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Home My WebLink About01-0757 '\, /b~~O -/0 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF DETERMINATION AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN * REY-485 EX AFP U2-DDl RecorOeci Re9iste, DATE ESTATE OF DATE OF DEATH FILE NUMBER P 3 :21 COUNTY ACN 01-14-2002 WERT 05-01-2001 21 01-0757 CUMBERLAND 201 ALVENA K EDWARD P SEEBER ESQ JAMES ETAL 134 SIPE AVE HUMMELSTOWN .02 JAN 11 Allount Rellitted Clerk~ PA 17 ~tnbelia! "_ f~;., PA MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE1 PA 17013 NOTE: To insure proper credit to your accountl subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR FILES ~ REY=;;8i--E)tAFP--fi2:.-ooi-----.-.-Nofic'E-oF--JjETE-RMiiiA'Tiifti-AifJj-AS-SESSMENY----------------------- ----- OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN .. ESTATE OF WERT ALVENA K FILE NO.21 01-0757 ACN 201 DATE 01-14-2002 ESTATE TAX DETERMINATION 1. Credit For State Death Taxes as Verified .00 2. Pennsylvania Inheritance Tax Assessed (Excluding Discount and/or Interest) .00 3. Inheritance Tax Assessed by Other States or Territories of the United States (Excluding Discount and/or Interest) .00 4. Total Inheritance Tax Assessed .00 5. Pennsylvania Estate Tax Due .00 TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) . TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 -IF PAID AFTER THIS DATEI SEE REVERSE SIDE (IF TOTAL DUE IS LESS THAN $1/ NO PAYMENT IS REQUIRED FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDI"'. (CR) 1 YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) It -~CJ-/O REV -1500 EX .. (6-00) CAPB HpRL EplO CRAC KOTK ES C P o 0 R N R 0 E E S N T C o M P T U A T X A T I o N REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER c,.") I OFFICIAL USE ONLY CJI "7$7 NUMBER o E C E o E N T COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Wert A1vena K. DATE OF DEATH (MM-DD-YEAR) COUNTY CODE YEAR SOCIAL SECURITY NUMBER 180-09-7176 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE DATE OF BIRTH (MM-DD-YEAR) REGISTER OF WILLS SOCIAL SECURITY NUMBER Wert, Elwood W. X 1. Original Return 2. Supplemental Return 4. limited Estate 4a. Future Interest Compromise (date of death after 12-12-82) X 6. Decedent Died Testate X 7. Decedent Maintained a Living Trust (Attach copy of Will) (Attach copy of Trust) D 9. Litigation Proceeds Received D 10. Spousal Poverty Credit D 11. Election to tax under Sec. 9113(A) (date of death between 12-31-91 and 1-1-95) (Attach Sch 0) 'ii'll~l~li~~il1.~~i:liil~ii,~ell~It1~eep~il~ti'!~~Bie$I~"~eN(I11.~-illffil~eNlTJit.;i.iJ.~I,lil~l.j~fj,II~Q'~QEIIB~iliQ~II;w"l} NAME COMPLETE MAILING ADDRESS 05/01/2001 12/17/1910 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) o Edward P. Seeber Es . FIRM NAME (If Applicable) James, Smith, Durkin & Connell TELEPHONE NUMBER 134 Sipe Avenue Hurnme1stown, PA 17036 3. Remainder Return ~rci~ reI flr_ai~_82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes OFFICIAL USE ONLY (8) 447,434.15 (11) 17,057.97 (12) 430,376.18 (13) 430,376.18 (14) 0.00 (15) (16) (17) (18) (19) 0.00 0.00 0.00 0.00 0.00 R E C A P I T U L A T I o N 1 533-3280 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (1) (2) (3) None None None (4) (5) None None (6) None 447,434.15 8,146.00 8,911.97 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)( 1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. 0.00 x X X X .0 0 .0 45 .12 .15 Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 129 East Green Street CITY I STATE I ZIP Shiremanstown PA 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1 ) 0.00 0.00 Total Credits ( A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty TotallnterestlPenalty ( 0 + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 0.00 0.00 0.00 0.00 . .... PLEASE.'ANS~~~'~~~;;~Z~'~:~~~:I:!8~~~i~i~~i:::~L~L~tl'~'~.;~~ 1. :~l:~:W: 1~+~:~:l~~:~id~~:liY~:::~~~'bk~ miiiiiii: Did decedent make a transfer and: 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 December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? . . . . . . . . . . . . . . . .. ...... ........ ...... D 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . D IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Yes No ~~ []] []] []] Under penalties of perjury, I declare that I have examined this return, inciuding accompanying scheduies 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 Elwood VI. Wert 129 East Green Street ----------------------------------------------------- Shiremanstown, PA 17011 James, Smith, Durkin & Connelly LLP _ _ _~~~_ _~!p~_ _~~~P-':~_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Hurnrnelstown, PA DATE ?- p~ tJ I For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [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% [72 P .S. 9116 (a) (1.1) Oil]. 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 twenty-one 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% [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%, 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 decedent's siblings is 12% [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. Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) # REV-1510 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERIT ANCE TAX. RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY .AI,.Tena K.. ~Alert c:: C::./" 1 Q (L (1 a _ 7' 7 C. ..........7r ............v v-' I..L..I V FILE NUMBER (1<; NI' /'l()()1 v....Jj VoL/ LVU..J,.. This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. ITEM NUMBER 1 DESCRIPTION OF PROPERTY RELA W5~MFII~ t~b~~~8~MrJJ~~~1fA1-~EJF t~~ffSFER. ATT ACH A COpy OF THE DEED FOR REAL ESTATE. 1,100 units Black Rock Income Trust, Inc. - Diversified closed-end bond fund account #U38l68, titled in the name of the Alvena K. Wert Living Trust dated 10/14/1997, valued per online services. 2 Commerce Bank, N.A. - Checking account #082002130, titled in the name of the Alvena K. Wert Living Trust dated 10/14/1997, valued per CIF Associate letter. DATE OF DEATH VALUE OF ASSET 7,711.00 % OF DECD'S INTEREST 100.00% 7,711.00 3 Decedent's residence - House and lot situate at 129 East Green Street, Shiremanstown, Cumberland County, PA, titled in the names of Elwood W. Wert and Alvena K. Wert, Trustees under the Elwood W. Wert Living Trust dated 10/14/1997, and Alvena K. Wert and Elwood W. Wert, Trustees under the Alvena K. Wert Living Trust dated 10/14/1997, as tenants in common; Deed reference Cumberland County Book 166, page 206; tax parcel ID #37-23-0555-223; valued per assessed value ($6,660) times common level ratio factor for Cumberland County (15.63); one-half (1/2) of asset's value is reported. EXCLUSION (IF APPLICABLE) 0.00 TAXABLE VALUE 2,247.51 100.00% 0.00 2,247.51 4 Janney Montgomery Scott LLC - Brokerage account #HB07-8651-8874 titled in the name of the Alvena W. 52,047.90 100.00% 0.00 52,047.90 Total of Continuation Schedule(s) 135,565.30 100.00% 0.00 135,565.30 249,862.44 TOTAL (Also enter on line 7, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. 447,434.15 Form REV-1510 EX (Rev. 1-97) Estate of: A1vena K. Wert Soc Sec #: 180-09-7176 Date of Death: 05/01/2001 Continuation of Schedule G (Inter-Vivos Transfers & Misc. Non-Probate Property) Item Description of Property # Date of Death % Decd Value of Asset Intrst Wert Living Trust dated 10/14/1997, valued per sales assistant letter. 5 Legg Mason Wood Walker, Inc. - Brokerage account #363-01719, titled in the name of the A1vena K. Wert Living Trust dated 10/14/1997, total securities valued per associate financial advisor letter. 145,241.25 100.00% 6 Legg Mason Wood Walker, Inc. - Accrued interest earned on brokerage account #363-01719, referenced above. 1,986.31 100.00% 7 Legg Mason Wood Walker, Inc. - Cash in brokerage account #363-01719, referenced above. 77 . 94 100.00% 8 Prudential Securities Incorporated - Brokerage account #044-291665-73, titled in the name of the A1vena K. Wert Living Trust dated 10/14/1997, valued per registered assistant letter. 101,498.09 100.00% 9 Prudential Securities Incorporated - Accrued interest earned on brokerage account #044-291665-73, referenced above. 1,058.85 100.00% 0.00 0.00 0.00 0.00 0.00 Taxable Value 145,241.25 1,986.31 77 .94 101,498.09 1,058.85 249,862.44 REV-1511 EX +(1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Alvena K. Wert FILE NUMBER SSfJ 180-09-7176 05/01/2001 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT 1 FUNERAL EXPENSES: Elizabethvi1le Monument - Monument 450.00 2 Hoover Funeral Homes, Inc. - Funeral goods and services 4,581. 00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. 3. Attorney's Fees James, Smith, Durkin & Connelly Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address 3,000.00 City Relationship of Claimant to Decedent State Zip 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Other Administrative Costs Cumberland County Register of Wills - Filing fee for inheritance tax return 15.00 2 James, Smith, Durkin & Connelly, LLP - Reserved for closing costs 100.00 TOTAL (Also enter on line 9, Recapitulation) $ 8,146.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97) REV-1512 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERIT ANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Alvena K. Wert SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS FILE NUMBER SS1f 180-09-7176 05/01/2001 Include unreimbursed medical expenses. ITEM NUMBER 1 DESCRIPTION Carol Stream Pharmerica - Prescription bill not covered by AMOUNT 102.90 insurance 2 Lower Allen Ambulance Service - Medical bill not covered by insurance 450.00 3 Sara A. Todd Memorial Home - Final nursing home bill 8,198.00 4 Weis Pharmacy - Prescription bill not covered by insurance 56.02 5 West Shore Ambulance Service - Medical bill not covered by insurance 105.05 TOTAL (Also enter on line 10, Recapitulation) $ 8,911.97 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-97) - REV-1513 EX. (9-00) COMMONWEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIAR IES ESTATE OF Alvena K. Wert FILE NUMBER SS11 180-09-7176 05/01/2001 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE D ISTR IBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1 A1vena K. Wert Family Trust U/A dated 10/14/1997 - Elwood W. 430,376.18 Wert, Trustee; ErN 25-6772353; spouse is income beneficiary during his lifetime. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) Copyright (c) 2000 form software only The Lackner Group, Inc. 430,376.18 Form REV-1513 EX (Rev. 9-00)