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HomeMy WebLinkAbout12-09-14 1505610140 REVA 500 EX (01-10) OFFICIAL USE ONLY Department of Revenue Bureau of Individual Taxes CountyCode Year File Number BuINHERITANCE TAX RETURN Po sox zaosol 2 1 1 3 1 1 7 3 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MIVIDDYYYY Date of Birth MMDDYYYY 1 0 1 1 2 0 1 3 0 4 0 4 1 9 5 6 Decedent's Last Name Suffix Decedent's First Name MI F E L L M A N R 0 8 E R T R (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 F� 2.Supplemental Return 3.Remainder Return(date of death prior to 12-13-82) El 4.Limited Estate 4a.Future Interest Compromise(date of 5.Federal Estate Tax Return Required death after 12-12-82) 6.Decedent Died Testate 7.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.Spousal Poverty Credit(date of death 11.Election to tax under Sec.9113(A) between 12-31-91 and 1-1-95) (Attach Sch.O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number C H R I S T A M A P L I N 7 1 7 5 4 1 5 5 5 0 REGISTER OF WILLS USE ONLY First line of address 8 4 5 S I R T H O M A S C 0 U R T Second line of address S U I T E 1 2 C City or Post OfficeState ZIP Code C->FILED 'rn L7 n H A R R I S 8 U R G P A 1 7 1 0 9 �n CO Correspondent's e-mail address: CHRISTA@JANBROWNLAW.COM U•' o Under penalties of perjury.I declare that I have examined this return,including accompanying schedules and statements,and to-lt e 1;&&may k ge 2nq bEd f, itis rue,correct and complete.Declaration of preparer other than the personal representative is based on all information of which)prtarer%s a owleQQe. TI G ATU O E RESPONSIBLE FOR FILING RETURN DATE _ n rn ES 9154 HO ROAD HUNTINGDON PA 16652 SI T RE&FPR AR OT ERTI; N REP ATIVE A RE 845 SIR THOMAS COURT, SUITE 12 HARRISBURG PA 17109 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 1505610240 REV-1500 EX Decedent's Social Security Number Decedent's Name: ROBERT R • FELLMAN 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. 3 9 5 3 . 0 7 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested . . . . . . . 7. 8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 3 9 5 3 . 0 7 9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9. 9 7 1 9 • 4 3 10. Debts of Decedent,Mortgage Liabilities,and Liens Schedule I 10. 1 7 5 . 4 3 11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 9 8 9 4 • 8 6 12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. - 5 9 4 1 . 7 9 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. - 5 9 4 1 . 7 9 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 _ 0 . 0 0 15. 0 . 0 0 16. Amount of Line 14 taxable at lineal rate X 0 . 0 0 16. 0 . 0 0 17. Amount of Line 14 taxable at sibling rate X.12 0 . 0 0 17. 0 . 0 0 18. Amount of Line 14 taxable at collateral rate X.15 0 . 0 0 18. 0 . 0 0 19. TAX DUE . . .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 0 . 0 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑X Side 2 L 1505610240 1505610240 REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 13 1173 DECEDENT'S NAME ROBERT R. FELLMAN _ STREET ADDRESS 212 B N. West 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 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. Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00 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; ...I........................... ❑ ❑X c. retain a reversionary interest;or ................................................................................................ ❑ 0 d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ Q 2. If death occurred after December 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? ......... ❑ 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 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(1.2)[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,uncle Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. REV-1508 EX+(08-12) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: ROBERT R. FELLMAN 21 13 1173 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. Susquehanna Valley Federal Credit Union savings account; 7.46 Account#17501 2. Members 1st Federal Credit Union regular savings account; 5.00 Account#242346-00 3. Members 1st Federal Credit Union checking account; 150.42 Account#242346-11 4. Members 1st Federal Credit Union supplemental savings account; 0.23 Account#242346-01 5. 2001 Honda Civic 3,321.00 (see attached Kelley Blue Book value) 6. Proceeds from sale of personal property 298.48 7. Heffler Claims Group proceeds 170.48 TOTAL(Also enter on Line 5,Recapitulation) $ 3,953.07 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER ROBERT R. FELLMAN 21 13 1173 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Trefz& Bowser Funeral Home, Inc. 4,784.29 2. Paxtang Cemetery; internment 860.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Years)Commission Paid: 2. Attorney Fees: Jan L. Brown &Associates 3,500.00 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: Register of Wills, Cumberland County 153.50 5 Accountant Fees: 6. Tax Return Preparer Fees: 7. Trefz& Bowser Funeral Home, Inc.; additional death certificates 48.00 8. Cumberland Law Journal; legal advertising 75.00 9. The Sentinel; legal advertising 243.64 10. Bureau of Motor Vehicles; title for motor vehicle 50.00 11. Register of Wills, Huntingdon County; fee for taking oath 5.00 TOTAL(Also enter on Line 9,Recapitulation) $ 9,719.43 If more space is needed,use additional sheets of paper of the same size. nem512sw(12w2) DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES&LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER ROBERT R. FELLMAN 21 13 1173 Report debts incurred bythe decedent prior hndeath that remained unpaid ut the date xf death,Including unehmbursm4medical expenses. REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: ROBERT R. FELLMAN 21 13 1173 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. Estate of Robert Fellman, Crist Fellman, Executor Lineal 0.00 9154 Homestead Road Huntingdon, PA 16652 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. H. 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. TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed,use additional sheets of paper of the same size. ATTACHMENT TO REV-1500 ESTATE OF FILE NUMBER ROBERT R. FELLMAN 21 13 1173 A waiver of penalty is respectfully requested as the first Administrator, Robert Fellman, who was the father of the decedent passed away on March 17, 2014 during the administration of his son's estate; and although the debts outweighed the assets he had been paying the decedent's/estate's bills from his personal funds. The vehicle listed on Schedule E was received by the Administrator (Robert Fellman) as reimbursement for the administrative expenses (funeral expenses of the decedent)that he paid. Administrator Robert Fellman paid the funeral expenses of$4,784.29, Paxtang Cemetery bill of$860.00, and Register of Wills fees in the amount of $108.50, from his personal funds and not from funds of the decedent or estate. The current_Administrator is Crist Fellman who is the half-brother of the decedent and the son of the first Administrator. No inheritance taxes are due. Kelley Blue Book Page 1 of 2 I -M Kelley Blue BOOK The Trusted Resource` i 1 35 for current offers 1 lam' • . . • ..• en i Advertisemt Why ads? i 1 2001 Honda Civic , Pricing Report Style:LX Coupe 2D Mileage:97000 f Private Party Value Excellent $3,546 i Very Good $3,321 Good i $3,221 i Fair j $2,821 -...................... Values valid until 11/26/2013 ` 1 Vehicle Highlights Fuel Economy: Max Seating:5 i City 28/Hwy 35/Comb 31 MPG Doors:2 Engine:4-Cyl,1.7 Liter i I 1 Drivetrain:FWD Transmission:Manual,5-Spd 1 I iEPA Class:Compact Cars Body Style:Coupe I iCountry of Origin Japan Country of Assembly:United States i i Your Configured Options Our pre-selected options,based on typical equipment for this car. 'Options that you added while configuring this car. I I i http://www.kbb.com/honda/civic/2001-honda-civic/lx-coupe-2d/?vehicleid=4412&i... 11/22/2013 Kelley Blue Book Page 2 of 2 Engine j Comfort and Convenience Safety and Security ©1995=20h 4-Cyl, 1.7 Liter Air Conditioning Dual Air Bags ! slue Book C�. Transmission Power Windows Wheels and Tires All righti ✓ Manual,5 Spd Power Door Locks Steel Wheels Drivetrain Cruise Control FWD i Steering I Power Steering Tilt wheel j Entertainment and Instrumentation j I AM/FM Stereo Cassette j C 2013 Kelley Blue Book Co.,Inc.All rights reserved.11/2212013-1112612013Edition for Pennsylvania 17109.The specific Information required to determine the value for this particular vehicle was supplied by the person generating this report.Vehicle valuations are opinions and may vary from vehicle to vehicle.Actual valuations will vary based upon market conditions,specifications, vehicle condition or other particular circumstances pertinent to this particular vehicle or the transaction or the parties to the transaction.This report Is intended for the Individual use of the person 1 generating this report only and shag not be sold or transmitted to another parry.Kelley Blue Book assumes no responsibility for errors or omissions.(v.13113) j I http://www.kbb.com/honda/civic/2001-honda-civic/lx-coupe-2d/?vehicleid=4412&i... 11/22/2013 $1.82 062S0007824161 US POSTAGE FIRST-CLASS MAIL FROM 17109 s#am } 12/08/2014 USPS FIRST CLASS MAIL® JAN L. BROWN 845 SIR THOMAS COURT, SUITE 12 HARRISBURG PA 17109 C001 SHIP Register of Wills To: County Of Cumberland 1 Court House Square Ofc Carlisle PA 17013-3301