HomeMy WebLinkAbout12-03-14 ,I
1505610143
REV-1500 Ex(02-11),ff
PA Department of Revenue y OFFICIAL USE ONLY
p Penns Ivania County Code Year File Number
Bureau of Individual Taxes DEPARTMENT OF REVENUE
PO BOx.280601 INHERITANCE TAX RETURN 21 14 00478
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
03 12 2014 03 28 1945
Decedent's Last Name Suffix Decedent's First Name MI
PERRY SR BARRY E
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
PERRY I MARJORIE K
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 2. Supplemental Return 3. Remainder Return(Date 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)
6 Decedent Died Testate 7. DecedenMaintained
aiinnt ined a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) CopyC Trust)
F] 9. Litigation Proceeds Received ❑ 10.b iween Po e, and -1-95�f Death F 11.Election to tax under Sec.9113(A)
(Attach Schedule O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
MARK A MATEYA 717 241 6500 }
REGIeEMOF WILL&VSE 4128
M -C.1 Crnj tlf
First Line of Address
55 W CHURCH AVENUE �, Wro
Second Line of AddressCD -TI
Q _
-' � I V r" rr11
City or Post Office State ZIP Code OA(TE FILED
CARLISLE PA 17013
:i
Correspondent's e-mail address: roam mateyalaw.com
UnderASenalties of perjury,I declare that I h e examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is tr e,correct and complete.Delaratioryof preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSONRESPONSI LE FOR NG URN DATE
arjorie K Perry
ADDRESS
1812 Fa' la CourtRock Hill SC 9732
SIGNTURE O EPARER��RESENTATIVE DTE
Mark A. Mateya h Z Z j
ADDRESS
55 W. Church Avenue, Carlisle, PA
Side 1
1505610143 1505610143 J
1505610243
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: Perry, Barry E Sr
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... I.-
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. . 14 , 608 . 86
6. Jointly Owned Property(Schedule F) ❑X Separate Billing Requested............ 6. 123,359. 91
7. Inter-Vivos Transfers&Miscellaneous Inn,-Probate Property
(Schedule G) u Separate Billing Requested...:.!...... 7.
8. Total Gross Assets(total Lines 1 through 7).....................1.................................. 8. 137 , 968 . 77
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 20, 721. 30
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 49, 517 . 92
11. Total Deductions;(total Lines 9 and 10)................................................................ 11. 70 ,239.22
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 67 , 729. 55
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 Line13)............................................... 14. 67 , 729. 55
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 31,182 . 87 15. 0 . 00
16. Amount of Line 14 taxable 36,546. 68 16. 1, 644 . 60 .
at lineal rate X ..045
17. Amount of Line'14 taxable
at sibling rate X.12 17. 0 . 00
18. Amount of.Line 14 taxable
at collateral rate X.15 0 . 00 18. 0 . 00
19. TAX DUE................................................................................................................ 19. 1, 644 . 60
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. E
Side 2
150561024.3 1505610243 J
REV-1500 EX Page 3 File Number 21-14-00478
Decedent's Complete Address:
DECEDENT'S NAME
Perry, Barry E Sr
STREET ADDRESS
280 Chestnut Drive
CITY STATE ZIP
Shippensburg PA 17257
Tax Payments and Credits:
1. Tax Due(Page 2, Line 19) (1) 1,644.60
2. Credits/Payments
A. Prior Payments
B. Discount 0.00
Total Credits(A +B) (2) 0.00
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) 1,644.60
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;............................................................................... ❑ ❑x
b. retain the right to designate who shall use the property transferred or its income;.................................. ❑ ❑x
d. receive the promise for life of either payments,benefits or care?..................................................... x
c. retain a reversions interest;or..............
P PY ❑ ❑x
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?....... ❑ ❑x
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 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 172 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, & MISC.
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Perry, Barry E Sr 21-14-00478
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 disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Cash-Proceeds from yard sale of personal items,tools,fishing&hunting equipment 1,560.00
2 Members 1st Federal Credit Union-Savings Account No. 403172-00 24.86
3 Automobile-1994 Ford F150 Truck-Good condition-Kelly Blue Book appraisal-See 2,000.00
Attached
4 Gun Safe-Stack-On Gun Safe-Model E-24-MB-E-S Elite Fire resistant safe 799.00
5 Juke Box-Rock-Ola"Ultra"Jukebox-Serial#360984-Appraised by Ted Fike. See Attached 1,400.00
Appraisal
6 Miscellaneous -lawn mowers 450.00
7 Miscellaneous Shotguns,Pistols&Crossbow 7,400.00
8 Trailer/Hauler-North Newton Trailer-6 x 8-VIN#4KPBF1113DNO08086 975.00
TOTAL(Also enter on Line 5, Recapitulation) 14,608.86
(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)
Kelley Blue Book Page 1 of 2 ✓
= 4
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'
Margie
From: Bommeremuse@aoicum
Sent: Thursday,June Z6' 2OI412:34PK4
To: Perry, Margie
Subject: Rock-Ola ^U|tra^ Jukebox Appraisal
The following is a basic, retail appraisal to the best of my experience and ability for the above mentioned juke box serial#
3OO984ofthe 1g8D'sera:
Based onthe cosmetic condition himin (very good\. considering itk; ingood working condition and full ofrecords, that
machine on my sales floor would be have been listed for$1,400.00 with the lowest selling price being $1,200.00.
| started inthe home amusement business asenextended hobby in the 1970'sand have sold approximately 50
restored/repaired jukeboxes per year for many years prior to me selling the business in 2007. Please call mewith any
questions 703-618-0987. TedFika
'
'
�
Rev-1509 EX+(01-10)
pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Perry, Barry E Sr 21-14-00478
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. Marjorie K Perry 280 Chestnut Dr . Spouse
Shippensburg, PA 17257
B. John Davidson 6 Dykeman Road Son-in-Law
Shippensburg, PA 17257
C.
JOINTLY OWNED PROPERTY:
DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM LETTER DATE FOR JOINT MADE INCLUDE NAME OF NUMBEER OR SIMILARnANCIAL IDENTIFY NG(TUTION AND BANK NUMBER.ATTACH DEED OUNT FOR DATE OF DEATH DECD'S DECE ENT'S INTEREST
VALUE OF
NUMBER TENANT JOINT JOINTLY-HELD REAL ESTATE. VALUE OF ASSE INTEREST
1 A Members 1st Federal Credit Union-Checking 1,159.12 50.000% 579.56
account No.xxx93-Jointly owned with
spouse
2 A Members 1st Federal Credit Union -Account 3,220.58 50.000% 1,610.29
No. xxx93-Savings Account-Jointly owned
with spouse
3 A Orrstown Bank-Checking account xxx758- 1,355.62 50.000% 677.81
Jointly held with spouse
4 A 01/26/2006 Real Estate-280 Chestnut Drive, 182,500.00 50.000% 91,250.00
Shippensburg, Cumberland County-See
Attached HUD-1
5 B 07/22/2004 Real,Estate-655 Wild Area Lane,Mifflintown, 116,969.00 50.000% 58,484.50
Juniata County-Parcel No. 2-1-18-Jointly
owned with son-in-law John Davidson-Fair
Market Value SEPARATE BILLING
REQUESTED ON THIS ASSET FOR 1/2 OF
THE VALUE($29,242.25)AT THE LINEAL
RATE. SPOUSE WILL RECEIVE THE
REMAINING 1/2($29,242.25)AT SPOUSAL
RATE.
TOTAL(Also enteron Line 6, Recapitulation) 152,602.16
(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 F(Rev.01-10)
REV-1511 EX+(10-09)
pennsylvania. SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITACE TAX
RESIDEN"DEC ENTTURN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Perry, Barry E Sr 21-14-00478
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 12,465.40
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State ZiD
Year(s)Commission Paid Waived
2. Attorney's Fees Mateya Law Firm 7,500.00
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation)
Claimant
Street Address
City State ZiD
Relationship of Claimant to Decedent
4. Probate Fees 343.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 412.40
See continuation schedule(s)attached
TOTAL(Also enter on line 9, Recapitulation) 20,721.30
Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev. 10-09)
i
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Perry, Barry E Sr 21-14-00478
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Expenses
1 Fogelsanger Bricker Funeral Home-Funeral Services 11,495.40
2 Jim Hipich -Fee for grave opening 100.00
3 Spring Hill Cemetery-Purchase of burial plot 870.00
H-A 12,465.40
Other Administrative Costs
4 Cumberland County Register of Wills-Fee for filing of Surety Bond 15.00
5 Cumberland Law Journal-Legal Advertisement 75.00
6 Sally J.Winder, Esq-Legal Fees for Real Estate Settlement;See attached HUD-1
7 State Farm Insurance-Surety Bond 100.00
8 The Sentinel -Legal Advertisement 222.40
H-B7 412.40
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98)
Rev-1512 EX+(12-08)
SCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Perry, Barry E Sr 21-14-00478
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 Chambersburg Hospital-Medical expenses not covered by insurance 300.00
2 Johns Hopkins Physicians-Medical expenses not covered by Insurance 298.08
3 Members 1st Federal Credit Union-Mortgage-Loan No. L0004 3,054.78
4 Orrstown Bank-Open End Loan-Account No. 209035 1,110.16
5 Orrstown Bank-Mortgage-Account No. 3000648-One half of amount due as decedent and 43,922.43
spouse liable for debt
6 Summit Cancer&Hematology-Medical expenses not covered by insurance 35.00
7 Summit Physician Service-Medical services 536.92
8 West Shore EMS-Ambulance Service on 3/11/14 260.55
TOTAL(Also enter on Line 10, Recapitulation) 49,517.92
(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-1613 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Perry, Barry E Sr 21-14-00478
NAME AND ADDRESS OF RELATIONSHIP TOSHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT
tee(s) (Words) ($$$)
0 of List Trus
I� TAXABLE DISTRIBUTIONS [include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
1 Renea Brenaman Child One-third(1/3)of 12,347.42
1088 Heritage Ave one-half(1/2)of
Shippensburg, PA 17257 residual estate
Plus Juke Box&
2 Shelly Davidson Child One-third(1/3)of 13,122.42
6 Dykeman Road one-half(1/2)of
Shippensburd,PA 17257 - residual estate
plus guns,
3 Barry E Perry Jr Child One-third(1/3)of 15,547.40
Fayette Street one-half(1/2)of
Shippensburg, PA 17257 residual estate
plus Truck and
4 Marjorie K Perry Spouse One-half(1/2)of 123,359.91
1812 Fairlawn Court residual estate
Rock Hill,SC 29732
Total 164,377.15
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate.
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)
MATEYA LAW FIRM
A PROFESSIONAL CORPORATION
55 W. Church Avenue
Carlisle, PA 17013
Phone 717-241-6500 Fax 717-241-3099
www.mateyalaw.com
December 1, 2014
PA Department of Revenue
Inheritance Tax Division
Harrisburg, PA
Re: Estate of Barry E. Perry
File No. 21-14-00478
To Whom it May Concern,
Attached please find the REV-1500 which is being filed in the above-referenced matter.
This matter involves an intestate decedent who had surviving children from a previous marriage.
The children listed are not the children of the surviving spouse. Therefore,the assets of the
estate are divided evenly between the surviving spouse who will receive 50% and the children
will share the remaining 50%of the residual estate.
The Administratrix has requested that a separate billing be issued on the jointly owned
asset listed on Schedule "F, #5", which was jointly owned by the decedent and his son-in-law.
The surviving spouse is entitled to one-half of the $58,484.50 in the amount of$29,242.25 at a
tax rate of 0% and the surviving children should be taxed at the rate of 4.5 %on the remaining
$29,242.25. This is the amount which we are requesting separate billing be issued to the
children.
I have included as payment on one-half(1/2) of the value of the assets listed on Schedule
"E" for the children's one-half share of the assets in the amount of$7,304.43 in the amount of
$328.70. The remaining one-half of the amount on Schedule"E"would be taxed at the spousal
rate.
Please contact me if you have any questions or are in need of additional information. I
may be reached at(717) 241-6500 or by e-mail at mam@mateyalaw.com.
Sincerely,
Mark A. Mateya
MAM/aa mam@mateyalaw.com
Leave A Legacy
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