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HomeMy WebLinkAbout04-14-05 (2) '. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT w ~ ~ Sf/) olt:~ wQ.o J:OO olt:..l t:1D c( DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) J- Z W o w o w o GROVE SYBILLA E. DATE OF DEATH (MM-DD-Yearl DATE OF BIRTH (MM-DD- Year) q\; ,~~ ~~f3 .// 02/03/2005 08/19/1911 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAl) FILE NUMBER 2 1 -0 5 0 1 2 9 COiJNlYCOoE --VEA;r- - - 'NUMs'ER-- SOCII\L SECURITY NUMBER 187-50-0084 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 3. Remainder Return (date llldeatll prior tn 12-13-S2) o 5. Federal Estate Tax Return Required lL 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (AttachSch ( 1XI1. Original Return o 4. Limited Estate o 6. Decedent Died Testate (A1IachcopyclWill) o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (datellldea1h after 12.12.82) o 7, Decedent Maintained a Living Trust (AlIachcopy lllTrust) o 10. Spousal Poverty Credit (dale llldeath belween 12-31.91 and 1-1-95) ~ z W Q Z o Q. f/) W It: It: o o TELEPHONE NUMBER 717 432-4514 DiIIsbu (1) (2) (3) (4) (5) z o i= :s ::>> J- ~ c( o W IX: 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly OWned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) (6) (7) (9) (10) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o i= ~ ::>> Q. :i o o >< <( I- 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X _(15) 50,442.31 X ~(16) X .12 (17) X .15 (18) (19) 16. Amount of Line 14 taxable at "neal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT <~Slr${DE:ANO.RE HeCKMA1H <, < PA 17019 0;... FiCtf,f_ U:':~~- 34,704.29 22,552.74 ;'11 (8) j'l 57,257.0 ( .', 6,152.69 662.03 (11) (12) (13) 6.814.7 50,442.3 O.C (14) 50,442.~ 2,269.! 2,269. Decedent's Complete Address: STREET ADDRESS 911 Grantham Road, Box 104 CITY I STATE I ZIP Grantham PA 17027 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) $2.269.90 $1.794.02 $94.42 Total Credits (A + B + C) (2) $1,888.44 3. InteresUPenalty if applicable D. Interest E. Penalty T otallnteresUPenalty ( 0 + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 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) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check AGENT $0.00 $381.46 $0.00 $381.46 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; ........................................................................... 0 1&1 b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 1&1 c. retain a reversionary interest; or ...................................................................................................... 0 1&1 d. receive the promise for life of either payments, benefits or care? ............................................................. 0 1&1 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?............................................................... ..... .......................... 0 1&1 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. 0 1&1 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... 0 1&1 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 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. SIGNATURE OF PERSON RESPONSIBLE FOR FILING R TURN DA ADDRESS For dates eath on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [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% [72 P.S. ~9116 (a) (1.1) (ji)). The statute does not exemot 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 twenty-one 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% [72 P.S. ~9116(a)(1.2)J. Thi"\ t",v ............ ill'"u.\.....~n,.a ....." +hn "'". ""''',''' ....f= "..",nto",".."" +,... "'.. .f:nr +hn 'Ir-,... .....f fh..... "'.........."'....""'".',.. I:",",,,' h""',,/i.....:"'..i....o :'Io .to A t:.OI.. nv<'V"\,...+......~ "nt,..,,, ;,... 70 D C ~O-t -ta./1 ')\ f7') 0 C ~(H -tal",\/1 \1 111e: lel^. lale 11ll}JV~OU UIIlItC II~l VOIUt:: Vlllall~ICI:;' lUUI IVI lilt:: U~CUlllICUe:l.ol::;Ut;lll;) IlIlCQI UvllCllvICUIt:i;:) 1"......\.110, C^"",t;tJlO" IIULCU nllL. r.v. 'j.-:lIIV\I.L} ltLr.\J. ~;)IIV\aJ\IJJ' The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [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-1508'EX + (6-98) '* SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GROVE. SYBILLA E. FILE NUMBER 21 05 Indude 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. 0129 ITEM NUMBER 1. 3. 4. 5. 6. 7. 8. 9. 10. 11. DESCRIPTION PNC BANK, NA - Certificate of Deposit no. 31500229326 PNC BANK, N.A. - Certificate of Deposit no. 31500218646 CITIZENS BANK - Certifcate of Deposit no. 6140634353 CITIZENS BANK - Certificate of Deposit no. 6140789443 CITIZENS BANK - checking account no. 6100742911 CITIZENS BANK -Interest check from CD#6140634353 CITIZENS BANK - interest check from CD#6140789443 PNC BANK, NA - interest check from CD#31500229326 and CD#31500218646 Capital Blue Cross - health insurance claim Capital Blue Cross - health insurance claim VALUE AT DATE OF DEATH $5,009.21 $5,009.21 $9,000.61 $8,001.30 $7,441.25 $20.11 $18.8E $19.7( $101.8; $82.1! TnT^L (^Is" ""t". "n I;"" J:: O""ap','u'nt'lon) ~ IVII"\ .n V'OIICIV IIIIC"",I'\CI"" l fa I" (If more !/pace is needed, insert additional sheets of the same size) 34,704.: o PNCBAN< February 23, 2005 Jane Alexander Attorney at Law 148 S Baltimore St. Dillsburg, P A 17019 scp RE: Estate of Sybilla E Grove (Deceased) SSN: 187-50-0084 DOD: 02-03-2005 Dear Ms. Alexander: In response to your request for Date of Death balances for the customer noted above, our records show the following: Certificate of Deposit Account #31000250166 Established 12-15-2004 SYBILLA E GROVE AQUILLA R LICK DOD balance: $10,021.57 + $12.85 accrued interest Account #31500218646 Established 09-5-2001 SYBILLA E GROVE DOD balance: $5,000.00 + $9.21 accrued interest Account #31500229326 Established 06-05-2002 SYBILLA E GROVE DOD balance: $5,000.00 + $9.21 accrued interest Please note that this office only provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings accounts). We do not process any financial transactions or provide statements. If you need assistance with any of these items, please call1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office. Sincerely, ~ :J ,~y Erica L Schlegel 1-800-762-1775 P7-PFSC-04-F 500 First Ave. Pittsburgh PA 15219 Member FDIC .~ CITIZENS BANK Account Number 6140694353 Account Title SYBILLA GROVE Date Opened 2/1/95 Account Type Time Deposits Principal Balance as ofDOD $9000.00 ---.---... Interest from Last Posting to DOD $.61 Account Balance as of DOD $9000.61 YTD Interest to DOD $37.76 .~ CITIZENS BANK Account Number 6140789443 Account Title SYBILLA GROVE Date Opened 3/1/01 Account Type Time Deposits Principal Balance as of DOD $8000.00 - Interest from Last Posting to DOD $1.30 Account Balance as ofDOD $8001.30 YTD Interest to DOD $40.17 .~ CITIZENS BANK Account Number 6100742911 Account Title SYBILLA GROVE Date Opened 10/4/77 Account Type Checking Principal Balance as ofDOD $7441.25 Interest from Last Posting to DOD Account Balance as of DOD $7441.25 YTD Interest to DOD $.00 . REV-150g EX + (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF GROVE. SYBILLA E. FILE NUMBER 21 05 0129 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 A. Aquilla R. Lick 911 Grantham Road, Box 104 Grantham, PA 17017 Daughter B c 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 OR SIMILAR DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTL V-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENl'SINTERES 1. A. 12/15/2004 PNC BANK, N .A. - Certificate of Deposit no. 31000250166 $10,034.42 100. $10,034.4L 2. A. Members 1st Federal Credit Union - Savings account no. 130002 $12,518.32 100. $12,518.3L (balance as of 12/31/2004) TOTAL (Also enter on line 6, Recapitulation) $ ')1"') ~E= "?J (If more space is needed, insert additional sheets of the same size) LL,;J;J2./. fvlR MEMBERS 1st FEDERAL CREDIT UNION REGULAR SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established 130002 -00 12/02/1992 $12,528.95 $.69 $12,529.64 Aquilla R. Lick 12/02/1992 MFjBERS 1ST ~E.. ~AL ~R. EDIT UNION ,~{11?t'a< // <<?c,;k- 'Denise A. Wolfe / Insurance Services Supervisor March 18, 2005 Estate of: SYBILLA E. GROVE Date of Death: 02/03/2005 Social Security Number: 187-50-0084 5000 Louise Drive . Po.Box40 · Mechanicsburg,Pennsylvania 17055 . (717) 697-1161 . www,members1st.org 'REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GROVE SYBILLA E SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Debts of decedent must be reported on Schedule I. FILE NUMBER 21 05 0129 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Cocklin Funeral Home - funeral $530.70 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Repnesentative (s) Frances E. Kunkle $883.33 Social Security Number(s)/EIN Number of Personal Repnesentative(s) 185281211 Street Addness 5421 Paradise Road City Dover State PA Zip 17315 Year(s) Commission Paid: 2005 2. Attorney Fees Jane M. Alexander, Esquire $2,650.00 3. Family Exemption: (If decedenfs address is not the same as daimanfs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Register of Wills $132.00 5. Accountanfs Fees 6. Tax Return Preparer's Fees $100.00 7. Tina M. Burkey - witness fee $25.00 8. Register of Wills - filing inheritance tax return and Inventory $25.00 9. Halvard E. Alexander - notary fees $30.00 10. Register of Wills - filing release $10.00 TOTAL (Also enter on line 9, Recapitulation) $ 6152.69 (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent GROVE, SYBILLA E. Decedent's Name Page 1 21 05 0129 File Number Schedule H - Funeral Expenses & Administrative Costs - 81 ITEM NUMBER DESCRIPTION AMOUNT B. ADMINISTRATIVE COSTS: Personal Representative's Commissions 2. Name of Personal Representative (s) AQuilla Lick $883.33 Social Security Number(s)/EIN Number of Personal Representative(s) 199342578 Street Address 911 Grantham Road. Box 104 City Grantham State PA Zip 17027 Year(s) Commission Paid: 2005 3. Name of Personal Representative (s) Darvin J. Grove $883.33 Social Security Number(s)/EIN Number of Personal Representative(s) 210326154 Street Address 22 Tannery Road City Dillsburll State PA Zip 17019 Year(s) Commission Paid: 2005 .,., SUBTOT AL SCHEDULE H.B1 $1,766.66 II) o o N uS N ~ Cll ::;, ... .c Q) u.. s Cll C <( II) .... o II) o Q) > e C) u.i ~ :c >- tn e! :E ci z ~ o .... >C o ...:. .lIl::toN :3~~ It: E <( ~.2!o.. .:::; - E ... c Cll l:T1!.c: <(C)- e! .... l! :EmC) - o e Q) c ::;, u.. o I- o o ,,; en M .... 00 0.... 00 o "It CON "E! ~ 5 oS! .~ - Q) -s,tn ::;, ii e S .c :;:; S :s o 'C I- <( tn :E w !:: w Xl ~ () CI .- Z :i;o ><( J: Z o .. c ~ 8- <( GI III J: '&i Q. ~ E; .... GI GI () 0 Z ~ ~ OOCO ooco OOeD MOil) ... ... E l/) .2 GI .. ._ III Q." o 0 o l5 i::r::l!! .- >. GI :!:: CI ~ li.!!.S! OOLL o o i-) ~.f'Q 'it, ~':i ~~s;;.,." --:;? ~. ., ~, ~~>'D ~~ ~ "'-0- 0 g~ ~ en OQ 0000 0000 00";0 enoeno ...... ... .~ .] ~ ~ ~ I- ~ ; S c ii ~ g to Q, E E <( o () GI GI LL GI GI GI U LL GI .~ ~ c:: GI .~ .s U) GI U)~ ~ l5 ~ :i_BE ~~S~ i;'.! ~ i;' 'gcE'g ~~c3~ i.: S .!!! 'C e Q) "E! o iii E ~ ii c o :;:; :s 'C <( co en en .... M N ... Q) .c .s u o Q) ::;, C ~ 0 0 0 0 0 0 0 0 ,,; 0 0 &ri en II) II) en M en 0 M M N ... ,... Ii .:.: Z w ::l!i a.. S Iii a w U) llll Q Z ~ u: .:.: <C LL ::r:: ~ Z 0 S = w a:: .l!l U) ::l!i w 0 U) en a.. ::l!i l- S llll W a U) w .. ~ ::) (.J .s ::i w 0 ;:=- U <3 w w ~ l!! > Z ... C ~ ~ :s !:;!. .S! w 0 'tl tn 1!! LL ::l!i oJ 0 iii 0 w 0 U Di:: GI W 0 0 ~ :::l ::) c:: .... U) c:: 0 ::l U) ::) i III 0 LL ::) <C 0 ::l!i ~ REV-1512 EX + (6-98) *' SCHEDULE' DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GROVE. SYBILLA E. FILE NUMBER 21 05 0129 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. Neighborcare Pharmacy Services, Inc. - expenses of last illness $17.28 2. HCR Manor Care - expense of last illness $534.75 3. Guistwite Family Practice - expense of last illness $110.00 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed. insert additional sheets of the same size) 662.0~ . "V-"""'w COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER GROVE SYBILLA E. 21 05 0129 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE 1. TAXABLE DISTRIBUTIONS [Include outright spousal distributions. and transfers under Sec. 9116 (a) (1.2)] 1. Frances E. Kunkle Daughter 1/5 residue 5421 Paradise Road Dover. PA 17315 2. Sherman Grove Sone 1/5 residue 106 Pine Ridge Road East Berlin. PA 17316 3. Leon Grove Son 1/5 residue 7160 Carlisle Road Dover, PA 17315 4. Aquilla Lick Daughter 1/5 residue 911 Grantham Road, Box 104 Grantham, PA 17027 5. Darvin J. Grove Don 1/5 residue 22 Tannery Road Dillsburg, PA 17027 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET n. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. None $0.00 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. None $0.00 TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ a.O( (If more space is needed, insert additional sheets of the same size) last Bill anh Q}t$tamtnt of SYBILLA E. GROVE I, SYBILLA E. GROVE, of the Borough of Dillsburg, County of York and Commonwealth of Pennsylvania, being of sound mind, memory and understanding, do hereby publish and declare this to be my Last Will and Testament, hereby revokir,g and declaring null and void any and all Wills and Codicils heretofore written by me. ITEM 1. direct that all my just debts and funeral expenses be paid as soon after my demise as may be convenient to the proper administr~tion of my estate. ITEM II. All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, I give, devise and bequeath unto my children, Frances E. Kunkle, Aquilla Lick, Leon Grove, Sherman Grove and Darvin J. Grove, in equal shares- per stirpes and not per capita. ITEM III. order and direct my hereinafter named Execlltors to pay all estate and inheritance taxes prior to further distri- bution of my estate. ITEM V. I nominate, constitute and appoint Frances t. Kunkle, Aquilla Lick and D~rvin J. Grove, Or the survivor of th~m, as Execlltors of this, my L~st Will and Te"tament. direct that my "aid Execu~ors shall not be required to post bond other than their personal assurance for their duties as Executor. IN WITNESS WHEREOF, I, SYBILLA E. GROVE, have hereunto sub- scribed my hand to this my last Will and Testament, this ~ day of /)1 (J 0 , 1982. ~-&a. [, ~~'-~ Sy lla E Grnve SIGNED, PUBLISHED and DFCLARED by the Rbove named SYBILLA E. GROVE, as Rnd for her Last Will and Testament in the presence of us, who at her renuest and in her presence and in the presencA ~f ~ach other, have signed our names as ottesting witnesses hereto. \ .0 I ./ >&~1'~?_i..l~1fl,~Cl "fn~ 7J7 7Yz'f/l# res i ding at ,~tJ~t1fdf-r~ ',~/ . / / residing at o!l jJ hAAAj Po.. -2-