HomeMy WebLinkAbout09-28-15 J 15056ZQ1D5
REV-1500 EX��.,,,�",
OFFICIAL WE OlILY
PA Oeparbnent d Rev�nua ��a�,�,,;�,o,� Cou�/ s Y�x� File Number� .
Bu�M Individusl Tares INHERITANCE TAX RETURN � 6 U �
PO BdX 290601
�+s�,ro.w►»+ze�aso� RESIDENT DECEOENT �
ENTER DECEDENT INFORMATION BELOW
5ocial Securily Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
� 1023'c004 12201913
Deeedent's last Name s�R� DeoedenCs FErst Name nni
BASEHORE FRANK E
(If Applicable)Errter Survtving Spouss's Intormatlon Below
Spouse's t.ast Name Suffuc Spouse's Fint Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL!N APPROPRIATE BOXES BELOW
Q 1. Onpmsl Retum Q 2. Supplame�W Retum � �. Pria w�9-82) �Da1e of OeaM
� 4, lirroted EstaOo Q 4a. futws Inurost Camp►omise(dste d Q 5. federal Estats Tax Rewm Raquhed
dealh aPoer 12-t2-92)
[= 8. DeCedm�t Oied Tesfet� Q T. Osoetlent NleiMiinstl a Livinp Truat _ 8. Total Number of Sals Deposd Boxes
(Attach Copy of W61) U►ttad+Capy W Ttust.)
(� 9. Libgsoon Prooeeds RecsiveA Q 10. Spousal Poverty Crodi1(Date W Oe+u� Q 11. Eloction b Tax uad�r Sec.9n9(A)
9etwea�12-51-9/snd t-7-85) (Attech Schedufe 0)
CORAEBrONDENT-THIS SECTION MUST BE COMPLEiEC.ALL CORRE8PON6ENCE AND CONqCENnAI TAX UIFORMATION SHOULD 8E QUtECTED TO:
Name Daytime Talephone Number
ROBERT G. FREY 7172435838
REGISTER OF 1ML18 USE ONLY
� �.,:>
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C"� `cs�-i � :1 �,„.i
First Line of Address �' c? :J 3 ''; r',
[-.�j .. ,CJ
5 S. HANOVER ST. " , � • -j
Sacond Lirte of Addreu `l. � rJ ;
G� _:+
,
'�E FIIED'��
City or Post Office State 21P Code -- -
P A 17D13 r�v �-,�i
CARLISLE -
c� �-> c'
conssponde�t's e-ma�i address: R F R E Y aF REY T I l E Y.C 0 M �
Und�r penaloss of O�N�Y.I deWro Uwt t h�w e�remined tlds rMurn.indudin0��mP�Y�O���nd afatanwMa.and to tl+�bost ot my knoiM�dps and belief.
d is trus oon�oct and eomDNts.Dedualbn af or�ue►atl�er tlwn tlie oaraonal roo�saee�liw b pa�ed on aN InMrmaion ol whid�orow�Ms aew knorvisdoe.
$ICiN/�IRE�F P�SON ESPCN LE FOR FIUNCa RETURN �9A� J/�
�C.;��/' / /
�ADORESS
238 DGE IL ROAD PT. B MECHANI�SBURG PA 17050
SIGNl1 E F PREP E N REP ESEN7ATIVE �� �
ADDRE
5 SOUTH HANOVER ST. R SlE PA 17013
PLEASE USE�IGtNAL FORM ONLY
Sid@ 1
� 1505610105 15056b0105 ,J
�
J lsosb�o2os
REW1500 EX(FI)
Decede�Ys Social Securiry Number
w�+•.ra„w: FRANK E BASEHORE
RECAPITULATION
�. Reai es�a�e�scneduien�.......................................... �. 113090.00
2. Stocks and 8onds(S�edub B)..................................... 2. U.0 D
3. Cbaely Held Cotporafion,Partnership or Sole-Proprietorahip(Schedule C)... 3. �.0�
4. Mortgages and Notes Receivable(Schedub O)......................... 4. 0.00
5. Cash.Baok Deposits and MisceUa�eous Penonal Property(Scheduk E)..... 5. 6 2 5 6.14
4. Jointly Owned Properly{Schedule F) �Separate&INng Requested....... 6. 0.00
7. Inter-Vivos Transfan�Misoeilaneous Non-Probate Properly
(Schedub G) 0 Separate Bi�ing Requested....... 7, 0.0 0
8. Total Grosa Assets(totat Lines 1 thro�mh 71........................... 8. 119 3 4 6.b 4
9. Funeral Expenses ar►d Administntive Casts(Schedufe H)................. 9. S O 9 4.�4
10. Oebts of Deaedent,Mortgage LiabNdies and Liens(SChedule 1).............�a. 32210. 4$
11. Total Deductlons(total Lines 9 and 10).............................. 11. 3 7 3 Q 4.5 2
�2. Net vaiue ot estaca�une e mi�us une���............................t z. 820 41.b 2
t 3. Charitabb and Govammental Bequests/Sec 8113 Trusts for which
an elecGon to tax has not been made{Schedu�J)...................... 13. �•00
�4 Net Value Sublect to Tax(Line 12 minus Line 13)...................... 14. 8 2 O 41.6 2
�TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of line 14 texable at
ths spousal tax rate,or
transfers under Sec.9N6
(a)(1.2)X.0 0 15. �•00
16. ArrwuM of Line 14 taxable
at�i�ea�ratex.o 45 82041.62 ts. 369b.87
17. Amount ot Line 14
taxable at sibling rate X.12 �7. 0.00
18. Arnount ot Line 14 taxabb
at collateral rate X •15 18. �•��
19. TAXOUE........................................................ i9. 3Ia91.87
20. FlI.L IN THE BOX IF YOU ARE REGUESTING A REFUND OF AN OVERPAYMENT O
Side 2
� 1505610205 15�5610205 �„�
REV�t500 EX(FI) Pagc 3 File Number 207-09-0811
Decedent's Complete Address: 21-14-0063
DECEDENT'S NAME
FRANK E BASEHORE
STREETADDRESS
700 WALNUT B0T70M ROAD
CITY STATE ZIP
CARLISIE PA 17013
Tax Payments and Credits:
t Tax Dua(Page 2,Line t 9) (t) 3691.67
2 Credlts/Payments
A Pnor Payments
B Discount
Total Credits(A+g� �Z� 0 00
3 Interest
(3) 1711 i 5
4 It Llne 2�s greater than Line t �Line 3,enter the diHerence.Th�s is the OVERPAYMENT.
FIII in box on Page 2,Line 20 to request a refund. (4) 0 00
5 If line t +Line 3�s greater than Line 2,enter ihe diHerence.This is the TAX DUE. (5) 5403.62
Make check payable to: REGISTER OF WILLS,AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS
i �id decedent make a transfer and: Yes No
a. retain the use or income oi the property transierred......... ... ..................._........ ........................................_._ ❑ �
b retain the right to designate who shali use the property transFerred or its income . __._ _ .... _ _ __ ❑ �
cretam a reversionary interest.......... ..................... . ..... .._ ........_ ...._.. _...... ._............................._..... .. ❑ �
d receive the promise for life of either payments,benefits or care?......................... . .. ....... .........__..__.. _ _.. ❑ �
2. H death occur�ed after Dec. 12, 1982,did decedent transfer property within one year oi dealh
without receiving adequate consideration?............................................................._ ..............................._.......... ❑ �
3 Oid decedent own an"in trust for'or payable-upon-death bank account or security at h�s or her death�... __. _ � Q
4. Did decedent own an individual retirement account,annwty or other non-probate property,which
containsabeneficiarydesignation?... _ __.. . ,_ ... . __...... _ ... .__... ..... ... ....... __........._...... _...... __ ❑ �
If TNE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART Of THE RE7URN.
For dates ot death on or after July 1, 1994,and betore Jan. 1, 1995,the tax rate imposed on the net value of transters to or for the use oi the surviving
spouse is 3 percent(72 P.S §9tt6(a)(t.tt(i)�
For dates o(death on or atter Jan. 1, 1995,the tax rate imposed on the net value o(transiers to or for the use of the sunriving spouse is 0 percenl
(i2 P S.§9116(a)(t.t}(ii)J.The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure ot
assets and filmg a tax return are stitl applicable even if the survivinq spouse is the only beneficiary.
Foi dates of death on or after July t.2000
� The tax rate fmposed on the net value of transfers trom a deceased ch�ld Zt years ot age or you�ger 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)J
• The tax rale imposed on the net vaiue of transfers to or for Ihe use of the tle;.edeM's hneal benefic�ar�es�s A.5 percent,except as noted m[72 P S §9116f a}(t)j.
• The tax rate imposed on the net value of trans(ers to or for the use of the decedent's siblings is 12 percent(72 P.S.§9116(a)(t.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-i502 EX�(t2-t2)
pennsylvania SCHEDULE A
�P������ REAL ESTATE
MIHERRANCE T/U(RETURN
RESIOENT DECEOENT
�STATE OF: FILE NUMBER:
Frank E Basehore 21.14-0063
All n�l p�opxty mra�d solNy w n a LMaat M conwnon mwt M rvpoR�d at hk msrkst vatao. Fair nwrlcet vaWs is a�ned as tla prke at whicA p�openy
wouW Ds exepangad baew�an�wiNrq buyer and a wdfinp se9a.�hor bainp oompWeO o�buy or seY.bolh havinp�aaonabla krwwbdps of 1M ralwant fads.
Rwl Uat Is own�d wph t ot turvlvoesh mwt bs disdoaW on SchoduM F.
Attach a oopy of the setqement sheet if the property haa bee�sold.
�� Inctude a oi the deed VAI.UE AT DATE
NUMBER � �9 decedenCs interest if owned ss tenant in�ommon. OF OEATH
DESCRIPTION
t. 365 NoRh locust Poirrt Road.Assessed Vaiue 113.090.00
TOTAL(Also enter on line 1,Recapitulation.) S 113 090.00
if more spaCe is needed.use additional sheets of paper of the same size.
R�,.'�°�'`°�'2' SCHEDULE E
pennsylvania CASH, BANK DEPOSITS� � MISC.
MIHERITMICETAXRE7URM PERSONAL PROPERTY
RESWENT�CEDENT
ESTATE OF: FILE NUMBER:
Frank E easehore 21-14-0063
Include the prooeeds of dtigation and the date the prooeeda we�e received by the estate. ,
Alf ro olntly owr�d with M of survivo►ship must be disclased on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF OEATH
1. MB�T Bank axount 1149954 6.256.14
TOTAL(Also enter on Ime 5.Recapitulation) S 6,256.�4
!f mOre spaoe b needed.use add'dional sheets M paper of the sama size.
REV-1311 EX+(06-13)
pennsylvania SCHEDULE H
°E�'""'�NTOF`�'�"`� FUNERAL EXPENSES AND
���E�o�`�"" ADMINISTRATIVE COSTS
E8TA7E OF FILE NUMBER
Frank E Basehore 21.14-0063
DeeedenYs det�s must be repated on Schedule I.
ITEM
NUMBER DESCRIPTI�N AMOUNT
A. FUNERAL EXPENSES:
1.
B. ADMINISTRATNE COSTS:
1. Pe►soml RepreseMaNve Commiseions:
Nsme(s)of Penond Represonlatiw(s)
Street AdAress
City State ZIP
Year(s)Commissbn Poid:
2. Aaorntr Fees: 4,500.00
3. Famdy Ezemption:(q decaoenC�adeross is�IAs ssme�s daGnaM's,aqaeh explaeaGon.)
ClaNnent
StraetAder�s
Ciq Spte 21P
Relationship of Clai�+t to Qeosdani
e. Proe.te Pees� 328.50
5. Accou�ant Fses:
s. Tax Ret�un Propatar feas:
7. Advertising in Cumberland Law Joumal arM The SeMinel 265.54
TOTAL Also�ter on Line 9,Reca itulation S 5,094.04
I(rtwre spaae is needed,use addiNonal sheets of pepe�of the same size.
REV.1512 EX•I/I421
pennsylvania SCHEDULE I
��M��N� DEBTS OF DECEDENT�
INNERITANCH TAX RETURN
RESIDENT DECEDENT MORTGAGE LIABILITIES 8 LIENS
�STATE OF FILE NUMBER
Frank E Basehore 21•14-0063
Rqart debts hiwrred b�r tla d�cadmt prior to de�tk tb�t remabMd anpttd at�dNe�deuh�Inciudlag wa�6Nwrs�d medkal�xp�ns�s.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF OEATN
1.
Medical assistance estate rec�overy claim from Department of Public Welfare 32,210.48
TOTAI(Also eMer on L'me 10.RecapitulaGon) S 32,210.48
M more apseo is ntidsd.Y�rt sddYionel shaets d M�t same size.
REV•151�EX+(01•10)
pennsylvania SCHEDULE J
DEPARTMENT Oi NEVENUE
INMERRANCE TA1(RETURN BENEFICIARIES
qESIDENTOECEDENT
ESTATE OF: FfLE NUMBER:
Fr�nk E Basehore 21_14.0063
RELAT�ONSFNPTODECEDENT AMOUNTORSMARE
NUMpER NAME AND AO�RESS OF PERSON(S)RECEMNG PROPERTY Oo Not Ust Tnaq�(s) QF BSTATE
� TW(AB�E OISTRIBUTIONS(lewiude ou�ht apouaal distributlons and vanthn under
See.9/18(a)(1.2).]
Paul J.Basehore
�� 238 Ridgge Hill Road,Apt.B.Mechanicsburg, PA 17050 Son 1/3
Gary F.Basehore
z' 230 Getmany Road,East Be�lin.PA 17316 Son 1/3
3. Janice B.ArmsVong
379 North Locust Point Road. MeChanicsburg,PA 1705� Daughter 1l3
ENTER OOLLAR AMOUNTS FOR QISTRIBUTIONS SMOWN ABOVE QN LINES 15 TNROUGM 1B Of REV-1500 COVER SMEET.AS MPROPRIATE.
(I NON-TAXABIE OISTR18UT10NS
A SPOUSAL OiSTRIBU710NS UNOER SECTION 9119 FOR NMICM AN EIECTION TO 7AX IS NOT TAICEN:
1.
9- CHARITABLE ANO GOVERNMENTAI DISTRi8UT10NS:
1.
TOTAL OF PART p—ENTER TOTAL NON-TAXABLE OlSTR18UT10NS ON IINE 13 OF REV-130Q COVER SF�ET. S 0.00
n ewre apke is�aaded.uae adai6awu sMels a papa�a un ssme sae.
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499 Mitchell Road,Millsboro,DE 19966 Adjustment Services
Phone 888-502-4349
F� (302)934-2955
January 28,2014
Frey & Tiley
Attorneys at Law
5 South Hanover Street
Carlisle,PA 17013
Re: Estate of Frank E. Basehore
Social Securitv: 207-09-0811
Date of Death: October 23, 2013
Dear Sir or Madam:
Per your inquiry on January 23,2014,please be advised that at the time of death,the above-named decedent had
on deposit with this bank the following:
1. Type ofAccount CheckingAccount
Account Number 1149954
Ownership(Names o,� Frank E.Basehore
Paul J.Basehore
Opening Date 03/04/1993
Balance on Date of Death $ 6,256.14
Accrued Interest $ .00
__ _.. _........ _..... _ .........
Total $6,256.14(Balance as of IO/23/2007
For any additional information on the above accounts,including ownership and any changes,closures and/or reimbursement of funds,
piease call the Carlisle Park at 717-795-1710. Sorry that dates after 7 yrs has been purged,so I gave you the balance for 10/20/2007.
We were unable to locate any safe deposit box for the above-mentioned decedent.
7'his letter dces not include any acwunts in which the deceased may have been listed as Power of Attorney,Custodian of Uniform Transfers,
Representa6ve Payee,or Trustee under a Written Agreement
Sincerely,
Valarie Mercer
Adjustment Services
"'� pennsylvania
DEPARTMENT OF HUMAN SERVICES
August 21, 2015
FREY &TILEY
ROBERT G FREY ESQUIRE
5 S HANOVER ST
CARLISLE PA 17013
Re: Frank Basehore
CIS #: 500166982
� Incident Date: 10/23/2004
Dear Attorney Frey:
Pursuant to your request, please be advised that the Department's statement of
claim dated 01/27/14 in the amount of $32,210.48 is current.
Thank you for your cooperation in this matter. If you have any questions, please
contact me.
Sincerely,
��r.�`�r,�-r ✓�r-�--
Patricia Nace
TPL Program Investigator
717-772-6617
717-772-6553 FAX
Bureau of Program Integrity � Division of Third Party Liability � Recovery Section
PO Box 8486 � Harrisburg, Pennsylvania 17105-8486
Frank Basehore Estate
Interest Calculation
Tax Due $ 3,691.87
Interest through 5/4/15 $ 1,707.37
Total due, 5/4/15 $ 5,399.24
Less, Payment made, 5/4/15 $ (5,000.00)
Balance due $ 399.24
interest from 5/4/15 to 9/15/15 $ 4.38
Tota I d ue, 9/15/15 $ 403.62
Total Tax paid $ 3,691.87
Total Interest paid $ 1,711.75
Practitioner Portal 8/19/15,Z:59 PM
Penaity and Interest Caiculations
caLc��.��a��v Q�,�rEs-
7/23/�5 TO 5f 4/2015
TAX DEFICIENCY $ 3,691.8�
CALCULATEC� INTEREST $ 1,703.37
E�ALANCE AS C)F 5/4J2015 � 5,399.24
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Practitioner Portal 9/14/15, 5:24 PM
Penalty and Inter�st Calculations
��,�.���.�-�z�n� ��►�-�s-
5/4j15 TCJ �/15/2015
TA�C aE�ICIEN�Y $ 3�9.24
C�L�ULATE6� INTEREST $ 4.3�
��1L�I�CE AS QF 9/15;2�15 $ 4�3.��
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