HomeMy WebLinkAbout03-27-15 pennsytvania 1505614105
oEvnn.ne'rt of revenue EX(03-14)(FI)
REV-1500 OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN I 4
-]
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
—1 10142014 09091924
Decedent's Last Name Suffix Decedent's First Name MI
ISTATHES MARJORIE IV
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
F F]
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
cW 1.Original Return O 2.Supplemental Return O 3. Remainder Return(date of death
prior to 12-13-82)
O 4.Agriculture Exemption(date of C=) 5. Future Interest Compromise(date of C=:) 6. Federal Estate Tax Return Required
death on or after 7-1-2012) death after 12-12-82)
O 7. Decedent Died Testate O 8. Decedent Maintained a Living Trust 9. Total Number of Safe Deposit Boxes
(Attach copy of will.) (Attach copy of trust.)
O 10. Litigation Proceeds Received O 11.Non-Probate Transferee Return O 12. Deferral/Election of Spousal Trusts
(Schedule F and G Assets Only)
O 13. Business Assets C=:) 14.Spouse is Sole Beneficiary
(No trust involved)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
[JAMES P. STATHES (717) 737-8884
First Line of Address
226 WOOD STREET
Second Line of Address
City or Post Office State ZIP Code
CAMP HILL PA 17011
C=1
Correspondent's email address: Jpstat55@Comcast.11et .,
REGISTER1011'VIi1LL�USE 01WLY >
REGISTER OF WILLS USE ONLY
DATE FILED MMDDYYYY
.,
DATE'FILED STAMP C..? (.0
PLEASE USE ORIGINAL FORM ONLY
Side 1
05 4�iuiuii
0 1505614105
1505614205
REV-1500 EX(FI)
Decedent's Social Security Number
Decedent's Name: STATHES MARJORIE V. [
RECAPITULATION
1. Real Estate(Schedule A). ... .. . ... .. .. ........ ..... ..... . .... ... .... . 1. 180,000.00
2. Stocks and Bonds(Schedule B) .. . ... .... ... .. ... . ...... ........ . ... . . 2. 14,603.03
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. 205,207.50
6. Jointly Owned Property(Schedule F) O Separate Billing Requested .. .. .. . 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested.... ... . 7.
8. Total Gross Assets(total Lines 1 through 7).. . ... .. ...... ... . ........ .. . 8. 399,810.53
9. Funeral Expenses and Administrative Costs(Schedule H)......... .... .... .. 9. 22,833.38
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)..... .... .. .. .. 10. 2,152.60
11. Total Deductions(total Lines 9 and 10). . .. .. .. ..... ... . ...... ... ..... .. 11. 24,985.98
12. Net Value of Estate(Line 8 minus Line 11) . .... .......... ..... ... .. .... . 12. 374,824.55
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. 374,824.55
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_ 15.
16. Amount of Line 14 taxable
at lineal rate X.0 45 374,824.74 16, 16,867.11
17. Amount of Line 14 taxable
at sibling rate X.12 17.
18. Amount of Line 14 taxable
at collateral rate X.15 18.
19. TAX DUE .. ..... . . .... .. . .... ... ....... ...... ............ .... ... .. 19. 16,867.11
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Under penalties of perjury,I declare 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 person responsible for filing the return is based on all information of which preparer has
any knowledge.
SIGNATURE OF E SON RESPONS LE FO FILING RETURN DATE
rK I 03/25/2015
ADDRESS
226 Wood Street, Camp Hill, PA 17011-2641
SIGNATURE OF PREPARER OTHER THAN PERSON RESPONSIBLE FOR FILING THE RETURN DATE
ADDRESS
111111111111111 q111 111111111111111111 Side 2 J
15056142 1505614205
REV-1500 EX (FI) Page 3 File Number
Decedent's Complete Address: I t iuF -0 6►�o
DECEDENT'S NAME
STATHES MARJORIE V.
STREET ADDRESS
226 WOOD STREET
CITY I STATE ZIP
CAMP HILL PA 17011
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 16,867.11
2. Credits/Payments
A. Prior Payments 16,087.14
B.Discount _ 843.36_
(See instructions.) Total Credits(A+B) (2) 16,930.50
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) 63.39
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 .......................................................................................... ❑ 0
b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ 0
c. retain a reversionary interest .............................................................................................................................. ❑ 0
d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ N
2. If death occurred after Dec. 12, 1982,did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................................. ❑ 0
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ N
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
containsa 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 step-parent 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+(12-12)
10 pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
STATHES, MARJORIE V. 2114-0640
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.
ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1 226 Wood Street,Camp Hill,PA 17011-2641 (Hampden Township, Cumberland County) 180,000.00
=Parcel/PIN : 10-20-1850-046 + _
Tax Assessment as of DOD 06/27/2014:$173,400.x CLR 0.97=$168,198.00
(Stathes,Paul A, DOD: 07/03/2008)
Tax Assessment as of Transfer Date 03/27/2015:$173,400.xCLR 0.99=$171,666.00
I
i
TOTAL(Also enter on Line 1, Recapitulation.) $ �� 180,000.00
If more space is needed,use additional sheets of paper of the same size.
REV-1503 EX+(8-12)
I(De pennsylvania SCHEDULE B
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
STATHES, MARJORIE V. 2114-0640
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 598 Shares Manulife Financial Corporation(MFC)Common Stock CUSIP:56501R106 11,840.40
(299 shares Book Entry;299 shares Certificate) @ $19.80/share
Day's High (06/27/2014):$19.89/share
Day's Low (06/27/2014):$19.70/share
Day's Median (06/27/2014):$19.80/share
2 139.5267 Shares Manulife Financial Corporation(MFC)Common Stock CUSIP:56501R106 2,762.63
DRP Shares(Dividend Reinvestment Program) @$19.80/share
Last Quarterly Dividend before DOD credited 06/19/2014
Day's High (06/27/2014):$19.89/share
Day's Low (06/27/2014):$19.70/share
Day's Median (06/27/2014):$19.80/share
TOTAL(Also enter on Line 2, Recapitulation) $ 14,603.03
If more space is needed,insert additional sheets of the same size
REV-1508 EX+(o8-12)
2 pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
STATHES, MARJORIE V. 2114-0640
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. Personal Checking Account: #5140061457 (DOD Balance$49,869.93+0.33 Accrued Int.) 49,870.26
PNC Bank,NA P.O. Box 609,Pittsburgh, PA 15230-9738
2. Money Market Savings: #5005055572 (DOD Balance$51,110,75+3.069 Accrued Int.) 51,114.44
PNC Bank,NA P.O.Box 609,Pittsburgh, PA 15230-9738
3. Certificate of Deposit: #31200296256 (DOD Balance$47,260.17+3.62 Accrued Int.) 47,263.79
PNC Bank,NA P.O. Box 609,Pittsburgh, PA 15230-9738
4. 'Personal Savings Account: XXXXXXX027 (DOD Balance$50,293.60+0.41 Accrued Interest) 50,294.01
Members 1st Federal Credit Union 5000 Louise Drive,P.O.Box 40,Mechanicsburg, PA 17055-0040
5. Cash on Hand 120.00
6. 2000 Honda Accord EX SDN VIN: 1HGCG6677YAO12735, Fair Condition (Paint/Structural Deterioration) 2,225.00
Kelley BlueBook Value,April-June,2014 Wholesale/Trade-in
7. Personal Effects: Apparel/Footware 200.00
8. Personal Effects: Costume Jewelry/Misc.Chains, Earrings 200.00
9. Personal Effects: Dishes&Glassware 100.00
10. Personal Effects: Books&Magazines 50.00
11. Personal Effects: Bedroom Furniture(Bed,Dresser,Night Stand,Dressing Cabinet)20+yrs.old 250.00
12. Personal Effects: Kitchen Furniture (Table,4xChairs)30+yrs.old 50.00
13. Personal Effects: Dining Room Furniture(Table,Hutch,6xchairs) 250.00
14. Personal Effects: Living Room Furniture(Sofa,Chair,Coffee Table,2xEnd Tables&Lamps) 200.00
15. Personal Effects: Family Room Furniture(Sofa,Love Seat,2xLamps,End Table,Chair) 250.00
16. 2014 Federal Personal Income Tax Refund(Form IRS 1040) 2,770.00
Filed,but not received as of 03/27/2015
TOTAL(Also enter on Line 5, Recapitulation) $ 205,207.50
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+(08-13)
10 pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
STATHES MARJORIE V. 2114-0640
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Neill Funeral Home, Inc. Burial 3,300.00
2. Neill Funeral Home, Inc. Casket&Outer Burial Vault 4,990.00
3. Neill Funeral Home, Inc. Care/Preparation of Remains 1,190.00
4. Neill Funeral Home Transportation(Limousine/Service Vehicle) 395.00
5. Neill Funeral Home Flowers&Memorial Booklets 445.00
6. Neill Funeral Home Cemetery 1,495.00
7. Neill Funeral Home Clergy(Religious Facility/Cantor/Ceremony) 545.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s) James P. Stathes
Street Address 226.Wood Street_
city,Camp Hill _ _._ -----State PA__ZIP 170-11._.-
Year(s)Commission Paid:_N/A
2. Attorney Fees: IJ c o a s Law 0� � % N_ 2,500.00
3. Family Exemption: (]f decedent's address is not the same as claimant's,attach explanation.)
3,500.00
Claimant James P. Stathes
Street Address 226 Wood Street
city Camp Hill State PA ZIp 17011
Relationship of Claimant to Decedent Son
4. Probate Fees: 468.50
5. Accountant Fees: 0.00
6. Tax Return PreparerFees: 0.00
7. Neill Funeral Home, Inc. Certified Copies of Death Certificate 72.00
8. Neill Funeral Home, Inc. Newspaper Notice(PennLive/Patriot News) 325.00
9. Cumberland County Law Journal Estate Notice(3 Weeks) 75.00
10. The(Carlisle,PA)Sentinel Estate Notice(3 Weeks) 179.92
11. Camp Hill Cafe Funeral Luncheon/Beverages(90 persons) 1,205.82
12. PPL Electric Utilities(50%shared expense w/son) 429.83
TOTAL(Also enter on Line 9, Recapitulation) $ 22,833.38
If more space is needed, use additional sheets of paper of the same size,
REV 1511 EX+
RESIDENT DECEDENT
INHERITENCE TAX
ESTATE OF FILE NUMBER
STATHES, MARJORIE V. 2114-0640
SCHEDULE H
FUNERAL AND ADMINISTRATIVE COSTS
ADDENDUM
ITEM DESCRIPTION AMOUNT
NUMBER
13. UGI Gas Utilities ** 432.94
14. PA American Water Water Utility ** 149.16
15. Hampden Township Trash Removal/Sewer ** 235.43
16. Edward Graff Lawn Care/Weeding /Mulching ** 270.00
17. Allstate Auto /Property Insurance Premiums 463.12
18. U.S. Postal Service Insured/Certified/Registered Mailings 75.86
19. U.S. Postal Service Postage Stamps 9.80
20. Recorder of Deeds Mortgage Transfer Filing Fees 81.00
** 50% actual - shared expenses w/son
REV-1512 EX+(12-12)
pennsylvania SCHEDULE I
�y DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
STATHES, MARJORIE V. 2114-0640
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. Hampden Township Tax Collector 2014 Cumberland Valley School District Real Estate Tax 1,485.72
2. Holy Trinity Greek Orthodox Cathedral: 2014 Stewardship Commitment(Unpaid Balance as of DOD) 575.00
3. QVC/QCard Revolving Credit Account 72.72
4. Pa.Department of Revenue 2014 PA Personal Income Tax Owing(and due by 04-15-2015) 6.00
5. UGI Gas Utilities (Billing Period 5-30-14 to 6-30-14)($26.32x.050=$13.16)" 13.16
"Shared expense with son
TOTAL(Also enter on Line 10, Recapitulation) $ 2,152.60
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REV-1513 EX+(01-10)
' pennsylvania SCHEDULE J
+' DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
STATHES MARJORIE V 2114-0640
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).]
1• Alexander P.Stathes Son 187412.28
255 Fairway Drive,Etters,PA 17319
2. James P.Stathes Son 187412.27
226 Wood Street,Camp Hill,PA 17011-2641
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 II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 0.00
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