HomeMy WebLinkAbout08-13-15 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 �I 1:5pO 1
Harrisburg,PA 17128-0601 RESIDENT DECEDENT O 1
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
0 5 0 3 2 0 1 5 0 3 3 1 1 9 2 4
Decedent's Last Name Suffix Decedent's First Name MI
W A I T E L E T I T I A J
(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
❑X 1.Original Return 2.Supplemental Return 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)
E] 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 E] 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
D O U G L A S G - M I L L E R 7 1 7 2 4 9 2 3 5 3"
REGISTER OF WI�BE US94
rn
C CD n
CD
First line of address M
O
_
I R W I N & M c K N I G H T P - C �' _ `` ;70 C:1
Second line of address = CQ
6 0 W E S T P 0 M F R E T S T R E E Tc QT] 3
City or Post Office State ZIP Code <a C--DATE FILE
P.
C b
C A R L I S L E P A 1 7 0 1 3 y,', ccn
Correspondent's e-mail address:
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 PERSON RESPONSIBLE FOR FILING RETURN DATE
ADDRESS
7--ALLIANCE DRIVE, APT 201 CARLISLE PA 17013
SIGN RE O PREP ER H IAN REPRESENTATIVE D
t
AD SS
60 WE T POMFRET STREET CARLISLE PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610140 1505610140 J fib\
V�
1505610240
REV-1500 EX Decedent's Social Security Number
Decedent's Name: L E T I T I A J . W A I T E
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. Mortgages and Notes Receivable(Schedule D) .... .................. .... 4.
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)... . . .. 5.
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested ... . .. . 6. 4 1 4 6 . 7 6
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested .. .. ... 7. 4 5 5 2 9 . 0 0
8. Total Gross Assets(total Lines 1 through 7) .... . ..... ... .. .. ...... .... 8. 4 9 6 7 5 . 7 6
9. Funeral Expenses and Administrative Costs(Schedule H) ... . . ........ ..... 9. 5 0 0 5 . 5 0
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) ......... . ... 10.
11. Total Deductions(total Lines 9 and 10) . .... .......... .. ........ . ..... 11. 5 0 0 5 . 5 0
12. Net Value of Estate(Line 8 minus Line 11) ......... . .. ........... . .... 12. 4 4 6 7 0 . 2 6
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) .... . ......... ....... . 13. 0 . 0 0
14. Net Value Subject to Tax(Line 12 minus Line 13) ... .. .............. ... 14. 4 4 6 :7 0 . 2 6
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 . ❑ ❑
16. Amount of Line 14 taxable
at lineal rate X.0_ 0 . 0 0 16. 0 . ❑ 0
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 4 4 6 7 ❑ . 2 6 18. 6 7 0 0 . 5 4
19. TAX DUE . . .. .. .. ... . . .. ......... .... . ..... ......... . .... .. . .. . 19. 6 7 ❑ 0 • 5 4
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑X
Side 2
1505610240 1505610240
REVA500 EX Page 3 File Number
Decedent's Complete Address: 0 0
DECEDENTS NAME
LETITIA J. WAITE
STREET ADDRESS
7 ALLIANCE DRIVE APT 201
CITY STATE ZIP
CARLISLE PA 117013
Tax Payments and Credits:
t. Tax Due(Page 2,Line 19) (1) 6,700.54
2. Credits/Payments
A.Prior Payments 7,390.88
B.Discount 335.03
Total Credits(A+B) (2) 7,725.91
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) 1,025.37
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; ...................................................................... F1IKb. retain the right to designate who shall use the property transferred or its income; ...............................
El X
c. retain a reversionary interest;or ................................................................................................ I—] 1K
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? ....................................................................................... ❑ 0
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? ......... ❑ M
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation?.................................................................................................. 0 ❑
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
[12 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 decedents 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 decedents siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is defined,undl:
Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
REV-1509 EX+(01-10)
pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
LETITIA J. WAITE 0 0
If an asset was made jointly owned within one year of the decedent's date of death,it must be reported on Schedule G.
SURVMNG JOINT TENANTS)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A.ARBUTUS I. BARR 7 ALLIANCE DRIVE,#201 FRIEND
CARLISLE, PA 17013
B.
C.
JOINTLY-MED 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 DECEDENTS VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST
1. A. METRO BANK 8,293.52 50. 4,146.76
CHECKING ACCOUNT#537167355
TOTAL(Also enter on Line 6,Recapitulation) $ 4,146.76
If more space is needed,use additional sheets of paper of the same size.
REV-1510 EX+(08-09)
pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
LETITIA J. WAITE 0 0
This schedule must be completed and filed ifthe answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH %OF DECO'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER.ATTACH ACOPY OFTHE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IFAPPLICABLE) VALUE
1. ALLIANCE DEVELOPMENT FUND, INC. 90,979.14 100.00 45,450.14 45,529.00
BENEFICIARIES:
CHAPEL POINTE AT CARLISLE
ARBUTUS I. BARR
*EXCLUSION REPRESENTS THE PORTION GOING TO
CHAPEL POINTE AT CARLISLE
TOTAL Also enter on Line 7,Recapitulation)l $ 45 529.00
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
LETITIA J. WAITE 0 0
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. HOFFMAN-ROTH FUNERAL HOME 2,450.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Years)Commission Paid:
2. AttomeyFees: IRWIN &McKNIGHT, P.C. 2,500.00
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
4. Probate Fees:
5 Accountant Fees:
6. Tax Return Preparer Fees:
7. REGISTER OF WILLS-FILING FEE 55.50
TOTAL(Also enter on Line 9,Recapitulation) $ 5,005.50
If more space is needed,use additional sheets of paper of the same size.
REV-1513 EX+(01-10)
pennsylvania SCHEDULE
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
LETITIA J. WAITE 0 0
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec.916(a)(1.2).]
1. ARBUTUS 1. BARR Collateral 44,670.26
7 ALLIANCE DRIVE, APT 201
CARLISLE, PA 17013
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
IL 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. CHAPEL POINTE AT CARLISLE
700 S. HANOVER STREET
CARLISLE, PA 17013
$45,800(SEE SCHEDULE G)
TOTAL OF PART H-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. S 0.00
If more space is needed,use additional sheets of paper of the same size.
07/24/2015 10:20 717-920-4666 DEPOSIT SERVICES PAGE 02/02
METRO
3801 Paxton Street 888.937,0004
BANK Harrisburg. PA 17111 mymetrobank.com
July 24, 2015
Douglas G. Miller
Irwin &McKnight, PC
60 W Pomfret St
Carlisle, PA 17013-3222
RE: Estate of: Letitia Waite
Tax Identification Number-
Date of Death: May 3, 2015
To Whom It May Concern:
This letter is in reference to decedent account information you requested for the
individual listed above.
We are able to provide the following:
Account Type,Checking
Account Number* 537167355
Date Opened: 1130/06
Primary Owner- Letitia J. Waite
Secondary Owner Arbutus Barr (Added as co-owner 11/6/09 was trustee at opening)
Beneficiary: Chapel Pointe at Carlisle
Date of Death Balance: $8,293.09
Principal Balance: $8,293.09
YTD Interest. $3.72
Accrued Interest": $.43
** Please note: The accrued interest will not be paid if the account is closed prior
to the date the interest is scheduled to post.
The customer did not have a safe deposit box at Metro Bank.
�Please feel free to contact me at(888) 937-0004 if I may be of further assistance.
Sincerely,
�in�dyta`njb'ery �
Support Associate/Deposit Services
Metro Bank
219 North Hanover Street
Carlisle,Pennsylvania 17013
717.243.4511
toll free 1.866.451.4511
fax 717.243.3723
www.hoffmanroih.com
OVFUNER7ALHOME & CREMATORY, INC. info@hoffmanroth.com
Christopher K Hoffman—Owner/President William E.Hoffman- Vice President Robert A.Filbum ID—Supervisor
David E.Feczko—Funeral Director Till A.Lazar—Funeral Director&Preneed Counselor
May 12, 2015
Arbutus I. Barr
7 Alliance Drive, Apt. 201
Carlisle, PA 17013
Statement of Funeral Expenses for: Letitia Waite
Date of Death: May 3, 2015 Account Id: 17506-109
PACKAGE:
Immediate Cremation
OPTION 6-Cremation $ 2,390.00
Sub Total: $ 2,390.00
TOTAL FUNERAL HOME CHARGES: $ 2,390.00
CASH ADVANCES:
5 Certified Death Certificates at$6.00 each $ 30.00
Coroner's Fee $ 30.00
Sub Total: $ 60.00
TOTAL FUNERAL EXPENSE: $ 2,450.00
Balance: $ 2,450.00
Issued By:
A Minishy of
The Christian and Missionanj Alliance
AOOUUy Number: 2766
GIFT TY AGREEMENT
One Life - Dmmor is not the Annuitant
Immediate Payments
This Agreement is made between the Estate of Letitia Waite c/o Arbutus Ban-. Exocutor, 7
Alliance Drive Apt 2O1' Carlisle, FA 17O13 (hereinafter"the Oonor'). and The Orchard
Foundation, of 8595 Explorer Drive, Colorado Springs, CO 80920 (hereinafter"The Orchard
Foundation").
I' Transfer of Property by Donor
The Orchard Foundation certifies that the Donor, oaanevidence cfher desire tosupport the work
of The Orchard Foundation and to make a charitable gift, on May 3, 2015 contributed to The
Orchard Foundation the property described in Schedule A attached hereto, the fair market value
mfwhich is $82.00O.00.
2' Payment of Annuity
/nconsideration of the property transferred bvthe Donor, The Orchard Foundation shall pay on
annual annuity of$6.386.00from the date ofthis Agreement and shall pay such amount toMiss
Arbutus Barr o{7Alliance Drive Apt 281. Carlisle, PA17O13. (hereinafter"the Annu|tont") oolong
as she is living.
3. Payment Dates; First Installment
The annuity shall bepaid inquarterly installments of$1.5S9.00. The first installment shall bo
payable on August 1, 2015 in the amount of$1,564.24, prorated on the basis of the number of
days }nthe initial payment period. Subsequent installments beginning onNovember 1. 2O15 and
continuing every quarter thereafter shall bointhe full amount of$1.588.00.
4' Birth Date ofAnnuitant
The birth date ofthe Annuitant iaDecember 27. 1B29.
5. Payment Correction
If the stated birth date of the Annuitant should be found to be incorrect at any time, the amount
payable or benefit accruing under this Agreement shall be such as would have been provided
according to the correct birth date. If any underpayment or overpayment has been made on
account of such misstatement, any such underpayment shall promptly be paid to the Annuitant,
and any such overpayment shall be charged against the current and/or next succeeding
payment(s) to the Annuitant.
6. Irrevocability; Non-assignability; Termination
This annuity is irrevocable and non-assignable, except that it may be assigned to The Orchard
Foundation. The Orchard Foundation's obligation under this Agreement shall terminate with the
regular payment preceding the Annuitant's death.
7. Uses and Purposes of Gift
Upon The Orchard Foundation's satisfaction of its obligation under this Agreement, an amount
equal to the residuum of the gift shall be used by The Orchard Foundation for the purposes
indicated in the attached Letter of Intent.
8. Entire Agreement; Governing Law
This Agreement, together with Schedule A and the Notice to Pennsylvania Donors attached
hereto, constitutes the entire agreement of the parties. This Agreement shall be governed by the
laws of the State of Colorado.
This Agreement is effective as of May 3, 2015.
DONOR: The Orchard Foundation:
Estate of Letitia Waite Timothy W. Cummings, VP/COO/CFO
TOF-1 dna-I-PA
The Orchard Foundation Prepared for:
Miss Arbutus Barr
June 29, 2015
7.8% Charitable Gift Annuity
ASSUMPTIONS:
Annuitant [12/27/1929] 85
Date of Gift 5/3/2015
Cash Donated $82,000.00
Payout Rate 7.8%
Payment Schedule quarterly
at end
CALCULATIONS:
Charitable Deduction $45,450.14
Number of Payments in First Year 2
Days in First Quarterly Period (5/1/201.5 to 7/31/2015) 92
Days of Payment Credit in First Quarterly Period (5/3/2015 to 7/31/2015) 90
Annuity $6,396.00
Quarterly Payment $1,599.00
First Partial Payment on 08/01/2015 (90/92 x $1,599.00) $1,564.24
BREAKDOWN OF ANNUITY:
Tax-free Ordinary Total
Portion Income Annuity
2015 to 2015 2,657.12 506.12 3,163.24
2016 to 2021 5,372.64 1,023.36 6,396.00
2022 to 2022 1,656.90 4,739.10 6,396.00
2023 onward 0.00 6,396.00 6,396.00
After 6.8 years, the entire annuity becomes ordinary income.
Prepared by: Darlene Lanzi IRS Discount Rate is 1.8%
These calculations are for illustration purposes only and should not be considered legal,accounting,or other professional
advice. Your actual benefits may vary depending on several factors,including the timing of your gift.