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HomeMy WebLinkAbout09-29-15 . pennsylvania 1505618403 DEPARTMENT OF REVEN `EX(03-14) REV-1500 OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 15 0350 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 01 02 2015 11 18 1938 Decedent's Last Name Suffix Decedent's First Name MI MARTHINSEN MARGARET K (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 ❑X 2. Supplemental Return El 3. Remainder Return(date of death prior to 12-13-82) 4, Agricultural Exemption(date of 5. Future Interest Compromise(date of 6. 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 0 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) EJ13. Business Assets 14. Spouse is Sole Beneficiary (No trust involved) CORRESPONDENT•THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number HUBERT X GILROY 717 243 3341 First Line of Address 10 EAST HIGH STREET Second Line of Address City or Post Office State ZIP Code CARLISLE PA 17013 Correspondent's email address: hgilroyC�martsonlaw.com cz, REGISTER,OFTNIL�S USE"LY - :a REGISTER OF WILLS USE ONLY rrJ t 1 f Tl DATE FILED MMDDYYYY Co "> > -r1 Co I.._ rTl ---i t" DATE'FILED STAMR::-) C7 Side 1 1505618403 IIII84IILIIVIIIIIIIIIII 1505618403 j 1505618411 REV-1500 EX Decedent's Social Security Number Decedent's Name: Marthinsen, Margaret Kate 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. 154 -15 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested............ 7. 19,736 - 41 8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 19,890 -56 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 30 - 011 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 30 -011 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 19,860 - 56 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. 19,860 - 56 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. 0 .00 16. Amount of Line 14 taxable at lineal rate X .045 131281 -75 16. 597 -68 17. Amount of Line 14 taxable at sibling rate X.12 0 .110 17. 0 . 00 18. Amount of Line 14 taxable at collateral rate X.15 6,578 - 81 18. 986 -82 19. TAX DUE................................................................................................................ 19. 1,584 -50 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. SIGNA URE OF ON RESP SIB E FOR FILING RETURN Guy H. Marthinsen Y__2© ADDRESS 604 es outher Street, Carlisle, PA 17013 SIG" P ARE R THAN REPRESENTATIVE Hubert X. Gilroy DATE aD ADDRESS 10 East High Street, Carlisle, PA I IIIIiI ILII VIII VIII VIII VIII VIII VIII VIII IIII IIII IIII Side 2 1505618411 1505618411 REV-1500 EX Page 3 File Number 21-15-0350 Decedent's Complete Address: DECEDENT'S NAME Marthinsen, Margaret Kate STREET ADDRESS 210 Todd Circle CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due(Page 2, Line 19) (1) 1,584.50 2. Credits/Payments A. Prior Payments B. Discount Total Credits(A +B) (2) 3. Interest (3) 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) 1,584.50 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;............................................................................... ❑ ❑ b. retain the right to designate who shall use the property transferred or its income;.................................. ❑ ❑ c. retain a reversionary interest;or............................................................................................................... ❑ ❑ d. receive the promise for life of either payments,benefits or care?............................................................ ❑ ❑ 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?....... ❑ ❑ 4. Did decedent own an individual retirement account,annuity,or other non-probate property which ❑ ❑ contains a beneficiary designation?.................................................................................................................. 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 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 [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 decedent's lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)]. • 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. Rev-1508 EX+(08-12) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Marthinsen, Margaret Kate 21-15-0350 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 NUMBER DESCRIPTION OF DEATH 1 USAA-Refund 106.39 2 USAA-Refund 47.76 TOTAL(Also enter on Line 5, Recapitulation) 154.15 (If more space is needed,additional pages of the same size) Copyright(c)2012 form software only The Lackner Group,Inc. Form PA-1500 Schedule E(Rev.08-12) Rev-1510 EX+(08-09) SCHEDULE G pennsylvania INTER-VIVOS TRANSFERS AND DEPARTMENT OF REVENUE /► INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Marthinsen, Margaret Kate 21-15-0350 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. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % DECD'S EXCLUSION TAXABLE NUMBER THINCLUDE DATE OF RANSFERSATTACH A CIOPYEOF THE DEED FSHIP OR REAL ESTATE. VALUE OF ASSET DECEDENT AND INTEREST (IF APPLICABLE) VALUE 1 Allianz-Annuity Contract#70712905. Beneficiaries: 19,736.41 100.000% 19,736.41 Guy Marthinsen (son)1/3,Jennifer Weller(niece) 1/3, and Hugh Marthinsen(son) 1/3,see attached. TOTAL(Also enter on Line 7, Recapitulation) 19,736.41 (If more space is needed,additional pages of the same size) Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule G(Rev.08-09) REV-1511 EX+(08-13) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RESIDENT DECED NTTURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Marthinsen, Margaret Kate 21-15-0350 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State ZiD Year(s)Commission Paid 2. Attorney's Fees 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) Claimant Street Address City State ZiD Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 30.00 See continuation schedule(s)attached TOTAL(Also enter on line 9, Recapitulation) 30.00 Copyright(c)2013 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.08-13) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Marthinsen, Margaret Kate 21-15-0350 ITEM NUMBER DESCRIPTION AMOUNT Other Administrative Costs 1 Register of Wills-Filing fee-Original PA Inheritance tax return 15.00 2 Register of Wills-Filing fee-Supplemental PA Inheritance tax return 15.00 H-B7 30.00 Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98) REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Marthinsen, Margaret Kate 21-15-0350 NAME AND ADDRESS OF RELATIONSHIP TOSHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT Do Not List Trustee(s) (Words) ($$$) ITAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] Guy H.Marthinsen Son Schedule G-1 6,640.88 604 West Louther Street and 50%of Carlisle, PA 17013 residue Hugh H. Marthinsen Son Schedule G-1 6,640.88 3103 West Euclid Ave and 50%of Tampa, FL 33629 residue Jennifer Weller Niece Schedule G-1 6,578.81 8914 Yorkshire Lane Manassas,VA 20111 Total 19,860.57 Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate. NON-TAXABLE DISTRIBUTIONS: II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule J(Rev.01-10) Allianz Life Insurance Company of North America Afflanz �l PO Box 59060 Minneapolis, MN 55459-0060 800.950.1962 September 9, 2015 ESTATE OF KATE H MARTHINSEN C/O DENA BRURNBAUGH 10 EAST HIGH STREET CARLISLE PA 17013 Re: Kate H Marthinsen, deceased Dear Executor: This letter is in reference to your re uest for information on the following contract number: Annuity Contract Number 70712905 Primary Beneficiary Name GUY MARTHINSEN JENNIFER WELLER HUGH MARTHINSEN Cash Surrender Value $19,736.41 as of 01/02/2015 For more information or assistance: please contact me at 800.950.1962, Monday through Friday, 8 a.m. to 5 p.m. Central time or the agent of record. Sincerely, Annuity Claims Allianz Life Insurance Company of North America c: Charles Randolph Lee LCL-1626 r.4.17.2013