HomeMy WebLinkAbout07-26-05 (2)
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17126-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENrs NAME (LAST, FIRST. AND MIDDLE INITIAL)
Bretz Charles W
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-OD-Year)
OFfiCIAL USE ONLY
FILE NUMBER I n 3
2 1 - 05 - QUi U'
COU'iIDcoor -YEAR- - - NiliBE~-
SOCIAL SECURITY NUMBER
1 8 1 - 1 0 - 1 170
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 3. Remainder Return (daleofdeath prior 10 12-13-82)
o 5. Federal Estate Tax Return Required
_ 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
David H. Stone Es uire 414 Bridge Street
FIRM NAME (If A"licab~1
Stone LaFaver & Shekletski
TELEPHONE NUMBER
717-774-7435 New Cumberland PA 17070
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0.00 X _(15) 0.00
21,926.79 x .045 (16) 986.71
0.00 x .12 (17) 0.00
0.00 X .15 (16) 0.00
(19) 986.71
12/14/2004 3/30/1913
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST, AND MIDDLE INITIAL)
[Xl 1. Original Return
o 4. limited Estate
o 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (<:Iateof<:\ealll af\ef 12.12-B2}
o 7. Decedent Maintained a Living Trust (AIlach copyofTrusl)
o 10. Spousal Poverty Credit (daleofdealt1 belween 12-31.91 aoo1.1.95)
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5,007.12.i
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4,237.29!' '::'.!
OFFICIAL USE ONLY
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1. Real Eslate (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. JoinUy OWned Properly (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
6. Tolal Gross Assets (tolal Unes 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
(1)
(2)
(3)
(4)
(5)
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(6)
(7)
(9)
10. Debls ofDecedent, Mortgage Uabilibes, & Uens (Schedule I) (10)
11. Total Deductions {total Unes 9 & 10)
12. Net Value of Estate (UlIe 6 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)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rare, ortranslers under Sec. 91 16 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Une 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
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13,947.70
I
7,661.32~
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(8)
30,853.43
8,926.64
(11)
(12)
(13)
8,926.64
21,926.79
(14)
21,926.79
Decedent's Complete Address:
STREET ADDRESS
21 Creekside Dr.
CITY I STATE I ZIP
Enola PA 17025-
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
8. PMor Payments
C. Discount
(1)
986.71
3. InteresUPenalty if applicable
D. Interest
E. Penalty
Total Credits (A + 8 + C)
(2)
0.00
T otallnteresUPenalty ( 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)
8. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
0.00
986.71
986.71
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 ofthe property transferred; ........................................................................... 0 00
b. retain the Mght to designate who shall use the property transferred or its income; ........................................ 0 00
c. retain a reversionary interest; or ...................................................................................................... D 00
d. receive the promise for I~e of either payments, benefits or care? ............................................................. 0 00
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adeeuate consideration?................................ .............................................................. 0 00
3. Did decedent own an "in trust fo~ or payabie upon death bank account or secuMty 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? ....................................................................................................... 00 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this relum, including accompanying schedules and statements, and 10 the best of my knO'Nledge and belief, il is true, correct and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIG~!!JRE OF PERSON ~ESPONSIBLE FOR ~ DATE
r-- ~ a-. 1-\3-() \
ADDRESS 511 North 2nd 51.,
Wormle sbur
SIGNATURE OF P R OT
PA 17043
DATE
-1'3- -
ADDRESS
PA 17070
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 ofthe 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 reeuirements for disclosure of assets and filing a tax return are still appiicable 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 naturai 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 decedenrs lineal beneficiaMes is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(I)J.
The tax rate imposed on the net value of transfers to or for the use of the decedenrs siblings is 12% [72 P.S. ~9116(a)(1.3)J. 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.1503 EX + (6.98)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Bretz Charles W
FILE NUMBER
21
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1
OESCRIPTION
124 shs. MetLife Inc. stock @ $40.38 each
VALUE AT DATE
OF DEATH
5007.12
TOTAL (Also enter on line 2. Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
5007.12
REV-1508 EX + (6-98)
*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Bretz Charles W
FILE NUMBER
21
Include the proceeds of \\tigafum ancl1he date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on SChedule F.
ITEM
NUMBER
1
DESCRIPTION
Waypoint Bank-Certificate of Deposit #71 00024171. Prine. $4,235.86, Int. $1.43
VALUE AT DATE
OF DEATH
4,237.29
TOTAL (Also enter on line 5. Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
4 237.29
REV-1509 EX + (6-98)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTL Y.OWNED PROPERTY
ESTATE OF
Bretz Charles W
FILE NUMBER
21
If an asset was made joint within one year of the decedenfs date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. Twila A. Hawbaker
511 N. 2nd St
Daughter
Wormleysburg, PA 17043-
B
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JOINTLY.OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %0' DATE OF DEATH
nEM FOR JOINT I MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VAlUE 0'
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTl Y-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEOENrSINTEREST
1- A 05/15/9' Waypoint Bank-Joint Cert of Deposit #95303472 1,962.88 50 981.44
Princ. $1,962.02, In!. $.86
2 A 07/13/9E Waypoint Bank-Joint Cert. of Deposit #900003177 11,247,47 50 5,623.74
Princ. $11,244.07, In!. $3,40
3 A 07/26/8e Waypoint Bank-Joint Checking Aeel. #1000001650 9,490.26 50 4,745.13
Prine. $9,489.88, Inl. $.38
4 A 5/15/97 Waypoint Bank-Jt Cert. of Deposit #965303473 2,235.22 50 1,117.61
Prine. $2,216.78, In!. $18,44
5 A 4/12/96 Waypoint Bank-Jl. Cert of Deposit #991284167 2,959.55 50 1,479.78
Prine. $2,957.63, Inl. $1.92
TOTAL (Also enter on line 6, Recapitulation) $ 13947.70
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX + (6-98)
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Bretz Charles W
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
21
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERlY
ITEM INQ.UoeTHE~EOfTHETRANSFEREE,THEIRRELATIONSHIPTODEceOENTAND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE
NUMBER THEDATEOFTRANS~ER ATTACH A COPY OF THE OEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IFAPPLICAElLEl VALUE
1 Waypoint Bank-IRA Account #117511774 Princ, $7,657.26, 7661.32 100. 7,661.32
Int. $4.06 beneficiary Twila Hawbaker
TOTAL (Also enter on line 7 Recapitulation) $ 7661.32
(If more space is needed, insert additional sheets of the same size)
REV-'511 EX + (1*,
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Bretz Charles W
FILE NUMBER
21
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Sullivan Funeral Home-funeral expenses 6,545.50
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Numbe~s)IEIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees David H. Stone, Esquire 2,000.00
3. Family Exemption: (If decedenfs address is not lt1e same as claimant's, attach explanation)
Claimant
Street Address
City Slate Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Register of Wills-filing Inh. Tax Return and Inv. 30.00
8. Mellon Investors-transfer fee on stock 151.14
9. Reserve for closing expenses 200.00
TOTAL (Also enter on line 9, Recapitulation) $ 8 926.64
(If more space IS needed, insert additional sheets of the same size)
REV_1513EX.I*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
Br"t7 w 21
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, and transfers under
Sec. 9116 {a)(1.2)J
1 Twila Hawbaker Lineal 21,926.79
511 N. 2nd 5t
Wormleysburg PA 17025-
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, 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
1.
TOTAL OF PART II - 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)
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MetUfe Inc
Date High Low Close Volume
12{31{2004 40.9700 40.5100 40.5100 985,400
12{30{2004 40.8300 40.5000 40.6800 1,132,900
12/28{2004 41.1600 40.5500 41.0100 1,235,400
12/27{2004 40.9000 40.2200 40.4100 1,072,000
12{23{2004 40.8000 40.5700 40.5900 741,200
12{22/2004 41.0000 40.2800 40.6300 1,982,900
12{21{2oo4 40.7000 39.9000 40.5700 1,956,900
12{20{2004 40.2500 39.9000 40.1000 2,144,400
12{17{2004 40.3100 39.5200 39.6100 4,063,900
12{16{2004 41.1800 40.1200 40.8000 2,336,000
12{15{2004 41.2700 40.2200 41.1800 2,016,400
12{14{2004 40.5500 40.1200 1,530,700 'I (;J..~ $ 5'00/. I ;c
I
12/13{2004 40.6000 40.1400 40.6000 1,489,900
12{10{2004 40.8600 39.5900 40.3300 1,800,200
12{9{2004 40.2500 39.3400 40.1400 1,727,000
12{8{2004 40.1400 39.8500 40.0800 1,940,900
12{7{2004 39.9200 39.6300 39.7600 4,159,000
12{6{2004 40.2600 39.6300 40.1000 3,002,400
12{3{2004 40.6900 39.7400 40.4800 1,489,800
12{2{2004 40.4600 39.6500 39.9700 1,590,100
12{1{2004 39.9300 39.0000 39.8300 2,392,000
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III /.::,-'_lll-,,- 1).:1.1 Data Source: FT Interactive Data Corporation
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VlWay~qint
1/12/2005
STONE LAF AVER & SHEKLETSKI
414 BRIDGE ST PO BOX E
NEW CUMBERLAND P A 17070
The information which you requested on the account(s) of CHARLES W BRETZ
(Social Security Number 181-10-1170) is/are as follows:
Account Nwnber
Class of Account
Date Opened
Principal Balance
Accrued Interest
1000001650
CHECKING
072685
9489.88
.38
9490.26
Balance at Date of
Death
Account Ownership JTO
Name of Joint TWILA A
Owner, ifany HAWBAKER
Date Ownership 072685
Was Established
Account Nwnber
Class of Account
Date Opened
Principal Balance
Accrued Interest
991284167
CERTIFICATE
041296
2957.63
1.92
2959.55
Balance at Date of
Death JTO
Account Ownership TW1LA A
Name of Joint HAWBAKER
Owner, if any
. 04129"
Date OwnershIp
Was Established
Additional
Information
Requested
117511774 7100024171 900003177 95303472 965303473
RETIREMENT CERTIFICATE CERTIFICATE CERTIFICATE CERTIFICATE
112487 013102 071398 051597 051597
7657.26 4235.86 11244.07 1962.02 2216.78
4.06 1.43 3.40 .86 18.44
7661.32 4237.29 11247.47 1962.88 2235.22
SOLE
SOLE
JTO
TWILA W
BRETZ
051597
JTO
TWILA A
HAWBAKER
071398
JTO
TWILA A
HAWBAKER
051597
112487
013102
E WATTS
SENIOR SERVICES REP.
P.O. Box 1711. HARRISBURG. PENNSYlYANIA 17105-1711
T",II C..~,e l_aCC~\A/A,,"""I......../1 Ctl::.tt:: O"=let. ~~A"" lu___u A___ -.- ,-.- ...---
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
INVENTORY
Estate of Charles W. Bretz
No. 21 - 05 -OuLP3
, Deceased
Date of Death 12/14/2004
Social Security No. 181-10-1170
also known as
Twila Hawbaker, Informant
Personal Representative(s) of the above Estate, deceased. verify that the items appearing in the fol/owing inventory include all of the
personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation
placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no
real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. l!We
verify that the statements made in this inventory are true and correct. I/We understand that false statements herein made are subject to the
penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsifICation to authorities.
Name of
Attorney: David H. Stone, Esquire
1.0. No.: 39785
pe~~o:~at
~i1a Hawbaker
511 N. 2nd SI., Wormlevsburg, PA 17043
Address: 414 Bridqe Street
New Cumberland
Dated
PA 17070
Telephone: 717-774-7435
Description
124 shs. MetLife Inc. stock @ $40.38 each
Value
5,007.12
Waypoint Bank-Certificate of Deposit #7100024171, Princ. $4,235.86,
Inl. $1.43
4,237.29
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Total
(A.ttach Additional Sheets if necessary)
9,244.41
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative.
include the value of each item, but such figures should not be extended into the total of the Inventory.
RW-4