HomeMy WebLinkAbout08-16-05 (2)
REV-1500 EX (6-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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NUMBER
J-
2
W
C
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DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
Klinedinst, Ida E.
DATE OF DEATH (MM-DD-YEAR)
05/23/2005
REV-1500
FilE NUMBER
~-'-- cJS
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
: 205-09-4699
DATE OF BIRTH (MM-DD-YEAR)
06/16/1917
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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~ 1. Original Retum
o 4. Limited Estate
06. Decedent Died Testate (AttachoopyofW")
o g. Litigation Proceeds Received
o 2. Supplemental Retum
o 4a. Future Interest Compromise (dale 01 dealh aft" 12.12<12)
o 7. Decedent Maintained a Living Trust IAttach """ofT",~)
o 10. Spousal Poverty Credit (dale oIdea"""Iw'en 12-31-91 and 1-1-95)
03. Remainder Retum ldale oIdea" prior 10 12-13-52)
o 5. Federal Estate Tax Retum Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(AliAttach SchO)
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THIS SECTION MUST BE COMPLETED. ALL CORRESPONI;lENCl:,AND 'CONFIDENTIAL TAX INFORMATIONSHOULO BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
Richard E. Klinedinst 13 Monarch Lane
FIRM NAME (If Applicable) M h . b PA 17050
ec antes urg,
,. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Noles 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
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
TELEPHONE NUMBER
(717) 697-7047
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14. Net Value Subject to Tax (Line 12 minus Line 13)
(1)
(2)
(3)
(4)
(5)
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en
C~
(6)
C:
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44,502.52
0'
(7)
C)
CJ"'
(9)
(8)
12,619.00
1,555.89
(11)
(12)
(13)
44,502.52
(10)
14,174.89
30,327.63
(14)
30,327.63
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate. Of transfers under Sec. 9116 (a)(I.2)
16. Amount of Line 14 taxable allineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
x .0 (15)
30,327.63 X.o 45. (16)
1,364.74
x .12 (17)
x .15 (18)
(19)
1.364.74
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
20.0
Decedent's Complete Address:
STREET ADDRESS
13 Monarch Lane
CITY Mechanicsburg
I STATE .
PA
I liP n
17050
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
1,364.74
68.24
Total Credits ( A + B + C ) (2)
68.24
3. Interest/Penaity if appiicable
D. Interest
E. Penalty
TotallnterestJPenalty ( 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)
A. Enter the interest on the tax due.
(5)
(SA)
1,296.50
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
1,296.50
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 [KJ
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 [KJ
c. retain a reversionary interest; or.......................................................................................................................... 0 [i]
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [i]
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0 [KJ
3. Did decedent own an "in trust for" 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 which
contains a beneficiary designation? ........................................................................................................................ 0 [KJ
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 pe~ury, I declare that I have examined this return, induding accompanying schedules and statements, and to the besl of my knowledge and belief, it is true. correct and complete.
OecIaratioo of preparer other than the personal representative is based on a" information 01 which preparer has any knowledge.
SI~TU~E OF PERSON RESPONSIBLE FQR FILING RETURN
~~~~~
ADDRESS
13 A <?nc..~c
SIGNAT OF PREP
,., D);E
----3f-L~( a~__
/70$"0
DATE \l;; / J /
7:Lre;,(J~-
2?'Y':tk:>
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. 39116 (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. 39116 (a) (1.1) (iill.
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 applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after Juiy 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 PS. 39116(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. 39116(1.2) [72 P.S. 39116(a)(1)).
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. 39116(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 blood or adop~on.
REV-1508 EX> (6-98) .-
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Ida E. Klinedinst
FILE NUMBER
In dude the proceeds of litigation and the date the proceeds were received by the estate.
All property jolntly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
Checking Account: PNC Bank Account Num. 5003507176 952.69
2 Money Market: PNC Bank Account Num. 5003508179 253.46
3 Certificate of Deposit: Sovereign Bank Account Num. 0575135579 10,000.42
4 Certificate of Deposit: Sovereign Bank Account Num. 0575138599 5,000.39
5 Certificate of Deposit: Commerce Bank Account Num. 0000301656 5,845.19
6 Checking Account: Commerce Bank Account Num. 0536984115 14,658.64
7 Prepaid Funeral: Malpezzi Funeral Home, Mechancisburg, PA 7,791.73
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
44,502.52
......
Commerce
_flank
e.vn- Bonk/Harrl.burg N.J..
100 lkNWo A.."u.
CMnp HIli. PA 17011
1188-937-0004
STAT9IleNT DATE
IDA g XI.:tNEDllUlT
13. HOtuliI,~ LllNE.
KECHA)lICSlWRG PA 17050
06/03/05
0000301656
At:CO<JIIIT NO,
CImlID
... nMl: DE'POSIT ..* 12 NO. ONB WAY CD
ACC~~I\tl. ",a0003.o1j;S6
-- --..uvrouS" STll.TEIfllN'l' 'llJ\Ll\HCE .. ......... ..... ..... .. .
PLUS 13 D&:Ii'OSI'lS l\!ltl OTIl&R ~ITS ...................
LESS 1 WITHDRA~ l\!ltl OTHER DEBITS ........... .....
~ ST~ BALANC&:AS OF 06/oa/as ... ................ ......
--"':ocr'
S.845.1ll
5.S.5.1lI
.00
--~--------------------------------------------------------------------------------
.u TIME DEPOSI~ ~ftlANSACTIO!'lS u.
l>An: D:E'CI\:tP'ftON
06/24 OJ:POSIT AT 1. nooo
07/24 l:w.rnsS'l' PAYJG:1l'f
08/24 I1<<'1'2IlES'1' PAYJG:1l'f
09/24 IMTDSST PAYHSIilT
10/2 << I1<<'1'2IlES'1' 'l'A'tlmm
11/24 IMTDSS'1' PAnam'l'
12/24 INTERBST PAYHSIilT
01/24 DI'J!I!1U!ST PAYMlm'l'
02/24 IN'l':ElUUI'r PAnam'l'
03/24 I1<<'1'2IlEST 'I'~
04/2<< tJt'I:I:RBS'l' PAYJG:1l'f
OS/24 ItfrltUST i'Anam'l'
06/01 ItfrltUST PAYHSIilT
06/01 PIIlNALTY nut!: WI'l'HDRAHAL
PAYBl't J'ltDa1\AI. :to l'IUHBEi\
INft:1IE6T PAID Y:u.s>. TO l)AT&:
TRl\l!ISACTJ:ON lIHOUNT
5,737.84
9.34
9.66
9.68
9.389.71
9.42
9.75
9.76
S.U
9.79
9.49
2.54
5,845.1.9-
23-2324730
50.1.6
,,'0Te::. C!!el:: ~'\)C'Dcn= OlY"olC eI"l.1:lIIUDI'\O"I'A~'T'u...r^b...TIW'\..1
u_io-...cnl....
~mmerce
, .Bank
C_.....Ba~r_gN.A
100 $enale.AVerUM
CllI11pHlll Po 11011
".ont.....
1'&11" 1 of :2
11.>A E KLIlIEDl:NS'1'
13 lIlOl!Il\RCR Ll\NE
MECHANl:CSBURG PA 17050
I ftAT_ DM. I
~fi/t2Ia6.
j053UU115
I\CCCUM"f ~.
2
..
CLOSltD
" .ac~,NUH8p"".Q536984115
PaEV10US S~TEMEN'1' B~ AS or 05/10/05 ....." ...... ..... .......
P~VS 1 DEPOSITS AND OTHER cRtDITS ...................
loBSS 2 clIE~S AND OTIf1!:R DEBITS ......................
CuaaBNT STA~ ~CB AS or 06/12/05 . .3.3..... .......... .......
NtlII!821\ OF DAXS IN THIS S'l'ATEMEN'f 1?I'.I'.:t0ll
19,342.22
1.42
19,343.64
.00
-----------------------------------------------------------------------------------
... CHECK TRANSACTIONS ...
SEIUAL DATE AllOUNT
102 05/19 4,685.00
ft1'.lAL bATE
JlNCXlIr.r
----------------------------------------~---------------------------.------.-------
... CIIBCKING ACCOUNT TllANSAC'nOllS *.*
DATE VESClUP'nON
06/02 mn:1\E$T PAYMENT
06/02 CLOlIIlIG WI'1'l!IlRAlIAL
DJ:Iln:s
14,658.64
CREDITS
1.42
---------------------------------------.-------------------------------------------
*.* BALANCE 8Y DATE ***
05/10 19,342.22 05/1~ 14,657,22 06/02
1>.1\11:21\ nm2i\AL IV NUMB1tll
IItTERBS'l' PA1D 1I:J:All '1'0 DATE
.00
2~-2~24730
2.63
* ** IlIIftIIJ:ST EAJINEl) :rHI S STATBMEIt'1' PERton
DArs IN PERIOD ................,........
l:NBRJ:ST Bl\P.NED ........................
AIOlI1lU. PEIICIllNTAGIiI YULe IlAP.NIiID CAPYl....
....
22
1.<42
0.14t1
----------------------------------------------------
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Q PNCBAN<
QPNCBAN<
Purchase Receipt
Offlcfal ~eck
lJ.4O
lI!JI)St)R PARK (n~)
5288 SIMPSON FERRY ROAO
MECHANIcssmG PA 17055
Cashbox 01
Purcha$e Receipt
Off1clal ~
OociJliIefIt !(umber: t 195844
Purchase Date: J\.ne t 2005
Purchase fllOll\t: $952 .59
Payee:
ESTATE OF IDA E KLINEDINST
RaIIUter:
RICHARD E KlINEDINST
04{)
~IINOSl.R PARK (115)
S288 SlWSON FERRY RlIAD
MECHANICSllURG PA 17055
castbox 01
OocIJIent NuIIHlr: 119!i1l45
Purchase Date: June 1 2005
Purchase Aaoont: $253 .46
Payee:
ESTATE Of IDA E KllltEDlllST
Relitter:
RICHARD E KLINEDINST
SOF Account IlUlber
Source of Funds Check
5003508119
$253.46
SOf Accou'lt IluIIber 5003501116
Source of Funds CheCk $952.69
Systlll Ollte/T1Je '" 1 1 :32 JJlI 1 2005
illS ID 1IltSH1151 Sequence IluAlber 00099
Batch 301
Purchase Fee $0.00
Thl' 41l4'lt or )1yn1llt " "ttPtld ,,*,lItt to
mlflCllU1ll1lld to tb lules 1lIlll1.",latillll' If
thiS 1NJt. OIPDSIt1 DeY not 'I wanlb'. fll
lolatl ultll4l1l1111. ,mlpt shClIlld lit hlld
llIltll VlrWIId ulth mr stltu..l.
Systell DatelT1e " 11:34 JUN 1 2005
illS ID II11SH1151 SNJence IUPr 00100
Batch 301 r
Purchase Fee $0 .00
nil dlJasit 1/ PIl'lI.t is IIC8PtH SIIlllecl 10
wriflClllion 11\4 to tkl lull11lld ruvlatllllll of
lhl. bR, Puttm W lilt kl evaill\l. for
!lIIadlll. ultkdlllUlll, 1lecI1,1 IllooII lit held
\lI'Itll "'11111' vlth ravl stllt_t.
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REV-1511 EX+ (12-99)_
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Ida E. Klinedinst
FILE NUMBER
Debts 01 decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
Malpezzi Funeral Home, 8 Market Plaza Way, Mechanicsburg, PA
(Contract Price: Includes professional services, casket, vault, cemetery expenses, clergy/organist)
Church: Saint Mark's Lutheran, Mechanicsburg, PA
Luncheon: L'Kosta Villa, Mechanicsburg, PA
Flowers: Garden Bouquet, Mechanicsburg, PA
Engraving of tombstone
8,177.00
3.
200.00
160.00
350.00
100.00
2.
4.
5.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City
State
Zip
Vear(s) Commission Paid:
2. Attorney Fees
3.
Family Exemplion: (If decedent's address is not the same as claimant's, attach explanation)
Claimant Richard E. Klinedinst
Slreel Address 13 Monarch Lane
3,500.00
Clly Mechanicsburg
Relationship of Claimant to Decedent Son
State PAZip 17050
4.
Probate Fees
132.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets 01 the same size)
12,619.00
.
~
Malpe22iFuntral Home
8 Markollt Plaza Way
Mechaniesb\lrg,PA 17055
(717)697-46%
June 2, 2005
Richard E. Klinedinst
13 Monarch Lane
Meehaniesburg, P A 17050
The Funeral Service rat Ida 6, KlinadillSt
We sineetely appreeiale tlte e6nfidence yoo have pla~ in us and will continue 10 assisl you in every way we can. PIe\I.e
foel free to eontact us if you have any questions in reprd to thintatement.
THl!FOLLOWINO IS AN IfllMlZlID STAT6MllNT 01' THl! 56RYICl".~. FACll.I11E.~. AUTOMOTIYE EQUIPMEN'J'.
AND MERCHANDISE THAT YOU SflLECTET) WlfGN MAKING THB fUNF..RAL AIUl.ANGBMb'NTS.
I. PROFESSIONAL SERVICES
s.tv_ of FIWfAl Dlrel:lorlSllIlf. . . . , . .
FUNERAL f10M!!; SERVICE CHARGES
SELECTED MERCHANDISE:
W~I'<lpl.,.CMk<l. . . . . _ ., . . .
12 Ga. ROll\>lar Steel. . . . . . . . . . .
R<cister. M""""",I Cllt<l$.At:l:n. . . . . . . ... .....
THE COST 01' OUR S&RVlc&5.EQUIPME.'IT. ^-'1D MERCIIANDISE
TllA T YOU HAVE SELF..C1V) . , , . . . , . . . . . . , . $6653.00
AT THE TIME FUNElW.. AlU\J\NGBMENTS WERI> MADE, WE ADY ANCED CER1'AlN PAYMBNTS TO
OTHERS AS AN ACCOMMODATION. llIB FOLLOWING IS AN ACCOUNTINO FOR THOSe CfIARGBS,
CASK ADVANCES
OpcnincO..."". _ . , , . . .
Ccmoter)' Equipment. . . _ . .
N<w>pe1lC< NOlicos - ....n.1 1 Days .
~ N<>tiocs - SCllIiod 2 DQ)'$ .
CIolJYIMalis otretill&, . . . . .
Orpni:<l, . . . . . . . . . .
Certified Copies O(~ Pearl> Certlfl<:atc .
TOTAL CASH ADVANCES AI'lD SPEClAL CHARGES .
CONTRACT PRICE
HISTORY
1l5I.l1l200Homhoo&f>l. . .
06"'0lI2OO;.F.~Di'_llt .
TOTALAMDUNTDVE.
$3"'~.oo
53545.ell
$196$.00
$10J$.00
$58.00
5625.00
$110.00
$266.00
$168.00
$200.00
$11'.00
$30.00
$ISU.OO
58t 77.00
$-1791.13
$.106.00
$219.27
PD
(;; J;0.s--
REV-l512 EX. (12-03)
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
Ida E. Klinedinst
FILE NUMBER
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, Including unreimbursed medical expenses
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
Ambulance: West Shore EMS
113.89
2.
Nursing Home (non~overed expenses): Messiah Village, Mechanicsburg, PA
1,442.00
TOTAL (Also enter on line 10, Recapitulation) $
{If more space is needed, insert additional sheets of the same size)
1,555.89
..
/a.ec",-
I
I
P"ge 2 of 2
D"bo
6/30/05
Account
536006935
~
Check 91, Amount $17,255.00 Date Presented 6/312005
Cheek 94, Amount $279.27 Date Present 6/1612005
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""OOOD'u... a:oUJO~II,E,.ll; 53. 1.00'.1 Ii". .. .~~.
Check 93, Amount $113.89 Date Presented 6/1612005
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=-' . .' .' .. . r5;tr~."",
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Check 95, Amount $1,442.00 Date Presented 6/1712005
REV-1513 EX+ (9-00) ..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
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)]
1. Richard E. Klinedinst, 13 Monarch Lane, Mechanicsburg, PA 17050 Son 0.50
2. Larry F. Klinedinst. 12642 Green Garden Way, Chester, VA 23836 Son 0.50
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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00
(If more space is needed, Insert additional sheets of the same size)