HomeMy WebLinkAbout11-21-14 1505610105
REV-1500 EX(02-11)(R)�
PA Department of Revenue Pennsylvania OFFICIAL USE ONLY
280601 oEP^wTME�r011-11E County Code Year File Number
PO 80X 2
Bureau Individual.Taxes INHERITANCE TAX RETURN
1
Harrisburg,PA 1'7128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
02/27/2014 09/30/1923
Decedent's Last Name Suffix Decedent's First Name MI
_._ ...... _...... .. ..... W........... . -...............
Swartz Sara q
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
n/a
........ . .................. .__ . _.._. i
�...�.. THIS RETURN M� �._, -........ ..... ._ .... - _ _�...
Spouse's Social Security Number
-- UST BE FILED IN DUPLICATE WITH THE
._........_.... _ ........................... .................. REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
C@D 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 C=:) 5, Federal Estate Tax Return Required
death after 12-12-82)
OID 6. Decedent Died Testate C=D 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
C=:) 9.Litigation Proceeds Received C=:) 10.Spousal Poverty Credit(Date of Death C=:) 11. Election to Tax under Sec.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
...... ..._ _ ._.. ..._ ._...... ... .__. .. .. _......................_. - _ .. _. _._ . ....... . ........... _. ..... ..._......._._.
Adam R. Deluca, Esq. (717)249-1177
REGISTER OF WILLS USE Q,gY
s70 rTl
C7
First Line of Address := C�o
.... .......... .. .............. ..............................
61 West Louther Street ' •, ;M rte'
.�
Second Line of Address
T71
City or Post Office State ZIP Code DATE FILEDi C
-. ._
.._........... ......._........___. .. ._.,. .......... ............. i 1—� O
Carlisle �PA (17013
Correspondent's e-mail address:adeluca@keystonehearings.com
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.
SIGNATYR�OF PERSOV,)ESPOf/�ISIB,LE F NG RETURN DATE �/t
ADDRESS
5 Alliance Drive, Apt. 204, Carlisle, PA 17013
SIGNA�OF PREPAR �R TH�y+R ENTCATIVE DAT
IVIM ei
ADDRESS
61 West Louther Street, Carlisle, PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610105 1505610105
1505610205
REV-1500 EX(FI)
Decedent's Social Security Number
Decedent's Name: SARA A. SWARTZ
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 and Notes Receivable(Schedule D).. ............ ........ .. . .. 4.
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. 41,481.50
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. 7,147.81
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested...... .. 7. 49,823.34
8. Total Gross Assets(total Lines 1 through 7). ................. . .. ....... . 8. 98,452.65
p ( )........... ........ 9. ;
9. Funeral Expenses and Administrative Costs Schedule H 11,965.92
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1). ....... ....... 10. 105.51
,
11. Total Deductions(total Lines 9 and 10).... .. .......... . ..... .. ......... 11. 12,071.43
12. Net Value of Estate(Line 8 minus Line 11) . .... .... ... ...... .. .......... 12. 86,381.22
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) .... ...... ..... ......... 13. 1 9,139.47
14. Net Value Subject to Tax(Line 12 minus Line 13) ... ......... . .. ........ . 14. ' 77,241.75
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.0_ 16
17. Amount of Line 14 taxable
at sibling rate x.12 58,962 8117.€ 7,075 54
18. Amount of Line 14 taxable
at collateral rate x.15 18,278.9418 2,741.84
..........................._.... . . .. .. ....... �._........ _.._.
19. TAX DUE . ....... . ....... .......... .......... ... . .... ........ .... . 19., 9,817.38
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
L 1505610205 1505610205
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
SARA A. SWARTZ
STREET ADDRESS
5 Alliance Drive,Apt. 204
CITY STATE ZIP
Carlisle PA 17013
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 9,817.38
2. Credits/Payments
A.Prior Payments 5,000.00
B.Discount 263.15
Total Credits(A+B) (2) 5,263.15
3. Interest
(3)
4. If Line 2 is greater than Line 1 +Line 3,enter the 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) 4,554.23
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 feversionary interest .............................................................................................................................. ❑ E
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?.............................................................................................................. 0 ❑
3. Did decedent own an"in trust for'or payable-upon-death bank account or security at his or her death?.............. ❑ 0
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation? ........................................................................................................................ E ❑
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 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)(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 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 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+(o8-i2)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Sara A. Swartz 21-14-0281
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. Members1st FCU,5000 Louise Dr.,PO Box 40,Mechanicsburg,PA 17055 Savings Acct#425328 1,822.51
2. Members1st FCU,5000 Louise Dr.,PO Box 40,Mechanicsburg,PA 17055 Checking Acct#425328 4,031.72
3. Members1st FCU,5000 Louise Dr.,PO Box 40,Mechanicsburg,PA 17055 Acct#42532818mo CD 2,035.87
4. Wells Fargo Bank,N.A.,PO Box 6995,Portland,OR 97228 Acct#247412083986471 58mo CD 5,605.21
5. Wells Fargo Bank,N.A.,PO Box 6995,Portland,OR 97228 Acct#1554636769 High Yield Savings 12,816.37
6. Wells Fargo Bank,N.A.,PO Box 6995,Portland,OR 97228 Acct#3574230920 Prime Checking 7,199.93
7. Wells Fargo Bank,N.A.,PO Box 6995,Portland,OR 97228 Acct#3000187897887 Way2Save Savings 0.77
8. Wells Fargo Bank,N.A.,PO Box 6995,Portland,OR 97228 Acct#257410050248997 Reitrement CD 4,512.47
9. AAA membership refund 59.72
10. Public School Employees'Retirement System-final benefit payment 1,247.41
11. UnionCentral refund 144.17
12. American General Life Insurance Company policy refund 173.84
13. OPTUM Rx refund 134.09
14. AMA Insurance refund 13.42
15. United States Treasury-income tax refund 1,684.00
TOTAL(Also enter on Line 5, Recapitulation) $ 41,481.50
If more space is needed,use additional sheets of paper of the same size.
REV-15og EX+(oi-io)
I, pennsylvania SCHEDULE F
DEPARTMENTRE JOINTLY-OWNED PROPERTY
INHERITANCECETAXTAX RETURN URN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Sara A. Swartz 21-14-0281
If an asset became jointly owned within one year of the decedent's date of death,it must be reported on Schedule G.
SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A.Loree I. Swartz 5 Alliance Drive,Apt.204, Carlisle, PA 17013 Sister
B.
C.
30INTLY 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 DECEDENT'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INITEREST DECEDENTS INTEREST
1. A. 05/19(77 Series E US Savings Bond($50 face)Serial No.L2078461986E 278.80 50 139.40
A. 04/15/77 Series E US Savings Bond($50 face)Serial No.L2067858514E 276.08 50 138.04
A. 06/08/10 Wells Fargo-58 month CD-Acct#247402083994424 5,583.43 50 2,791.72
A. 11/30/11 Members1stFCU-18 month CD-Acct#425328 8,157.30 50 4,078.65
TOTAL(Also enter on Line 6, Recapitulation) $ 7,147.81
If more space is needed,use additional sheets of paper of the same size.
REV-1510 EX+(08-09)
Pennsylvania
SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Sara A. Swartz 21-14-0281
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 DATE OF DEATH °/a OF DECD'S EXCLUSION TAXABLE
INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND
NUMBER THE DATE OFTPANSR R ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST IF APPLICABLE VALUE
1. Members1st FCU-15 month CD-Acct#425328-Made Joint on 3/11/13 with 12,936.64 50 3,000.00 9,936.64
Loree I.Swartz(sister)
2 Transamerica Life Insurance Company-Annuity#02SFD034871-Named 8,674.27 100 8,674.27
Beneficiary:Loree I.Swartz(sister)transfer date May 20,2014
3 American Genderal Life Companies-Annuity#FJ225980-Named 31,212.43 100 31,212.43
Beneficiary:Loree I.Swartz(sister)transfer date May 26,2014
TOTAL(Also enter on Line 7, Recapitulation) $ 49,823.34
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+ (08-13)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Sara A. Swartz 21-14-0281
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
Ronan Funeral Home-Professional Services of Funeral Director and Staff 11 3,410.00
2 Other Merchandise(outer burial container,memorial package, urn/vase) l� 775.00
Grave opening/closing — 400.00
4. Clergy Honorarium and Organist l 225.00,1
5. Newspaper Notice(Sentinal)
Death Certificates and Coroner Fee Ar 90 00 ii
�. Flowers *(all items paid to Ronan)*.
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:'
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
i 6,100.00 j!
2. Attorney Fees: t
l� J
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) _ J
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: 1+_ 213,50;1
5. Accountant Fees:
6. Tax Return Preparer Fees:
7• jAdditional Short Certificates -- 2000.. `
rr. t Cumberland Law Journal Estate Advertisement w 4 �� 75.00
1-91
Patriot News Company Estate Advertisement 154.741
❑
TOTAL(Also enter on Line 9, Recapitulation) $ — + 11,965.92
If
;
If more space.is needed,use additional sheets of paper of the same size.
REV-1512 EX+(12-12)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Sara A. Swartz 21-14-0281
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. George Branscum,M.D. 10.00
2. Millenium Pharmacy Systems, Inc. 95.51
TOTAL(Also enter on Line 10, Recapitulation) $ 105.51
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(01-10)
�i pennsytvania SCHEDULE J
� i DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
SARA A. SWARTZ 21-14-0281
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. Loree I.Swartz:5 Alliance Dr.,Apt.204,Carlisle, PA 17013 sister 25%
2. Wendy Gingrich: 1 Green Meadow Dr.,Carlisle,PA 17013 niece 5%
3. Bonnie Grove:165 FallsviewAve.,York Haven,PA 17370 niece 5%
4. Phyllis Hurley: 106 W.Big Spring Ave.,Newville,PA 17241 niece 5%
5. Suzanne Clark:34 Parsonage St.,Newville,PA 17241 niece 5%
6. Tom McCullough,Il:506 Lewisberry Rd.,New Cumberland,PA 17070 nephew 5%
7. Peggy Wendling:9941 Acme Rd.,Rittman,OH 44270 niece 5%
8. Sue Walker: 127 Booze Rd.,Shippensburg, PA 17257 niece 5%
9. Kay Rentzel:22 Triplett Ct.,Dillsburg, PA 17019 niece 5%
10. see attachment A for remainder
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 UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
The Huntsdale Church of the Brethren:170 Church Rd.,Carlisle,PA 17015 15%
2. Childrens Aid Society Southern PA Church of the Brethren 343 Lincoln Way W.,New Oxford,PA 17350 10%
TOTAL OF PART II—ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 9139.47
If more space is needed,use additional sheets of paper of the same size.
SCHEDULE J CONT'D
TAXABLE DISTRIBUTIONS
10. Amy Despine: 419 Penn St., Hanover, PA 17331 Niece 5%
11. Ray E. Swartz, II: 3153 Smoketown Rd.,Spring Grove, PA 17362 Nephew 5%
LAST WILL AND TESTAMENT OF
SARA SWARTZ
I, SARA SWARTZ, of Cumberland County, Pennsylvania, declare this to be my
Last Will and Testament and hereby revoke all prior Wills and Codicils.
1. I direct that all my just debts, funeral expenses, and administrative
expenses shall be paid from my estate as soon as practicable after my death. It is my
wish that upon my death my body shall be cremated and my ashes shall be buried in my
plot in Prospect Hill Cemetery,Newville,PA.
2. I give my hummel figurines to my two sisters and my two sisters-in-law,
to share equally, per stirpes.
3. I direct that the rest, residue, and remainder of my estate shall be given,
devised, and bequeathed as follows:
a) I give twenty-five (25%)percent to my sister, Loree I. Swartz;
b) I give fifteen (15%)percent to the Huntsdale Church of the Brethren;
c) I give ten(10%)percent to The Children's Aid Society of New
Oxford,Pennsylvania; and
d) I give fifty (50%)percent to my nephews and nieces,to share equally,
per stirpes.
4. I appoint my sister, Loree I. Swartz, as Executrix of this my Last Will and
Testament. In the event that Loree is deceased,unable or unwilling to serve, or shall
cease to serve for any reason whatsoever, then I nominate, constitute and appoint my
niece, Suzanna L. Clark, as alternate Executrix of this my Last Will and Testament.
5. The Executor or Executrix of this Will shall have the power to distribute
my estate in cash or in kind, or partly in either.
6. I direct that no Executor or Executrix acting under this Will shall be
required to enter bond in any jurisdiction.
7. I recommend that my Personal Representative retain the law firm of Allied
Attorneys of Central Pennsylvania, L.L.C., to probate my estate.
Page 1 of 4
WITNESS WHEREOF, I have hereunto set my hand this day
of 2012.
SARA SWARTZ v
The preceding instrument consisting of this and three other pages was on the day and date
hereof signed,published and declared by SARA SWARTZ, as and for her Last Will and
Testament in the presence of us,who at her request, in her presence, and in the presence
of each other have subscribed our names as witnesses hereto.
Witness Winess
Page 2 of 4
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
: SS
COUNTY OF CUMBERLAND
I, SARA SWARTZ,the TESTATRIX,whose name is signed to the attached or
foregoing instrument,having been duly qualified according to law,do hereby acknowledge
that I signed and executed the instrument as my Last Will and Testament;that I signed it
willingly, and that I signed it as my free and voluntary act for the purposes therein
expressed.
SARA SWARTZ U
Sworn or affirmed and acknowledged before me by SARA SWARTZ,the TESTATRIX,
this day of ,2012.
Xotary Pugic/At�torney
SIE E C!IE;ITOK, Nma,�y Public
C afjj�jq Boio,Cumberland County
1�"l ;0
�My Commission Expires March 24,2015
y Commission ren 1,S�1100"1,CExp`1
Page 3 of 4
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND
UVv\-
WE, WJcand 0..c.1 A
the witnesses whose names are attached to the foregoing document, being duly quali ie
according to law, do depose and say that we were present and saw testatrix sign and
execute the instrument as her Last Will; that she signed willingly and that she executed it
as her free and voluntary act for the purposes therein expressed; that each subscribing
witness in the hearing and sight of the testatrix signed the Last Will and Testament as
witnesses and that to the best of our knowledge the testatrix was at the time 18 or more
years of age, of sound mind and under no constraint or undue influence.
Sworn or affirmed and subscribed before me by
(lam vr'a., andthis
?k- &i4�-T-
I(¢ day of J U l 52012.
otary lic/A omey
NOTA Al SSEAI
P� IAP�P•P�a�lP i.iOP�,P�%ctG'�y i�a]�cArlisle
'BOTo,Cumberland Cou
�:-C1-�� ;f?'•.i'sSPt�13 Exp Sros f`iIa,1Ch 24
Page 4 of 4