HomeMy WebLinkAbout05-28-15 J pennsylvania 1505614105
DEPARTMEM OF REVENUE Ex(03-14)(FI)
REV-1500 OFFICIAL USE ONLY
Bureau of Individual Taxes INHERITANCE TAX RETURN
Ha County Code Year File Number
BOX 280601
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYM
�I 02192015 [06011989
Decedent's Last Name Suffix Decedent's First Name MI
Wood Michael __1 Fs IJ
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
(AD 1.Original Return p 2.Supplemental Return p 3. Remainder Return(date of death
prior to 12-13-82)
C=) 4.Agriculture Exemption(date of O 5. Future Interest Compromise(date of O 6. Federal Estate Tax Return Required
death on or after 7-1-2012) death after 12-12-82)
C=:) 7. Decedent Died Testate p 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 p 11. Non-Probate Transferee Return p 12. Deferral/Election of Spousal Trusts
(Schedule F and G Assets Only)
O 13. Business Assets O 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
M. Sandra Wood (717)774-8520
First Line of Address
6210 Rivendale Ct.
Second Line of Address
City or Post Office State ZIP Code
Mechanicsburg PA F17050
Correspondent's email address: mswl @pSu.edu
.v
REGISTE F WILLS US"NLY M
REGISTER OF WILLS USE ONLY .yy
DATE FILED MMDDYYYY C.
:5:. C a —c
DATE FILED-STA1AP3 ` +
PLEASE USE ORIGINAL FORM ONLY Sys
Side 1
111111111 IN
1505614105 1505614105
1505614205
REV-1500 EX(FI)
Decedent's Social Security Number
Decedent's Name: Michael S. Wood
RECAPITULATION
1. Real Estate(Schedule A). .......... ........... ....................... 1.
2. Stocks and Bonds(Schedule B) ... ....... .... .... ....... ........ ...... 2. 9,261.55
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. 652.27
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. 65.02
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested........ 7.
8. Total Gross Assets(total Lines 1 through 7).. ............... ............ 8. 9,978.84
9. Funeral Expenses and Administrative Costs(Schedule H).... ............... 9. 17,018.50
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............... 10.
11. Total Deductions(total Lines 9 and 10).... .... ........... .... ........ .. 11. 17,018.50
12. Net Value of Estate(Line 8 minus Line 11) ............... ......... .... .. 12. 0.00
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. 0.00
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 I-`
(a)(1.2)X.0_ 15.
16. Amount of Line 14 taxable
at lineal rate X.0_ 16.
17. Amount of Line 14 taxable
at sibling rate X.12 17.
18. Amount of Line 14 taxable
at collateral rate X.15 18.
19. TAX DUE ..... ... .............. ... .............................. .. 19. 0.00
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
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.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE
05/27/2015
ADDRESS r
6210 Rivendale Ct., Mechanicsburg, PA 17050
SIGNATURE OF PREPARER OTHER THAN PERSON RESPONSIBLE FOR FILING THE RETURN DATE
ADDRESS
Side 2
1 142 1505614205 J
REV-1500 EX (FI) Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
Michael S. Wood
STREETADDRESS
6210 Rivendale Ct.
CITY STATE ZIP
Mechanicsburg PA 17050
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 0.00
2. Credits/Payments
A.Prior Payments
B.Discount
(See instructions.) Total Credits(A+B) (2)
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)
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5)
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.......................................................................................... ❑ E
b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ 1111111
c. retain a reversionary interest .............................................................................................................................. ❑ E
d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ 0
2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................................. ❑ E
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ N
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 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)].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+(02-15)
Zj pennsytvania SCHEDULE B
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Michael S.Wood 2015-00221
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
263 sh PPL Corp(common Stock,parval 0.01)mkt Val 35.215 cusip 69351T106(TD Ameritrade) 9,261.55
TOTAL(Also enter on Line 2, Recapitulation) $ 9,261.55
If more space is needed,insert additional sheets of the same size
REV-15o8 EX+(o8-]2)
Q7pennsytvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Michael S. Wood 2015-00221
Indude 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. TD Ameritrade Acct.(Brokerage)755836355 Total Cash&Cash Equivalents 39.27
2 Personal property(Bowflex,CDs,DVDs,books,PS4&3 games) 600.00
3 Cash in wallet 13.00
TOTAL(Also enter on Line 5, Recapitulation) $ 652.27
If more space is needed, use additional sheets of paper of the same size.
REV-1509 EX+(02-15)
pennsylvania SCHEDULE F
DEPANHERTM NT OF CETAXRETURN JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Michael S.Wood 2015-00221
If an asset became 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. M. Sandra Wood 6210 Rivendale Ct. Mother
Mechanicsburg, PA 17050
e.
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.ATrACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 06/15/05 PNC Joint checking Acct 50-0483-8516.Start date estimated. 130.04 50 65.02
TOTAL(Also enter on Line 6, Recapitulation) $ 65.02
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+ (02-15)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Michael S. Wood 2015-00221
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Myers-Hamer Funeral Home:professional services,casket,vault,flowers,facility use.Bill attached. 10,716.00
Rolling Green Cemetery:purchase of lot,interment,granite marker,marker installation.Bill attached. 6,123.00
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:
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: 130.50
5. Accountant Fees:
6. Tax Return Preparer Fees: 49.00
7.
TOTAL(Also enter on Line 9, Recapitulation) $ 17,018.50
If more space is needed,use additional sheets of paper of the same size.
COMMONWEALTH OF PENNSYLVANIA SHORT CERTIFICATE
COUNTY OF CUMBERLAND
-t
of q(I A
I, LIS M. GRAYSON, ESQ.
Register for the Probate of Wills and Granting
Letters of Administration in and for
_ CUMBERLAND County, do hereby certify that on
the 27th day of February, Two Thousand and
Fifteen,
175®
Letters of ADMINISTRATION
in common form were granted by the Register of
said County, on the
estate of MICHAEL SCOTT WOOD late of HAMPDEN TOWNSHIP
(First,Middle,Last)
a/k/a MICHAEL S WOOD
in said county, deceased, to M SANDRA WOOD
(First,Middle,Last)
and that same has not since been revoked.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the
seal of said office at CARLISLE, PENNSYLVANIA, this 27th day of February
Two Thousand and Fifteen.
File No. 2015- 00221
PA File No. 21- 15- 0221
Date of Death 211912015
S. S. #
Aa /U �44
Re is er Of Wills
01 ha h IV 0, 09MA P-�A
De ty
NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL
DATE OF DEATH VALUATION for: MICHAEL S WOOD
Acct.No.Ending In 6355
Account Title: MICHAEL S WOOD
Date of Death: 2/19/2015
Business Day Used: 2/19/2015
Date of Death Date of Death Date of Death
Quantity Symbol Security Name High Price LowPrice Average Value
CASH& CASH EQUIVALENTS
39.27 Cash Insured Deposit Money Market $1.00 $1.00 $39.27
TOTAL CASH& CASH EQUIVALENTS -$39.27
263 PPL ; PPL Corporation $35.47 $34.96 $9,261.55
TOTAL STOCKS $9,261.55
TOTAL DATE OF DEATH VALUE : $99300.82
This information is furnished as part of a general information service and TD Ameritrade shall not be liable for any damages arising out of any inaccuracy in the information.
This information may differ from your TD Ameritrade monthly statement;you should rely on the monthly statement as the official record of your TD Ameritrade account.
**No quote available;used EOM statement
Performance Select Statement
PNC Bank g PNCBANK
Primary account number:50-0483-8516
Page 1 of 4
For the period 02/19/2015 to 03/18/2015 Number of enclosures:0
000715 p For 24-hour banking,and transaction or
MICHAEL S WOOD interest rate information,sign on to
M SANDRA WOOD PNC Bank Online Banking at pnc.com.
6210 RIVENDAL $ For customer service call 1-888-PNC-BANK
MECHANICSBURG PA 17050-2127 Monday-Friday:7AM-10 PM ET
Saturday&Sunday: 8 AM-5 PM ET
Para servicio en espan-ol, 1-866-HOLA-PNC
Moving? Please contact us at 1-888-PNC-BANK
21 Write to:Customer Service
PO Box 609
P.A'523n-97?8
C3 Visit us at PNC.com
TDD terminal:1-800-531-1648
For hearing impaired clients only
IMPORTANT ACCOUNT INFORMATION
The information below amends certain information in our"Consumer Schedule of Service Charges and Fees"("Schedule").All other
information in our Schedule continues to apply to your account.Please read this information and retain it with your records.
Effective May 10,2015
The ATM Transaction Fee at Non-PNC Bank ATM's in the United States,Canada,Puerto Rico and the U.S.Virgin Islands will be$3.00
each.
The Domestic Outgoing Wire fee will be$30.00 each.
Effective June 1,2015
American Express Travelers Cheques and Gift Cheques will no longer be available for purchase.
We have tools to help you bank when and where you want.
Get 2V7 accesst-_y'c:s PNC Bank account;.+nfo=at+_o:,-and s&vilces,by,*!'sing•PNC's ATMs,Mob?iP t3arEk,iii.O!j ne B king ane'more-Ge
to pnc.com/alwaysopen foe more information.
Performance Select Michael S Wood
Interest Checldng Account Summary M Sandra Wood
Account number: 50-0483-8516
Overdraft Protection has not been established for this account.
Please contact us if you would like to set up this service.
Overdraft Coverage-Your account is currently Opted-Out.
You or your joint owner may revoke your opt-in or opt-out choice at any time.
To learn more about PNC Overdraft Solutions visit us online at pnc.com/overdraftsolutions.
Call 1-877-588-3605,visit any branch,or Sign on to PNC Online Banking,and select the"Overdraft
Solutions"link under the Account Services section to manage both your Overdraft Coverage and Overdraft
Protection settings.
N
PNr1Ml Tn1_If1R71AR7_Akin-NAINNNN_M,)-nniRQ7
Performance Select Statement
For the period 02/19/2015 to 03/18/2015
jRFor 24-hour information,sign onto PNC Bank Online Banking MICHAEL S WOOD
on pnc.com. Primary account number:50-0483-8516
Account number:50-0483-8516-continued Page 2 of 4
Balance Summary
Beginning Deposits and Checks and other Ending
balance other additions deductions balance
177.23 1.00 48.19 130.04
Average monthly Charges
balance and fees
130-70 1.00-
Transaction Summary
Checks paid/ Check Card POS Check Card/Bankcard
withdrawals signed transactions POS PIN transactions
1 12
Total ATM PNC Bank Other Bank
transactions ATM transactions ATM transactions
Activity Detail
Deposits and Other Additions There was 1 Deposit or Other Addition
Date Amount Description totaling$1.00.
()2/19 1.00 Non-PNC ATM Surcharge Reimbursement
Banking/Check Card Withdrawals and Purchases There was 1 Banking Machine Withdrawal
Date Amount Description totaling$21.00.
(2;/1.9 887 POS Purchase Wet-nians 6416 C Mechanicburg PA
02/19 21.00 A'I'M Witbdrawnd 6416 Carlisle Mechaniesbur PA There were 2 Check Card/Bank card PIN POS
Q2/20 14.23 POS Purchase Giant 6529 Enola PATO' purchases totaling$22.70.
4-.49 4054 Debit Card Purchase Sheetz iviechanicsbu PAThere was I other Banking Machine/Check
Card deductions totaling$4A9.
Daily Balance Detail
Date Balance Date Balance
0`2;%19 148-76 02/20 130.04
MYt.RS--H.ARNuR Ft,NERAL HOME. INC.
" 190?MARKET STREET
i i I iTf"! i ii l3;
CAMP HILL I>l:.�sl'I_t.AMA 17011
RORER-I'M LIAR\ISR
—'=- 717-737-9961 717-737-4618 SUPEMISOR
ap
` PHONE FAX
llUS77\Ik.R:\la;lk
FUNER AI.DIRECTOR
LOCALLY Ow`ED AND OPERATED www.myers-harner.conl s n7yerS-harper@coirlcast.net
March 7, 2015
Ms. M. Sandra Wood
6210 Rivendale Court
Mechanicsburg PA 17050
Services for Michael Scott Wood
February 25, 2015
Charges for Services Selected $ 51490.00
Professional Services
Use of Facilities
Automotive Equipment $ 5,490.00
Charges for Merchandise Selected
Casket $ 21950.00
Vault 14465.00
$ 4,415.00
Cash Advanced
Newspaper Notice/Local $ 403.00
Clergy 150.00
Flowers 165.00
Certified Copies 48.00
Fair Dresser 45.00
$ s�s.00
Total: $102
^
^
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-
Page - _ _
Rolling Green Cemetery
1811 Carlisle Road, Camp Hill, PA 17011 (717) 761-4055
Contract Number: 062440000326
STATEMENT OF INTERMENT RIGHTS, MERCHANDISE AND SERVICES SCHEDULE -A
INTERMENT RIGHTS, MERCHANDISE AND SERVICES
— - .
INTERMENT RIGHTS Price
Qty Description Unit Gross
I Interment Rights Includes 3338.47 PC/ECF $2,595.00 $2,595.00
Description of Interment Rights: Lots
Sec-BLOCK 6 Lot-165 Sp-3
TOTAL INTERMENT RIGHTS $2,5
MERCHANDISE AND SERVICES
1 Granite Star Granite w/Vase Pink Pearl 28x18 $254.00 - $254.00
Mode #: Granite StaGranite vw"VasePink Pea28x18
1 24X14 Williamsburg Pine wNase $1,321'.00 $1,321.00
...... ~ 24'`14 Williamsburg. Pine ,.'.~.~
1 Interment-Adult $1,495.00 $1,495.00
1 Processing Fee $120.00 $120.00
l Marker Installation $uuuuV --$338u0 —
TOTAL MERCHANDISE AND SERVICES $3,52
TOTAL INTERMENT RIGHTS, MERCHANDISE AND SERVICES $6,123
SCHEDULE A -SUMMARY
TOTAL CASH PRICE : $6,123.00
N �
11 D i l ity
h4nwnr5nl
Date Received
Rolling Green Cemetery
1811 Carlisle Road Customer Signature
Camp Hill PA 17011
717-761-4055 Certificate of Ownership
Contract # 40000326 Purchaser Name M Sandra Wood
Date Purchased Feb 23, 2015 Address 6210 Rivendale Ct
Date Issued Mar 11, 2015 Mechanicsburg, Pa 17050
Purchased For Michael S Wood
This is to certify that the above named purchaser(s) has purchased and fully paid for the following items:
(1) Interment Service (1) 24x14 Bronze Memorial
(1) 28x18 Granite Base (1) Memorial Installation Service
This certificate is issued pursuant to and made subject to all conditions and provisions of the original Purchase Agreement asfully
set forth herein. 1 ,� ,�• ��1 �µ ,.� .�... �_d,
\Authorized Signature---------~,,
6210 Rivendale Ct.
Mechanicsburg, PA 17050
May 27, 2015 m C>
c6 7
Register of Wills ,
Cumberland County
Courthouse
err
One Courthouse Square, Suite 102 --A �
Carlisle, PA 17013 a
Sirs;
Enclosed is the estate filing for Michael S. Wood, deceased February 19, 2015, File number
2015-00221. I have enclosed a third signed copy with a stamped return envelope for you to time
stamp to send back to me.
Sincerely,
M. Sandra Wood
V j ar .�
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