HomeMy WebLinkAbout05-22-15 1505610140
REV-1500 EX (02-11)(FI)
OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 4 ❑ 4 5 6
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
0 5 0 3 2 0 1 4 0 7 2 5 1 9 4 6
Decedent's Last Name Suffix Decedent's First Name MI
Q U E N Z L E R M A R Y K
(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 F 2.Supplemental Return 3.Remainder Return(Date of Death
Prior to 12-13-82)
4.Limited Estate i 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 Schedule O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
k.
Name Daytime Telephone Number
S U S A N J H A R T M A N 7 1 7 2 4 9 7 7 8 0
REGIST4!;jOF WILLS USeNLY
c n :77 M
o m
First Line of Address s 7-D '
1 I R V I N E R 0 W r ry ry i rrl'
Second.Line of Address ~" . CD
C?
c =3 — t1
City or Post Office State ZIP Code DATE FILED m
C A R L I S L E P A 1 7 0 1 3 o U' <D
Correspondent's e-mail address: Susan(nduncanhartmanlaw.COm
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 PERSON R SPOBBNSIBLE FOR FILING RETURN DATE
AD SS
121 LANCASTER BLVD . MECHANICSBURG PA 17055
SIGNATU OF PREPARER OTHER T)WN REPRESENTATIVE DATE
s r
D ESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610140 1505610140
1505610240
REV-1500 EX(FI)
Decedent's Social Security Number
Decedent's Name: MARY K - Q U E N Z L E R
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. 6 9 2 1 • 0 8
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. 1 8 6 . 5 8
7. Inter-Vivos Transfers&'Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested . . . . . . . 7.
8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 7 1 0 7 . 6 6
9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9. 5 3 9 7 . 4 2
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) . . . . . . . . . . . . . 10. 1 7 1 3 . 7 5
11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . 11. 7 1 1 1 • 1 7
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . .. . . . . . . . . . . . . . . 12. - 3 . 5 1
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. - 3 • 5 1
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
1505610240 1505610240
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:
MARY K. QUENZLER 21 14 0456
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. MARANATHA ACCOUNT 6,621.60
2. AETNA- PHARMACY REFUND 10.20
3. ROWE'S AUCTION - SALE OF PERSONAL PROPERTY 264.55
4. COMCAST REFUND 24.73
TOTAL(Also enter on Line 5,Recapitulation) $ 6,921.08
If more space is needed,use additional sheets of paper of the same size.
REV-1509 EX+(01-10)
pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE JOINTLY-OWNED:PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
MARY K. QUENZLER 21 14 0456
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)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A. JANE STOVER 121 LANCASTER BLVD. COUSIN
MECHANICSBURG, PA 17055
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
I. A. 4/26/10 METRO BANK CHECKING ACCOUNT 373.16 50. 186.58
#833325483
TOTAL(Also enter on Line 6,Recapitulation) $ 186.58
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
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MARY K. QUENZLER 21 14 0456
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. MYERS-HARNER FUNERAL HOME 709.00
2. GRAVE STONE ENGRAVING 100.00
3. ORGANIST 100.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)ofPersonalRepresentative(s) JANE STOVER, ADMINISTRATOR 1,000.00
Street Address 121 LANCASTER BLVD.
City MECHANICSBURG State PA ZIP 17055
Year(s)Commission Paid:
2. Attorney Fees: DUNCAN & HARTMAN, PC 3,100.00
3. Family Exemption:(If decedents 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 133.50
5 Accountant Fees:
6. Tax Return Preparer Fees:
7. CUMBERLAND LAW JOURNAL- ESTATE NOTICE 75.00
8. THE SENTINEL- LEGAL AD 179.92
9.
TOTAL(Also enter on Line 9,Recapitulation) $ 5,397.42
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,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MARY K. QUENZLER 21 14 0456
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. PPL 60.44
2. VERIZON 31.72
3. HERSHEY MEDICAL CENTER 17.85
4. PPL 97.29
5. MECHANICSBURG MEALS ON WHEELS 98.00
6. WEIS PHARMACY 10.20
7. VERIZON 20.55
8. TRASH HAULING 125.00
9. VET BILL 155.00
10. CLEANING APARTMENT 100.00
11. FOREST PARK HEALTH CENTER-COPIES 164.98
12. HOLY SPIRIT HOSPITAL-COPIES 20.00
13. LIFE CARE HOSPITALS -COPIES 426.22
14. HEALTH PORT HOLY SPIRIT-COPIES 184.64
15. HEALTH PORT= HERSHEY 141.86
TOTAL(Also enter on Line 10,Recapitulation) $ 1,713.75
If more space is needed,insert additional sheets of the same size.
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
MARY K. QUENZLER 21 14 0456
Decedent's Name Page 1 File Number
Schedule I - Debts of Decedent, Mortgage Liabilities, & Liens
ITEM
NUMBER DESCRIPTION AMOUNT
16. REIMBURSE EXPENSES -MARTSON LAW OFFICE 60.00
SUBTOTAL SCHEDULE 60.00
GRAND TOTAL SCHEDULE 1 $ 1,713.75
REV-1513 EX+(01-10)
pennsylvaniaSCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
MARY K. QUENZLER 21 14 0456
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. JANE STOVER Collateral
121 LANCASTER BLVD. 1/3 SHARE
MECHANICSBURG, PA 17055
2. CAROL WARNICK
4479 MARSH ROAD 1/3 SHARE
WAYNESBORO, PA 17268
3. CATHERINE HERSHEY
1117 BALDWIN STREET 1/3 SHARE
MECHANICSBURG, PA 17055
I
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.
a
NOTICE OF INHERITANCE TAX , pennsytvania
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION APPRAISEMENT, ALLOWANCE OR DISALLOWANCE DEPARTMENT OF REVENUE
.__,._-
PO BOX 260601 OF DEDUCTIONS, AND ASSESSMENT OF TAX ON REV-1548 EX AFP (11-14)
HARRISBURG PA 17126-0601 JOINTLY HELD OR TRUST ASSETS
DATE 05-11-2015
ESTATE OF QUENZLER MARY K
DATE OF DEATH 05-03-2014
FILE NUMBER 21 14-0456
COUNTY CUMBERLAND
SSN/DC
JANE K STOVER ACN 14132322
121 LANCASTER BLVD APPEAL BY DATE:07-10-2015
MECHANICSBURG PA 17055-3548 (See reverse side under Objections)
Amount Remitted
MAKE CHECK PAYABLEWkD REMIT PAYMENT TO:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALONG THIS LINE '+� RETAIN LOWER PORTION FOR YOUR RECORDS 4=-
REV-1548'EX AFP C11-14)-------.—,._------------_ --
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE: 05-11-2015
ESTATE OF:QUENZLER MARY K DATE OF DEATH:05-03-2014 COUNTY:CUMBERLAND
FILE NO. : 21 14-0456 S.S/D.C. NO. : 167-40-2364 ACN: 14132322
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: METRO BANK ACCOUNT NO. : 833325483
TYPE OF ACCOUNT: C )SAVINGS ( X) CHECKING C )TRUST ( )TIME CERTIFICATE
DATE ESTABLISHED 04-26-2010 -
Account Balance 373. 16 NOTE: TO ENSURE PROPER CREDIT TO
Percent Taxable X 0.500 YOUR ACCOUNT, SUBMIT THE
Amount Subject. to Tax 186.58 UPPER PORTION OF THIS NOTICE
Debts and Deductions - .00 WITH YOUR TAX PAYMENT TO THE
Taxable Amount 186.58 REGISTER OF WILLS AT THE
Tax Rate x . 15 ABOVE ADDRESS. MAKE CHECK
Tax Due 27.99 OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID C-)
p l
�J
INTEREST IS CHARGED THROUGH 05-19-2015 TOTAL TAX PAYMENT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF .TAX DUE 27.99
REVERSE SIDE OF THIS FORM INTEREST AND PEN.
TOTAL DUE 28.23