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HomeMy WebLinkAbout03-12-15 (2) REV-1500 EX (01-10) 1505610140 OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO Box 280601 INHERITANCE TAX RETURN 2 1 1 4 0 1 1 7 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW 0 7 2 3 2 0 0 2 0 1 0 8 1 9 2 3 Decedent's Last Name Suffix Decedent's First Name MI F R Y C L A R E N C E W (if Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI F R Y F R A N C E S S Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW O 1.Original Return 2.Supplemental Return 3.Remainder Return(date of death prior to 12-13-82) ❑ 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 El 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 D O U G L A S G M I L L E R 7 1 7 2 4 9 2 3 5 3 REGISTE"F WILLS USS ONLY 70 r ri `y 7 3 Via: First line of address r k.(,, �71 7' I R W I N & M c K N I G H T P C Second line of address 6 0 W E S T P 0 M F R E T S T R E E T City or Post Office State ZIP Code DATE FILED C A R L I S L E P A 1 7 0 1 3 - 3 2' 2 Correspondent's e-mail address: Under penalties of pejury,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. SIGNATURE OF PERSON SPO IBLE F R FILING RETURN DATE r SS dG 5 KISSME ROAD NEWVILLE PA 17241 SIGNATU F P PAR OTH TH REPRESENTATIVE D 7E low ADDRE 60 WEST POMFRET STREET CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610140 1505610140 J 1505610240 REV-1500 EX RECAPITULATION 1. Real Estate(Schedule A) . . . . . ... .. .. .. .. . .. . . .. ... ... . .. . . . .. . .. . . . 1. 2. Stocks and Bonds(Schedule B) .. . . . . . ... . . .. .. . . . . . ... ... . . . . . . . . . . . 2. 4 7 8 4 . 4 0 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. 6 2 0 7 2 • 6 1 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . .. . . 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested . . . . . . . 7. 0 . 0 0 8. Total Gross Assets(total Lines 1 through 7) .. . . ... . .. .. . . .. .. . . . . . . . . . 8. 6 6 8 5 7 . 0 1 9. Funeral Expenses and Administrative Costs(Schedule H) .. . . . .. . . . . . . . . . . . 9. 1 4 1 2 4 . 2 4 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) .. . . . . . . . . . . . 10. 11. Total Deductions(total Lines 9 and 10) .. . . . .. . . ... . . . .. . . . .. . . . . ... . . 11. 1 4 1 2 4 . 2 4 12. Net Value of Estate(Line 8 minus Line 11) .. . ... .. . .... . . . . . . .. . .. . . . . . 12. 5 2 7 3 2 . 7 7 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 2 7 3 2 . 7 7 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 _ 4 1 3 6 6 . 3 9 15. 0 . 0 0 16. Amount of Line 14 taxable at lineal rate X.045 1 1 3 6 6 . 3 8 16. 5 1 1 . 4 9 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. 5 1 1 . 4 9 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Side 2 L 1505610240 1505610240 REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 14 0117 DECEDENTS NAME CLARENCE W. FRY STREET ADDRESS 95 KISSME ROAD CITY STATE ZIP NEWVILLE PA 17241 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 511.49 2. Credits/Payments A.Prior Payments B.Discount Total Credits(A+B) (2) 0.00 3. Interest (3) 286.87 4. If Linen 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) 798.36 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; ...................................................................... ❑ 121 b. retain the right to designate who shall use the property transferred or its income; ............................... ❑ X❑ c. retain a reversionary interest;or ................................................................................................ El ❑X d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ ❑X 2. If death occurred after December 12,1982,did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... El0 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?.................................................................................................. ❑ 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(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 DEPINHERITANCE OF URN STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER CLARENCE W. FRY 21 14 0117 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 60 SHARES OF PRUDENTIAL FINANCIAL, INC. STOCK 4,784.40 60 SHARES @$79.74 PER SHARE _$4,784.40 TOTAL(Also enter on Line 2,Recapitulation) $ 4,784.40 If more space is needed, insert additional sheets of the same size 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: CLARENCE W. FRY 21 14 0117 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. AIG LIFE INSURANCE 62,072.61 ANNUITY#T001564280 TOTAL(Also enter on Line 5,Recapitulation) $ 62 072.61 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 CLARENCE W. FRY 21 14 0117 Decedents debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. EGGER FUNERAL HOME 6,081.20 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Names)of Personal Representative(s) LOVE F. BAKER 3,350.00 Street Address 65 KISSME ROAD City NEWVILLE State PA ZIP 17241 Year(s)Commission Paid: 2. Attorney Fees: IRWIN & MCKNIGHT, P.C. 4,100.00 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: REGISTER OF WILLS 298.50 5 Accountant Fees: 6. Tax Return Preparer Fees: 7. REGISTER OF WILLS- FILING FEE 15.00 8. CUMBERLAND LAW JOURNAL- ESTATE NOTICE 75.00 9. THE SENTINEL- ESTATE NOTICE 189.54 10. NOTARY FEES 15.00 TOTAL(Also enter on Line 9,Recapitulation) S 14 124.24 If more space is needed,use additional sheets of paper of the same size. Continuation of REV-1500 Inheritance Tax Return Resident Decedent CLARENCE W. FRY 21 14 0117 Decedent's Name Page 1 File Number Schedule J -Beneficiaries-1 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).] 8. HOPE F. FRY Lineal 19 W. BIG SPRING AVENUE NEWVILLE, PA 17241 Computershare Investor Centre-United States https://www-us.coniputershare.com/Investor/wizard/sell/NEMrhD... &mputershare Investor Centre - United States Sell your shares Prudential PRUDENTIAL FINANCIAL INC Confirmation Share Type - Book Your request to sell 60 share(s)from your PRUDENTIAL FINANCIAL INC has been received.This market order will expire at the end of the business day. Market sales requests entered after 4:00 P.M. Eastern Time or on a day the market is closed,will be processed the next day the market is open. The date your shares are sold is Trade date,and your payment will be sent on Settlement date 3 business days later. Your current share balance will not be updated to include this pending transaction until the settlement date.The Pending Transactions page will provide you with a status of your request. Your sale order reference No.:2250:11750618:381167:RDI:D submitted on 3/10/2015 3:16 PM.You can print this page for your records. Confirmation of Order Details Date 3/10/2015 Quantity 60 Order Type Market order Currency USD Proceeds Distribution Check Automated Sale confirm Email : knoel@irwinmcknight.com Estimated Cost Basis and Tax Information Type Covered Noncovered Shares N/A 60 Proceeds N/A USD 4784.40 Cost Basis N/A N/A Estimated short term(gain/loss) N/A N/A Estimated long term(gain/loss) N/A N/A Copyright©2015 Computershare Limited.All rights reserved. Reproduction in whole or in part in any form or medium without express written permission of Computershare Limited is prohibited. Please view our Terms and Conditions and Privacy policy. 1 of 1 3/10/2015 3:16 PM THE AIG LIFE um COMPANIES N.S. Death Claims Department P.O.Box 15403 Amarillo,TX 79105-5403 (800)233-2947 June 24, 2009 FINAL REQUEST Frances Fry C/O Hope Fry 95 Kissme Rd T-450 Newville, PA 172418711 Re: Name of Deceased: Clarence Fry Contract Number: T001564280 Beneficiary: Clarence W. Fry Estate Dear Sir or Madam: We have received notification of the death of Clarence Fry, the owner/annuitant of the referenced contract. On behalf of AIG Life Insurance Company, we wish to express our sincerest condolences for your loss. The following items are enclosed: 1) Claims Checklist- A list of items required to initiate a claim for this contract. 2) Beneficiary options page - A list of claim options available to the referenced beneficiary. 3) Applicable documents for completion. We appreciate your prompt attention to this matter. Should you have any questions or require further assistance, please contact our Client Care Center by using our toll free number of 1-800-233-2947. Sincerely, T� (�[;U--�— B.M. Graves �✓ Annuity Claims Manager Enclosures AIGL Cvr Ltr Mar 11 2015 11 :51HM Egger Funeral Home 7177764589 p» 1 15 Big Spring Avenue NEWVILLE, PENNSYLVANIA 17241 F.CHARLES EGGER,Supervisor 717-776-3414 FRANK C. EGGER,Funeral Director March 11,2015 Funeral bill for Clarence W. Fry Date of Death July 23,2002 Professional Services $3,145.00 3 Veath Certificates$2.00 a piece $6.00 Clergy offering $50.00 Organist $35.00 Burial Vault $843.00 18 gauge blue Sterling casket $1,905.00 Obituary $97.02 Total $6,081.20 Paid in Fall September 7,2002