HomeMy WebLinkAbout11-14-14 1505611101
REV-1500 EX(02-11) '
lvania OFFICIAL USE ONLY
PA Department of Revenue penY
Bureau of Individual Taxes 0EPAP7ns ME OF FEVENOE County Code Year File Number
PO BOX 28o6o1 INHERITANCE TAX RETURN
Harrisburg,PA 17128-0601 RESIDENT DECEDENT �p
ENTER DECEDENT INFORMATION BELOW
o9o9ao / .,i- y
Decedent's Last Name Suffix Decedent's First Name MI
V\o (' E501.t)i f9s. 6e+:+ I M
(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
9M . 1. Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death
Prior to 12-13-82)
O 4. Limited Estate O 4a. Future Interest Compromise(date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit 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 COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
be In 0 Y
REGISTER� ALS USE 4Y RT
r>7 q n
L= C
First Line of Address ti f
� 0 < Z'Z a
'+
Second Line of Address z `7
C
f"-
- DATE FILED f`
City or Post Office State ZIP Code w
----G 14,es B Lx r� 100. o
Correspondent's e-mail address: r()M ale— ) m0.�
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,corr mplete.Declaration of pr rer other than th rsonal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSN RESPONSIBL FILING-TURNr DAYE //jy/
ADDRESS J� /� T� y- /
SIGNATURE OF/vPJREPPAAREER OTHER THAN REPRESENTATIVE U DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY '
Side 1
L• 1505611101 1505611101 IAI
�v
_J1505611201 ;
REV-1500 EX
RECAPITULATION
1. Real Estate(Schedule'A)� `: `-t ..1..` ..i.... .. ...�.....r.
2. Stocks and Bonds(Schedule B) .. ... .. ... . . ... .. 2. L7�UU�_o,• J
• � -# -1 - . •t .`. .
�J3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) .. . . . 3. l_.J� ��;`,OJ• „ {
, l
4. Mortgages and Notes Receivable(Schedule D) ..... . ... ... ... .. ... .. ... . 4. LlO'•;��
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). .:. .. . 5. U�1 �, Qr-i1
+ 6. Jointly Owned Property(Schedule F)` O Separate Billing Requested ... .. .. 6. OILI / r, Li i Q}s
7. Inter-Vivos Transfers 8�Miscellaneous Non-Probate Property -
(Schedule G) O Separate Billing Requested.... .. .. 7..UL j 1�j UL�l�
8. Total Gross Assets total Lines 1 through 7 . .. . ..... . .... rj J
9. Funeral Expenses and Administrative Costs(Schedule H)..... . .. . . . .. . .. .. 9. LD A Lj'141 6'��.'Q� �
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1). .....:.. .. .:. . 10. J} [ _ �.'JL_.)
11. Total Deductions(total Lines 9 and 10). .. . ... .. . ...... . . . .. .... ..... 11. l v a
12. Net Value of Estate(Line 8 minus Line 11) . . .... .. ..... . ... . . .. . .: ... .. . 12: LQ
{ 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which - /�-
• an election`to tax has not been made(Schedule J)
.. ... .. ...... .... . . ... .. . 13. QLjM- 01-:1101Vim'
(^� }`
t 14. Net Value Subject to Tax(Line 12 minus Line 13) . . ..... ... .. ... . . ... .. . . 14.
r. 4 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 1i� S=ri -� i> f
(a)(1.2)X.0_ �J3iU� •I .FI,. 15 ._� 'L�L_s�
16. Amount of Line 14 taxable
at lineal rate X.0-
17.
0_17. 17 AmountLine taxable } L(--0 �.� (�u�A i �(-� +n•�� jt
3 at sibling rate X.1.12 •I Ult-E,�
If 18. Amount of Line 14 taxable "' - �• w t
at collateral rate{X.15 i, f`� , 1 18. OE
a�' � �• r
19. TAX DUE ... . .. °i."t.. f ....F?.... .?, .,. .... . . .... .. i19. ��7;•L?"3�
, .
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p
t F,
Side 2 _
,y 1505611201 1505611201
REV-1500 EX Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
�G o-n
STREET ADDRESS
f O
CITY �r�l STATE/JZIP
Tax Payments and Credits: Q
1. Tax Due(Page 2,Line 19)
2. Credits/Payments i
A.Prior Payments
B.Discount
Total Credits(A+13) (2)
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)
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 ............................................ ❑ 9
c. retain a reversionary interest ...........................................:.................................................................................. ❑
d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ R1
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?.............. ❑ Q
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 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(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-15og EX+(o1-io)
pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
If an asset became jointly owned within one year of the decedent's date of death,it must be reported on Schedule G.
SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A. W f 5 e- 0—�5��J -7017 U4016 Wck l ii
& '< Is 3 ��
1 <_456LL�j P14 1-7037
B.
C.
JOINTLY OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A.
9
ry14,®D n,o �, 00
TOTAL(Also enter on Line 6, Recapitulation) $
If more space is needed, use additional sheets of paper of the same size.
REV-1510 EX+(08-09)
pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
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 %OF DECD'S EXCLUSION TAXABLE
ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND
NUMBER THE DATE OF TRANSFER.."��ATT"TACH A COPY OF THE DEED FOR REAL ESTATE. VALUEOFOF ASSET INTEREST (IF APPLICABLE) /V/ALUE i1
1. Sa11I/v95 Ac -, l�Q/j11�J ( �SoN o�A(a� . Y I ��FIG � a_1 �Y e oV
4
TOTAL(Also enter on Line 7, Recapitulation) $ va
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
Decedent's debts must be reported on Schedule L
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
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:
6, Tax Return Preparer Fees:
7,
TOTAL(Also enter on Line 9, Recapitulation)
If more space is needed,use additional sheets of paper of the same size.
Senior Checking Plan Account Statement
For the period 07/1812012 to 8811512012
For 24-hour information,sign on to PNC Bank Online Banking BETTY MORGAN
on pnc.com. Primary account number.,51-4031-9729
Page 2 of 5
Senor Checldng Plan Betty Morgan
Regular Checldng Account Summary Denise R Dotson
Account naavber: 51-4031-9729
Overdraft Proteedon has not been established for this account.
Please contact us if you would like to set up this service.
Overdraft Coverage-Your account is currently Opted-Out.
You or your joint owner may revoke your opt-in or opt-out choice at any time.
'ro,loam more about PNC Overdraft Solutions visit us online at pnc comloverdraftsatutions.
Call 1-877-588-3805;visit any branch,or Sign on to PNC Online Banking,and select the"Overdraft
Solutions"link under the Account Services section to manage both your Overdraft Coverage and Overdraft
Protection settings.
Balance Summary
Beginning Deposits and Checks and other Er.dlnq
balance other additions deductions balance
605.07 1,868.00 868.92 1,604.15
Average monthly Charges
balance and fees
690.16 .00
Transaction Summary
Checks paid/ Check Card POS Check Card/Bankcard
withdrawals signed transactions POS PIN transactions
4 0 0
Total ATM PNC Bank Other Bank
transactions ATM transactions ATM transactions
0 0 0
Activity Detail
Deposits and Other Additions There were 2 Deposits and Other Additions
Date Amount Description totaling$1,888.00.
08/03 1,218.00 Direct Deposit-Xxsoc Sec
US Treasury 303 XXXXX8393A
08/14 650.00 Deposit Reference No. 521633430
Checks and Substitute Checks
Check Date Reference Check Date Reference
nun , A.mnurt paid number number Amount paid number
155 28.92 07/25 086509552 158* 70.00 07/20 OM9140
156 20.00 08/09 083199402 159 350.00 08/06 085215540
"Gap In check sequence There were 4 checks listed totaling
_
$468.92.
Online avid Dectronic Banking Deductions There were 2 Online or Electronic Banking
Date Amount Description Deductions totaling$400.00,
07/23 300.00 Payment,E-Check Check Pymt Fia Cardservices 157
08/03 100.00 Twh Auto Transfer To 5005189095
Daily Balance Detail
Date Balance Date Balance Date Balance Date Balance
07/18 605.07 07/23 235.07 08/03 1,324.15 08/09 954.15
07/20 535.07 07/25 206.15 08/06 974.15 08/14 1,604.15
Signature Card Image Page Page I of 1
Account ; 5140319729 LrScanDate: Wed May 30 00:00:00 EDT 2001 ** MULTIPLE I!
PNC Banc, NatioMl Association BB C Of�i'ice copy
AttaR oft Addimm ! !!B!Tolesw o ssiwnbots
717- 8-8193 (H)
sirthdato
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AuVowbod ..�..
01-PNC C aing
5141319M CW 00131 0612811 13 49 1
W ad
$60**ooff SOVI a cbraft •so a cow gear"d MEOW"do a all w< �e�k
-M",wch ww be."Mw 0 w,.ftia we*"Ol to doffs of my WWINL I w=160"Oft of s'
,uw at jest rr!sort by Mc out
tSM Vft I Addn_" ;� Rd. rzix~,, tArrew
BEM "DRGAN 8/AMOMS 0 HOWAN WA
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MISE a WTSDN
1 NtlRftN OR
WMSBKr PA 17111-8007 u toast las
. aiaai,e
Claim for Account PNCBANK
of Deceased Depositor
The undersigned hereby claim the remaining balance in the account(s)with PNC Bank,National
Association("PNC Bank")of the deceased person named below. By signing this form Undersigned certify that they
are related to the Deceased as shown following their signatures below,that they are all of legal age,that they are the
closest surviving relative of the Deceased(either the spouse,child,father or mother,or sister or brother)and are
rightfully entitled to claim property of Deceased o'r�t/o�exercise judgment as to its deposition.
Name of Deceased 44
Deceased's Residence �� n - � `� T J io
Date of Death
Account No-Q95'1 9 f Account No.
Balance$ j Balance$
(total of balances on deposit cannot exceed$3,500)
Undersigned directs PNC Bank tto pay
-the balance in the above account(s)as follows:
1,!74:50G 1. To �v,t 1,!74:50 ,a relative(as defined above).
A copy of the receipted funeral bill is attached*
G 2. To licensed funeral director,who
buried or cremated Deceased,whose bili is attached*
G 3. To who paid a licensed funeral
director to bury or cremated Deceased whose receipted bill is attached
*Original Licensed Funeral Director's bill must be presented to Bank for inspection and photostat attached
hereto. Alternatively, an affidavit, executed by a licensed funeral director which sets forth that satisfactory
arrangements for payment of funeral services have been made may be presented. If the amount on deposit (not to
exceed$3,500)exceeds the balance due for the funeral bill,then such sums shall be paid to decedent's spouse,child,
the father or mother,or any sister or brother(preference being given in the order named).
Undersigned agrees to indemnify and save harmless PNC Bank from and against all action, suits, claims,
damages and expenses incurred by reason of its having so paid the balance in Deceased's account(s). This agreement
shall inure to the benefit of PNC Bank, its successors and assigns, and shall bind the Undersigned, jointly and
severally,their executors,administrators,heir,and assigns.
Executed by the Undersigned this the, day of _c200 with the intention that
they be legally bound hereby.
L, 4a 00?L,-7— (Seal) Rel ti ship
Address Jt 3-3
�T
(Seal) Relationship
Address
(Seal) Relationship
Address
(Seal) Relationship
Address
C:IDOCUM E-11pp261611LOCALS-11TempU.notes.data\claimDecd_lwp
rs -
EQUAL Rousm
OPPORTUNITT
SUSQUEHANNA VIEW
A P A --- R -- T M E N T S �,
Date: 8/23/2012
Estate of Betty Morgan
PO BOX 253
Ickesburg,PA 17037
Re: Morgan Securi��osit
Dear'Sir dr Madam:
The apartment located at 208 Senate Ave#104 Camp Hill,PA 17011 was vacated on 8/17/2012. We are
required by law to return the security deposit or provide an explanation for the use of the deposit towards
damages, etc.. We have held the security deposit in the amount of$325.00. Attached is an explanation of the
application of the deposit.
By law the first two years of interest may be kept as an administrative fee. For three or more years of
occupancy the administrator may keep up to 1%of the amount of the Security Deposit as an administrative
fee. If your interest amount exceeds 1%of the total of the security deposit and is in excess of$1.00,the
remaining amount will be returned to you or applied to any balance owed on the account.
Thank you for renting from an HDC managed community. Please be advised that if there are questions
about the disposition of the security deposit please contact us within ten (10)days at the rental office of the
property and ask to speak to the,manager. Please be advised that you have thirty(30) days from the date of
this letter make payment on this account(if money is owed) or the account will be forwarded to Green Flag
Recovery by Transworld Systems for collection. If you have any questions;please feel free to contact me
during business hours at 717-763-1184.
Refund Due: 483.O0
Amount you owe: 0.00
Sincerely,
G
Kristen Mansberger
Manager
-----------—_-_----.--___--------__...___. . __._.._.-._.___...... ___...
^itara!-rxn^rr na m-n it m r•rtnae�a r . ern.n Iran a innarn s-rn•s _ rr, �-rs�}-rr^. s.e�w rnai s-ro+-.a�r�+r,rte�-x ^rri.�,. s ,ann r.r...n.. .-rn
Zimmerman uer - -
FUNERAL HOME, INC .
4100 Jonestown Road (717) 545-4001 Dale A.Auer, Supervisor
Harrisburg, PA 17.1.09 Fax(717)541-9943 Amanda J.Seiders, Funeral Director
Aug 10, 2012
Mrs . Denise R. Dotson
P.O. Box 253
Ickesburg, PA 17037
Betty M. Morgan - Deceased
SPECIAL CHARGES
Direct Cremation
Forwarding Remains
Receiving Remains
Immediate Burial
_Natj-onw_isla..Guarantee.Program_,.:_
Worldwide Travel Protection
TOTAL SPECIAL CHARGES $0.00
PROFESSIONAL SERVICES
X Services of Funeral Director & Staff $1 ,695 .00
X Embalming $725 .00
X Dressing/Cosmetizing/Casketing $245.00
Facilities & Staff for Viewing ( $200/hour)
Facilities & Staff for Funeral Service
Facilities & Staff for Memorial Service
X Staff & Equipment for Viewing ( $200/hour) $200.00
X Staff & Equipment for Funeral Service $615 .00
Staff & Equipment for Memorial Service
Private Family Viewing
Witnessing the Cremation
Packaging/Forwarding of Cremated Remains
Personal Delivery of Cremated Remains
Scattering of Cremated Remains
TOTAL PROFESSIONAL SERVICES $3,480.00
AUTOMOTIVE EQUIPMENT
X Removal Vehicle $250.00
X Casket Coach $250 .00
Flower Car
X Lead Car/Clergy Car $195.00
Service Vehicle
Family Car
TOTAL AUTOMOTIVE EQUIPMENT $695 .00
MERCHANDISE
Register Book
Memorial Cards
Thank You Cards
Remembrance Package
X Bradford Copper 20G $1 ,395.00
Cardboard Container
Alternative Container
Outer Burial Container
Veterans Flag Case
Grave/Memorial Marker
X Remembrance Package $120.00
X Laminates ( 7+1 Free) $31 . 50
TOTAL MERCHANDISE $1,546. 50
CASH ADVANCED ITEMS
X Grave Opening $1 ,779 .00
Cemetery Equipment
Vault Service Charge
X Harrisburg Patriot News $220, 12
Newspaper Notice
X Clergy Honorarium $150.00
Church/Organist/Soloist
X Flowers - Casket Spray $195.04
X Flowers - Single Rose (Daughter) $5 . 52
X Flowers --3 Roses (Grandchildren) ....5.11:..88
X Certified Copies of Death Certificate $60.00
TOTAL CASH ADVANCED ITEMS $2,421 . 56
SUMMARY OF CHARGES
Special Charges $0.00
Professional Services $3 ,480.00
Automotive Equipment $695. 00
Merchandise $1 , 546 . 50
Cash Advanced Items $2 ,421 . 56
SUB TOTAL $8,143 .06
CREDITS -$1 , 270.00
AMOUNT PREPAID -$5, 905.00
TOTAL $968 . 06
AMOUNT PAID Aug 15 , 2012 -$968 .06
a
BALANCE DUE $0.00
THIS STATEMENT MAY NOT REFLECT ALL NEWSPAPER CHARGES
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0001914987 NOV 13 2014
MAILED FROM ZIPCODE 17037
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