HomeMy WebLinkAbout07-16-15 (2) pennsylvania 1505618403
DEPARTMENT OF R 11EX(03-14)
REV-1500 OFFICIAL USE ONLY
County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
Po Box.28oso1
Harrisburg,PA 17128-0601 RESIDENT DECEDENT 21 14 1040
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYW Date of Birth MMDDYYYY
10 12 2014 12 22 1928
Decedent's Last Name Suffix Decedent's First Name MI
FREEBURN JACQUELINE F
(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
® 1. Original Return ❑ 2. Supplemental Return ❑ 3. Remainder Return(date of death
prior to 12-13-82)
❑ 4. Agricultural Exemption(date of ❑ 5. Future Interest Compromise(date of ❑ 8. Federal Estate Tax Return Required
death on or after 7-1-2012) death after 12-12-82)
® 7. Decedent Died Testate ❑ 8. Decedent Maintained a Living Trust 9. Total Number of Safe Deposit Boxes
(Attach copy of will) (Attach copy of trust.)
❑ 10. Litigation Proceeds Received ❑ 11 Non-Probate Transferee Return ❑ 12. Deferral/Election of Spousal Trusts
(Schedule F and G Assets Only)
❑ 13. Business Assets ❑ 14. Spouse is Sole Beneficiary
(No trust involved)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALLCORRESPONDENCE AND CONFDENTUU_TAX MFORMATION SHOULD BE DIRECTM TO:
Name Daytime Telephone Number.
ELIZABETH H FEATHER 717 232 7661
First Line of Address
3631 NORTH FRONT STREET
Second Line of Address
r'V
City or Post Office State ZIP Code r7l n
HARRISBURG PA 17110
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Correspondent's email address: @cklegal.net
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REGISTtROF-VVI,�4S U NLY "i FYI
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REGISTER OF WILLS USE ONLY C7
DATE FILED a 1~-� t— M
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DATE FILED STAMP
Side 1
1505618403 1505618403
1505618411
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: FREEBORN, JACQUELINE F.
RECAPITULATION
1. Real Estate(Schedule A).......................................................................................... 1. 143 , 700 - 0 0
2. Stocks and Bonds(Schedule B)............................................................................... 2. 334 , 444 - 58
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 9 , 6 8 1 • 9 5
6. Jointly Owned Property(Schedule F) IN Separate Billing Requested............. 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested............. 7. 9 , 6 19 8 0
8. Total Gross Assets(total Lines 1 through 7).......................................................... 8. 517 4 4 6 . 33
9. Funeral Expenses and Administrative Costs(Schedule H)..................................... 9. 2 1 , 5 35 16
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................. 10. 2 , 669 8 9
11• Total Deductions(total Lines 9 and 10).................................................................. 11. 2 4 , 2 05 0 5
12. Net Value of Estate(Line 8 minus Line 11)............................................................. 12. 4 9 3 , 2 41 2 8
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. 493 , 241 2 8
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 .00 15.
16. Amount of Line 14 taxable
at lineal rate X ,045 493 , 241 • 28 16. 22 , 195 • 86
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. 22 , 195 • 86
20• FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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.
SIG TU RS N RE P NSIB FILING RETURN Walter W. Freeburn,Jr. DATE
/J
AD �
304 N. 21st Street, Camp Hill-4A 17011
SI �Pg R&. ER OJHER THAN REPRESENTATIVE Elizabeth H Feather 11JE y 1�
ADDRES&S Caldwell & Kearns P.C.
3631 North Front Street, Harrisburg, PA 17110
111111111111111111111111111111111111111 IN Side 2
1505618411 1505618411 J
REV-1500 EX Page 3 File Number 21 - 14 - 1040
Decedent's Complete Address:
DECEDENT'S NAME
Freeburn, Jacqueline F.
STREET ADDRESS
308 N. 21st Street
CITY STATE ZIP
Camp Hill PA 17011
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 22,195.86
2. Credits/Payments
A. Prior Payments 15,000.00
B. Discount 789.47
Total Credits(A +B) (2) 15,789.47
3. Interest
(3) 1.05
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4)
Check box on Page 2,Line 20 to request a refund
5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 6,407.44
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
b. retain the right to designate who shall use the property transferred or its income;.................................... ❑ Fxl
c. retain a reversionary interest;or.................................................................................................................. ❑ 0
d. receive the promise for life of either payments,benefits or care?.............................................................. ❑ ❑x
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?....................................................................................................................... ❑
3. Did decedent own an"in trust for' or payable upon death bank account or security at his or her death?......... ❑ 0
4. Did decedent own an individual retirement account,annuity,or other non-probate property which
contains a beneficiary designation?...................................................................................................................... Fil ❑
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 spo
is 3 percent[72 P.S.§9116(a)(1.1)(i)].
For dates of death on or after January 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
V?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
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 ears 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)('
•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.
pennsylvania
' DEPARTMENT OF REVENUE SCHEDULE A
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Freeburn, Jacqueline F. 21 - 14 - 1040
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 wilfing seller, neither being compelled to buy or sell, both having
reasonable knowledge of the relevant facts. Real property which 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.
Include a copy of the deed showing decedent's interest if owned as tenant in common.
ITEM VALUE AT DATE OF
NUMBER DESCRIPTION DEATH
1 Real property situate at 308 North 21st Street, Camp Hill Borough, Cumberland County, Camp 143,700.00
Hill, Pennsylvania. Assessed value $160,500.00 X .99 CLR = $158,895.00. See attached
Realtors statement of market value $141,000.00 with repairs and updates. Value used is
assessed value, minus labor costs for repairs of$15,195.00.
TOTAL(Also enter on Line 1, Recapitulation) 143,700.00
REV-1503 EX+(8-12)
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Freeburn, Jacqueline F. 21 - 14- 1040
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM DESCRIPTION UNIT VALUE VALUE AT DATE OF
NUMBER DEATH
Morgan Stanley Brokerage Account-Assets listed as follows:
1 609.073 Units of Blackrock Equity @ $24.47 per unit 14,904.02
2 2,984.182 Units of Blackrock Low Dur Bd @$9.76 per unit 29,125.62
3 523.623 Units of Goldman Sachs Grw @ $30.90 per unit 16,179.95
4 5,893. Units of Invesco Premier @ $1.00 per unit 5,893.00
5 707.629 Units of Janus Forty @ $40.40 per unit 28,588.21
6 640.551 Units of Janus Perkins Mid Cap @$23.73 per unit 15,200.28
7 4,295.591 Units of Loomis Sayles Bond @ $15.39 per unit 66,109.15
8 477.489 Units of Lord Abbett Dev Growth @$23.77 per unit 11,349.91
9 1,850.013 Units of Natixis Loomis @ $12.08 per unit 22,348.16
10 260.857 Units of Oakmark I @$65.66 per unit 17,127.87
11 920.049 Units of Oakmark Internatl I @ $23.71 per unit 21,814.36
12 1,917.542 Units of Prudential Sht Trm Corp @ $11.31 per unit 21,687.40
13 357.379 Units of Royce Micro Cap @$14.53 per unit 5,192.72
14 270.359 Units of Royce Premier Inv @ $20.74 per unit 5,607.25
15 1,176.710 Units of T Rowe Price Emerging Mkts @$12.68 per unit 14,920.68
TOTAL(Also enter on line 2, Recapitulation) 334,444.58
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN continued
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Freeburn, Jacqueline F. 21 - 14 - 1040
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM DESCRIPTION UNIT VALUE VALUE AT DATE OF
NUMBER DEATH
16 2,320 Shares of Bank of America @$16.55 per share 38,396.00
Page 2 of Schedule B
pennsylvania SCHEDULE E
1y} DEPARTMENT OF REVENUE CASH BANK DEPOSITS AND MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
FILE NUMBER
ESTATE OF Freeburn, Jacqueline F. 21 - 14 - 1040
Include the proceeds of litigation and the date the proceeds were received by the estate.All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE OF
NUMBER DESCRIPTION DEATH
1 PNC Bank Checking Account No. 5140123881 27,181.95
2 2002 Taurus 2,500.00
TOTAL(Also enter on Line 5, Recapitulation) 29,681.95
REV-1609 EX+(01-10) SEPARATE BILLING REQUESTED
" pennsylvania
DEPARTMENT OF REVENUE SCHEDULE F
INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Freeburn, Jacqueline F. 21 - 14- 1040
If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G.
SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT
Walter W. Freeburn, Jr. 304 N 21st Street Son
A Camp Hill, PA 17011
JOINTLY OWNED PROPERTY: pE p p
ITEM LETTER DATE Include name of inanRcial InOstitutlon anOd bank account numbe DATE OF DEATH %OF DATE OF DEATH
NUMBER FOR JOINT MADE or similar identifying number.Attach deed for'ointl -held real VALUE OF ASSET DECD'S VALUE OF
TENANT JOINT y 9 y INTEREST DECEDENT'S INTEREST
estate.
1 A 04/03/2006 PNC Bank Savings Account No. 5004840296 2,473.07 50% 1,236.54
TOTAL(Also enter on line 6, Recapitulation) 1,236.54
REV-1510 EX+(08.09)
pennsylvania
DEPARTMENT OF REVENUE SCHEDULE G
INHERITANCE TAX RETURN INTER-VIVOS TRANSFERS &
RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY
ESTATE OF Freeburn, Jacqueline F. FILE NUMBER
21 - 14- 1040
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
STEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF EXCLUSION
NUMBER Include the name of the transferee,their relationship to decedent VALUE OF ASSET DECO'S TAXABLE VALUE
PF APPLICABLE}
and the date of transfer. Attach a copy of the deed for real estate. INTEREST
Morgan Stanley Brokerage IRA, beneficaries are
Walter W. Freeburn, Jr. and Donald L. Freeburn, her
sons
1 32.599 Units of Blackrock Equity @$24.47 per unit 797.70 797.70
2 133.219 Units of Blackrock Low Dur Bd @$9.76 per 1,300.22 1,300.22
unit
3 2.690 Units of Goldman Sachs @$30.90 per unit 701.12 701.12
4 259. Units of Invesco Premier @$1.00 per unit 259.00 259.00
5 32.90 Units of Janus Forty I @$40.40 per unit 1,329.16 1,329.16
6 29.535 Units of Janus Perkins Mid Cap @ $23.73 per 700.87 700.87
unit
7 197.209 Units of Loomis Sayles Bond @$15.39 per 3,035.05 3,035.05
unit
8 20.347 Units of Lord Abbett Dev Growth @$23.77 483.65 483.65
per unit
9 83.86 Units of Natixis Loomis Say @$12.08 per unit 1,013.03 1,013,03
TOTAL(Also enter on line 7, Recapitulation) 9,619.80
REVA611 EX+(06.13)
tpennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE
COSTS
RESIDENT DECEDENT /'iLAY� i fW WJ
FILE NUMBER
ESTATE OF Freeburn, Jacqueline F. 21 - 14 - 1040
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT
A. 1 Funeral Services, Cemetery, Vault, Marker 2,207.45
2
3
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zip
Year(s)Commission Paid
2. Attorney's Fees Caldwell&Kearns P.C. --Elizabeth H Feather 7,500.00
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 Register of Wills 575.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1 Cumberland Law Journal -Advertise Letters 75.00
See attached 11,177.21
TOTAL(Also enter on line 9, Recapitulation) 21,535.16
REV-1511 EX+(08-15)
pennsylvania SdvduleH
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN (Funeral Bqx-nsm&
RESIDENT DECEDENT Almmistafive Cos1S "Rued
�.VI�Y FILE NUMBER
ESTATE OF Freeburn, Jacqueline F. 21 - 14 - 1040
2 Sentinal-Advertise Letters 233.02
3 C&K-copies, overnight mailing 34.22
4 C&K- Postage, Insurance for mailing BoA Stock Certificates 35.00
5 Bank of America Stock Trading Fee 117.80
6 Home Depot-Supplies 220.90
7 PPL Electric 26.47
8 Penn Waste 41.55
9 UGI 60.75
10 PA American Water 12.33
11 UGI 60.00
12 PA American Water 16.01
13 PPL Electric 28.27
14 Home Depot-Supplies 305.07
15 Farmers Mutual Homeowners Insurance 416.00
16 Borough of Camo Hill -Sewer 165.00
17 UGI 60.00
18 PA American Water 17.03
19 PPL Electric 31.60
20 Home Depot-Supplies 249.47
Page 2 of Schedule H
REV-1511 EX+(08.13)
2,'7 pennsylvania ScWule H
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN Funeral Expenses&
RESIDENT DECEDENT Almin'IstratNe Costs continued
ESTATE OF Freeburn, Jacqueline F. FILE NUMBER
21 - 14 - 1040
21 Sherwin Williams- Paint 25.94
22 RF Fager-Supplies 46.85
23 UGI 60.00
24 Home Depot-Supplies 39.80
25 PPL 31.66
26 Penn Waste 41.55
27 PA American Water 14.99
28 UGI 60.00
29 PPL Electric 25.45
30 PA American Water 16.05
31 Borough of Camp Hill - Sewer 165.00
32 UGI 60.00
33 PPL Electric 25.04
34 Home Depot-Supplies 76.56
35 PA American Water 15.03
36 L.H. Brubaker-Gas Range 598.90
37 Home Depot-Supplies 541.08
38 Lowes-Supplies 264.10
39 PPL Electric 29.49
Page 3 of Schedule H
REV-1511 EX+(08.13)
pennsylvania SdvduleH
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN Funeral E)gxnSes&
RESIDENT DECEDENT Administrative Costs continued
FILE NUMBER
ESTATE OF Freeburn, Jacqueline F. 21 - 14 - 1040
40 UGI 60.00
41 Penn Waste 41.55
42 PA American Water 16.05
43 School Real Estate Taxes 860.28
44 J.H. Myers- Entrance locks 57.77
45 R F Fagers-Supplies 126.13
46 Gelco-Carpet cleaning 158.95
47 New windows 1,755.00
48 New flooring, lights, doors, paint, misc items for repairs 3,833.50
Page 4 of Schedule H
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medicalexpenses.
REV-1513 EX+(01.10)
pennsylvania
DEPARTMENT OF REVENUE SCHEDULEJ
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF Freeburn, Jacqueline F. FILE NUMBER
21 - 14- 1040
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY Do Not List Trustee(s)
TAXABLE DISTRIBUTIONS distributions,
outright spousal
and transfers
under Sec.9116(a)(1,2))
1 Walter W. Freeburn, Jr. Son 1/2 of Residue
304 N. 21 st Street
Camp Hill, PA 17011
2 Donald L. Freeburn Son 1/2 of Residue
822 Westridge Drive
Hockessin, DE 19707
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate.
IYNON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00