HomeMy WebLinkAbout08-05-05
REV-1500 EX + (&(JO)
*' COMMONWEALTHOF
. PENNSYLVANIA
DEPARTMENT OF REVENUE
OEPT. 280601
HARRISBURG, PA 17128-0001
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENTS NAME (LAST, RRST, AND MIDDlE INITIAL)
Motter Ph IUs I.
DATE OF DEATH (WOO-Year)
DATE OF BIRTH (MM-OO-Year)
0212712005 07118/1934
(IF APPl.lCABlE) SURVMNG SPOUSE'S NAME (LAST, RRST, AND MIDDlE INITIAL)
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o 4. Limited Esla1B
o 6. DecedentDiedTes1ate (_COIlYofWll
o 9. Litigation Proceeds Received
o 2. Supp/emen1a1 Retum
o 4a. Future InlelestCompromise l_of_*12-12-82j
o 7. Decedent Main1ained a Living Trustl_COIlYofTrust)
o 10. Spousal PoverIyCredtt(_of__12.31-91 and 1-1-95)
FILE NUMBER
2 1 -0 5 0 2 2 4
COOOv~ --vEAR- - - iiiiER- -
SOCIAL SECURITY NUMBER
1 8 6 -2 8 - 3 8 7 0
THIS RETURN IIUST BE FILED IN llUPUCATE WITII THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Retum Cdai! of_priorlD 12.13-821
o 5. Fedellll Esla1B Tax Retum Required
Q.. 6. Tolal Number of Safe Deposit Boxes
o 11. EIeclion to tax under Sec. 9113(A)(_SchO)
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THIS SECTION MUST BE COMPlETED. ALL CORRESPONDENCE AND CONFIDENTIAL. TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
William A. Duncan E uire Duncan & Hartman, P.C.
FIRM NAME (W Applicable)
Duncan & Hartman P.C. One Irvine Row
TELEPHONE NUMBER
717-249-7780 Cartisle PA 17013
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1. Real Esla1B (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Par1nership or SoIe-Proprietorship (3)
4. ~ages & Notes Receivable (Schedule 0) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. JoinUy Owned Property (Schedule F) (6)
o Sepalllle Billing Requested
7. Inter-VIVOS TllInsfel5 & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
6. Total GlOSS Aaels (total Lines 1-7)
9. Full8llll Expenses & Administlative Cll51s (Schedule H) (9)
10. Debls of Decedent ~ Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total LInes 9 & 10)
12. Net Value of Estate (Line 6 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Till (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPlICABLE RATES
(6)
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15. Amount of Une 14 taxable at the spousal tax
1lIle, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at Mneallllle
x .000 (15)
44,345.07 X .045 (16)
17. Amount of Line 14 taxable at sibling IlIte
18. Amount of Line 14 taxable at lXlIIa1Bral rate
X .12 (17)
X .15 (18)
(19)
19. Till Due
20. 0
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> > Ht;; SURt;; TO ANSWt;;R ALL OUBTlON.Cl ON Rt;;Vf;RSt;; SlOt;; AND Rt;;CHECK MATH < <
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8,610.86
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10,095.51
248.04
(11)
(12)
(13)
(14)
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54,688.62
10,343.55
44,345.07
44,345.07
0.00
1,995.53
1,995.53
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A rtment 221
CITY
Canisle
STATE
PA
ZIP
17013
Tax Payments and Credits:
1. Tax Due (Page 1 Une19)
2. Credits/Payments
A. Spousal Poverty Credn
8. Prior Payments
C. Discount
(1)
1,995.53
3. InteresUPenalty if applicable
D. Interest
E. Penalty
Total Credits (A + 8 + C) (2)
Total Interest/Penalty ( 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. (5A)
8. Enter the total of Une 5 + 5A. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
1,995.53
1,995.53
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 of the property transferred; ........................................................................... 0 00
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 00
C. retain a reversionary interest; or ...................................................................................................... 0 00
d. receive the promise for life of enher 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 adequate consideration?............................................................................................... 0 00
3. Did decedent own an 'in trust for' 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 00
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 peljury. I decl....lhal I have examined this return, includi!!l! accompanying schedules lIId stalements, and to Ihe best of my knowledge and belief. it is true, COfTllClllld complete.
OecIntion of preparer oIt1er thM the persoo'" _tali.. is based on "'I Information of which preparer has MY knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE
C~~ ~.. '1'04"'JJ~ r"?~O. <i-
ADDRESS Clarence E. Fenicle, Administrator
281 Potato Road Ca isle
SIGNATURE PRE RER ']j E ESENTATIVE
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 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) (ii)].
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disciosure of assets and filing a tax retum 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-ooe 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)J.
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)J.
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
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REV-1503 EX + (6-98)
'.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Motter Phyllis I
FILE NUMBER
21 05
All property joinlly-owned with right of survivorship must be disclosed on Schedule F.
0224
ITEM
NUMBER
1.
DESCRIPTION
123.839 shares AMERICAN BAL FD CL B BALBX @ $17.62 per share
VALUE AT DATE
OF DEATH
2,182.04
2.
633.167 shares FEDRTD FXD INC STRT INCA STIAX @ $8.82 per share
5,584.53
3.
Washington National Insurance Company, Conseco Services, LLC.
Annuity Contract No. 00152460 (principal $1,210.96 and interest $2,284.79)
3,495.75
4.
PNC Bank checking account #5140188546
$7,007.45 + $0.19 accrued interest
7,007.64
5.
PNC Bank savings account #5130349158
$871.46 + $0.16 accrued interest
871.62
6.
PNC Investments retirement account #61607803
26,936.18
TOTAL (Also enter on line 2, Recapitulation) $
46 077. 76
Ilf r'nn1"C), on!::lroQ io ncw:wfAl'l lneort ~IMiti^n~1 ""hae1o nf the C!~ma. el7C\
REV-1508 EX + (6-98)
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SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Motter Phyllis I
FILE NUMBER
21 05
Include the proceeds of l/ligation and the date the proceeds were received by the estate.
AD property jolntly-owned wilh right of survivorship must be disclosed on Schedule F.
0224
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
300.00
Proceeds from sale of 1989 Cavalier
2.
The Sentinel, refund
43.37
3.
PNC Bank checking account no. 5140188546, close account
7,205.70
4.
PNC Bank savings account no. 5130349158, close account
871. 72
5.
Monumental Life Insurance, premium refund
25.00
6,
Monumental Life Insurance, premium refund
10.58
7.
Comcast, refund.
26.99
8.
SPX Corporation, refund for over payment of medical premium.
127.50
TOTAL (Also enter on line 5, Recapitulation) $
8610.86
(If rTVlfP. ~Mr:A iet nAAriP.f1 inAArt Al1ttitinn~1 ~hAP.b:t of thA AAMP. ~i7P.)
REV-1511 EX+(12-99)
..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Motter Phyllis I
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21 05
0224
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Ewing Brothers, professional services 4,171.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Represenlative (s) Clarence E. Fenicle 2,734.00
Social Security Number{s)/EIN Number of Personal Represetota1ive(s)
streetAddress 281 Potato Road
City Carlisle State P A Zip 17013
Year(s) Commission Paid: 2005
2. AttDmey Fees William A Duncan, Esquire 2,.734.00
3. Family Exemption: (W decedent's address is not 1he same as claimanfs, attach explanation)
Claimant
street Address
City State Zip
Relationship of Claimant to Decedent
4. ProbateFees to date: $109.00 259.00
In Reserve: $150.00
5. Aocoun1anl's Fees
6. Tax Return Preparer's Fees
7. The Sentinel, advertise Letters 122.51
8. Cumberland Law Journal, advertise Letters 75.00
TOTAL (Also enter on line 9, Recapitulation) $ 10,095.51
..
(If more space IS needed, Insert additional sheets of the same size)
REV-1512 EX + (6-98)
o.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
ESTATE OF
Motter Phvllis I
FILE NUMBER
21 05
0224
Include unrelmbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1. PPl, invoice
VALUE AT DATE
OF DEATH
53.32
2. Sprint, invoice
30.88
3. Darlene Moyer, 2005 personal taxes
9.90
4. Comcast, invoice
16.95
5. Watershed Urology PC, medical invoice
110.00
6. Check printing fee to PNC Bank
26.99
TOTAL (Also enter 01\ line 10, Recapitulation) $
(~more space is needed, insert additional sheels of the same size)
248.04
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
p 1Vlli~ I
NUMBER
I.
SCHEDULE J
BENEFICIARIES
1.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS pndude outright spousal distributions, and transfers under
See. 9116 (a)(1.2)]
Clarence E. Fenicle
281 Potato Road
Carlisle, PA 17013
Edward L. Fenicle
137 Cedar Street
Carlisle, PA 17013
Brian K. Long
132 South 18th Street
Camp Hill, PA 17011
FILE NUMBER
21 05
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
0224
AMOUNT OR SHARE
OF ESTATE
One-Third Residue
One-Third Residue
One-Third Residue
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-l500 COVER SHEET
ll. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
Son
2.
Son
3.
Son
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-l500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
0. PNC1NVESTMENTS
Member NASD and SlPC
May 4, 2005
Duncan & Hartman, P.c.
Attorneys at Law
One Irvine Row
Carlisle, PA 17013
Attention: William A. Duncan, Esquire
RE: Estate of Phyllis I. Motter
Date of Death - 02/27/05
Social Security No: 186-28-3870
Dear Mr. Duncan:
Thank you for your letter dated March 22, 2005. Please find below the requested
information:
1. Title of Account:
Phyllis I. Motter
2. Date Established:
11/05/1996
3. Date of Death Value:
123.839 Shares AMERICAN BAL FD CL B BALBX @ $17.62 per share
633.167 Shares FEDRTD FXD INC STRT INCA STIAX @ $8.82 per share
Please do not hesitate to contact me if I can provide you with further information.
(1.nce ely,
. <) ,/1
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Charles E. Little, CFP
Vice President
Senior Financial Consultant
CELldjp
A member oflhe PNC Finand,,1 Serviees GI'OUP
2 East Main Street Mechanicsburg Pennsylvania 17055
www.pncinvestments.com
Important Investor Information: Securities and brokerage services are provided by PNC Investments LLC,
member NASD and SIPC. Annuities and other insurance products are offered by PNC Insurance Sei'vices, Inc.
a licensed insurance agency.
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I I ~MayL'JseValue
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CONSECO SERVICES, L.L.c.
May 17,2005
William A. Duncan
Duncan & Hartman, P.c.
One Irvine Row
Carlisle, P A 17013
RE: Washington National Insurance Company
Annuitant: Phyllis I. Motter
Contract Number: 000152460
Dear Mr. Duncan:
This letter is in response to your correspondence regarding the above referenced annuity
contract.
The contract was invested with nonqualified funds. The contract number is 000152460.
The sole owner of the contract is Phyllis I. Motter. There are no joint owners listed on
this contract. The date of death value as of February 27,2005, was in the amount of
$3,495.75 (principal $1,210.96 and interest $2,284.79).
If you have questions or need add' 'onal information regarding this matter, please contact
our office by calling (800) 525- 0 2, extension 7461.
~.
CON S E CO.
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March 24, 2005
William Duncan
Attorney at Law
One Irvine Row
Carlisle, PA 17013
RE: Estate of Phyllis I Motter (Deceased)
SSN: 186-28-3870
tx)D; 02-27-2005
scp
Dear Mr. Duncan:
In response to your request for Date of Death balances for the customer noted above, 0111"
records show the tollowing;
Checking Ac:c:ount
Account #5140188546 Established 04-01-1974
PHYLLIS I MOTTER
DOD balance: $7,007.45 + $0.19 accrued intercm
Savings Account
Account #5130349158 Established 03-31~1983
PHYLLIS I MOTIER
DOD balance: $871.46 + $0.16 accrued interest
The decedent maintained Investment Account #61607803, for further information please
call 1-800-162-6111.
Please note that this office only provides date of death balances for deposit accounts
(lRAs, CDs, Checking and Savings accounts). We do not proc:ess any iiuudal
transactions or provide statemeuts. If you need assistance with any of these items,
please call 1-888-PNC-BANK (1.888-762-2265) or stop by your local PNC Bank branch
office.
Sincerely,
~ ::1.~
Erica L Schlegel
1-800-762-1775
P7 -PFSC-04-F
500 First Ave.
PirtsbUl"gh PA 15219
Member FDIC
TOTAL P.Ol
. .
Ewing Brothers Funeral Horne, Inc.
630 South Hanover Street
Carlisle, P A 17013-
(717)243-2421
March 5, 2005
Clarence E. "Bu Fenicle
281 Potato Rd.
Carlisle, P A 17013
The Funeral Service for Phyllis I. Motter
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please
feel free to contact us if you have any questions in regard to this statement.
THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT,
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
1. PROFESSIONAL SERVICES
Services of Funeral Director/Staff. . . . . . . . . .' . . . . . . .
FUNERAL HOME SERVICE CHARGES . . . . . . . . . .
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE
THAT YOU HAVE SELECTED . . . . . . . . . . . . .
Cash Advances
Certified Copies of the Death Certificate.
Flowers (Family Spray & Satin Pillow) .
Sentinel obit . . . . . . . . .
TOTAL CASH ADVANCES AND SPECIAL CHARGES .
Total
Total Cost .
. . . . . . . . . . . . . . . . . . . .
SUB-TOTAL
INITIAL PAYMENT / DISCOUNT / CREDITS
TOTAL AMOUNT DUE
The unpaid balance over 45 days is subjected to a 1.00 % service charge per month _ 12.0000 % per annum.
Member of National Funeri;ll Directors Association
.
$3875.00
$3875.00
$3875.00
$72.00
$159.00
$65.00
$296.00
$4171.00
$4171.00
0.00
$4171.00
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
FENICLE CLARENCE E
281 POTATO ROAD
CARLISLE, PA 17013
_n__u_ fold
ESTATE INFORMATION: SSN: 186-28-3870
FILE NUMBER: 2105-0224
DECEDENT NAME: MOTTER PHYLLIS I
DATE OF PAYMENT: 08/05/2005
POSTMARK DATE: 08/05/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 02/27/2005
NO. CD 005653
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $1,995.53
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TOTAL AMOUNT PAID:
REMARKS: CLARENCE E FENICLE
CHECK# 102
SEAL
INITIALS: SK
RECEIVED BY:
REGISTER OF WILLS
--
$1,995.53
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS