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)
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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
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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
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