HomeMy WebLinkAbout12-16-14 � 15056b0105
REV-1500°"°�-11„Fn�
o�cw.usE a�..v
PA Department of Revenue P����a County Code Ye� F�7e Number
oEranrtoa�ncw .
Bureau of Individual Taxes INHERITANCE TAX RETURN /�/�
PO BOX z8o6oi
Har►isburg PA i�iz8-o6oi RESIDENT DECEDENT ,� � / � �l
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYVYY Date of Birth MMDDVYYY
' 03/21/2014 06/04/1922
Decedent's Last Name Su�ix becedenYs First Name _ MI
McCullough �ois H
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name ��
Spouse's Social Securtty Number �{�S RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL!N APPROPRWTE OVALS BELOW
� 1.Original Retum O 2.Supplemental Return O 3. Remainder Retum(Date of Death
Priorto 12-13-82)
p 4.Limited Estate O 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Retum Required
death atier 12-12-82)
O 6.Decedent Died Testate � 7.Decedent Maintained a Living Trust � 8. Total Number of Safe Deposk Boxes
{Attach Copy of Will) (Attach Copy of Trust)
O 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 11. Election to Tax under Sec.9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT-THIS SECTION MUST BE CONtPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Tetephone Number
_ _
John C Oszustowicz (717)243-7437 r.�,
_ _ __ __ _. _ � �
REGI�IER�WILLS ONL�
� � � ��
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First Line of Address �� � r-- �, "`�
j,._ �'.. ('F1 ��.1
104 S Hanover St. "" r.� � �"'
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Second Line of Address '�' c-� � � n �`�
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. �� � "k �..�. '^ .
Gty or Post Office State ZIP Code V � fl� � �
__. ___
_ _ � ;� _ n� {n C�
Carlisie PA 17013 ' �
CorrespondenYs e-mail address:
Under penalti�of pery'ury,I declare that I have exarrwied this retum,includi accompanying schedules�d statemenls,a�d to the best of my knowledge and beliet,
it is true,correct and campk.ke.Dedaration of preparer other than the representaNve is besed on all in(ormation M which preparer has any knowledge.
SlGNATURE OP PERSON RESP SIBLE FOR FILING itETURN DATE
��ct.�,�..v n1 ..�. - .�i(. /2 -/2 - � /
aoo�ss
�
108 He her Hilt Court, Bel Air, MD 21Q14
SIGNAT PREP THE N REPRESENTATIVE DaFE ( /
/
ADDRES
104 S anover St., Carlisie, PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610Z05 15056�U105 � �
�.
J 1505610205
REV-1500 EX(FI) DecedenYs Social Security Number
DecedenYs Name:
RECAPITULATION
1. Real Estate(Schedule A). ....... ..................................... 1. __ '
2. Stocks and Bonds(Schedule B) 2. 2,004,199.60 '
... ...... ... ...... .....................
3. Closely Held Corporation, PaRnership 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. 8,693.94 ,
6. Jointly Owned Property(Schedule F) O Separate Billing Requested . ...... 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property 197,144.59 '
(Schedule G) O Separate Billing Requested........ 7.
8. Total Gross Assets total Lines 1 throu h 7 ............. 8. 2,210,038.13
� 9 )................
9. Funeral Expenses and Administrative Costs(Schedule H)............. ...... 9. 24,881.99
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............... 10. 2,044.40
11. Total Deductions(total Lines 9 and 10)........ ......................... 11. 26,926.39 ',
12. Net Value of Estate(Line 8 minus Line 11) .............................. 12 2,183,111.74 ',
13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which ,
an election to tax has not been made(Schedule J) ........................ 13. '
14. Net Value Sub'ect to Tax Line 12 minus Line 13 ............. 14. 2,183,111.74 ,
1 � ) ...........
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- ' 15. ', _
16. Amount of Line 14 taxable
at lineal rate X.0 45 2,183,111.74 �g. 98,240.03 '
17. Amount of Line 14 taxable _ __
at sibling rate X.12 17. , _ '
18. Amount of Line 14 taxable . .
at collateral rate X.15 ' �$• ' _
19. TAX DUE ........................ ............................ ..... 19. 1 '
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT �
Side 2
� 1505610205 1505610205 J
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
Lois S McCullough
_----- ---- _---._—.__—_
STREETADDRESS
210 Big Spring Road
_ _ - - ---------
-- ___
_—_ ____----- --
_____---- -------- -STATE.. —.__ ZIP
CITY
Newvil le PA 17241
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 98,240.03
2. CreditslPayments
A.Prior Payments ___ 94,000.00
__ ----- ---
B.Discount 4,947.37
__ —_—_ _—
Total Credits(A+B) (2) 98,947. 7
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) 707.34
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.......................................................................................... ❑ �
b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ �
c. retain a reversionary interest.............................................................................................................................. ❑ �
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
containsa 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)j.
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 stiil 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 decetlent'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-i5o3 EX+(8-iz)
�" pennsylvania SCHEDULE B
� DEPARTMENTOFREVENUE STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Lois McCullough 21-14-0519
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1' PNC Bank Acct 004-257923-McCullough Trust(see attachment 1) 1,664,747.88
2 PNC Bank Acct.005-822639-Alvin McCullough Trust(see attachment 2) 339,451.80
TOTAL(Also enter on Line 2, Recapitulation) $ 2,004,199.68
If more space is needed,insert additionai sheets of the same size
REV-15o8 EX+(o8-1z)
° � �pennsylvania SCHEDULE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC.
� � INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Lois McCullough 21-14-0519
Inciude 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
�. 2013 federal tax refund 7,517.00
2 Green Ridge Village Retirement Home refund 1,176.94
TOTAL(Also enter on Line 5, Recapitulation) $ 8,693.94
If more space is needed,use additional sheets of paper of the same size.
REV-1510 EX�+(03-J9)
e.�'�i pennsylvania SCHEDULE G
DEPARTMENTOFREVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX R�r�RN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Lois McCullough 21-14-0519
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
DESCRIPTION OF PROPERTY DATE OF DEATH °/a OF DECD'S EXCLUSION TAXABLE
ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND
NUMBER THE DATE Of TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APVLICABLE) VALUE
1. Premiere Select IRA#004-196371 held at PNC Investments 197,144.59 100 197,144.59
TOTAL(Also enter on Line 7, Recapitulation) $ 197,144.59
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+ (08-:L3}
� � pennsylvania SCHEDULE H
' DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Lois McCullough 21-14-0519
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' Egger Funeral Home-Newville,PA 2,344.74
2 Minister fee-William C. Beck 200.00
s Memorial Service-food and location rental 450.00
a Flowers for service-Blue Mountain Blooms 113.42
5 Organist fee-Helen Mowery 50.00
s Donation for ash burial at Green Ridge Village Memorial Garden 50.00
� Funeral travel expense for Nancy Longnecker,Executrix 270.91
B, ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City_..___ _State ZIP_.____....__
Year(s)Commission Paid:
2. Attorney Fees
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
5, Accountant Fees: 15,000.00
6. Tax Return Preparer Fees: 2,350.00
�• The Sentinel-legal advertising 179.92
s Cumberlantl County Law Journal-legal advertising 75.00
s Martson Law Offices-Professional fees re:trust research 268.00
�o Accounting filing fees 3,530.00
TOTAL(Also enter on Line 9, Recapitulation) $ 24,881.99
If more space is needed,use additional sheets of paper of the same size.
r�.v-is».Fx+ t�z-rz)
, � pennsylvania SCHEDULE I
DEPARTMENTOFREVENUE DEBTS OF DECEDENT,
iNHeRirnNceTaxReruaN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Lois McCuliough 21-14-0519
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
VALUE AT DATE
ITEM OF DEATH
NUMBER DESCRIPTION
1• Graham Medical Clinic-physician 26.76
2 Millennium Pharmacy 68.33
3 PA Dept of Revenue-tax estimates for 2014 485.00
4 Pinker&Associates-podiatrist 8'52
5 Willard Longnecker-reimbursement for expenses paid for decedent 125.00
6 Nancy Longnecker-trustee fees 1,292.30
7 Mobilex-X-ray 38.49
TOTAL(Also enter on Line 10, Recapitulation) $ 2,044.40
If more space is needed,inserk additional sheets of the same size.
REV-1513 EX+(01-10)
��.��� ; pennsylvania SCHEDULE �
� DEPARTMENT OF REVENUE gENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF:
FILE NUMBER:
Lois McCullough 21-14-0519
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. Nancy Longnecker 108 Heather Hill Ct.,Bel Air,MD 21014 Daughter 50%
2 James McCullough 5410 NW 62ntl Ave,Ocala,FL 34482 Son 50%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF 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.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
L
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.
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�./ Ai-tachrne.r�-� i
RE: 004-257923/Mccullough(Trust)
The value of the above-referenced account on March 21,2014 is as follows:
,;:
i
24,558.57Q FEDERAT�D GfJV�RNMENT QBLIGATIQNS C2�pSQ $1.00 $ 24,558.57 -
10$.QaID ALLSTATE CORP' ALL. 56.06 $ 6,054.48 -- -
--_
_ ---- -- -
962.OQU R7&TiNC C�M T 34.30' $ 32,996.60
--_.
92.q(30 CBS Cf3RP NEW Ct B CBS 65.69' $ 6,043.48
34.DQQ C�N"CURYLINK tNC CTL 31.34 $ - 1,065.56 --_ __
_._
280.QDU CH�URC?N COI�P NEW CUX 115.63' $ 32,376.40 ----
-
�OQ.00� �pCA C�LA'CQ KO 38.44 $ 30,752.00 --- -___
504AaCI�OMCAST C�f2P N�1N CL A CMCSA. 50.(�Q' $ 25,200.00
_--- _ - -
295.UQQ iJtSN�Y WALT CO DIS 80.35 $ 23,703.25
----_ _
---
93 588.24.5 EATON UANCE NA'C I�AUNI lNC4ME FUND EANAX 9.41 $ 880,665.01 '
471.00il FRANKLIN FINL SVCS Ct?RP Ff2/#F 18.00 $ 8,478.00
-- �
240.000 FRUNTIER CQM11�U�tJCA'1�QN5 GQRP F'fR � ���5.49�, $ 1,298.40
----
700,OOQ GENERAL�LECTRIG GQ GE 25.40 $ 17,780.00 - ------ -- --
732.000 GEtttERAL MILl.31NC G1S 51.03' $ 37,353.96
-- -- _
600.000 G'LATFELTER GLT 28.64' $ 17,184.00
--------
300.OQQ NERSHEY C� HSY 104.84: $ 31,452.00
------- - - _
476.00U.iNVESCO PA1/ALUE A�IUN.IKtC�ME TR.GE3M UPV 13.12 $ 6,245.12
- ------ _--
_ 495.�OQ MGDQNALDS CORP MCD 95.47 $ 47,257.65
10,986.65.0 NU�fEEN PA M[1N[CIPAL BUND CL A FPNTX 1'`0.68 $ 117,337.42 i
2,434.506 OPPENHEIMER GLOBAL ALlOCAT10N FUND QVGIX 17.36 $ 42,263.02
_ _ �
251.000 PNC FINL SVCS GR4UP PNC 86.$7 $ 21,804.37
------
700.00Q PPL C�RP PPL 32.44 $ 22,708.00 ------ -
- ---- _.
38.000 PROGRESS ENERGY INC G�3N'FII�[GENT PREX ' 0.33 $ 12.35
500.DOQ PUSLIC SERVECE ENl'ERPRTSE GR�UP II�G PEG 36.90 $ 18,450.00 I
400.00Q SYSCO GQRP SYY 36.06 $ 14,424.00 _ i
'S00.U00 TECO ENERGY INC TE 16.69 $ 8,345.00 I
2,693.536 VANGUARD PA LONGTERM TAX�JC WV VPA1X 11.28 $ 30,383.09
- - ----__
1,2Q0.000'VERIZQN COMMUNiCAT.10NS VZ 46.91 $ 56,292.00
-- ____ _
92.000 VIACOM INC N�W CL B VIAB 87.03 $ 8,006.76
250.000 WALMARTSTORES;INC WMT 76.10 $ 19,025.00
----
244.000 WEIS MARKETS INC WMK 51.26 $ 12,507.44
10;00O.00Q ALLEGHENY`CNTY.'PA HI�HER ED BLDG 09'729E�M3 107.12 $ 10,711.50 $ 233.33
10,OQO.OQO DUKE"CAP C�RP-SR NT ` 26439RA�f9 t20.63' $ 12,063.00 $ 377.78
15,00O.00Q FQRp Ml'R CO QEL DEB 345370BX7 115.15 $ 17,272.35 $ 135.42
15;000.000 PENNEY JC INC MTN BE�R 70816FAD5 97.25 $ 14,587.50 $ 446.88
7;00O.00Q SPRINT CAP CORP NT 852060Af)4 96.13 $ 6,728.75 $ 168.44
____ _ $1,663,386.03 $ 1,361.85
---- ------_- ---
Grand Total(Market Value+Accrued Interest) S 1,664,747.88
LOIS N�C GU�IoUC�n At-t-c��hm�r�� 2
RE: 005-822639/Alvin Mccullough (Trust)
The value of the above-referenced account on March 21,2014 is as follows:
�,. , ., .. ,
. �>� ����:,,�., -.�
E
h
��°;�.
2,66�.63t� F�C�ERfiTED GUV�NMENT CIBLIGATIUNS QGQSQ $1.00 $ 2,668.53 -----
1,Q12.000 AT&T INC CUM 7` 34.3Q $ 34,711.60
--- ----__
34;�€��G�N'Tt,JRYLINK INC CTL 31.34 $ 1,065.56
--- -- __
60ti:t}p�l Ct)�ACC?LA`CO ` KO 3$.44' $ 23,064.00
-- ---
6�i?, �!Q Ct�#NECAST CfJRR NESLU�L.A CMCSA 50.OQ' $ 30,000.00
--- _ _
7;6�1 4v(}�ATON VA�fG�NA'f MUhti INGOM�FUND �ANAX 9.41'
- _-- -
CLASS A ` $ 72,000.14
�3t1(3.0O{�EX�QN°M��IL Ct3F�P � XpM �4.3a: $ 28,293.00 ----
____ .--
240.U00 FR�NTIER COMMUNICATlC}NS CORP FTR �5.41 $ 1,298.40
- - -----
700.OQ0 GENERAL ELECTRIC CO GE 25.4Q' $ 17,780.00
- ----- -_ ___
984.QD0 HAWTMORN'BANGSWARES!N� MWBK 13.43 $ 6,500.12
_- �
1;556.297 KEELEY MtD CAP URLUE FUND ' KMCUX 16.11 $ 25,071.94 i
---- ----- -- -
500.000 PUBLIC SERVICE ENTERPRISEGRQUP JIVC PEG 36.90 $ 18,450.00
- _ _
1,350.Q00 VERIZON COMMUNICATIC�NS VZ 46.91 $ 63,328.50
-
200.000 WALMART STORES INC WMT 76.10 $ 15,220.00
-- _ —__ -_--- $ 339,451.80 $ -
-- ----- --- ____ _ -
Grand Total(Market Value+Accrued Interest) _a_ 339,451.80
* Date of Death price is calculated using that days closing value.
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RE: 004-196371/Lois Mccullough(IRA)
The value of the above-referenced account on March 21,2014 is as follows:
&..
,r.
�e�`-
�� .�
4;092,"T4�FRIM�:FUNI��?Al�.1�11�Q„'�Y CiA�uS FCIAXX' $1.00 $ 4,092.74 ----
152.7�5 AM�RICAN�UR�AA IFt �,t��lli7'Fi CLASS AEG�'X 4'7.88 $ 7,791.75 ---__._
472.638 AMERICAIV�F�C)WTH� ,(yC? �`AM�FtfCA GF'A�X" 43.3f:' --- --
CLASS�1 $ 20,493.58
147.3 'qRT1�/1M I�IID CAP VRLU� ARTQX 27.38 $ 4,034.00 ---- _ _
_ 9'f 18.28'( �I.ACI�RC7CK C�RE'B4N;1�'PORTFOUO CMCBX 9.52 $ 91,566.04 ---- . .
1,10Q.37'[ EATON VANGE LARGE-CAP VALUE CLA EHSTX 24.35 $ 26,794.03 I
1�36fi i fi� �tDELi7Y ACJVISC?R:FL R�iTE HIGM IRIC CL T FFRTX 9.98 $ 13,634.35 -----_ _
_ 82. P Q E MG ' I EM X 1.79 ,7 4. ---- --
199.5�8:MAI(�lSTAY EpO�H GL��At;�QUITY YlD l EPSYX 19.78 $ 3,946.86 -___
52Q.�27 PIMGO•LfNGONSTRAtNE� BL11NS7'L CLASS PFIUX 11.15 $ 5,801.65 -------
_ � � 52.11Q T RO�l1fE PRIG�:M�D:CAP.�f�<l�tV1'�I � RF�MGX ���� 7�.((� $ 3,962.44 - -----
89.89.$T R�WE.RRlC�R�AL�S� A7��'{JNC? TFiREX 23.08 $ 2,074.85 ----- -_ _-
1 026.493 WELLS FARGO ADVT INTL BOND FD ADM ESIDX 10.87 $ 11,157.98
_ $- -_- ----- _ _
— ---- --- --- -- $ 197,144.59 $ -
----- -
— ---
______ rand Total(Market Value+Accrued Interest) a 197 144.59
' --- �
1� �� �.