HomeMy WebLinkAbout10-03-14 � 1505610143
REV-1500 Ex`°z_,,,
OFFICIAL USE ONLY
PA Department of Revenue pennsylvania County Code Year File Number
Bureau of Individual Taxes �P�TMENTOFREIIENUE
Po BOx.28o60� INHERITANCE TAX RETURN 21 �'
Harrisburg, PA 17128-0601 RESIDENT DECEDENT �y' ��5,
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
01 02 2014 08 06 1954
DecedenYs Last Name Suffix DecedenYs First Name MI
BANKS TIMOTHY J
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Su�x Spouse's First Name MI
� Spouse's Social Security Number
' THIS RETURN MUST BE FILED IN DUPUCATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
� 1. Original Retum � 2. Supplemental Return � 3. Remainder Return(Date of Death
Prior to 12-13-82)
� 4. Limited Estate � 4a.Future Interest Compromise � 5. Federal Estate Tax Retum Required
(date of death after 12-12-82)
� g Decedent Died Testate � pecedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) ❑ (Attach Copy of Trust) .
9. litigation Proceeds Received �p,Spousal Ppvert Credit Date of Death 11.Election to tax under Sec.9113 A
❑ between 12-31�31 and�-�-ss� � (qttach Schedule O) � �
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
LINDA J OLSEN 717 540 4332
�..,
RE�TER OF WI�USE Ot�Y-
c -� �D rn
First Line of Address � � � � p
fri -;--� n —i �r) �7
2000 LINGLESTOWN ROAD :-� ,_;� r-... ---� �.�
r-- ::,., �--� :.':) C7
Second Line of Address "� : 7 �"�
�.r:
SUITE 202 � ' --� `�"' `�
� ''.? '"r'j �'i
'D7kTE F�D -R' �
City or Post O�ce State 21P Code - -'-
HARRI SBURG PA 17110 —� ~ r-- rn
H C!� 0
° w '*7
CorrespondenYs e-mail address: lolsen@hazenelderlaw.com
Under penalties of pery'ury,I deGare 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.DeGaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON R FILING RETURN
^ AT� / ,/
- Thomas J. Banks � �
ADDRESS
_ 122 No. Paxtanq St., Harrisburg, PA 17111
SIGNA�TU OF PREPAR R OTH THAN REPRESENTATIVE DATE
Linda J.Olsen �_ —(
ss
2000 Linglestown Road, Harrisburg, PA 17110
Side 1
L 1505610143 1505610143 J
� 1505610243
REV-1500 EX
DecedenYs Social Security Number
Decedenl'sName: Ban�(S� Timothy James
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... 1.
2. Stocks and Bonds(Schedule B)............................................................................. 2.
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. 7 , 4 62 . 4 7
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers&Miscellaneous N�q-Probate Property
(Schedule G) ` ' U Separate Billing Requested............ 7.
g. Total Gross Assets(total Lines 1 through 7)........................................................ g. 7 , 4 62 . 4 7
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 1 , 58 6 . 7�
10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule I)............................ 10. 18 , 573 . 52
11. Total Deductions(total Lines 9 and 10)................................................................ ��. 20 , 160 . 22
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. -12 , 697 . 7 rJ
13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J)............................................... 13.
14. Net Value Subject to7ax(Line 12 minus Line 13)............................................... 14. -12 , 697 . 75
TAX COMPUTATION-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.00 15. 0 . 0 0
16. Amount of Line 14 taxable
at lineal rate X .045 0 . 0� 16. 0 . 0�
17. Amount of Line 14 taxable
at sibling rate X.12 0 . �� 17. � . ��
18. Amount of Line 14 taxable
at coilateral rate X,15 � . �� 18. � . �0
19. TAX DUE................................................................................................................ 19. � . ��
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. �
Side 2
� 1505610243 1505610243 J
REV-1500 EX Page 3 File Number 21
DecedenYs Compiete Address:
DECEDENT'S NAME
Banks, Timothy James
STREET ADDRESS
Green Ridge Village
CITY STATE ZIP
Newville PA 17241
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. �q�
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.
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;or............................................................................................................... ❑ ❑X
d. receive the promise for life of either payments,benefits or care?............................................................ � O
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?.................................................................................................................... ❑ 0
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?.................................................................................................................. ❑ �
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)(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 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 decedenYs 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 decedent's 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-1508 EX+(11-10�
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, 8� MISC.
' DEPARTMENT OF REVENUE
� INHERITANCETAXRETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Banks, Timothy James 21
�
4 Include the proceeds of litigation and the date the proceeds were received by the estate.
� All property jointly-owned with the right of survivorship must be disclosad on schedute F.
�
I
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Advocacy Alliance 6,183.4T
2 Social Security-payment received after death 1,279.00
TOTAL(Also enter on Line 5,Recapitulation) 7,462.47
(If more space is needed,additiona!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) sC H E D U L E H
pennsylvania
DEPARTMENT OFREVENUE F U N E RAL EXP E N S ES AN D
INHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Banks, Timothy James 21
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
q, FUNERAL EXPENSES:
See continuation schedule(s) attached 256.22
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Thomas J. Banks
StreetAddress 122 No. Paxtang St.
C�ty Harrisburg state PA zio 17111
Year(s)Commission Paid 2014 309.00
2. Attorney's Fees Hazen Elder Law 1,000.00
3. Family Exemption: (If decedenYs address is not the same as claimanYs,attach explanation)
Claimant
Street Address
City State Zio
Relationshio of Claimant to Decedent
4. Probate Fees
5. AccountanYs Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 21.48
See continuation schedule(s) attached
TOTAL(Also enter on line 9, Recapitulation) 1,586.70
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
Banks, Timothy James 21
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Ex enses
1 Funeral luncheon -BJ's Steak& Rib House 256.22
H-A 256.22
Other Administrative Costs
2 Hazen Elder Law-disbursements 6.48
3 Register of Wills-filing fee for inheritance tax return 15.00
H-B7 21.48
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98)
Rev-1512 EX+��y-pg)
' SCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF REVENUE
I INHERITANCETAXRETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Banks,Timothy James 21
i
; Report debts inaurred by the decedent prior to death that remained unpaid at the date of deatb,including unreimbursed medical ezpenses.
i ITEM VALUE AT DATE
i NUMBER DESCRIPTION OF DEATH
i 1 DPW-Class 3 claim (total claim$519,949.41) 18,573.52
i
TOTAL(Also enter on Line 10, Recapitulation) 18,573.52
(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)
pennsyivania $CHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN B E N E F I C IARI ES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Banks,Timoth James 21
RELATIONSHIP TO
NAME AND ADDRESS OF SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT
(V1lords) ($$$)
' I� TAXABLE DISTRIBUTIONS [include outright spousal
� distributions,and transfers
� under Sec.9116 a 1.2
; 1 Elizabeth Banks Mother 100%of the
' Newville,PA estate
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-TAXABLE 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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C L I E N T U E N E R A l F U t3 D G f E P. A T I �d G q E P 0 R T
�3,467.OQ
C�IENT 9AN200 TIM�THY BANKS SSJI 165-52`86�41 PRES@NT �u�IAL aCGOU��T TOTAL:
TRAPISALT:Or15 FOR P=�ItlD 10j01;+2093 TC 12�31J210a
TRX
,)R�dL TYF EOD DATE ACCOUNTt! OESCRIpTIRN CHErK.fP.EF�I pA.TE REAS� INC SRCJVENDR 7RX AMOUr�T BALAN�E
---- ------^------�--- ------ �--______ -__- _..____ -_-----_ .�_-____ ----
_____9C....________7G�=�=.�=���.G_-_.-_...�___�.--._____`G�e�."__������:.___._._.....']G_�°-___ ^G--_-_-- �G�____�.�7C�=--._.._._P
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B�G ent: s;,s4�,1&
CRJ �r;c 'EO/03�13 55ti soc SEC ADM IN�o*tE 3375211 1Qf0���13 S9C s�c ADM SN 1,259.00 ?,2n7.18
��DJ OE 'f0/07f13 57Qd00 MISC. EXPENSE '1�J07/13 D1S' EXP 23�000 -2_ln �+.205.�8
".D.! ExP 10j'16J�3 51U00� RoD�&BOARD-RE1�TfMORT 1:52151 'i4(16/13 GREEtd RiDGE vl�Lkr,E -3,665.51 5,539.57
CDJ ExP 10f16f13 590000 P�NTHLY fEE WdEi?4 10�':6,113 MPNTHLY FEE 1 THE A�Ut�CACY A -35.00 5,564.57
LPJ �XF 1pf21/'13 5?'��0 PtxsC. ExPEtdSE 155Z447 10f21f13 ?RES8Y7ER2Ara aor�S -�Z.qO 5,492.5�
GA.J ANC 11�09�13 Ssk S0: S�C ADt�i INCONE 15fl6447 1'1f0i�13 90t 5E� A6M IF! 1,259.00 5,751.57
CDJ RE 11/05�13 5?��00 NISC_ EXPE��SE 13jO5f13 QIST �XF 2f1fX}L3U -'I.50 6,?50.07
rbJ EY,P 11�06j13 521d00 PEaSC���AL-SPE�90I"I6 15E952b 19%O6/13 SPA� -E�.00 5,670_Oi
rRJ D{ 11?07;`13 4'C,'0000 PISTRIBiJTEO [NCOME -�OOOQOUO 11jOT/13 1RAN blsT iNCGYE TCt DISTRIBUSED IN �6.t7 5,fi,96-8�+
CD,I E7tF 91/19f13 59000b t�10'+i7HLY FEE OOtlSi?9 'i1j'i9/13 MOh�TNE.Y FEE 1 THE AL�VOCACY R �35.001 6,651.�4
CRd tr�c 12Jo3/�3 s�A SOC SE4 ADM I:47CGn� �381�1 12f'Q��13 SOC SEC A6M Ihl 1r259.00 i,91�.84
CDJ D� 12/Qb/13 57QOCId MISC, E?fPENSE 12�05/13 D�S7 EXP Z9CY300 -1.&9 7.9Ck3.96
COJ EXP 12f'12f13 529tX?d PERSONAI�SP�h.DIh� 1573083 92J12�?3 xMAS SPOG -�Qf3.04 7,4Q8.96
GbJ E.\'P 12)1C�f13 51��OQ0 RC1fIM&Ei.^.ARa-RE��7�l10RT 957�t$Sb 1c�j'16f13 GREEN RIC6E VII.LAGE -1,199.49 6r21$.4�
�D,! EXP 12J17'13 59�J hit)tvTHLY' FEE ' s p
CR.t INC 03�14 SSA SQC . OME 1S�T79'1 01;03(14 SOr �E� qp11 iN 1,2i9.Q� 7,45t.47
CDJ Oc t�1�07f'f4 S70C100 MtSt. EJCPENS� U1 ja7f1=� DI.ST EXp 2E0(�0 -2.12 r,460.35
cP� DI 01 j08�'14 t,BQp� 4IS'�RtBU7ED INC6�9E -��000000 d1!QSJ14 1'RAti OiST ��COnE TO �:5TRZ8urE4 IN 20.46 7,u8D.81
CDJ ExP 01j22f14 570��C1 nisc. �r,PEhs� 1�8Gb74 01,l22f'94 V.L. SEEBdID fuuERAt� -�,r63.04 4,71�.3`1
C6J pE 02J06f14 57GDOQ MISL. E�PENSE 02f06�14 DZST ExP 28000�7 -'�.83 L,715.�$
7RANSACTIbN COlih�7: $(J �h1� Br1_: $G;?15.9$
H�� �� �W Estate P[anning • Elder Law • Special Needs Planning
2000 Linglestown Road �.:(71'�540-4332
Suite 202 Fnx: (71�540-4313
Harrisburg, PA 17110 www.HazenElderLaw.com
October 2, 2014
�
CERTIFIED MAIL � � ;� ,.��
Register of Wills � � � � �
Cumberland County Courthouse '`'� " c> � r� �
One Courthouse Square +��� �-; r�+ -; �n
;�. ��} - ., � � i:;�
Carlisle, PA 17013-3387 ", . ; ,, C.,,
. ' c: � � �y� �
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m��ri �
Re: Estate of Timothy James Banks ' _, =- r�
�
File No.: °`, __.; � rn
Social Security No.: 165-52-8641 ` w � `�
Inheritance Tax Return
To: The Register of Wills:
Enclosed for filing please find the original and one copy of the above-referenced
Inheritance Tax Return, along with a copy of the first page of the Inheritance Tax Return.
Please date stamp the first page of the return and return it to my office in the enclosed
self-addressed envelope.
Also enclosed is a check for the filing fee in the amount of$15.00. Please note
that a member of the Banks family will be providing your office directly with a certified
death certificate for the decedent.
If you have any questions, please do not hesitate to contact me.
Sincerely,
C� �� ���x'-.r��v
Corinne Eggers Woodhouse
Paralegal
Enclosures
cc: Thomas Banks, PR
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