HomeMy WebLinkAbout06-05-15 REV-1500 EX (01-10) 1505610140
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 5 0 2 9 7
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
0 2 0 8 2 0 1 5 0 8 2 6 1 9 2 0
Decedent's Last Name Suffix Decedent's First Name MI
B R E T Z S R D A V I D R
(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
O 1.Original Return M 2.Supplemental Return 3.Remainder Return(date of death
prior to 12-13-82)
❑ 4.Limited Estate M 4a. Future Interest Compromise(date of 5.Federal Estate Tax Return Required
death after 12-12-82)
❑X 6.Decedent Died Testate ❑ 7. Decedent Maintained a Living Trust 0 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 Sch.O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
ry
J A M E S H T U R N E. R E S Q U I R E 7 1 7,�, 2 3 2 a+ �5�1
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REGI&Ef-UF WILLSrAE ONLY Q
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First line of address � n CJ t (_-J
4 7 0 1 N 0 R T H F R O N T S T R E E T
Second line of addressnl
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City or Post Office State ZIP Code DATE FILEN Cn
H A R R I S B U R G P A 1 7 1 1 0
Correspondent's e-mail address: jh) t@turnerandoconnell.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 PERS P NS LE FOR FILIN RETURN DATE
6/1/2015
AD E
110 CAROL LAN ENOLA PA 17025
SIGNATURE P T ER THAN REPRESENTATIVE DATE
r
6/1/2015
A DRE
4701 NORTH FRONT STREET HARRISBURG PA 17110
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610140 1505610140
REV-1500 EX Page 3 File Number
Decedent's Complete Address: 21 15 0297
DECEDENT'S NAME
DAVID R. BRETZ, SR
STREET ADDRESS
2305 GOOD HOPE ROAD
CITY STATE ZIP
ENOLA PA 17025
Tax Payments and Credits:
I. Tax Due(Page 2,Line 19) (1) 29,059.66
2. Credits/Payments
A.Prior Payments 28,000.00
B.Discount 1,452.98
Total Credits(A+B) (2) 29,452.98
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) 393.32
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; ...................................................................... ❑ ❑X
El 191
b. retain the right to designate who shall use the property transferred or its income; ............................... El IRc. retain a reversionary interest;or ......................................................... ..
d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ 0
2. If death occurred after December 12,1982,did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... ❑ 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?.................................................................................................. ❑
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
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,unde
Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
J 1505610240
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: DAVID R - B R E T Z, SR
RECAPITULATION
1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . 1. 3 7 5 0 0 1 . 0 0
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. 2 8 8 2 0 8 . 1 2
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. 4 3 7 3 . 6 6
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested . . . . . . . 7.
8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 6 6 7 5 8 2 . 7 8
9. Funeral Expenses and Administrative Costs(Schedule H) . .. . . . . . . . . . . . . . . . 9• 1 5 1 9 1 . 3 9
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) . . . . . . . . . . . . . 10. 6 6 2 1 . 2 5
11. Total Deductions(total Lines 9 and 10) . . .. . . . . . . . . . . . . . . .. . . . . . . . . . . . 11. 2 1 8 1 2 . 6 4
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . .. .. . . . . . . . . . . . 12. 6 4 5 7 7 0 . 1 4
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. 6 4 5 7 7 0 . 1 4
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 6 4 5 7 7 0 . 1 4 16. 2 9 0 5 9 . 6 6
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. 2 9 0 5 9 . 6 6
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑X
Side 2
1505610240 1505610240 J
REV-1502 EX+(01-10)
pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
DAVID R. BRETZ SR 21 15 0297
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 jointly-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 decedent's interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1 2305 Good Hope Road, Hampden Township, Cumberland County, Pennsylvania(valued 375,000.00
per appraisal of Clause Real Estate Appraisals dated March 31 2015)_
2 Unimproved parcel located on Tower Road, East Pennsboro Township, Cumberland 1.00
County, Pennsylvania (title to property is subject to pending litigtion which has been
ongoing for several years; cost of clearing title exceeds value of property and
executors do not intend to pursue it
TOTAL(Also enter on Line 1,Recapitulation.) $ 375 001.00
If more space is needed,use additional sheets of paper of the same size.
REV-1508 EX+(11-10)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE
CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
DAVID R. BRETZ SR 21 15 0297
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. Oppenheimer Portfolio 288,116.12
2. 2014 income tax refund 92.00
TOTAL(Also enter on Line 5,Recapitulation) $ 288,208.12
If more space is needed,insert 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:
DAVID R. BRETZ, SR 21 15 0297
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.Susan D. Bretz 101 Sharon Road daughter
Enola, PA 1 7025
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. 12/0/09 savings account held at Members 1st Federal Credit 1,276.23 50. 638.12
Union, PO Box 40, Mechanicsburg, PA 17055
2. A 9/18/02 checking account held at Members 1st Federal Credit 2,470.53 50. 1,235.27
Union, PO Box 40, Mechanicsburg, PA 17055
3. A. 9/18/02 savings account held at Members 1st Federal Credit 5,000.54 50. 2,500.27
Union, PO Box 40, Mechanicsburg, PA 17055
TOTAL(Also enter on Line 6,Recapitulation) $ 4,373.66
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
DAVID R. BRETZ, SR 21 15 0297
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Rolling Green Cemetery 2,610.00
2. Richardson Funeral Home 1,724.89
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: Turner and O'Connell 5,000.00
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: Register of Wills 610.50
5 Accountant Fees:
6. Tax Return Preparer Fees:
7. Estate advertising: Cumberland Law Journal 75.00
8. Estate advertising: Journal MultiMedia 171.00
9. Romeo Land Surveying 5,000.00
TOTAL(Also enter on Line 9,Recapitulation) $ 15 191.39
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
DAVID R. BRETZ, SR 21 15 0297
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. Michael Langan, Tax Collector-2015 county/township tax on property 2305 Good 820.24
Hope Road, Hampden Township
2. Millenium Pharmacy 403.03
3. Union Hall Medical Assoc. 87.81
4. Coyne and Coyne 309.80
5. Sarah.A. Todd Memorial Home 2,223.33
6. Linda Simons -2014 income tax preparation 80.00
7. Clauser Real Estate Appraisal 1,500.00
8. Kerry's Lawn and Garden - lawn mower maintenance 197.04
9. Bretz Landscaping-removal of debris 1,000.00
TOTAL(Also enter on Line 10,Recapitulation) $ 6,621.25
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:
DAVID R. BRETZ SR 21 15 0297
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. David R. Bretz, Jr. Lineal 322,885.07
110 Carol Lane
Enola, PA 17025
2. Susan D. Bretz Lineal 322,885.07
101 Sharon Road
Enola, PA 17025
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 11-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.
Bill anb C)FOtament
1, DAVID R. BRETZ, SR., of Enola, Cumberland County, Pennsylvania,
being of sound and disposing mind, memory and understanding,hereby declare this instrument to
be my Last Will and Testament, revoking any and all Willsby me heretofore made.
ITEML I direct my hereinafter-named Executrix or Co-Executors, to pay all my just
debts,funeral expenses and administration expenses, including inheritance taxes, as soon as may
be convenient after my decease.
ITEM 11. 1 give all the rest, residue and remainder of my Estate, real, personal or
mixed,ofwhatsoever nature and wheresoever situate,unto In'Y Wife,BERTHA D.BRETZ,and hereby
nominate, constitute and appoint her as Executrix of this, Last Will and Testament.
ITEM111. In the event my wife,BERTHA D.BRETZ should predecease me or we should
both die in a common disaster, then:
A. 1 I give all the rest, residue and remainder of my Estate, real,personal or
mixed,xed, of whatsoever nature and wheresoever situate, in equal shares, to my son,
DAVID R. BRETZ,JR, and my daughter,SUSAN D. GREGG;
B. I hereby nominate, constitute and appoint my son, DAVID R. BRETZ,JR.,
and my daughter, SUSAN D. GREGG, as Co-Executors of this, my Last Will and
Testament.
ITEMIV Idirect that my Executrix or Co-Executors,shall not be required to give bond
for the faithful performance of their duties in this or any other jurisdiction.
ITEM V My Executrix or Co-Executors, is hereby authorized and empowered to sell
at public or private sale or sales all of the personal property of which I may die seized and to
likewise sell all real estate of which 1 may die seized and to'cdnvey the same byfee simple deed or
deeds to the same effect that I could personally do, if living.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and
�Tlament, consisting of two(2)typewritten pages, bearing'7 my signature, this 2_4,6 day of
• A.D. 2002.
SIGNED IN THE PRESENCE OF: —(SEAL)
bWvidA. Bretz, Sr.
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