HomeMy WebLinkAbout01-29-15 (3) - J 1505610105
REV-1500 EX(02-11)(FI)
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania
P DEPARTMENT Of REVENUE y Count Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN +I
Ha BOX 280601
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
06072014 10051920
Decedent's Last Name Suffix Decedent's First Name MI
LOMADY CLARA S
(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 BOXES BELOW
Q 1. Original Return Q 2. Supplemental Return 0 3. Remainder Return(Date of Death
Prior to 12-13-82)
Q 4. Limited Estate Q 4a. Future Interest Compromise(date of 0 5. Federal Estate Tax Return Required
death after 12-12-82)
0 6. Decedent Died Testate 0 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
Q 9. Litigation Proceeds Received Q 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 Schedule O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number,,
C7
JAMES A . GALLAGHER, CPA 215663#3,35
REof�TEQ OF FWILLSVSE ON_t�Y
CD
First Line of Address
380 RED LION ROAD LE1
Second Line of Address { h— rn
�rr--1 G) CJ
SUITE 101 yy DATE FILED n
City or Post Office State ZIP Code
HUNTINGDON VAL PA 19006
Correspondent's e-mail address: J A G A L L A G H E R C P A @YAH 0 0 .C O M
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.
SIGNATURF OF PERSON RESPO SIBLE FO FILING RETURN DATE
ADDRESS `
6 KENGREY DRIVE, CARLISLE, PA 17015
TURE OF PR RO HER THAN RESENTAT� DAT
ADDR SS
38J3 RED LION ROAD SUITE 101 HUNTINGDON VALLEY PA 19006
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610105 1505610105 J
1505610205 ,
REV-1500 EX(FI)
Decedent's Social Security Number
DecedenrsName: CLARA S LOMADY
RECAPITULATION
1. Real Estate(Schedule A). . . . . ... . .. . . . . . . . . . . . . . . . . . . . ... . . . .... . . 1. 0 . 00
2. Stocks and Bonds(Schedule B)... ... . . . . . . . . . . . . . . . . . . . . . . . . .. .. . . . 2. 780554 . 09
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C). . . 3. 0• 00
4. Mortgages and Notes Receivable(Schedule D).. . . . . . . . . . . . .. . . . . . . . ... 4. 0.00
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). . .. . 5. 154017. 25
6. Jointly Owned Property(Schedule F) =Separate Billing Requested . . .. . . . 6. 0 • 00
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) =Separate Billing Requested. . . ... . .7. 97001. 32
8. Total Gross Assets(total Lines 1 through 7).. .. . . . .. . . . . . . . . . . . . . . . . . . 8. 1031572.66
9. Funeral Expenses and Administrative Costs(Schedule H). . . . . .. . .. . . . . . . . 9. 17254 . 71
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1). . . . . . . . . . .. .10. 251.28
11. Total Deductions(total Lines 9 and 10) . . .. .. . . . . . . .. . . .. .. . . . . . . . . . . 11. 17505 . 99
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . .. ... . . . . . . . . .. . . . 12. 1014066 .67
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J). . . . . . . .. . . . . . . . . . . . . . 13. 25000.00
14. Net Value Subject to Tax(Line 12 minus Line 13). . . . . . . . . . . . . . . . . . . . . . 14. 989066 . 67
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 15. 0.00
16. Amount of Line 14 taxable
atlinealratex.o 45 989066. 67 16. 44508.00
17. Amount of Line 14
taxable at sibling rate X . 12 17. 0 . 00
18. Amount of Line 14 taxable
at collateral rate X . 15 18. 0.00
19. TAX DUE. . . . . . . . . . .. .. . . . . . ... .. .. .. . . . . . . . . . . . . . . .. .. . . . . . . .. . . 19. 44508.00
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
L 1505610205 1505610205 J
REV-1500 EX(FI) Page 3 File Number 163-16-7853
Decedent's Complete Address: 21-14-0718
DECEDENT'S NAME
CLARA S LOMADY
STREETADDRESS
770 S HANOVER STREET
CITY STATE ZIP
CARLISLE PA 17015
Tax Payments and Credits:
1. Tax Due(Page 2, Line 19) (1) 44508.00
2. Credits/Payments
A.Prior Payments 38500.00
B. Discount 2026.00
Total Credits(A+B) (2) 40526.00
3. Interest
(3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT.
Fill in box 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) 3982.00
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............................................................................................................................. ❑ 0
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?............................................................................................................. ❑
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
contains a 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 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 PS.§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-1503 EX+(8-12)
pennsylvania SCHEDULE B
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Estate of Clara S. Lomady 21-14-0718
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Pioneer Multi-Asset Income Fund, Class C-8069.222 shares 97,314.82
2. Franklin Income Fund, Class C-37690.355 shares 97,241.12
3. Templeton Global Balanced Fund, Class C-28613.763 shares 97,000.66
4. PIMCO Income Fund, Class C-6426.963 shares 81,622.43
5. PIMCO Ass Asset Fund,Class C-5637.926 shares 71,658.04
6. Fidelity Advisor Strategic Real Return Fund, Class C-6730.285 shares 64,341.52
7. AT&T common stock, 1544 shares 54,070.88
8. Fidelity Real Estate Income Fund, Class C-3681.141 shares 43,363.84
9. Prudential Short Duration High Yield Income Fund, Class C-3922.566 shares 38,598.05
10. Fidelity Advisor New Insights Fund, Class C- 1236.425 shares 31,504.11
11. PIMCO Intl Stockplus Ar Strategy Fund, Class C (US Dollar Hedged)-3262.926 shares 25,124.53
11, Blackrock Global Long/Short Equity Fund, Class C-2124.044 shares 24,384.03
12. Comcast Corp. common stock, 150 shares 7,936.50
13. Templeton Global Bond Fund, Class C-42.709 shares 574.44
14. Primary Fund in liquidation-221.93 shares 221.93
15. U. S. Savings Bonds(3)-list attached 903.10
16. Frontier Communications, common stock, 162 shares 921.78
17. Verizon Communications Inc., common stock,675 shares 33,358.50
18. Comcast Corp, common stock, 196 shares 10,370.36
19. Alcatel-Lucent ADR, 11 shares 43.45
TOTAL(Also enter on Line 2, Recapitulation) $ 780,554.09
If more space is needed,insert additional sheets of the same size
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REV-1508 EX+(08-12) SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OFPERSONAL PROPERTY
INHERITANCE TAXAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Estate of Clara S. Lomady 21-14-0718
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. Pershing Brokerage Account, Cash balance 37,654.34
2. AXA Equitable, Life Insurance Proceeds(Spouse) 31,942.80
3. Orrstown Bank, Shippensburg, PA 17257-Checking Account#146002685 1,416.04
4. Citizen's Bank, Checking Account#610477-502-4 19,268.36
5. Fox Chase Bank,Advantage Checkinig Account#160196176 20,194.81
6. Fox Chase Bank, Savings Account#120135132 2,982.33
7. Fox Chase Bank, Certificate#240602037 18,321.75
8. Pension-PA Treasury Department-annuity payment 753.73
,9. Receivable-UNUM-Long Term Care reimbursement 3,000.00
10. Receivable-Nationwide Financial, Life Insurance Proceeds(Spouse) 14,873.09
11. Receivable-U S Treasury-income tax refund for 2014 3,320.00
12. Receivable-PA Department of Revenue-income tax refund for 2014 290.00
TOTAL(Also enter on line 5, Recapitulation) $ 154,017.25
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(08-13)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RE
RESIDENT DECEDENTTURN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Estate of Clara S. Lomady 21-14-0718
Decedent's debts must be reported on Schedule 1.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1 Dickinson College-funeral luncheon 251.22
2. FJFG LLC, Grantville, PA-funeral dinner 261.88
3. LeRoy's Flowers Corp, Hatboro, PA 287.21
4. Christopher Heitkamp, funeral services 300.00
5. Walmart,food and supplies-funeral reception 248.46
B. ADMINISTRATIVE COSTS:
1 Personal Representative Commissions: 12,500.00
Name(s)of Personal Representative(s) Susan Martin
Street Address 6 Kengrey Drive
city Carlisle State PA ztp 17015
Year(s)Commission Paid: 2015
2. Attorney Fees:
3. Family Exemption:(if decedents address is not the same as claimants,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: 693.50
5. Accountant Fees: 2,500.00
& Tax Return Preparer Fees:
7. The Sentinel-death notice 137,44
8. Cumberland Law Journal-death notice 75.00
TOTAL(Also enter on Line 9, Recapitulation) 17,25431
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+(12-12)
pennsylvania SCHEDULE 1 .
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN DEBTS OF DECEDENT,
RESIDENT DECEDENT MORTGAGE LIABILITIES& LIENS
ESTATE OF FILE NUMBER
Estate of Clara S. Lomady 21-14-0718
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.
George Branscum, MD-medical services 108.54
2. Carlisle HMA Physician Management-medical services 10.00
3. Millennium Pharmacy Systems, Inc. -medicines 122.74
4. Chapel Pointe at Carlisle, Carlisle, PA for residency cost 10.00
TOTAL(Also enter on Line 10,Recapitulation) $ 251.28
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Estate of Clara S. Lomad 21-14-0718
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
Susan Martin
1 6 Kengrey Drive, Carlisle, PA 17015 Daughter 25%
Nancy Schale,
2. 262 Walnut Street, Shippensburg, PA 17257 Daughter 25%
Frederick Lomady
3. 1544 Fitzwatertown Road,Willow Grove, PA 19090 Son 25%
4.
Judith Schreiber
49 Mt. Zion Road, Carlisle, PA 17015 Daughter 25%
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. Reformed Church of Willow Grove, 1404 North Hills Avenue,Willow Grove, PA 19090 25,000.00
TOTAL OF PART II—ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 25,000.00
If more space is needed,use additional sheets of paper of the same size.