HomeMy WebLinkAbout01-1149
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REV-1500 EX + (6-00)
/1-:;)6'-2
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
114~
OFFICIAL USE ONLY
OATEOF BIRTH (MM-DD-YEAA)
FILE NUMBER
~\ 01
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
189-09-4836
THIS RETURN MUST BE FILED IN DUPUCATE WITH THE
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME(lAST, FIRST, AND MIDDLE INITIAL)
Martin Mar V.
OATEOF DEATH (MM-DD-YEAR)
NUMBER
09/08 2001 06/09/1920
IF APPLICABLE SURVIVING SPOUSE'S NAME LAST, FIRST,AND MIDDLE INITIAL
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
X 1. OrigInal Return 2. Supplemental Return
CAPB 4. limited Estate 4a. Future Interest Compromise (date of death after 12-12-82)
HpRL X 6. Decedent Died Testate 7. Decedent MaintaIned a living Trust
EplO
CRAC (Attach copy of WlII) (Attach copy of Trust)
KOTK o 9. Litigatron Proceeds Received 010.
ES Spousal Poverty Credit
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X A
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3 date of death
. Remainder Return prior to 12-13-82)
5. Federal Estate Tax Return Required
J;L 8. Total Number of Safe DeposIt Boxes
o
11. Election to tax under Sec. 9113(A)
(Attach Sch 0)
~~IOMJlkoQtQ. ~Jill iii
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.nus~i;CnClI!(MUST.\~M
NAME
(date of death between 12-31-91 and 1-1-95)
.1l'tE. .g~Ul~~B _ormiN~ ,&i I IAL\Ti;
COMPLETE MAILING ADDRESS
Ste hen L. Bloom, Es uire
FIRM NAME (If Applicable)
Ste hen L. Bloom, Es uire
TElEPHONE NUMBER
2100 Longs Gap Road
Carlisle, PA 17013
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249- 1
Real Estate (Schedule A)
Stocks and Bonds (Schedule B)
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)
o 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 (Une 8 minus Une 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 (Une 12 minus Une 13)
(114,701.31)
(1)
(2)
(3)
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N\>ne
o OFFICI lttlEONLY
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:'1
(4)
(5)
Nbne
7,717.54
-
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N
j,;.
(J)
:....1
(6)
278:71
),
None
(8)
7,996.25
8,004.09
114,693.47
(11)
(12)
(13)
122.697.56
(114,701.31)
(14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Une 14 taxable at the spousal tax
rate, or transfers under Sec. 9116(a)(1.2)
16. Amount of Line 14 taxable at lineal rate (114,701. 31)
17. Amount of Une 14 taxable at sibling rate
18. Amount of Une 14 taxable at collateral rate
.0 0
.0 45
.12
.15
x
X
X
X
(15)
(16)
(17)
(18)
(19)
0.00
0.00
0.00
0.00
0.00
Copyright (c) 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
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Decedent's Complete Address:
STREET ADDRESS
CITY I STATE I ZIP
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits ( A + B + C) (2)
0.00
TotallnterestlPenalty ( D + 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. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
0.00
0.00
0.00
0.00
;"""'''''!!~'t!~~~~''~~~'!~~!'!~A~!'~g!t!tg!~~~m~U~~~lgl~~!!I~~!!~t~~!i!~~!!~!!
1.
mmw
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!~~!!!~~!~!!~~~'~!g~!~!l~~~!!~t~~~~mlmmm
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? .
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.
Yes No
~~
o
o
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IT]
IT]
IT]
Under pe alties of perJury, I declare that I have examIned this return, Including accompanying schedules and statements, and to the best of my knowledge and belief, It Is true,
nd complete. DeclaratIon of preparer other than the personal representative Is based on all Information of which pre parer has any knowledge.
URE OF PERSON RESPONSIBLE FOR FILING RETURN
DATE
121Ft/of
DATE'
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) (0].
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) (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 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 linear beneficiaries is 4.5%, except as noted in 72 P.S. 9116(1.2)
[72 P.S. 9116(aX1)].
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 brood or adoption.
CopyrIght (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00)
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ADDITIONAL Personal Representatives
Estate of Mary V. Martin SS# 189-09-4836 09/08/2001
***************************************************
Under penalties of perjury, the undersigned declare that they
have examined this return, including accompanying schedules and
statements, and to the best of their knowledge and belief, it is
true, correct and complete.
Signature
..-
j-A~ J.-J h1 a....:::t:=;:::
Name
Address Line 1
Address Line 2
City, State, Zip
Fred H. Martin
204 S.M.E.
Shippensburg, PA 17257
Date
j/-.-/9-0j
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REV-'150B EX +(1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCETJ()( RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Mary V. Martin SS# 189-09-4836 09/08/2001
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
NUMBER
1
DESCRIPTION
Church of God Home, Personal Cash Account
VALUE AT DATE
OF DEATH
467.63
2
Cumberland County Veteran Benefit
100.00
3
M&T Burial Account #21000000989428
7,149.91
TOTAL (Also enter on line 5. Recapitulation) S 7,717.54
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97)
I
REV-'1509 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHEArTANCETAX RETURN
RESIDENT DECEDENT
ESTATE OF
Mary V. Martin
SCHEDULE F
JOINTLY-OWNED PROPERTY
SSII 189-09-4836
09/08/2001
FILE NUMBER
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
A.
SURVIVING JOINT TENANT(S) NAME
Gerald S. Martin
ADDRESS
4 Windcroft Court
Carlisle, PA 17013
RELATIONSHIP TO DECEDENT
Son
B.
c.
JOINTLY -OWNED PROPERTY,
LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of frnanclallnstltution and bank DATE OF DEATH DECO'S VALUE OF
account number or simllar Identifying number.
NUMBER TENANT JOINT Attach deed for Jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1 A 10/01/97 M&T Savings Acct. 525.58 50.00% 262.79
1/15004201073670
2 A 08/01/96 M&T Checking Acct. 111281968 31.84 50.00% 15.92
TOTAL (Also enter on line 6, Recapitulation) $ 278.71
(If more space is needed insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc.
Form REV-1509 EX (Rev. 1-97)
--
REV-'1511 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Mary V. Martin
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
B.
1.
2.
3.
SSlft 189-09-4836
FILE NUMBER
09/08/2001
DESCRIPTION
AMOUNT
1
FUNERAL EXPENSES,
Ewing Brothers Funeral Home
6,785.11
2
K-Mart, Cemetery Flowers
5.25
3
Shirley Martin, Funeral reception
179.58
4
Sue Bower, Funeral expense
60.00
Total of Continuation Schedu1e(s)
49.15
ADMINISTRATIVE COSTS,
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:
Attorney's Fees
Family Exemption:
Claimant
Street Address
Stephen L. Bloom, Esquire
(If decedent's address is not the same as claimant's, attach explanation)
925.00
City
Relationship of Claimant to Decedent
State
Zip
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
TOTAL (Also enter on line 9, Recapitulation) $ 8,004.09
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form softwareonJy CPSystems, Inc. Form REV-1511 EX (Rev. 1-97)
---
Estate of: Mary V. Martin
Soc Sec #: 189-09-4836
Date of Death: 09/08/2001
Continuation of Schedule H-A
(Funeral Expenses)
Item
It
Description
Amount
5
The Sentinel, Advertising
49.15
49.15
---
REV-1512 EX +(1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Mary V. Martin
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, AND LIENS
SSjf 189-09-4836
09/08/2001
FILE NUMBER
Include unreimbursed medical expenses.
ITEM
NUMBER
1
DESCRIPTION
Department of Public Welfare, Claim for restitution of medical
assistance
AMOUNT
114,693.47
TOTAL (Also enter on line 10, Recapitulation) $ 114,693.47
(It 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 t (9~OO)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCETIV< RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
Marv V Martin
09/08/2001
FILE NUMBER
SSfj 189-09-4836
NUMBER
I.
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [Include outright spousal distributions, and
transfers under Sec. 9116(aX1.2))
1
Fred H. Martin
204 S.M. E.
Shippensburg, PA 17257
Son
2
Gerald S. Martin
4 Windcroft Court
Carlisle, PA 17013
Son
AMOUNT OR SHARE
OF ESTATE
50% Estate
Residue
50% Estate
Residue
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
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.
--
0.00
Form REV-1513 EX (Rev. 9-00)
LAST WILL AND TESTAMENT
I, MARY V. MARTIN, of South Middleton Township, Cumberland
County, Pennsylvania, being of sound and disposing mind and memory,
do hereby make, publish and declare this to be my Last Will and
Testament, hereby revoking any and all former Wills or Codicils by
me made.
1. I direct that all my just debts, funeral expenses,
testamentary expenses and all inheritance taxes (whether such taxes
may be payable by my estate or by any recipient of any property)
shall be paid from my residuary estate as soon as practicable after
my decease and as part of the administration of my estate. My
Executor shall have no duty or obligation to obtain reimbursement
for any such tax so paid, even though on proceeds of insurance or
other property not passing under this Will.
2. I give, devise and bequeath all of my estate, both real
and personal property, in equal shares, to my sons, FRED H. MARTIN
and GERALD S, MARTIN, absolutely, and I hereby appoint my said sons
as Executors of my estate.
3. I direct that my Executors shall not be required to file
~a bond to secure the faithful performance of their duties in any
(Q1. 'd't'
Jurls lC lon.
cg
4 .
I authorize and empower my personal representatives, in
': their sole and absolute discretion, to purchase or otherwise
acquire and retain any investments of which I die seized or any
real or personal property of any nature; to sell, lease, pledge,
/1V~
M.V.M.
Page 1 of 4 Pages
-----
mortgage, transfer, exchange, dispose of or grant options in regard
to any or all property of any kind forming a part of my estate for
such terms and such prices as they may deem advisable; to borrow
money for any purposes connected with the protection and
preservation of my estate; to mortgage or pledge any real or
personal property forming a part of my estate or to join in or
secure the partition of same; to compromise any claims or demands
of my estate against others or of others against my estate; to make
distribution in kind and to cause any share to be composed of cash,
property or undivided fractional shares in property different in
kind from any other share; and to execute and deliver such
instruments as may be necessary to carry out any of these powers.
IN WITNESS WHEREOF I have hereunto
Jut} \ t.c
{I day of C 0}t.~La~J
set my hand and seal this
, 1992.
~fitr ~A~I/
ary . artin
(SEAL)
SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named
Testatrix, as and for her Last Will and Testament, in the presence
of us, who at her request, have hereunto subscribed our names as
witnesses thereto,
in the presence of the said Testatrix and of
each other.
" 2L 1;;;' ~
/ I) i
lflA '?1 / r:;' ie'
'Cf/~Uy d. Lu'<<LLk)
Page 2 of 4 Pages
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COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF CUMBERLAND
I, Mary V. Martin, Testatrix, whose name is signed to the
attached or foregoing instrument, having been duly qualified
according to law, do hereby acknowledge that I signed and executed
the instrument as my Last Will; that I signed it willingly; and
that I signed it as my free and voluntary act for the purposes
therein expressed.
~fi/f!/ 7)J '7/?L?A:?,i;;/
ary V. Mart~n
Sworn or affirmed to and acknowledged before me by Mary V.
Martin, the Testatrix, this /.//f'day of '1~uut'-~/-' 1992.
/i '-
(-a/I.u.;" of'- fl,
Notary pUbC
Nolanal Seal
COMMONWEALTH OF PENNSYLVANIA ) ~"'~t\',=~
: S S . My CommtSS<on EXpires May 22, 1995
COUNTY OF CUMBERLAND ) Member, PennsylvaniaAssocialionotNo!aries
We, t.z-LuL~' d Yna.u"c7J c't--r,d ~~~u,-L<f- cf (/-'~~"-/
the witnesses whose names are signed to the attached or foregoing
instrument, being duly qualified according to law, do depose and
say that we were present and saw Mary V. Martin, the ~'estatrix,
sign and execute the instrument as her Last Will; that the
Testatrix signed willingly and that the Testatrix 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 witnesses; and that to the best of our knowledge the
Testatrix was at that time 18 or more years of age, of ound mind
and under no constraint or undue rkf~u ceo / /
/1 '/.
'" ./ / / 'I
Address /0 '" ~. ,Auu
-rz:L.; ;-;:~,,; ~. /'7o/J
~~~ CJ.L~~I
AddreJr- /0 '- . IY'f~' ~/t .(Lf
~J ,~..{ ,/ / ~ /70/.3'
.
Sworn or affirmed to and subscribed before me this 1'/11r day of
'}/..,"~>< 'j' 1992.
,
/) , "J
.---rO-l. I..r ji( d
Notary Public
,
7)L-<-'J/ ~ <-I '
(}
I Nolarial Seal
~neL. Myers, ~FtitlIk:
" C~r"~1,8 ~ro C~mberland COU
__ _,', _' "'.,i~" r-,,'p;:~GMaY22.;%5
Me" ""r, Pems~iVan.a-AssciOBiOii of NotarieS
Page 3 of 4 Pages
------
mM&rBank
November 5, 200 I
RE:
Estate Search
The Estate of:
Date of Death (D.a.D.)
To Whom It May Concern:
MARY V MARTIN
9/8/2001
Identified below is the account information requested.
I. M&T Bank accounts in which the decedent's name appears:
Account
Type
Account Number
CHK ZrfC/1.>
SAY
tD/"17
PASS SAY
"In
1281968
15004201073670
21000000989428
Account Tide
GERALD S MARTIN -":ft:
MARY V MARTIN
GERALD S MARTIN
MARY V MARTIN
FTC BURIAL ACCOUNT
Opcning Branch
D.O.D.
Balances
(Includes Accr.
Int.)
$31.84
$525.58
4319
4319
4319
$7149.91
Account Number
2. Loans, Mortgages, or other obligations titled in the decedent's name
Amount Owed
NO Safe Deposit Box titled in the Decedent's name existed at our office.
Account Description
Accrued Interest
$.00
$.32
$10.57
If you have any questions about the information provided, please contact our Records Department at (716) 635-4010 or 1-800-724-
2440 outside of the Buffalo, NY calling area. Thank you.
Sincerely,
M&T BANK CORPORATION
BY Autho~~~
DATE 1/ (<:::/0)
~
lQ1
Manufacturers and Traders Trust Company. 1100 Wehrle Drive. PO Box 767. Buffalo. NY 14240-0767
------
EWING BROTHERS FUNERAL HOME
Since 1853
William M. Ewing, L.F.D.
Seymour A. Ewing, L.F.D.
Steven A. Ewing, L.F.D.
630 South Hanover Street
Carlisle, Pennsyivania 17013
Telephone (717) 243-2421
October 22, 2001
Mary V. Martin Family
Funeral expenses for Mary V. Martin.
Date of Death - S~pt. 8. 2001
Professional Services, use of Facilities and Equipment.
Metal Sealer Casket (Last Supper )
Grave opening (Cumberland Valley Memorial Gardens)
Minister
Hairdresser
Death Certificates (5)
Flowers $132.50
. J'/ao
31.80
.3.71
---------
$205.11
~
(Q1
Received Oct. 17, 2001 from M & T Bank $7,155.)5
Received Oct. 5,2001 from Cumberland County
Widow of Veteran 100.00
------------
.'.,;. f:" ,,~.
." ..: ".::-
"'-,. . .'
.!IF -~- f ;..<
- fi CO I
~~ 1-
'0 - J.
$7,255.35
6,785.lb
------------
$ .470.J.lf
Refund
10- J.l- J.oo I
Member of National Funeral Directors Association
-
$2,995.00
2,625.00
---------------
$5,620.00
815.00
100.00
35.00
10.00
205.11
-------------
$6,785.l\
,
STEPHEN L. BLOOM
ATTORNEY AND COUNSELLOR AT LA W
2100 Longs Gap Road
Carlisle, Pennsylvania 17013,Tel 717-249-7717
Federal EIN 25-1851818
Invoice submitted to:
Martin, Mary V. Estate
4 Windcroft Court
Carlisle, PA 17013
Gerald S. Martin, Executor
December 18, 2001
In Reference To: Estate Administration
Invoice #784
Professional Services
Hrs/Rate Amount
9/13/01 SLB Conference with clients; Preliminary administrative matters 1.00 175.00
175.00/hr
9/12/01 PL Preliminary preparations for administration 0.25 23.75
95.00/hr
9/13/01 PL Initial consultation with Executors; Preliminary preparations for probate 1.67 158.33
95.00/hr
9/14/01 PL Review documents; Prepare for administration of estate 3.50 332.50
95.00/hr
10/15/01 PL Telephone conferences with M&T Bank re joint accounts; Telephone 0.42 39.58
conference with Gerald Martin re status of joint accounts, funeral bills 95.00/hr
and Church of God account
10/16/01 PL Telephone conference with Ewing Brothers re funeral bill and burial 0.50 47.50
trust fund; Correspondence to Department of Public Welfare re Medical 9500/hr
Assistant lien; Telephone conference with Church of God Home re
personal cash account
10/19/01 PL Telephone conference with Executor re joint accounts at M& T Bank, 0.25 23.75
cash account at Church of God Home and DPW lien 95.00/hr
10/22/01 PL Review correspondence from Executor re joint account and burial trust 0.17 15.83
fund 95.00/hr
PRACTICAl. COUNSI~L + CHRISTIAN PERSPECTIVE
------
Martin, Mary V. Estate
10/29/01 PL Review invoice/refund from Ewing Brothers Funeral Home
11/15/01 PL Review correspondence from M&T Bank re account information;
Telephone conference with M& T Bank representative re dates of
account initiation, titling and status; Review correspondence from
Department of Public Welfare re estate recovery lien and research re
same
11/16/01 PL Telephone conferences with Ms. Keener at Church of God Home;
Telephone conference with Executor re status of Department of Public
Welfare Estate Recovery Claim; Telephone conferences with Ms.
Smith at Department of Public Welfare re same; Correspondence with
Executor; Administrative matters
11/29/01 PL Telephone conference with Department of Public Welfare
representative
11/30/01 PL Telephone conference with Ms. Smith at Department of Public Welfare
re new Regulations and Procedure re Burial Trust balance; Telephone
conference with Department of Revenue re inheritance tax treatment of
Burial Trust remainder; Research re Department of Public Welfare
Regulations; Administrative matters
12/11/01 SLB Conference with Paralegal re estate administration and tax matters
PL Review file status re DPW claim; Preparation of Inheritance Tax return
Subtotal of charges
Discount Credit
For professional services rendered
Balance due
PAYABLE UPON RECEIPT. THANK YOU
PRACTICAL COUNSEL'" CHRISTIAN PERSPECTIVE
----
Hrs/Rate
0.17
95.00/hr
3.00
95.00/hr
2.67
95.00/hr
0.25
95.00/hr
2.33
95.00/hr
1.00
175.00/hr
1.25
95.00/hr
18.43
Page
2
Amount
15.83
285.00
253.33
23.75
221.67
175.00
118.75
$1,90957
t$984~7)
$925.00
$925.00
~
~
*'
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
ESTATE RECOVERY PROGRAM
PO BOX 6486
HARRISBURG, PA 17105-8486
October 29, 2001
STEPHEN L BLOOM
LORI A SULLIVAN LEGAL ASSISTANT
2100 LONGS GAP RD
CARLISLE PA 17013
Re: MARY MARTIN
CIS #: 890142211
Co/Rec: 21/0083627
Date of Birth: 06/09/1920
SSN: 189-09-4836
Dear Ms. Sullivan:
Please be advised that the Department of Public Welfare maintains a
claim in the amount of $114,693.47 against the above-mentioned estate. This
claim is for restitution of medical assistance granted on behalf of the
decedent for which the Probate Estate is now responsible to reimburse the
Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as
amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's
itemized statement of claim.
A portion of this medical expense, namely $22,517.12, was incurred
during the last six months of the decedent's life; therefore, it is a Class 3
claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries
Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $92.176.35, is
to be entered as a priority Class 6 claim against the estate.
Please acknowledge receipt of this letter and advise whether the
Commonwealthts claim is admitted and when payment may be expected. If the
estate accounting is complete, please provide a copy. ~f the estate contains
real estate, please provide copies of the deed, the latest tax assessment,
and a current appraisal. if available.
Sincerely,
:S~L.~
Sharon E. Smith
TPL Program Investigator
717-772 -6397
717-772-6553 FAX
Enclosure
11-dt! ..;1.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z8D6Dl
HARRISBURG, PA 171Z8-D6Dl
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
Rel;C:
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
02-04-2002
MARTIN
09-08-2001
21 01-1149
CUMBERLAND
101
.02
FEB 1 3
":10 :48
STEPHEN L BLOOM
2100 LONGS GAP RD
CARLISLE PIC.H,QI3
Cumt,~;
C/
*'
REV-15~7 EX AFP liZ-DOl
MARY
v
Allount Rellitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ~
REv=is4j-EY-AFP--fi'2-:ooY-NorlcE--oF-YNHEiiITANcE-rAx-APPR]rIsEi.fENT~--ALi-owANcE-OR------------ -----
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF MARTIN MARY V FILE NO. 21 01-1149 ACN 101 DATE 02-04-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
7 .717 . 54
278.71
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
(10)
8,004.09
114.693.47
(11)
(12)
(13)
(14)
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
7,996.25
122.697 !i6
114,701.31-
.00
114,701.31-
14, IS and/or 16, 17, 18 and 19 will
returns assessed to date.
NOTE: If an assessment was issued previOUSly, lines
reflect figures that include the total of ALL
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate (15)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate (17)
18. Allount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
.00 X 00 =
.00 X 045=
.00x 12 =
.00 X 15 =
(19)=
.00
.00
.00
.00
.00
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 DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
RESERVATION: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or fDr years, the Commonwealth hereby expressly reserves the right tD appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate Dn any such future interest.
PURPOSE OF
NOTICE:
TD fulfill the requirements of SectiDn 2140 Df the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S.
SectiDn 9140).
PAYMENT:
Detach the top portiDn of this NDtice and submit with your payment tD the Register Df Wills printed Dn the reverse side.
--Make check Dr money order payable tD: REGISTER OF HILLS. AGENT
REFUND (CR):
A refund Df a tax credit, which was nDt requested Dn the Tax Return, may be requested by cDmpleting an "ApplicatiDn
fDr Refund Df Pennsylvania Inheritance and Estate Tax" (REV-1313). ApplicatiDns are available at the Office
Df the Register Df Wills, any Df the 23 Revenue District Offices, or by calling the special 24-hour
answering service fDr fDrms Drdering: 1-800-362-2050; services fDr taxpayers with special hearing and I Dr
speaking needs: 1-800-447-3020 (TT Dnly).
OBJECTIONS:
Any party in interest nDt satisfied with the appraisement, allDwance, Dr disallowance Df deductiDns, Dr assessment
of tax (including discDunt Dr interest) as shDwn on this NDtice must object within sixty (60) days Df receipt of
this Notice by:
--written protest tD the PA Department of Revenue, Board Df Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR
--election tD have the matter determined at audit Df the account Df the persDnal representative, OR
--appeal tD the Orphans' CDurt.
ADMIN-
ISTRATIVE
CORRECTIONS: Factual errDrs discDvered on this assessment shDuld be addressed in writing tD: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: PDSt Assessment Review Unit, Oept. 280601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. See page 5 Df the bDDklet "InstructiDns fDr Inheritance Tax Return fDr a Resident
Decedent" (REV-150l) for an explanatiDn Df administratively correctable errDrs.
DISCOUNT:
If any tax due is paid within three (3) calendar mDnths after the decedent's death, a five percent (5%) discDunt Df
the tax paid is allowed.
PENALTY:
The 15% tax amnesty nDn-participation penalty is cDmputed Dn the total Df the tax and interest assessed, and nDt
paid before January 18, 1996, the first day after the end Df the tax amnesty period. This non-participatiDn
penalty is appealable in the same manner and in the the same time periDd as YDU would appeal the tax and interest
that has been assessed as indicated on this nDtice.
INTEREST:
Interest is charged beginning with first day Df delinquency, Dr nine (9) mDnths and Dne (1) day from the date Df
death, to the date Df payment. Taxes which became delinquent befDre January 1, 1982 bear interest at the rate Df
six (6%) percent per annum calculated at a daily rate Df .000164. All taxes which became delinquent Dn and after
January 1, 1982 will bear interest at a rate which will vary frDm calendar year to calendar year with that rate
annDunced by the PA Department Df Revenue. The applicable interest rates for 1982 thrDugh 2002 are:
Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest FactDr
1982 20% .000548 1992 9% .000247
1983 16% .000438 1993-1994 7% .000192
1984 11% .000301 1995-1998 9% .000247
1985 13% .000356 1999 7% .000192
1986 10% .000274 2000 8% .000219
1987 9% .000247 2001 9% .000247
1988-1991 11% .000301 2002 6% .000164
--Interest is calculated as fDllows:
INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any NDtice issued after the tax becDmes delinquent will reflect an interest calculation tD fifteen (15) days
beYDnd the date of the assessment. If payment is made after the interest cDmputatiDn date shDwn Dn the
NDtice, additiDnal interest must be calculated.