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Home My WebLink About11-26-14 1505610143 REV-1500 EX(02-11) OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code Year File Number Bureau of Individual Taxes o Akr"wrurwvms PO BOX-260801 INHERITANCE TAX RETURN 21 11 01051 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 03 10 2009 07 13 1920 Decedent's Last Name Suffix Decedent's First Name MI 14ANN HELEN L (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name SUMX Spouse's First Name Mf Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return Q 2 Supplemental Return E] 3. Remainder Return(DMB of Death Prior to 12-13-82) 4.Limited Estate 4a.Future Interest Compromise5. Federal Estate Tax Return Required (date of death after 12-12-82) F] 6. Decedent Died Testate D • (A =� d W� Rnj (At1-hCQj3yQ{WiV) t)a Living Trust 8. Total Number of Safe Deposit Boxes 9,Litigation Proceeds Received E] to.r=rlv�o 2ygl%credit 1p F ,ale a ocath I and .95 F I I.Efecton to tax under Sec.911 13(A) (Attach Schedule 0) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number AARON C JACKSON ESQ 717 237 4800 REGISTEftOF WILLS USE-ONLY First Line of Address C 7 = t => FTI 409 NORTH SECOND STREET C7:) cl T1 Second Line of Address SUITE 500 City or Post Office State ZIP Code 17DATE FILED HARRISBURG PA 171011357 ---i rTj CZ) -T! Correspondent's e-mail address: aaron.14cks2n@bipc.com Under penalties of perjury,Ideclare that hT=yarnred this return including acrompanyfng schedules and statements,and to the best of my knowledge and bellef, It Is truf.correct and complete.De ration preparer other than the personal representative,Is based on at[Information of which preparer has arty knowledge. SIGNA a P RSON R )NM F FM RETURN DATE Holly L.Ritchey ADDRESS 0 1204 Allendale Roa ,MechanlcsbttPA 17055 SIGNATURE OF PSEPARM OTHER THAN REPRESENTATIVE DATE Aaron C.Jackson Esq. ADDRESS 409 North Second Street,Suite 500,Harrisburg,PA 17101-1357 Side 1 1505610143 1505610143 PA Inheritance Tax Return Signature of Additional Fiduciaries ESTATE OF FILE NUMBER Mann, Helen L. 21-11-01051 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 then the personal representative is based on all information of which preparer has any knowledge. y� Signature#2 Name GregoryZAllann Address1 9455 Southern Hills Circle Add ress2 City, State,Zip Lone Tree,CO 80124 �. Date z Signature#3 Name Barry A.Mann AddreSsl 107 Stoopville Rd. Address2 City,State,Zip Newtown,PA 18940 Date PA Inheritance Tax Return Signature of Additional Fiduciaries ESTATE OF FILE NUMBER Mann, Helen L. 21_19-01051 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 belier,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#2 Name Gregory E.Mann Address1 9455 Southern Hills Circle Address2 City, State,Zip Lone Tree,CO 80924 Date Signature#3 Name Barry A.Mann Addressl 107 Stoopville Rd Address2 City,State,Zip Newtown,PA 18940 OJDate 1505610243 REV-1500 EX Decedent's Social Security Number Decedents Name: Mann, Helen L. RECAPITULATION 1. Real Estate(Schedule A)....................................................................................... 1. 2. Stocks and Bonds(Schedule B)............................................................................. 2. 11, 036. 58 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. 1, 116. 46 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers&Miscellaneous N Probate Property (Schedule G) u Separate Billing Requested............ 7. 8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 121153. 04 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 12 , 153 . 04 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J)............................................... 13. 14. Net Value Subject to Tax(Line 12 minus Line 13)............................................... 14. 12 , 153. 04 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 . 00 16. Amount of Line 14 taxable 12 ,153 . 04 16. 546. 89 at lineal rate X .045 - 17. Amount of Line 14 taxable at sibling rate X.12 0. 00 17. 0 . 00 18. Amount of Line 14 taxable at collateral rate X.15 0 . 00 18. 0 . 00 19. TAX DUE................................................................................................................ 19. 546. 89 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑ Side 2 1505610243 1505610243 REV-1500 EX Page 3 File Number 21-11-01051 Decedent's Complete Address: DECEDENT'S NAME Mann, Helen L. STREET ADDRESS 1778 Winterhaven Drive CITY STATE ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2, Line 19) (1) 546.89 2. Credits/Payments A. Prior Payments B. Discount Total Credits(A +B) (2) 3. Interest (3) 4, If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) 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) 546.89 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............................................................................................................... ❑ ❑ 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 1:1 El abeneficiary 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 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-1503 EX+(6-98) SCHEDULE B .rR STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Mann, Helen L. 21-11-01051 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 GE Stock 11,036.58 TOTAL(Also enter on Line 2, Recapitulation) 11,036.58 (If more space is needed,additional pages of the same size) Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule B(Rev.6-98) Rev-1508 EX+(11-10) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Mann, Helen L. 21-11-01051 Include the proceeds of litigation and the date the proceeds were received by the estate. All propertyjointlyowned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Genworth Financial -Unclaimed property refund 966.70 2 USAA-Unclaimed property refund 149.76 TOTAL(Also enter on Line 5, Recapitulation) 1,116.46 (If more space is needed,additional pages of the same size) Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev. 11-10) REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Mann, Helen L. 21-11-01051 RELATIONSHIP TO NUMBER NAME AND ADDRESS OF DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE PERSON(S)RECEIVING PROPERTY stees (Words) ($$$) Do Not List Tru ITAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] Barry A. Mann Son One Third of 107 Stoopville Road Residuary Estate Newtown,PA 18940 Gregory E. Mann Son One Third of 9455 Southern Hills Circle Residuary Estate Littleton,CO 80124 Holly L. Ritchey Daughter One Third of 1204 Allendale Road Residuary Estate Lemoyne, PA 17043 Total Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appopriate. 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) --- Commonwealth of Pennsylvania 1 of 1 Remittance Advice 000462 57 17664480 Pennsylvania Treasury - Bureau of Unclaimed Property Payment C AZA. a 77717220 -------------------------------------------------------------------------------- i�aert,r 113 Holder Name Description Amount :2123124 E_:ERAL ELECTRIC COMPAN DIV REINVESTMENT 11,036.58 Total: 11,036.58 i t I ' I � O C> ' L7 c PAYEE INFORMATION: NOTE: Direct payment inquiries to: MANN HELEN M ESTATE OF PA Unclaimed Property 1.800.222.2046 1204 ALLENDALE RD P.O. Box 1837 MECHANICSBURG 'PP,-1`7055=PAUS ' - Harrisburg; PA 17105-1837 FOLD ON PERFORATION,THEN DETACH CAREFULLY I i f Genworth Financial a GEN-WORTH LIFE AND ANNUITY INSURANCE A'"^4: UNCLAIMED PROPERTY PO BOX 1280 LYNCHBURG VA 24505 I i 9=-----32157 1 1 0770 103 c k iEyN MANN .ESTATE f C-/O HOLLY RITCHEY 1204 ALLENDALE RD ECHANIECSBURG PA 17055 Check Summary Rep I aces ck # 26365967 CHECKNUMBER CHECK DATE PAYEE TOTALAMOUNT 9000002157 111/10/141 HELEN MANN ESTATE $966.70 aJm,011C3 an Please detach before negotiating check Genworth Financial +#+ 9000002157 51194 GENVORTH LIFE AND ;NZITY INSURANCE ATTN: UNCLAIMED PROPERTY PO BOX 1280 110398035 LYNCHBURG VA 24505 DATE OF CHECK PAY: NINE HUNDRED SIXTY SIB AND 70/100 DOLLARS 11/10/14 TO THE ORDER OF HELEN MANN ESTATE H C/O HOLLY RITCHEY 1204 ALLENDALE RD CHECKAMOUNT MECHANICSBURG PA 17055 $966.70 P�rrarazl 14 c`r C�/rrirui i saraK of nws�ttica N.n. Authonzed Signature 118900000 2 L S Iii' i:0 L &90044 Si: LO 76 711' ,� t�iMBER 1 kSgdE'Sid[SEr �O LATE 10-31=2014. 00182. 1 Sar. ,Asltonio. Texas 78288 �+C3,13.u^-i'.tSSlri=i3L_/l_R1_l�" EST OF ?MS HELEN MhNN C�O EOL�LY L RII� 1 04 As LENDALE RD ` MECHANICSBURG PA 17055-4407 E I Attached is a check to replace check number 005273318 previously issued on 10-14-2014 . We are issuing this replacement check at 18433-1013 FACE OF DOCUMENTHAS A COLOREA)BACKCROUNDA111',RACK-CONTAINS ANARTIFICIAL I%ATERNIARK.1101.1)AT ANGLE TO VIEW. 51-44/119 CT 5315756 pok11'Tt DATE USAA NUMBER 9800 Fredericksburg Road .: >z s- 10-31-2014 00182 79 62 San Antonio, Texas 78288 USAA® REPLACES CHECK NR 005293319 DATED 10-14-2014 PAY *—ONt HUNDRED FORTY NINE AND 76/100 DOLLARS TO THE ORDER OF FST OF MRS HELEN MANN ******149. 76 BANK OF AMERICA HARTFORD, CONNECTICUT 11'00053 1575611' 1:0 L L900445i: 2 24000983411'