HomeMy WebLinkAbout06-08-15 1505614134
ExL
(03-14)(FI)
REV-1500 -FICIAL USE ONLY
I
Bureau of Individual Taxes County Code Year File Number
PO,BOX 280601 INHERITANCE TAX RETURN 2 1 1 4 1 0 6 0
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
1 1 0 1 2 0 1 4 0 6 1 1 1 9 3 3
Decedents Last Name Suffix Decedent's First Name MI
K E E F E R A N N A M
(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
nX 1.Original Return Fj 2.Supplemental Return f-1 3.prior to 2-
der Return(date of death
❑ P 113-82)
4.Agriculture Exemption ❑ 5.Future Interest Compromise(date of ❑ 6.Federal Estate Tax Return Required
(date of death on or after 7-1-2012) death after 12-12-82)
7.Decedent Died Testate ❑ 8.Decedent Maintained a Living Trust 0 9.Total Number of Safe Deposit Boxes
(Attach copy of Y411.) (Affach copy of trust)
❑ 10.Litigation,Proceeds Received ❑ I'l.Non-Probate Transferee Return F1 12.Deferral/Election of Spousal Trusts
(Schedule F and G Assets only)
F] 13.Business Assets ❑ 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
K A R L K R E I S E R E S Q U I R E 7 1 7 6 8 4 6 9 4 1
First Line of Address
5 5 3 L 0 C U S T S T R E E T
Second Line of Address
City or Post Office State ZIP Code
C_ 6,D C>
Ca
C 0 L U M B I A P A 1 7 5 1 2
00
Correspondent's e-mail address KKREISER553(MGMAIL.COM
E
REGISTER OF WIL]Lti7�US ONLY-�j
REGISTER OF WILLS USE ONLY
ct
DATE FILED MMDDYYYY C)
co
DATE FILED STAMP
PLEASE USE ORIGINAL FORM ONLY
Side I
1111111111 Hill IN 1111111111111111111111111111 IN IN
1505614134 1505614134
150562,4234
REV-1500 EX(FI)
Decedents Social Security Number
Decedents Name: ANNA M- KEEFER
RECAPITULATION
1. Real Estate(Schedule A) 1 1 8 7 0 0 0 . a 0
2. Stocks and Bonds(Schedule 8) 2. 3 9 6 4 2 1 2 4
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. 0. 0 0
4. Mortgages and Notes Receivable(Schedule D) .......................... 4. 11 . 11
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. 1 0 6 0 7 4 1 4 7
6. Jointly Owned Property(Schedule F) n Separate Billing Requested ...... 6. a 11 11
7. Inter-Vivos Transfers&Miscellaneous NO Property
(Schedule G) n Separate Billing Requested ...... 7. 5 8 8 1 5. 8 4
8. Total Gross Assets(total Lines I through 7) ........................... 8. 1 7 0 2 9 7 8 . 5 5
9. Funeral Expenses and Administrative Costs(Schedule H) .................. 9. 1 3 5 7 7 6 . 5 6
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) ............. 10. 2 7 2 3 8 . 6 3
11. Total Deductions(total Lines 9 and 10) ............................... 11. 1 6 3 0 1 5. 1 9
12. Net Value of Estate(Line 8 minus Line 11) ............................ 12. 1 5 3 9 9 6 3 . 3 6
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made(Schedule J) ...................... 13. 1 4 7 0 6 6 . 5 0
14. Net Value Subject to Tax(Line 12 minus Line 13) ...................... 14. 1 3 9 2 8 9 6 . 8 6
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax raw,or
transfers under Sec.9116
(a)(1.2)X-0 _ 0 . a a 15. 0 . 0 11
16. Amount of Line 14 taxable
at lineal rate X-015- 1 3 9 2 8 9 6 . 8 6 16. 6 2 6 8 0 . 3 6
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 0 0 17. 0 . a 0
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 0 0 18. 0 . 0 a
19. TAX DUE ............................................... ...... 19. 6 2 6 8 0 . 3 6
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0
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.
SIGNA � Xj._.
PERSON Pjz-SPONSIBLE FOR FILING RETURN DA
25X49c, 1.11
ADDRESS r
611 LINDEN ROAD HERSHEY PA 17033
SIGNATURE OFA!2A�RJEytR THAN PERSON RESPONSIBLE FOR FILING THE RETURN
J�
ADDRESS C -41�� e7lEZ15-
553 LOCUST STREET COLUMBIA PA 17512
11111111111111111111111111111111111 Side 2
1505614234 1505614234
REV-1500 EX (FI) Page 3 File Number
Decedent's Complete Address: 21 14 1060
DECEDENTS NAME
ANNA M. KEEFER
STREET ADDRESS
913 SHIREMONT DRIVE
CITY
ZIP
11705C
STATE ZIP
LNECHANICSIBURG PA
Tax Payments and Credits:
I- Tax Due(Page 2,Line 19) (1) 62,680-36
2. Credits/Payments
A.Nor Payments r-n 000.00
B.Discount 3,134.02
(See instructions.) Total Credits(A+B) (2) 63,134.02
3. Interest
4. If Line 2 is greater than Line 1+Line 3,enter the difference.This is the OVERPAYMENT. (3) 0.00
Fill in oval on Page 2,Line 20 to request a refund. (4) 453.66
5. If Line 1+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 ...................................................................... El FX1
b. retain the right to designate who shall use the property transferred or its income ............................... 171 0
c. retain a reversionary interest ..................................................................................................... E] 191
d. receive the promise for life of either payments,benefits or care? ....................................................... ❑
2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... El IXI
3. Did decedent own an*in trust for'or payable-upon-death bank account or security at his or her death? ......... 171 FRI
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation?................................................................................. ................ rXI F-1
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 an 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 decedents 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 decedents 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-1502 EX+(12-12)
pennsylvania SCHEDULE Q
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
ANNA M. KEEFER 21 14 1060
All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property
would be exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts.
Real property that is joint-owned with right of survivorship,must be disclosed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
ITEM Include a copy of the deed showing decedents interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1. Single family home located at 913 Shiremont Drive, Mechanicsburg, PA 17050 187,000.00
TOTAL(Also enter on Line 1,Recapitulafion.) )$ 187 000.00
if more space is needed,use additional sheets of paper of the same size.
REV-1503 EX+(8-12)
pennsylvania SCHEDULE B
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ANNA M. KEEFER 21 14 1060
All property jointly owned with right of survivorship,must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Pepsico Inc. -938 shares stock at$96.68 per share-account#C0001248901 90,560.16
2. Pepsico Inc-2,516 shares stock at$96.76 per share-account#C0001248928 243,139.79
3. Pesico Inc. -dividends for accounts#C0001248901 and#C0001248928 2,262.37
4. MetLife-22 share stock at$51.177 per share-account#C0062729775 1,125.89
5. MetLife-dividends-account#C0062729775 744.26
6. Mattel, Inc. -738 shares at$28.10 per share-account#C0000898261 20.617.10
7. Mattel, Inc. -dividends-account#C000898261 280.44
8. Hershey Federal Credit Union-account#231387550-savings bonds- 37,691.23
see attached list of bonds
TOTAL(Also enter on Line 2,Recapitulation) $ 396,421.24
If more space is needed,insert additional sheets of the same size
REV-1508 E:X+(08-12)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS $MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
ANNA M. KEEFER 21 14 1060
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. Cititzens Bank-Time Deposit Account#6140706173 16,992.51
2. Citizens Bank-Checking account account#6100716686 11,343.90
3. Citizens Bank-Checking account#6100713016 20,047.63
4. Citizens Bank-Checking account#6300989171 30,100.04
5. Belco Community Credit Union-Savings account#867708 696.09
6. Belco Community Credit Union-Certificate of Deposit#5100 1,085.38
7. Santander Bank-Certificate of Deposit#0575134226 4,939.82
8. Santander Bank-Checking account#0431130582 679.73
9. Santander Bank-Certificate of Deposit#2475012718 867.87
10. Santander Bank-Savings account#2334024169 1,516.55
11. Santander Bank-Money Market account#2334086800 10,759.57
12. Santander Bank-Certificate of Deposit account#2335543308 4,785.20
13. Santander Bank-Certificate of Deposit#2335548356 9,279.82
14. Santander BAnk-Certificate of Deposit#2335548364
9,007.21
15. Pepsico Inc.-pension payment-account#DB715807-001
2,094.49
38.58
16. Advance Publications of Perry and Juniata Counties, Inc.-refund
TOTAL(Also enter on Line 5,Recapitulation) $ 060 741.47
if more space is needed,use additional sheets of paper of the same size.
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
ANNA M.KEEFER 21 14 1060
Decedents Name Page 1 File Number
Schedule E-Cash, Bank Deposits,&Misc. Personal Property
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
17. Ameriprise Financial-Mutual Fund account#01012975723002 19,295.97
18. Ameriprise Financial-partial redemption-account#02015384801002 3,150.00
19. L.B.Smith-sale of 2010 Ford Fusion 11,000.00
20. Cumberland Valley School District-refund-dental insurance 38.82
21. Verizon Wireless-telephone refund 136.06
22. Erie Insurance-refund-car insurance-account#0280250012 316.00
23. AAA Central Penn-membership refund 35.77
24. Merrill Lynch Wealth Management-account#872-37825 900,992.93
25. PA Media Group-newspaper refund 117.09
26. West Field Insurance Company-homeowners insurance refund 390.00
29.21
27. PSERS-pension payment
28. Pinnacle Health-medical refund
1,005.43
SUBTOTAL SCHEDULE E 936,507.08
GRAND TOTAL SCHEDULE E (Also enter on Line 5,Recapitulation) $ 1,060,741.47
REV-1510 EX+(08-09)
pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCETAXRETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ANNA M. KEEFER 21 14 1060
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REVA500 is yes.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR REIATIONSHIP TO DECEDENT AND DATE OF DEATH %OFDECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER.ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST pFaPaucnmEl VALUE
1. Ameriprise Financial-Individual Retirement Account- 58,815.84 100.00 58,815.84
#02015384801002
TOTAL(Also enter on line 7,Recapitulation) $ 58 815.84
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
ANNA M. KEEFER 21 14 1060
Decedents debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Myers Buhrig Funeral Home-funeral bill 9,178.74
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)ofPersonalRepresentaWe(s) P. Daniel Keefer 85,148.00
Street Address 611 Linden Road
city Hershey State PA zIP 17033
Years)Commission Paid: 2015
2.
Attorney Fees: Karl Kreiser 40,000.00
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
1,195.00
4. Probate Fees: Cumberland County Register of Wills
5 Accountant Fees:
6. Tax Return Preparer Fees:
179.82
7. The Sentinel-estate legal notice 75.00
8, Cumberland County Law Journal-estate legal notice
TOTAL(Also enter on Line 9,Recapitulation) $ 135 776.56
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
ANNA M. KEEFER 21 14 1060
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. Verizon-telephone and television bill 352.99
2. Verizon Wireless-intemet bill 32.04
3. Santander Bank-bank fee-date of death values 20.00
4. Sears Master Card-outstanding balance-credit card account#5121072010114652 15.99
5. PPL Electric Utilities-electirc bill 193.22
6. Pennsylvania American Water-water bill 61.39
7. United States Postmaster-registered mail for bonds and stock certificates 107.24
8. Shipley Energy-heating bill 1,089.86
9. Hershey Credit Union-membership fee 25'00
10. Pulmonary and Critical Care M -medical bill 59.56
11. Hampden Township-sewer and trash bill 248'27
12. Zimmerman Plumbing and Heating-repair work to 913 Shiremont Drive 2,164.00
13. UPS-overnight mailing fee 14.99
14. 1-800-Got-Junk-removal of refrigerator 140.00
395.00
15. Diana Reed and Associates-preparation of 2014 income tax
TOTAL(Also enter on Line 17Re�ca:piftulafijon) $ 27 238.63
if more space is needed,insert additional sheets of the same size.
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
ANNA M. KEEFER 21 14 1060
Deoedenrs Name Page 2 File Number
Schedule 1-Debts of Decedent, Mortgage Liabilities,& Liens
ITEM
NUMBER DESCRIPTION AMOUNT
16. United States Treasury-federal income tax payment 7,041.00
17. Commonwealth of Pennsylvania=Pennsylvania state income tax payment 312.00
18. Pepsico Qualified Savings Plan-reimbursement 1,551.08
19. Hanna Howard Real Estate-real estate commission 5,935.00
20. Coldwell Banker Residential Brokerage-real estate commission 5,610.00
21. Guardian Transfer-title service 110.00
22. Commonwealth of Pennsylvania-transfer tax 1,870.00
SUBTOTAL SCHEDULE 1 22,229.08
GRAND TOTAL SCHEDULE I (Also enter on line 10,Recapitulation) $ 27,238.63
REV 1513EX+(01-10)
pennsylvania SCHEDULE
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
ANNA M. KEEFER 21 14 1060
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Tmstee(s) OF ESTATE
TAXABLE DISTRIBUTIONS 1pndudeo - 't spousal distributions and transfers under. See.U9116(a)(1.2).]
1 Robert A. Keefer Lineal
315 North 19th Street 1/3 residue of estate
Clarinda, Iowa 51632
2. Donald E. Keefer Lineal
1004 Enderbury Drive 113 residue of estate
Raleigh, NC 27610
3. P. Daniel Keefer Lineal
611 Linden Road 1/3 residue of estate
Hershey, PA 17032
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. The Mechanicsburg Presbyterian Church 5%residue of estate
300 East Simpson Street
Mechanicsburg, PA 17055
2. Presbyterian Church of the Master 1.67%of residue
10710 Corby Circle
Omaha, Nebraska 68164
3. North Raleigh Curch of Christ 1.67%of residue
8701 Falls of Neuse Road
Raleigh, NC 27615
TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. L$
if more space is needed,use additional sheets of paper of the same size.
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
ANNA M. KEEFER 21 14 1060
Decedents Name Page 3 File Number
Schedule J-Beneficiaries-2B
II. B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
4. Evangelical Free Church of Hershey
330 Hilltop Road 1,66%of residue
Hummelstown, PA 17036
SUBTOTAL SCHEDULE J-213
Law Offices
MOUNTZ&KREISER
553 Locust Street
Columbia,Pennsylvania 17512
David T.Mountz (717)684-6941
Karl Kreiser FAX (717)6845562
June 3,2015
Register of Wills
Clerk of Orphans' Court
1 Courthouse Square
Suite 102
Carlisle, PA 17013
Attn: Lisa M. Grayson, Esquire
Re: Estate of Anna M. Keefer
File No. 21-2014-1060
Dear Attorney Grayson:
I have enclosed two copies of Rev-1500—Inheritance Tax Return for the Estate of Anna
M. Keefer.and a copy of page one of the return. Please stamp the copy and return in the enclosed
stamped and addressed envelope. Please contact me if you have any questions.
Sincerely,
C
Karl Kreiser
Attorney at Law
KK:ers
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