 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)J. For dates 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 filing a tax return are stifl appiicable 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 �et 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 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 biood or adoption. OM4671 2.000 REV-1508 EX+(08-12) pennsylvania SCHEDULE E DEPARTMENTOF REVENUE CASH, BANK DEPOSITS & MISC. RESIDENTDECEDENTTURN PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Ann L. Schmidt 21 14 0410 Include the proceeds of litigation and the date the proceeds were received by the estate. All propert 'ointl owned with ri ht of survivorshi must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Metro Bank Checking Account #2833082860 791.80 TOTAL(Also enter on line 5,Recapitulation) $ 7 91.8 0 2wnsno 2 00o If more space is needed,use additional sheets of paper oTthe same size. RF1/-1509 D(+(Ot-10) pennsylvania SCHEDULE F DEPAHTMENTOFREVENUE INHERITANCE TAX RETURN JOINTLY OWNED PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUM BER: Ann L. Schmidt 21 14 0410 If an asset became jointly owned within one year of the decedenYs date of death,it must be reported on Schedule G SURVNING JOINTTB�tAM(S)NANE�S) ADDRESS R�ATIONSHIPTO DEC�ENT A Best, Jacqueline A 509 Ellen Road, Camp Hill, PA 17011 Daughter JOINTLY OWNED PROPERTY: �ETTER �'TE DESCPoFTION OF PFtOPB2TY °h OF DATE OF DEATH �� FOR JOINT MADE INCLUOE NAM1E OF iINANGIAL INSTITUTION PN�BANK FGGWNT NUFSER OR SIMUR DATE OF DEATH ��Q�fT'S VALUE OF NUNBER TENANT JOIM IDENTIFYING NU1.6ER.ATTACH OEEU FIXi JpNTLY HELD NEAL ESTATE. VALL�OF ASSET �HT�EST DE{i�B`T�S INTEREST 1 A 6/8/2009 Metro Bank Savings Account #626993026 200.00 50.0000 100.00 Owned jointly with Jacqueline A. Best 2 A 7/31/2007 Improved real estate located in Aampden Township, Cumberland County, Pennsylvania, know as 509 Ellen Road; further identified as Tax Parcel Number 10-20-1848-306 255,595.00 50.0000 127,797.50 TOTAL (Also enter on Line 6, Recapitulation) S 127,897.50 swasne z o0o If more space is needed, use additional sheets of paper of the same size. Estate of: Ann L. Schmidt 21 14 0410 Schedule F Part 2 (Page 2) Item Joint DOD Value of Perc DOD Value of No. Cot. Date Description Asset Int. Interest Owned as joint tenants with right of survivorship with Jacqueline A. Best. See attached copy of Deed; the other name joint tenant, Charles F. Schmidt, predeceased the Decedent on 10/28/2007. Valuation is determined by multiplying the tax assessed value of $263,500 by the applicable Common Level Ratio factor of 0.97. $263,500 x 0.97 = $255,595 Decedent's interest was 50�, or $127.797.50 Total (Carry forward to main schedule) 0.00 REV-�sioEx+ros-os> SCHEDULE G pennsylvania DEPARTMENTOFREVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Ann L. Schmidt 21 14 0410 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. DESCRIPTION OF PROPERTY EXCLUSION TAXABLE ITEM INCUAEThEN�MEOFTIfTRANSFEREE,THE�RREL4TION5FNPTODECEDEMAND DATEOFDEATH %OFDECD�S NUMBE TFf DATE OFTRM6FER ATfACHACOPV OF TF£DEED FOR REAL ESTATE VALUE OF ASSET IMEREST IF APPLICABLE VALUE � Mutual of Omaha Annuity Contract No. U01131932 11,818.21 100.0000 0.00 11,818.21 Beneficiary is Jacqueline A. Best TOTAL(Also enter on line 7,Recapitulation)$ 11 818.21 If more space is needed,use additional sheets of paper of the same size. 9W46AF 2A00 RE�-,5„Ex'"0-09> SCHEDULE H pennsylvania DEPARITAENTOF REVENUE FUNERAL EXPENSES AND INHERITANCETAXRETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Ann L. Schmidt 21 14 0410 DecedenYs debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: � Funeral and administrative expenses and debts of the decedent listed on Schedules H and I will be paid from non-probate sources including, but not limited to, the assets reported on Schedules F and G Total from continuation schedules . . . . . . . . . 2,979.00 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: 6,000.00 3. Family Exemption: (If decedent's address is not the same as claimanYs,attach explanation.) 7 91.8 0 Claimant Jacqueline A. Best Street Address 509 Ellen Road City Camn Hill State PA ZIP 17011 Relationship of Claimant to Decedent DAUGHTER 4. Probate Fees: 10 8.5 0 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. 1 Cumberland Law Journal Legal advertisement 75.00 2 The Patriot News Legal advertisement 246.90 TOTAL(Also enter on Line 9,Recapitulation) $ 10,201.20 swasnc z o0o If more space is needed, use additional sheets of paper of the same size. Estate of: Ann L. Schmidt 21 14 0410 Schedule H Part 1 (Page 2) Item No. Description Amount 1 Pastoral memoriam 579.00 2 Gravemarker 2,400.00 Total (Carry forward to main schedule) 2,979.00 REV-1512EX+(12-12) SCHEDULE I pennsylvania DEPARTMENTOF REVENUE DEBTS OF DECEDENT� INHERITANCETAXRETURN MORTGAGE LIABILITIES 8� LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Ann L. Schmidt 21 14 0410 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 87.717.8 Par Note and Mortgage dated July 31, 2007, in the principal amount of $183,500 87,717.80 Recorded in the Cumberland County Recorder of Deeds Office as Instrument Number 200732016 The balance owed at Decedent's death was $175,435.61. The Decedent's proportionate interest was 50�, or $87.717.80. TOTAL(Also enter on Line 10,Recapitulation) S 87,717.80 zwnsnr+z o0o If more space is needed, insert additional sheets of the same size. REV-1513EX+(01-10) SCHEDULE J pennsylvania DEPARTMENTOF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Ann L. Schmidt 21 14 0410 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).] � Jacqueline A. Best 509 Ellen Road Camp Hill, PA 17011 Mutual of Omaha Annuity Contract No. U01131932 Value: 11,818.21 Value of remaining net taxable estate: 30,770.30 Daughter 42,588.51 2 James J. Best 371 Airport Drive Coldwater, MI 49036 Son 0.00 3 Frederick L. Best 161 Canal Drive SE Ocean Shores, WA 98569 Son 0.00 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 78 OF REV-1500 COVER SHEET,AS APPROPRIATE. �� 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. $ 0.0 0 swasni z o00 If more space is needed, use additional sheets of paper of the same size. � a — � � � _ � ru — � � � -� '�' a = _ a �' � a — a -_ w .� ....... E — .� � : cn — • � � . o =- - � � = � - y � � � O n, �- � � C� C� t-" � �-. o � � � 'A � `� o � � � � � � za ° t� �vo s � r�i� oy� �� a � �.� � oyo � c � �+ �_ � � � z � Y;=: o� � � � o � � a o � �� a� ,,d � � r V� `'' � 04 � � � O � � r� � �,, -x; .� o ° 'rv�iyy � �.__� � r T:. � o b � �c. �- � °� � y J� 0 � ��;` ,„�� - ``.�; � � ° � � � d `��' � `� N � o y Oi-�i y� �� z d �.,' � D o N uNrr�o o s,. o N� � 9"T' A )'^ V� � o �l e � � � a� N �� `� � � O r'a z m o� ml�� a — R