HomeMy WebLinkAbout08-12-15 � 1505610140
REV-1500 �` �°,_,°>
PA Department of Revenue OFFICIAL USE ONLY
Bureau of individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 5 0 7 4 1
Harrisburc�,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death nnMDDYYYY Date of Birth MM�DVYYY
0 6 2 1 2 0 1 5 0 9 1 5 1 9 3 6
DecedenYs Last Name Su�x DecedenYs First Name MI
D U R F T H E R E S A A
(If Applicable)Enter Surviving Spouse's Infortnation Below
Spouse's Last Name Suffix Spouse's First Name MI
D U R F T H 0 M A S A
Spouse's Social Security Number
1 7 1 2 8 5 3 0 8 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
O 1.Original Return � 2.Supplemental Retum � 3.Remainder Return(date of death
prior to 12-13-82)
� 4.Limited Estate � 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 _ 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 Se�113(� m
between 12-31-91 and 1-1-95) (Attach�},i.O) u"'� rn �
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMA �OULD BE ECT ,r T�
Name Daytime Teleph�Nom�er � '�� ��
1`"1 �. �-_ F-.�. �,! t`"'i
M A T T H E W A . M c K N I G H T 7 1 7 2 �+��'9� --�2 �5 �' `'
...._ ._. ,_,
� �
REGISTER OF,WILLS USE O �� "�
" �
��� fri
Fi�st line of address ~ �,� o
- , cJ'1
I R W I N & M c K N I G H T , P • C • �'
Second line of address
6 0 W E S T P OM F R E T S T R E E T
City Of POSt Office State ZIP COde DATE FILED
C A R L I S L E P A 1 7 D 1 3
CorrespondenYs e-mail address:
Under penalties of perjury,I deciare that I have examined this retum,inciuding 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 PERSON RESPONSIB FOR FILING RETURN DATE
CZ°/ .cr�A . ���f.,.c�/� ,�- //- / �_
ADDRESS
121 BIG POND ROAD SHIPPENSBURG PA 17257
SIG TURE F PAR R OTHER THAN REPRESENTATIVE TE
�/ ,�
ADDRESS
60 W T POMFRET STREET CARLISLE PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1 �
L 1505610140 150561�140 J �
J 1505610240
REV-1500 EX Decedent's Social Security Number
DecedenYs Name: T H E R E S A A• D U R F
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. MoRgages and Notes Receivable(Schedule D) .. .. . . .. .. ... . . ..... ... . . . 4. •
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E).. . . .. . 5. 7 6 2 6 . 4 5
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested .. . ... . 6. •
7. Inter-Vivos Transfers&Miscellaneous N n-Probate Property
(Schedule G) � Separate Billing Requested .. . . ... 7. .
8. Total Gross Assets(total Lines 1 through 7) .. . ....... .... . .. .. ... ... .. 8. 7 6 2 6 , 4 5
9. Funeral Expenses and Administrative Costs(Schedule H) ... ... .. .. . . . .. . .. 9• 5 3 2 5 . 5 D
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule I) .. . ... .. .. . .. 10. 3 9 1 4 � . 3 6
11. Total Deductions(total Lines 9 and 10) .. . . .. . . .. . .. . . .. . . . . . ..... . . . . 11. 4 4 4 6 5 . 8 6
12. Net Value of Estate(Line 8 minus Line 11) .. .. . .. . . .. ..... .. .. ..... .. . 12• - 3 6 8 3 9 . 4 1
13. Charitable and Govemmental 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 6 8 3 9 . 4 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)(�z)x.o _ 0 . D 0 �5. 0 . 0 0
16. Amount of Line 14 taxable
at lineal rate X.045 0 . 0 0 �g. 0 . 0 0
17. Amount of Line 14 taxable
at sibling rate X.12 � . 0 0 17. � . � �
18. Amount of Line 14 taxable
at collateral rate X.15 � • � � 1g. � • � �
19. TAX DUE . . .. .. ... . .. .. .. . . . .. . .. .. . .. . . . . .. .. . . ... .. ... . . .. .. . 19. � . 0 �
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT �
Side 2
L 1505610240 1505610240 �
REV-1500 EX Page 3 File Number
Decedent's Complete Address: 2� 15 0741
DECEDENTS NAME
THERESA A. DURF
STREET ADDRESS
121 BIG POND ROAD
CITY STATE ZIP
SHIPPENSBURG PA 17257
Tax Payments and Credits:
�• Tax Due(Page 2,Line 19) (1) 0.00
2. Credits/Payments
A.Prior Payments
B.Discount 0.00
Total Credits(A+B) (Z) 0.00
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) 0.00
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: ..............................................:....................... ❑ 0
b. retain the right to designate who shall use the property transferred or its income; ............................... ❑ 0
c. retain a reversionary interest;or ................................................................................................ ❑ ❑X
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? ....................................................................................... ❑ �
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? ......... ❑ �
4. Did decedent own an individual retirement account,annuity or other non-probate propeRy,which
contains a beneficiary designation?.................................................................................................. ❑ X❑
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 t�ansfers 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 retum 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 decedenYs 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-1508 EX+(OB-12)
pennsyivania SCHEDULE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS � MISC.
R SEDENTDEC D NTTURN pERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
THERESA A. DURF 21 15 0741
Include the proceeds of Iftigation and the date the proceeds were received by the estate.
All property joinUy owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. M&T BANK-CHECKING ACCOUNT#9866276240 7,626.45
TOTAL(Also enter on Line 5,Recapitulation) $ 7 626.45
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(10-09)
pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
THERESA A. DURF 21 15 0741
DecedenYs debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s) ALBERT T. DURF 500.00
SheetAddress 121 BIG POND ROAD
City SHIPPENSBURG State PA Z�P 17257
Year(s)Commission Paid:
2. ,4ttomeyFees: IRWIN &McKNIGHT, P.C. 1,200.00
3, Family Exemption:(If decedenYs address is nat the same as claimanYs,attach explanation.) 3,500.00
Claimant THOMAS A. DURF
StreetAddress 121 BIG POND ROAD
City SHIPPENSBURG State PA ZIP 17257
Relationship of Claimantto Decedent SPOUSE
4. ProbateFees: REGISTER OF WILLS 125.50
5 Accountant Fees:
6. Tax Retum Preparer Fees:
7.
TOTAL(Also enter on Line 9,Recapitulation) $ 5 325.50
If more space is needed,use additional sheeis of paper of the same size.
REV-1512 EX+(12-12)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCETAXRETURN MORTGAGE LIABILITIES 8�LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
THERESA A. DURF 21 15 0741
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. DEPARTMENT OF PUBLIC WELFARE-CLAIM 39,140.36
CIS#230345559
TOTAL(Also enter on Line 10,Recapitulation) S 39 140.36
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:
THERESA A. DURF 21 15 0741
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 pnclude outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1. THOMAS A. DURF Spousal
121 BIG POND ROAD REMAINDER
SHIPPENSBURG, PA 17257
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.
� � ,
���t �t.� �xrt� J �e���r�t.e.r�
I, THERESA A. DURF, of Southampton Township, Cumberland
County, Pennsylvania, declare this instrument to be my last
will and testament , hereby expressly revoking all wills and
codicils heretofore made by me .
l. I direct my executor to pay all of my debts, funeral
and administrative expenses as soon as may be done conveniently
after my decease .
2. I authorize and empower my executor to sell any realty
owned by me at my death and not specifically devised or bequeathed
herein, at either public or private sale, and to give good and
sufficient deeds therefor, in fee simple, as I could do if
living.
3. I devise and bequeath all of my estate of every nature
and wherever situate to my husband, Thomas A. Durf, providing
he shall survive me by sixty days.
4 . Should the gift in Paragraph No. 3 not take effect, I
devise and bequeath all of my estate of every nature and wherever
situate to my son, Albert Thomas Durf, and if he is not living
at the time of my death, to his children, share and share alike.
5 . I nominate and appoint Thomas A. Durf to be the
executor of this my last will and testament; he is to serve
as such without bond. Should he die before my death, renounce
or refuse to serve for any reason, or die leaving any of my
estate unadministered, I nominate and appoint Albert Thomas Durf,
. ,�
� , • .
ACKNOWLEDGEMENT AND AFFIDAVIT
We, THERESA A. DURF � BETZI A. MORRISON �
and SHARON L. SCHWALM , the testatrix and the witnesses,
respectively, whose names are signed to the foregoing instrument,
being first duly sworn, do hereby declare to the undersigned
authority that the testatrix signed and executed the instrument
as her Last Will and that she had signed willingly, and that she
executed it as her free and voluntary act for the p�urposes therein
expressed, and that each of the witnesses, in the presence and
hearing of the testatrix , signed the Will as a witness and that
to the best of their knowledge the testa�r'ix was at that time
eighteen years of age or older, of sound mind and under no
constraint or undue influence .
� ,
;f ��---L��--,�r .
THERESA A. DURF ;/
b
� .
BETZ A. MORRISON
�!J��'J'i.t�Lil�t � ���l����
-HARON L. SCHWALM
COMMONWEALTH OF PENNSYLVANIA .
. SS :
COUNTY OF CUMBERLAND •
Subscribed, sworn to and acknowledged before me by
THERESA A. DURF , the testat�'1X , and subscribed
and sworn to before me by BETZI A. MORRISON , and
SHARON L. SCHWALM , witnesses , this �7`� day of
December , 1981 ,
�"� �. c��.
ROG�R ��.:�:�� ' ,-,-..-, i�
.;;.... �'' ru:;_L
c�rus�E ou�o,�z����:�Er�.��,�,�e�!.,�NTY
MY COMh91SSI0N EXPIRES OCT.3,19tj4 ;
� �
� '
as substitute executor, also to serve as such without bond, with
the same powers as are given herein to my executor.
6. I hereby suggest that my personal representative retain
the services of Irwin, Irwin & Irwin, as attorneys in the
settlement of my estate .
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
;r7' day of December, 1981.
�? , /f�! '%
��,�1.�'��Z--.,�• ��-:�x (SEAL)
THERESA A. DURF
Signed, sealed, published and declared by Theresa A. Durf,
the above named testatrix, as and for her last will and testament ,
in the presence of us, who at her request, in her presence and in
the presence of each other have subscribec� our names as witnesses
hereto.
.
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p ��zs��
499 Mitchell Road,Millsboro,DE 19966 Records Management
Phone 888-502-4349
F ax (302)934-2955
July 13,2015 •
Law Offices of Irwin &McKnight,PC
West Pomfret Professional Building
60 West Pomfret Street
Carlisle,PA 17013-3222
Re: Estate of: Theresa A Durf
Social Security: 021-30-0829
Date of Death: June 21,2015
Dear Sir or Madam:
Per your inquiry on July 7,2015, please be advised that at the time of death,the above-named decedent
had on deposit this bank the following:
1. Type of Account Checking
Account Number 9866276240
Ownership(Names o fl Albert T Durf(POA)
Theresa A Durf
Opening Date 12/22/2014
Balance on Date of Death $7,626.45
Accrued Interest $ .00
Total $7,626.45
For any additional information on the above accounts, including ownership and any changes,closures
and/or reimbursement of funds,please call Walnut Bottom at 7�7-532-2414.
We were unable to locate any safe deposit box for the above-mentioned decedent.
This letter dces not include any accounts in which the deceased may ha.ve been listed as Power of Attorney,
Custodian of Uniform Transfers,Representa.tive Payee,or Trustee under a Written Agreement.
Sincerely,
Tomara Williams
Records Management
RECEIPT FOR PAYMENT
LISA M. GRAYSON, ESQ. Receipt Date: 7/O1/2015
Cumberland County - Register Of Wills Receipt Time: 09 :26 : 54
One Courthouse S uare Receipt No. : 1081835
Carlisle, PA 17�13
DURF THERESA A
Estate File No. : 2015-00741
Paid By Remarks : CJWIN & MCKNIGHT
------------------------ Receipt Distribution ------------------------
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS TEST 30 . 00 CUMBERLAND COUNTY GENER.AL FUN
WILL 15 . 00 CUMBERLAND COUNTY GENERAL FUN
SHORT CERTIFICATE 35 . 50 BUREAU 0 DRE�EIPTSG&NCNRTR M D
JCS FEE
AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN
INH TAX RETURN 15 . 00 CUMBERLAND COUNTY GENERAL FUN
INVENTORY 15 . 00 CUMBERLAND COUNTY GENERAL FUN
RENUNCIATION 5 . 00 CUMBERLAND COUNTY GENERAL FUN
----------------
Check# 1077 $125 . 50
Total Received. . . . . . . . . $125 . 50
��
'�:�' penns�lva�ia R���4y��
� DEPARTMENT OF HUMAN SERVICES 201�1
�J�� 2 5
�w Q�s��
)uly 20, 2015
IRWIN & MCKNIGHT LAW OFFICES
MATTHEW A MCKNIGHT
WEST POMFRET PROFESSIONAL BUILDING
60 WEST POMFRET STREET
CARLISLE PA 17013-3222
Re: Theresa Durf
CIS #: 230345559
SSN: ###-##-0829
Date of Death: 06/21/2015
ESTATE RECOVERY STATEMENT OF CLAIM
Dear MATTHEW A MCKNIGHT:
Under State and Federal law, the Department of Human Services (the Department) is
required to recover medical assistance (MA) reimbursement from the probate estates of
deceased individuals who were over age 55 when such assistance was received. 42 U.S.C.
§1396p(b)(1). 62 P.S. § 1412. This letter sets forth the amount of the Department's claim
against the estate of the above referenced individual and explains the obligations of
executors, administrators, and persons receiving estate property.
Although the amount in the estate may be considerably less than that�ahich
is owed to the Department, our claim is against the estate, no one else.
Statement of Claim Amount
The Department maintains a claim in the amount of$39.140.36 against the
above-mentioned estate. This claim is for repayment of MA granted on behalf of the
decedent. Enclosed is the Department's itemized statement of claim.
A portion of this medical expense, namely $34.159.86, was incurred during the last
six months of the decedent's life; therefore, it is a Class 3 claim pursuant to Section 3392 of
the Decedents, Estates, and Fiduciaries Code, 20 Pa. C.S.A. 3392(3). The balance of the
claim, namely $4,980.50, is to be entered as a priority Class 5.1 claim against the estate.
You should refer to Section 3392 for a more complete explanation of the priority rules.
If a lawsuit is �led for injuries sustained by the decedent prior to death, then the
Department may also have a lien against the personal injury action. A statement of claim
for that injury-related lien must be requested separately.
Bureau of Program Integrity� Division of Third Parly Liability � Recovery Section
PO Box 8486 � Harrisburg,Pennsylvania 17105-8486