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HomeMy WebLinkAbout03-30-15 1505610140 REV-1500 Ex (01-10) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number PO BOX 280601 2 1 1 4 1 1 7 3 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 0 5 0 8 2 0 1 4 0 6 2 5 1 9 5 2 Decedent's Last Name Suffix Decedent's First Name MI R E I T Z D E N N I S I (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 0 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 11.Election to tax under Sec.9113(A) between 12-31-91 and 1-1-95) (Attach Sch.O) i CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number M A R C U S A M c K N I G H T I I I 7 1 7 2 4 9 2 3 5 3 REGISTER OF WILLS USE ONLY f rn First line of address co -v N I R W I N & M c K N I G H T P C rot h -a Q Second line of address r m �p M e 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 ILD© t C A R L I S L E P A 1 7 0 1 3 rno cJ i 01 r CIO ... Correspondent's e-mail address: 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 PER�O�N�SIBL F�G RETURN DATE ADDRESS 124 STATE ROA MECHANICSBURG PA 17050 SIGNATURE OF PREPA 0 R ENTATIVE DATE _ ADDRESS 60 WEST POMFRET TREE CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 �'J J 1505610240 REV-1500 EX Decedent's Social Security Number Decedents Name: DENNIS I• R E I T Z RECAPITULATION 1. Real Estate(Schedule A) .. .. . . . . . . ... . ... . . .. . . .. . . . ... . . . . . . . ... . . 1. 2. Stocks and Bonds(Schedule B) .. .. . . .. . ... . . ... .. . . . . . ... . . . . .. . . . . .. 2• 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. 4 9 9 4 1 . 3 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. 4 9 9 4 1 , 3 1 9. Funeral Expenses and Administrative Costs Schedule H 5 9 3 9 . 0 9 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) .. . .. . . . .. . . . 10. 1 3 0 5 . 5 2 11. Total Deductions(total Lines 9 and 10) . . .. . . . . .. . . .. . . . .. .. .. . .. . . . . . 11. 7 2 4 4 . 6 1 12. Net Value of Estate(Line 8 minus Line 11) . .. . . .. . . ... . . .. . . .. . . . .. . . . 12. 4 2 6 9 6 . 7 0 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. 4 2 6 9 6 . 7 0 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 . 0 0 15. 0 . 0 0 16. Amount of Line 14 taxable at lineal rate X.0 0 . 0 0 16. 0 . 0 0 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. 0 . 0 0 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 1173 DECEDENT'S NAME DENNIS I. REITZ STREET ADDRESS 43 WEST COLUMBIA ROAD, APT 4 CITY STATE ZIP ENOLA PA 117025 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 4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT. (3) 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; ...................................................................... ❑ 0 b. retain the right to designate who shall use the property transferred or its income; ............................... MX 171 c. retain a reversionary interest;or ................................................................................................ Eld. receive the promise for life of either payments,benefits or care? ....................................................... ❑ 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? ......... ❑ 0 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-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: DENNIS I. REITZ 21 14 1173 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. AMERICAN GENERAL LIFE COMPANIES 49,941.31 LIFE INSURANCE POLICY#G230808 LIFE INSURANCE- NON TAXABLE ASSET J TOTAL(Also enter on Line 5,Recapitulation) $ 49 941.31 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 RESIDENT DECEDENT ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER DENNIS 1. REITZ 21 14 1173 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. STEPHEN R. ROTHERMEL FUNERAL HOME 2,910.00 2. FUNERAL LUNCHEON 125.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Years)Commission Paid: 2. Attorney Fees: IRWIN &McKNIGHT, P.C. 2,725.00 3, Family Exemption:(If decedent's 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 170.50 5 Accountant Fees: 6. Tax Return Preparer Fees: 7. POSTAGE 8.59 TOTAL(Also enter on Line 9,Recapitulation) $ 5,939.09 If more space is needed,use additional sheets of paper of the same size. REV-1512 EX+(12-12) pennsylvania SCHEDULE DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES&LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER DENNIS 1. REITZ 21 14 1173 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. STATE EMPLOYEE RETIREMENT SYSTEM-REIMBURSEMENT OF OVERPAYMENT 154.64 2. CAPITAL ONE -CREDIT CARD 1,150.88 TOTAL(Also enter on Line 10,Recapitulation) $ 1,305.52 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: DENNIS I. REITZ 21 14 1173 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. EILEEN A. SONES Sibling 124 STATE ROAD 1/2 REMAINDER MECHANICSBURG, PA 17050 2. JANET M. COE Sibling 1381 WALNUT LANE 1/2 REMAINDER MACUNGIE, PA 18062 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. $ If more space is needed,use additional sheets of paper of the same size. ' . American General -- - Life Companies February 18, 2015 Estate of Dennis Reitz Eileen A. Sones-Administrator 124 State Road Mechanicsburg,PA 17050-3156 Re: Dennis Reitz Policy Number: G230808 — Claim Number: 2014-05-27-2142-01 United States Life Insurance Company Dear Ms. Sones: We have completed our review of the claim submitted on behalf of Dennis Retiz. Based on our review of this claim,premiums for Mr. Reitz's Life Insurance coverage under G230808 were paid through April 2, 2014. The Grace Period of this policy would have extended his coverage period until May 2, 2014. Mr. Reitz passed away May 8,2014 which was past the date his policy would have terminated. Based on an administrative review of this insured's payment history, the decision was made to extend coverage for this claim less the premium due and payable. The Life Insurance Amount of this policy is $50,000.00. We wish to advise you that the premium payment in the amount of$58.69 for the billing period 4/2/2014-5/16/2014 has been deducted from the Life Insurance Amount of the policy. A check in the amount of$49,941:3-1 will be mailed to-you-unde-r--separate cover. Please feel free to contact us if you should have any questions. Our toll free number is: 1-800-250-8898. Sincerely, Peggy Riegert Life Claims Department American General Life Companies,LLC Affinity Benefit Solutions® Distributing products issued by:American General Life Insurance Company of Delaware.American General Assurance Company. American General Indemnity Company American General Life Insurance Company and The United States Life Insurance Company in the City of New York 3600 Route 66•Neptune,NJ 07753•732-922-7000•www.americangeneral.con/affinitybenefits This company does not solicit business in New York. RECEIPT FOR PAYMENT ------------------- ------------------- LISA M. GRAYSON, ESQ Receipt Date: 12/12/2014 Cumberland County - Register Of Wills Receipt Time : 15 :48 :33 One Courthouse Square Receipt No. : 1079922 Carlisle, PA 17613 REITZ DENNIS I Estate File No. : 2014-01173 Paid By Remarks : IRWIN & MCKNIGHT CJ ------------------------ Receipt Distribution ------------------------ Fee/Tax Description Payment Amount Payee Name PETITION LTRS ADM 90 . 00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 5 . 00 CUMBERLAND COUNTY GENERAL FUN JCS FEE 35 . 50 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN INH TAX RETURN 15 . 00 CUMBERLAND COUNTY GENERAL FUN INVENTORY 15 . 00 CUMBERLAND COUNTY GENERAL FUN RENUNCIATION 5 . 00 CUMBERLAND COUNTY GENERAL FUN ---------------- Check# 8641 $170 . 50 Total Received. . . . . . . . . $170 . 50 e Qw- 7601 Penn Ave South,Suite A650 Cap"Cfie Minneapolis,.MN 55423-5007 or Contact Information Hours of Operation Account. Inforn-mrton Toll-Free 855-234-1142 7:00 am-7:00 p I m CT(M-Th) Total Unpaid Balance:$1,150.88 Fax 877-326-5689 7:00 am-5:00 pm CT(F) PF Reference No: CL630247 Probate Case NO:201401173 Date of Death:5/8/2014 IE#il##IEIEIII#E#IIIIIEIIH#iEl#IEIEEII#EIII#N#IE _ MARCUS A MCKNIGHT III RECEIVED 60 W POMFRET ST CARLISLE,PA 17013 SEB 2 6 -110 ,:i M 0 41&WKNIGHT LAW 01-FICES FEBRUARY 23,2015 Dear MARCUS A MCKNIGHT III You'll find a copy enclosed of our claim against the estate of DENNIS I REITZ If you have questions, please contact us toll-free at 1-(855) 234-1142. Cordially, Capital One Estates Care Team NOTICE:PLEASE SEE REVERSE SIDE FOR IMPORTANT INFORMATION NOTICE OF CLAIM (Filed Pursuant to 20 Pa.C.S. § 3532) COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE OF DENNIS I REITZ , DECEASED No. 2014-01173 To the Clerk of the Orphans' Court Division: Enter the claim of Capital One et al. (Claimant) in the amount of$ 1,150.88 , against the above entitled Estate. The Decedent, who resided at (Street Address) died on 5/8/2014 Written notice of (Date of Death) said claim was given to MARCUS A MCKNIGHT III (Personal Representative or his/her counsel) at 60 W POMFRET ST CARLISLE PA17013BFED (Address) ;w on ADiane Arndt (Date) Authorized Representative Capital One et al. N/A N/A 7601 PENN AVE SOUTH,SUITE A650 (Claimant's Counsel) (Supreme Court I.D.No) (Street Address) N/A MINNEAPOLIS,MN 55423 (Address) (City,State,Zip) N/A N/A (Telephone) Form OC-07 rev.10.13.06 PA Defau1LR20140129 Claim Detail CL630247 IN RE THE ESTATE OF: DENNIS I REITZ CASE NUMBER: 2014-01173 PF REFERENCE NO: CL630247 Claim detail is as follows: ************9428 Capital One $623.09 UNSECURED. THE DECEDENT PURCHASED GOODS AND/OR SERVICES IN THE AMOUNT OF$623.091 EVIDENCED BY ACCOUNT NUMBER************9428. ************4949 Capital One $527.79 UNSECURED. THE DECEDENT PURCHASED GOODS AND/OR SERVICES IN THE AMOUNT OF$527.79, EVIDENCED BY ACCOUNT NUMBER************4949. Claim Balance: $ 1,150.88 CAPITAL ONE REFERS TO EITHER CAPITAL ONE N.A. OR CAPITAL ONE BANK USA, N.A. Claim_Details_CAPONS LR20121227