HomeMy WebLinkAbout01-29-15 1505610140
REV-1500 EX (01-10)
OFFICIAL USE ONLY
PA Department of Revenue
County Code Year File Number
Bureau of Individual Taxes
PO BOX 280601 - INHERITANCE TAX RETURN 2 1 1 4 0 $ 0 6
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDrfYY Date of Birth MMDDYYYY
0 8 1 2 2 0 1 4 0 1 2 0 1 9 5 2
Decedent's Last Name Suffix Decedent's First Name MI
Go o d I i ng George W
If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name Mi
N / A
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
FX_J 1.Original Return � 2.Supplemental Return 3.Remainder Return(date of death
prior to 1.2-13-82)
M 4.Limited Estate 4a.Future Interest Compromise(date of 5.Federal Estate Tax Return Required
death after 12-12-82)
F-1 6. Decedent Died Testate 7.Decedent Maintained a Living Trust 0 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 0 11. Election to tax under Sec.9113(A)
between 12-31-91 and 1-1-95) (Attach Sch.0)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
S C 0 t t W . Mor ri s o n Esq 71c-7 5 8 2-,3 0
171 c7 Ii`
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F&GI. #R OF WILUSE D
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T1
rl-,) r rl
First line of address co �3
6 We s t Ma i n S t r e e t
Second line of address k_� -Tl
P 0 Box 2 32 C>
City or Post Office State ZIP Code DATE FILf.Q, n
New B I o o mf i e I d PA 17068
Correspondent's e-mail address: smorrisonlavvOcentu rylink.net
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 prepares other than the personal representative is based on all information of which preparer has any knowledge.
SIO URE OF PER N RnElbfi ISLE FOR FILING RETURN DATE
5742 Waggoners Gap Road Landisburg PA 17040
SIGN
REPARER OTHER THAN REPRESENTATIVE VATE
f/1.3 6
DVF�E 9S�es Main Street New Bloomfield PA 17068
PLEASE USE ORIGINAL FORM ONLY
Side I
1505610140 1505610140
1505610240
REV-1500 EX
Decedent's Social Security Number
Decedent's Name:
George W. Goodling
RECAPITULATION
1, Real Estate(Schedule A)
2. Stocks and Bonds(Schedule B) ... .. . ... . .... ... .... .. .. ........ . .. .. 2.
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) . . . . . 3.
t�
4. Mortgages and Notes Receivable(Schedule D) 4.
3028+ 29
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). . . . . .. 5.
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 3 0 2 8 • 2 9
9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . .. . . . .. . .. . . . 9. 1 T9 6 7 • 3 3
10, Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) . .. ...... . . .. 10. 4 8 8 4 2 . 4 0
11. Total Deductions(total Lines 9 and 10) . . ... .... .... . . . . . . . .. . . , . . .. 11. 6 6 8 0 9 . 7 3
12. Net Value of Estate(Line 8 minus Line 11) . . . .. ... . .. . . . . . . .... . . . . . . . 12. - 3 .3 7 $ 1 4 4
I,
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. 3 3 7 8 + 4 4
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.o _ 0 . 0 0 15. 0 . 0 0
16. Amount of Line 14 taxable
at lineal rate X.0 0 . 0 0 16. 0 . 0 0
i
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 j
19. TAX DUE . 19. 0 • 0 0
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Side 2
1505610240 150561.0240 J
REV-1500 EX Page 3 File Number
Decedent's Complete Address: 21 14 0806
DECEDENTS NAME
George W. Goodlin
STREETADDRESS
102 Amy Drive
CITY STATE T1'7(013
Carlisle PA
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 f
(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; ............................... ❑ X❑
c. retain a reversionary interest;or ..........................................:..................................................... ❑ n
d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ XX
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? ......... ❑ X❑
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
t
contains a beneficiary designation?.................................................................................................. ❑ 0
a
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(1.2)[72 P.S.§9116(x)(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+(6-88) ;
3.
SCHEDULE E&pp �+
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
f_
George W Goodling 21 14 0806
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. Members 1 st Federal Credit Union Savings Account#54363-00 3,238.241
2. Members 1 st Federal Credit Union Checking Account#54363-11 790.05
3. Ofle-half interest in 1985 Peerless Mobile Home, title#36838676202 5,000.00
4. Subaru Legacy Sport(just purchased) 24,000.00
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I
,
' t
I
i
I
TOTAL(Also enter on line 5,Recapitulation) $ 33 028.29
(If more space is needed,insert additional sheets 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 t
ESTATE OF FILE NUMBER
George W. Goodlinq 21 14 0806
Decedents debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Nickel Funeral Home 9,518.81
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s) .Edward D. Deiter 4,000.00
Street Address 5742 Waggoners Gap Road
city 1_andisburg State PA ZIP 17040
Year(s)Commission Paid:
f
2, Attorney Fees: Scott W. Morrison 4,000.00
3, Family Exemption:(If decedent's address is not the same as claimant's,attach explanation,)
Claimant 3
Street Address y
1
City State ZIP
Relationship of Claimant to Decedent
i
4• Probate Fees: Lisa M. Grayson 140.50
5 Accountant Fees:
6. Tax Return Preparer Fees:
7, The Sentinel-estate advertising 233.02
8. Cumberland Law Journal-estate advertising 75.00
TOTAL(Also enter on Line 9,Recapitulation) . $ 17 967.33
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+(12-08)
Pennsylvania SCHEDULE
DEPARTMENTOFREVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES,&LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
George W. Goodling 21 14 0806
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. Subaru account balance 23,125.56
2. Members 1st Federal Credit Union-Visa account 19,461,43
3. Bank Americard -account 5,443.17
4. Holy Spirit Medical Group-account 38.85
5. Urology of Central PA, Inc. -account 25.50
6. Quantum Imaging and Therapeutic Associates-account 169.74
7. Center for Kidney Disease & Hypertenstion-account 26.32
8. Andrews and Patel Associates, PC-account 54.09
9. Holy Spirit Medical Group-account 221.27
r
10. Holy Spirit Hospital -account 250.00
11. Camp Hill Emergency Physicians-account 32.47
i
y
i
1
TOTAL(Also enter on Line 10,Recapitulation) $ 48 842.40
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J i
DEPARTMENT OF REVENUE BENEFICIARIES
i
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
George W. Goodlinq 21 14 0806
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE 1
k
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 v
Sec.9116(a)(1.2).] !
1. Edward D. Deiter Sibling
5742 Waggoners Gap Road 100% .
Landisburg, PA 17040
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:
1.
TOTAL OF PART H-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.
pennsylvania
bEPARTMENT'OF PUBLIC WELFARE
October 30, 2014
SCOTT W MORRISON ESQUIRE
6 W MAIN ST
PO BOX 232
NEW BLOOMFIELD PA 17068
i
y
Re: George Gooding
SSN: ###-##-
3
Dear Attorney Morrison:
Pursuant to your letter dated October 25, 2014, the Department's, Estate Recovery
Program, has reviewed the information you provided regarding the above-referenced j
individual. i
It has been determined that this individual did not receive any type of assistance
during the questioned period.
Therefore, according to the information you provided, the Department's Estate
Recovery Program will not seek any recovery from this estate. If your client applied for
Medical Assistance and had an application and/or hearing pending at the time of death,
J please advise us and provide'any-additional information that may affect a recovery by our
Department. "
y�.
Thank you for your cooperation in this matter. If you have any questions, please
contact me.
Sincerely
CIL
rr?
a
Vince A. Porter
Recovery Section Manager
(717)772-6604
Bureau of Program Integrity Division of Third Party Liability Recovery Section
PO Box 8486 1 Harrisburg, Pennsylvania 17105-8486
St �
MEMBERS 1St
FEDERAL CREDIT UNION
i
PRIMARY OWNER: George W. Goodling
REGULAR SAVINGS ACCOUNT: ?
Account Number/Suffix 54363-00
Date Account Established 03/30/1987
Principal Balance at Date of Death $3,238.15
Accrued Interest to Date of Death $0.09
Total Principal and Accrued Interest $3,238.24
Name of Joint Owner None
CHECKING ACCOUNT:
Account Number/Suffix 54363-11
Date Account Established 08/25/1992
Principal Balance at Date of Death $790.05
Accrued Interest to Date of Death $0.0
Total Principal and Accrued Interest $790.05
Name of Joint Owner None
VISA ACCOUNT: 4833660000035598
Date Opened: 08/26/1992
Principal Balance at Date of Death $19,461.43
Name of Joint Cardholder None
I
MEMBERS 1sT FEDERAL CREDIT UNION
t,
Christopher J. Zimmerman
Lending Insurance Support Specialist
October 31, 2014
Estate of: George W. Goodling
Date of Death: 08/12/2014
Social Security Number:
5000 Louise Drive P.C7.Box 40 Mechanicsburg,Pennsylvania 17055 * (800) 283-2328 www.memberslst.org
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