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HomeMy WebLinkAbout02-25-15 (2) REV-1500 EX(02-11) tvb 1505610143 PA Department of Revenue OFFICIAL USE ONLY p pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE PO BOx.280601 INHERITANCE TAX RETURN 21 14 0627 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW 05 26 2014 01 06 1967 Decedent's Last Name Suffix Decedent's First Name MI DOMENE III RALPH R (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 X❑ 1. Original Return 2. Supplemental Return 3. Remainder Return(Date of Death Prior to 12-13-82) ❑ 4. Limited Estate 4a. Future Interest Compromise 5. Federal Estate Tax Return Required (date ofdeathafter 12-12-82) El6 Decedent Died Testate � 7. (Aeech C,Maintained a Living Trust � B. Total Number of Safe Deposit Boxes IJ (Attach Copy of Will) py ) El 9. Litigation Proceeds Received 10.b fo eenP12 31 1 a dt(Da95�f Death 11 Election to tax under Sec.9113(A) T (Attach Schedule 0) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number MICHAEL L BANGS 717 730 7510 REGISTq�OF WILLS 4S ONLY C a 1,7.1 First Line of Address r'wi c> cV ' 429 SOUTH 18TH STREET :7-;, - ,� ✓ Second Line of Address ' [SATE FILED ~I City or Post Office State ZIP Code CAMP HILL PA 17 011 I-11 Correspondent's e-mail address: mikebangs@verizon.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 preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR F LING RETURN DATE Anita D.Thompson - ADDRES 412 North 21st Street, Camp Hill, PA 17011 SIGNATURE OF PREPARER OTH THAN REPRESENTATIVE DATE �" 1 - Michael L. Bangs ;�- ADDR SS 429 South 18th Street, Camp Hill, PA 17011 Side 1 L 1505610143 1505610143 ���� , s '� � "fi r A� 1 1505610243 REV-1500 EX RECAPITULATION 1. Real Estate(Schedule A).......................................... ............................................ 1 2341729 . 00 2, Stocks and Bonds(Schedule B)......... ................................................................... 2. 1 Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C)......... 3. 4, Mortgages&Notes Receivable(Schedule D)...__.........._..................._....._ 4- 5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)......... 5. 54 , 746 . 79 6, Jointly Owned Property(Schedule F) ❑ separate Billing Requested............ 6. 5 , 367 . 31 T Inter-Vivol Transfers&Miscellaneous Non Probate Property (Schedule G) U separate Billing Requested............ 7. 8. Total Gross Assets(total Lines 1 through 7)......_................................................ 8. 294 , 843 . 10 9, Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 15, 475 . 05 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 3.59, 346 . 67 11. Total Deductions(total Lines 9 and 10)............................................................... 11. 174 , 821 . 72 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 120, 021 . 38 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. 120, 021 . 38 TAX COMPUTATION-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.00 15. 0 . 00 16. Amount of Line 14 taxable 120 , 021 . 38 16. 5 , 400 . 96 at lineal rate X .045 17. Amount of Line 14 taxable at sibling rate X.12 0 . 00 17. 0 . 00 18. Amount of Line 14 taxable at collateral rate X.15 0 . 00 18. 0 . 00 19. TAX DUE_.......... ....... ......... ...... ....... ............_........ ......._...... 19. 5,400 . 96 20, FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. El Side 2 1505610243 1505610243 REV-1500 EX Page 3 File Number 21-14-0627 Decedent's Complete Address: DECEDENT'S NAME Domene, Ralph R. III STREET ADDRESS j 506 Lamp Post Lane CITY STATE ZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 5,400.96 2. Credits/Payments A. Prior Payments 5,000.00 B. Discount 263.16 Total Credits(A +B) (2) 5,263.16 3. Interest (3) 4, If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2,Line 20 to request a refund 5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 137.80 Make Check Payable to. REGISTER OF WILLS, AGENT. 777 77 7 7717 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;.................................. ❑ ❑x c. retain a reversionary interest;or............................................................................................................... x d. receive the promise for life of either payments,benefits or care?............................................................ ❑ 0 2. If death occurred after Dec. 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 ❑ ❑ containsa 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 January 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-1502 EX+(01-10) SCHEDULE A pennsylvania REAL ESTATE DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Domene, Ralph R. 111 21-14-0627 All real property owned solely or as a tenant In common must be reported at fair market value.Fair Market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on schedule F. Attach a copy of the settlement sheet if the property has been sold Include a copy of the deed showing decedent's interest if owned as tenant in common. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH I Real Estate-506 Lamp Post Lane, Hampden Township. Tax Parcel No. 10-19-1598-194. 234,729.00 (Assessed value$237,100.00 x Common Level Ratio Factor for Cumberland County[.99] fair market value$234,729.00) TOTAL(Also enter on Line 1, Recapitulation) 234,729.00 (if more space is needed,additional pages of the same size) Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule A(Rev,01-10) Rev-1508 EX+(11-10) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Domene, Ralph R. III 21-14-0627 Include the proceeds of litigation and the date the proceeds were received by the.estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Integrity Bank-Checking Account 14,742.67 2 Integrity Bank-Savings Account 25,120.15 3 Refund from Chase 142.16 4 Refund from Comcast Cable 81.92 5 Refund from Hanlon Investment 148.38 6 Refund from Motorists Mutual Insurance Co. 316.96 7 Refund from New Hampshire Insurance Company 5.00 8 Sale of Automobile 9,218.42 9 SERS Annuity payment 4,971.13 TOTAL(Also enter on Line 5, Recapitulation) 54,746.79 (If more space is needed,additional pages of the same size) Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev. 11-10) Rev-1509 Ex+(01-10) pennsylvania SCHEDULE F DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Domene, Ralph R. 111 21-14-0627 If an asset was made joint within one year of the decedent's date of death,it must be reported on schedule G. SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT A. Anita D.Thompson 412 North 21st Street Mother Camp Hill, PA 17011 B. C. JOINTLY OWNED PROPERTY: LETTER DATEDESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECD'S VALUE OF NUMBER FOR JOINT MADE NUMBER OR SIMILAR IDENTIFYING NUMBER.ATTACH DEED FOR VALUE OF ASSE INTEREST DECEDENT'S INTEREST TENANT JOINT JOINTLY-HELD REAL ESTATE. 1 A 09/06/1990 PSECU -Savings Account 189.41 50.000% 94.71 2 A 09/06/1990 PSECU -Vacation Share account 1,838.23 50.000% 919.12 3 A 09/06/1990 PSECU-Checking account 8,706.95 50.000% 4,353.48 TOTAL(Also enter on Line 6, Recapitulation) 5,367.31 (If more space is needed,additional pages of the same size) Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule F(Rev.01-10) REV-1511 EX+(10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE DE EDENAX TURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Domene, Ralph R. III 21-14-0627 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s)attached 2,912.67 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zio Year(s)Commission Paid 2. Attornev's Fees Michael L. Bangs 9,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) Claimant Street Address City State Zio RelationshiD of Claimant to Decedent 4. Probate Fees 208.50 5. Accountant's Fees 405.00 6. Tax Return Preparer's Fees 7. Other Administrative Costs 2,948.88 See continuation schedule(s) attached TOTAL(Also enter on line 9, Recapitulation) 15,475.05 Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev. 10-09) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Domene, Ralph R. III 21-14-0627 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Neill Funeral Home 2,912.67 H-A 2,912.67 Other Administrative Costs 2 Boyer& Ritter-Accounting analysis 255.00 3 Charles M.Miller-Locksmith;change of locks on real estate 50.00 4 Cumberland Law Journal -estate advertisement 75.00 5 James D. Pivonka-Preparation of decedent's final lifetime tax returns 175.00 6 Register of Wills-additional short certificates 10.00 7 SERVPRO of New Cumberland 2,210.10 8 The Patriot News-estate advertisement 173.78 H-137 2,948.88 Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98) Rev-1512 EX+(12-08) SCHEDULE 1 pennsylvania DEBTS OF DECEDENT, DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Domene, Ralph R. III 21-14-0627 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 AT&T Mobility 115.97 2 AT&T Mobility-5/14/14 to 6/13/14 127.59 3 Bank of America Credit Card 1,197.31 4 Chase Mortgage-Payment 7/22/14 735.45 5 Chase Mortgage-8/18/14 payment 735.45 6 Chase Mortgage-outstanding balance as of 1/20/15 148,836.42 7 Chase Mortgage-payment 6/23/14 735.45 8 Chase Mortgage-9/16/14 735.45 9 Chase Mortgage-10/8/14 735.45 10 Chase Mortgage-11/5/14 735.45 11 Chase Mortgage-12/29/14 735.45 12 Hampden Township-sewer/trash 7/1/14 to 9/30/14 155.05 13 Hampden Township-sewer/trash 10/1/14 to 12/31/14 155.05 14 Michael Langan,Tax Collector-school real estate tax(2014-2015) 2,011.47 15 Motorists Insurance-Homeowners insurance 646.00 16 PA American Water-6/19/14 to 7/18/14 34.28 17 PA American Water-Homeowner repair program 50.38 Total of Continuation Schedules See attached pages TOTAL(Also enter on Line 10, Recapitulation) 159,346.67 (If more space is needed,additional pages of the same size) Copyright(c)2008 form software only The Lackner Group, Inc. Form PA-1500 Schedule I(Rev. 12-08) Rev-1512 EX+(12-08) SCHEDULE 1 pennsylvania DEBTS OF DECEDENT, DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT continued ESTATE OF FILE NUMBER Domene, Ralph R. III 2.1-14-0627 ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 18 PA American Water-5/20/14 to 6/18/14 38.87 19 PA American Water Company-7/19/14 to 8/19/14 35.05 20 PA American Water Company-8/20/14 to 9/19/14 33.01 21 PA American Water Company-9/20/14 to 10/17/14 45.27 22 PA American Water Company-10/18/14 to 11/19/14 40.16 23 PP&L Electric-6/11/14 to 7/14/14 73.92 24 PP&L Electric-7/14114 to 8/12/14 63.93 25 PP&L Electric-5/13/14 to 6/11/14 60.26 26 PP&L Electric-8/12/14 to 9/11/14 86.81 27 PP&L Electric-9111/14 to 10/13/14 79.35 28 PP&L Electric-10/13/14 to 11/11/14 68.12 29 UGI-5/30/14 to 6/30/14 11.46 30 UGI-6/30/14 to 7/30/14 11.47 31 UGI -4/30/14 to 5/30114 19.92 32 UGI-7/30/14 to 8/28/14 11.47 33 UGI-8128114 to 9/29114 11.47 34 UGI -11/14 bill 13.46 Copyright(c)2008 form software only The Lackner Group,Inc. Form PA-1500 Schedule I(Rev. 12-08) Rev-1512 EX+(12-08) SCHEDULE 1 pennsylvania DEBTS OF DECEDENT, DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT continued ESTATE OF FILE NUMBER Domene, Ralph R. III 21-14-0627 ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 35 Waste Management 165.00 TOTAL(Also enter on Line 10, Recapitulation) 159,346.67 Copyright(c)2008 form software only The Lackner Group, Inc. Form PA-1500 Schedule 1(Rev. 12-08) REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Domene, Ralph R. III 21-14-0627 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S)RECEIVING PROPERTY DECEDENTDo Not LIst Trusteefsj (Words) ($$$) ITAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] Anita D. Thompson Mother 412 North 21st Street Camp Hill, PA 17011 Total Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet as appropriate. NON-TAXABLE DISTRIBUTIONS: II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule J(Rev. 01-10) July 25, 2014 Integrity B A N K Bangs Law Office 429 South 181h Street Camp Hill, PA 17011 ATTN: Michael L Bangs RE: Estate of Ralph R Domene, III SS# 180-54-4382 DOD: May 26, 2014 Dear Mr. Michael L Bangs, I am writing in regards to the letter in which you sent inquiring about accounts that Ralph R Domene held at Integrity Bank, The following accounts have been located at Integrity Bank held by Ralph R Domene, III: Checking Account 201058449 Opened: December 3, 2012 Closed: July 10, 2014 Type: High Yield Checking Ownership: Individual Balance as of DOD: $14742.67 Interest Rate: 0.15% Savings Account 401034290 Opened: December 3. 2014 Closed: July 10, 2014 Type: Privileged Savings Ownership: Individual Balance as of DOD: $25120.15 Interest Rate: 0.15% If I can assist you further, please feel free to contact me at (717)901-5500 or contact me via email at lbatista@integritybankonline.com. ely, illian atis a Branch Manager Integrity Bank Si7 1 rely, i�kj ian Batis a Cavnp Hill. P-I I_0 I i Phone: -1_`)20-900 Fax: PSECO 08/04/2014 Bangs gs Law Office.. LLC Michael L. Bangs Esquire 429 S IS" St. Camp Hill, PA 17011 Re:�' -PHR DOMEINE,Deceased. PSECU Reference�43 10178217750 Dear Attorney Michael L. Bangs; The above referenced person has an account with PSECU which was opened on September 6, 1990. The Share accounts were jointly held by RALPH R DOMENE and ANITA D THOMPSON, The PSL, Visa and Auto loans were individually held. The following are the Date of Death Balances for RALPH R DOMENE's account with PS; CU: Account Date of Death Balances Interest—May 1 26 Savings (Sl) $ 189.41 SO.02 Vacation Share (S2) $1,838.23 $ 0.20 Checking (S4) $8,706,95 $0.70 Loans: Signature Loan (L20) $O.00 Visa Loan (L9) $ O.00 Auto Loan (Lll) $10,078-55 The joint owner needs to close the decedent's account with PSECU at the earliest convenience, The Auto loan balance was paid in full on July 21,2014. If you have any questions, please contact our department toll-free at(800)237-7;28,)28, press 6, extension 3 120 or email accountservices&secu.corn Sincerely, Lisa Carl Member Service Representative PSECT-1 R 0. BOX 67013 HARPISBURG, PA 17106-7013 800.237.7328 .,psecu.corn THIS CREDIT UNION IS FEDERALLY INSURED BY THE NATIONAL CREDIT UNION ADMINISTRATION.EQUAL OPPORTUNITY LENDER.