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Home My WebLink About04-21-15 2 pennsylvania 1505614105 FX(03-14)(F) REV-1500 OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 06022012 08021921 1 Decedent's Last Name Suffix Decedent's First Name MI I = I MARGARET (if Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI N/A THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return C:) 2. Supplemental Return C=:) 3. Remainder Return(date of death prior to 12-13-82) C=:) 4.Agriculture Exemption(date of C=) 5. Future Interest Compromise(date of C=D 6. Federal Estate Tax Return Required death on or after 7-1-2012) death after 12-12-82) C=:) 7. Decedent Died Testate C=:) 8. Decedent Maintained a Living Trust 0 9. Total Number of Safe Deposit Boxes (Attach copy of will.) (Attach copy of trust.) C=:) 10. Litigation Proceeds Received C=:> 11. Non-Probate Transferee Return C=:) 12. Deferral/Election of Spousal Trusts (Schedule F and G Assets Only) C=) 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 Andrew H. Shaw (717)243-7135 First Line of Address 200 S. Spring Garden St Second Line of Address ........... Suite11 City or Post Office State ZIP Code Carlisle [1LO 13 Correspondent's email address: andrew@ashawlaw.com REGISTER OF WILLS U§ZONLY OF WILLS USE ONLY M rn C-> DATETILED MMODYYYY G-> CZ3 LLJ "J r— r.3 T-_,1 r" rpt CD DATE FILID'STAMPO -q -n M C) PLEASE USE ORIGINAL FORM ONLY Side I 111111 11111 11111 6 4 1505614105 .J 1505614205 REV-1500 EX(FI) Decedent's Social Security RECAPITULATION 1. Real Estate(Schedule A). ................. ......_............... 0.00 2. Stocks and Bonds(Schedule B) ...... ................................. 2. 37,391.94 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. 1 0.00 4. Mortgages and Notes Receivable(Schedule D)........................... 4, 0,00 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E).... ... 5. L 4,401.28 6. Jointly Owned Property(Schedule F) C=D Separate Billing Requested ....... 6. 0.00 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) C=D Separate Billing Requested.......;. 7. 0.00 8, Total Gross Assets(total Lines 1 through 7)........ ... ..........._... 8. 41,793.22 it 9. Funeral Expenses and Administrative Costs(Schedule H).. ............ ... .. 9.1 3,834.50 1 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1).... .......... . 56,048.41 1 11. Total Deductions(total Lines 9 and 10). .. ........... ..... ........... 11. l 59,882.91 1: 12, Net Value of Estate(Line 8 minus Line 11) . ..................... 12 -18,089.69 13. Charitable and Governmental Bequests/Sec.9113 Trusts for which an election to tax has not been made(Schedule J) ... ....... .............. 13, i0.00 14. Net Value Subject to Tax(Line 12 minus Line 13) ..... 14. 1 -18,089.69 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.91160.00 (a)(1.2}X.0 0 15. 0.00 16. Amount of Line 14 taxable at lineal rate X o 45 0.00 16.1 0.00 1 17. Amount of Line 14 taxable i at sibling rate X.12 I o0.0017. 0.00 1& Amount of Line 14 taxable at collateral rate X.15 0.00 i 18. 0.00 19. TAX DUE.............. ................ 19. 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT C=) 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. SIGNATUREN RESP QNSIBLE FOR FILINRETJ.RN ATE dor k3ood News Consulting, Inc. AUUKL65 AsTgate AdITIMIStIdLIVI 140 Roose*t Ave.,York, P 7 01 SIGNATURE OR'yREPARE<)DVE-fTH PASON RESPONSIBLE FOR FILING THE RETURN DATE ADDRESS 200 S. Spring Garden Street, Carlisle, PA 17013 � ��i�� Side 2 J u11It 1505614205 REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Margaret H. Fick STREETADDRESS 210 Big Spring Road CITY STATE 7Z0 17241 Nevvville PA Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 0.00 2. Credits/Payments A.Prior Payments 0.00 B.Discount 0.00 (See instructions.) Total Credits(A+B) (2) 0.00 3. Interest (3) 0.00 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 I +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.......... ...... ............. .................... ...... D 0 b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ c. retain a reversionary interest ..._..............................__.............._..............................._............___............. d. receive the promise for life of either payments,benefits or care?...................................................................... E71 0 2. If death occurred after Dec. 12,1982,did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................................. El E 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. El 0 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation? ........................................................................................................................ E:1 N 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)(11)(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)1 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) IffPennsylvania SCHEDULE B DEPARTMENT OFREVENUE r p INHERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF FILE NUMBER Margaret H. Fick 21-12-1150 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1' 630 shares Verizon stock at$47.92 per share 30,189.60 2 174 shares AT&T stock at$36.29 per share — 6,314.46 3 151 shares Frontier Communication stock at$5.88 per share 887.88 I TOTAL(Also enter on Line 2, Recapitulation) Is IL 37,391.94 I If more space is needed,insert additional sheets of the same size ILII if) CONSULTINC,, bic. I' 140 Roosevelt Ave. Suite 206 ®' York,PA. 17401 717-843-1504 i; i s(' .1`,10(!; ., .., Solutions For Elder Care Management (SPECIALIZING IN DEMENTIA CARE) May 24, 2012 Computershare P.O. Box 43078 Providence, RI 02940-3078 Please surrender and sell all shares to the address of record for: Margaret H. Fick SSN 182-12-5375 DOB 8/2/1921 Company Name: AT&T Inc. Account Number: C3002059991 Shares: 174 Company Name: Frontier Communications Corporation Account Number: C0004523504 Shares: 151 Company Name: Verizon Communications Inc. Account Number: C0007446985 Shares: 630 Please contact Jason Herrold, at 717-812-8877, with any questions. Sincerely, Tina Hess, BS, CMC,NCG For Good News Consulting, Inc. As Guardian CULTURE OFC.A.R.f=. TM Compassionately Caring about People who Are relying on us to build Relationships that create mutual Expressions of love and respect. Our Value Statement: 'Speak up for those who cannot speak for themselves(advocate),for the rights of all who are destitute. Speak up and judge fairly;defend the rights of the poor and needy." Prov.31:8-9 REV-i5o8 EX+(08-12) pennsytvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Margaret H. Fick 21-12-1150 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. M&T Checking Account,#9856023172 3,619.13 �2 F&M Trust Account,#0003368408 782.15 TOTAL(Also enter on Line 5, Recapitulation) $ 4,401.281 If more space is needed,use additional sheets of paper of the same size. �Bank, "ACCOUNT NO ` ACCOUNT TYPE STATEMENT PERIOD PAGE 9856023172 M&T CLASSIC CHECKING W/INTEREST APR.24-MAY.23,2012 1 OF 1 00 0 06914M NM 017 16949 MARGARET H FICK GOOD NEWS CONSULTING INC, GUARDIAN `,�t 140 ROOSEVELT AVE SUITE 206 YORK PA 17401 INTEREST EARNED FOR STATEMENT PERIOD 0.02 ROUTE 30 & PENNSYLVANIA AVE INTEREST PAID YEAR TO DATE 0.48 ACCOUNT SUMMARY BEGINNING DEPOSITS & OTHER CURRENT ENDING BALANCE OTHER ADDITIONS CHECKS PAID SUBTRACTIONS INTEREST PD ` BALANCE NO. AMOUNT NO. AMOUNT NO. AMOUNT 1,650.90 11 6,439.56 51 4,471.35 0 1 0.00 0.02 3,619.13 ACCOUNT ACTIVITY POSTING DEPOSITS,INTEREST CHECKS & OTHER DAILY DATE TRANSACTION DESCRIPTION & OTHER ADDITIONS SUBTRACTIONS BALANCE 04-24-12 BEGINNING BALANCE $1,650.90 04-26-12 CHECK NUMBER 0142 300.00 1,350.90 04-27-12 CHECK NUMBER 0141 1,218.00 132.90 04-30-12 CHECK NUMBER 0143 100.00 32.90 05-03-12 DEPOSIT 6,439.56 6,472.46 05-11-12 CHECK NUMBER 0144 1,635.35 4,837.11 05-16-12 CHECK NUMBER 0145 1,218.00 3,619.1.1 05-23-12 INTEREST PAYMENT 0.02 3,619.13 ENDING BALANCE 1 $3,619.13 CHECKS PAID SUMMARY 141 04-27-12 1,218.00 142 04-26-12 300.00 143 04-30-12 100.00 144 05-11-12 1,635.35 145 05-16-12 1,218.00 ANNUAL PERCENTAGE YIELD EARNED = 0.00 EFFECTIVE JULY 30, 2012, THE FEE FOR EACH DAY THAT THERE IS A TRANSFER FROM YOUR SAVINGS, MONEY MARKET, OR CHECKING ACCOUNT TO COVER ONE OR MORE OVERDRAFTS IN YOUR CHECKING ACCOUNT WILL BE $12.50. THIS FEE WILL BE CHARGED TO THE ACCOUNT FROM WHICH THE FUNDS WERE TRANSFERRED. THIS FEE DOES NOT APPLY TO A POWER CHECKING OR MYCHOICE PREMIUM CHECKING ACCOUNT. L008A(6107) ' \ ` Rg7A 20 South Main Strect TRUSTeoBox wm mUSo (,uumvowuor .eu172n1 Last statement: April 07' 2012 Page 1 of r� This statement: May O7' ZO12 0003368408 Total days instatement pnriod' 3O � Direct inquiries to: —^~`~~^~AUTO—MIXED*ADC17O' 717 264-6116 � 025/909725Ma0040*1371 F&K8Trust Ux'/Nr"I'll"'r'd'U'Yr|"h'/x"'h'N|4/|'oh/' 20 South Main Street MARGARET*F|CK Chambersburg, PA 17201 MARGARET wBRArsK C/O GOOD NEWS CONSULTING INC 140ROOSEVELT AVE SUITE 2V6 YORK PA 17401'3333 . Freedom Premier Account number 0003368408 Beginningba|ance g5'482.08 Enclosures l Total additions 315.07 Low balance $482.08 Total subtractions 5,015.00 Average balance g2'222.25 Ending balance $ 782.15 Avg collected balance $2,222.00 Interest paid year to date $0.84 DEBITS Date Descr'lation 05-07 Service Charge ff",60 mw!wTswxmCe CREDITS Date Description Additions Preauthorized Credit 315.00 05-07 Interest Credit 0.07 DAILY BALANCES Dote Amount D,un Amount D,uo Amount 04-07 5,482.08 05-01 797.08 04-18 482.08 05-07 782.15 ` INTEREST INFORMATION Annual percentage yield earned 0.0496 Interest-bearing days 30 Average balance for APY $2,222.25 Interest earned M07 REV-1511 EX+ (08-13) wimm pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Margaret H. Fick 21-12-1150 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: El El LLLL B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: C=�00�- Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: 2. Attorney Fees: 2,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 334.50 5. Accountant Fees: 6. Tax Return Preparer Fees: 33 7. �.. El TOTAL(Also enter on Line 4, Recapitulation) $. 3,834.50 If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+(12-12) E pennsytvania SCHEDULE1., DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Margaret H. Fick 21-12-1150 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 Green Ridge Village 5'6 048.41 F-1 F_ F] I F-1 I 0 1 _J F-1 F-1 I F-1 I E] F-1 FJ I F-1 I El F-1 17, 1 F] TOTAL(Also enter on Line 10, Recapitulation) $ 56,048.41 If more space is needed,insert additional sheets of the same size. t _ RESIDENT STATEMENT FROM GREEN RIDGE VILLAGE Statement Date Due Date ACCOUNT NUMBER SWAIM HEALTH CENTER 210 BIG SPRING ROAD 12/31/2012 Upon Receipt 61655GRV NEWVILLE, PA 17241-9486 a 1[011171 717-776-8256 NMI $56,048.41 AMOUNT PAID $ Please make check payable to GREEN RIDGE VILLAGE MARGARET H FICK Remit To: c/o TINA HESS Presbyterian Homes Inc/Green Ridge/Swaim GOOD NEWS CONSULTING, INC. P O Box 416825 140 ROOSEVELT AVENUE Boston MA 02241-6825 SUITE 206 YORK, PA 17401 Please detach and return this portion with your remittance to the address above. Comments `I`you have.any.questions regardingyour statement,please contact the Business,Ofiice at(7.1.7).7.76-8256. T@SSG 7 t� �. .,�'' }a$i'��'�r , .,'d�t@ ';"u,��1°"'�, r��(�� +��X�..'f v` �,,�' +kg,. Balance Forward $56,048.41 TOTAL BALANCE DUE: $56,048.41 II I j I FACILITY NAME RESIDENT NAME ACCOUNT NUMBER SWAIM HEALTH CENTER MARGARET H FICK 61665GRV