HomeMy WebLinkAbout06-09-05
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-Q601
DECEDENT'S NAME {LAST, FIRST, AND MIDDLE INITIAL) use a b1ant. block to sepa-. words
OFFICIAL USE QNL Y
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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SOCIAL SECURITY NUMBER
FLE NUMBER
2 1
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4 5
COUNTY COllE YEAR
NUNllER
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1 8 7 -1 4 -0 3 2 0
DATE OF DEATH
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5
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DATE OF BIRTH
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7 /1 9 1 4
{IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAl SECURITY NUMBER
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
(XI 1. Original Retum 02.SupplementalRetum 0 3. Remainder Retum (daleofdeathpfiorlD12-13-82)
o 4. limited Estate 0 4a. Future Interest Compromise {daE ofdealll after 12-12-82) 0 5. Federal Estate Tax Return Required
(XI 6. Decedent Died Testate (AlIach copy of Will) 0 7. Decedent Maintained a living Trust (AIUd1 copyofTrust) _ 8. Total Number of Safe Deposit Boxes
o 9. Litigation Proceeds Received 0 10_ Spousal Poverty Credo (do. of _ """" 12-31-91 ,"<1-'-951 0 1,. Election to tax under Sec. 9113(AIi"'" 50' 01
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
John M_ Eakin Market Square Building
FIRM NAME (If Applicable)
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TELEPHONE NUMBER
717 766-3172
,. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
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4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6_ Jointly Owned Property (Schedule F)
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Deoeden~ Mortgage L..bilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
Mechanicsburg, PA 17055
(1)
(2)
(3)
(4)
(5)
(6)
(7)
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OfF-!CIAL.USE 'o~
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52,516.82
11,407.83
(9)
(10)
(8)
8 ,7 4 3 , 0 0
, 1 3 8 . 4 5
(11)
(12)
(13)
(14)
(15)
8 ,8 8 1 4 5
5 5 ,0 4 3 2 0
5 5 ,0 4 3 ,2 0
0 .0 0
6 3 ,9 2 4 ,6 5
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. NelValue Subject!o Tax (Line 12 minus Line 13)
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15. Amount of line 14 taxable
at the spousal tax rate ,
See instructions on reverse side for applicable percentaQe
16. Amount of line 14 taxable
at6%rate
17. Amount of line 14 taxable
at 15% rate
5
5
18. Tax Due
x
x
.06
(16)
(17)
(18)
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6 ,4
19.
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
Ullder pellalties of peijury, I declare that I have examilled this retum, illcludillg accompallying schedules and stalemellts, alld to tt\e best of my knowledge and belief, it is true,
correct and complete. Declaration of preparer other
thall the personal representative is based on all illformalion of which preparer has any knowledge.
SIGNATURE OF PERSON RESPON IB R FILING ETURN ADDRESS
tf ' ' .:1,-3Q) st>. ~d
~ESS j
DATE
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DATE
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, Decedent's ComDlete Address:
STREET ADDRESS
613 Geneva Drive AD!. 20
CITY I STATE I ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Une 18)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
8,256.48
41282
Total Credits (A + B + C) (2)
412.82
3.
InteresUPenalty it applicable
D. Interest
E. Penalty
5.
T otallnteresUPenalty ( D + E ) (3)
If line 2 is greater than line 1 + line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 1910 request a refund (4)
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. (5A)
8. Enter the total of Une 5 + 5A. This is the BALANCE DUE. (58)
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
a. retain the use or income of the properly transferred; .............................................................. 0
b. retain the right to designate who shall use the properly transferred or its income; .................0
c. retain a reversionary interest; or ..............................................................................................0
d. receive the promise for life of either payments, benefits or care? ........................................... 0
2. If death occurred on or before December 12,1982, did decedent within two years
preceding death transfer properly without receiving adequate consideration? 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 fo~' or payable upon death bank account or security
at his or her death? ....................................................................... ......................... ................ .... 0
4. Did decedent own an individual retirement account, annuity, or other non-probate property? ..... 0
4.
7,843.66
7,843.66
No
!XI
!XI
!XI
!XI
!XI
!XI
!XI
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN
72 P.S. ~9116 (a) (1.1) (i) provided for the reduction olthe tax rate imposed on the net value of transfers to or for the use of the
surviving spouse from 6% to 3% for dates of death on or after July 1, 1994 and before January 1, 1995.
72 P.S. ~9116 (a) (1.1) (ii) provided for the reduction of the rate imposed on the net value oltransfers to or for the use of the surviving
spouse from 3% to 0% for dates of death on or after January 1, 1995. The statute does not exemDt 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 JANUARY 1, 1995 - Please answer the following question by placing an Y' in the
appropriate space.
Did the decedent create a trust or similar arrangement which is soley for the surviving spou--'- ...___r.... ~-- L'_
lifetime? Yes 0 No 0 Dv t. 135. 00
If you answered yes to the above question, the tax on the trust or similar arrangement is postpone 'l)-I
spouse, at which time it will be fully taxable at the raters) applicable to the remainder beneficiary(iE ru
Schedule J, Part II, in order to remove it from the calculation olthe tax due in this estate. You may
make the election available under Section 9113. If the election is made, the trust or similar arrangE
first decedent spouse, the portion of the trust or similar arrangement which benefits the surviving s
and the remainder is taxed at the rate(s) applicable to the remainder beneficiary(ies). If you choosl
attach Sclhedule 0 to a timely-filed lax return, along with Sclhedule(s) K andlor M in order to show I
similar arrangement between the surviving spouse and the remainder beneficiary(ies).
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ACTION
PROD CODE DDA
STFD
40 OP
PAGE 1
ACCOUNT
1 THF TRANSACTION STATEMENT FORMAT 05/05/27 15.05.56
MS 50852 ACTION COMPLETE
SEARCH FROM 05/04/06 THRU 05/05/05
5004057314 SHORT NAME MCLAUGHLIN JUDITH A
ACTN POST EFFECTIVE CHECK NUMBER TRAN AMOUNT D/C BALANCE
TRACE ID DESCRIPTION
* 04/06 2.31 C 1,709.01
I-GEN10S040600006344 INTEREST PAYMENT
* OS/05 2.19 C 1,711.20
I-GEN10S0S0S00006433 INTEREST PAYMENT
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PF: 4-TOP S-BOTTOM 6-INQ 7-SB 8-SF 9-ASUM 10-TRIG 11-CUTO 12-XTFD -STSM
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Total Banldng Statcmcnt
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a For 24-hour clIstomer service information, sign-on to Account Link @
by Web on pncbank.com or call 1-888-PNC.8ANK
An'uunt 11lnuber: 51-4007.16"7 -l'(ll1til1l1~d
For tho p.rlod 02/04/2005 to 03/04/2005
ELIZABETH M ZIMMERMAN
Primary accollnt number: 51-4007-1647
Page 2 of3
Activity Detail
Deposits and Otber Additions
DatI! Amount Descrlplton
02/28 ) :'\8. 73 Dcpllsil Rt'fn l'IH't' No. !J277~1~:IJO
03/02 .lI.7:' Deposit Rdt'ICllt't' NlI. 02:1:\~1,'iJ~I,'i
03/03 1,09G.OO Oil-eel Dcposil . Sue Sce
US TIC;lSUll303 XXXXXOJ20"\
03/04 1.).1 Intcrcsl P;lpllt'lIt
lhere were" Deposits and Other Additions
totaling $1,280.80.
Cbeclls and Sub"titute Cbecl,,,
Check Dille
numt-er Amount paid
1931 80.02 02/07
1932 .80 02/09
1933 10.73 02/07
Rererence
numblOlr
E.lWlfllOI.;lji)
[0'.11212.%0
02l,I.::ti\I,!",
Che/;J.-, D~te Ref<:!rence
number Amount paid number
l~n,1 505.00 02/07 1l2lJill.]07
l~l35 58.79 OVI.~ o2i21or;Ol
I~U(j 10.01 03/'02 E09~ 1659%
.. Gap in check sequence
There were 6 checks listed totaling
$701.35.
Daily Balance Detail
Dale Balance
02/(JI 9,951.1 ()
02/07 9,3-19.35
Date
02/0~1
02_/18
Balance
~1,3.18.55
~I,2.'w.7(j
Date
02/23
O:l/02
Balance
9,.12.'~..19
9,'133.21
Oat'!!
fn/OJ
03/0-1
Balance
10,529,21
10,530.35
Choioe Plan
Performance Money Market Acoount Summary
Account number: 50-0405-7314
Elizabeth M Zimmennan
Judith A McLaughlin
Balance Summary
Beginning Deposits and Checks and other Ending
balance other additions deductions balance
1,704.85 1.85 .00 1,7013.70
Average monthly Charges
balance and fees
1,70.1.91 .00
Interest Summary
Annual Percentage Number of days Average collected Interest EarMd
YIeld Earned (APYE) In Interest period balance for APYE this period
1.37r. 2U 1,701.UI 1.85
Please see the Activity Detail section for
additional information.
As of 03/04, a total of $5.07 in interest was
earned this year,
Activity Detail
Deposits and Otber Additions
Dale Amount Description
03/0,j 1.85 Interest Parment
There was 1 Deposit or Other Addition
totaling $1.85.
Daily Balance Detail
Date Balance
02/01 1,70'1.85
Date
03/0.1
Balance
1, 70G. 70
Certifioates of Deposit
Investment
numb!!r
Descr! ptlon
Maturity date
Inlerest
rate
0.60%
2..12 %
Elizabeth M Zimmerman
Judith A McLaughlin
OrIginal or
renewal value
5,227.77
5,628.H
Curren!
value
5,257.75
5,730.33
31400225.H9
31700185079
Readr Access CD
17 MOlllh(s) FL,ed Rale
03/20/2005
11/05/2005
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
Zimmerman Elizabeth
21
05
0245
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Malpezzi Funeral Home 6,945.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (5)
Social Security Numbe~s) I EIN Number of Personal Representative(s)
Street Address
City State Zip
Yea~s) Commission Paid:
2. Attomey Fees John M. Eakin 1,400.00
3. Family Exemption: (If decedenfs address is not the same as c1aimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Letters Testamentary 143.00
5. Accountants Fees
6. Tax Return Preparer's Fees
7. Community Bank Insurance Services - Admin. Bond 240.00
8. Register of Wills - filing fee 15.00
TOTAL (Also enter on line 9, Recapitulation) $ 8743.00
(If more space IS needed, insert additional sheets of the same size)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
ESTATE OF
Zimmerman Elizabeth
FilE NUMBER
21 05
0245
Include unrelmbunsed medical expen....
ITEM
NUMBER
DESCRIPTION
AMOUNT
1.
Health South, lV
41.34
2.
PP&L - Electric
37.58
3.
Manor Care, Beauty Shop
14.00
4.
West Shore Transport - ambulance
45.53
TOTAL (Also enter on line 10, Recapitulation) $
(If more space IS needed, Insert additional sheets of the same Size)
138.45
<:'''''''''''1''.*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
Zir'" ?1 O/i O?4/i
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)
1. Judith A. McLaughlin niece residue
2350 South Ridge Court
Beavercreek, Ohio 45434
2 Scott A. McLaughlin grandnephew $5,000.00 bequest
Sierra Vista, AZ. 2817 viadloesta
3. Lisa M. Anderson grandniece $5,000.00 bequest
CMR 444 Box 648
AP AE090960648
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
f.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space is needed, inserl additional sheets of the same size)
':>S -'V'L'\-S
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G)
LAST WILL AND TESTAMENT OF ELIZABETH M. ZIMMERMAN
I, ELIZABETH M. ZIMMERMAN, of the Township of Upper
Allen, County of Cumberland and State of Pennsylvania, being
of sound and disposing mind, memory and understanding, do make,
publish and declare this my Last Will and Testament, hereby
revoking and making void any and all prior Wills by me at any
time heretofore made.
1.
I direct the payment of all my just debts and funeral
expenses as soon after my decease as the same can conveniently
be done.
2.
I give and bequeath the sum of Five Thousand Dollars
($5,000.00) to SCOTT A. McLAUGHLIN, son of Judith Ann McLaugh-
lin.
3.
.,
I give and bequeath the sum of Five Thousand D~llars
($5,000.00) to LISA M. McLAUGHLIN, daughter of Judith Ann Me:
Laughlin.
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4.
I nominate, constitue and appoint CCNB BANK, N.A., to
be the guardian of the estate of any beneficiary who is not of
age on the date of my death, and direct that said guardian in
its sole discretion, shall apply principal as well as interest
for the maintenance, education and support.of such beneficiary
when the same is in his or her best interest, without the neces-
sity of petitioning the Orphans I Court for permission to make
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such expenditures; I direct that sahd guardian shall take
possession of all insurance or annuity contracts on my life
to which said beneficiary is entitled, and any and all pensions
or death benefits from my employer or from any society or or-
ganization of which I am a member, said proceeds to be added
to the share of each beneficiary under this Will.
5.
All the rest, residue and remainder of my estate,
of whatsoever nature and wheresoever situate, I give, devise
and bequeath to my niece, JUDITH ANN McLAUGHLIN, absolutely
and unconditionally.
6.
I nominate, constitute and appoint my niecw, JUDITH
ANN McLAUGHLIN, to be the Executrix of this, my Last Will and
Tes tament.
IN WITNESS WHEREOF, I have hereunto set my hand
and seal this
If Ii day of April, A. D. 1985.
Signed, sealed, ptililished and declared by the above-
named ELIZABETH M. ZIMMERMAN, as and for her Last Will and
Testament. in the presence of us. who, at he~ request and in
her presence. and in the presence of each other, have hereunto
subscri.bed our names as witnesses.
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