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HomeMy WebLinkAbout06-13-05 REwts.j EX + {6.lllI) . COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-ll601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT I- Z w Q w o W Q DECEDENT'S NAME (LAST, FIRST, AND MiDDlE INITIAL) Smith Mabel S. DATE OF DEATH (MM-DO-Year) DATE OF BIRTH (MM-OO-Year) OFFICIAL USE ONlY FILE NUMBER 2 1 -0 5 0 1 9 2 C&iNJycoor -YEAR- - - Nlimt-- SOCIAL SECURITY NUMBER 195-32-4361 THIS RETURN MUST BE FLED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAl SECURITY NUMBER ~ "0:'" 00." WOO Ilt:9 (J8:a:I < 02/12/2005 03/22/1910 (IF APPLICABlE) SURVMNG SPOUSE'S NAME (LAST, FIRST. AND ...DDlE INITIAL) N/A 1Kl1. Original Retum D 4. Limited Estate IKl 6. DeredentDied Testate __"''''''') D 9. Litigation Proceeds Received D 2. Supplemenlal Retum o 4a. Future Interest Compromise (daleofdeath after 12-12-82) o 7. Decedent Maintained a Living Trust (Alla:hcopYofTrusl) o 10. Spousal Poverty Credit (dateofdealhbetween 12-31-91 and 1-1-95) o 3. Remainder Return (daleofdealhpriorIll12.13-82) D 5. FedOlaI Estate Tax Retum Required ~ 8. Tolal Number of Safe DeposR Boxes D 11. EIec\ion 10 lax under Sec. 9113(A) 1-"" OJ .... z W o z o 0. '" W " " o o THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS Robert R. Black Es uire Landis & Black FIRM NAME (" Aoolk:able) Landis & Black 36 South Hanover Street TELEPHONE NUMBER 717 243-3727 Carlisle PA 17013 z o i= :5 :J l- ii: c( o w 0:: z o i= ~ :J Il. :E o o >< c( I- 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation. PartnelShip or Soie-Proprietolship (3) 4. Mor1gages & N_ Receivable (Schedule D) (4) 5. Cash. Bank Deposils & _neous P"""nal Property (5) (Schedule EI 6. JoinUy OWned Property (Schedule F) (6) D Saparate Billing Requested 7.lnter.VIVOS Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or LI 8. Total Gross Assets (Iolal Lines 1.7) 9. FunOlaI Expenses & Administrative Cosls (Schedule H) (9) 10. Dobis of Deoedent Mor1gage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (Iolal Lines 9 & 10) 12. Net Volue of Estate (Line 8 minus Line 11) 13. Charitable and Governmenlal BequeslslSec 9113 Trusls for which an election 10 lax has not been made (Schedule J) OFFICIAL USE ONLY 124,977.90 o 208,935.94 (,,) -q \""") C') 14. NetVolue Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14iaxable at the spousal lax rate. or transfers under Sec. 9116 (0)(1.2) 16. Amount of Line 14 laxable at lineal rate 19. Tax Due X _(15) X_(16) X .12 (17) 312,674.05 X .15 (18) (19) 17. Amount of Line 14 iaxable at sibling rate 18. Amount of Line 14laxable at collateral rate 20. 0 CHECK HERE IF YOU ARE REOUESTING A REFUND OF AN OVERPAYI.1ENT (8) 333,913,84 19,311.30 1,928.49 (11) (12) (13) 21,239.79 312,674.05 (14) 312,674.05 46,901.11 46.901.11 Q.'S ~ Decedenfs Comolete Address: STREET ADD~SS . 'a~ Cumberland Crossin S One Langsdorf Wav CITY C rl" I I STATE PA I ZIP 17013 a Ise Tax Payments and Credits: 1. Tax Due (Page 1 Une 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 46,901.11 38.000.00 1.999.94 Total Credits (A + B +C) (2) 39,999.94 3. InteresUPenalty ~ appiicable D. Interest E. Penalty T otallnteresUPenaity ( D + E ) (3) 4. II Une2 is greater than Une 1 +Une 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Un. 20 to request a refund (4) 5. II Une 1 + Une 3 is greater than Une 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Une 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 6,901.17 6,901.17 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "J(" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ........................................................................... 0 1RI b. retain the rightto designate who shall use the property transferred or its income: ........................................ 0 1RI c. retain a reversionary interest; or ...................................................................................................... 0 1RI d. receive the prornise lor life of either payments, benerils or care? ............................................................. 0 1RI 2. ~ death ocourred after December 12, 1982, did decedent transler property within one year of death without receiving adequate consideration?.......ou.................................................................................... 0 00 3. Did decedent own an "in trusttor' or payable upon death bank account or security at his or her death? ................. 0 00 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a .beneficiary designation? ....................................................................................................... 0 1RI IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ADDRESS t; ADDRESS PA 17013 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of translers 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 oftransters to or lor the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)). The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum are still appiicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rale 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)(I)]. The tax rate imoosed on the net valueoftransters 10 or for the use of the decedenfs sib/inos is 12% 172 P.S. ~91161a~1.311. A sib/ino is defined. under Section 9102. as an REV-1503 EX + (6-98) * COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Smith Mabel S. FILE NUMBER 21 05 AU property jointty-owned with right of sUIVivorship must be disclosed on Schedule F. 0192 ITEM NUMBER 1. VALUE AT OATE OF OEA TH TOTAL (Also enter on line 2, Recapitulation) S 124,977.90 REV.150B EX + (6-98) * SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Smith Mabel S ITEM NUMBER 1. 2. 3. 4. 5, 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. FILE NUMBER 21 05 Indude the proceeds of litigation and the date the proceeds __ received by the estate. All property joinlly-owned with right of survivorship must be disclosed on Schedule F. DESCRIPTION overelgn an c ec Ing account no. letter for all items and balances. (Principal $504.28) (Interest $.00) Sovereign Bank Certificate of Deposit no. 1675330607. (Principal $100,000.00) (Interest $168.77) Sovereign Bank Certificat of Deposit no. 1675335184. (Principal $12,000.00) (Interest $19.20) Sovereign Bank Certificate of Deposit no. 2335129272. (Principal $12,833.37) (Interest $20.64) PNC Bank Certificate of Deposit no. 31400184827. See attached letter for all items and balances. (Principal $11,028.69) (Interest $19.29) PNC Bank Certificate of Deposit no. 31700186519. (Principal $8,864.29) (Interest $31.26) PNC Bank Certificate of Deposit no. 31600212233. (Principal $11,527.86) (Interest $24.85) PNC Bank Certificate of Deposit no. 31900212761. (Principal $10,406.63) (Interest $22.43) PNC Bank Certificate of Deposit no. 31900212841. (Principal $9,185.22) (Interest $14.86) PNC Bank Certificate of Deposit no. 31100242870. (Principal $14,371.70) (Interest $11.30) PNC Bank Certificate of Deposit no. 31900242376. (Principal $4,000.00) (Interest $50.12) PNC Bank Certificate of Deposit no. 31600242019. (Principal $4,000.00) (Interest $50.13) PNC Bank Certificate of Deposit no. 31600242020. (Principal $1,809.82) (Interest $22.68) PNC Bank checking account no. 5140059517. (Principal $6,889.28) (Interest $.28) U.S. Government, 1040 form refund 2004. Patriot News, refund. TOTAL (Also enteron line 5, Recapitulation) $ 0192 VALUE AT DATE OF DEATH 100,168.77 12,019.20 12,903.68 11,047.98 8,895.55 11,552.71 10,429.06 9,200.08 14,383.00 4,050.12 4,050.13 1,832.50 6,889.55 94.00 4.80 208 935.94 Continuation of REV-1500 Inheritance Tax Return Resident Decedent Smith, Mabel S. Decedenfs Name Page 1 21 05 0192 File Number Schedule E - Cash, Bank Deposits, & Misc. Personal Property VALUE AT DATE OF DEATH 18. Commonwealth of Pennsylvania, PSERS, pro-ration. 686.92 19. Cumberland Crossings, nursing home, personal account refund. 33.89 SUBTOTAl SCHEDULE E 910.53 GRAND TOTAl SCHEDULE E $ 208,935.94 REV-1-511 EX + (12.99) * SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Smith Mabel S FILE NUMBER 21 05 0192 Debts oI_nt must be reported on SclIeduIe I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXP~NSES: 1. Hollinger uneral Home, services 8,202.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of PelSOf1lll Represenlative (s) None Social Security Numbel(s)/EIN Numbet' of Personal Represenlative(s) Street Address City State Zip Yea~s) Commission Paid: 2. AltDmey Fees Landis & Black 10,000.00 3. FamUy Exemption: (~_nrs address is not 1f1e same as claimants, attach expIanatioo) Claimant None Street Address City State Zip Relationship of Claimant (0 Decedent 4. Probale Fees Landis & Black, advanced (itemization shown below) 609.30 5. Accountanfs Fees 6. Tax Retum Prepare(s Fees 7. Reserve for Closing and Filing Releases. 500.00 Probate Fees Advanced: Register of Wills - Probate Will $360.00 Register of Wills - Short Certificates $8.00 Cumberland Law Journal - advertise Letters $75.00 The Sentinel- advertise Letters $129.77 Register of Wills - Short Certificates $16.00 Fed Ex - stock transfer $20.53 TOTAL (Also enter on line 9, Recapitulation) $ 19311.30 REV-1512 EX + (t>-98) *' SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS COMMONWEALTH DF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Smith Mabel S FILE NUMBER 21 05 0192 Include un reimbursed medical expenses. ITEM NUMBER DESCRIPTION 1. West Shore EMS, invoice VALUE AT DATE OF DEATH 287.11 2. Continuing Care R1X, invoice 68.26 3. Cumberland Crossings, nursing home care 1,408.30 4. Graham Medical Services, invoice 110.00 5. Cumberland Goodwill Ambulance Services, invoice 54.82 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 1 928.49 SCHEDULE J BENEFICIARIES E_of FileNwnber Smith, Mabel S. 21-os.o192 ReIa1ionship to Decedent Amount or Share - Name and Address of Person(s) Receiving Property Do Not Ust Trustee(s) ofE.- I. TAXABLE DISTRIBUTIONS (Include outright spousal distributions) I. Edna L _ker, SSN 186-24-8320 None Specific Bequest 203 Oak Drive, MI. Holly Springs, PA 17065 2. Edna L Hawbaker, as set forlh above None 33113'1(, 3. John F. Hawbaker, SSN 177-24-5589 and Edna L Hawbaker None 33113'1(, .. ael forth above 4. Mary Dea Haaa, SSN 198-38-5219 None 33 113'1(, 635 VIsta Avenue, Northumberland, PA 17857 ENTER DouARAMouNTs FoR OISTRlBUTIONS SHOWN A8CNE ON lINES 15 THRouGH 17.AsAPPRoPRlATE. ON REV 1500CCNER SHEEr II. NON-TAXABLE DISTRIBUTIONS A. Spousal dIslrlbutions under SecIIon 91 I 3 for which an election to tax Is not being made. 1. B. Charitable and Governmental Distribulloos 1. TOTAL OF PART n - Enter TolaI Non-Taxable DIsIrlbuIIons on Una 13 of REV 1500 Cover Sheel LAST WILL AND TESTAMENT OF MABEL S. SMITH I, MABEL S. SMITH, of the City of Harrisburg, Dauphin County, Pennsylvania, declare this to be my Last Will, hereby revoking all prior wills and codicils. FUNERAL EXPENSES FIRST: I direct the payment of my funeral expenses, including my gravemarker, as soon as may be convenient after my death. PAYMENT OF DEATH TAXES SECOND: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of administration of my estate. PERSONAL PROPERTY THIRD: All my personal effects, clothing, furniture, furnishings, jewelry, other tangible personal property of every kind and insurance thereon, I give to my executors for distribution in accordance with the instructions that I have heretofore given them. Any items not so disposed of shall be sold by my executors and the proceeds added to my residuary estate. BEQUESTS FOURTH: I give the indicated amounts or items to the following individuals who survive me: to Kathleen M. Leib, my friend, all of my shares of stock in PNC Bank if she shall survive me for a period of thirty (30) days. If she shall not so survive me, I give such shares of stock to Edna L. Hawbaker ifshe shall survive me for a period of thirty (30) days. If she shall not so survive me, I give such shares to John F. Hawbaker ifhe shall survive me for thirty (30) days. Ifhe shall not so survive me, I give such stock, per stirpes, to the issue of Edna L. Hawbaker who survive me for a period of thirty (30) days. DISTRIBUTION OF RESIDUE JfW" J H: I give the rest of my estate, in equal shares, as follows: fu ' ( . (' ~J ~ _I ,. initials A. One- third to John F. Hawbaker and Edna L. Hawbaker if they shall survive me for a period of thirty (30) days. If they shall not so survive me I give this share, per stirpes, to the issue ofJohn F. Hawbaker and Edna L. Hawbaker who survive me for a period of thirty (30) days. B. One-third thereof to my friend, Kathleen M. Leib, providing she shall survive me for a period of thirty (30) days. If she shall not so survive me, I give this share of my estate to Edna L. Hawbaker if she shall survive me for a period of thirty (30) days. If she shall not so survive me, I give such share of my estate to John F. Hawbaker ifhe shall survive me for thirty (30) days. Ifhe shall not so survive me, I give such share of my estate, per stirpes, to the issue of Edna L. Hawbaker who survive me for a period of thirty (30) days. C. One-third thereof to Mary Dee Haas. If she shall not survive me, I direct that her share be added to the other two shares of the residue of my Will. POWERS OF EXECUTORIRIX SIXTH: I confer upon my executor the right to sell or otherwise convert any real or personal property at public or private sale, at such time or times, in such manner, and for such price or prices, and upon such terms and conditions as my executor shall determine, and to execute and deliver good and sufficient conveyances, assignments and transfers thereof, without liability of any purchaser for the application of any consideration; to borrow money and to secure its payment by mortgage of real or personal property, pledge of investments or otherwise, without liability on the part of the lenders to see to the application thereof; to retain any investments at discretion; to invest and reinvest at discretion, without restriction to so-called "legal investments;" to make distribution in cash or in kind; and to do all other acts and things necessary or appropriate in the management, administration and distribution of my estate. APPOINTMENT OF EXECUTORIRIX SEVENTH: I appoint John F. Hawbaker and Edna L. Hawbaker, or the survivor thereof, executors of my will. I direct that my executors shall not be required to furnish security in any jurisdiction. INTERCHANGEABILITY OF LANGUAGE EIGHTH: Words used in the singular may be read to include the plural or the plural may be read as the singular. Similarly, the masculine form may be read to include the feminine and neuter; the feminine may be read to include the masculine and neuter; and the neuter may be read to include the masculine and feminine. c'J" / / l / (,o()... \ initials HEADINGS NINTH: The headings used on the various paragraphs of this will are included for convenience only and sha1I have no legal significance. I have signed this will this 511 day of .5.e ~ ' 2000. .f) r. /' t' fe" , ;' .<"/) 'f ///' /, //!.a/i.el~v ,',/,/),>'")/ z:?5 ' Mabel S. Smith r1M- /l4it<Jt )Witess "/fi1 It~r. / Witrn$s / ACKNOWLEDGMENT and AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND SS, I, Mabel S. Smith, the testatrix in, and 0.h ~ h.u~ " the witnesses to thelast will, the attached or . \ foregoing instrument, who have signed the instrument, having been duly qualified according to law do depose and say: (a) that I, the testatrix, do hereby acknowledge that I signed and executed the instrument as my last will, that I signed it willingly and as my free and voluntary act for the purposes therein expressed; and ) R~~d. ~. &.(t~ and (b) that we, the witnesses, were present and saw the testatrix sign and execute the instrument as her last will, that she signed it willingly and executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testatrix signed the will as a witness and that to the best of our knowledge the testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. J), . I' j) /. '.;j,' 't' h (,. - .., '" / ]'L). /j.-{~--L, ,,. .,",j/)--}LL~ 1./ Mabel S. Smith, Testatrix, (:)It-tfi 1tn2 / Ilt/.1 j~ Witn~s 9il9d:J ~~ I - Notary Publi ~ Notarial Seal Susan K. Guyer, Notary Public Canisle Born, Cumberland County My Commission Expires Sept 4, 2003 Member, PannsylvaI1ia I\SSOCialiOI1 01 NotarieS t So, ign Bank' :' ~,/! :, de; S~i$~. Qcan~youge(lbrrM:" Court Ordered Processing / MAl MB3 02-10 P.O. Box 841005 Boston, MA 02284 April 19, 2005 Landis & Black Attention: Robert R. Black 36 South Hanover Street Carlisle, PA 17013 RE: Estate of Mabel S. Smith Date of Death: 2/12/05 Dear Mr. Black: Per your request, enclosed please find the account information as of the date of death for the above-named decedent. For your information, accrued interest is not included in the date of death balance. Please feel free to contact me if I can be of any further assistance. Very truly yours, ~()(9UV~"I<l-,~ Laurie DiGiandomenico OAG Team Leader (617) 533-1789 Enclosures Sovereign Bank ESTATE OF SOCIAL SECURITY #: DATE OF DEATH: Mabel S. Smith 195-32-4361 February 12, 2005 Account #: 1671001516 Type: Checking In the name of: Mabel S. Smith Date of Death Balance: $504.28 Int.(YTD) from 1/1/2005 to 2/12/2005 Accrued interest to date of death: $0.00 Other Info: Closed 3/1/05 Former Waypoint #100191709 Open date: 1/15/2002 $0.14 Account #: 1675330607 Type: CD In the name of: Mabel S. Smith Date of Death Balance: $100,000.00 Int.(YTD) from 1/1/2005 to 1/31/2005 Accrued interest to date of death: $168.77 Other Info: Closed 3/1/05 Former Waypoint #7100020476 Open date: 1/15/2002 $373.67 Account #: 1675335184 Type: CD In the name of: Mabel S. Smith Date of Death Balance: $12,000.00 Int.(YTD) from 1/1/2005 to 1/31/2005 Accrued interestto date of death: $19.20 Other Info: Closed 3/1/05 Former Waypoint #7100022907 Open date: 1/24/2002 $42.49 Account #: 2335129272 Type: CD In the name of: Mabel S. Smith Date of Death Balance: $12,883.37 Int.(YTD) from 1/1/2005 to 1/31/2005 Accrued interest to date of death: $20.61 Other Info: Closed 3/1/05 Former Waypoint #456252390 Open date: 8/19/1994 $45.63 Page 1 of 1 o PNCBAN< April 6, 2005 Landis & Black 36 S Hanover St. Carlisle, P A 17013 scp RE: Estate of Mabel S Smith (Deceased) SSN: 195-32-4361 DOD: 02-12-2005 Dear Sir or Madam: In response to your request for Date of Death balances for the customer noted above, our records show the fullowing: Certificate of Deposit vAccount #31400184827 Established 04-25-2000 MABEL S SMITH DOD balance: $11,028.69 + $19.29 accrued interest Account #31700 186519 Established 05-22-2000 MABEL S SMITH DOD balance: $8,864.29 + $31.26 accrued interest !.-/ Account #31600212233 Established 06-30-200 I MABEL S SMITH DOD balance: $11,527.86 + $24.85 accrued interest :/Account #31900212761 Established 06-30-200 I MABEL S SMITH DOD balance: $10,406.63 + $22.43 accrued interest ~ Account #31900212841 MABEL S SMITH DOD balance: $9,185.22 + $14.86 accrued interest ",/Account #31100242870 Established 07-02-200 I Established 06-30-2001 MABEL S SMITH DOD balance: $14,371.70 + $11.03 accrued interest Page I of2 \/ Account #31900242376 Established 06-30-2004 MABEL S SMITH DOD balance: $4,000.00 + $50.12 accrued interest Account #31600242019 Established 06-30-2004 MABEL S SMITH DOD balance: $4,000.00 + $50.13 accrued interest Account #31600242020 Established 06-30-2004 MABEL S SMITH DOD balance: $1,809.82 + $22.68 accrued interest Checking Account Account #5140059517 EstablishedO 1-01-1978 MABEL S SMITH DOD balance: $6,889.27 + $0.28 accrued interest Please note that this office only provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings accounts). We do not process any financial transactions or provide statements. If you need assistance with any of these items, please call1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office. Sincerely, ~ ':2. ~ Erica L Schlegel 1-800-762-1775 P7-PFSC-04-F 500 First Ave. Pi\lSburgh P A 15219 Member FDIC Page2of2