HomeMy WebLinkAbout09-25-15 1505614234
REV-1500 EX(FI) Decedent's Social Security Number
Dec--denfsName: M. LOUISE HEBERLIG
RECAPITULATION
1. Real Estate(Schedule A) ... .. . . . .. ..... ............. .......... ... 1.
Z 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. 9 1 • 5 8
6. Jointly Owned Property(Schedule F) M Separate Billing Requested ....... 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) F] Separate Billing Requested ..... 7. 4 2 3 0 3 6 . 2 4
8. Total Gross Assets(total Lines I through 7) ........ . .. . . ....... ... ... 8. 4 2 3 1. 2 7 . 8 2
.9. Funeral Expenses and Administrative Costs(Schedule H 9. 1 5 9 7 5 . 0 0
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) .. ........... 10. 1 0 3 5 0 . 0 0
11. Total Deductions(total Lines 9 and 10) ........... ....... ...... 11. 2 6 3 2 5 . 0 0
12. Net Value of Estate(Line 8 minus Line 11) . .... .. ............. .. .. .... 12. 3 9 6 8 0 2 . 8 2
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 9 6 8 0 2 • 8 2
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 3 9 6 8 0 2 . 8 2 16. 1 7 8 5 6 . 1 3
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. 1 7 8 5 6 . 1 3
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 a d complete.Declaration of preparer other than the person responsible for filing the return is based on all information of which preparer has
any knowledge,7 k
S=113OF P 2==ILING RETURN
ADbRESS
1327 BALTIMORE ROAD SHIPPENSBURG PA 17257
S[Gn,E OF P EPAR THAN PV N RESPONSIBLE FOR FILING THE RETURN D
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ADD S
ATRFET
74 r)RTH SEC04 CHAMBERSBURG PA 17201
1111111 Illil 11111 illll Illli illll VIII VIII Illll 11111 Illi 1111 Side 2
t 1505614234 1505614234
REV-1500 EX (FI) Page 3 File Number
Decedent's Complete Address: will not probated
DECEDENT'S NAME
M. LOUISE HEBERLIG
STREET ADDRESS
1327 Baltimore Road
CITY STATE ZIP
IShippensburg PA 17257
Tax Payments and Credits:
1• Tax Due(Page 2,Line 19) 17,856.13
2. CreditslPayrnents
A.Prior Payments
B.Discount 892.80
(See instructions.) Total Credits(A+B) (2) 892.80
3. Interest
(3)
4. If Line 2 is greater than Line I+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) 16,963.33
Make check payable to: REGISTER OF WILLS, AGENT.
7
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 ...................................................................... f_1 0
b. retain the right to designate who shall use the property transferred or its income ............I.................. 171 1&1
c. retain a reversionary interest ...... ............................................................................. ................. ❑
1XI
d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ FX1
2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death
without receiving adequate consideration? .................................................................... f nX
3. Did decedent own an"in trust for'or payable-upon-death bank account or security at his or her death? ......... nX 171
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation?........................................................ ......................................... 171 nX
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
r
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 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)(I)I.
• 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-1508 EX+(08-12)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
M LOUISE HEBERLIG will not probated
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. Prime Share Account with Patriot Federal Credit Union 5.95
2. Money Market Account with Patriot Federal Credit Unon 0.01
3. Draft Account with Patriot Federal Credit Union 3.40
4. Refund, Bankers Life and Casualty Company 82.22
i
TOTAL(Also enter on Line 5,Recapitulation) $ 91.58
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
M. LOUISE_HEBERLIG will not probated
This schedule must be completed and filed if the 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 %OFDECO'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER.ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IFAPPUCABM VALUE
1. Account*528-02695 with Edward Jones, valuation attached, 423,036.24 100.00 423,036.24
titled M. Louise Heberlig, transfer on death to Kim D.
Michaels, granddaughter
TOTAL(Also enter on Line 7,Recapitulation)1 423 036.24
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
M. LOUISE HEBERLIG will not probated
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Fogelsanger-Bricker Funeral Home, funeral expenses 11,825.00
2. Flowers for funeral 175.00
3. Meal after funeral 75.00
4. Gravemarker 400.00
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: Joel R. Zullinger 2,850.00
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: filing return 20.00
5 Accountant Fees:
6. Tax Return Preparer Fees:
7. Clean out of room at Menno Haven and moving expenses 650.00
TOTAL(Also enter on Line 9,Recapitulation) $ 15 975.00
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
M. LOUISE HEBERLIG will not probated
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. Kim D. Michaels, power of attorney fees incurred by decedent prior to death 350.00
2. Menno-Haven, balance due for care services 10,000.00
TOTAL(Also enter on Line 10,Recapitulation) $ 10 350.00
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:
M. LOUISE HEBERLIG will not probated
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. Kim D. Michaels, 1327 Baltimore Road, Shippensburg, PA Lineal
17257 entire estate
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:
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.
50
Irtriot
FEDERAL CREDIT UNION
Fifty Years of Financial Freedom
August 20, 2015
Zullinger Davis Trinh Law Offices
Joel Zullinger
74 North Second St
Chambersburg, PA 17201
RE: Estate of M. Louise Heberlig
To Whom It May Concern:
I am writing in regards to your request for date of death share values on the above referenced
member. This account was in the sole name of the deceased.
Account Date of Interest Accrued Open Date
XXXXXX5290 Death Principal Rate Interest to
DOD
Prime Share (00) $5.95 0.100% $0.00 07/05/1984
Money Market (20) $0.01 0.000% $0.00 1/24/2000
Draft Account (25) $3.40 0.00% $0.00 9/2/2005
If you have any questions with regard to the above balances, or need additional information,
please contact a Membership Officer at 717-263-4444.
Sincerely,
Patriot Federal Credit Union
EdwardJones
Estates - Historical Date of Death Valuation Worksheet
Account Registration:
M LOUISE HBBERLIG Account Number: 528-02695 Date: Jul 20, 2015
Date of Death: Jul 12, 2015
Date of Death Valuation: Jul 12, 2015
Alternate Date of Valuation:
�✓ Check here if date of death was a closed market day (i.e., holiday, weekend)
Use the additional worksheets (pages 2 -8)to determine the total value and dividends/interest due for stocks, cds, bonds and mutual funds held in the deceased
person's account.Then use those totals to complete section B and C to determine the overall total account value.
A.Total Cash Held:
1. Cash $
2. Money Market $
3. Insured Bank Deposit $
B.Total Value of Assets Held:
4. Stocks $
5. Bonds/CDs $ 334,856.00
6. Mutual Funds $ 73,884.99
7. Miscellaneous Securities $ 11,618.88
C.Total Dividends/Interest Due:
8. Stocks dividends $
9. Bonds/CDs interest $ 2,676.37
10. Mutual Funds dividends $ 0.00
11. Miscellaneous distributions $ 0.00
D.Total Account Value: $ 423,036.24
Edward Jones, its employees and financial advisors do not provide tax or legal advice.This information is believed to be reliable, but its accuracy and
completeness are not guaranteed. Consult with a competent tax specialist or attorney for professional advice on your specific situation.
Revised 16 Oct 2012
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Estates ~ Historical Date ofDeath Valuation Worksheet
Bonds/CDs (fixed income products) Account Number: 528-02695 DateJul 20, 2015
Quantity* Security Description CUSIP Payment Date Value Per Item** Total Value* Interest Due to Date
(Face Value) (Bid Price) (Bid x 10 x Units) of Death
1. 25,000 ALLEGHENY CTY 5.0% 01 728VKJ8 111.280 $ 27,820.00 $ 246.53
3. 10,000 LANCASTER SCH 4.20% 514383RK6 103.910 s 10,391.00 s 47.83
7. 20,000 PA ST PITTS UNIV 5.0% 70917RYX7 110.450 s 22,090.00 s 158.33
8. 30,000 PA ST TPK 5.0% 709223RD5 104.030 s 31,209.00 s 170.83
9. 20,000 PA ST TPK 5,0% 709223SG7 107.380 s 21,476.00 s 113.89
11. 25,000 PRINCE GEORGES 4.75% 74171TDT8 100,260 s 25,065.00 $ 3M8
° Note: Bonds trade in increments of 1,000 rather than fractional amounts; Therefore a$5,000 bond equals a quantity of 5 Units.
**To calculate the Total Value for each bond listed multiply the"bid price" times "l 0" times the "number of units"
Edward Jones, its employees and financial advisors do not provide tax or legal advice. This information is believed to be reliable, but its accuracy and
completeness are not guaranteed. Consult with a competent tax specialist or attorney for professional advice on your specific situation.
Revised 10Oct cn1u
EdwardJones
Estates - Historical Date of Death Valuation Worksheet
Bonds/CDs (fixed income products) (Continued) Account Number: 528-02695 Date: Jul 20, 2015
Quantity* Security Description CUSIP Payment Date Value Per Item" Total Value" Interest Due to Date
(Face Value) (Bid Price) (Bid x 10 x Units) of Death
-17. 40,000 GE CAPITAL FIN 3.850% 36160WMM8 104.530 $ 41,812.00 $ 396.60
-18. $ $
19.1 $ $
20. $ $
21. $
-22. $ $
-23. $ $
24. $ $
-25. $ $
-26. $ $
27- $ $
- 28. $ $
29. $ $
30. $ $
- 31. $ $
32. $ $
33.1 $ $
1 Total Bonds Page 5 1 $ 41,812.00 $ 396,601
*Note: Bonds trade in increments of 1,000 rather than fractional amounts; Therefore a$5,000 bond equals a quantity of 5 Units.
**To calculate the Total Value for each bond listed multiply the "bid price" times ""1 0" times the "number of units"
Edward Jones, its employees and financial advisors do not provide tax or legal advice.This information is believed to be reliable, but its accuracy and
completeness are not guaranteed. Consult with a competent tax specialist or attorney for professional advice on your specific situation.
Revised 16 Oct 2012
Edward ones
Estates - Historical Date of Death Valuation Worksheet
Mutual Funds Account Number: 528-02695 Date: Jul 20, 2015
Dividends(Accrual
Quantity Security Description CUSIP Payment Date Value Per Item Total Value Funds Only)Due to
Date of Death
EX. $ $ $
1 1,460.920 INV MUNI INC FID C 001419530 $ 13.38 $ 19,547.11 $
2. 12,183.381 L.A. SHT DUR INC FD C 543916704 $ 4.46 $ 54,337.88 $
3. $ $ $
4. $ $ $
5. $ $ $
6. $ $ $
7. $ $ $
8.1 $ $ $
9. $ $ $
10. $ $ $
11" $ $ $
12. $ $ $
- 13. $ $ $
14. $ $ $
15. $ $ $
16, $ $ $
17.1 1 $ $ $
1 Total Mutual Funds 1 $ 73,884,991 $ 0.00
Edward Jones, its employees and financial advisors do not provide tax or legal advice.This information is believed to be reliable, but its accuracy and
completeness are not guaranteed. Consult with a competent tax specialist or attorney for professional advice on your specific situation.
Revised 16 Oct 2012
EdwardJones
Estates - Historical Date of Death Valuation Worksheet
Account Number: 528-02695 Date: Jul 20, 2015
Miscellaneous Securities (including Cash Accrued Interest, Money Market Accrued Dividends, Unit Trust; Life Insurance, Limited Partnership, etc)
Dividends/Interest
Cluantity Security Description CUSIP Payment Date Value Per Item Total Value Due to Date of Death
i (Optional)
EX. $ $ $
1 49.00000 PA INS MUNI INC TR 70884G603 $ 287.12 $ 11,618.88 $
2.1 $ $ $
3. $ $ $
4. $ $ $
5., $ $ $
6. $ $ $
7. $ $ $
8. $ $ $
9. $ $ $
10. $ $ $
11. $ $ $
12. $ $ $
13. $ $ $
14.. $ $ $
15. $ $
16. $ $ $
17.1 $ $ $
Total Miscellane I ous $ 11,618.88 $ 0.00
PCI 8
Edward Jones, its employees and financial advisors do not provide tax or legal advice. This information is believed to be reliable, but its accuracy and
completeness are not guaranteed. Consult with a competent tax specialist or attorney for professional advice on your specific situation.
Revised 16 Oct 2612
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Estates - Historical Date of Death Valuation Worksheet
Account Number: G2O4]2GO5 Date: Jul 2O.2U15
_
Use this page to combine the totals from ndhidual total value and dividends/interest due for stocks, OOo, bonds and
mutual funds held in the deceased person's account.Then use those totals to complete section B and C to determine the overall total account value.
A.Total Cash Held:
1. Cash '
2. Money Market
3. Insured Bank
B.Total Value ofAsbeteHeld:
i
4. Stocks }
5. Bonds/CDs, 334,866]]0
�
6. Mutual Funds 73,884.89
7. Miscellaneous Securities 1181888
C.Total Dividends/Interest Due:
8. Stocks dividends
9. Bonds/CDs interest
10. Mutual Funds dividends
11. Miscellaneous distributions OOO
D.Total Account Value: 42808624
°The above totals also display onpage 1ofthis worksheet.
Edward Jones, its employees and financial advisors do not provide tax or legal advice. This information is believed to be reliable, but its accuracy and
completeness are not guaranteed. Consult with a competent tax specialist or attorney for professional advice on your specific situation.
Revised 10Oct 2u1u