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Home My WebLink About08-18-14 REVA500Ex(02-11) 1505610143 PA Department of Revenue OFFICIAL USE ONLY P Pennsylvania County code year File Number Bureau of Individual Taxes nE=^XNEa.OraaVEaVa PO 80x.280601 INHERITANCE TAX RETURN 2 1 13 1286 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Dale of Birth 11 29 2013 03 14 1942 Decedent's Last Name Suffix Decedent's First Name MI MAYBERRY EDWARD A (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 Prior to 12-13-82) ❑ 4. Limited Estate ❑ 4a. Future Interest Compromise ❑ 5. Federal Estate Tax Return Required (date of death after 12-12-82) ® g Decadent Died Testate ❑ 7 Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of wiIQ (Attach Copy of Trust) ❑ 9. Litigation Proceeds Received ❑ 10.Spousal Poverty i na iitl(Dat95of Death ❑ 11.Election to tax u under O See.9113(A) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number SCOTT E ALBERT ESQ 717 653 7374 REGISTER OF WILLS USE ONLY First Line of Address 50 EAST MAIN STREET � r nq— c-, c= Second Line of Address [,p-5,>r - I'D F?V:;T7 CO rl3 C. v -FILED -,x CD C> City or Post Office State ZIP Code —n MOUNT JOY PA 17552 Correspondent's e-mail address: admin @scottalbertlaw.com .. Under penalties of perjury,I te.Dee that I have examined this return,including accompanying schedules and statements,and to the best r as any knowe 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. '^ SI A R F PERSON RESPONSIBLE FOR FILING RETURN DATE ;jte(, - Mark E. Mayberry 19 ADDRESS 4107 Whitman Lane, Middletown, PA 17057 SIGNATURE OF PREPARER QTIjER THAN REPRESENTATIVE DATE 1 \l��\ \\y�p�\Q Scott E Albert Esq ADDRESS Law Office of Scott E.Albert 50 East Main Street, Mount Joy, PA 17552 Side 1 1505610143 1505610143 J 1505610243 REV-1500 EX Decedent's Social Security Number D�denrzNama: MAYBERRY, EDWARD A. 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. 31 , 772 . 87 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6. 2 , 861 . 74 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested............. 7. 15 , 742 . 41 8. Total Gross Assets(total Lines 1 through 7).......................................................... 8. 50 , 3 7 7 . 02 9. Funeral Expenses and Administrative Costs(Schedule H)..................................... 9. 15 , 670 . 84 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................. 10. 12 , 117 . 84 11. Total Deductions(total Lines 9 and 10).................................................................. 11, 27 , 788 . 68 12. Net Value of Estate(Line 8 minus Line 11)............................................................. 12. 22 , 588 . 34 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. 22 , 588 . 34 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 lineal rate x .045 22 , 588 . 34 16. 1 , 016 . 48 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE................................................................................................................... 19. 1 , 016 . 48 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 - 1 286 Decedent's Complete Address: DECEDENT'S NAME Mayberry, Edward A. STREETADDRESS 266 Carlisle Avenue CITY STATE ZIP Enola PA 17025 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 1,016.48 2. Credits/Payments A. Prior Payments B. Discount Total Credits(A +B) (2) 0.00 3. Interest (3) 0.00 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) 1 ,016.48 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 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?......... ❑ ❑x 4. Did decedent own an individual retirement account,annuity,or other non-probate property which contains a beneficiary designation?...................................................................................................................... ❑x ❑ 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)]. 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 On 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 decedent's 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 decedent's 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,w ether(y bloo or adoption. + pennsylvania SCHEDULE E DEPARTMENT OF AXRET CASH BANK DEPOSITS AND MISC. INHERITANCE TAX RETURN RN f RESIDENT DECEDENT PERSONAL PROPERTY FILE NUMBER ESTATE OF Mayberry, Edward A. _ 21 �- 13- 1286 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 OF NUMBER DESCRIPTION DEATH 1 M&T Bank Checking Account#951088685 666.89 2 M&T Bank Savings Account#15004207086669 8,196.38 3 M&T Bank Savings Account#15004229771644 16,956.07 4 Patriot News- refund 28.89 5 Liberty Mutual - insurance refund 462.93 6 Capital One- refund 86.33 7 IRS-2013 Income Tax Refund 3,345.10 8 Personal Property 200.00 9 Cash on hand 1,830.28 TOTAL(Also enter on Line 5, Recapitulation) 31,772.87 REV-1509 EX+(01-101 ! pennsylvania DEPARTMENT OF REVENUE SCHEDULE F INHERITANCE NTD DECEDED ENT RETURN JOINTLY-OWNED PROPERTY ESTATE OF Mayberry, Edward A. FILE NUMBER 21 - 13- 1286 If an asset was made joint within one year of the decedent's date'of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT Kelly M. Mayberry 233 S Enola Drive Son A Enola, PA 17025 JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT similar identifying number.Attach deed for jointly-held real estat S/ALUE OF ASSET INTEREST DECEDENTS INTEREST 1 A 08/06/1996 Santander Bank 5,723.47 50% 2,861.74 Checking Account#921708785 TOTAL(Also enter on line 6, Recapitulation) 2,861.74 REVA 510 EX+(08-09) pennsylvania DEPARTMENT OF REVENUE SCHEDULE G INHERITANCE TAX RETURN INTER-VIVOS TRANSFERS & RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY ESTATE OF Mayberry, Edward A. FILE NUMBER 21 - 13- 1286 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 PROPERTY DATE OF DEATH %OF EXCLUSION NUMBER Include the name of the transferee,their relationship to decadent VALUE OF ASSET DECO'S (IF APPLICABLE) TAXABLE VALUE and the date of transfer Attach a copy cf the dead far real estate. INTEREST 1 Paychex 401 k-Account#0027-0027W155 15,742.41 15,742.41 Beneficiary: Estate of Edward A.Mayberry 4107 Whitman Lane Middletown, PA 17057 TOTAL(Also enter on line 7, Recapitulation) 15,742.41 REV-1511 EX.(1049) pennsylvania ��rr�r��r��ppS��Cr�F�EEyDppU��Lrr��E��++H�� A,1 DEPARTMENT OF REVENUE FUNMryLIBIT JFSG� MD RESIDENT DECEDENT URN R AMA,SwTW� �WI��1VJ1IV1 ESTATE OF Mayberry, Edward A. FILE NUMBER 21 - 13- 1286 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER FUNERAL EXPENSES: A. 1 Geigle Funeral Home 12,082.00 2 Woodlawn Memorial Gardens 1,377.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(s)Commission Paid 2. Attorney's Fees Scott E. Albert, Esquire 1,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Register of Wills 228.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 Cumberland County Law Review 75.00 See attached 408.34 TOTAL(Also enter on line 9, Recapitulation) 15,670.84 Sdiedule H Funeral Eigmies& COMMONWEALTH PENNSYLVANIA INHERITANCE TAX RE TURN w fth ^�AI confffited RESIDENT DECEDENT ESTATE OF Mayberry, Edward A. FILE NUMBER 21 - 13- 1286 2 The Sentinel 63.10 3 Miscellaneous Costs (travel/postage/notary/copies) 148.24 4 Reimbursement to Mark Mayberry for out-of-pocket expenses (for Estate EIN#) 197.00 Page 2 of Schedule H pennsylvania SCHEDULE [ DEPARTMENT OF REVENUE DEBTS OF DECEDENT INHERITANCE TAX RETURN , MORTGAGE RESIDENT DECEDENT LIABILITIES & LIENS . FILE NUMBER ESTATE of 'Mayberry, Edward A. 21 - 13- 1286 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 Millennium Pharmacy 645.04 2 Hazen Elder Law(for attorney fees incurred prior to decedent's passing) 2,510.00 3 Dr. Paul Dalbey(podiatrist) 30.00 4 Thornwald Nursing Home 8,880.70 5 Receivable Performance Management(for Verizon) 44.79 6 Pennsylvania Department of Revenue (2013 Income Tax) 7.31 TOTAL(Also enter on Line 10, Recapitulation) 12,117.84 REV-1513 EX-(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF Mayberry, Edward A. FILE NUMBER 21 - 13- 1286 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE PERSONS NUMBER RECEIVING PROPERTY ( ) Do Not Lis TniNi (s) (Words) ($$$) I� TAXABLE DISTRIBUTIONS[include outright spousal distributions and transfers under Sec.6116(a)(1.2)] 1 Mark E. Mayberry Son 1/4 of Residuary 4107 Whitman Lane Estate Middletown, PA 17057 2 Jill M. Smith Daughter 1/4 of Residuary 312 Center Street Estate Enola, PA 17025 3 Corey M. Mayberry Son 1/4 of Residuary 2105 Jellico Court Estate Woodbridge,VA 22191 Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate. II. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE p /� /�p INHERITANCE TAX RETURN BENEFICIARIES continued RESIDENT DECEDENT ESTATE OF FILE NUMBER Mayberry, Edward A. 21 - 13- 1286 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) RECEIVING PROPERTY Do Not List Trus (s) j, TAXABLE DISTRIBUTIONSIinclude outright spousal distributions,and transfers under Sec.9116(a)(1.2)] 4 Kelly M. Mayberry Daughter 1/4 of Residuary 233 South Enola Drive Estate Enola, PA 17025 Page 2 of Schedule J