HomeMy WebLinkAbout09-09-14 { _
J 1505610105
REV-1500°"W°'"Fr)�
OFFICIAL USE ONLY
PA Department of Revenue P nnsylvania
Bureau of Individual Taxes County Code Year File Number
Po BOX 28o6o1 INHERITANCE TAX RETURN n I I(�1 I��
Harrisburg,PA 17128o6ol RESIDENT DECEDENT d " �GNU
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
( I 1 06/16/2014 12/25/1914
Decedent's Last Name Suffix Decedent's First Name MI
Caulfield I (Winifred
(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
t>D 1.Original Return t'O 2.Supplemental Return O 3. Remainder Return(Date of Death
Prior to 12-1382)
O 4.Limited Estate O 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
O 6.Decedent Died Testate OI D 7.Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
O 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O it. Election to Tax under Sec.9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule 0)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTERJO:
Name_ _ Daytime Teleph�_a Number L >,
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m
Joanne E. Caulfield (828) 545-79� n
--- ---------- '—� �
REGISTC'Z)FSWIUtS USE ONLY —1
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First Line of Address
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90 River Walk Drive '1
Second Line of Address _O -H O r PrT
co
City or Post Office State ZIP Code DATE FILED
Asheville _� I NC 28804
Correspondent's e-mail address:joannec7766 @gmail.com
Under penalties of perjury,I declare that I have examined this retum,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 wall information of which preparer has any knowledge.
SIGN)JURE OF PERSON Rf.$PON51BLE FOR FILIN RETURN DATE
ACORESS C�
a Nc 2 88
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610105 1505610105 J
— �Y
1505610205
REV-1500 EX(FI) Decedent's Social Security Number
Decedent's Name: Caulfield, Winifred T.
RECAPITULATION --
1. Real Estate(Schedule A). ...... ... . .. ....... ......... ..... 0.00
2. Stocks and Bonds(Schedule B) .............. .. . .. .... . .. ............. 2. 430,338.00
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. 0
4. Mortgages and Notes Receivable(Schedule D) ... ... ... . ............ 4. 0.00
5 Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E).. . . . . . 5. I 122,268.00
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. 000
7. InteT-Vivos Transfers&Miscellaneous Non-Probate Property
21500000
(Schedule G) C=D Separate Billing Requested.. . . . . . . 7.
8. Total Gross Assets(total Lines I through 7).. . . . . . . .. . . .. .... 8. 767,606.00
9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. I 5,993.00
1,243.00
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)...... 10
if. Total Deductions(total Lines 9 and 10)... . .. .... 7,236.00
. 11' L
12. Net Value of Estate(Line 8 minus Line 11) .. .. ... .... ..... ........... 12. 760,37000
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) ............. .... .... 13.
14. Not Value Subject to Tax(Line 12 minus Line 13) ........... ..... . 14, 760,370.00
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or ------ -------
transfers under Sec.9116 0.00 15,
(a)(1.2)X.0-
16. Amount of Line 14 taxable
at lineal rate X.0 45 760,370.00 16. 1 34,217.00
17. Amount of Line 14 taxable
at sibling rate X.12 1 17.
18. Amount of Line 14 taxable
at collateral rate X.15 18.i
34,217.00
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . ... .. . .... .... ... ........ 19,F
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT C=)
Side 2
1505610205 1505610205
REV-1500 EX(Fl) Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
Winifred T. Caulfield
STREETADDRESS
4837 East Trindie Road, Room 316
Country Meadows
CITY STATE ZIP
Mechaniscburg PA 17050
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 34,217.00
2. Credits/Payments
A.Prior Payments _
S.Discount 0.05ae4&,9
Total Credits(A+B) (2) 1,801.00
3. Interest
(3)
4. if Line 2 is greater than Line 1+Line 3,enter ft difference. This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4)
5. if Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 32,416.00
I
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....................._..................................................................................................... ❑ 0
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? ..................._...._.................._..,..._............-........__........._..........._.._......... ❑ 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.
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)(1)],
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)(i)].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 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 V2 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)1.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 IX+(9-1])
Pennsylvania SCHEDULE B
CIEPPRTMEM OF flEVEN1IE
INHERITANCE TAX RETURN STOCKS Bt BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Joseph P. and Winifred T. Caulfield Living Trust
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM
VALUE AT DATE
NUMBER DESCRIPTION
OF DEATH
I See attached spreadsheet for all stocks and bonds
TOTAL(Also enter on Line 2, Recapitulation) § 430,337.51
If more space is needed,insert additional sheets of the same size
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REV-1508 EX+(o8-i2)
UU7pennsylvania SCHEDULE E
' DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Joseph P. Caulfield and Winifred T. Caulfield Living Trust
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. M&T Checking Account,Trindle Road,Camp Hill,PA,Acct#22053379 11,241.00
2 Capital One 360 Savings Account,St.Cloud,MN,Acct#6827834 106,694.00
3 Janney Montgomery Scott LLC Insured Cash Account,account#confidential,available on request 4,333.00
TOTAL(Also enter on Line 5, Recapitulation) $ 122,268.00
If more space is needed,use additional sheets of paper of the same size.
REV-1510 EX+(OB-09)
�pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER—VIVOS TRANSFERS AND
INRERrrANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Joseph P. Caulfield and Winifred T. Caulfield Living Trust
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.
ITEM DESCRIPTION OF PROPERTY
nON DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
wauoE TrvE xnrti= DES RIPTION OF rooE®en nxo
NUMBER 1EDAUCFTxAws . A79HAW 0fF DEEDRA UESrATE. VALUE OF ASSET INTEREST (rFWUrAME) VALUE
1. Edward Caulfield,Son,6/18/13 Cash 7,000.00 3,000.00 4,000.00
2 Jan Caulfield, Daughter-in-Law,6/18/13 Cash 7,000.00 3,000.00 4,000.00
3 Mary Jane Marks, Daughter,6118/13 Cash 14,00000 3,000.00 11,000.00
4 Joanne Caulfield,Daughter,6118/13 Cash 14,000.00 3,000.00 11,000.00
5 Paul Caulfield,Son,6/18/13 Cash 7,000.00 3,000.00 4,000.00
6 Janice Caulfield, Daughter-in-Law,6/18/13 Cash 7,000.00 3,000.00 4,000.00
7 Cristin O'Neal,Granddaughter,6/18/13 Cash 7,000.00 3,000.00 4,000.00
8 Cailin O'Neal,Granddaughter,6/18/13 Cash 7,000.00 3,000.00 4,000.00
9 Sheileen McLaughlin,Granddaughter,6118/13 Cash 2,500.00 2,500.00. 0.00
10 Mike Flanagan,Grandson-in-Law,6/18/13 Cash 2,500.00 2,500.00 0.00
11 Patrick Caulfield,Grandson,6118/13 Cash 5,000.00 3,000.00 2,000.00
12 Aaron Caulfield,Grandson,6118/13 Cash 5,000.00 3,000.00 2,000.00
13 Cailin O'Neal,Granddaughter,8/20/13 Cash
4,000.00 0.00 4,000.00
14 Edward Caulfield,Son, 1213/13 Cash 7,000.00 0.00 7,000.00
15 Jan Caulfield,Daughter-in-Law, 12/3/13 Cash
7,000.00 0.00 7,000.00
16 Manuel Marks,Son-in-Law, 1213/13 Cash 7,000.00 3,000.00 4,000.00
17 Mary Jane Marks,Daughter, 1213113 Cash
7,000.00 0.00 7,000.00
18 Joanne Caulfield, Daughter, 1213/13 Cash
14,000.00 0.00 14,000.00
19 Paul Caulfield,Son, 1213113 Cash 7,000.00 0.00 7,000.00
1445 1 SN TOTAL(Also enter on Line 7, Recapitulation) $ 100,000.00
If more space is needed,use additional sheets of paper of the same size.
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Schedule G, Page 2
Joseph P. Caulfield and Winifred T. Caulfield Living Trust
Item Description _ Value @ %of Exclusion Taxable Value
Number Death interest
20 Janice Caulfield, Daughter-in Law 12/3/13 Cash 7,000 0 7,000
21 Sheileen McLaughlin, Granddaughter 12/3/13 2,500 500 2000
Cash
22 Mike Flanagan, Grandson in Law 12/3/13 Cash 2,500 500 2000
23 Cristin O'Neal, Granddaughter 12/3/13 Cash . 7,000 0 7,000
24 Cailin O'neal, Granddaughter 12/3/13 Cash 7,000 0 7,000
25 Patrick Caulfield, Grandson 12/3/13 Cash 5,000 0 5,000
26 Aaron Caulfield, Grandson 12/3/13 Cash 5,000 0 5,000
27 Paul Caulfield, Son, 4/3/14 80,000 0 80,000
subtotal 115,000
Total, Both pages 215,000
REV-1511 EX+(08-13)
` pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
iNHERnANCE TAX RE7URN ADMINISTRATIVE COSTS
RESIDENT DEOMENT
ESTATE OF FILE NUMBER
Joseph P. Caulfield and Winifred T. Caulfield Living Trust
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPE_NSES:__:._-.......
1' Grave digging at Gate of Heaven Cemetery 6120114 700.00':
zi .Funeral refreshments 2,516.00-
3; Shepherd Funeral Mass - 355 00 >,
B. ADMINISTRATIVE.COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State_ZIP
Years)Commission Paid:
2. Attorney Fees: .. ... . ...- ..:
3. Family Exemption:(If decedents address is not the same as claimant's,attach explanation.)
Claimant
Street Address
city State_ZIP
Relationship of Gaimant to Decedent
4. Probate Fees:
5. Accountant Fees: 150.00
6. Tax Return Preparer Fees: 600.00
_._._.... ... . ......—.... —... — —
512.00
7. Investment broker fees
.,-:-:.,.: ..._..:,..--.8:.00,
a.' ;loss on sale of assets 1,10 .
9., ;postage,mailings,photocopies 2.0
u ::::::
<<................-, 5,993.00
TOTAL(Also enter on Line 9, Recapitulation) $;
If more space is needed,use additional sheets or paper of the same size.
e
REV-1512 Ex+(12-12)
�pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
1NHERTTANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESmENT DECEDENT
ESTATE OF FILE NUMBER
Joseph P. Caulfield and Winifred T. Caulfield Living Trust
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. Diamond Pharmacy-unreimbursed meds for final illness 529.00
2 Emergency Room Physicians unreimbursed copay 28.00
3 Holy Spirit Physicians June 2014 84.00
4 Quantum Imaging June 2014 5.00
5 Holy Spirit Hospital June 2014 150.00
8 Orthopedic Institute of PA Surgery June 2014 185.00
7 West Shore Ambulance June 2014 copay 200.00
8 West Shore Anesthesia June 2014 25.00
9 Genesis Rehabilitation Services June 2014 37.00
TOTAL(Also enter on Line 10,Recapitulation) $ 1,243.00
If more space is needed,insert additional sheets of the same size.
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