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Home My WebLink About04-07-15 . , � 1505610140 REV-1500 EX (02-11)(FI) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RFTURN Harrisburq, PA 17128-0601 RESIDENT DECEDEf�T 2 1 1 3 1 3 5 8 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MPJIDDYYYY 1 1 1 � 2 0 1 3 0 4 f] E� ], 9 1 8 DecedenYs Last Name Suffix UecedenYs First Name MI Z E I G L E R J E A N M (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 FlLED ItJ DUPLICATE WITH THE REGISTE�: �,lF VV�IILLS FILL IN APPROPRIATE OVALS BELOW � 1.Original Return � 2.Supplemental Return n 3. Remainder Return(Date of Death Prior to 12-13-82) � 4. Limited Estate � 4a. Future Interest Cornpromise idatn ns �I 5. Federal Estate Tax Retum Required death after 12-12-32) � 6.Decedent Died Testate � 7.Decedent Mainta?ned a�i�::rg 7rus3 n..__ 8.Tetal Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) � 9. Litigation Proceeds Received � 10. Spousal Poverty Credit(Daie of Death � 11. [lect�on to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-�J5) (Attach Scheduie O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE ANU CON,"-IDENTIAL TpX INFORMATIQN SHOULD BE DIRECTED T0: Name Daytime Telephone Number I V 0 V • 0 T T 0 I I I 7 1, 7 2 4 � 3 3 �I 1 � I REGISTER OF WILL.�'i U�E ONLY � o �I First Line of Address � Cp �' � �'�7 I� 1 0 E A S T H I G H S T R E E T �i � � � � II �. c� cn � � Second Line of Address � .`� �'' � �� ".:. r,�� ."'�'7 � `.�7 C3 City or Post Office State Z!P Code — -a-��D�E Fit� � � '� C A R L I S L E P A 1 7 0 1 3 1 -� w r��,,, r�r� y�. � � � w -� CorrespondenYs e-mail address: IOTTO(�a,MARTSONLAW.COM Under penalties of perjury,I declare that I have examined this return,including accompanying sr,hedules and statemen;s,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. SIGNA E OF PEFjSON R�SP NSIBLE FOR FILING RETURN DATE � �'�.�=--�.��a��-. ��.L-t�..�-�i� ;f _ � _'%� ADDRESS 1101t�EGENT COURT CARLISLE PA 17013 SIGNATUR�P E �THAN�PRESENTATIVE , / Dp1TE � J .�— `.f tc `^ ADDRESS 10 EAST HIGH STREET CARLISLE PA 17�13 PLEASE USE ORIGINAL FORM ONLY Side 1 � 1505610140 ],505610140 J � Continuation of REV-1500 Inheritance Tax Return Resident Decedent JEAN M.ZEIGLER 21 13 1358 DecedenYs Name Page 1 File Number Correspondents Name Daytime Telephone Number I V 0 V • 0 T T 0 I I I 7 1 7 2 4 3 3 3 4 1 First line of address 1 0 E A S T H I G H S T R E E T Second line of address City or Post Office State ZIP Code � A R L I S L E P A 1 7 0 1 3 Correspondent's e-mail address:I 0 T T 0 a�M A R T S 0 N L A W• C 0 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. SIGNATURE 9F j�R QN RESPONSIBLE FOR FILING RETURN � ��T�/� j� ci � ADDRES 544 I SON STREET CARLISLE PA 17013 � 1505610240 REV-1500 EX(FI) DecedenYs Social Security Number �ecede�t's Narr�e: J E A N M • Z E I G L E R RECAPITULATION 1. Real Estate(Schedule A) 1. � • � � . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. Stocks and Bonds(Schedule B) 2, 9 9 4 . 8 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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. 2 1 2 7 . � � 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. � • 0 � 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) � Separate Billing Requested . . . . . . . 7. 0 . � � 8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 3 1 2 1 , 8 5 9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9• 2 3 2 . 0 0 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule I) . . . . . . . . . . . . . 10. 8 3 4 . 9 6 ��. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 1 0 6 6 . 9 6 12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 2 � 5 4 . 8 9 13. Charitabie 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. 2 � 5 4 . 8 9 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 O 15. O . 0 0 16. Amount of Line 14 taxable at�inea�rate X.045 2 0 5 4 . 8 9 �6. 9 2 . 4 7 17. Amount of Line 14 taxable at sibling rate X.12 � . � 0 17. 0 . 0 0 18. Amount of Line 14 taxable at collateral rate X.15 0 • 0 0 1 g. � • 0 0 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 9 2 • 4 7 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT � Side 2 � 1505610240 1505610240 J REV-15o0 EX(FI) Page 3 File Number Decedent's Complete Address: 2i 13 i3s8 DECEDENT'S NAME JEAN M.ZEIGLER — --- _ _— ------ ___ STREET ADDRESS 544 WILSON STREET _ __------- --- — CITY I STATE ZIP CARLISLE I PA 17013 Tax Payments and Credits: �• Tax Due(Page 2,Line 19) (1) 92.47 2. Credits/Payments A.Prior Payments B.Discount Total Credits(A+B) (2) 0.00 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) 0.00 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 92.47 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 ............................... ❑ � c. retain a reversionary interest ..................................................................................................... ❑ X❑ d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ 0 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? ......... ❑ � 4. Did tlecetlent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation?.................................................................................................. ❑ 0 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 stili 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[�2 P.s.§s�ts(a)(�)�. • The tax rate imposed on the net value of transfers to or for the use of the decedenYs 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 DEPARTMENTOFREVENUE STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER JEAN M.ZEIGLER 21 13 1358 Ali property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 20 shares of Metlife Inc. (MET) 994.85 See attached. TOTAL(Also enter on Line 2,Recapitulation) $ 994.85 If more space is needed, insert additional sheets of the same size REV-1508 EX+(08-12) pennsylvania SCHEDULE E DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC. INHERITANCETAXRETURN pERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: JEAN M.ZEIGLER 2] 13 1358 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. Selective Insurance Company of America-flood insurance premium refund 1,873.00 2. MetLife,Inc. -dividend check received after date of death 23.20 3. UGI Utilities,Inc. -refund 230.80 4. Prudential-life insurance payable to the Estate($5,874.99) 0.00 5. MetLife-life insurance payable to the Estate($1,74036) 0.00 TOTAL(Also enter on Line 5,Recapitulation) $ 2,127.00 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 INHERITANCETAXRETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER JEAN M.ZEIGLER 2l 13 1358 DecedenYs debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1, B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: 2, Attorney Fees: Martson Law Offices(estimated) 215.00 3, Family Exemption:(If decedenYs address is not the same as claimanYs,attach explanation.) Claimant Street Address �i�y State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 5 Accountant Fees: 6. Tax Return Preparer Fees: 7. Stock Valuation 2.00 8. Register of Wills-filing fee 15.00 TOTAL(Also enter on�ine 9,Recapitulation) $ 232.00 If more space is needed,use additional sheets of paper of the same size. REV-1512 EX+(12-12) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT� INHERITANCETAXRETURN MORTGAGE LIABILITIES 8�LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER JEAN M.ZEIGLER 21 13 1358 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. 2013 personal income tax returns 834.96 TOTAL(Also enter on Line 10,Recapitulation) $ 834.96 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: JEAN M.ZEIGLER 21 13 1358 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 spousai distributions and transfers under Sec.9116(a)(1.2).] 1. Brenda Z. Davidson Lineal 1,027.45 ll O1 Regent Court 1/2 of estate residue Carlisle, PA 17013 2. Kimberly C.Zeigler Lineal 1,027.44 544 Wilson Street 1/2 of estate residue Carlisle,PA 17013 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. 1. B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. 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. Estate Valuation Date of Death: 11/10/2013 Estate of: Jean E. Zeigler Estate Valuation Date: 11/10/2013 Report Type: Date of Death Processing Date: 09/29/2014 Number of Securities: 1 File ID: 8199.1.zeigler.metlife Shares Security Mean and/or Div and Int Security or Par Description High/Ask Low/Bid Adjustments Accruals Value 1) 20 METLIFE INC (59156R108; MET) COM New York Stock Exchange 11/OB/2013 50.66000 4�.60000 H/L 11/11/2013 50.14000 49.47010 H/L 49.467525 989.35 Div: 0.275 Ex: 11/06/2013 Rec: 11/08/2013 Pay: 12/13/2013 5.50 Total Value: 5989.35 Total Accrual: 55.50 Total: 5994.85 Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricinq Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7,4.0) ��. � ��