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HomeMy WebLinkAbout12-03-14 (2) REV-1500 Ex(02-11) 1505610143 OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE PO BOx.280601 INHERITANCE TAX RETURN 21 14 00246 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 03 05 2014 11 22 1919 Decedent's Last Name Suffix Decedent's First Name MI JONES AGNES T (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI 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 Compromise ❑ 5. Federal Estate Tax Return Required (date of death after 12-12-82) ® 6 Decedent Died Testate ❑ Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) ❑ 9. Litigation Proceeds Received ❑ 10.between Poverty y91 audit;DatteS)f Death ❑ 11"EAttachn to tax u under Sec.9113(A) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number DEBRA K WALLET 717 737 1300 REGISTER OF WILLS USE ONLY First Line of Address C> 24 NORTH 32ND STREET c r © Second Line of Addressr1l C-3 ( ATL= 14D W O City or Post Office State ZIP Code ,�; C Ate,P HILL PA 17011 - , -, -n M �_. T m Correspondent's e-mail address: walletdeb@aol.com -: N U3 s 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 tr orrect and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG ATU E OF PERSON RESPONSIBL O FILING RETURN DAT ' Jacqueline Jones A ESS 20 Cherish Drive, Camp Hill, PA 17011 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE 04bea, -i. oft44,4— Debra K Wallet 21, ( �y ADDRESS Law Offices of Debra K.Wallet 24 North 32nd Street, Camp Hill, PA 17011 Side 1 1505610143 1505610143 1505610243 REV-1500 EX 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 4 , 064 . 56 p p rty(Schedule E)................ 5. 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6. 38 , 803 . 6 8 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested............. 7. 8. Total Gross Assets(total Lines 1 through 7).......................................................... 8. 42 , 868 . 24 9. Funeral Expenses and Administrative Costs(Schedule H)..................................... 9. 13 , 720 . 73 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................. 10. 1 , 174 . 95 11. Total Deductions(total Lines 9 and 10).................................................................. 11. 14 , 895 . 68 12. Net Value of Estate(Line 8 minus Line 11)............................................................. 12. 27 , 972 . 56 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. 27 , 972 . 56 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. 16. Amount of Line 14 taxable at lineal rate X .045 27 , 972 . 56 16. 1 , 258 . 77 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE................................................................................................................... 19. 1 , 258 . 77 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Pil Side 2 1505610243 1505610243 REV-1500 EX Page 3 File Number 21 - 14 - 00246 Decedent's Complete Address: DECEDENT'S NAME Jones, Agnes T. STREET ADDRESS 20 Cherish Drive CITY STATE ZIP 'Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 1,258.77 2. Credits/Payments A. Prior Payments 2,798.18 B. Discount 62.94 Total Credits(A +B) (2) 2,861.12 3. Interest (3) 0.00 4, If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) 1,602.35, 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) 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 c. retain a reversionary interest;or.................................................................................................................. ❑ d. receive the promise for life of either payments,benefits or care?.............................................................. ❑ ❑x 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?....................................................................................................................... ❑ 7 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?...................................................................................................................... ❑ ❑x IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. M' 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 retturn 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)1. A sibling is defined under Section 9102,as an individual who has at least one parent in common with the decedent,w ether by blood or adoption. Pennsylvania SCHEDULE DEPARTMENT OF REVENUE CASH, BANK DEPOSITS AND MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY FILE NUMBER 1 1 1 �0 ESTATE OF Jones, Agnes T. 121 - 14-00246 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 DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 Independence Blue Cross refund 442.02 2 Blue Cross payment for Holy Spirit Hospital invoice 1,184.00 3 PA National Insurance Co. refund 40.00 4 Emeritus at Creekview rent refund 2,285.00 5 Verizon refund 40.05 6 PP&L refund 73.49 TOTAL(Also enter on Line 5,Recapitulation) 4,064.56 REV-1509 EX+(01-10) pennsylvania DEPARTMENT OF REVENUE SCHEDULE F INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY RESIDENT DECEDENT ESTATE OF Jones, Agnes T. FILE NUMBER 21 - 14 -00246 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 Jacqueline Jones 20 Cherish Drive Daughter-in-Law A Camp Hill, PA 17011 JOINTLY OWNED PROPERTY: LETTER DATE C�FfSCRIPTIO C�F PROd%RTY *.OF DATE OF DEATH ITEM FOR JOINT MADE Include name o Inanaal ins I u Ion an bank account numberDATE OF DEATH DECD'S VALUE of NUMBER TENANT JOINT or similar identifying number.Attach deed for jointly-held real VALUE OF ASSET INTEREST DECEDENT'S INTEREST estate. 1 A 05/10/2005 PNC Bank Acct. #5112015883 4,773.17 50% 2,386.59 2 A 06/09/2005 PNC Bank Acct. #11020015902 63,104.57 50% 31,552.29 3 A 07/22/2010 PNC Bank Acct. #5006638032 3,718.60 50% 1,859.30 I 4 A 07/01/1978 Riverfront FCU Acct. #56609 6,011.00 50% 3,005.50 i I I I I I i TOTAL(Also enter on line 6, Recapitulation) 38,803.68 REV-1511 EX+(10-09) I pennsylvanian SCHEDUIEH F DEPARTMENT OF REVENUE J MMAL 003MMS AM INHERITANCE TAX RESIDENT DECEDE TTURN AMNIST�w� MLA11����11�7�IV'1 ESTATE OF Jones, Agnes T. FILE NUMBER21 - 14-00246 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER FUNERAL EXPENSES: A. 1 Neill Funeral Home 10,801.84 2 Royer's Flowers 651.88 3 Holiday Inn (funeral luncheon) 1,054.53 4 Funeral clothing 188.98 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(s)Commission Paid 2. Attorney's Fees Debra K. Wallet, Esq. 750.00 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 243.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs Postage, photocopies, etc. 30.00 TOTAL(Also enter on line 9, Recapitulation) 13,720.73 pennsylvania SCHEDULEI DEPARTMENT OF REVENUE DEBTS OF DECEDENT INHERITANCE TAX RETURN , MORTGAGE RESIDENT DECEDENT LIABILITIES & LIENS ESTATE OF Jones, Agnes T. FILE NUMBER21 - 14- 00246 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 Verizon 60.80 2 Holy Spirit Hospital 1,114.15 TOTAL(Also enter on Line 10, Recapitulation) 1,174.95 REV-1513 EX+(01-10) n, pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF Jones, Agnes T. FILE NUMBER 21 - 14-00246 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) RECEIVING PROPERTY Do Not List Trustee(s) I� TAXABLE DISTRIBUTIONS[include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] 1 Jacqueline Jones Daughter-in-Law Residuary Estate 20 Cherish Drive Camp Hill, PA 17011 2 Helen Sweeney Granddaughter Bedroom set 3276 Gaul Street Philadelphia, PA 19134 3 Anthony Capcino Nephew 5,000.00 44 Fairview Road Hamburg, PA 19526 Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate. II. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1 Our Lady of Lourdes Church 500.00 225 Salt Road, Enola, PA 17025 B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 REV-1513 EX+(01-10) Pennsylvania SCHEDULE J ' DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES continued RESIDENT DECEDENT ESTATE OF FILE NUMBER Jones, Agnes T. 21 - 14-00246 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) RECEIVING PROPERTY Do Not List Trustee(s) ITAXABLE DISTRIBUTIONS(include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] 4 Jodie Johnson Granddaughter 2,000.00 4415 Carlisle Road Gardners, PA 17324 5 Jeanette McGough Granddaughter 2,000.00 221 Haller Road Ridley Park, PA 19078 6 Julianne Ezzi Granddaughter 2,000.00 926 Willcliff Drive Mechanicsburg, PA 17050 Page 2 of Schedule J LAST V VILL d 7l N D 1 E S JS A M E E CD ® F co V AGNES To JONES I, AGNES T. JONES, of Camp Hill, Cumberland County, Pennsylvania, being of sound and disposing mind, memory, and understanding, do hereby slake, publish, and declare this to be my Last Will and Testament and hereby revoke all other Wills and Codicils that I have made, including the Will dated August 8, 2005. FIRST: I give and bequeath to those individuals listed below who shall survive me by thirty (30) days: A. My bedroom set to my granddaughter, HELEN SWEENEY, of �a Philadelphia, Pennsylvania; i E. The sum of Five Thousand ($5,000) Dollars to my nephew, ANTHONY :\ CAPCINO, of Hamburg, Pennsylvania; �<j C. The sum of Two Thousand ($2,000) Dollars to my granddaughter, JODIE JOHNSON, of Carlisle, Pennsylvania; D. The sum of Two Thousand ($2,000) Dollars to my granddaughter, JEANETTE MC GOUGH, of Ridley Park, Pennsylvania; E. The sum of Two Thousand ($2,000) Dollars to my granddaughter, JULIANNE EZZI, of Mechanicsburg, Pennsylvania; 4 { F. The sum of Five Hundred ($500) Dollars to OUR LADY OF LOURDES CHURCH, in Enola, Pennsylvania. SECOND: All the rest, residue, and remainder of my Estate, of whatever nature and wherever situate, I give, devise, and bequeath to my daughter-in-law, JACQUELINE JONES, of Camp Hill, Pennsylvania, so long as she shall survive me by thirty (30) days. THIRD: Should my daughter-in-law fail to survive me by thirty (30) days, then I give, devise, and bequeath all the rest, residue, and remainder of my Estate, of whatever nature and wherever situate, in equal shares, to those of my eleven grandchildren who shall survive me by thirty (30) days. FOURTH: All interests of any beneficiary in the income or principal of this Estate, while undistributed and in the possession of my Executrix, even though vested and distributable, shall not be subject to attachment, execution or sequestration for any debt, �? contract, obligation or liability of any beneficiary and, furthermore, shall not be subject to pledge, assignment, conveyance, or anticipation. - FIFTH: All inheritance, estate, and succession taxes (including interest and any a penalties thereon) payable by reason of my death shall be paid out of and be charged generally against the principal of my residuary estate, wit out appo•tionment or right of reimbursement � from any person. In the event that a substantial portion, as determined in the sole and absolute judgment and discretion of my Executrix, of the non-probate assets such as an annuity or mutual funds are directed to be paid to a beneficiary or beneficiaries, so that the taxes referred to herein would be paid out of the probate residue passing to the beneficiary or beneficiaries of this will (whether or not the same as the beneficiary or beneficiaries under the non-probate assets), my Executrix, in the Executrix's sole and absolute judgment and discretion, shall have the right to allocate the full or partial payment of the taxes to the beneficiary or beneficiaries of the non-probate assets. SIXTH: In addition to all rights and powers conferred by law, I authorize and empower my Executrix and her successors, in her absolute discretion and without necessity of obtaining court approval: A. To buy investments at a premium or discount. B. To hold property unregistered or in the name of a nominee. C. To give proxies, both ministerial and discretionary. D. To compromise claims. E. To join any merger, consolidation, reorganization, voting trust plan, or any other concerted action of security holders and to delegate discretionary duties with respect thereto. J F. To lend to, and buy from, my estate. G. To borrow and to pledge real and personal property as security therefore. H. To sell at public or private sale for cash or credit or partly for each, to ex change, or to lease for any period of time, any real or personal property, and to give options �. for sales, exchanges, or leases. I. To exercise any option permitted by law which she believes to be advantageous from the viewpoint of overall tax reductions, including, without limitation of the foregoing, power and authority to claim administration or other expenses either as income tax deductions or inheritance or estate tax deductions, without regard to whether they were paid from principal or income and without requiring adjustments between principal and income for ! d any resulting effect on income or estate taxes, and a deduction of such expenses for income tax purposes shall be given effect in computing the respective shares of all persons interested in my estate set forth herein, even though the eff-'ect is to increase the share of one beneficiary or class of beneficiaries hereunder at the expense of another; and to make such adjustments, if any, between beneficiaries with respect thereto as she shall deem appropriate in view of the nature of the transaction and the amounts involved. J. To distribute in cash or in kind or partly in each. K. To employ agents, legal counsel, brokers, and assistants, and to pay their fees and expenses as she may deem necessary or advisable to carry out the provisions of this Will or any Trust. The powers granted hereunder.shall be exercisable with respect to all real and personal j property, including, but not limited to, income and principal held for minors or disabled beneficiaries at any time, until the actual distribution of all property. All powers, authorities and discretion granted here shall be in addition to those granted by law and shall be exercisable j without leave of court. However, nothing herein shall be interpreted or construed to encourage, authorize, empower, or permit the Executrix to act or cause anyone to act in a manner contrary to or inconsistent with accented standards of portfolio diversification and risk management. SEVENTH: I nominate, constitute, and appoint my daughter-in-law, JACQUELINE JONES, as Executrix of this, my Last Will and Testament. In the event of the renunciation, death, resignation, or inability of my daughter-in-law to act for whatever reason in this capacity, then I nominate, constitute, and appoint my nephew, ANTHONY CAPCINO, as Executor of this, my Last Will and Testament. , , I direct that no representative named above shall be required to post security for the faithful performance of his/her duties in any jurisdiction insofar as I am able by law to relieve him/her of such obligation. Any of my representatives shall be entitled to reasonable compensation for the performance of the duties set forth here. IN WITNESS WHEREOF, I have hereunto set my hand and seal this day of A�11ws , 2013, on this, the fifth of five typewritten pages. I have also signed the left-hand margin of the first four of these pages for purposes of identification only. Y' AGNL,g T. JONES SIGNED, PUBLISHED, and DECLARED by the Testatrix, AGNES T. JONES, as 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 hereunto subscribed our names as witnesses. ACKNOWLEDGMENT Commonwealth of Pennsylvania County of Cumberland I, AGNES T. JONES, Testatrix, whose name is signed to the attached instrument, having been duly qualified according to law, do hereby acknowledge that '.1 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. AGN' 'T. SONES;' Sworn or affirmed to and subscribed before me by AGNES T. JONES, the Testatrix, this J7-h day of Ac-,i n r , 2013. ,4 Notary Public COMMONWEALTH OF PENNSYLVANIA Notarial Seal Mary McGill,Notary Public Camp HIII Bora,Cumberland County My Commisslon Explres Nov. 15,2015 „ MEMBER,PENNSYLVANIA ASSOCIATION OF NOTARIES i r AFFIDAVIT Commonwealth of Pennsylvania County of Cumberland We, Debra K. Wallet and 1`'�`l ,, ly`3l: -� ;:�,�;i , the witnesses whose names are signed to the attached instrument, being duly qualified according to law, depose and say that we were present and saw the Testatrix, AC;;NES T. JONES, sign and execute the instrument as her Last Will and Testament; that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that, to the best of our knowledge, the Testatrix was at that time 18 years of age or older, of sound mind, and under no constraint or undue influence. Sworn or affirmed to and subscribed before me by it' __ and witnesses, this �-h day of 2013. ti Notary Publici, COMMONWEALTH OF PENNSYLVANIA Notarial Seal Mary McGill,Notary Public Camp HII;Boro,Cumberland County My Commtson Expires Nov. 15,2015 MEMBER,PENNSYLVANIA,ASSOCIATION OF NOTARIES PLEASE NOTE: Because there were insufficient Estate assets to pay the funeral expenses, debts of Decedent, and administrative costs, daughter-in-law, Jacqueline Jones, has paid these from the joint accounts listed on Schedule F. ,Law O��iced o� DEBRA K.WALLET 24 N.32nd STREET CAMP HILL,PA 17011-2917 PHONE:(717)737-1300 Email:Walletdeb@aol.com FAX: (717)761-5319 December 2, 2014 Lisa M. Grayson, Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 RE: Estate of Agnes T. Jones Will No. 2014-00246 Dear Ms. Grayson: Enclosed are an original and one copy of the Pennsylvania Inheritance Tax Return, one copy of an Inventory of the Estate, and one copy of a Status Report Under Rule 6.12 for filing in the above-captioned estate. I have enclosed a copy of the first page of each to be stamped in and returned to me in the pre-addressed envelope provided. Thank you. Sincerely yours, Debra K. Wallet DKW/mm Enc. cc: Jacqueline Jones, Executrix M f P:J , f1 M yZE 1--� Pte— M CO D OF 'ki-G- TER OF 111'.1.1 ZIP 17011 011012807720 207j 3 =CLrfieK OFt t NURT FhstCass I�aiIl� r " 1'aw C�ffieei of DEBRA K.WALLET 24 N.32nd STREET CAMP HILL,PA 17011-2917 ` �l �;? `1 • To: Lisa M. Grayson, Register of Wills . Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 - • 1 ° s '