HomeMy WebLinkAbout09-02-14 (2) _J 1505610105
REV-1500 EX(�u)(FI)�
oA Department Pennsylvania OFFICIAL USE ONLY
,..of In n of al Taxuc
Bureau a'Individual Taxcs —� """` County Code Year _ Fie Number
PO BOX 28o6 tlINHERITANCE TAX RETURN / f� p /
Harrisburg PA 17128-o6oi RESIDENT DECEDENT ��1 ` T) 0 l7 J
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death _MMDDYYYY Date of Birth MMDDYYYY
y// -j �i%3�v�� J
Decedent's Last Name Suffix Decedent's First Name MI
cur key �o;S —y _
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name _ Ml
L— i Cj
Spouse's Social Security Number
j- — THIS RETURN 67US7 BE FLED IN DUPLICATE WITH Tlie
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
1.Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death
Prior to 12-13-82)
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 O 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 11. Election to Tax under Sea 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
REG IMF WILLS USE 0161
W V -13 C
First Line of Address _ M N m
� ! SGt. :I(so n Drl've
Second_Line of Address n O
E— W C'3
City or Posl Oftice State ZIP Code -DATE FILED r Trl
�.—1 O
Rsf 73erlii� — ._-] A [/73 / J N .
Correspondent's e-mail address:
Under penalties of perjury,I declare that I have examined this return.Induding 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.
SIGNA E OF PERSON RJONSIB FOR FILING RETURN DATE
ADDRES / o�`/`i-'+\ s -z.,I/V,IIC. cra-jr�7-, / L �(p�
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610105 1505610105
J 1505610205
REV-15on Ex(;:n
Decedent's Social Security Number
Decedent's Name: Lois Sharkey
RECAPITULATION
1. Real Estate(Schedule A). . . .. . . ... . .. . . . . . . .. .. ... . . . . . . . . . .... . . . ... 1. 0.00
2. Stocks and Bonds(Schedule B) . . ..... . . . . . ... .. . . . . .. . . . .. . .. .. . .. . . . 2. _ 0.00
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) .... . 3. 0.00
4. Mortgages and Notes Receivable(Schedule D).. . .. .. . ... .. .. . . ....... . . .
4. 0.00
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E)..... . . 5. 77,898.49
6. JOlntly Owned Property(Schedule F) O Separate Billing Requested ... .. . . 6. 0.00
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property -
(Schedule G) O Separate Billing Requested.. .... . . 7. 0.00
8. Total Gross Assets(total Lines 1 through 7). . . . . .. ... ..... . . . .. . .... . ... 8. 77,696.49
9. Funeral Expenses and Administrative Costs(Schedule H).. .. ..
s. 12,045.35
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I). .. .. . .. . .... . . 10. 0.00
11. Total Deductions(total Lines 9 and 10). .. ..... . . . . .... . .. . . . .. .... .... 12,045.35
12. Net Value of Estate(Line 8 minus Line 11) . .. . . . ... .. ... .. . .. . . . ..... .. . 12. 65,858.14
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which - -an election to tax has not been made(Schedule J) .. ... ... .. .. . .. ... .. . .. . 13. 0.00
14. Net Value Subject to Tax(Line 12 minus Line 13) .. ...... .. . 63,853 14
TAX CALCULATION-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.0_
15.
16. Amount of Line 14 taxable -
at lineal rate X.045 65,853.14 76. 2,963.39
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. 2,963.39
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
O
Side 2
1505610205 1505610205 J
REV-1500 EX(FI) Page 3 File Number
I
Deeedeifitc`sr tComrptete
DECECENT'S rMME
ols B Sharkey
STREET
10
1 Mt. Allen Drive
CITY STATE ZIP
Mechanicsburg PA 17055
Tax Payments and Credlfs_,
1. Tao Dut(Priyt 2,Low 19) 1 2 3.14
2. CreditsiPayments
A,Prior Fraymcnt-
K Discount
Total Credits(A+S) (2) 0.00
3. Interest
4, if Line Z re_gfe ater than Line,1.+ Limi,3,enter lhq difference. This isfire QVIEURPAYNIURT. (3) 0.00
Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00
5. It Line 1+Line 3 is greater than Line 2,enter the difference.I his is the TAX DUE. 2,�963A4
Make check payable to: REGISTER OF WILLS, AGENT
PI FARF AM-qW;:R T14FFni I nWiNr nIIFRTInN4.q AV PI ArINr AN "Y" IN TWF APPRnPRIATF: A] nrl(-q
1. Did decedent make a transfer and: Yes No
9y. retain+{,n 115`A or income of the property transferred...................................... .............._ I
It. retain the fight 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? ............................................ ....... ❑ 0
2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death
without receiving adequate consideration?..... ............-......................................................................
1 Did decedent own an 4m trust toe'or payable•upon-dearn bank account or security at his or her death'?..........._ U W
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) @1,
For dates of death an 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,I)(ii)j.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 (cm impuzvuu Uri the net value of transfers from, a deceased c1lild 21 years of age or younger of death to or for t,he use &I a natural parent,an
adoptive parent or a stepparent of the child is 0 percent 1`72 P.S.49116(a)(1.211.
• T;it inA 106ti)TIPUbt!)UI I V It I ICI Vd;UUUr!I dh 16 iuvi 'U? iivu UtVvri;IV jVICU6,i',:i 41CV;
III The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 R& A sibling is defined,
ender Section ec.,JnHj H,,,, ... 0 has a!least one parent in rM-Ion,I6 h the decedent,,nhether by blood or zdolp;on.
_2 __an dua I ..h P.
REV-i5o8 EX+(08-12)
�j pennsytvania SCHEDULE E
DEPARTMENT OF REVENUE
INHERITANCE RETURN CASH, 3AnK DEPOSITS & ti-1 S;.
RESIDENT DECED ENT PERSONAL PROPERTY
I
i
ESTATE OF. FILE NUMBER:
Lois B Sharkey
.__,.., -- eds --.:_ date
m�wuc uiZ proceeds ui d wit, and -, date--Z pi DIEEUJ wac iZCENZu uy the 25iatZ.
All Y Y �JVII I\t�V'riilG3'dii`all 11 6 VI iVl 1 VI i111Y VIViI VG YIpN ViGY VII illicu'ui2 i,
ITEM
NUMBER DESCRIPRON VALUE AT DATE
OF DEATH
1. Police and Fire Federal Credit Union-Account#72462301 (received 6/2014)
901 Arch Street Philadelphia PA 19107
Checking
22,673.20
Savings
106.44
Money Market
2,782.06
Certificates totaling
29.105.47
2, Philadelphia Federal Credit Union-Account#810674(received 5/2014)
6707 Germantown Ave Philadelphia PA 19119
Savings
3,231.32
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898 .9
TOTAL(Also enter on Line 5, Recapitulation) 7
on) g i � �,���•
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+ (08-13)
pennsylvania SCHEDULE H
Lti PAKTiAENT OF REVENUE FUNFRAL EXPENSES AND
INHERITANCE DECEDENT T REn,""
M
RESIpE I ADMINISTRATIVE COSTS
Ep
ESTATE OF FILE NUMBER
Lois B Sharkey
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION
AMOUNT
A. FUNERAL EXPENSES
I Fackler-Wiedeman Funeral Homes 5,546.00
357 South Second Street Steelton,PA 17113-2524
2. 1 Robert L.Mannal Funeral Home 6.315.85
6925 Frankford Avenue Philadelphia,PA 19135
1 I
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Names) of Personal Representative(s)
Street Address
city State ZIP
Year(s)Commission Paid:
2• Attorney Fees:
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
A• Probate Fees:
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5. Accountant Fees:
6. Tax Return Preparer Fees:
I
%• Cumberland county Register of Wills 83.50
Letters of Administration etc...
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TOTAL (Also enter on Line 9, Recapitulation) $ 12,045.35
if more space is needed, use addinonai sheets or paper of the same size.
REV-1512 EX+ (12-12)
pennsylvania SCHEDULE I
_ DESTS OF DECEDENT
� ncomruEyr�c oEvcnl� VLYIJ Vf YL\.LYLI\II
INHERrrANCE TAX RETURNc MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Lois B Sharkey
Decent debts incurred by the decadent prior to death that remained unpaid at the date of death ,nchudin nnreimb_rsed medical expenses
ITEM - ___..._ .__. _..___.
NUMBER DESCRIPTION VALUE AT UAIE
OF DEATH
1. Messiah Lifeways
1An 6"t.Allen O M Mechan;csbu.g,PA 17055 oo a,1.C3
2 4inrt oharmcy
a SeMDe , Inc.
219 North Baltimore Ave Mt.Holly Springs,PA 17065 56.84
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3. State Farm
100 State Farm Place Ballston Spa,NY 12020-8000 61.29
I �
4. Bank of America
PO BOX 982238 Ei PAso,TX 79998-2238 i s.5u
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i TOTAL(Also enter on Line 10, Recapitulation) $ 22,742.72
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+ (01-10)
"` pennsylvania SCHEDULE J
;:,::;
INHERITANCE TAX RETURN i BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Lois B Sharkev
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),)
1• JOhn Steel"key son r of
813 Station Ave Haddon Heights,NJ 08035
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2. Colleen Scollon daughter 50%
34 Jackson Drive East Berlin,PA 17316
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ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS TINDER SECTION 9113 FOR WHICH AN ELECTION TO TAX 15 NOT TAKEN:
1.
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B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
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TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET.
If more space is needed,use additional sheets of paper of the same size.
• W 'S r v yr� xr y A S 1 r'Fk �. �¢ L' ty .
,7r rY1. . I mart .dY ,�i' a +4.y�,e{' Y`trE7 '' p� s ck_ ,.m ,Ctia!• "+F y' .t"y Ak Sr#'r .
eft
krM wJ. Y � l "Jda A SX s :; a ..r I ur r `k. ,ye p�„�.5 '• 1 C iS� Y y `7w"'
/• Ey J( k "' 'mil' T r T' rtit�?y✓ t A,S' +, �'7 L�., v � 17 ` V .Lt S{J ` F� �T `w. .q�r 1.
i1'
n r 2 } J r
k a yry °"L..��A �l�eixl i .�t..M +e "` •ry ° �lr Y 0Y! y1fE '}Q
rs
tl7 inn ,'A.r ,rrTjt .
isUt �. 4 -�('(" Y ,�.y� '•ra,`` �.
:R :t jA � i'.tv w "}':i vr�, Y,�k4 4 .,.1 r + ..}J..,. s" T +�°i.:...d r 71',yf h"".s'1 •. - ?(r :`�
. DPL xr oEO AMOUNT I SALES TAX
DATE Rx NUMBERI QTY. DESCRIPTION' CD.i CI 'I
1
ti ' � •
:1�
ALER T North Noh Baltimore Ave A FINANCE CHARGE OF 1.50 % PER MONTH
+
PHARMACY SERVICES,INC. Mt Holly springs, PA 17065 IAN ANNUAL PERCENTAGE RATE OF 18.0%) OR A
Responsive. Innovative. Reliable. 800-266-9954 (717)486-8606 MINIMUM SERVICE CHARGE OF $ 1.00 WILL BE CHARGED
www.AlertPharmacy.com
ON ALL AMOUNTS 30 DAYS OR MORE PAST DUE
STATEMENT OF ACCOUNT IF YOU RECEIVE A NEW INSURANCE CARD FOR YOUR
PRESCRIPTIONS BE SURE TO SUPPLY US WITH A COPY.
Date 01/31/2014
PMT DUE. . 02 24 14
SHARKEY, LOIS SHARL01
30 DAYS. 53 . 84 222 MESSIAH CIRCLE RM 206 GRP-47
MENCHANICSBURG PA 17011 PAGE 1
Amount Pai
PLEASE DETACH AND RETURN TOP PORTION WITH YOUR PAYMENT
ALERT PHARMACY SERV. INC.219 NORTH BALTIMORE AVE. MT HOLLY SPGS, PA 17065
DATE Rx NUMBER CITY. • r • - - -gilC•ll1 DED.Co. L
* ACTIVITY FOR SHARKEY, LOIS -SHARLOI - -071312
11/26/13 9124089 88.60 BIOTENE DRY MOUTH 01 * 10.56- .00 10.56-
12/13/13 9124064 474 CERTA-VITE LIQUID 01 * 9.48- .00 9.48=
12/15/13 9124081 946 METOCLOPRAMIDE 5 01 1.17- .00 1.17-
. 00
1 . 17- 20 . 04-
LEGEND NON-LEGEND —T 0 T—A LTAZ'
FOR MONTH FOR MONTH - '
Previous Ratance Charges this month Finance Charge TOTAL CHARGES Taal Paywam a twit, AMOUNT DU.
75 . 05 + . 00 + 1 . 00 = 76 . 05 21 . 21 = 54 . 84
FOR ALL PHARMACY RELATED INQUIRES PLEASE CALL Alert Pharmacy Services,Inc at 1-800-266-9954
_. .. . . ... -- ..
State_ment Terminology on reverse --
u
AStateFarm�
State Farm Payment Plan NOtICe Of Automated Paymen]LOIS PO Box 2329 -Bloomington IL 61702-2329 State Farm Payment Plan: 0AT1 008108 0006 0038-0023-13 38-9DC2 Accountholder Name; SHARSHARKEY, LOIS M
222 MESSIAH CIR APT 206 'Total Amount:MECHANICSBURG PA 17055-8619 To Be Paid On: Februa
No See Important Information
'IIIIIIIII"III"II'IIIII.I'I""..IIII'III'IIIII'IIIII...I.IIIII
Agent Brian Cover
7005 Bustleton Ave
Philadelphia PA 19149-1806
Phone: 215-332-9000
Important Information
NOTE: Retuning payment of$61.29 will be entered FEB 1,2014 through your financial institution..
0
• Future notices will only be mailed if your amount due changes. Please continue to account for this amount in your financial records each
s
g month.
• State Farm®cares about the security of your information. We have recently enhanced how customers are verified. You may be asked
new questions to verify your identity when you access your account online or call into our contact center.
• Changes and payments made after January 13,2014.will be reflected on a subsequent billing notice:'
Ifyou have any questions or would like to discuss other State Farm products,your agent is ready to assist you.
Thanks for letting us serve you!
THIS IS YOUR
Thankyoufor
REDESIGNED STATEMENT.
your business' We've redesigned our billing statements to better
organize your billing information. As a valued customer,
Keep an eye on this section we want to draw your attention to this redesign so you
in the coming months for news can easily identify, pay, and file your billing statements.
and products to meet your needs!
As always, please contact your State Farm® agent with
questions regarding your coverage options.
oozwi
SFPP Account 0038-0023.13 Page 1 of 2 Prepared January 13, 2014
MESSIAH S L a .. I I �
Forth PBX1
ewa s�
at MESSIAH VILLAGE
100 MT.ALLEN DR.,MECHANICSBURG,PA 17055 RESIDENT# UNIT I STMT. DATE _
71312 206 1 06/30/2014
RESIDENT(S)
COLLEEN SCOLLON THE ESTATE OF LOIS SHARKEY
34 JACKSON DRIVE
EAST BERLIN, PA 17316 TOTALAMOUNT DUE $22 611.09
DATE DUE 07/31/2014
DETACH AND RETURN THIS PORTION WITH YOUR REMITTANCE $ — —
- ---_-----------____ -------------------_________._.............. AMOUNT REMITTED
DATE DESCRIPTION RATE Days/
Units CHARGES CREDITS BALANCE
Balance Forward 22,611.0
SENT FOR COLLECTIONS
RESIDENT 11 CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTAL AMOUNT DUE
71312 0.00 0.00 0.00 0.00 22,611.09 $22,611.09
RESIDENT NAME THE ESTATE OF LOIS SHARKEY Foy PM1
N/A
Please make check payable to Messiah Lifeways at Messiah Village.
A 1%finance charge may be assessed on accounts for which payment has not been received by the due date.
If you have any questions or concerns about your bill, please address them directly to Fiscal Services at 790-8220.
BankAmericarde Bank of America''"W'
.: LOIS 8 SKARKEY
Account Number:4264 2892 4539 9789
December?.4-January 24,2014 '
Account information: .a�e.
w%-w.bankofamcrimemn
Mail billing inquiries to: New Balance Total..........................................................................$13.50 Previous Balance..............................$8169
hank of America Current Payment Due-..............................................._....._............$13.50 Payments and Other Credits..................-8.47
P.O.Box 932235 Purchases and Adjustments..................1128
El Paso,TX 799932235 Total Minimum Payment Due............................................................$13.50 Fees Charged...................................................0.00
Mall payments to: Due Date........................................................................2/21/14 Interest Charged...............................................0.00
Bank of America
P.O.Box 15019 Late Payment Warning:It we do not receive your Total Minimum Payment by New Balance Total..............................$13-50
Wilmington,DE 19886-5019 the date listed above.you may have to pay a late fee of.up to$35.00 and
Customer Service: your APR's may be increased up to the Penalty APR of 29.99W - Total Credit Line............................$6.500.00
1.8004212LJO Total Minimum Payment Warning:if you make only the Total Minimum Total Credit Available.....................$6.486.50
Payment each period,you will pay more in interest and it will take you longer Cash Credit Line.............._...........$2.000.00
(1.800.34621781-17Y) to pay off your balance.For example: Portion of Credit Available
. -
for Cash.......................................$2.000.00
• - -, n Statement Closing Date ...................1%24/14
. . Days in Billing CyGff:.................
........ .....
Only the Total i month $13.50
Minimum Payment
If you would like information about credit counseling services,call
1-866-3005238.
rnansecdon posting Reference Account
Dato Date Doscnpbba Number Number Amount row
Payments'and Other Credits
01/14 PMT FROM BILL PAYER SERVICE 7737 -8.47
-$8.47
Purchases and Adjustments
01/11 01/13 NETFLIX.COM NETFLIX.COM CA 6031 9789 13.28
3622298'/99
$13.28
20 00001350000013S0000008470004264289245399789
BANK OF AMERICA Account Number: 4264 2892 4539 9789 ,
P.O.BOX 15019
WILMINGTON,DE 19886.5019 New Balance Total ...............................................................$13.50
I'II IIP'[Jill uf11111111111t Total Minimum Payment Due...................................................13.50
Payment Due Dat e.......................................-..............02/21/14
03 0128 N 832 644 1 25486 IhI01 AT 0.408
LOIS 8 SHARKEY Enter payment amount S
34 JACKSON DR `
EAST BERLIN PA 17316-9309
-i Chack here for a change of marling address or phons numbers.
' Pease pmucl,all cc reci ons on the mimeo aide. M � <
}I}.1111 If III I"1,1111111111 if III I If i}I(1 I I l"'111'111 Mail this coupon along with}vur check""his tm Bank of America
1: 5 240 2 2 2 501: 01313 79 24 5 399 769u,