HomeMy WebLinkAbout11-14-14 REV-1500 EX(02-11) Ta
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 0161
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
02 06 2014 10 25 1928
Decedent's Last Name Suffix Decedent's First Name MI
DOVE BRUCE E
(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
n 1. Original Return ❑ 2. Supplemental Return 113. 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) ❑
FXI 8 Decedent Died Testate ❑ Deceder]t Mainlalned a Living Trust 8. Total Number of Safe Deposit BOX2S
(Attach Copy of Will) (Attach L000py of l rust) p
❑ 9. Litigation Proceeds Received ❑ 10.between l2 er�J1 a dit(D% f Death ❑ 11.Election to tax under Sec.9113(A)
i (Attach Schedule O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
Tv
HEATHER D ROYER ESQ (717)234 2g1 ;
» c� rn,rn
REGIS T %LLS,�5JE OgY
First Line of Address `-
71 :a �� C3
4431 N FRONT ST 3RD FL %' CD
Second Line of Address
- r- M,
DATE FILED i
City or Post Office State ZIP Code d
HARRISBURG PA 17110
Correspondent's e-mail address: hroyerCZD_sasllp.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.
SIGNATU�PERSON
FOR FILING RETURN DATE
Joan L Plank I d
ADDRES
5961 Lon view Road Harrisburg, PA 17112
SIGNATURElOF REPAIJERVZLLER THAN REPRESENTATIVED E
Heather D. Royer Esq. f( 1 011
ADDRESS
4431 N. Front St., 3rd FI., Harrisburg, PA 17110
Side 1
1505610143 1505610143
1505610243
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: Dove, Bruce E.
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 , 120 . 83
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. 7 , 120 . 83
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 6,257 . 08
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 263 , 938 . 48
11. Total Deductions(total Lines 9 and 10)................................................................ 11. 270 , 195 . 56
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. -263 , 074 . 73
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. -263 , 074 . 73
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 0 . 00 16. 0 . 00
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. 0 . 00
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 21-14-0161
Decedent's Complete Address:
DECEDENT'S NAME
Dove, Bruce E.
STREET ADDRESS
1000 W. South Street
CITY STATE ZIP
Carlisle PA 17013
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 +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) 0,00
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;.................................. ❑ Nx
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?.................................................................................................................... ❑ ❑x
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
containsa 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.
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-1508 EX+(11A0)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Dove, Bruce E. 21-14-0161
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 Estate of Bruce E. Dove v. United Church of Christ Homes, Inc.-Docket No. 14-2670 Civil 0.00
Please suspend valuation, including interest, until proceeds,if any,are received.
2 Fulton Bank Checking Account-No. 1619-05213 4,947.49
Accrued interest on Item 2 through date of death 0.03
3 Pre-Paid Funeral Plan 1,942.22
4 Sterling Investors-Premium refund 231.09
TOTAL(Also enter on Line 5, Recapitulation) 7,120.83
(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-1511 EX+(10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX
RESIDENT DEC D NTURN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Dove, Bruce E. 21-14-0161
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 2,756.80
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State ZiD
Year(s)Commission Paid
2. Attorney's Fees Smigel,Anderson &Sacks, LLP 3,100.00
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation)
Claimant
Street Address
City State Zio
RelationshiD of Claimant to Decedent
4. Probate Fees 113.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 286.78
See continuation schedule(s)attached
TOTAL(Also enter on line 9, Recapitulation) 6,257.08
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
Dove, Bruce E. 21-14-0161
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Ex eenses
1 Brownstone Cafe-Luncheon 125.87
2 Hetrick-Bitner Funeral Home-Funeral 2,242.33
3 Rev.Josefina Perez 200.00
4 Romberger Memorials-Engraving 125.00
5 Royer's Flowers&Gifts-Flowers 63.60
H-A 2,756.80
Other Administrative Costs
6 Cumberland Law Journal-Legal Advertisement 75.00
7 The Sentinel -Legal Advertisement 211.78
H-137 286.78
Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98)
s
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
Dove, Bruce E. 21-14-0161
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 Betsy Dove-Reimburse-snacks for Bruce 75.00
2 Pennsylvania Department of Public Welfare -Medicaid Lien 261,096.98
3 Sarah A.Todd Memorial Home -Monthly residence bill 1,503.40
4 Sarah A.Todd Memorial Home -Final residence bill 947.98
5 Sterling Investors-Premium 315.12
TOTAL(Also enter on Line 10, Recapitulation) 263,938.48
(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)
REVA 513 EX+(01.10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Dove, Bruce E. 21-14-0161
NAME AND ADDRESS OF RELATIONSHIP TOSHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (Words) ($$$)
I� TAXABLE DISTRIBUTIONS [include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
Bets ove Daughter 1/5 Interest in
1 2 Townhill Roa Residuary Estate
rk Springs, P 7372
Duane Son 1/5 Interest in
cl y Dov Residuary Estate
1 42 Townhill Ro d
Y k Springs 17372
Ricky L. ove Son 1/5 Interest in
11 Red Bud Lane - Residuary Estate
Jonestown, PA 17038
Ronald E. Dove Son 1/5 Interest in
Center Avenue Residuary Estate
Fredericksburg, PA 170 6
Joan L. Plank Daughter 1/5 Interest in
5961 Longview Road Residuary Estate
Harrisburg, PA 1711
Total
Enter dollar amounts or distrib tions shown above on lines 15 through 18 on Rev 1500 cover sheet as appropriate.
NON-TAXABLE DI RIBUTI NS:
II. A.SPOUSAL DIS RIBUTIO SUNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHAR ABLE A GOVERNMETTAL DISTRIBUTIONS
V
V
J.
V �
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)
REGISTER OF WILLS CERTIFICATE OF
CUMBERLAND COUNTY GRANT OF LETTERS
PENNSYLVANIA
No. 2014- 00161 PA No. 21- 14- 0161
Estate Of: BRUCEEDOVE
(First,Middle,Last)
Late Of: CARLISLE BOROUGH
CUMBERLAND COUNTY
Deceased
0 Social Security No:
WHEREAS, on the 24th day of February 2014 an instrument dated
November 30th 2004 was admitted to probate as the last will of
BRUCE E DOVE
(First,Middle,Last)
late of CARLISLE BOROUGH, CUMBERLAND County,
who died on the 6th day of February 2014 and,
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, LISA M. GRA YSON, ESQ. , Register of Wills in and
for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby
certify that I have this day granted Letters TESTAMENTARY to:
JOAN L PLANK
who has duly qualified as EXECUTOR(RIX)
and has agreed to administer the estate according to law, all of which
fully appears of record in my office at CUMBERLAND COUNTY COURTHOUSE,
CARLISLE, PENNSYL VA NIA,
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of rimy office on the 24th day of February 2014.
- Register of pyills
ilL
�iDeRu'fY
c_
**NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST)
LAST WILL AND TESTAMENT OF BRUCE F. DOVE
KNOW ALL MEN BY THESE PRESENTS, That I, BRUCE E. DOVE, currently of the
Township of Derry, County of Dauphin and Commonwealth of Pennsylvania, do make, publish
and declare this instrument to be my Last Will and Testament, hereby revoking and making void
any and all former Wills by me at any tulle heretofore made.
FIRST - I direct the Executrix hereof to pay all my just debts, funeral expenses and costs
of administration as soon as conveniently may be done after my death. I further direct the
Executrix hereof to pay all inheritance, estate, transfer and succession taxes which may be levied
or assessed upon any property which is included as part of my gross estate for the purpose of any
such tax.
SECOND—I give and bequeath the following items of personal property to my son,
DUANE A. LOVE:
(a) my dog which is part border collie and part shepard; -
(b) 1999 Chevy 2500 series pickup truck; and
(c) all of my furr.4ure and furnishings which he desires =
to use when establishing a residence of his own.
THIRD—I give and bequeath my 12 gauge shot gun to my son, RICKY L. DOVE.
FOURTH—Furthermore, I specifically direct my Executrix to pay, as an expense of the
administration of my Estate, the rent for my apartment for the calendar month subsequent to the
Page 1
BED W-1 W-2
date of my death so that my said son, DUANE A. DOVE, shall have a place to reside while he
looks for a residence and so that my Executrix is not forced to prematurely remove my
possessions from my apartment.
FIFTH - I give, devise and bequeath all the rest, residue and remainder of my estate, both
real and personal, as follows:
(a) One-fifth (1/5) thereof to my daughter, JOAN L. PLANK;
(b) One-fifth (1/5) thereof to my daughter, BETSY A. DOVE;
(c) Orie-fifth (1/5) thereof to my son, DUANE A. DOVE;
(d) One-fifth (1/5) thereof to my son, RICKY L. DOVE; and
(e) One-fifth (1/5) thereof to my son, RONALD E. DOVE.
SIXTH—I appoint my said daughter, JOAN L. PLANK, Executrix hereof. In the event
of the death, resignation, renunciation or inability of my said daughter, JOAN L. PLANK, to
serve as Executrix then I appoint my said daughter, BETSY A. DOVE, Executrix hereof. I do
hereby give to the Executrix hereof full power, discretion and authority at any time or times to
sell, at private or public sale, mortgage, lease, pledge, exchange or otherwise deal with or
dispose of the property comprising my estate upon such terms as deemed best, to settle and
compound any and all claims in favor of or against my estate as deemed best and, for any of the
foregoing purposes, to make, execute and delivery any and all deeds, mortgages, contracts,
Page 2
Y BED W-1 W-2
leases, bills of sale or other instruments necessary or desirable therefor.
LASTLY - I direct that no fiduciary appointed by this, my Last Will and Testament, shall
be required to give Bond and that if, notwithstanding this direction, any Bond is required by any
law, statute or rule of court, no Surety shall be required thereon.
IN TV Vil1V1"SS WHEREOF, I have set rrry hand and seal to this, my
Last Will and Testament, consisting of three (3)pages on the margin of which (except this page)
I have affixed my initials this day of A.D. 2004.
F
(SEAL)
Signed, sealed, published and declared by BRUCE E. DOVE, the above named Testator,
as and for his Last Will and Testament, in the presence of us and each of us, who at his request,
and in his presence, and in the presence of each other, have hereunto subscribed our names as
attesting witnesses.
1
ACKNOWLEDGMENT
STATE OF PENNSYLVANIA
:ss .
COUNTY OF CUMBERLAND
I, BRUCE E. DOVE, the testator 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 that I signed
it willingly and as my free and voluntary act for the purposes therein expressed.
Sworn to or affirmed and acknowledged before me by BRUCE E. DOVE, the
testator, this 3001day of Movemb r , 2004.
BRUCE E. DOVE
Testator
Not ry ublic
NOTARIAL SEAL
NANCY L. ANDERSON, Notary Public
Hampden Twp., Cumberland County
My Commission Expires.Jan. 28, 2007
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
:ss
COUNTY OF CUMBERLAND
We, GREGORY R. REED and SUSAN F. REED, the witnesses whose names are signed to
the attached or foregoing instrument, being duly qualified according to law, do depose and say
that we were present and saw the testator sign and execute the instrument as his Last Will; that
the testator signed willingly and executed it as his free and voluntary act for the purposes therein
expressed; that each subscribing witness in the hearing and sight of the testator signed the will
as a witness; and that to the best of our knowledge the testator was at that time 18 or more years
of age, of sound mind and under no constraint or undue influence.
Sworn to or affirmed and subscribed to before me by GREGORY R. REED and SUSAN
F. REED, witnesses, this 30 " day of �J,Jtrnbey- , 2004.
Witfress
R
Witness
Notary Public
NOTARIAL SEAL
NANCY L.ANDERSON, ubli
or andrCountyr
Hampden Twp.,
My Commission Expires Jan. 28, 2007