Loading...
HomeMy WebLinkAbout09-03-14 � 15�5610143 REV-1500 Ex`°Z_„> `� OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENTOFREVFNUE PO BOX.280601 INHERITANCE TAX RETURN 21 14 00343 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 01 11 2014 02 02 1924 DecedenYs Last Name Suffix DecedenYs First Name MI STAUB MARy E (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 n 1. Original Retum � 2. Supplemental Retum �� 3. Remainder Retum(Date of Death Priorto 12-13-82) f � 4. Limited EStale l qa Future Interest Compromise � �--! (date of death after 12-12-82) 5. Federal Estate Tax Return Required ❑ 6 Decedent Died Tesiate �I � Decedent Maintained a Living Trust �__ 8. TOi81 NUftlb2�Of S2f2 De OSit BOx25 (Attach Copy of Will) L—I (Attach Copy of Trust) P r� 9 �� �� � L� �1.Election to tax under Sec.9113(A) 9. Liti ation Proceeds Received �p.Spousal Povert redit Date of Death between 1237- and -1-95) (AttaCh SChedule O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SH6U�D BE DIRECTED TO: Name Daytime�lephone N�er � � WM D SCHRACK III ESQ 717 �� 97� � � m° 'o ►-�, � s� REGIS'�TE��jINILL�SE�11� y�,,. �:� �`' �S7 C3 First Line of Address �y � �� —� � � 124 W HARRISBURG STREET _:? � Y'�° 3 :� � Second Line of Address -r� "'� ~ � � — 1'V Ct� CJ ..J -� DATE FILED City or Post Office State ZIP Code DILLSBURG PA 170191268 Corresponde�Ys e-mail address: SChPaCklaW@COI71CaSt.net 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 representative is based on all information of which preparer has any knowledge. SIGNATU E OF PERSON RESPONSIBLE FOR FILING RETURN UATE Jacob L. Staub AD ESS 109 W. Portland Street, Mechanicsburq, PA 17055 SIGNATURE OF PRE E HE N REPRESENTATIVE DATE Wm. D. Schrack 111 Esq. ADDRESS 124 W. Harrisburg Street, Dillsburg, PA 17019-1268 Side 1 � ],5�56],D143 ],505610143 � V � � 150561D243 REV-1500 EX DecedenYs Social Security Number Decedent'sName: StaUb, Mary E. - _ _ ___- -- - - _ -- --- - -- RECAPITULATION 1. Real Estate(Schedule A)....................................................................................... 1. 2. Stocks and Bonds(Schedule B)............................................................................. 2. 2 , 401 . 96 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. 13 , 623 . 7 6 6. Jointly Owned Property(Schedule F) � Separate Billinq Requested............ 6. 7. Inter-Vivos Transfers&Miscelianeous o -Probate Property (Schedule G) � � Separate Billing Requested............ 7_ 8. Total Gross Assets (total Lines 1 through 7)........................................................ g. 16 , 025 _ 72 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 15 , 970 . 30 10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule I)............................ 10. 2 , 348 _ 7 9 11. Total Deductions(totai Lines 9 and 10)................................................................ 11. 18 , 319 . 0 9 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. -2 ,2 93 . 37 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. -2 , 2 93 . 3 7 - --- ----- __ - TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousai tax rate,or transfers under Sec.9116 15. 0 . 0 0 (a)(1.2)X.00 16. Amount of�ine 14 taxable � . 0 0 16. 0 . 0� at lineal rate X .045 17. Amount of Line 14 taxable at sibling rate X .12 0 . 0� 17. 0 . 0 0 18. Amount of Line 14 taxabie at collateral rate X.15 � . �� 18. � . �� 19. TAX DUE................................................................................................................ 19. 0 . �� 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. � Side 2 � 1505610243 150561�243 � REV-1500 EX Page 3 File Number 21-'14-00343 DecedenYs Complete Address: DECEDENT'S NAME Staub, Mary E. --- ---- --- -- - - - -- ---- STREETADDRESS Messiah Village 100 Mt.Allen Drive _ __ -_- -- CITY STATE ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2, Line 19) �1) 0.00 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) 0.�� Make Check Payable to REGISTER OF WILLS, AGENT. _ . , , „ E,n� . 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:............................................................................... �.__..f �x_� b. retain the ri ht to desi nate who shall use the ro ert transferred or its income:.................................. � x_ 9 9 P p Y � . �_ � c. retain a reversionary interest;or............................................................................................................... I__I �_x_� d. receive the promise for life of either payments,benefits or care?.._........................................................ L_� �_x� 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without r.._, receivingadequate consideration?.................................................................................................................... i_ I rx I 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 r containsa beneficiary designation?.................................................................................................................. L._ x IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMP�ETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. _ �� . ,f ., > ,.� „ a , �_ . �. ,,. 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 return are stili applicable even if the surviving spouse is the oniy 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 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 blood or adoption. Rev-1503 EX+(6-98) � SCHEDULE B jr;��;;� STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN � RESIDENTDECEDENT ESTATE OF FILE NUMBER Staub, Mary E. 21-14-00343 All p�operty 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 Prudential Financial Stock redeemed 2.401.96 TOTAL(Also enter on Line 2, Recapitulation) 2,401.96 (If more space is needed,additional pages of the same size) Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-15�0 Schedule B(Rev.6-98) Rev1508 EX+(71-10) SCHEDULE E pennsyivania CASH, BANK DEPOSITS, 8� MISC. DEPARTMENT OF REVENUE INHERITANCETAXRETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF (FILE NUMBER Staub, Mary E. 21-14-00343 Include the proceeds of litigation and the date the proceeds were received by the estale. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 PNC Bank-CD#31000237671 3,688.19 � 2 Messiah Lifeways-resident refund 9,935.57 TOTAL(Also enter on Line 5, Recapitulation) 13,623.76 (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•1511 EX+(�0•09) pennsylvania SCHEDULE H - DEPARTMENTOFREVENUE FUNERAL EXPENSES AND INHERITANCETAXRETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Staub, Mary E. 21-14-00343 DecedenYs debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT N BER A. FUNERAL EXPENSES: See continuation schedule(s)attached 10,471.20 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personai Representative(s) Street Address City State Zio Year(s) Commission Paid 2. Attornev's Fees Wm. D. Schrack III Esq. 4,750.00 3. Family Exemption: (If decedent's address is not the same as claimanYs,attach explanation) Ciaimant Street Address City State Zio Relationshio of Claimant to Decedent 4. Probate Fees 98.50 5. AccountanYs Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 650.60 See continuation schedule(s) attached TOTAL(Also enter on line 9, Recapitulation) 15,970.30 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 Staub, Mary E. 21-14-00343 , ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Cocklin Funeral Home 10,471.20 H-A 10,471.20 - Other Administrative Costs 2 AXA Equitable-reimbursement of overpayment 129.78 3 Cumberland Law Journal -estate advertisement 75.00 4 Miscellaneous expense during period of administration 25.00 5 Register of Wills-additional Short Certificate 5.00 6 Register of Wills-Inheritance Tax Return filing fee 15.00 7 Reserve for future administrative expense 200.00 8 The Patriot-News-estate advertisement 200.82 H-B7 650.60 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 OFREVENUE INHERITANCETAXRETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Staub, Mary E. 21-14-00343 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 Messiah Lifeways-balance owed 2.317.22 2 Quantum Imaging-last illness 1.83 3 Verizon-balance due 29.74 TOTAL(Also enter on Line 10, Recapitulation) 2,348.79 (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 OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Staub, Ma E. 21-14-00343 RELATIONSHIP TO NUMBER NAME AND ADDRESS OF DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE PERSON(Sl RECEIVING PROPERTY (Words) ($$$) o Not 'st Tr s I� TAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116 a 1.2 Jacob L.Staub Child 109 W. Portiand Street Mechanicsburg, PA 17055 Deborah D.Stevens Child 37543 Anheim Road Livonia, MI 48150 Tota I Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet,as a ro riate. NON-TAXABIE 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) . W � � . � .�� � � . � .. ..... � �� . 4i � (n N � _ � � �/f � � � . . . . . . � . � p� . C, _ ' � �}' � . .. w �o V - O � LL ~ �� N p . . . . � ¢ . � . � N . * _ . � � . . ¢ �0" C�O � .1 � U v [D n. .k . .. O � a , .�c -' . � �[ ,k _ O . Q � . c a o � � .� � ... � ..� p � � � Q� �,�I Y . � �. . ~ . _ i :. � , . . `— . .. (� I . .. _ . �"� � j � .. � � i . . Z � . * " � . Z � �' . U � C N w V �v N tv � " -h d' z y . . .. it m `p C..) . �} ' C o� �.:.: � (..) * ._ rn � � o � �. � . °' '� a'� c . � * �� a � . U' � ;� m .. . '. . _ a � . ° a E�' .'°c n- . �. T ... � � N � .-0.- l N � d Y �Q �.. � ..�:. y . a�i N 6 V � � N _ � Z . . . ��'.0 'C. �� � .. . . . E t ' :L.� IC . � . � �L- t O � � z y U..Q I ¢ _ � � . U '4 � Q�..� u � �p . � a Y ' " ... � d C . . .. . . . p O Q .. . � _ pQ V _ . _ C . � VI N . � . . _ �� tU w` — __ C C ' . � .. . � � •L N . . . . . . � m � R o ¢ O = � �.n � ..' o O � n, - a � � � _ � .�J . . . ....� { � }� . . � . _ ._. .� . � o .a . . . . . Q- ° a .. . . . . C/). . fU r � Y �- � r = ru � � � e> � z a; � a o, Cr' � � w � - Y a e x Y U � _ g Y R rv 0 W, X N 1 w ° � � � O ° � � _. � F w - .. ° x �0 � a, z O _ ,_ _ � o � c0 a o � � a � N W Q Q � �, . �� � jW � rL a � cr� U-t � � � .-a o c�i� z q < .:Q U� � � � a �. � . � J � . Q_ W� � ..- � . ,../ ' . . . . .. � � -�i o • z J W . . . � .. . . � ..:� . . � � ] [� �° w p' `Y � } � Q 0 0 � d . . . .4- . .. . . �■ -, . � �p . � . . m .. w � . � � � � , _ . � W . �a f- . . . � . .. ... � ? � . . - . �� � p .' .. �� _ Q � � e Z YZ � . . . . Q' V . � . cD � .� . � .J . ,.Q ��� � � � � .. p ti = � w � - � -� � . � . � . . � � � . � . . � w s r �, � � ,_, � 1• s � o O ru � � � Q � � i� � � � W � J �: Q . � �U i 7 -. Q � Q - . � � � LL O ... � � ..: � LL � .. �� z �-+ a � cs Q r� � Q� w �c�� t� ti .� m ca� �« p � ''C W t �QC� N Q' � Q:Q� �� o O � ,� �'�' cn ��U o O W '�r.�' r-_v r-Z N ❑ � � � �' sw¢ Q, p � � wwQ �� � O Qi � ; �_ � '_ � �-�_ �--n = \ �N U c J // � � . z = � \ L.LJ ci o- � �/� . .Q��LU « �c� o _ \ � j \ �� � � �. � �/�� �c�� iAt�i" � � :� ` �' U- s \`���' C.� � 'a - � � _ �, _:� _ �} y �, z � y Z O � @ ¢z � . ������. � . . . . T. 3 .'�� � �. 3 ��. . .. . .Q � � �� ., :��D � . • .� . . T� . . .. .. -.E.� . T .� . � ' p p C4 C6� .. . . V N:.: � a . � � U N .� . .�.. O . . - . . _. . . . . '*""1� t i• L v I T I L . V J� �r I I 1 V 1i U Cl 1 I I( ���J. J"�)U r, I ��' .��� . .�C�*d�i'{'�V,•1 A'7k.'.7P[.i�S: N1ay?9, ZU14 Vi%illiarn D Schrack rY�Esq. 124 Z�v'Harzzshur� St r)illsbur�, PA. I7019-1.2GR � fiE= Mary�.�taub t � � SSN: 196-1��74E7 � UGU_ (1�-11 L(l14 r7ear Tv[r. Schrack: Zn�-esp�nse to�T�ur rec�uest for Date af I7e�th(DO�)balances for the customez r�oted abo�'e, our. recorc�s shov�Y t�ae follo�win�: Cez-t��cate t►f Depusit Account# 3I000237671 Established_ 0�-�2-2004 MA.ItY E STAUB Ut�D balance: � 3,�S�.X�+0_OQ accr.ued iz�texest lnterest paici tl1-�11-2U14 tluli U1-11-2U14 $ 1.97 �Y l� Checl�ir�g Acci►utnt Acc•o�unt# 500570663� Estai�lishec3: �F�-?5-;?t)Oq ___._ A�ARY E �TAUB L701)l�;�lanc.e: � O.00} no» �I:texest bear.in� . `��I'�1tS ACCOLIIl r ero Lialance a.t tlie time of de�th. Safe�ept�sx�J3c�:� The decedent n-�in�inecl sai`�deposit ba:�#0015� M.A��Y�;�'�'AUB Located:�t: Messiah�ill�ge L�rarich 939 Or�k v�al Ivlechanicsb�tug;PA 17U55-8409 (717) b�l.-=�pyl. � :C'a.�e 1 0�2 ESTATE OF MARY STAUB vendo��o�A�wdr# 004635 / 0 Trans.Code Description' Date Amount FtEFUND RESIDENT REFUND Ol/31/2014 $9,935.57 STAUB, MARY E — TO CLOSE ACCT � �-��ri_: � - � � � - .. � . . � . . . . . � CheckDate: O1/31/2014 Check#: 0000802904 Total: $9,935.57 Messiah Liteways at Messiah Village-Messiah Lifeways at Messiah Village-Messiah Lifeways a[Messiah Village-Messiah Liteways at Messiah Viliage-Messiah Lifeways at Messiah Village-Messiah Lifeways at � _ = _ _ ' _ � ���S�n�C = �� �' ��.� - �� = � - - > -: �' e -- � _' �:��� - _ _ . ... ..._ ._ .� � '� - ' � --�i@EE���� � :� _ _ « - ���j�� �; _ _ ` = OQ00802904 �� � �,..���'c�_ �: ' - : ��� : : t _ atlJC�S$fAHVIF.LJIGE ,�-�313 ,�..� . � ,..�p'., , f , �ioonnt auer�or 11/techan�csburg PA 17055 ,.��I'IUaI')/,31, 20't4T"'.- ��., �.� �;�� fs �."; e�,, < ,; ° r,s�. ��` -' , ' .,, �- 'NINETHOU3AfVDIVINE•HUIVQR�Q�'HfRTX-FlVE. " *�r**� � t30LLARS ANQ FiFTY'S�VEN C�NTS "� ' g,935 57: _ 4 " t? �� .. �E�}��4`S��k d . ., :." ; :, � : �� � c �. � � ES h" y 4+yt{"� . t �s Pay to the order d� ��:�'A,`��;�F`M�If�Y ST14U$ ` � �, , r . ; x � , � �: ESTATE��M��RII'S�G`Axt�B � • . ,,, .�. ,. , :C%O V11lL.LIAM ��iFZA�E,`/�-� - - _ — :1241N`�HARR[SBUR��� ` - �:: , - r- - _ -.' ; . -;DlLL:SBURG; PA 17(}�-�� ° _- = . : ; .; __ ..,.; =- __� .-= � � ..: . ; , . . . _,—_ - '--�:�`3�'3`L�B�:��t1-8�0�5'� LAW QFFICE OF WNt. D. Scxx�cK III 124 WEST HARRISBURG STREET DILLSBURG, PA 17019-1268 �1'elephone 717-�32��733 e-mail: 'Teleiax 717-4�3Z-1053 Schracklaw@corncast.net Septernber 2, 201�1, Rc.Kister of Wills Cumbcrland County� Court House 1 Courthouse Square Carlislc, PA 17013-3387 Re: Estate of Mary E. Staub D/D: January 11, 2014 File #: 21-14-00343 Dc�u- Re�;istcr: You will find cnclosed herewith two copies of the REV-1500 form filed on behalf of Jacob I.. Staub, Administrat.or of the above-not�ed estate. This submission is accom�anied a copy of the lconl pa�e oF the Return, as well as duplicate copies of the 612 Stat�us Report. Please accept ttie Return and the Status Report as filed. I ask that you return a tit7ic-st�unpcd copy of the front page of the Return and one copy of the status report. Thank you for your attention to this request. Sin�el , '-���� �„ .�' . . Schrack III d���� -�: w �-. ��'• �.,., }-- -� �=. . � � � � ���� ►.� �.. a` c, c::� C� �.y d-- i;_�' c a � r� -m- W k:.S � �` � v: 4 F— � '� -�" -..`t Q w � � � � � G� � Lu G�." � � � � �°v � '�� a� - N W � �U O w +.� �,/O � i�/.-¢a • N U N �� N � r- � � O ..._._. p o r-- C Q"I� •� � 3 oN � � x A" 4-- � v�i a 3 � o -o � �..• � � o ^ � � '� i r6 .� N � N r-- i-�r-- � C� +� i L tn p�y N � � •r � '� .� O r- — 01 � U i 4J � � � U .-i V