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HomeMy WebLinkAbout03-30-15 (2) 1505610140 REV-1500 EX (°'-'°' PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number Po Box 280601 INHERITANCE TAX RETURN 2 1 1 4 1 2 0 9 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 1 1 4 2 0 1 4 0 7 1 3 1 9 2 2 Decedent's Last Name Suffix Decedent's First Name MI Owen Geral di n E (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI N / A 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(date of ❑ 5.Federal Estate Tax Return Required death after 12-12-82) © 6.Decedent Died Testate ❑ 7.Decedent Maintained a Living Trust d 8.Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) ❑ 9.Litigation Proceeds Received ❑ 10.Spousal Poverty Credit(dale of death ❑ 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 SCot t W , Mor ri son Esq 717 587 2300 C-tEBSTER OF WICILS U$E10 51 First line of address !"71 rte' CA3 .� 6 We s t Mai n S t r e e t C3 ` Second line of address P O . Box 2 32 City or Post Office State ZIP Code a.) DATErRtOED New BI oomfi e d PA 17068 cam ' C^) ,. Correspondent's e-mail address: srnorrisonlaw@centurYlink.net Under penalties of pedury,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. SIGNATJ#R RSON RESPONSIBLE F_QRxFILING RETURN ADORES 30 Her4hv Her' Drive Mahwah NJ 07430 SIGNA ER THE THAN R ATIVE T 0 AD 6 e ai Street New Bloomfield A 17068 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 J a�� 1505610240 REV-1500 EX Decedent's Social Security Number Decedent's Name: Geraldine E. Owen 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. 1 9 6 3 5 3 • 2 4 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. 2 5 0 5 3 4 3 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested . . . . . . . 7. 8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 2 2 1 4 0 6 • 6 7 9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . .. 9• 5 7 1 8 • 5 2 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) . . . . . . . . . . . . . 10. 1 5 2 8 . 7 9 11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 7 2 4 7 . 3 1 12. Net Value of Estate(Line 8 minus Line 11) .. . . . . . . . . . . . . . . . . . . . . . . . . . . 12• 2 1 4 1 5 9 . 3 6 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) . . . . . . . . . . . . . . . . . . . . . . 13• 1 0 0 0 . 0 0 14. , Net Value Subject to Tax(Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . 14. 2 1 3 1 5 9 . 3 6 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.045 1 9 0 6 5 9 . 3 6 16. 8 5 7 9 . 6 7 17. Amount of Line 14 taxable at sibling rate x.12 1 7 5 0 0 . 0 0 17. 2 1 0 0 . 0 0 18. Amount of Line 14 taxable 5 0 0 0 . 0 0 18 7 5 0 . 0 0 at collateral rate X.15 . 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 1 1 4 2 9 . 6 7 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Side 2 1505610240 1505610240 J REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 14 1209 DECEDENT'S NAME Geraldine E. Owen STREET ADDRESS 801 N. Hanover Street CITY STATE ZIP Carlisle PA 117013 Tax Payments and Credits: 1, Tax Due(Page 2,Line 19) (1) 11,429.67 2. Credits/Payments A.Prior Payments 10,000.00 B.Discount 526.30 Total Credits(A+B) (2) 10,526.30 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) 903.37 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; ...................................................................... El ❑X b. retain the right to designate who shall use the property transferred or its income; ............................... ❑ ❑ X c. retain a reversionary interest;or ................................................................................................ ❑ 0 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? ....................................................................................... El ❑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 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 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+(6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF FILE NUMBER Geraldine E. Owen 21 14 1209 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, The Bank of Landisburg CID#700022730 20,006.41 2. The Bank of Landisburg CD#700023169 25,013.39 3. The Bank of Landisburg CID#700023918 20,006.14 4. The Bank of Landisburg CD#700023987 10,007.67 5. The Bank of Landisburg Passbook Savings Account#5120 5,904.96 6. The Bank of Landisburg MMA Account#648302 83,774.36 7. Church of God Home-refund 13,073.54 8. Brockie Healthcare, Inc. -refund 92.76 9. State Farm - refund 258.45 10. The Bank of Landisburg DDA Account#51 18,215.56 TOTAL(Also enter on line 5,Recapitulation) $ 196,353.24 (If more space is needed,insert additional sheets of the same size) REV-1509 EX+(01-10) pennsylvania SCHEDULE F DEP ARTMENTOFREVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Geraldine E. Owen 21 14 1209 If an asset was made jointly owned within one year of the decedent's date of death,it must be reported on Schedule G. SURVIVING JOINT TENANT(S)NAMIE(S) ADDRESS RELATIONSHIP TO DECEDENT A.Thomas Owen 30 Herlihy Drive Son Mahwah, Nj 07430 B. C. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 3/22/05 The Bank of Landisburg CD#700015318 50,106.85 50. 25,053.43 TOTAL(Also enter on Line 6,Recapitulation) $ 25 053.43 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 Geraldine E. Owen 21 14 1209 Decedent's 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: Scott W. Morrison 5,000.00 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: Lisa M. Grayson, Esquire 410.50 5 Accountant Fees: 6. Tax Return Preparer Fees: 7. The Sentinel 233.02 8. Cumberland Law Journal 75.00 TOTAL(Also enter on Line 9,Recapitulation) $ 5,718.52 If more space is needed,use additional sheets of paper of the same size. REV-1512 EX+(12-08) pennsylvania SCHEDULE DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Geraldine E. Owen 21 14 1209 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. Brokie Pharmatech -medical bills 1,293.94 2. Vohra Health Service- medical bills 10.00 3. Thomas Owen - reimbursements 164.85 4. Carlisle Medical Center- medical account 50.00 5. Wellspan Physician - medical account 10.00 TOTAL(Also enter on Line 10,Recapitulation) $ 1,528.79 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: Geraldine E. Owen 21 14 1209 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. Mary Fisher Collateral 7313 Spring Road 2500.00 Shermans Dale, PA 17090 2. Shirley Bitner Sibling 311 Third Street 5000.00 Summerdale, PA 17093 3. Ronald Hoffman, a/k/a, William Ronald Hoffman Sibling 1501 State Road 5000.00 Duncannon, PA 17020 4. Carrie Hoffman Sibling 65 Gambers Corner Road 5000.00 Duncannon, PA 17020 5. Roy Hoffman Sibling 101 Pennell's Church road 2500.00 Duncannon, PA 17020 6. Shirley Hoffman Collateral 621 Lincoln Street 2500.00 Duncannon, PA 17020 7. Thomas A. Owen Lineal 30 Herlihy Drive 2/3 rest and residue Mahwah, NJ 07430 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. Mt. Zion Lutheran Church 1,000.00 P. O. Box 207 Landisburg, PA 17040 TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 1,000.00 If more space is needed,use additional sheets of paper of the same size. Continuation.of REV-1500 Inheritance Tax Return Resident Decedent Geraldine E. Owen 21 14 1209 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 TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec.9116(a)(1.2).] 8. Benjamin A. Owen Lineal 30 Herlihy Drive 1/3 rest and residue Mahwah, NJ 07430 LAST WILL AND TESTAMENT OF GERALDINE E. OWEN � a I, GERALDINE E. OWEN, of 201 E. Water Street, Landisburg,Perry County, Pennsylvania,being of sound and disposing mind, memory and understanding do hereby make publish and declare this my Last Will and Testament, hereby expressly revoking all other writings in nature testamentary by me at any time heretofore made. FIRST: I direct that all my debts and funeral expenses be paid as soon after my decease as may be practicable. SECOND: I direct that inheritance tax on property disposed of herein shall be paid I l from my residuary estate. THIRD: I give, bequeath and devise all the rest and residue of my estate and property, real,personal and mixed, of whatsoever nature and wheresoever situated of which I may own at the time of my death, or to which I may be entitled or of which I may have the right to dispose at the time of my death,to my husband,Robert C. Owen, if he is living at the time of my death. 06-4"-- � (SEAL) GERALDINE E. OWEN Page one of three FOURTH: .In the event that my husband is not living at the time of my death, or in the event that he and I shall die simultaneously,then I give,bequeath and devise all my property as follows: 1. ONE THOUSAND DOLLARS ($1,000.00)to Mt. Zion Lutheran Church of P. O. Box 207, Landisburg,PA 17040. 2. TWO THOUSAND FIVE HUNDRED DOLLARS ($2,500.00) to Mary Fisher of 107 E. Water Street, Landisburg,PA 17040. 3. FIVE THOUSAND DOLLARS ($5,000.00)to my sister, Shirley Bitner. 4. FIVE THOUSAND DOLLARS ($5,000.00)to my brother, Ronald Hoffman. 5. FIVE THOUSAND DOLLARS ($5,000.00)to my sister, Carrie Hoffman. 6. TWO THOUSAND FIVE HUNDRED DOLLARS ($2,500.00)to my brother, Roy Hoffman. 7. TWO THOUSAND FIVE HUNDRED DOLLARS ($2,500.00) to my sister-in-law, Shirley Hoffman. 8. TWO-THIRDS (213)of the rest and residue to my son, Thomas A. Owen. 9. ONE-THIRD (113)of the rest and residue to my grandson,Benjamin A. Owen. (_J6." (SEAL) GERALDINE E. OWEN Page two of three j FIFTH: I hereby appoint my husband, Robert C. Owen, as Executor of this,my Last Will and Testament,but in the event that he is unable or unwilling to serve, I then appoint my son, Thomas A. Owen, as Executor of this,my Last Will and Testament, and further appoint him guardian of Benjamin A. Owen, and I direct that he shall not be required to give bond or other security in any jurisdiction wherein proceedings may be held in connection with my.estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 16th day of March, i 2005. WITNESS: n (SEAL) i GERALDINE E. OWEN i. 7 - Page three of three •� pennsylvania DEPARTMENT OF PUBLIC WELFARE January 12, 2015 SCOTT W MORRISON ESQUIRE 6 W MAIN ST PO BOX 232 NEW BLOOMFIELD PA 17068 Re: Geraldine Owen SSN: ###-##- Dear Attorney Morrison: Pursuant to your letter dated January 10, 2015, the Department's, Estate Recovery Program, has reviewed the information you provided regarding the above-referenced individual. It has been determined that this individual did not receive any type of assistance during the questioned period. Therefore, according to the information you provided, the Department's Estate Recovery Program will not seek any recovery from this estate. If your client applied for Medical Assistance and had an application and/or hearing pending at the time of death, please advise us and provide any additional information that may affect a recovery by our Department. Thank you for your cooperation in this matter. If you have any questions, please contact me. Sincerely CL Vince A. Porter Recovery Section Manager (717)772-6604 Bureau of Program Integrity i Division of Third Party Liability i Recovery Section PO Box 8486 1 Harrisburg, Pennsylvania 17105-8486 The eankof Landisburg, ESTABLISHED 1903 P.O. BOX 179 • LANDISBURG, PA 17040 Bank records indicate the following account balances on 11/14/2014 for GERALDINE E OWEN SS # 30 HERLIHY DRIVE MAHWAH, NJ 07430 Balance Acct Sole Jt Acct Account Prior to Interest Accrued Opened Ownership With Number Type Interest Bearing Interest Thomas 3/22/2005 NO Owen 700015318 CD 50,000.00 YES 106.85 9/22/2009 YES N/A 700022730 CD 20,000.00 YES 6.41 1/25/2010 YES N/A 700023169 CD 25,000.00 YES 13.39 81412010 YES N/A 700023918 CD 20,000.00 YES 6.14 9/7/2010 YES N/A 700023987 CD 10,000.00 YES 7.67 1/3012007 YES N/A 51 DDA 18,215.56 NO 0.00 Passbook 1111711947 YES NIA 5120 SF.vings 5-,_900.26 YES 4.70 12/28/1982 YES N/A 648302 MMA 83,_763.35 YES 11.01 BY MReisinger 4 LANDISBURG - 717-789-3213 BLAIN - 536-3118 SHERMANS DALE - 582-8511